Bellevue – David Oshinsky

Fascinating book about the history of Bellevue Hospital in New York.  Before reading this book, I thought Bellevue was a mental institution and didn’t even know it was still in existence.  Contrary to my assumptions, it’s very much in existence and is one of the oldest and most respected hospitals in the country.  It actually was started as an “almshouse” in 1736 and moved to its current location on the East River in 1816 (on the grounds of an old estate named ‘Bellevue’).  The reason so many outside of New York – including me – think of it as primarily a mental institution (and one with a pretty sordid reputation) is because of a series of articles and a book describing the horrific conditions in the psychiatric ward at the hospital and the mental institution that some patients were sent to from the hospital.  The amazing thing is that the articles were written in the 1880s (and another round in 1900) – yet their effect endures.

The truth is that the hospital has been on the front lines of just about every type of disease in America.  Its original role in the city remains its role today – free healthcare to those who otherwise can’t afford it.  And because it’s a huge public hospital in the largest city in the country, it sees every disease and condition imaginable.  It was interesting to read about how it dealt with Yellow Fever, Puerperal Fever (fever caused by uterine infection following childbirth – by 1874, one of every THREE women who delivered in Bellevue died after childbirth because of it [hard to know how many women gave birth at a hospital versus at home] – the hospital finally noticed that birthing rooms run by midwives had a much better survival rate than those run by male obstetricians – after several years it occurred to them that the male obstetricians were often coming to the delivery room after being in the morgue overseeing dissections and autopsies, and of course they went from one to the other without washing their hands or garments – once they bought into ‘germ theory’ [something the American medical profession was extremely slow to adopt – much slower than Europe], Puerperal Fever went away), Typhus, and other plagues of the nineteenth century.

Bellevue was on the cutting edge of nursing also.  Before the Civil War, nurses didn’t really exist in this country (Florence Nightingale and her crew came about in Britain as a result of the Crimean War roughly five years before the Civil War), but as a result of the war started to have a role in hospitals.  When the Civil War started, only Catholic nuns were used as nurses, but since there were only so many of them, the military finally opened it up to other women.  They had to overcome the prejudice of some male doctors who thought women were too flighty and delicate to handle the serious demands of medical work.  The doctors were also wary of women getting their foot in the door and then wanting to usurp the doctors’ authority or even become docs themselves.  The American Medical Association addressed this with a statement that said women weren’t fit for being doctors because of “uncertainty of rational judgment, capriciousness of sentiment, fickleness of purpose, and indecision of action.”  When the army decided to hire nurses beyond the Catholic nuns, it advertised for women who were single, literate, and over 30, and who were “plain almost to repulsion in dress and devoid of personal attractions.”  The nurse was allowed “no bows, no curls or jewelry, no hoop skirts.”  Amazingly, the army was inundated with applications and the war turned nursing into a serious profession.  After the war, Bellevue was one of the first hospitals to hire them.

Bellevue has been on the front lines of most outbreaks in this country for the better part of three centuries.  From old time diseases like those mentioned above to the AIDs crisis of the 80s and 90s and even the sole Ebola case in New York – it’s seen them all, and is very respected as a result.  It’s a totally different place than what I thought.

Really enjoyed the book and learned a lot.  Would definitely recommend it to anyone who likes history.

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