Summary and Analysis of Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital: Based on the Book by David Oshinsky
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Summary and Analysis of Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital: Based on the Book by David Oshinsky
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This short summary and analysis of Bellevue includes:
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Pulitzer Prize–winning historian David Oshinsky provides a comprehensive account of New York City’s famous Bellevue Hospital, from its early inception as a poorhouse infirmary to its most recent struggles and triumphs, including a dramatic evacuation during Hurricane Sandy and the successful treatment of an Ebola patient.
In the centuries between, the hospital contends with epidemics ranging from yellow fever to AIDS, a meddling journalist named Nellie Bly, and the tragic murder of a doctor on hospital grounds by a mental patient. Some of Bellevue’s finest staff are highlighted, including two doctors who operated on American presidents and two others who virtually invented forensic science.
The history of Bellevue is the history of New York City, in all of its complicated and controversial glory, and its mission to serve the underprivileged is a fulfillment of the duty inscribed on the Statue of Liberty: “Give me your tired, your poor, your huddled masses.”
The summary and analysis in this ebook are intended to complement your reading experience and bring you closer to a great work of nonfiction.
Product Details
| ISBN-13: | 9781504044912 |
|---|---|
| Publisher: | Worth Books |
| Publication date: | 03/21/2017 |
| Series: | Smart Summaries |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 30 |
| File size: | 2 MB |
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Summary and Analysis of Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital
Based on the Book by David Oshinsky
By Worth Books
OPEN ROAD INTEGRATED MEDIA
Copyright © 2017 Open Road Integrated Media, Inc.All rights reserved.
ISBN: 978-1-5040-4491-2
CHAPTER 1
Summary
Introduction
New York City's 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 Bly's famous exposé on the abhorrent conditions of its insane asylum, as well as from the long list of celebrities who've checked in, including like Sylvia Plath and William Burroughs. John Lennon's killer was taken to Bellevue for evaluation while the rock star lay in the hospital's 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: Bellevue's standing and indispensability in the community has continued into the present day. It still serves New York City's 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 "humors" — blood, 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 Potter's 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 Potter's Fields.
2. Hosack's 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.
Need to Know: Though authorities were still operating under the Miasma Theory, the cholera outbreak did have a few positive impacts. The city began street cleaning in Five Points in 1832, and an aqueduct was constructed to take the place of the tainted wells.
3. The Great Epidemic
In this era, the wealthy relied on private practice doctors who usually made house calls. The middle class and working class (a.k.a., the "worthy poor") relied on dispensaries, basically walk-in medical clinics administering routine care. There was also another hospital, the private New York Hospital, that had a "'do not admit'" list including drunks and the contagious.
In the 1840s, a new facility was opened on Blackwell's Island (modern-day Roosevelt Island) that took a large population of Bellevue's psychiatric patients, but the hospital continued to be inundated with new immigrant patients, this time bearing typhus. This outbreak was caused by poor conditions aboard ships fleeing Ireland's potato famine. The fatality rate was 40%, and it took the lives of patients and doctors alike. New York Hospital sent those suspected of having typhus to Bellevue.
Just after the typhus outbreak in 1852, the Sisters of Charity opened St. Vincent's Hospital. It was a private facility, but, unlike New York Hospital, it was open to the immigrant population, provided they were Irish Catholic. A Jewish hospital (later named Mount Sinai) opened in 1855, and later a German Catholic facility in 1868.
Need to Know: Despite a growing need due to typhus and the ever-increasing immigrant population, hospitals continued to face stigma. For Bellevue, the problem was compounded by an article in the New York Times reporting on another epidemic within its walls — a rat infestation.
4. Teaching Medicine
Meanwhile, doctors continued to have a hard time getting corpses in order to conduct medical research on them. In 1854, the state passed "the Bone Bill," allowing for unclaimed corpses from the prisons and poorhouses to be donated to science.
It was not terribly common for doctors at the time to attend medical school. It was cheaper to simply become an apprentice to a practicing doctor and then strike out on one's own. However, The College of Physicians and Surgeons (P&S) was in operation for those who wanted the education, with the esteemed Dr. Valentine Mott, an expert surgeon, on faculty. In 1841, Mott set about opening his own teaching facility at NYU, along with John Draper, author of the Bone Bill, and other high quality medical staff.
