Opium for Mothers at Bellevue

Doctors in the mid-1800s drugged women during and after childbirth to prevent infection

 By Anna Kerber

Bellevue Hospital on First Avenue in 1898. (New York Public Library Digital Collections)

Bellevue Hospital on First Avenue in 1898. (New York Public Library Digital Collections)

The early days of the oldest hospital in the U.S. were grim. Founded in 1739, the Bellevue Hospital on First Avenue in New York was an almshouse, a penitentiary and a hospital—all at the same time. The first maternity ward in the United States was set up at Bellevue in 1799. There, professor Alonzo Clark (1807-1887) established opium as the most effective treatment for bacterial infection commonly incurred during childbirth.

During the first half of the 19th century, Bellevue gained a notoriously bad reputation. Due to poor hygienic conditions, typhus and Asiatic cholera epidemics haunted the place, killing patients and staff alike. In 1832 alone some 600 cholera deaths were recorded there. Typically, one out of five inmates who entered Bellevue didn’t make it out alive. And for the mothers who delivered at Bellevue, cholera and typhus were not the only threats. Puerperal or childbed fever, a bacterial infection mothers acquired during childbirth—which was often induced—was rampant. Peritonitis, an inflammation of the abdominal membrane, has been described as the “cruellest [sic] feature of the disease.”

“It might be a question whether the term hospital could be applied to Bellevue at this time of which little that is good can be recorded,” Robert J. Carlisle wrote in “An Account of Bellevue.” The conditions were horrible enough to shock the Common Council, which then launched an investigation. Their report documented “scenes of neglect and filth.” Between 1854 and 1855, the hospital was crowded to its utmost capacity; the number of patients treated in 1853 was 5,564, and had nearly doubled since 1847.

The women’s ward No. 20 at Bellevue around 1888. (Courtesy antiquemed.com)

The women’s ward No. 20 at Bellevue around 1888. (Courtesy antiquemed.com)

Of the 21 cases of puerperal fever reported in 1840, 19 proved fatal. When in 1851 some six new cases were reported in the hospital, visiting professor Clark decided to take up a treatment that had yet to experimentally be proven to be effective: opium, in high dosages.

“I want you to narcotize those women within an inch of their lives.” Those were the instructions Stephen Smith, then a resident at Bellevue, reported in The Medical News that he had received from Clark. When Smith, 40 years later, addressed the annual meeting of the Fifth District Branch of the New York State Medical Association, he did so as its president, and the Journal of the American Medical Association referred to him in a subsequent report as “a gentleman now known over the whole land as a learned and distinguished surgeon.”

Smith revealed in great detail how he started treating the women with one grain (an equivalent of 64.7 milligrams) of opium three times a day with an hour in between the doses. He later increased the dosage to two grains and then three. His instructions were to increase the dosages until the desired effect—drugging the women without overdosing them—were achieved. In one case, a patient received four grains (260 mg) three times a day. Another woman received 1,950 grains (126 grams) of opium over the 12 days of her treatment. Roughly two grams of opium contains a lethal dose of morphine.

Some doctors believed that opiates had a direct effect in preventing over-distention of the small intestine; others thought that it was plainly the narcosis that helped patients through a natural healing process. However, the six drugged women all recovered without any other treatment. For the following 20 years, opiates remained the chief remedy for peritonitis at Bellevue. And so it continued until the work of Ignaz Semmelweiss, a Hungarian physician, was widely accepted. He had discovered in the mid-1800s that hygienic conditions in hospitals could drastically reduce the incidence of childbed fever.

Comments are closed.