Roman: This is 99% invisible. I’m Roman Mars.
Jessica: I am walking down 106th Street, towards Manhattan Avenue. I can see the building
in the distance.
Roman: That’s producer Jessica Miller, wandering around her old neighborhood.
Jessica: Oh yeah, so you can see on the back of this tower there’s like a smokestack, or at least the remnant of a smokestack.
Roman: Jess used to live near Central Park and she’s been walking by this building and wondering about it for a long time. So, she met up with Jim Rasenberger, who’s done some writing about the building for the New York Times.
Jessica: Hey, are you Jim?
Jim: Yes, Hi. How are you?
Jessica: Hi, I am Jessica.
Jim: Nice to meet you.
Jessica: Nice to meet you too.
Jessica: The address of the building is 455 Central Park West, and it looks like a
castle. It’s huge, it takes up the whole east end of the block. It’s made up of red brick with this intricate stone trim and it’s got five or so large cylindrical turrets with silver cones on
Jessica: It’s gigantic.
Jim: Gigantic, I was gonna say ginormous.
Jessica: You can ginormous!
Jessica: The building looks like something out of a fairy tale.
Roman: Like Rapunzel could let down her hair through one of the turret windows for some knight in shining armor who just wandered over from Central Park.
Jessica: But what I found out is that this building’s past is not very fairytale-like at all.
Do you want to like just take a walk around the building and see what we see? I saw coming up around this side there are these things that look like smokestacks kind of off of this back tower.
Jim: Yeah, I mean the main that the main smokestack has been torn down and it was part of the crematorium where they used to burn bodies.
Roman: Well, that just took a dark turn.
Jessica: So, the building has been renovated but when it was built in 1887 it was the country’s first Hospital devoted solely to the treatment of cancer, and they weren’t very good at treating cancer yet, so that crematorium smokestack, it was smoking pretty often. The old castle-like building at 455 Central Park West can actually tell us a lot about the history of cancer and the history of hospital architecture but let’s set the scene a little bit.
Roman: It’s the late 1800s, and people seem to know that cancer starts as a tumor and that sometimes the tumor can be removed but they don’t know a whole lot beyond that
and a lot of hospitals in the U.S. don’t even want to treat cancer patients.
Elaine: Some people feared the disease, they thought it was contagious. Some doctors thought it was contagious and also there was a lot of stigma about having the disease.
Jessica: That’s Elaine Shatner, she’s a clinical associate professor of medicine at Weill Cornell Medical College and she’s writing a book about cancer awareness.
Roman: On top of misconceptions about cancer being contagious there was another reason that hospitals might have hesitated to take cancer patients. At the time, they had to publish their death rates. So they’d turn away patients who were likely to skew the numbers. This is why you had tuberculosis hospitals and other specialty hospitals for diseases that were particularly deadly.
Jessica: In the late 1800s Europe was a bit ahead of the U.S. in terms of cancer treatment.
Elaine: During and after the Civil War patients in the United States who had money, or could afford to go to Europe would do so for care. Doctors from the United States who then you know, for the most part, had minimal education would go to Europe to study science and pathology and surgical techniques.
Roman: One such man was J. Marion Sims. Sims went to Europe and learned a few surgical techniques for removing cancer. He wanted to bring this knowledge back to the U.S. where he had worked previously at the New York Women’s Hospital and then in 1874, the hospital decided:
Elaine: They wouldn’t let women with cancer in.
Jessica: For all the reasons we just talked about it was too deadly, they thought it might be contagious….
Roman: So, in 1884 some philanthropists including the Elizabeth Colum who had lost her son to cancer and later died from the disease herself, broke ground on what would become the first Hospital exclusively devoted to cancer care. It opened in 1887 and was designed by architect Charles Haight.
Jessica: Earlier I talked about the hospital looking like a castle from a fairy tale and it turns
out that was a pretty common style for hospitals at that time.
Elaine: They looked like castles, they looked like aristocratic mansions. We see in the architecture that they have…..they’re walled they have, they have elaborate entries, sometimes turrets, they have all the trappings of a very very wealthy neighborhood. They’re very domestic in their architectural outlook.
Jessica: That’s Anne Marie Adams.