In 1846, the first operation using ether as an anesthetic was conducted at Massachusetts General Hospital, and the days of operating as quickly as possible while the patient was forcibly held down were over. In 1861, Dr. Mott, along with Drs. Lewis A. Sayre, Frank H. Hamilton, and Stephen Smith founded the Bellevue Hospital Medical College. Admission was restricted to white males. By 1864, women were permitted to audit classes, but were treated abhorrently by staff and other students.
Need to Know: Midcentury saw a surge in popularity for homeopathic practices, some legitimate, some quackery. Those in favor of these practices were a vocal minority led by Dr. Samuel Hahnemann, and they attempted to get Bellevue to add homeopaths to the staff, to no avail.
5. A Hospital in War
The day after Bellevue Medical College opened, the Civil War began, rupturing the country and tanking New York City's economy. Many Bellevue doctors enlisted, including Dr. Frank Hamilton, who tended to soldiers at the Battle of Bull Run and penned A Treatise on Military Surgery and Hygiene in efforts to correct further medical mistakes in the field. At the hospital, younger, less-experienced doctors were hired to fill in. The passage of the National Conscription Act in 1863 resulted in class turmoil in New York City, as poorer citizens were forced into the draft, while the wealthy could pay a fee and be excused. There were riots as a result, and many of the wounded were treated at Bellevue, alongside injured soldiers.
A few years later, a student of Frank Hamilton's named Charles Augustus Leale went to the theater to watch a play called Our American Cousin. The play was interrupted when John Wilkes Booth shot President Lincoln. Leale ministered to Lincoln in the theater before advising his handlers move him to a house across the street, where he remained by the president's side until he passed away. Dr. Valentine Mott, a friend of Lincoln's, took the news of the president's death especially hard, and became ill. He died the day after Lincoln's funeral.
Need to Know: Written before anyone understood the importance of hand washing, A Treatise on Military Surgery and Hygiene reads, in Oshinsky's words, is "a virtual guide to death by infection." But Hamilton still managed to make many valuable contributions to the practice of surgery, like serrated bone cutters, special forceps to remove bullet fragments, various splints, guidelines for bone settings, and even plastic surgery.
6. "Hives of Sickness and Vice"
Over the pre- and post-war years, Bellevue's Dr. Stephen Smith tried to improve health and hygiene for the Irish immigrant population. To do so, he had to go to battle with Tammany Hall, a New York City political institution, rife with corruption, that was meant to serve the immigrant communities. A survey was conducted called Sanitary Conditions of the City which outlined the squalid living conditions of the immigrants, who were often forced to live in cramped quarters without appropriate toilet facilities or proper garbage removal. Smith blamed Tammany for its failure to act in the better interest of the citizens it was supposed to protect. The survey resulted in the 1866 establishment of the Metropolitan Board of Health of New York City, which jumped into action to solve these problems.
Need to Know: After Smith explained the dire situation to William Cullen Bryant, the journalist penned an article for the Evening Post on the subject and members of New York City's elite, including John Jacob Aster Jr., August Belmont, and Peter Cooper, formed a Citizens Association to address the immigrants' plight.
7. The Bellevue Ambulance
Another member of Stephen Smith's public health team was Edward Dalton, a doctor who had served in the war and witnessed the Battle of Antietam where the first horse-drawn "ambulances" were used to move injured soldiers from the battlefield to safety. Back in New York City, Dalton employed stagecoaches to make runs from the sites of medical emergencies to Bellevue, toting a doctor and medical equipment in the carriage. By the 1890s, ambulances were responding to an average of 4,400 calls per year, but Dalton, who died of tuberculosis, would not live to see the service's widespread success.
Need to Know: The ambulance service became renowned after the Orange Riots of 1871, a bloody clash between Irish Catholics and Protestants where hundreds were injured (most of them sent to Bellevue) and 60 were killed.
8. Bellevue Venus
In 1867, Bellevue hired a medical photographer, Oscar Mason. Mason's major contribution was the "Wall of the Unknown Dead," where photographs of the dead could be identified by loved ones, who could then claim their remains. Mason took the first photograph of a blood transfusion in progress, a famous photograph of a young woman with elephantiasis, and photos of a man whose middle finger was grafted onto his nasal cavity after his entire nose had rotted off from an infection. When Bellevue acquired its first X-Ray machine in 1896, Mason became the operator.
Need to Know: Mason's photographs improved Bellevue's public image by creating a visual representation of the hospital as the site of cutting-edge procedures and medical research.
