Jersey City is just across the Hudson River from New York City and is the second largest city in the state of New Jersey. Jersey City is the site of the first permanent European community in the state. The community was originally founded on land that was occupied by the Lenape tribe. It was purchased from the tribe on November 22, 1630 by the Dutch and became the colony of Pavonia [1-3]. Control of the colony reverted to the British following a surprise naval attack in 1664. A Dutch naval attack in 1673 regained the colony for the Dutch. One year later, the colony was again in British hands following the Westminster Treaty [4].

During the Revolutionary War, areas of the city were under control of both patriots and British troops. Battle for control occurred in a region known as Paulus Hook, which was eventually abandoned by retreating patriots and taken over by the British, remaining under British control until the end of the war in 1783 [5].

Over the next 50 years, Jersey City saw the addition of numerous manufacturers, including the Dixon Crucible Company (the makers of the Number two pencil), Colgate Palmolive and the American Pottery Manufacturing Company. These along with a host of other smaller manufacturers would eventually employ the large influx of German, Italian and Irish immigrants [6]. In the late 1880s, three passenger railroad terminals opened in Jersey City next to the Hudson River. Tens of millions of immigrants passed through these stations as they made their way westward from Ellis Island into the United States. The railroads became and would remain the largest employers in Jersey City into and during the early 20th century [7]. While the influx of foreigners was significant in most Northeastern cities, Jersey City experienced the most dramatic influx. Newark’s population increased from 17,000 in 1840 to 72,000 in 1860. Jersey City expanded from a mere village of 3,000 to a city of 30,000 during the same period and reached 120,000 after another twenty years with immigrants representing most of that growth. In 1860, the immigrant population of Hudson County, where Jersey City was the county seat, was reported to be 42%. In contrast, the extreme southern counties of Salem, Cumberland and Cape May averaged only a 4% immigrant population. By 1860, a clear majority of Jersey City’s adult male population was foreign-born. The Irish were the largest group, making up over one third of the population. The British and Germans together constituted another quarter [8]. Well over half of the Irish immigrants were unskilled workers. These workers represented over 75% of the unskilled laborers in Jersey City. Unskilled workers did not receive sufficient income to support a family or escape poverty (even in good times), and skilled workers generally earned an amount barely sufficient to assure a minimally decent life. Men in white-collar jobs usually had incomes that were sufficient to provide a very good life for their families; Jersey City’s wealthiest citizens were among these [8]. This disparity in income was reflected in the housing that one occupied. These residences would range from the vermin- and disease-infested tenements where most of the “skilled workers” resided (usually with immediate family as well as extended family) to the opulent private homes of Jersey City’s wealthy. By the first decades of the nineteenth century, every American city had established an almshouse. Jersey City was no exception; the larger the city, the greater the number of rootless and dependent [9]. If you were an unskilled person and unable to find a job or if you became ill and were unable to have someone care for you at home, there was a very good chance that you would end up in Jersey City’s almshouse.