Anne: Hi I’m Anne Marie Adams, I’m director of the School of Architecture at McGill University.
Jessica: She’s also written about hospitals from this time period and she says that in the late 1800s hospitals were charitable institutions run by wealthy philanthropists, where poor people went for care.
Roman: Rich people still mostly received care at home but hospital administrators wanted to change that.
Anne: Architecture is a tool of persuasion to convince wealthier people to come to the
hospital to be healed.
Roman: So in 1887, the first cancer Hospital opened its doors to both pain and non-pain patients with cancer and it tried hard to be an inviting place for paying customers, even the food was good.
Anne: So they had great chefs. You know, part of being competitive was having really good food. People went to hospital dining rooms to celebrate special occasions like birthdays. Like we might today to go to a hotel dining room even though if we’re not staying at the
hotel, and so obviously that’s changed a lot.
Roman: The hotel comparison is pretty spot-on. The Cancer Hospital was designed
mostly for palliative care, in other words, just making people comfortable than relieving pain.
Jim: So, they had champagne parties they took people on carriage rides in Central Park.
Jessica: Again that’s Jim Rasenberger who I met up with at the beginning of the story.
Jim: It was a beautiful building and meant to be beautiful so that people didn’t feel like they were going off to a terrible place to die but rather going off to the French countryside.
Jessica: And the big round turrets with lots of windows that make the building look like a
castle were actually wards that housed patients.
Jim: The patients were in beds around the perimeter and there would be ten or eleven bed and so the doctor would come in and make his rounds from bed to bed to
Roman: Just to make sure you can really picture this the rooms were perfectly circular and about forty feet in diameter and an aerial view of when the rooms looked a bit like the face of a clock with beds around the perimeter.
Jessica: But the round rooms weren’t just about aesthetics.
Jim: By having these rounded rooms, fewer corners It was thought that you could keep the hospital cleaner.
Jessica: You know dirt accumulates in corners so just get rid of the corners, that’s kind of brilliant. Another distinguishing feature of this hospital and of others at the time was tons of windows.
Anne: And the idea was that the open window would allow fresh air to flush the space between the patients. And this of course played into the idea that that sickness has traveled in bad air.
Roman: This idea that sickness was spread by polluted smelly air was called the Miasma theory.
Jessica: But the weird thing is by the time the Cancer Hospital was built the Miasma theory had been debunked by the germ theory which rightly held that diseases spread through germs or microbes. The architecture just hadn’t caught up yet.
Anne: The architectural design of a hospital doesn’t always correspond exactly to the medical theories of that time, almost like society is hesitating to fully endorse the medical theory.
Jessica: Light airy rooms, champagne parties, carriage rides through the park – it all
sounds kind of charming.
Roman: Until we get to the part about how nobody had any idea what they were doing, medically speaking.
Jessica: Beyond palliative care the main treatment for cancer at the time was surgery, but surgery for cancer was still incredibly primitive.
Elaine: You know just sort of massive cutting of people with tumors with the idea of removing every lymph node in their body and as much as possible as could be done, while keeping them alive.
Roman: Surgery was also hugely risky this was before the top of antibiotics so a lot of people died from infections after surgery but desperate patients take desperate measures.
Elaine: You know if a doctor said I can take this out of you and it was causing pain and bleeding you know, people would often agree.
Jessica: The surgeries at the cancer hospital in New York as in other hospitals at that
time were happening in an amphitheater so that students could watch and learn.
Roman: There’s a show on Cinemax that I watch called, The Knick that graphically
dramatizes these amphitheater surgeries from around the same time period.
Man 1: I want the students to take note that Dr. Christiansen is entering on the medial
line, just above the pubis. As you can see there is significant blood in the cavity vacuum over it
Roman: Surgeons from this time were doing pioneering work and patients were pioneering guinea pigs. They had to start somewhere but that show makes me so so happy that I live in the 21st century.
Jessica: Agreed. Things were bad, and they stayed bad for cancer patients for quite
Elaine: As late as 1920 only 15% or so of patients survived a cancer diagnosis for more than two years. Almost everyone died, so the numbers were bleak and in 1900 the numbers were even worse.
Jessica: Which must be why they felt they needed a crematorium on site.
