As the country's first public hospital, Bellevue in New York City has acquired quite the reputation in its three centuries of existence. Founded in 1736, it first earned notoriety for its psychiatric facilities, home to New York City's mentally ill in a time when they were simply called crazy, demented, or freaks.
This legacy isn't so far off the mark, but it's certainly incomplete. Much more than a treatment center for the insane, Bellevue has a rich history filled with medical feats, scientific innovation, and yes, some dark incidents.
David Oshinsky is an author who outlines the hospital's fascinating story in his new book, Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital. We spoke to him for his take on some of the most surprising and historic moments from the hospital's nearly 300 years of treating patients.
During your research on Bellevue, what was the most interesting story you came across?
David Oshinsky: There are so many, but I think what really caught my interest was the story of Alexander Anderson, who was the first physician at Bellevue.
What really got me interested in him was that he was a 22-year-old apprentice doctor in the 1790s who didn't really want to be a doctor. He wanted to be an engraver, and he turned out to be the greatest engraver of the early 19th century in America. But his parents thought he had to do God’s work in medicine, so he became a doctor.
Then he took a job at this godforsaken isolated pesthouse where they were just shipping yellow fever victims to die. Alexander Anderson sort of took over, and he didn't know how to deal with them medically; he basically bled them and purged them, which is what they did in those days. But he also treated them with incredible kindness and compassion.
"Frankly, they could basically experiment on uncomplaining bodies."
He stayed at Bellevue through several epidemics in which his son died of yellow fever, his wife died of yellow fever, his mother, and father, and brother had died of yellow fever, but he believed he had been stationed there for a reason. He was going to do what he could for these people who were basically on their deathbed.
When I read that, I realized that it was the beginning of this circle of what Bellevue stood for. Many people have said it’s a mental hospital, that there are all kinds of horror stories about it, but what it really was was a hospital that turns no one away. Where doctors have a sense of compassion about the people they treated, and still do.
Why do you think Bellevue was such an epicenter for treating epidemics, starting with yellow fever, all the way up through AIDS?
Oshinsky: Bellevue is the flagship public hospital of New York City. It was the first public hospital, the earliest public hospital, it was the biggest public hospital.
It was a public hospital that really attracted some of the greatest medical minds of three centuries, because they believed it was their duty to help the poor. They believed that they were going to see everything at Bellevue, there was no disease, no condition that they weren’t going to see.
"My mother would say, 'Keep it up and you're going to Bellevue.' It was like a national punch line."
And, frankly, they could basically experiment on uncomplaining bodies. These were people who -- the deal was that if they came to Bellevue, the doctors who treated them would look toward advancing medical science. The doctors weren't doing Frankenstein work on them, they were actually trying to push the envelope of medical discovery forward. But that basically was part of the deal.
So I think the answer is, this is where the poor came, this is where the immigrants came, and with the immigrants came all kinds of afflictions. And a tradition grew out of that.
Given the hygienic conditions in the 1800s, particularly for immigrants, it makes sense that they'd be the biggest patient group at Bellevue.
Oshinsky: If you were sick in 1850, if you had any money at all, the doctor came to your house, you didn’t go to the hospital. Hospitals were these really down-and-out kinds of places. But what made Bellevue different was that it was a down-and-out kind of place that had amazing physicians working there.
"Fifty percent of everyone who was operated on at Bellevue died within a month."
There were other moments in Bellevue's history, obviously the AIDS crisis was extraordinary, and Bellevue was the epicenter of the AIDS crisis in New York City, which was the greatest AIDS crisis in the country. More patients were sent to Bellevue, more AIDS patients died at Bellevue than anywhere else.
A lot of the house staff were very frightened of treating people who were going to die, and they didn't know if they were infectious, these were very young patients who were no older than the interns and residents who worked at Bellevue. It was emotionally draining, and it was scary. But they prevailed as physicians, and these patients were treated with incredible compassion.
It's especially amazing because everyone was so scared, unsure of what exactly AIDS was or how it could be transmitted.
Oshinsky: You could barely find a dentist in New York City who would treat an AIDS patient in the 1980s, it really had reached that level. And you had one physician [Linda Laubenstein] who had polio, who went around in a wheelchair.
At one point she was treating about one quarter of all the AIDS patients in New York City. At her office in Bellevue.
What was the most interesting time period in Bellevue's history?
Oshinsky: One was when the new generation of Bellevue physicians who demanded germ theory, who demanded that there had to be antiseptic medicine, that you had to listen to [Louis] Pasteur and [Joseph] Lister and give up the old ways.
So many patients were dying of postoperative infections, I think 50% of everyone who was operated on at Bellevue died within a month of postoperative infection. There were a lot of doctors at Bellevue, especially the old guards who didn't want to change their ways, didn't believe in handwashing, didn't believe in sterilizing instruments. That battle was probably in some ways the most important thing that happened at Bellevue in the 19th century.