The Almshouse: history in shaping the municipal hospital

The history of the municipal hospital can be traced to sixteenthcentury England when the burden of caring for the poor and the sick was transferred to the public following the closing of religious institutions by Henry VIII in the 1530s. This burden was placed upon local communities between 1552 and 1601 through a series of parliamentary acts. Local officials were now charged with caring for the chronically ill, the aged, the homeless, the permanently disabled, orphans, and the mentally ill as well as vagrants. Petty criminals were also common in the almshouse and were often used as aids to care for the infirm [10]. While many of these individuals were capable of living at home, it was widely believed that this would be an easy way of life would cause an increase in pauperism, thus a very diverse group of citizens were packed into almshouse-workhouse complexes. The almshouse or work house was also known as the pest house or lunatic house due to its frequent lice infestations and because the complexes often housed the mentally ill [11]. Conditions at most of these facilities were deplorable, especially for infants. Historical data show that some early English almshouses had an 82% infant mortality rate [12]. Improvements were far from swift, and as late as the mid 1800s, inspectors continued to report insufficient beds, food that was poorly and not thoroughly cooked, dirty dishes as well as poorly trained and poorly paid doctors if and when they came [4]. England also had an alternative to the almshouse: the voluntary hospital. These institutions, which were begun in approximately 1710, were the product of private charities and were run by a group of prominent, usually wealthy citizens. They differed dramatically from the almshouses in that they were selective, preferring to admit acutely ill patients who had at least a chance of recovery. These patients usually gained admission only after they were recommended by a board member or could pay something toward their care. Through the influence of board members, prominent physicians were asked to attend patients. This affiliation would increase the physician’s prestige in the community. Medical students were soon invited to participate in patient care. These students gladly accepted the opportunity to be tutored by one of the prominent physicians on staff. These hospitals were the precursors to the hospital internship system of later years and contributed to the development of medical knowledge and the education of new physicians. The selection of non-medical staff was also performed with great care, and overall the voluntary hospital provided care that was far superior to that of the hospital portion of the almshouse (most almshouses did not have separate hospital sections, and the segregation of the sick from the drunk or mentally ill rarely occurred) [13]. The importation of the almshouse to the United States was a natural occurrence that came with British colonization. Some improvements were made to British almshouses; however, those in colonies such as Massachusetts continued to be what was best described by pioneering social worker Homer Folks as “the dumping-ground for the wreckage and waste of human society” [14]. The desperate plight of those relegated to these institutions was exacerbated by mistreatment. This mistreatment was usually not of a physical nature (although physical mistreatment did occur); the residents of these facilities were often the victims of political corruption. The almshouse had become a place from which bent politicians could siphon funds. Following each election cycle, the party that had gained control felt that its political future depended upon persuading the voters that the almshouse had been managed extravagantly by its predecessor. These parties also attempted to satisfy the voters that all methods of austerity were in place and that there were no extravagances being given to those whose only crime was being poor or ill. The reality of this circumstance was that the already downtrodden population endured additional suffering so that the voting public would have a perception of good public funds stewardship. Examples included the supply of food being reduced to the lowest possible point and purchased at the lowest price with little regard to quality, repairs to buildings postponed indefinitely and in dismissing nurses and attendants [15]. Whether or not these methods were endorsed by those in the community is hard to gauge without specific election results in specific towns. This phenomenon was an early example of political involvement in the medical care of the poor, however when it was realized that these poor immigrants would one day become citizens and vote some wise politicians took a different approach.

Frank Hague aka “the boss”

No history of the hospital known as the Jersey City Medical Center can be undertaken without at least a brief history of its city’s legendary mayor Frank Hague. Frank Hague served as Mayor of Jersey City, New Jersey from 1917 to 1947. Hague was said to run “one of the most corrupt political machines in the country” [16]. Whether or not he was as corrupt as legend states is arguable [17]. However, there is no question regarding the amount of political power he wielded in both New Jersey and at the national level. This was a notable feat considering his background. There can be no doubt that the social and geographical aspects of Jersey City during Hague’s early childhood played a part in the decisions he made in later life.

