This book was 100% written by a historian, not a biographist, so temper expectations accordingly. Bellevue is a famous–some might say infamous–hospital in New York City, and when I saw my friend Melora’s review, I was intrigued by the combination of NYC, medicine and general nuttiness. However, Oshinsky believes one should start at the very beginning; to wit, from the very origins of ownership on the piece of land Bellevue occupies to its more modern role in the city. Along the way he digresses into the development of medical practice, immigration, the Civil War, politics in NYC, public health, the politics of poverty and health, electroshock therapy, AIDS, and Sandy. The topics are often interesting, but result in an uneven whole.
Bellevue, the name of a river estate, was leased in 1795 by to become a hospital for people suffering from ‘yellow fever” since it was so far from the city. As Oshinsky continues, he traces the origins of disease management in the burgeoning seaport of NYC and Bellevue’s role in both caring for poor immigrants and unusual diseases.
He recounts how the ‘practice’ of medicine grew, developing from its infancy along the lines of surgeons (the ‘bone-setter’), doctors and apothecaries. Doctors were usually wealthy people who may have gone to school, or may have only apprenticed, and Bellevue’s never-ending supply of patients meant a never-ending opportunities for students to learn on people who couldn’t afford to go elsewhere. Oshinsky is especially fascinated by the practice of blood-letting and tells us far too much about it. However, it was apparently part of the cause of death of one of our Presidents.
A section on the Civil War brought advances in medicine–eventually–and about the same time, anesthesia was developed that allowed people to better tolerate surgery. Progress was made on successful amputations that doctors during the war brought back to Bellevue. Bellevue doctors were also connected with treating Presidents Lincoln and Garfield.
Meanwhile, as NYC grew, so did the need for more medical facilities, which often seemed to pan out among class lines, with New York Hospital taking fee-paying patients. As NYC struggled with immigrant issues and prejudice, hospitals started to ‘specialize,’ with Jews’ Hospital opening in 1855 (now the famous Mount Sinai) and the ‘German Hospital’ in 1868 (anti-German sentiment in WWI led to it being renamed Lenox Hill in 1918). There were also hospitals focusing on Presbyterians, Episcopalians, German Catholics (St. Francis) and poor Italians (Columbus). [Ed.: now that America is less religious, we just have hospitals for the Catholics. And a lot of hospitals unofficially stratified by economic status]
Public health departments took off because of a Bellevue doctor who realized many of his typhus patients lived in a particular East Side tenement. Collaborating with a journalist, they shamed a landlord into repairs. He testified before Congress and helped write the Metropolitan Health Act, revolutionizing public health and improving a child mortality of 25% [Ed.: another good thing government does, people, is look after your health and safety]. Another doctor who had helped start an ‘ambulance corps’ during the Civil War ended up at Bellevue, where he became instrumental in getting ambulance stagecoaches (stocked with whiskey, bandages and a straightjacket, all the essentials of a modern E.R. –I’m joking!)
A section on Hurricane Sandy in 2012 was intriguing. Despite the lessons from Hurricane Katrina, and Hurricane Irene the year earlier, staff at Bellevue decided to shelter in place and stay open. Though generators were on the thirteenth floor, the fuel pumps for Bellevue (located along the river, remember) were in the basement. As the local Con Edison blew, the generators ran dry and a gasoline bucket brigade was formed. When the extent of Sandy’s damage became clear, Bellevue finally closed, resulting in a patient diaspora.
I also found the section on AIDS fascinating. NYC was pretty close to ground zero with the epidemic, and Bellevue, with its tradition of providing health care to the uninsured, indigent people of the city, was one of the first places to notice the unusual clusters of Kaposi’s sarcoma and pneumocistis carcinii (since renamed jiroveci) that characterized late stages of the syndrome. It dovetailed briefly with a discussion on hospice/end-of-life care and nursing, which was both interesting and sad.
Most sections were extremely interesting, but there was a lot of digressive and filler material that detracted from the focus on Bellevue specifically. For instance, the section on Hurricane Sandy was contrasted with another nearby semi-private hospital, Tisch Hospital, as well as hospitals in New Orleans. Independently of a book about Bellevue, that would have been an interesting book in and of itself. I certainly found descriptions of dealing with hospitalized patients during disaster fascinating. The section on AIDs is likewise contrasted with response to the crisis in San Francisco–interesting, definitely, and again worth of a book–but less important to Bellevue itself. It felt like many historical books focused to the mass market, digressing into semi-titillating side-stories that aren’t as germane.
Overall, lots of fascinating topics covered, contextualized by one of America’s first hospitals to serve the poor. There’s a nice set of colorplates in the edition I read, which is interesting, and particularly helpful in discussion of a somewhat controversial painting of surgeon pre-sterile surgery. Many thanks to Melora for bringing it to my attention!