The Rise and Fall of LICH: America’s First Teaching Hospital
By Susan K. Harris
Because I walk past The Long Island College Hospital site every day, I’ve watched the busy institution as it slowed down, then closed. I miss the doctors and nurses scurrying past; I miss the linguistic jangle and ethnic mosaic that the hospital brought to our increasingly homogeneous neighborhood. (I also miss the fact that at 5 pm, when shifts changed, I just might be able to find a parking spot.) If all goes as planned, few newcomers will be aware that a vibrant hospital once stood on this site. As LICH disappears, I thought we might look back at its history, a bit of our collective “memory” of a substantial piece of Cobble Hill’s past.
Part I: The Nineteenth Century
We know LICH as the large complex on the northwest corner of Cobble Hill–currently the site of a power struggle between developers and the community. Its origins, though, were modest. It was first organized in March, 1856, as the Brooklyn German General Dispensary–“German” because its major sponsors were German doctors concerned that there be medical care for the large number of German immigrants then living in the neighborhood. In the mid-19th century a “dispensary” was what we would call a clinic–an office staffed by doctors who diagnosed illnesses and “dispensed” medicines. The Brooklyn German General Dispensary went a little farther than that; it also had wards for in-patient treatment. Located at 132 Court St, it boasted two consulting physicians, two consulting surgeons, one resident physician, and one “cupper and leecher.” According to Smith’s Brooklyn City Directory, 1856-1857, the Dispensary was “Open to the poor from 2 to 4 o’clock every day, Sunday excepted.”
The Dispensary met a real need: it treated 850 patients in its first 19 months, and it soon outgrew both its quarters and its founders’ ambitions. In 1857 the doctors who had organized the Dispensary partnered with a group of prominent Brooklyn businessmen to develop a hospital and medical school in the neighborhood. Briefly named The St. John’s Hospital, then The Long Island Hospital and Medical College, by 1858 it was formally referred to as The Long Island College Hospital.
The name signaled a major breakthrough for American medical practice. To us it seems logical that medical schools partner with hospitals so that medical students can practice on real human bodies, but in the 1850s that was a radical idea. Some European medical practices–most prominently, in Paris and Vienna–were beginning to experiment with teaching hospitals, but in the U.S. aspiring practitioners still learned their craft through apprenticeships with established doctors. If they were ambitious, they might also attend some lectures on the science behind the practice, but these were not required, and people living outside city centers had little access to formal lectures. In contrast, LICH combined required series of medical lectures with practice in the adjacent hospital. Thus it became the first American teaching hospital.
The founding fathers saw two advantages to this. In addition to improving medical care in Brooklyn, they hoped the medical school would challenge Manhattan’s status as the only modern city in the area. Desirous, they claimed, of reflecting “both honor and credit upon our ‘City of Churches,'” they charged that the “City of Brooklyn has neglected to establish its own ‘temples of science'” because of its “contiguity to another great city.” In 1857 Brooklyn was an independent entity (it did not amalgamate with Manhattan until 1898) and the founders were clearly feeling competitive. A medical college would put Brooklyn on the map, bringing a reputation for scientific innovation to the rapidly growing western section of Long Island.
The Brooklyn/Manhattan rivalry was on. The gentlemen organizers were all financial heavyweights–they included men like financier Daniel Chauncey and railroad magnate (and future state senator) Samuel Sloan. Despite each member of the committee contributing $100 outright and pledging up to $500 more, however, they needed outside money to realize their goals. To raise it they sent out 2000 copies of a solicitation letter whose mission statement was calculated to appeal to their neighbors’ charitable instincts and civic pride. “This Institution appeals in the strongest manner to our benevolence and Christian sympathies,” it opined. “Here the unfortunate, the friendless, and the destitute will find a home when afflicted by sickness, their wants be relieved, and the best medical attendance supplied to them. If unable to pay for these benefits, they are freely bestowed without charge to any and all.” They also noted that the proximity of the docks–site of frequent accidents–suggested that the hospital be located in the immediate area.
Having appealed to potential donors’ better natures, the letter outlines the proposed “Temple of Science.” This was to be “a college, where all the branches of medical science shall be taught and illustrated, and where medical students can be practically trained.” The College would employ seasoned doctors and lecturers in anatomy and related fields. Students would train for surgery, gynecology, and general medicine. (That they would learn their craft on the bodies of charity patients was taken for granted–in those days people who could afford to have doctors and nurses come to their homes rarely went to hospitals.)
