In 1863, New York was a burgeoning city of 800,000. Then as now, its diverse population was marked by extremes of wealth and poverty. With little access to life-sustaining work and medical care, growing numbers of poor New Yorkers, especially the lame and deformed, had little hope of improving their lot in life.
With the philanthropic efforts of Robert M. Hartley, Dr. James A. Knight, a general practitioner from Maryland, founded a new institution to meet the needs of this unfortunate group of patients. On April 13, 1863, the Society for the Relief of the Ruptured and Crippled was incorporated in the State of New York. The Hospital, now the oldest existing orthopedic hospital in the United States, with 28 inpatient beds, was located in Dr. Knight's private residence on Second Avenue and 6th Street. It opened its doors to its first patients on May 1, 1863, in the middle of the Civil War. In its first year, 824 patients were received and treated.
It soon became clear that a larger building would be needed to accommodate the growing demand for the Hospital's services. A group of prominent New Yorkers led by John C. Green, a successful China trader, set about raising more than $200,000 for a new facility, which opened in May of 1870 on the northwest corner of 42nd Street and Lexington Avenue, the site presently occupied by the Hyatt Hotel.
The Hospital for the Ruptured and Crippled flourished under Dr. Knight's leadership. His attitude toward care emphasized sunshine and fresh air, along with diet, exercise, electrical stimulation, and gentle rehabilitation, known as Expectant Treatment. Given the frequency and severity of surgical infection at the time, Dr. Knight considered surgical treatment detrimental. With few exceptions, surgical operations were not performed during his tenure as Surgeon-in-Chief.