In the 1850s, twenty years before Hague’s birth, Jersey City and most of its social organizations were led by the native-born Protestant population. This population also made up the city’s economic elite. The degree of Protestant influence affecting all aspects of Jersey City approached that of a government-endorsed religion. However, there were a large percentage of new Irish Catholic immigrants. These immigrants changed the previous virtually all-Protestant Jersey City to a city with a significant Catholic minority. Various groups were formed to attempt to convert this increasing population to Protestantism. In April 1854, a group called The Tract Society hired a full-time city missionary, the Rev. William G. Verrinder. The position of City Missionary was a quasi-official post in Jersey City. Verrinder was given access to the primarily poor Irish Catholic boarders at the county Alms House located in Jersey City [18]. Xenophobia was so prevalent that the New Jersey State Assembly appointed a three-man committee to put forth a resolution urging Congress to increase the period of naturalization for citizenship from 5 to 21 years. Although this was defeated, one member, John Roberts (the Assemblyman from Camden, another urban area in the state with an increasing immigrant population) said what many were no doubt thinking: “Foreign tongues are heard on every hand. Foreign newspapers flood the country. Districts of foreigners, townships of foreigners, counties of foreigners, with foreign hearts, and foreign manners, and foreign institutions, dot the whole country. Foreign quarters are found in our cities, and bands of armed foreigners parade our streets with foreign insignia. Foreign priests employ the thunders of foreign politico-religious power to force from the hands of the legal trustees the property of American citizens” [19]. Over the next thirteen years, although the city’s population nearly doubled, the proportion of Catholics increased from one-third to two-fifths. The overall city population grew 88.7%, with the Protestant population increasing by only 72% but the Catholic population increasing by 115%. These numbers posed a threat to the hegemony of the nativeborn Protestants of Jersey City [20]. Increased attempts at proselytizing and other coercive attempts at assimilation and “de-Catholicization” created an even wider rift between the two groups and prompted the Irish to defend both their Irish identity and their Catholicism. In 1872, the New York Irish World described the conflict thusly: “Our lot is cast among a people who hate our nationality—a people who would absorb us if they cannot prevent our growth. How shall we preserve our identity? How shall we perpetuate our faith and nationality, through our posterity, and leave our impress on the civilization of this country as the puritans have?” [21]. The Jersey City newspaper the Daily Sentinel did not help in calming matters when it said that “No Irishman ever died of hard work in America.” As well as claiming that the “…average Yankee worked twice as hard as the average Irish man”, the article went on to say that the main causes of Irish poverty were that the Irish drank too much and that the Irish collected and groveled in crowded cities where the labor force was always in excess and labor was bitterly contested [22]. Between 1860 and 1868, the Irish gradually entered Jersey City politics, believing that as a group they held significant numbers, especially because a large percentage of earlier immigrants had gained citizenship. Although the majority of Irish Catholics were members of the Democratic Party, it should not be assumed that this was always the party of the city’s poor working class Irishman. Many who had “made it” as successful business owners and professionals attempted to distance themselves from the poor working class Irish of Jersey City. This created a rift within the Irish community. These members of the community quickly learned that achieving some level of success and affluence does not automatically earn the Irishman respect and rank and that the stigma of their Catholicism prevented them from entering the social and political worlds of the native-born [23]. Because an increasing number of Jersey City Irish immigrants had become U.S. citizens and had thus obtained the right to vote, the Protestant population (both Republicans and Democrats) was now a minority. This population began to fear that the immigrants would come to govern their city. These citizens thus closed ranks and had the state legislature change the form of government in Jersey City from an Aldermanic to a Commission. In 1871, the legislature cited the lack of the fitness of lower class immigrants to govern an American city; Jersey City was now ruled by a Protestant-dominated, state-appointed minority commission [24].

In addition to changing Jersey City’s charter (which dictated how the city government was to be run), the state legislature also set about redistricting the city. By deliberately gerrymandering the city’s sixteen wards into six districts, the state legislature concentrated as many Irish into a single district as possible. The district encompassed the tenements and shanties along the Hudson River docks and the Erie right of way, as well as the swampland at the base of Bergen Hill. Not only did this consolidate the Democratic vote to a single district (the finished product yielded a voting district with fewer than 100 Republicans), it simultaneously limited Irish political power by ensuring a Republican Protestant victory in the remaining districts. The resulting shape of the district was that of a horseshoe [25]. Frank Hague was born into this anti-immigrant, anti-Catholic district of Jersey City known as the Horseshoe. Baptized as Francis, a name he would never again use in his public or private life, Frank Hague was the fourth of eight children born in 1871 to John and Margaret Hague, both immigrants from Ulster’s County Cavan, Ireland [26]. His birth, like that of most in this era, occurred at home on a kitchen table in a dilapidated frame house that was dubbed “the Ark” due to a stagnant pond that often swelled to surround the house after rainstorms [27]. The house was located on 10^th Street in an area that is currently the exit of the Holland Tunnel.