The other things that are extremely important are the AIDS crisis, and the courageous evacuation during Hurricane Sandy, which closed the hospital for the first time in 300 years. Those were really extraordinary moments.
"It was barbaric, absolutely barbaric."
You can't factor out Bellevue as a psychiatric hospital. When I was growing up as a kid in New York City, when I was acting weird my mother would say, "Keep it up and you're going to Bellevue." It was like a national punch line.
When so many people you meet think Bellevue is only a psychiatric hospital, that's part of it. But what I try to show in the book, was that's why it's reputation has meant a lot more; it's actually a rather small part of the larger operation.
Bellevue was also a teaching hospital, and before anesthesia, there would be people screaming and bleeding out for student doctors to see. How exactly did that work?
Oshinsky: Basically if you had to amputate before 1845, you had to get that limb off within seconds, or no more than a minute, or the patient would die of shock and blood loss. It would be absolute agony.
They would actually ask the patient when the patient came onto the table, "Do you want us to do this procedure?" If the patient said no, they would take the patient off, and if the patient said yes, they would start. Regardless of what the patient said afterwards, it didn’t matter, that operation would continue to happen.
"She really wanted to reach kids... and she thought electric shock was the answer."
It was purposefully held in a part of the hospital where the screams could not be heard. They would give the patient a little whiskey and maybe put a rag in the person's mouth, and they would go ahead and do what they had to do. It was barbaric, absolutely barbaric.
Bellevue had a lot [of amputations], as the city began to grow there [were] industrial accidents, people losing limbs, falling off, infections. This went on quite frequently at Bellevue, and without anesthesia, doctors, surgeons who were performing these operations would become nauseous themselves. Some of them would walk away from the operating room, sometimes they couldn't go through with it.
There's one part in my book where they take a limb off a young boy with his father holding him down, and at the end of the operation, the father [got sick]. On the other hand, according to the Bellevue doctors, the boy was just fine, his life had been saved.
But the extreme methods didn't end with amputations, right? Electroshock therapy was also used at Bellevue.
Oshinksy: What's most extraordinary about it, and not in a positive way, is that it was used on very young children at Bellevue; you know, it was used on 4-year-old kids at Bellevue.
The person who did it, Lauretta Bender, was a pioneer in autism, She was one of the very few early people studying autism who didn't believe it was caused by the coldness of the mother. She really wanted to reach kids who were not amenable to traditional therapy, and she thought electric shock was the answer.
It turns out it wasn't the answer, and it turns out that in retrospect it was an absolutely awful, awful idea. But at the time what she simply was trying to do was reach these children any way she could.
Bellevue has been known as a hospital that treats underserved groups. What do you think that means for the future of Bellevue and other public hospitals now that health care is so divisive in this country?
Oshinsky: It's a crapshoot, and the answer is that I don't know. There are fewer and fewer public hospitals. New York City once had 19; it's down under a dozen now. Public hospitals are in trouble, but public hospitals are the places that treat the undocumented, the uninsured, the homeless.
Bellevue especially, its emergency facilities, trauma facilities are so good that it will treat policemen who are shot, firemen who are overcome with smoke. Should the pope or the president get sick in New York City, Bellevue is the place where they would go in an emergency. In that sense, it's extraordinary.
"You come into the lobby for 15 minutes and you'll see what Bellevue means to New York City."
But many of our patients are emergency Medicaid patients or completely uninsured. And what the future holds for patients like them, particularly patients who are undocumented, because we don't ask, is a big issue. In the future, it will really be a big issue.
There are a number of ways to look at it. One is to look at the moral issue: Does everyone deserve health care? But if you are arguing about immigration, there are two sides to this issue, I fully understand it.
Basically, a lot of the people that Bellevue is treating, these are the people that make their sandwiches, these are the people that are washing your dishes. These are the people that are taking care of your kids, these are the people who are sneezing on the subway. So it sort of behooves us all to have good health care for everybody as a way of taking care of the larger community.
Do you think Bellevue will continue to retain its meaning to New York in the years ahead?
Oshinsky: I think Bellevue is so deeply embedded in the city's consciousness as we open the safety net that it will never go away. Bellevue will always be here, and we'll have doctors who believe in Bellevue's mission, and they will always be here. I don't think Bellevue has to worry.
Whether less-well-known public hospitals that don't function as well as Bellevue will die away is another story. I desperately hope not, but I can't answer that. People see Bellevue, there's something in our popular culture as New Yorkers that sees Bellevue as an absolutely essential place, and that I don't think is going away.
I have an office here, I see Bellevue every day. I see all kinds of different languages being spoken, and New York is the ultimate melting pot, and I'm proud to be a part of it. You come into the lobby for 15 minutes and you'll see what Bellevue means to New York City, and you'll see that it's a part of New York City.
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