Bellevue was for some years the only hospital under the management of the public authorities of New York City. After the erection of the Penitentiary, one of its rooms was set apart for a hospital. In 1848, during the administration of Moses G. Leonard, Commissioner of the Almshouse, at that time acting under the Common Council of the City, the first hospital building was erected on the Island called the "Penitentiary Hospital?" The building was of brick, and was completed in 1849, the same year that the "Ten Governor" system came into existence. The name was changed to the "Island Hospital" by resolution of the Governors December 15th, 1857. The Governors appointed a committee to examine the building soon after its completion, who reported that they found it "constructed in a most reckless and careless manner, and was as a public building a reproach to any city." It was pronounced insecure, and the Governors were about to pull it down, when it was accidentally destroyed by fire on the morning of February 13, 1858. At the time of the disaster, it contained 530 inmates, who were all removed without loss of life. It is believed that it would soon have fallen down if it had not been thus destroyed.

The corner-stone of the Charity Hospital, erected on the site of the one so happily destroyed, was laid with appropriate services July 22, 1858. An address was delivered on the occasion by Washington Smith, Esq., President of the board of Governors.

This magnificent structure is of stone quarried from the island by the convicts, and is the largest hospital about New York, and probably the largest on the continent. It is a three and a half story, 354 feet long, and 122 wide. The two wings are each 122 by 50 feet, and the central building 90 by 52, and 60 feet high. The entire hospital is divided into twenty-nine wards, most of which are 47½ feet in length, and ranging from 23 to 44 feet in width. The smallest ward contains 13 beds, and the largest 39. The Hospital contains 832 beds, but has capacity for 1,200, and each bed has 813 cubic feet of space, affording an abundance of pure air in all its parts. In 1864 no less than 1,400, most of them sick and wounded soldiers, were domiciled here. The eastern wing of the building is occupied by the males, and the western by the females, and the whole so classified as to accommodate to the best advantage the large number of patients always under treatment. Wards are set apart for consumptives, for venereal, uterine, dropsical, ophthalmic, obstetrical, and syphilitic disorders. Also for broken bones, and the other classes of casualty patients. Two wards are set apart for the treatment of diseases of the eye and the ear, and are in charge of distinguished physicians, who have made the diseases of those organs their special study. The stairways are of iron, the floors of white Southern pine, which, with their frequent ablutions and scourings, and the snow-white counterpane spread over each bed, gives such unmistakable evidence of neatness, as to quite surprise many not familiar with the conduct of public institutions. From six thousand to eight thousand patients are annually treated in this Hospital, most of whom are charity patients, four hundred or five hundred of whom die, and most of the remainder are discharged, cured or relieved.