Dr. David Oshinsky is a history professor specializing in medical history. He did a previous book on the Polio epidemic in the USA, and this book tells you a lot about how medicine in the USA changed over the years, on both social and scientific levels. He begins with Washington Square, originally a potter’s field until around 1830. While I was aware of the park’s origin as a dumping ground for the indigent dead, I didn’t know how much the plagues had to do with it. In 2009, when the park was redone, workers found a headstone from a 1799 Yellow Fever victim, which was unusual because none of the interred would’ve had the money for a headstone. The plague must have been so extensive that the regular cemeteries were full, otherwise a man of means would not have wanted to be buried there. It was the Yellow Fever and Malaria outbreaks that brought about the need for a public hospital at the city’s expense, and it ended up at an old alms-house in Kip’s Bay. Since medicine was not much good in those days, it wouldn’t cost much.
One of the most interesting chapters is on the Civil War and how it became a proving ground for a lot of the physicians who would go on to work at Bellevue. The Draft Riots became a test of how the city could handle a mass emergency, thanks to all the injured police and National Guard that had to be treated. The superintendent Frank Hamilton saw how badly things went on the battlefield, where the best a surgeon could do was amputate a leg (few had the skill to remove a bullet or properly stitch the cuts.) There was little use for a hospital if there was nothing that the doctors could do anyway, and since there were no antiseptics at the time, you were likely to die of infections.
Medical ethics are heavily covered in this book, because Bellevue’s doctors used have absolutely none. There would be improvements to the building, like a new mental patient wing, that quack doctors would use to experiment with insulin shock treatment and electroconvulsive therapy. Dr. Loretta Bender, their head of juvenile psychiatry, used ECT with reckless abandon, finding it a convenient way to deal with massive numbers of patients. It wouldn’t end until the 1970’s when there was more advocacy for medical rights. While medical improvements happened throughout the USA, the massive number of indigent patients meant that Bellevue was a great place to do experiments.
The author doesn’t mince words about the 80’s. The crack epidemic would flood the hospital’s mental wards with addicts, along with all the mental health problems associated with drug use. A doctor was raped and murdered in 1989 by a mentally ill crack addicted homeless criminal, living in a utility closet and sneaking in and out undetected, thanks to a stolen uniform. 9/11 and Hurricane Sandy would further test the hospital’s capabilities, thanks to the power outages and patient influxes. Unlike the days of old, patients are more likely to seek medical help now that they know they won’t be experimented on or have limbs amputated. While 9/11 brought a sudden patient influx, Hurricane Sandy made it harder to manage what the hospital already had. The patients had to be carried down the stairs, and fuel brought in for the generators.
The author does an amazing job with his research and he uncovers all kind of bizarre and shocking things about the city that I hadn’t known. He ends with an acknowledgement of all the previous books about Bellevue, including some that are still in print. I would recommend reading this book along with two earlier ones; A Finger In Lincoln’s Brain, and The Immortal Life of Henrietta Lacks. Both are about how medicine changed in the USA over the years, and how doctors often used patients as Guinea pigs.
Bellevue is a piece of NY history that you can use to tell if the city is functioning or not. There was a time when more patients left dead than alive. It was once filthy, then got cleaned up, then came drug addicts, then came improvements. The infamous hospital is a something of a measuring device for how the city of New York manages things. Despite the terrible reputation, Bellevue saves more lives than ruins them. When asked how the hospital handled all those patients on 9/11, I heard a doctor say it was easy compared to the hordes of heart attacks that they handle daily. Huge influxes of patients are a regularity at the hospital, and you’re more likely to die of a heart attack than a cut from flying glass. But for decades, Bellevue, like most US hospitals, was not a place to go if you got sick.