Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital by David Oshinsky (review)

Bellevue provides a lively account of the trials and tribulations of one of the United States' foremost public hospitals from its eighteenth-century origins to the present. Like many Americans of my generation, I became acquainted with Bellevue through the sitcom Barney Miller, in which the eponymous protagonist's world-weary refrain, "Send 'em to Bellevue," signaled the psychiatric ward's reputation as a chaotic dumping ground for the mentally ill. David Oshinsky's study, by contrast, delves beneath this popular image of disarray and near-breakdown in order to illuminate the complex workings of an essential provider of health care to all who enter its doors. Along the way, this biography of an institution tells the history of American medicine in microcosm, through Bellevue's organizational evolution, its importance to New York medicine, and its ever-shifting medical capacities in response to outbreaks of infectious disease, novel therapeutic practices, the ascendance of aspiring medical professionals, the rise of sanitary science and germ theory, the tumult of New York politics, and other developments in the overlapping spheres of medical and urban history.

First, the book investigates Bellevue's overall significance as "a vital safety net, a place of caring and a place of last resort" (p. 10). Already by 1800, the hospital's standing as "almshouse, pesthouse, death house" (p. 28) established the basic outlines of the narrative that continued to define the institution's notorious ill repute for the next two-plus centuries. As a repository of challenging cases, however, Bellevue, like other hospitals, attracted professionally ambitious physicians who wanted to make names for themselves. Hence many of New York City's leading physicians in the nineteenth and early twentieth centuries, including Valentine Mott Sr. and other founders of the College of Physicians and Surgeons, the Civil War surgeon general and post-bellum neurologist William A. Hammond, sanitarian Stephen Smith, pediatric specialists Job Lewis Smith and Abraham Jacobi, pathologist and bacteriologist William H. Welch, and bacteriological and public health trailblazers Hermann Biggs and William H. Park, all peopled Bellevue's corridors in various roles. Their work made the hospital a leading facility in the city, even as patient dumping by private hospitals, the ever-spiraling needs of the urban poor, and reports of abusive practices such as Nellie Bly's famous 1887 exposé of conditions at the lunatic asylum underscored an always-tenuous state of affairs.

Within this thematic of medical elites and the travails of a public hospital, Bellevue touches upon myriad other subjects of interest. With respect to the evolution of hospitals and medical education, Oshinsky highlights Bellevue's role as a teaching facility, Civil War training of nurses and nursing's professional origins, growing numbers of women and African Americans among the hospital's interns in the early twentieth century, and the workings of the infamous Jewish quota in medical school admissions. Innovations such as ambulance services established in 1869 that tied police stations and the hospital via telegraph, the growing sophistication of laboratory pathology and the professionalization of city coroners in the late 1890s, and psychiatric medicine at Bellevue in the middle decades of the twentieth century, which included the use of electroconvulsive therapy on children, all earn chapter-length accounts. Bellevue's history also reflected the threat of infectious disease to urban life, the sanitarian response of the 1860s, and the subsequent reception of germ theory. The book's final chapters mark the declining fiscal environment of recent decades, amid spiraling medical costs and urban crisis in the 1960s and 70s, the 1980s rise of the AIDS epidemic, and the overall stretching of public institutions to the breaking point, symbolized by Bellevue's shutdown after its backup electrical system failed during Hurricane Sandy in 2012.

Specialist readers will not be entirely satisfied with all aspects of Bellevue. Oshinsky's discussion of the novelty of pathology in the last third of the nineteenth century...