Stephen Smith (surgeon)

Smith maintained an active medical practice, was an attending physician at Bellevue Hospital for thirty-seven years, and authored three surgical texts, but he was best known for his public service.

[2][3][4] Lewis Smith died in 1829 when Stephen was six years old, most likely from typhoid fever[5] and Chloe raised the family with the help of the Thorn Hill Baptist Church and the local common school.

These conservative institutions reflected their New England roots; however, Smith was surrounded by the religious upheaval of the Second Great Awakening, the economic and transportation revolutions spawned by the nearby Erie Canal (1825), and the social energies of the abolitionist movement.

[9] The reason he usually gave for his career choice, as late as age ninety-five, was that he was too sickly as a youth to do the work of a farmer, making medicine the only option.

During his time at Bellevue, Smith began his seventy-year literary career by publishing a review of seventy-eight cases of urinary bladder rupture.

[18] That same year, he traveled to the Virginia swamps during the Peninsula Campaign of 1862, where he was appalled by the military's dismal sanitation and the reckless surgery of many Northern volunteer surgeons.

[19] Smith also volunteered at the Union Army's Central Park Hospital, where he developed a lower extremity amputation procedure that became the surgical standard in the United States and England for the next fifty years.

He served as the Medical College's professor of anatomy from 1863 to 1872 and developed a respected teaching approach that discouraged memorization and encouraged students to visualize the body as a machine they should construct from scratch.

[24][25] Harris argues that Smith was the one who taught Joseph Lister's antiseptic techniques to a young William Halsted, later one of the pioneers of modern American surgery.

He editorialized several times on behalf of women nurses during the Civil War, citing the women-led Sisters of Charity Hospital in Buffalo as one that, "has no equal in this country.

He encouraged sanitary principles and plain buildings based on the pavilion system during the Civil War, citing Florence Nightingale's hospital experience in Crimea.

The Boston Medical and Surgical Journal reviewed the final reports and found that Smith brought, "a ripeness of experience and a breadth of research which make his paper exceedingly instructive to the sanitary student.

He was a frequent critic of New York City's corrupt and inefficient sanitation efforts before the Civil War, but reformers brought him into the daily business of public health in 1864.

He editorialized in American Medical Times that the 1863 draft riots, “proceeded from those districts of the city notorious for their filthy and unpoliced streets, and wretched and uninhabitable tenement houses,” concluding, “The great and patent prevention for riots like that which we have witnessed is radical reform of the homes of the poor.”[62] As a health commissioner, Smith sought to convince the City Health Department to issue tighter building standards and to facilitate the construction of new housing for the poor using public and philanthropic funds.

[66][67] Cornell named Smith State Commissioner in Lunacy in 1882, a salaried position reporting to the Board that was charged with inspecting all facilities incarcerating New York's insane persons and adjudicating inmate complaints.

He wrote in his 1884 annual report: "Reforms affected by persuasion and appeals to the humanity, and especially the good sense of keepers, [are] more effective and more lasting than when enforced by the arbitrary power of law.

[73] The editor of The Medico-Legal Journal wrote about Smith's first three Lunacy Commissioner reports that, "They now furnish by far the most reliable data as to the actual condition of the insane in public and private institutions that we can have access to in the State of New York."

"[78] Smith wrote Who Is Insane in 1916 as a look back on his time as Lunacy Commissioner, a reflection of how he felt mental illness should be managed, and a commentary on how things had gone.

He stated that forced sterilization for preventing mental illness and disability was a procedure that, "is naturally shocking to the moral sense and must be attended with serious difficulties.

The medical charity issue hit the headlines in 1894 when George Shrady, launched a magazine attack against free hospitals and dispensaries because they deprived hard-working doctors of a fair income.

He advised the Board that English experience showed that free medical care could lead to permanent dependency and the solution was more control of dispensaries.

[84][85] Smith was satisfied by 1903 that the licensing law was working because dispensary use was no longer increasing faster than population growth, and he stopped worrying about the issue.

The New York City Board of Health asked Commissioner Smith to investigate the well-known summer increase in death rates and recommend measures to reduce mortality in 1871.

Smith responded with a tightly written report the following year, the essence of which was that Manhattan was becoming hotter due to urbanization, and excessive heat was the primary cause of the rise in summer deaths.

[97][98] The city continued removing street trees as it paved roads, built underground lines and vaults, and erected taller buildings during the rest of the century.

Smith was president of the city Tree Planting Association in 1914 and launched a publicity campaign to shame the Parks Department into enforcing his 1902 law.

This report, prepared by a young Laurie Davidson Cox and financed by John D. Rockefeller, set the Parks Department on its current path by documenting the state of the city's street trees and recommending a comprehensive approach to urban reforestation.

"[119] Smith often worked in the background during his younger years, letting his writing speak for him and giving credit to others, which he did in creating the New York State Board of Health in 1879.

[120] As he passed into the role of elder statesman, he was more willing to don the visible mantle of public and mental health cheerleader, writing books and granting newspaper interviews.

[121][122] He died of general debility at his daughter Florence's home in Montour Falls, New York, on August 26, 1922, six months short of his one-hundredth birthday.