Frank Hague’s neighborhood was home to a mixture of odors from the garbage that was hauled by barge from nearby New York City to the piers in Horseshoe as well as to the landfills that were used to extend the city into the river for the railroads. There was also the smell of pigs and cattle that were frequently driven through the crowded neighborhood streets on their way to the nearby stockyards and slaughterhouses that supplied meat for the New York market [28]. In addition to the odors, there was the noise of railroad yards and the blackened air from the perfume, soap, graphite and snuff factories. Their towering smokestacks spewed soot into the sky surrounding the Horseshoe. It was a landscape of poverty with a saloon on nearly every corner and where violence,including murder, was not an uncommon occurrence [29]. Jersey City, which had only introduced grade school education in 1860 and which had no public high school until 1872, made the completion of even a grammar school education an uncommon event in “the Shoe”, as it was affectionately known by its residents [30]. For many young people in “the Shoe”, education came second to helping earn money for the family. Most students thus voluntarily left school early. Frank Hague also left school early; however, his departure was due to unruly behavior. By the middle of the sixth grade at Public School 21, Hague had completed all of the formal education that he would ever receive [31].

Following his dismissal from the public school system of Jersey City, Frank Hague, like his brothers John and Hugh, joined one of the many local gangs, and although violence perpetrated by such groups was common, there is no indication that Hague was ever involved in violent gang activity. Hague instead chose to become proficient in the art of robbing the freight cars that passed directly through his neighborhood of poverty, crime and disease. In Hague’s neighborhood, even drinking the water could kill [32,33]. This poverty among the primarily Irish and downtrodden residents of the “Shoe” created a sense of camaraderie; all were suffering the same economic plight and experiencing feelings of hopelessness and disenfranchisement. There was a strong belief that the only person a resident of the Shoe could rely on was another resident of the neighborhood. An “us against the world” ethos was created. It became the ethos that Hague relied on in both his youth and his early political career [34]. Hague’s rise from Constable in 1896 to his election to Mayor in 1917 was less than meteoric. Along the way, Hague witnessed many things that he found unacceptable as well as personally irritating. In his capacity as the Director of Public Safety, he was appalled at the response time from emergency personnel, including those involved in the police, fire and ambulance services. He implemented changes, and those who failed to comply were soon out of a job. If the police, firemen or an ambulance were slow in responding, Hague would punish them, usually verbally. However, Hague had been known to physically reprimand the offender. A story in the New York Times told an account of an ambulance that took 45 minutes to reach the scene of an accident. The Mayor asked a young physician what had taken him so long. The doctor said, “I had to put my clothes on, didn’t I?” This statement earned the doctor “a swift punch in the face” [35]. In the national weekly magazine Colliers, newspaper reporter George Creel wrote of Hague: “Every home in Jersey City is supposed to have officers on hand within three minutes after a call…and there are few failures, for a cop never knows whether the telephone is from a frightened householder or from the boss himself, a menacing figure with eyes on his watch” [36]. The combination of Hague’s somewhat unorthodox methods to punish inept officers along with his ability to restore pride in the Jersey City police and its officers were extremely effective in reducing the city’s once astronomical crime rate [37]. Eventually, through the efforts of Hague, Jersey City had one patrolman for every 3,000 residents [38].

Hague also inherited a fire department that was on the verge of collapse, with alarm boxes that failed to signal alarms, frozen hydrants (even though there were Public Works Administration (PWA) employees paid to keep them free of ice) and faulty equipment. This equipment included rotting water hoses that leaked so much that it was impossible to have the stream reach a second-story fire [39]. At the time of Hague’s takeover of the department, fire insurance rates in Jersey City were among the highest in the nation. The poor reputation of the city’s department was the primary reason for this [40]. Despite his lack of formal education, Hague was a man with uncanny street smarts. He was able to combine this talent with exceptional organizational skills. He was also able to monetize these skills both for his own personal benefit and for that of the inhabitants of the city he loved. In describing Hague, Richard Connors said it best: “it is clear that he recognized the limits of the city he governed and tried to make it better and greater” [20].