9. Nightingales
In 1873, the Bellevue Training School for Nurses opened, the first of its kind in the nation. Around this time, there was an epidemic of women dying from puerperal fever in the maternity wards and a controversy over the cause of the disease. Many nurses cited Florence Nightingale's regulations on cleanliness and argued that the deaths were a result of poor ventilation and unhygienic practices. Meanwhile in Europe, Dr. Ignaz Semmelweis saw a potential link between puerperal fever and the fact that doctors moved directly from conducting autopsies in the morgue to delivering babies. As a result of the nurses' complaints, the maternity ward at Bellevue was moved and hand washing on the ward became mandatory.
Need to Know: Florence Nightingale did much to increase the field of opportunity for women in medicine. But some of her mandates also detracted from the perception of nurses as authority figures in their own right. In addition to her tenets on cleanliness, she stressed complete deference to doctors as the "experts" and a borderline saintly tenderness toward patients, qualities that can sometimes undermine a nurse's perceived professionalism.
10. Germ Theory
By the 1870s, Bellevue's reputation was soaring and internships were a coveted commodity. Two particularly noteworthy interns of the era were William Welch and William Halstead. After interning at Bellevue, both men furthered their studies in Europe, where they adopted Joseph Lister's germ theory, although, at the time, they were still in the minority.
Welch returned to New York City in 1878 and was hired by Bellevue to teach the first pathology course offered anywhere in the country. Halstead returned to the States in 1880, joining Welch at Bellevue where the two men found themselves contending with germ theory deniers like Frank Hamilton. Stephen Smith, however, was a Lister man.
Need to Know: Though some of the medical vanguard were hesitant to embrace germ theory, Robert Wood Johnson, an apothecary's assistant who attended the Philadelphia conference, was inspired to start a business with his brother selling sterile bandages. They called it Johnson & Johnson.
11. A Tale of Two Presidents
On July 2, 1881, President Garfield was shot by Charles Guiteau at a Washington train station. Secretary of State James Blaine called Frank Hamilton to come join the president's medical team. Garfield's death on September 19 was not the direct result of his injuries, however, but from a bacterial infection contracted due to the poor sanitary practices of his physicians. When Hamilton tried to charge the government $25,000 for his services, he was chastised and laughed out of Washington with one-fifth of what he asked for.
In 1884, William Welch received a lucrative job offer from Johns Hopkins University. Bellevue attempted to retain him via a new pathology lab donated by Andrew Carnegie, to no avail. William Halstead continued to make a name for himself as a surgeon at Bellevue until 1885 when he developed a severe cocaine addiction after testing the drug for medical purposes. Welch convinced his friend to check himself into a hospital to kick the habit, and then hired him on at Johns Hopkins, where Halstead had a productive career and continued to preach the germ theory gospel.
Need to Know: The medical community learned their lesson — in 1893 Bellevue's Dr. Joseph Bryant, a student of Stephen Smith's, took part in a secret operation to remove a cancerous lesion from President Grover Cleveland's mouth. The surgeons took all necessary sanitary precautions and the procedure was a complete success.
12. The Mad-House
The facility at Blackwell's Island continued to be the destination for most patients with psychological problems, but these patients were admitted to Bellevue first for evaluation. It is because of this relationship that Bellevue is still closely associated with mental illness. In 1887, journalist Elizabeth Jane Cochran, a.k.a., Nellie Bly, was hired by Joseph Pulitzer's New York World to conduct an investigation into the conditions of Bellevue and Blackwell's facility by pretending to be insane. At Bellevue, Bly faced some ignorant and untrained staff, but at Blackwell's she was neglected and waterboarded. After Bly's report, the city voted for a massive increase in funding for both Blackwell's and Bellevue, but it would take a lot of work and time to restore their good standing.
In 1900, New York World relaunched its investigation, sending a male journalist this time, who claimed to have witnessed three male nurses strangle a patient to death at Bellevue. The only witnesses besides the journalist (who had a history of dishonesty) were mental patients, and the nurses were acquitted, though this incident further stigmatized Bellevue and its male nursing staff in particular. Bellevue's school for male nurses was shut down a few years later amid allegations of homosexual conduct.
(Continues...)
Excerpted from Summary and Analysis of Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital by Worth Books. Copyright © 2017 Open Road Integrated Media, Inc.. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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Table of Contents
Contents
Context,Overview,
Summary,
Timeline,
Cast of Characters,
Direct Quotes and Analysis,
Trivia,
What's That Word?,
Critical Response,
About David Oshinsky,
For Your Information,
Bibliography,
Copyright,