The appeal worked–more or less. Cash flow is a continuing theme in LICH history, and it was clearly a problem from the start. One way the founders raised funds was by sponsoring a lecture series, with Ralph Waldo Emerson giving one of the first lectures (his talk netted $100, a large sum for those days). They raised enough to purchase the “Perry Property”– a mansion and grounds on Henry Street between Pacific and Amity–for the sum of $31,250, and a Charter was granted by the State Legislature on March 6, 1858. The venture began shakily; the medical school closed in 1859, only re-opening the following year through the generosity of William Henry Dudley, one of the doctors, who bought the property and maintained it in his name until the college could buy it back from him. Despite such financial adversity, the dedicated team of doctors and their supporters continued laying the institution’s foundations. By 1862 the hospital began receiving soldiers wounded in the Civil War, and seeing the need for competent doctors on the battlefield, the medical school initiated a course in military surgery. By 1873 the hospital was treating more than 10,000 patients per year, and by 1882 it had added a new wing, with new classrooms, wards, a museum, and steam heat. It also added new buildings. The Hoagland Laboratory, arguably the first bacteriological lab in the country, opened in 1888. This was a significant institution. Germ theory gained currency slowly in the late 19th century, and an entire building dedicated to bacteriology signaled the medical school’s position on the forefront of scientific innovation. The Polhemus Memorial Clinic, said to be the world’s first high-rise medical facility, went up in 1897. It continued the founders’ legacy, reserving two floors for outpatient clinics that treated the local poor. By 1899, when the LICH Alumni Association published a history of the institution and a list of its alumni, the college had expanded far beyond its founders’ expectations, adding a Nursing School, a four-year curriculum for medical students, and considerable new real estate. And its reputation extended beyond Brooklyn’s borders, as evidenced by the U.S. government sending soldiers who had been wounded in the Spanish-American War.
Part II: Into the Twentieth Century
By the turn into the 20th century, then, the Long Island College Hospital had more than met its founders’ expectations. It entered the new century energetically. The Polhemus Memorial Clinic added laboratories and spacious amphitheaters to the medical school, and 1900 saw the adoption of the 4-year medical curriculum pioneered at Johns Hopkins, Baltimore’s pedagogically innovative Medical School. In 1903 the Dudley Memorial Building, a residence for nurses, opened its doors, and over the next few years existing buildings were restructured, paving the way for a modern medical complex.
With the changes in medical curriculum came changes in oversight. In the 20th century, doctors, hospitals, and medical schools came under increasing scrutiny for standards, hygiene, and facilities. In 1909 the Carnegie Foundation began reviewing medical schools across the nation. The Foundation’s report, published in 1910, precipitated the demise of nearly half the medical schools in the country. LICH came off comparatively lightly; overall the institution got a B, primarily because it lacked full-time teachers (most professors also practiced medicine), a library, and physiology and pharmacology labs. Critical as it was, the report came at a good time for LICH, which had already begun raising its medical school standards. Acting on the report’s recommendations, the administration began hiring full-time professors and building laboratories. By 1914 the American Medical Society gave the College an A.
Oversight agencies continued to proliferate, however. In 1918 the American College of Surgeons cited LICH for poor record keeping, lax supervision of interns and residents, inadequate surgical follow-up procedures, and indifferent quality control. Throughout World War I the hospital operated in crisis mode, including a shortage of nurses and annual deficits. Still, its educational arm continued to improve: by 1922, 28 of the 108 students entering the medical school had B.A. degrees. This may sound low to us, but it was a big improvement over the entering class of 1860, when many students lacked even a high school diploma.
The relationship between the medical college and the hospital deteriorated, however, and in 1930 the two agreed to separate, forming two administrative units. The change had the most impact on the medical school, which now called itself the Long Island College of Medicine and included other Brooklyn hospitals (Kings County, Greenpoint, Coney Island, Brooklyn Jewish, Methodist Episcopal, and Brooklyn Hospital) for its clinical practices. Strapped for funds, the LICH hospital could not provide the increase in teaching beds, facilities and staff teaching time that would maintain its status as Brooklyn’s premier teaching hospital, and by the decade’s end that crown passed to Kings County.
The population LICH served continued to evolve. Although the institution’s founders envisioned the area’s German population as its client base, Irish immigrants were already present in the 1850s, and their numbers grew. Over the late 19th and early 20th centuries they were joined by Italians, Syrians, Lebanese, and both German and Russian Jews. Later groups included Puerto Ricans, Central Americans, and small numbers of African Americans and Asians. As these immigrants’ socio-economic status rose, so did their demands for social services. The increased demand, coupled with improved hospital standards, the evolution of medical insurance, and the introduction of complex medical technologies that could not be transported to private homes, motivated a historic shift in public attitudes towards hospital stays. Hitherto hospitals had been the often-dreaded last resort for the poor and the mentally ill. Anyone who could afford it was treated at home. Now this began to change: between the end of World War I and the 1950s medical care for the middle and wealthy classes shifted from the home to the hospital.