Happy days are here again

On September 4^th, 1929, U.S. stock prices began a precipitous fall. Despite occasional rallies during the next six weeks, the market came to a crashing halt on what has become known as “Black Tuesday”. On October 29, 1929 (the date that most economic historians usually attribute the start of the Great Depression), a record 12.9 million shares were traded. Because most Jersey City residents were not stock holders, they understood little of how these events would impact them. It would not be long before they would receive a lesson in the importance of Wall Street. During the next three years, stock prices in the United States continued to fall. By late 1932, they had dropped to only approximately 20% of their 1929 value. This began to strain many of the banks, most of which had large stock holdings in their portfolios. By 1933, 11,000 of the United States’ 25,000 banks had failed. The failure of so many banks reduced confidence in the economy, which led to decreased spending, reduced demand and a near halt in production. By 1932, U.S. manufacturing output had fallen to 54% of its 1929 level. This led to the unemployment of between 12 and 15 million workers (25-30% of the work force). Breadlines and soup kitchens were a common sight. Unemployment, especially in the construction and mining trades, was extremely high. Families lost their homes because they could not pay their mortgages and had no choice but to seek alternative forms of shelter, such as the shantytowns called Hoovervilles, which were named after President Hoover; many blamed Hoover for the problems that led to the depression [1]. The worsening depression affected many American big city bosses. With Real estate taxes going into default and with businesses closing, the well began to run dry. This severely affected their ability to provide patronage. It also became clear that Washington would not provide relief. President Herbert Hoover opposed any form of government intervention to ease the mounting economic distress, with the exception of the creation of the Reconstruction Finance Corporation (1932), which lent money to ailing corporations but was viewed as woefully inadequate. Unsurprisingly, Hoover lost the 1932 election to Franklin D. Roosevelt. Roosevelt garnered 22,821,277 votes to Hoover’s 15,761,254. He also captured 472 electoral votes to Hoover’s 59. Almost immediately following his inauguration, FDR began to implement his legislative agenda (known as the New Deal, a term that was coined during Roosevelt’s 1932 Democratic presidential nomination acceptance speech) for rescuing the United States from the Great Depression. Getting the nation back to work was the first priority of the new Roosevelt administration. Citizen employment was also the priority of the mayor of Jersey City [17]. The New Deal social welfare programs were widely believed to undermine the old-style political machine. This belief was known as the Last Hurrah thesis. In reality, the New Deal work relief programs strengthened political machines [41]. For Frank Hague, the Great Depression was a great sustainer. Federal funds began flowing to the states due to the establishment of the New Deal and its agencies, the Civil Works Administration and Works Progress Administration (WPA). Searle stated that: “Roosevelt used the WPA as a national political machine. Men on relief could get WPA jobs regardless of their politics, but hundreds of thousands of wellpaid supervisory jobs were given to the local Democratic machines.” Local political bosses such as Hague were able to trade jobs with the Civil Works Administration and WPA for votes for their political machines [42]. The allocation of funding to states was intended to be based on greatest need; however, the data do not support this. Political motivations affected WPA expenditures. This distribution was made via each state’s governor or its two U.S. Senators who, if they were Republicans, had difficulty in obtaining funds and thus had less patronage to funnel to the political bosses of that senator’s party. This essentially put an end to Republican boss rule in cities such as Philadelphia [43]. In states with Democratic governors, funds flowed more readily and opposition from political reformers ceased, primarily because these reformers needed work or feared that they may need assistance and thus could not afford to oppose the machine. As Flynn said of FDR, “it was always easy to interest him in a plan which would confer some special benefit upon some special class in the population in exchange for their votes,” and eventually “no political boss could compete with him in any county in America in the distribution of money and jobs” [44]. The one exception to this procedure was in New Jersey. Instead of the governor controlling the purse strings, the Roosevelt administration placed Jersey City Mayor Frank Hague in charge of the distribution of these federal funds. When solicited for jobs or other federal patronage, Harry Moore of New Jersey responded, “I do not have the power to appoint to these Federal positions. They are made upon the recommendation of the local organizations to Frank Hague. . . I would suggest that you get in touch with the mayor” [45]. WPA administrator Harry Hopkins began the federal flow by giving Hague $500,000 per month for relief in 1933 and ’34; during the five years Hopkins directed the WPA, he poured $50 million into Jersey City. Harold Ickes, director of the PWA, an agency that made contracts with private firms for the construction of public works, gave $17 million to Jersey City. By 1943, more than 8.5 million people had been put back to work on WPA-PWA projects including a large portion of Jersey City residents. Among the projects for which Hague would use this federal money was the construction of what many consider his legacy, the Jersey City Medical Center, which eventually became the third largest hospital in the world [46].

