When I read non-fiction, I usually end up reading something weird (Agent Zigzag or Grunt) or something awful (Nazi Hunters or Five Days at Memorial). It’s rare that I read a book that highlights the better angels of our nature, but that’s what I found (for the most part) in David Oshinsky’s Bellevue: A History of America’s Oldest Hospital. There are varying dates for the founding of Bellevue Hospital stretching back to the 1730s. Bellevue has been open ever since the eighteenth century and only closed briefly once, during Superstorm Sandy. The hospital’s mission has always been to take care of patients who couldn’t pay for their care. Even today, they take care of people no one else will.
Bellevue is as much a history of New York City as it is a history of the hospital. Oshinsky writes about the various epidemics that afflicted the city through the ages: yellow fever, typhus, cholera, Spanish Influenza. He also writes about the social pressures of waves of mass immigration, poverty, and the attitudes of the rich and powerful towards the “lower classes.” The two clash repeatedly over the centuries. Because of its huge population of poor crammed into filthy, infested tenements, disease is rife. Someone has to care for these people or, failing that, at least take care of the bodies. Bellevue was (and still is) that place.
The two factors (endemic disease and the reluctant providing of a medical safety net) would have made an interesting story all on their own, especially in an age where the social safety nets are being stripped away as fast as Congress can sign a bill. What I found most fascinating was the history of medicine at Bellevue. Bellevue is old enough to date back to the days of bleeding, various purges, and a lot of guesswork*. The patients of Bellevue, for better or worse, would be in for centuries of medical experimentation. Bellevue physicians made important discoveries in forensic medicine, surgery, emergency medicine, and were on the forefront of AIDS treatment in the 1980s. Two Bellevue physicians even won a Nobel Prize for Medicine in the 1950s.
Of course, along with the beneficial discoveries, there was a lot of misguided, painful, possibly damaging, practices. Yellow fever and cholera patients were bled repeatedly. Tuberculosis patients were bundled in blankets and parked out in the fresh air in all weather. Women died in high numbers from puerperal fever in the 1860s and 1870s even after germ theory had been widely accepted. From the 1930s to the 1950s, children in the psychiatric wards were subjected to insulin- and electro-shock therapy. Psychiatric care is where Bellevue physicians struggle most. Even though the 1990s, psychiatrists struggled to diagnose and treat their patients. Part of the problem was because, as a public hospital, Bellevue takes care of prisoners for the city and its staff are regularly called on to evaluate whether criminals are faking or genuinely mentally ill.
In spite of its failings (most of which can be chalked up to lack of resources), I have to admire Bellevue and its staff. There have been times in the hospital’s history when physicians have deserted their post but, for the most part, Bellevue has been and still is a place where anyone can be treated regardless of their ability to pay. Doctors and staff stayed to care for people during epidemics and pandemics and riots and disasters. They are heroes.
I received a free copy of this book from Edelweiss for review consideration.
* Fun fact I learned from this book: New York and other states in the late 1700s repealed measures to make sure that physicians had actually gotten medical training before they hung up their shingle. The reason? Legislators didn’t want to infringe on a person’s right to pursue any profession they wanted.