Worth Books - Summary and Analysis of Bellevue: Three Centuries of Medicine and Mayhem at Americas Most Storied Hospital: Based on the Book by David Oshinsky

Summary and Analysis of

Bellevue

Three Centuries of Medicine and Mayhem at Americas Most Storied Hospital

Based on the Book by David Oshinsky

Contents

Context

Pulitzer Prizewinning historian David Oshinsky presents a comprehensive history of New York Citys famed Bellevue Hospital, from its humble beginnings as an almshouse infirmary to the remarkable evacuation effort put forth by its staff when the hospital closed its doors during Hurricane Sandy. Drawing from numerous historical archives and firsthand narratives from memoirs and oral reports, Oshinsky provides an account of the hospital that is unrivaled in its attention to detail.

Through this prism, readers also get an historical account of the city of New Yorkthe hospital provided the first ambulance service, operated as ground zero for patient care during every major health epidemic from yellow fever to AIDS, and its personnel was responsible for numerous vital public health reforms. In a broader sense, the book is a history of American medicine. Bellevue staff attended to the multitudes of Irish peasants fleeing starvation via famine ships. It was the site of the first American nursing school, and it grappled with every major change in American healthcare policy. When the antisepsis debate came to America, it raged within Bellevues walls. While there have been books that capture different aspects or perspectives of the hospital in recent years, a complete history of Bellevue has not been published in 60 years.

Overview

Oshinsky traces Bellevue Hospitals history over a span of more than 220 years, covering major medical developments, public policy changes, distinguished personnel, and the impact of national events like the Civil War and 9/11. The history begins with Bellevues gradual metamorphosis from a one-room infirmary through several 19th-century expansions to accommodate New York Citys immigrant population surge. The practice of treating droves of impoverished patients with yellow fever and typhus established Bellevues reputation as a refuge for all those in need, regardless of social status, and has continued throughout the hospitals history, up to today.

Beginning in the 1860s, Bellevue Medical College became a well-regarded institute of learning where internships were in high demand. When the Civil War broke out, several Bellevue physicians enlisted and served in the Union Army. One such doctor returned with the idea of instituting an emergency ambulance service, the first in the country. When Dr. Joseph Lister brought his germ theory to America, stressing the importance of antisepsis practices, its efficacy became a subject of hot debate. It took the death of President Garfield, who was felled by a bacterial infection after being treated by one of Bellevues own, to make believers out of the chastened.

The hospital has had many such instances of controversy, from journalist Nellie Blys 1887 undercover report on the mental health facilities, to the on-site murder of a pregnant physician by an insane former patient a century later. In between, Bellevue dealt with Prohibition-related alcohol poisoning, overcrowding and budget cuts, and the horrible blight of HIV/AIDS. Belle vue s final chapters include accounts of 9/11 and Hurricane Sandy, the first time the hospital was forced to close in its long history.

Summary

Introduction

New York Citys Bellevue Hospital has a long and storied past, from treating yellow fever in the 18th century to AIDS in the 1980s, particularly notable for its commitment to serving immigrant and low-income communities with limited options. It is also a cultural symbol for its treatment of the mentally ill, stemming from Nellie Blys famous expos on the abhorrent conditions of its insane asylum, as well as from the long list of celebrities whove checked in, including like Sylvia Plath and William Burroughs. John Lennons killer was taken to Bellevue for evaluation while the rock star lay in the hospitals morgue. In 1989, a homeless mentally ill man murdered a pregnant physician on the hospital grounds.

The sensationalism of instances like these obscures the real history of Bellevue, a beacon of hope for the sick with nowhere else to go, and a site of innovation. It was the first American hospital to have a maternity ward, an emergency room, and an onsite morgue, and was one of the first to establish antiseptic practices. The doctors who perfected the cardiac catheterization process also worked at Bellevue.

Need to Know: Bellevues standing and indispensability in the community has continued into the present day. It still serves New York Citys immigrant population, though they are more likely to be African, Hispanic, or Chinese rather than the Irish or Italians commonly seeking treatment in the 18th and 19th centuries.

1. Beginnings

Bellevue began inauspiciously as a one-room almshouse infirmary in 1736, located in an area known as Bel-Vue; a large addition was established in 1795 amid the scourge of yellow fever. Medical theory at the time suggested that illnesses like these were the result of airborne toxins from sewers and dead or decaying materials. This was known as the Miasma Theory. Dr. Alexander Anderson was brought to Bellevue to help care for those infected, largely recent immigrants and those who worked near the water, as the illness was actually spread through mosquito bites. Medicine was very primitive, most physicians held no degrees, and in addition to the Miasma Theory, doctors believed illnesses were a result of imbalances in the humorsblood, phlegm, yellow bile, and black bile. As such, patients were either bled or given calomel, a purgative that contained mercury. Thousands died in New York City during the outbreak. Alexander Anderson resigned from Bellevue in distress after the disease wiped out his entire family.

Need to Know: Over the years, construction workers in Washington Square have dug up bodies that had been buried in what was once a Potters Field. In 2009, one such body was discovered, along with his headstone, dated 1799, which was mysterious, given that, ordinarily, anyone with the means to purchase a headstone would presumably have the means to afford a proper plot as well. Researchers looking into the matter soon discovered that the prevailing belief was that even after death, victims of Yellow Fever were contagious and they were therefore buried in Potters Fields.

2. Hosacks Vision

In 1788, the New York City population was scandalized by the discovery that doctors were regularly committing grave robbery to supply anatomy classes with corpses to dissect. In April of 1788, after a child reported seeing a corpse through a window at New York Hospital, a lynch mob came for the doctors. Authorities intervened and the doctors were taken to the safety of a jail cell. Not pacified, the mob rioted outside the jail. The state legislature established punishments for disinterring bodies and ruled that the bodies of executed criminals would be donated to science. Present at the riots on the doctors side was David Hosack, who would go on to an illustrious medical career.

After the 1811 expansion, the hospital was reopened, now with the official name of Bellevue Hospital. In 1832, there was a cholera outbreak in New York. The crowded Irish immigrant neighborhood Five Points was hit the hardest, due to overcrowding and polluted wells, though once again, doctors did not know the cause at the time. In a few months, Bellevue saw over 2,000 cholera patients and 600 deaths. Patients were treated with electric shock and tobacco injections. Researchers would not discover the actual cause of cholera, the microorganism Vibrio cholerae , until 1884.