The construction of urban city hospital

Although it would become a major medical complex that included a general hospital, a maternity hospital, a nursing school, tuberculosis hospital and even a medical and dental school, the Jersey City Medical Center had humble roots. During the 19^th century, Jersey City operated a variety of public facilities for the health and welfare of the poor and sick. Among the earliest of these facilities was the pest house, which opened in 1805 in an isolated section of the Paulus Hook area of downtown Jersey City. Used to quarantine sufferers of contagious diseases, the building on the site was known as the “Old Cabin” and subsequently served as the county poorhouse, the more common term for an almshouse. During the Civil War, it was once again turned into a facility to treat the sick and was used for cholera cases. In 1868, the city aldermen voted to demolish the existing building and establish the Jersey City Charity Hospital [1]. While awaiting the completion of the new hospital, the medical and surgical patients as well as the alcoholics (which represented a substantial population) were housed in the former mansion of Orestes Cleveland, who served as the mayor of Jersey City from 1864-1867 and again from 1886-1892. Obstetrical and pediatric patients were cared for in a smaller house on the property [1]. Although it had not yet been completed, many knew that the new facility would be outgrown in a very short time. Between 1869 and 1875, the hospital admitted 4,225 patients. Nearly 50% of these were Irish immigrants [47]. In a little over a decade, the hospital had performed 4,095 surgical procedures, 1,972 medical dispensary cases (a term used to describe sick visits), 691 ambulance calls and had filled 22,000 prescriptions. Although utilization continued to increase, it was another dozen years before the demolition of the facility and the initiation of construction for a new hospital. The new building would be called City Hospital instead of Charity Hospital and would not be completed until 1909. The use of the hospital facilities increased with the expanding population of Jersey City. In less than a decade, an additional story was added to the structure and a second building was constructed and attached to the original building. More than a century passed from the opening of the pest house in the city’s Paulus Hook section to the first “modern” hospital in Jersey City.

The modern hospital consisted of two wards of 25 beds, each on the first three floors (divided into male and female sections). Most residents who required hospitalization were housed in these wards. Exceptions were made for the wealthy residents of the city who could afford to obtain one of the very few private rooms; however, this was a rare occurrence, and most well-to-do residents viewed hospitals as unclean houses of death or refuges for the poor. These patients instead remained at home under the care of private physicians. This was a period in which the spread of infection in surgical cases began to substantially diminish, primarily due to the work of Philip Semmelweis and Joseph Lister, both of whom were instrumental in implementing changes to hospital and operating room habits. Scrubbing prior to surgery, sterilizing all instruments and ensuring a clean operating room and surgical field contributed to decreased hospital fatalities related to post-surgical infections. Once these procedures became widespread (something that took several decades), even the well-todo were willing to be hospitalized. These patients preferred one of the growing numbers of private or physician-owned hospitals. The poor were primarily left to the public hospitals. This was especially true in large cities where a substantial portion of the population lived on low wages or had no work at all.

The new facility had emerged from the era of the almshouse. It was equipped with two operating suites that were complete with induction rooms for anesthesia. The facility had an x-ray room, a sterilization room and a supply room. Most conditions were treated at the hospital; however, the stigma of mental illness remained common, and psychiatric patients were held in the county jail. This wellequipped hospital also served as a teaching facility for one of the very early nursing schools in the United States. Admission requirements included the completion of at least two years of high school. The school graduated its first class in 1909, and within five years the then-serving Mayor Mark Fagan had the city contract with architect John Rowland to build a facility to house the nursing students. The cost of the project was $30,000, approximately $1 million in today’s currency. However, from this period on, the hospital grew very little. The core development of the medical complex occurred under the auspices of Frank Hague.