Jim: Which must have been a really spooky sight if you were there and you could look out your window and see the smokestack. I mean, imagine looking out there and seeing smoke come out that smokestack that would have been pretty awful.
Jessica: Under that billowing smoke the New York Cancer Hospital soon earned a nickname, the Bastille. It was trying to look like a French chateau but it ended up feeling like a French prison.
Roman: Which is why, despite a huge demand for cancer treatment, the hospital couldn’t get people in the door.
Elaine: Fact is that very few people wanted to go to the New York Cancer Hospital and what’s amazing is that the place struggled financially. Cancer care before 1900 and for a long time after it was not lucrative.
Jessica: The hospital also tried to attract patients and funds by procuring a controversial new form of medicine: radium. For a while around 1920 the New York Cancer Hospital boasted the country’s single largest repository of radium.
Roman: Marie Curie visited to check out the radium repository in 1921 in a trip that made headlines, but radiation therapy even more so than surgery was not understood.
Elaine: It was administered by people who didn’t know how to administer it because they didn’t really understand it and a lot of the radiation workers doctors and nurses themselves developed cancer.
Roman: It wasn’t until the 1930s or so that thing started to improve.
Anne: Surgery became better the radiation treatments were working I think in the 1960s and 1970s then you have you know chemotherapy and just much more a much more organized approach to cancer care and one that ultimately became very lucrative.
Jessica: In 1939 the Cancer Hospital left 455 Central Park West for the Upper East Side where it became Memorial Sloan-Kettering which is now known as one of the best hospitals for cancer treatment in the US.
Roman: And of course hospitals don’t look like castles anymore, after World War one hospitals start to look like –
Anne: Small Civic institutions more like city halls or or schools they’re very square that it’s
called the block plan.
Jessica: We also see the end of big open wards with lots of beds.
Anne: Paying patients could expect single rooms or typical patients could could be
in a double room or a room of four patients.
Roman: And we said goodbye to good food, champagne, and carriage rides.
Anne: The money was channeled in things like surgical suites and in mechanical
equipment rather than in decoration and we we see like things like wooden beds and
dressers disappear everything becomes metal and has a kind of look of efficiency.
Jessica: After World War 2 the office building / skyscraper becomes the model for hospitals.
Anne: It all changes again and1980s with the onset of what we call patient-centered care where the atrium hospital just takes off.
Jessica: These are hospitals that look like shopping malls just one or two floors big open spaces.
Anne: I mean that’s very kind of capsule history of the 20th-century hospital.
Roman: We’ve done away with completely round rooms now, but the general idea of round rooms being easier to keep clean has actually persisted.
Anne: So where the wall meets the floor if you go visit a hospital today you’ll see it’s probably curved so that nothing could get stuck in the in the right angle between the wall and the floor.
Roman: As for the castle-like building that house the first cancer hospital it went through another really dark period.
Jim: In the mid-1950s, it becomes Tower nursing home, that becomes one of the most notorious nursing homes in New York and this is a place where terrible things happen roaches crawling around walls and patients being abused.
Jessica: The nursing home was shut down in the 1970s and the building sat vacant and in a state of disrepair for a long time. Jim Rasenberger used to walk by it in the 80s and said it was a spooky place.
Jim: He was at a haunted house you know but it was even better than that it was a haunted castle. It just seemed to be on an inevitable fall into a pile of bricks, it was really
they didn’t seem to be any escape from that fate because it had gotten so bad you thought well who’s gonna come in here now I mean who would come in and try to make something of this building.
Roman: That was New York in the 1980s in 21st century Manhattan even haunted castles
can be turned into luxury condominiums.
Jessica: In the year 2000, the building was bought by a developer, now it’s 17 condo units a parking garage a spa a pool and a fitness center.
Roman: The hospital castle on the park finally became on the inside what had always pretended to be on the outside – a nice place for rich people.
Roman: 99% invisible was produced this week by Jessica Miller and Katie Mingle with Sam Greenspan, Avery Truffle Minh and me, Roman Mars. We are a project of 91.7 local Public Radio KALW in San Francisco and produced out of the offices of arcsine and open-hearted collaboratively minded architecture firm that generously gives us our home in beautiful downtown Oakland, California.