The sea-change both improved hospitals’ cash flow and compounded their financial difficulties. On the one hand, employer-sponsored insurance programs made it much easier for patients to pay for hospital stays, specialist treatments, and multiple, technology-driven tests. Hospitals knew this; they also quickly realized that the way to attract middle-and upper-class patients was to develop private and semi-private rooms that would give the patients the sense of privacy and privilege to which they were accustomed. During the World War II years LICH raised its rates for such rooms, putting it in the black for the first time. The call for private and semi-private rooms continued to increase throughout the next decade. Patient/staff relations also began to change. John Edson, author of A History of the Long Island College Hospital, notes that in the 1950s LICH advised its staff to “maintain courteous relationships with their patients.” Apparently paying clients did not like to be treated like charity patients. (Nor, one assumes, did charity patients.)
The down side of the combination of technological and payment changes was that hospital costs shot up. The new machines did not come cheaply, and once bought, they weren’t easy to maintain. Many needed special housing conditions to keep them in working order (if you have ever wondered why hospitals are cold, that’s the reason: they keep the temps down to keep the machines happy). Most also needed specially trained technicians to operate them, and many were so complex that outside repairmen had to be hired when they broke down. Knowledge that private insurance (and later, Medicare and Medicaid) would ensure that hospitals got paid led to costly testing and multiple hospital stays, a course that eventually led to increased oversight, complex billing processes, and, often, only partial reimbursement. The upshot was that even as hospitals became venues of choice for medical services, costs began to outstrip intake, leading even well-managed institutions into the red.
Like most of the other hospitals in the country, LICH experienced all these pressures, eventuating in a major shift in its identity and mission. In 1950 the medical school, which had maintained a close relationship with the hospital even after the administrative split of 1930, merged with the new State University of New York to become SUNY Downstate. Offices, staff, students, and professors moved to Clarkson Avenue, the site of the SUNY Downstate Medical Center. Known for a time as the Health Science Center of Brooklyn, it was the only medical school on all of Long Island until 1971. After the merger, the Henry St. hospital no longer had the close association with the medical school that had driven its mission for nearly a century.
So America’s First Teaching Hospital entered the last third of the 20th century as a very different institution than it had begun. It had lost its medical school, and instead of being the premier teaching institution had become one of many Brooklyn hospitals through which interns and residents rotated as they learned their craft. Financial and social challenges continued, tracking major changes in the culture at large. The Nursing School is a good example. Nurses won a 5-day work week in 1950, a decided improvement over their former working conditions. Also in 1950, prodded by an accusation of discrimination by the Association of Colored Graduate Nurses, the Board announced a nondiscrimination policy. At the same time, the Board also announced that nurses who married or became pregnant would be immediately dismissed. Two steps forward, one back. Despite the ups and downs, the hospital celebrated its 100th anniversary on March 6, 1958 with a fund-raiser held at the Hotel St. George. Menu: cocktails, appetizers, steak, salad, veggies, desserts, and ice cream cake. Price pp: $8.50. Net intake: $39,000.00.
Part III: The Downward Slope
At the end of the 1970s, LICH seemed in good shape. The institution had achieved a tenuous fiscal solvency and was looking forward to a building campaign that would add the Polak, Othmer, and Fuller buildings and state-of-the-art technologies. The Divisions announced for the new Fuller Pavilion illustrate how far medical technology had come since 1857: the divisions included Nuclear Medicine and Nuclear Cardiology, Hemodialysis, Ultrasound and Radiology, Neuroscience, and Radiation Therapy. The building also boasted a small Linear Accelerator.
The new buildings increased the density of the existing campus. In the 1980s the hospital also expanded its geographical reach, buying St. Peter’s church on Hicks St and moving its nursing staff into it, and, in a trade-off with the Cobble Hill Association, receiving permission to build a parking structure on Hicks St.’s upper Van Vorhees Park in exchange for three Henry St. plots previously used for parking. These plots became the two playgrounds and the small passive-use adult park we know today.
But new buildings do not come cheaply, and the hospital’s debt increased. The Fuller extension alone cost $87,932,000. By the mid-1980s the hospital’s mortgage totaled $157,332,000. With this, social changes created serious ethical conflicts among the hospital staff. On the one hand, the Nursing School expanded its home care department and developed a midwifery program; on the other hand, the growing dispute about pregnancy termination divided the medical and administrative staff, especially the debate over extending the termination limit to 24 weeks rather than 20. An extension would help the hospital’s finances, but it would also shift the balance of OB/GYN operations from live births to abortions. Patients, families, and staff also confronted challenges over the Do Not Resuscitate program and over keeping brain-dead patients alive on respirators. Another increasing problem came with the AIDS epidemic, which brought a new set of far sicker patients into the hospital mix. By 1989 the hospital’s emergency room suffered from medical gridlock: according to John Edson, Emergency was “flooded with non-emergency patients, AIDS patients, and the homeless.” Poor discharge operations made it difficult to move patients from Emergency to beds. Edson also notes that the hospital’s support staff were known to be chronically rude to patients, and that attempts to remedy the situation had had limited success.