Frank Hague’s mother died in 1921. In the same year, construction began on the medical complex that eventually became the Jersey City Medical Center. Hague envisioned a maternity hospital that would provide high-quality care to any citizen of Jersey City free of charge. To initiate the project, Hague recruited members of the Hudson County Board of Freeholders, especially Mary Norton, who was concerned about the high infant mortality in Hudson County (which peaked at 212 per 1,000 births in 1923) [1]. Norton would later go on to become one of the first female members of the United States House of Representatives. With their assistance, a $1.6 million bond was issued by Hudson County for the construction of the project. A 10-story neoclassical building began in 1928 on the grounds of the hospital complex.

Designed by architect Christian Zeigler, the building would include a stainless steel chandelier in the delivery room, brass doorknobs and terrazzo floors. The public rooms on the first floor were decorated in aluminum and bronze, and the building also featured several penthouse apartments for staff and politicians as well as a movie theater on the top floor. On October 12th, 1931, the Margaret Hague Maternity Hospital opened its doors. Named after Hague’s mother, the Maternity Hospital had accommodations for 400 mothers and babies in the Eleanor Roosevelt Nursery. It offered extended visiting hours for working fathers and day care for the children of mothers who were in the hospital. For a number of years, the hospital was noted for its low maternal death rate and would deliver over 350,000 babies during its tenure. At its peak of operation in the late thirties, more babies were born there than in any other hospital of the nation; the total for 1936 was 5,088. Of the 6,096 mothers admitted in that year, only 20 died. This represents a maternal mortality of approximately one-third of 1%. Infant mortality for the hospital was 2.5%. Both figures were well below the national average [1,48].

The hospital boasted a staff of some of the top obstetricians and gynecologists in the country. Among them were Edward Waters, MD, who developed the waters-type supravesical extraperitoneal cesarean section. The facility was responsible for training thousands of obstetricians and gynecologist who would go on to practice throughout the United States. The hospital is also credited with developing the term “low birth weight babies”. The results of research and procedures developed at the hospital remain in use today [49].

Along with the maternity hospital, simultaneous construction was underway for a new 22 story building named the Holloway Building (commonly referred to as the surgical building). This building would soon take over many of the functions of the older general hospital and was completed in 1931. The building was erected behind the original 1909 hospital and the 1919 addition. The building stood out in sharp contrast to the older structures (as did the new 16-story nurses residence, Fairbank Hall, also known as East Hall) [1]. During this period, the hospital changed its name to the Jersey City Medical Center. Hague’s vision of not only a new general hospital but of numerous buildings housing various medical specialties contributed to the name change. Frank Hague’s vision of a medical Mecca was beginning to take shape and would continue to be molded with the help of his political ally President Franklin Roosevelt.

