Abstract
Pulitzer Prize winning historian David Oshinsky argues in his latest work that New York City’s oldest public hospital has long had a Janus-faced reputation. Bellevue is famous for producing countless medical achievements, as well as for never turning patients away. On the other hand, the hospital – in particular, its psychiatric unit – has always haunted the collective memory of New Yorkers as an American counterpart to London’s Bedlam. Oshinsky describes how Bellevue Hospital embodies ‘the better angels of medicine, despite its many warts’ (p. 322).
Chronologically and thematically divided into 20 chapters, Bellevue traces the history of New York City’s ‘most storied’ hospital, from its inception as an almshouse in 1736 to the recent ebola outbreak in 2014. Oshinsky focuses on narrating the story of Bellevue’s development over three centuries by relating episodes of remarkable doctors who worked at the hospital. While occasionally making comparisons with Sandra Opdycke’s No One Was Turned Away (1999), Oshinsky traces the chronology of Bellevue’s role in medical progress and the development of publicly funded healthcare in the USA, but equally exposes its ‘warts’, including devastating epidemics, its relation to Tammany Hall corruption, and some ‘questionable experiments’ done on its patients (p. 231).
Bellevue is sourced from personal papers, printed articles and oral interviews. The strength of the book lies in Oshinsky’s lively depictions of the doctors, with many daring tales of their Bellevue days. Oshinsky introduces us to Alexander Anderson, who treated eighteenth-century yellow fever patients with the ‘heroic’ approach, as well as to Dr Valentine Mott who operated in Bellevue’s nineteenth-century surgical theatre before the introduction of anaesthesia. A chapter about AIDS is brilliantly crafted, capturing the doctors’ ambivalent reactions towards their patients in the 1980s when the medical establishment still had little idea about the condition. Oshinsky reveals that some doctors feared that Bellevue, in addition to being regarded as a ‘snake pit’, would gain another layer of notoriety, potentially becoming known as ‘America’s AIDS hospital’ (p. 268). The author’s focus in this chapter – as it is in most chapters – is to spotlight Bellevue’s doctors, who were proud of the hospital’s reputation as a place where virtually no patients were turned away. Oshinsky gives an especially engaging depiction of Dr Linda Laubenstein, a physician who was also a polio survivor; he introduces her as a fierce advocate of those under her care who had no hesitation ‘terrorizing staffers she suspected of “short-changing” her patients’. A motorized scooter user, Laubenstein’s fury was remembered by one resident: ‘By the speed of the buzz, one could tell if Linda was on the warpath, and [we’d] duck into closets, or under desks or counters – anything to escape [her] wrath’ (p. 264).
Oshinsky’s narrative has a Rashomon-like quality as it contains a multiplicity of memories, exemplifying the varied nature of the Bellevue experience. A chapter about Bellevue’s psychiatric unit during the Great Depression discusses ‘one of the more questionable experiments in Bellevue’s history’: Dr Lauretta Bender’s electroconvulsive therapy (ECT) on children diagnosed with childhood schizophrenia (p. 231). Oshinsky introduces two sets of conflicting memories of Bender. One is of Bender as a brilliant, fearless professional and mother. One psychiatrist recalled how Bender frequently brought her own children to the unit, even though the institution was chaotic and the staff were often overwhelmed – demonstrating how motherhood did not have to hinder a female doctor’s career. A different recollection is that of attorney Ted Chabasinski, who was subjected to Bender’s experiments as a six-year-old in 1944. Chabasinski, more than 60 years after these experiences, which he described as frightening, remembered Bender as austere and cold: ‘Sometimes she would pass very close to me, looking at me but not acknowledging me, as if I didn’t exist.’ While Oshinsky describes Chabasinski’s experiences as ‘painful’, he also notes that Chabasinski may be using his memory as an instrument to ‘abolish what Chabasinski and his supporters see as the barbaric practice of electric shock’ (p. 235). Oshinsky leaves judgement open to readers, while tactfully complicating ethical discussions of particular psychiatric practices by bringing readers’ attention to the present: Bellevue resuming electric shock in 2015. The chapter ends with the words of a doctor working in Bellevue’s current electric shock programme who gives assurances that ECT is practised on a limited basis with extreme caution, only used as a ‘treatment of last resort’ (p. 237).
Bellevue was originally published through a non-academic press and is therefore readily accessible, both for clinicians and historians, as well as for general readers. For instance, Oshinsky includes brief explanations of medical terms that might be unfamiliar to non-clinicians. He weaves larger historical and social transformations into the narrative. For example, he explains how such events as the Civil War or the successive waves of immigrants settling in the city affected the medical practices of particular periods in the city’s history. However, from a historian’s standpoint, his citation style is somewhat unusual since he uses unnumbered endnotes referenced by page and extract. Nevertheless, the book is accurate and reliable.
Oshinsky’s tale of the hospital is largely told from the perspective of doctors. A historical work of Bellevue that details the perspectives of its patients would be an intriguing companion to this book. Nonetheless, Bellevue is approachable, brilliantly crafted, and invites every level of reader to join a discussion about the role of this public hospital in contributing to the social welfare of the most diverse city in the world. Thus, it should be noted that the scope of Bellevue goes beyond the history of medicine; it is also a unique social history of New York as viewed through the lens of the city’s oldest public hospital.