LICH wasn’t the only hospital suffering. According to Crain’s New York Business, by 2011 five of Brooklyn’s ten hospitals were in serious financial difficulties. Crain’s lists years of government funding cuts as the central cause: despite the loss of government revenue, these “safety-net” hospitals were still obliged to serve poor communities, where few patients had privately-funded insurance. The dearth of private insurance payments meant that the institutions’ revenues came from deeply discounted Medicare and Medicaid payments, not enough to keep them running without substantial other sources. Crain’s laid the blame on the state government; New York, the newsletter claimed, wanted to completely restructure regional health care, and was willing to close hospitals to facilitate consolidation.
So the story of LICH’s demise is part of a larger narrative about the restructuring of healthcare throughout New York City. The state government was far more concerned about the hospital’s financial leakages than about its service to the community. And leak it did. In 1989 LICH lost $5 million. In 1998 it was taken over by Continuum Health partners, a management group based in Manhattan. Attempting to pull the institution out of its financial hole, in 2007 Continuum began selling the Hospital’s buildings and shutting down programs, closing the sex abuse and psychiatric programs in 2008 and the nursing school in 2011. With this, they laid off workers: 100 in 2008, 150 in 2012. As Continuum faltered, the city searched for other options to save the hospital; in 2010 then-governor David Paterson engineered a merger with SUNY Downstate Medical Center, a move that seemed to brighten LICH’s future. But it too failed; by 2014 the hospital had shuttered forever, sold to Fortis Development and to NYU Langone.
Why did LICH close? Over the past 20 years, and certainly since the Continuum takeover, we have read countless accusations of mismanagement, political double-dealing, and community betrayal. It’s most likely that some of these accusations–maybe all of them–are true. But we also need to see LICH’s history within the evolution of healthcare in America. As this brief history shows, as soon as the hospital was established in 1857 the medical situation began to change: standards for doctors began to rise, patient populations began to shift, increasing technological and scientific breakthroughs made medical care, and hospitals specifically, very different in 1900 than they had been fifty years earlier. The 20th century saw even more profound changes. In addition to the continuing evolution of both medical science and its practice, financial pressures induced a series of structural changes: the rise of the powerful American Medical Association, of private and employer-sponsored insurance companies like Blue Cross/Blue Shield, of state and federal oversight, of federal and state-funded programs like Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), of experimental programs such as Managed Care, and of the ever-increasing disparity between people who could afford private insurance and those who couldn’t. Long Island College Hospital, located in an increasingly-affluent neighborhood whose residents did not, on the whole, constitute its patient base, was caught in the cross-hairs. By the second decade of the 20th century its struggle to serve patients who could not afford to cross the river to Manhattan’s hospitals gave in to New York City’s new normal: an abridged annex of a powerful Manhattan medical center (NYU Langone) surrounded by luxury residential towers.
“From the Cradle to the Grave: A LICH Timeline,” Brooklyn Paper, July 11, 2014.http://www.brooklynpaper.com/stories/37/45/dtg-lich-timeline-2014-11-07-bk_37_45.html.
“Dispensaries, Hospitals, and Medical Societies of Kings County, 1830-1860,” by William Schroeder, M.D. https://archive.org/details/101218967.nlm.nih.gov.
“The Founding Of America’s First College Hospital” http://www.downstate.edu/brooklynhistoryofmedicine/pdf/medschool/chap1.pdf.
Raymond, Joseph Howard. History of the Long Island College Hospital and its Graduates, Together with the Hoagland Laboratory and the Polhemus Memorial Clinic.” Brooklyn, NY: Published by the Association of Alumni, 1899. https://archive.org/stream/68140020R.nlm.nih.gov/68140020R#page/n3/mode/2up.
Edson, John N. Brooklyn First: A History of the Long Island College Hospital, 1859-1990. New York: The Long Island College Hospital, 1993.
“The Founding Of America’s First College Hospital.” http://www.downstate.edu/brooklynhistoryofmedicine/pdf/medschool/chap1.pdf.
Guide to the Archives, State University of New York Health Science Center in Brooklyn. Medical Research Library of Brooklyn, 1996. http://library.downstate.edu/archives.pdf
SUNY Downstate Medical Center, Department of Medicine History. http://www.downstate.edu/medicine/history.html
“Half of Brooklyn Hospitals on Life support.” Crain’s New York Business, June 5, 2011.
Author Information: Susan K. Harris has served on the faculties of Queens College (CUNY), Penn State, and the University of Kansas, and has published with Oxford, Cambridge, and Penguin presses, among others. She lives in Cobble Hill, Brooklyn.