Construction of new buildings along with Frank Hague’s dream came to an abrupt halt in 1933 due to the arrival of the Great Depression. This changed with the 1936 Presidential Election. In that election, FDR won Hudson County by a margin of 117,000 votes; New Jersey as a whole went Democratic by only 30,000 votes [50]. The large plurality in Hudson County enabled FDR to win the state’s electoral votes. Following the election, Hague was made vice chairman of the Democratic National Committee, and it was not long before federal funds began to flow to Jersey City via the WPA and PWA. Hague began to complete unfinished buildings as well as add to the complex. He achieved recognition for bringing first-rate healthcare to Jersey City while also putting his supporters to work. In 1934, the original 1909 hospital building was demolished, and construction began on the new medical and clinic buildings. On October 2, 1936, a public holiday was declared in Jersey City, and all school children and city employees were asked or possibly “required” to attend the dedication of the new hospital. A crowd of over 200,000 people was present to watch and hear President Roosevelt and Mayor Hague dedicate the new additions to the hospital. Author Marquis Child described the scene: [51] Mayor Hague had turned out the town and half the state in an imitation of a Roman triumph. From the moment the procession of cars rolled out of the Holland Tunnel the thunder of bombs assaulted the ear, and the whole city under a cloudless blue sky seemed one mass of flag-waving humanity. Hague, an iron-jawed master of ceremonies, rode in the presidential car…to Hague’s great public hospital and clinic in the center of the city. Christian Ziegler is credited with designing the Margaret Hague Hospital. The remainder of the Medical Center complex with the exception of one building (Murdoch Hall) was designed by John T. Rowland. Hague’s building boom continued with the 1932 completion of a 15-story staff house for use by interns and residents. A small number of suites were also built for permanently housed staff physicians. The house contained a large formal dining room, a gymnasium and numerous study rooms. It also boasted a number of penthouse apartments with working fireplaces. These luxury penthouse dwellings were used as inducements to draw high-quality physicians from their positions in New York City hospitals and were provided free of charge as part of their contracts with Jersey City. Over the years, the building would be known by many names, including O’Hanlon Hall, Jones Hall and Blozus Hall. This building was completed in 1932. The construction of the medical and clinic buildings continued as well. These buildings were pure Rowland. They featured Art Deco design and stepped setbacks on the upper floors. The clinic building and its adjoining medical building were both completed in 1938. Construction of the Hudson Count Tuberculosis Hospital began in 1933; due to the depression, this was halted. However, construction resumed as money began to flow. The hospital facility was formerly the site of a three-story building built in 1918 for the Jersey City School for Crippled Children. When this facility moved to new quarters, it was converted to the new Infectious Disease Hospital. In 1934, Jersey City received a loan of $2,996,000 from the Reconstruction Finance Corporation, and building resumed. When completed in 1936, the 250-bed, 22-floor hospital was the tallest building in Jersey City. It held that title until 1989. Its name was later changed to The Berthold S. Pollak Hospital for Chest Diseases in honor of one of the institution’s best-known physicians.

Frank Hague and Jersey City were the first experimenters in socialized medicine in the United States. During the Hague years, the annual cost to operate the hospital was estimated at $3 million. Notably, there was one year in which the hospital’s revenue was less than $15,000. Although the revenues were not this meager in all years, in no year did revenue ever come close to the cost of operating the facility. Statistics from 1934 show a complex that treated approximately 900 patients daily, and with its 750 employees it became a great place to employ party loyalists [1]. Education was among the many services provided by the hospital. On December 19^th, 1909, the first graduating class from the training school for nurses at the Jersey City Hospital was driven to a ceremony in buggies provided by Jersey City undertakers. The program continued to produce nurses over the next decade and began to thrive when Mayor Hague secured the services of Jesse Murdoch who was serving as the director of the Nurses Training School at the Post-Graduate Hospital in New York City. The hiring of Murdoch heralded the Center’s becoming a hub for the training of highly qualified nurses. Murdoch graduated from the Stratford General Hospital School of Nursing in Stratford, Ontario and later became the assistant chief of nursing in the Panama Canal Zone during the canal’s construction [52]. The school of nursing at the Jersey City Medical Center graduated its last class in July, 1966. Murdoch’s significant role in the nursing program as well as the Medical Center was forever cemented when a 17-story Art Deco building (that would house the school of nursing) was completed in 1941. Designed by Christian Ziegler, the same architect who designed the Margaret Hague Hospital, the building was named Murdoch Hall. The interior beauty and detail are still considered to represent one of the most magnificent examples of Art Deco [53]. Other structures were included in the complex. These included dormitories for nursing students, a power house for generating electricity and a massive laundry building. The total published cost of land purchased and buildings constructed during the administration of Frank Hague was $21.9 million. In addition, other properties and staff for the nurse dormitories cost an estimated $5 million. Despite its architectural splendor, the facility was simply larger than what was needed for the citizens of Jersey City and Hudson County. Critics argued that maintaining the complex would eventually hurt the city financially, a prophecy that proved true. The facility was never used 100% for municipal hospital purposes [1]. On May 16th, 2004, the Jersey City Medical Center ceased being a place for healing and closed its doors for the last time. Today, the facility is used as upscale condominiums with unobstructed views of New York City.