No One Was Turned Away: The Role of Public Hospitals in New York City since 1900 (review)

Sandra Opdycke. No One Was Turned Away: The Role of Public Hospitals in New York City since 1900. New York: Oxford University Press, 1999. x + 244 pp. $29.95.

During the 1980s a number of books detailed the history of the American hospital. Culminating in Charles Rosenberg's The Care of Strangers and Rosemary Stevens's In Sickness and In Wealth, these works fundamentally altered the way the hospital was understood as both a medical and a social institution. ¹ While all the books shared a social-historical perspective and generally addressed the history of the East Coast voluntary institutions, they differed substantially in their interpretation of the underlying forces that reshaped the hospital over the course of the twentieth century. ² Some emphasized the role of the economy, class divisions, demographic and social change; others emphasized the changing culture of medical and patient relationships, the hospital's internal culture, and the administrative reorganization of the agencies that paid for and supported hospital care.

Significantly, the enormous outpouring of scholarship on voluntary hospitals seemed to have petered out following the publication of Stevens's and Rosenberg's authoritative texts. With some notable exceptions, such as Susan Reverby's look at nursing both inside and outside the institution and Joel Howell's look at technology, ³ the debates over the nature of change in this central American institution appear to have hit a bit of a dead end. Historians have slowly moved away from the early emphasis on the history of the institution as a social enterprise that responded to broader currents in American life--such as immigration, urban development, class and gender relationships, and even capitalism. While in danger of overstating the case, I would suggest that the general trend of historians has been to move back into the institution, focusing on the culture of physicians and health professionals. We have retreated from the broad questions of political economy, race, class, and gender that were opened up in earlier works. In part, this may be due to the general exhaustion that overtook the field of social history in the 1980s. In part, it may be the general failure of medical historians to redefine the institution in ways that opened up questions. In part, medical history just moved in new directions.

Yet, despite the variety of books that appeared in the 1980s, and the variety of approaches that have been taken, the history of the hospital has hardly been mined and, in large measure, remains rich ground for historians interested in urban development, medical change, and public health policy. This book by Sandra Opdycke focuses on one of the arenas of research that has been left untouched: the development of the public hospital--specifically, Bellevue Hospital in New York City--and its place within the larger world of urban medicine and care. ⁴ In some important ways, Opdycke picks up where the social historians of the mid-1980s left off.

The book is both a history of the public, city-run hospital in the twentieth century, and a history of the concept of public care for the dependent as it has evolved in New York City. Using Bellevue Hospital as the prototype for the City-controlled public hospital system of New York, and New York Hospital as the template for voluntary hospitals, Opdycke reveals the growing gulf that separated their sense of social mission. The two institutions were organized at roughly the same moment in the eighteenth century. Both evolved into large, multidisciplinary institutions. Both served as teaching and training institutions for the major medical and professional schools in the city. Both focused on the urban poor as objects of care and charity. Yet, their missions slowly changed to the point of being profoundly different. Opdycke uses this comparison to evaluate the concept of "public...