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Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital

2018; Texas Heart Institute; Volume: 45; Issue: 2 Linguagem: Inglês

10.14503/thij-18-6639

1526-6702

Mark S. Scheid,

History of Science and Medicine

Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied HospitalDavid Oshinsky. 387 pages. New York: Doubleday; 2016. US $30.00. ISBN: 978-0-385-52336-3. Available from Amazon.com and Barnes & Noble.Field of Medicine: History of Medicine.Format: Hardcover book. Trim size: 6 × 9.5 inches.Recommended Readership: Anyone interested in how medicine and hospitals have changed over the last 300 years, as seen through the history of America's most famous public hospital.Content: 387 pages of text divided into 20 chapters, with an introduction and an epilogue.Overview: Founded in 1736 as an almshouse, Bellevue Hospital, the subject of David Oshinsky's powerful book, is today part of the Lower East Side row of hospitals nicknamed "Bed Pan Alley." By 1816, Bellevue contained an almshouse, a prison, an infirmary, and an insane asylum: it treated "the dregs of society." From that time until today, the hospital has remained committed to giving first-rate care to those with no other options.Bellevue is the major public hospital in the nation's largest city (and America's premier port of arrival). Its history is the history of medicine in the United States. Bellevue established America's first maternity ward, nursing school, on-site medical college, medical photography department, emergency service, psychiatric ward, ambulance corps, and pathology department. In patient care, Bellevue was on the front lines of the cholera epidemic in 1832, the "Great Epidemic" of typhus in 1847, the yellow fever and tuberculosis outbreaks of the 19th century, the AIDS and crack cocaine epidemics of the 1980s, and the Ebola virus scare of 2014. In 3 centuries, it has closed only once, when the floodwaters of Hurricane Sandy inundated it in 2012.Because of Bellevue's preeminence, many of America's greatest physicians taught or trained there, including William Welch, William Halsted, Walter Reed, William Gorgas, William Hallock Park, Joseph Goldberger, Thomas Francis, Albert Sabin, and Jonas Salk. André Cournand and Dickinson Richards, Jr., 2 of the 3 physicians awarded the 1956 Nobel Prize in Physiology or Medicine for discoveries regarding cardiac catheterization and pathological changes in the circulatory system, were Bellevue physicians.Oshinsky's history of Bellevue also documents the changes at public hospitals that have occurred over the years. Bellevue, and similar institutions like Kings County Hospital in Brooklyn, Los Angeles County General Hospital in Los Angeles, Cook County Hospital in Chicago, and Charity Hospital in New Orleans, were once prized destinations for generations of house officers from elite medical schools. Where else could they observe such a range of diseases and face such great diagnostic challenges? But the rise of Medicaid, Medicare, and private insurance networks eroded financial support for big public hospitals like Bellevue. Thus, the last chapters of Oshinsky's book deal with Bellevue's struggles to preserve patients' lives while simultaneously fighting for its own financial survival. By 1956, money was so tight that Dickinson Richards famously complained, "I can win the Nobel Prize in Medicine, but I can't take care of my patients at Bellevue."Strengths: One of the most difficult tasks for a historian is to find a focus that connects stories with a high degree of engaging personal detail to universal themes. Perhaps the best-known example of this approach is Barbara Tuchman's A Distant Mirror, an award-winning book that focuses on the life of Enguerrand de Coucy, a French nobleman who was caught up in many of the major events of 14th-century Europe.Oshinsky, a Pulitzer Prize-winning author, has found a similar opportunity in Bellevue, because the history of the hospital has closely mirrored the major events of American medical history over the last 3 centuries. Oshinsky often illuminates those wider themes with vivid opening scenes. For example, when a deranged assassin shot President James A. Garfield in 1881, Bellevue's top surgeon, Frank H. Hamilton, was summoned to the White House to treat him. The gunshot itself was not life-threatening; however, Hamilton's probing of the wound without gloves led to Garfield's death from infection. This vignette introduces the narrative on initiating Listerian antisepsis at Bellevue, a challenge led by interns William Welch and William Halsted that ended in triumph. Oshinsky is an excellent storyteller, and his book is a page-turner, full of clear portraits and incisive historical reporting.Weaknesses: None.Overall Grade: