PDF Summary:Bellevue, by David Oshinsky

Bellevue is a story about how a lone infirmary established in 1736 evolved into a world-renowned public hospital and hub for medical education and advancement. Author David Oshinsky chronicles the hospital's role in major disease outbreaks, public health crises, changing attitudes toward medical care, and groundbreaking contributions to fields like forensics, psychiatry, and surgery.

Through narrative accounts of staff like David Hosack, Stephen Smith, Edward Dalton, and Lewis A. Sayre, Oshinsky illustrates the defining moments that shaped Bellevue into a fixture of New York City—responding to epidemics, launching the first ambulance corps, incorporating photography into medical training, championing innovations like hand-washing and antiseptics, and transforming public health for underserved communities.

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Practical Tips

• Engage in informed discussions with your healthcare provider about the benefits and risks of procedures you're considering, using evidence-based research from reputable sources. This could involve preparing a list of questions and concerns based on current scientific literature to better understand how historical practices have evolved into modern medical recommendations.
• Implement a photo documentation strategy for skill development. If you're learning a new skill, like cooking or painting, regularly photograph your work to create a visual timeline of your improvement. This can be especially encouraging when you're feeling stuck, as it provides tangible evidence of how far you've come.
• Start a blog or social media campaign that features stories of individuals who defy conventional standards of beauty or propriety. Interview people from diverse backgrounds and share their experiences and perspectives on how they challenge societal expectations. This can help to normalize a broader spectrum of appearances and behaviors, fostering a more inclusive environment.
• Consider volunteering for medical studies that investigate the effects of physical treatments on neurological conditions. This could involve signing up for clinical trials or research programs that are looking for healthy volunteers to understand the broader implications of physical therapies on brain health.
• Share credible information with your social circle to foster informed discussions. If the topic comes up, you can provide insights based on the latest research you've read, without advocating for one side or the other. This helps create an environment where decisions are made based on knowledge rather than misconceptions.

The lasting influence of sterile methods in surgical procedures and their effective application.

In the year 1881, the incumbent President, James A. Garfield, was assassinated by an individual disgruntled over being denied a diplomatic post. Initially, it appeared that Garfield's condition was improving. His condition worsened quickly, and merely a few weeks later, he died, leaving the causes of his death a mystery. The comprehensive post-mortem analyses revealed numerous abscesses, suggesting the possibility of septicemia. Oshinsky describes the murder of Garfield as a critical juncture that spurred the evolution of medical practices in the United States, emphasizing the intense examination of the care he was given. Is it possible that the medical practitioners attending to Garfield worsened his state by overlooking the antiseptic methods advocated by Joseph Lister, which were gradually gaining acceptance among their peers? The consultants sought the expertise of Frank Hamilton, whose association with Bellevue ultimately diminished his professional reputation. Hamilton firmly believed in the curative power of fresh air and was convinced that handwashing or sterilizing surgical instruments was unnecessary, a viewpoint that became entrenched while he served as a surgeon with the Union Army, where such practices were often neglected. Facing skepticism, Hamilton affirmed his commitment to modern medical protocols when probed about the declining health of the President. The inadequacy of the guidelines left him utterly baffled, contributing to the premature demise of a president.

Practical Tips

• Create a personal policy for handling rejection that focuses on constructive responses. Whenever you face a denial or setback, refer to your policy for steps to take, such as seeking feedback, exploring alternative options, or taking time to reassess your goals. This proactive approach can help you channel disappointment into positive action and resilience.
• Educate yourself on the basics of first aid and common medical emergencies. Enroll in a local first aid course or use online resources to learn how to respond to health crises. This knowledge could be crucial in managing a situation effectively if your health or someone else's suddenly worsens.
• Create an emergency health information card to carry in your wallet, which includes your medical history, current medications, and any known allergies. In case of a health emergency, this card can provide first responders with critical information that could help them diagnose issues like septicemia more quickly.
• Volunteer at a local museum or historical society to help others understand the importance of learning from the past. By guiding tours or creating informational materials that highlight how pivotal events led to significant changes, you can foster a community-wide appreciation for historical lessons. This might include designing a pamphlet that draws parallels between past medical advancements and current public health initiatives.
• Engage with a local community health workshop as a participant to learn more about current antiseptic methods and public health guidelines. These workshops often provide hands-on training in proper hygiene and antiseptic techniques, allowing you to apply these practices more effectively at home and in public spaces.
• Volunteer to organize a cleanliness drive in your local community center. By coordinating with the center, you can set up a day where you and other volunteers clean and disinfect shared spaces. This activity not only helps maintain a clean environment but also raises awareness about the importance of cleanliness and sterilization in communal areas.
• Reflect on your own life experiences and write down how they have shaped your beliefs. Just like a surgeon's experiences might influence their perspective, your own life events have likely played a role in forming your worldview. Take some time to journal about significant events in your life and analyze how they have impacted your beliefs and actions. This can help you understand yourself better and may even lead to a shift in perspective.
• Create a personal health journal to track symptoms, treatments, and medical advice. Whenever you receive medical care, note down the guidelines or treatments suggested and any outcomes or side effects you experience. This record can be valuable for future medical consultations and for spotting patterns that may warrant a second opinion.

Bellevue played a pivotal role in developing an innovative vaccine amid the influenza pandemic of 1918.

The influenza pandemic of 1918 stood out as a particularly severe crisis, distinguishing it from previous outbreaks of measles, typhus, or cholera that had significantly impacted New York City. Nobody knew how to contain its spread or to alleviate the deadly lung infections that followed the initial bout of fever, chills, and sore throats. As fall set in, the urban environment grew more fraught with the appearance of new cases. As a measure to tackle the public health crisis, officials ordered the closure of schools and factories. Public transportation was cut back, theaters and sporting events were banned, and saloons across the city shut down, ending the “nightclub mayor” era of Jimmy Walker. During the 1918 influenza epidemic, Bellevue was inundated, treating over four thousand patients in just a few weeks, and fatalities reached into the hundreds daily. Oshinsky narrates how, in the midst of chaos, Bellevue adopted various strategies, including initiating blood transfusions obtained from a church in close proximity, though these efforts appeared to have limited success. The city, after many years, was considering the suspension of new patient admissions at the hospital because of the overwhelming strain the disease was placing on Bellevue. A strategy was essential to manage the excess patient volume. A strategy was needed that did not include laying out those who had fallen ill with the flu, and in some cases had died, on the hospital's lawn. Bacteriologist Hermann Biggs led the charge in developing an effective influenza vaccine, a critical endeavor that he pursued within the confines of Bellevue Hospital. Biggs's team, persuaded that inflammation of the lungs caused by a microbial invasion, rather than the initial virus, was the main contributor to fatalities, created an influenza serum that ultimately proved ineffective—an endeavor that, as Oshinsky observes, served to temper the growing hubris within the medical profession.

Context

• The 1918 influenza pandemic, also known as the Spanish flu, was one of the deadliest pandemics in history, infecting about one-third of the world's population and causing an estimated 50 million deaths globally.
• The pandemic occurred in three waves, with the second wave in the fall of 1918 being the most lethal, characterized by a high mortality rate among young, healthy adults, which was unusual compared to typical influenza outbreaks.
• At the time, medical science was not advanced enough to effectively treat viral infections, and antibiotics to treat secondary bacterial infections were not yet available, as penicillin was discovered in 1928.
• Suspending admissions would have had significant implications for the community, as Bellevue served a large and diverse population, including many who could not afford private healthcare. This decision would have forced many to seek alternative care or go without treatment.
• At the time, the understanding of viruses was limited, as viruses were not yet visible under microscopes. This made developing an effective vaccine particularly challenging, as scientists were unsure of the exact cause of the influenza virus.
• Hermann Biggs was a prominent public health official known for his work in bacteriology. His focus on bacterial causes was consistent with the prevailing medical theories of the time, which often emphasized bacterial pathogens over viruses.
• The urgency and scale of the pandemic pushed researchers to experiment rapidly, often without the rigorous testing that is standard today. This led to many trial-and-error approaches.
• The experience at Bellevue likely influenced future medical research by emphasizing the importance of humility and caution in scientific claims. It highlighted the necessity for rigorous testing and validation of medical interventions before widespread implementation.

At the dawn of the 20th century, Bellevue transformed into a complex urban medical center.

This segment of the story chronicles the considerable expansion and progress of the infrastructure at Bellevue Hospital. Oshinsky highlights the advancements in building design made by firms like McKim, Mead & White, and he scrutinizes the growing demand for space and amenities that would represent the core of healthcare in New York City.

The expansion and modernization of Bellevue were significantly advanced by the efforts of the architectural firm McKim, Mead & White.

As the 20th century began, Bellevue had established itself as a premier educational hospital in the nation, featuring 1,200 beds spread across more than 30 wards housed in fifteen aging structures that spanned four city blocks. Though its laboratories were considered among world's finest, the hospital's physical appearance recalled the 1840s, when reformers had called for it to be torn down. In 1902, the city commissioned the distinguished firm McKim, Mead & White, celebrated for designing prominent landmarks, to fulfill Bellevue's architectural needs; their portfolio includes the initial design of Madison Square Garden, the layout of Columbia University, and Pennsylvania Station. The endeavor was set to be opulent and provoke debate. The original design included a collection of sophisticated brick and stone structures, with a central Administration Building intended to be topped by an elegant glass cupola. The strategy included a fitness center, along with other recreational amenities like a pool and tennis courts, all designed to enhance the fitness and health of the medical staff working at the hospital. The architectural layout featured elegantly designed staircases that spiraled gracefully, floors adorned with marble, and columns that drew inspiration from Corinthian motifs. Each patient ward was designed with an uninterrupted balcony that capitalized on the invigorating river breezes. Criticism was relentless. Why allocate substantial resources to improve facilities dedicated to assisting those with limited economic means? Should a hospital dedicated to serving the impoverished present itself with the grandeur of a stately home? What challenge did Bellevue, which attracted the foremost medical professionals in the city, such as distinguished doctors, nurses, technical specialists, and research scientists, encounter? The initial alteration to the architectural design by McKim, Mead & White involved the elimination of the building's distinctive glass dome. The amenities, including the tennis courts, swimming pool, and gymnasium, were no longer available. The approach was so vital that deviating from it was never considered a possibility. Bellevue was universally acknowledged as requiring enlargement, updates, and enhancements to keep pace with the progress characteristic of the twentieth century.

Context

• At the time, New York City was undergoing significant urban development, with many public buildings being redesigned or newly constructed to reflect the city’s status as a growing metropolis.
• As a teaching hospital, Bellevue has been affiliated with New York University School of Medicine, providing training and education to medical students, residents, and fellows.
• The architectural firm McKim, Mead & White was one of the most influential American architecture firms of the late 19th and early 20th centuries, known for their role in shaping the Beaux-Arts architectural style in the United States.
• During the early 1900s, there was a trend towards incorporating classical architectural elements, such as domes and columns, into modern buildings. This was part of the Beaux-Arts movement, which emphasized grandeur and symmetry.
• Providing such amenities was believed to boost morale and efficiency among medical staff. The idea was that healthier, happier staff would be more effective in their demanding roles, ultimately benefiting patient care.
• The use of luxurious materials and classical design elements in a hospital setting might have been intended to symbolize the importance and dignity of medical care, elevating the status of the institution.
• During this period, there was a strong belief in miasma theory, which suggested that diseases were spread through "bad air." Designing hospitals with features that allowed for better air circulation was seen as a way to combat this.
• Wealthy philanthropists often funded public projects, and their preferences could influence design choices. The criticism might reflect a tension between philanthropic intentions and public expectations for practical spending.
• The hospital's extensive facilities and resources provided ample opportunities for clinical research, appealing to scientists and specialists interested in advancing medical knowledge.
• The early 1900s was a period of economic change, with increasing attention to how public funds were spent. The decision to eliminate costly features may have been influenced by public scrutiny and the need to justify expenditures on facilities serving the economically disadvantaged.
• Public projects often faced scrutiny regarding their cost and purpose. Sticking to the original design might have been a strategic decision to avoid further criticism and demonstrate a commitment to the hospital's mission and future.
• New regulations and standards for healthcare facilities emerged, necessitating updates to ensure compliance and improve patient safety and care quality.

Charles Norris was instrumental in the progression and enhancement of forensic science.

In 1918, New York City reformed its notoriously inadequate death investigation system by creating a new organization headed by a specialist in the study of disease. The position was created following disputes, as Oshinsky details, due to the apparent incompetence of appointed officials chosen for their political connections instead of their knowledge in healthcare. Charles Norris, the pathologist at Bellevue, effortlessly transitioned into his role and used his esteemed reputation to enhance the standing of the institution's morgue, making it renowned worldwide. Norris focused on the progression of medical science related to legal investigations by developing new techniques that not only determined the cause of death but also shed light on events leading up to it, thereby helping to differentiate between murders and suicides. He made a pivotal decision to recruit Alexander Gettler as a chemist for the scientific research facility at Bellevue. Gettler conducted a significant amount of his experimental research using animals. Oshinsky provides details on the methods Norris and Gettler used to determine if a body recovered from the river died by accident or was murdered, which involved assessing the differences in salt concentrations in different parts of the heart; they also assessed alcohol tolerance by habituating some dogs to whiskey and withholding water from others, noting the changes in behavior before putting them to death.

Practical Tips

• Improve your decision-making by consulting with subject matter experts before making significant life choices. For instance, if you're considering a career change, seek out a career counselor or someone established in the field you're interested in. Their specialized knowledge can help you make informed decisions, much like a disease specialist would provide insights into health-related matters.
• Start a community discussion group focused on local governance and accountability. Use social media or community bulletin boards to invite residents to participate in regular meetings where you can collectively analyze the performance of local officials. This group could serve as a platform to share findings, develop community-driven assessments of officials' competencies, and prepare collective actions or recommendations for improvement.
• Enhance your professional reputation by identifying and filling gaps in your workplace. Just as a pathologist might improve a morgue's standing, look for areas in your job where you can make a significant impact. For example, if you notice that your company's reports are often disorganized, take the initiative to create a new template or system for compiling information that everyone can use.
• Volunteer to assist with research at a nearby laboratory or research facility to gain practical experience and contribute to scientific advancements. This approach allows you to be involved in scientific discovery without having to be a professional scientist. You might, for instance, help with data collection for a study on local wildlife populations or assist in testing water quality in community rivers.
• Create a citizen science project to track local wildlife health. Use a smartphone app to document sightings of wildlife in your area, noting the condition of the animals and any unusual behavior. Share this data with local conservation groups or online citizen science platforms to contribute to broader research efforts on animal health and ecosystems.
• Enhance your critical thinking skills by creating a mock investigation game with friends or family. Use a fictional scenario where you have to determine the cause of an 'accident' using clues that involve the presence of different substances. This will help you practice deductive reasoning and understand the importance of chemical analysis in solving mysteries.
• You can increase your understanding of tolerance by tracking your own responses to substances like caffeine. Start by noting how much coffee you drink each day and any changes in how it affects you over time, such as needing more to feel awake or experiencing fewer jitters. This self-observation can give you insight into how tolerance develops in a non-harmful context.

During the Prohibition era, concerns escalated regarding the impact of alcohol poisoning on the well-being of the Bellevue community.

Oshinsky highlights the contradictory nature of Bellevue's past, where the institution often acquired expertise and resources precisely because of the events that caused its patients to experience hardship, adversity, and death. The catastrophic flu pandemic that occurred between 1918 and 1919 accelerated the evolution of microbiology into a distinct field of medicine, spurred by the increased need for a dedicated public health entity in the wake of the epidemic that occurred from 1847 to 1848. National Prohibition, which commenced in 1919, exerted a significant influence as well. The enforcement of prohibition, although frequently ignored by numerous drinking establishments in New York City, resulted in a marked increase in the volume of patients requiring immediate attention at Bellevue Hospital and also amplified the prominence of the work conducted by the medical examiner's laboratory.

The fundamental problem with Prohibition was that, even though legal alcohol sales were halted, it did not stop people from drinking. The prohibition resulted in an underground market for illicit alcohol, whose quality was dubious and strength inconsistent. Various mixtures were formulated with industrial alcohol, which was commonly modified to discourage its consumption. As Prohibition began in 1920, the trade of commercial alcohol quickly became dominated by illegal liquor suppliers, dealing in mixtures that were unsafe to ingest. The federal government took measures to curb consumption by enhancing the poisonous properties of denatured alcohol. The outcomes were both foreseeable and horrifying. The emergency unit at Bellevue often dealt with a wide array of health issues that plagued numerous working-class New Yorkers who, in the absence of other options, turned to bootleg liquor, leading to various medical problems from stomach issues and eyesight problems to critical illnesses and deaths.

The situation intensified and took on a political dimension as Charles Norris stepped into a position of leadership. Alexander Gettler, widely acknowledged for his expertise in determining the causes, timing, and conditions of death, made the Bellevue laboratory his primary tool. They meticulously recorded the lineage and birthplaces of the deceased, observing a demographic transition from a majority of Irish heritage to individuals with Italian and Jewish backgrounds. During this era, significant advancements were made in the domain of forensic pathology. Once seen as a perk for those lacking expertise but with influential connections, the field has evolved into one driven by rigorous and systematic scientific investigation.

Context

• Bellevue Hospital, located in New York City, was one of the oldest public hospitals in the United States. During Prohibition, it became a critical center for treating alcohol-related illnesses and poisonings, highlighting the public health crisis caused by the era's policies.
• The scale of the pandemic prompted governments and health organizations to invest in public health infrastructure and research, laying the groundwork for modern epidemiology and the establishment of institutions like the World Health Organization.
• The National Prohibition, enacted through the 18th Amendment and the Volstead Act, aimed to eliminate the consumption of alcohol in the United States by banning its production, distribution, and sale. This period lasted from 1920 to 1933.
• Despite the ban, illegal bars known as speakeasies flourished, and bootlegging became a lucrative business. Organized crime syndicates often controlled these operations, leading to increased criminal activity.
• Consuming denatured alcohol can lead to severe health issues, including blindness, organ failure, and death. Methanol, a common denaturant, is particularly dangerous as it metabolizes into formaldehyde and formic acid in the body.
• This strategy backfired, as people continued to consume these toxic mixtures, leading to widespread health issues and fatalities. It highlighted the unintended consequences of Prohibition policies.
• To prevent industrial alcohol from being consumed, the government required it to be denatured, meaning it was mixed with chemicals to make it undrinkable. However, bootleggers would attempt to remove these chemicals, often unsuccessfully, resulting in toxic beverages.
• Charles Norris was the first appointed Chief Medical Examiner of New York City, a position he took in 1918. His leadership was pivotal in transforming the medical examiner's office into a scientifically rigorous institution.
• During Prohibition, the need for forensic toxicology grew due to the widespread consumption of adulterated alcohol. Gettler's work was essential in identifying toxic substances in bootleg liquor, which often contained dangerous chemicals.
• During the late 19th and early 20th centuries, the United States experienced significant waves of immigration, particularly from Europe. Many Irish immigrants arrived during the mid-1800s, followed by large numbers of Italians and Eastern European Jews in the early 20th century. This shift in immigration patterns influenced the demographic makeup of urban areas like New York City.
• Forensic pathology, the study of determining causes of death by examining a corpse, was in its infancy in the early 20th century. The field was not as scientifically rigorous as it is today, often relying on less systematic methods.

During periods of financial hardship, Bellevue stood as a stronghold.

Bellevue has consistently maintained its dual function as a pioneer in medical advancements and scientific inquiry while ensuring essential support is accessible to communities in New York facing economic and social challenges. In the 1930s, as the economy faltered, Bellevue had to face tough choices, partly because of the unexpected consequences that came with the broadening of health insurance in the 1960s. As Oshinsky demonstrates, Bellevue repeatedly adapted its methods to achieve these dual goals.

In the midst of the Great Depression's harsh economic slump, Bellevue stood as a crucial support for the livelihood of both working-class and middle-class individuals.

During the 1920s, New York's significant economic prosperity stemmed partially from the city's relaxed approach to enforcing the ban on alcohol sales. Oshinsky observes that although restaurants prominently showcased their wine selections, the numerous unlicensed taverns, which were sometimes located just a short distance from the municipal headquarters, frequently escaped the attention of law enforcement. The metropolis, notwithstanding the mayor's preference for nocturnal events, continued its commitment by allocating funds to create a state-of-the-art psychiatric institution within the Bellevue complex, aimed at delivering top-tier treatment to individuals battling mental health conditions. The 1920s ended in turmoil, with the disastrous crash of the stock market plunging the nation into an economic crisis like no other. The once lively and frequently referred to as the Roaring Twenties period had come to an end. The Great Depression set off an unmatched wave of financial instability across New York. The swift increase in joblessness impacted more than a third of those participating in the workforce. The financial crisis that engulfed Wall Street's speculative bubble also led to the shutdown of numerous factories, stores, and dining establishments, previously supported by the spending of consumers who had since become impoverished. The city's private hospitals faced severe financial challenges that nearly led to their collapse, but Bellevue, a publicly funded hospital, demonstrated the most profound effects of the Depression by steadfastly providing care to patients irrespective of their ability to pay, as seen in its packed wards and corridors. The facility, previously avoided, began to experience a surge in visitors from different social and economic strata in New York, due to the growing link between poverty and illness.

Context

• Over the years, Bellevue had built a reputation for reliability and trust within the community, encouraging people from various backgrounds to seek its services during the Depression.
• The political leadership in New York City during the 1920s, including figures like Mayor Jimmy Walker, often turned a blind eye to Prohibition violations, reflecting a broader public sentiment against the ban.
• Unlicensed taverns often served as important social hubs, providing a space for community gathering and entertainment during a time when legal venues were limited. This social role sometimes afforded them a degree of protection from law enforcement actions.
• The 1920s, marked by Prohibition, saw an increase in mental health issues related to alcohol use, such as withdrawal and related disorders. Establishing a psychiatric facility could have been partly in response to these emerging public health challenges.
• The economic collapse led to widespread poverty, homelessness, and a significant shift in the social fabric, with many families losing their homes and livelihoods.
• Unemployment rates soared to about 25% nationwide, with even higher rates in industrial cities like New York, leading to widespread poverty and hardship.
• In response to the crisis, the federal government, under President Franklin D. Roosevelt, implemented the New Deal, a series of programs and reforms designed to provide relief, recovery, and reform to the economy.
• With reduced incomes, consumers prioritized essential goods over luxury items, leading to a decline in industries that produced non-essential goods and services.
• Private hospitals had to maintain their facilities and pay staff, but with reduced income, they struggled to cover these operational costs, leading to potential closures or reductions in services.
• The economic policies of the 1920s, including those that led to the stock market crash, had long-term effects on public health. The lack of regulation and the subsequent economic collapse highlighted the need for robust public health systems.

The influence of Medicare and Medicaid on Bellevue and similar public institutions.

President Lyndon Johnson's administration launched programs to direct federal support towards meeting the health care needs of the poor and elderly, providing a strategy to cope with the rising costs of medical care. The creation of Medicaid and Medicare served as a foundation for offering healthcare services to the impoverished and the elderly. Both initiatives, established in 1965, aimed to ensure that no American would be barred from healthcare due to financial limitations. Each state individually would determine the specifics. Upon initial observation, it seemed that New York's Medicaid initiatives were offering substantial assistance to medical facilities striving to cater to the needs of the disadvantaged. To make its poor and working class residents eligible for federal and state funding, the legislature set a family income cap at $6,000—a sum actually exceeding the national median. In a brief span of time, the initiative had garnered the participation of nearly 25% of the city's inhabitants, originally designed to provide medical assistance to welfare recipients. The outcome was as expected. Bellevue experienced a substantial decrease in patient numbers as people from the working and middle-income groups started choosing healthcare centers that would take their public health insurance plans. Public hospitals across the country experienced a similar decline, threatening their ability to keep operating.

Practical Tips

• Create a simple guide that explains the basics of Medicare and Medicaid in plain language and share it on social media or local community boards. This can help spread awareness and understanding among those who might be eligible for these programs but are unsure of how to take advantage of them.
• Develop a habit of reviewing and adjusting your household budget to align with changes in social program policies. If income caps for programs like Medicaid change, you may need to reassess your spending and saving strategies to ensure you remain eligible or to compensate for the loss of benefits.
• Create a personal checklist of essential health and welfare services in your area. Research local clinics, community centers, and social services, then compile a list with contact information and services offered. This proactive approach ensures you have a resource to turn to in times of need.
• Consider volunteering at a local healthcare facility to gain firsthand experience of their service quality. By spending time in the environment, you can observe the patient flow, staff interactions, and overall atmosphere, which can inform your future healthcare decisions.
• Encourage your workplace to adopt a public hospital support program as part of its corporate social responsibility initiatives. This could involve organizing fundraisers, matching employee donations, or sponsoring hospital events. By getting businesses involved, you can help create a new stream of financial support for public hospitals, which can aid in their sustainability and ability to serve the community.

Bellevue's shutdown during Superstorm Sandy and its pivotal function in caring for victims and emergency personnel.

In the wake of Hurricane Katrina's devastation in the summer of 2005, hospitals overcrowded and bereft of electrical power, with backup systems failing, were the scenes of numerous deaths, prompting the start of nationwide efforts to improve hospital preparedness for future emergencies. The hospital, perched on a landfill in Manhattan near a river subject to tidal fluctuations, was situated near a major power source notorious for its unreliability. In 2011, Hurricane Irene swept past New York, causing little damage to the city itself but serving as the first major test of the new evacuation guidelines. Medical facilities located in proximity to the East River, identified as a high-risk zone for flooding, were directed to relocate their patients to safer areas. The medical institution that includes Tisch Hospital, part of NYU's Langone Medical Center, complied with the order somewhat reluctantly, while Bellevue, nestled between Tisch and the VA Hospital and renowned for its dedication to staying open in emergencies, continued its services.

At the end of October 2012, the formidable Superstorm Sandy made landfall on New Jersey's coastline. The extensive and unforeseen repercussions of Hurricane Sandy caught New Yorkers off guard. Manhattan was hit by a remarkable storm that coincided with a high tide, resulting in a surge that astonishingly crested at a height of fourteen feet. Tisch left that night, and although the precise reasons are unclear, Bellevue's decision to stay put resulted in disastrous consequences. Oshinsky narrates how the nearby river's rising waters compromised the hospital's barriers, resulting in the flooding of Bellevue's subterranean sections and putting its backup power supplies at risk. The generators, which were installed above the anticipated flood levels, relied on electric fuel pumps located in the basement that were vulnerable to the imminent floodwaters.

During the blackout, the medical team had to quickly assess the most severely sick individuals to decide which patients would be prioritized for life-sustaining equipment in the event of a total power outage; the team responsible for patient care transitioned from using electronic IV pumps to manually delivering injections subcutaneously; medications were distributed in the low visibility provided by flashlights; meals relied on external catering services; and a varied assembly of healthcare workers, administrative staff, and military members worked together to guarantee that the generators, situated on the hospital's thirteenth level, received an uninterrupted supply of fuel. Bellevue sustained its activities continuously for three days. The staff's courageous efforts prevented a catastrophe on the scale of Katrina, despite it being a close call. In a move without precedent, the respected institution halted its functions when the final patients had been transferred to various other healthcare facilities.

Context

• The federal government increased funding for hospital preparedness through initiatives like the Hospital Preparedness Program (HPP), which provided resources to improve infrastructure and emergency response capabilities.
• Being in a high-risk flood zone means that Bellevue must contend with infrastructure challenges, such as ensuring that critical systems like power and water are protected from floodwaters. This often involves complex engineering solutions and contingency planning.
• Hurricane Irene was a large and destructive tropical cyclone that affected much of the Caribbean and the East Coast of the United States in late August 2011. It was the first hurricane to make landfall in the continental U.S. since Hurricane Ike in 2008.
• The hospital's choice to remain open during Hurricane Irene likely involved implementing rigorous emergency protocols to ensure patient and staff safety, showcasing its capability to handle crises.
• In response to the disaster, federal, state, and local governments coordinated relief efforts, including deploying the National Guard, setting up emergency shelters, and providing financial assistance for rebuilding.
• The flooding of the hospital's lower levels disrupted critical operations, including power supply systems, which are essential for maintaining life-supporting medical equipment.
• While the generators themselves were placed above anticipated flood levels, the electric fuel pumps required to supply them with fuel were located in the basement. This design flaw meant that rising floodwaters could incapacitate the pumps, cutting off the fuel supply and rendering the generators useless.
• In emergency situations like blackouts, hospitals often implement a triage system to prioritize patients based on the severity of their conditions and the likelihood of benefiting from immediate medical intervention. This process ensures that limited resources, such as life-sustaining equipment, are allocated to those in critical need.
• The shift to manual delivery can slow down the process of patient care, as each injection or medication distribution takes more time and effort, potentially affecting the hospital's ability to treat a large number of patients efficiently.
• Bellevue's efforts during the blackout reflect its critical role in the New York City healthcare system, providing essential services to a diverse and often underserved population.
• Unlike Katrina, which primarily affected the Gulf Coast, Superstorm Sandy impacted the densely populated urban environment of New York City, presenting unique logistical challenges for emergency response and hospital operations.
• The evacuation and transfer of patients required coordination among multiple agencies, including city and state health departments, emergency services, and other hospitals.

Bellevue has been instrumental in the proliferation and enhancement of medical knowledge.

This part of the text describes how Bellevue evolved to become a crucial hub for the advancement and instruction of medical professionals. Oshinsky highlights the significant impact that the changing composition of New York City's medical professionals has had on the historical development of Bellevue, noting the vital contribution of immigrant arrivals to the hospital's expansion and persistence.

Bellevue transformed from an isolated institution for health care into a globally recognized hub for medical education.

Oshinsky documents the evolution of Bellevue's programs designed to educate healthcare professionals, starting from their humble beginnings, evolving through various clinical methodologies, and culminating in a lasting affiliation with NYU as a standalone entity.

Bellevue Hospital Medical College was founded in the year 1861.

The Medical College commenced its operations in the year 1861 and received considerable acclaim. Its chief organizers were Lewis A. Sayre, Frank Hamilton, and the distinguished Valentine Mott, the nation's preeminent surgeon, who, at seventy-six and fresh from a worldwide tour that involved excising a tumor from the skull of the Ottoman Empire's Sultan, took on a role akin to a senior diplomatic advisor within Bellevue's surgical department. The institution's goals were explicit: it aimed to enrich the medical training of its students by introducing them to a wider range of healthcare scenarios, a move that underscored the shortcomings of the antiquated apprenticeship system during the Civil War era; it sought to champion cutting-edge medical innovations while distancing itself from figures like those who advocated for botanical remedies and a gentler medical practice in contrast to the more assertive methods of conventional medicine; and it aspired to provide students with an immersive, modern setting replete with the latest resources for exploring diseases and human anatomy, as well as ensuring a continuous influx of patients from philanthropic sources for comprehensive examination and care. Rapidly ascending to a position of eminence, Bellevue Medical College became the foremost teaching hospital nationwide.

Context

• The college was at the forefront of adopting new medical technologies and practices, reflecting a period of rapid advancement in medical science during the 19th century.

Other Perspectives

• The description of Mott's role might overshadow the contributions of other key figures at Bellevue who also played significant roles in the development and success of the surgical department.
• Exposure to a broad array of healthcare situations could inadvertently prioritize quantity of experience over quality of education and patient care.
• The pursuit of medical innovations often requires significant financial investment, and Bellevue may have faced challenges in securing the necessary funding to truly lead in this area, especially during periods of economic difficulty.
• Gentler medical practices can be beneficial for patient-centered care, emphasizing the importance of the patient's comfort and psychological well-being.
• The reliance on the latest resources might have also meant that the curriculum could become quickly outdated, requiring constant updates and potentially causing gaps in the consistency of the education provided.
• This model could have created a dynamic where patients from philanthropic sources were seen primarily as educational tools rather than individuals with their own healthcare needs and rights.
• The claim of becoming the foremost teaching hospital nationwide might not take into account regional differences and the impact of local teaching hospitals that were highly influential in their own areas.

Distinguished experts in the practice of medicine and surgery

Bellevue Medical College was founded at a time when healthcare was undergoing significant changes, with the introduction of anesthetics, the discovery of pathogens, and the initial reluctance of physicians to adopt new methods of preventing infection, as they were firmly entrenched in traditional practices. The staff members of Bellevue also adhered to this customary practice. David Oshinsky chronicles the career of Valentine Mott, which began in an era before the use of anesthesia. Mott received acclaim for his swift and resolute approach to surgery, as characterized by one of his supporters. He gained a reputation for his expertise in conducting lithotomies, which involve extracting stones from the bladder or bile duct, and he prided himself on finishing these intricate three-hour surgeries in less than two minutes, a feat during which he once secured an "aneurism of the subclavian artery" in such close proximity to the heart that his finger turned blue due to restricted blood flow. At seventy-five years old, Mott remained a prominent proponent for employing anesthetics and openly denounced homeopathy practitioners for relying on weak herbal concoctions for patient treatment. Sayre, on the other hand, favored a more conventional approach as opposed to Hamilton's methods. Sayre, an advocate for nutritional remedies, firmly believed in the restorative power of a diet rich in milk, eggs, butter, oysters, and sherry to enhance an individual's health. Hamilton was of the belief that surgical wounds would recover more effectively if left uncovered, considering the use of antiseptics or the application of bandages to be superfluous. The reputation of a professor at Bellevue was significantly influenced by their surgical achievements.

Practical Tips

• Start a book club focused on healthcare innovation to discuss and analyze how historical changes have shaped modern practices. This will encourage a deeper understanding of the healthcare field's evolution and foster a community interested in the subject.
• Encourage experimentation with small changes in your daily routine to build adaptability. Choose one aspect of your life, like your morning routine, and introduce a small change every week. Track how these changes affect your mood, productivity, or health. For instance, if you usually have coffee first thing in the morning, try switching to green tea for a week and note any differences. This personal experiment can help you become more comfortable with change and less resistant to larger shifts in the future.
• Develop a mentorship mindset by sharing knowledge with others in your community. Mott's career was marked by teaching and mentorship. You can apply this by volunteering to tutor students in subjects you're proficient in or by offering to help colleagues understand complex tasks at work, thereby honing your own understanding and communication skills.
• Improve your problem-solving speed by engaging in timed puzzles and games. Allocate specific time slots during the week to work on crossword puzzles, Sudoku, or brain-teaser apps with the goal of completing them as quickly as possible. This not only sharpens your mind but also conditions you to act with more urgency and precision.
• Explore virtual simulations to understand complex medical procedures like lithotomies. Many medical institutions and companies offer online platforms where you can watch or interact with 3D simulations of surgeries. This can give you a deeper appreciation for the skill and precision required in such procedures without needing a medical background.
• Create a step-by-step checklist for complex tasks you perform regularly. For example, if you're assembling a piece of furniture, cooking a new recipe, or setting up a new electronic device, break down the process into detailed steps. Use this checklist to ensure you don't miss any parts and to streamline your process over time. As you become more familiar with the task, you'll find ways to complete it more quickly without compromising on quality.
• Create a monthly discussion group with friends or family to talk about health topics, including vascular health, without turning it into a medical lecture. Use this as an opportunity to share personal experiences, concerns, and lifestyle tips that contribute to maintaining a healthy vascular system. This could involve discussing exercise routines, dietary habits, or even stress management techniques that support overall cardiovascular health.
• You can evaluate the credibility of medical information by cross-referencing claims with evidence-based research databases. When you come across a medical claim, whether it's about anesthetics or homeopathic remedies, take the time to look it up in databases such as PubMed or the Cochrane Library. These platforms compile peer-reviewed studies and clinical trial results, allowing you to compare the claim with scientific evidence and make informed decisions about your health.
• Create a comparison chart of conventional versus alternative remedies for minor health concerns. For example, if you have a sore throat, you might compare the relief you get from a doctor-recommended lozenge with that from a home remedy like honey and lemon. Document the time it takes for each method to provide relief, the duration of effectiveness, and overall satisfaction with the treatment. This hands-on approach allows you to personally assess the practicality of conventional medicine in everyday situations.
• Experiment with 'theme days' focused on particular food groups that are known for their restorative properties. For instance, have a "Green Leafy Vegetable Day" where you creatively incorporate spinach, kale, and other greens into all your meals. Observe how your body and mind feel on these days compared to your regular diet.
• Engage in a conversation with healthcare professionals about wound care during routine check-ups. Without challenging their expertise, express curiosity about the healing process of uncovered versus covered wounds and gather their perspectives. This can provide you with a broader understanding of current medical opinions and practices regarding wound care.
• Start a blog or a vlog where you regularly post content related to your field of interest or expertise. Consistently sharing your insights, experiences, and the lessons you've learned can attract an audience and establish your authority on the subject. If you enjoy cooking, for example, you could create a blog where you share unique recipes and cooking techniques, gradually building a reputation as a culinary expert.

The dismissal of Samuel Hahnemann's homeopathic methods sparked considerable controversy.

In the latter half of the 1840s, the practice of homeopathy, with its roots in Germany, saw a significant rise in acceptance among New Yorkers, especially among those who objected to the harsh traditional medical treatments such as bloodletting and the administration of substances that induce vomiting. Samuel Hahnemann was the proponent of the concept that a substance causing specific symptoms in a healthy person could, in a twist of logic, alleviate the same symptoms in someone suffering from them, based on the principle of 'like cures like.' Hahnemann bolstered his case by claiming that these treatments yielded the best results when given in minuscule amounts, similar to diluting a powerful elixir with a vast expanse of liquid. In 1857, Hahnemann's growing legion of supporters sued Bellevue Hospital demanding that its wards for general and acute care be split equally between "homoeopaths" and "allopaths," with a team of distinguished homeopathic physicians in attendance. The hospital's investigative committee ultimately dismissed the approaches of Hahnemann, equating them to the outdated notion that a king's touch could cure scrofula—a type of tuberculosis that affects the lymph nodes and has been recognized for many years. Yet homeopathy survived. Several teachers associated with Bellevue's medical schools were proponents of a conventional approach to treating illness, which involved the use of quinine, opium, and alcohol, and they dismissed homeopathy as devoid of any logical foundation.

Context

• Despite criticism, homeopathy has persisted and remains popular in various parts of the world, often integrated into complementary and alternative medicine practices. Its survival is partly due to patient satisfaction and anecdotal evidence of efficacy.
• During the 19th century, traditional medical practices often included harsh treatments like bloodletting and purging, which were based on the ancient theory of balancing bodily humors. These methods were increasingly questioned as medical science began to evolve.
• Hahnemann's ideas were part of a broader movement during the 19th century that sought gentler and more holistic approaches to medicine, appealing to those disillusioned with the aggressive treatments of the era.
• The process involves serial dilution, often to the point where no molecules of the original substance remain. This is done through a method called "succussion," which involves shaking the solution vigorously.
• Although the lawsuit did not succeed in changing Bellevue's practices, it underscored the persistent demand for alternative medical approaches and foreshadowed ongoing debates about medical pluralism.
• The practice was most prevalent in England and France from the Middle Ages until the 18th century. It was a ceremonial event, often involving a religious service, and was believed to demonstrate the king's divine favor and legitimacy.
• Quinine was used to treat malaria, opium for pain relief, and alcohol as a sedative or antiseptic. These substances were part of the conventional medical arsenal and were considered effective based on the scientific understanding of the time.

The collaborative relationship that blossomed between Bellevue and the NYU Medical School was significantly influenced by the Flexner Report.

In 1910, a critical evaluation of medical education throughout the United States and Canada was published by the Carnegie Foundation. Abraham Flexner, a progressive deeply intrigued by the methods used in German medical training, wrote a report that depicted most schools as entities that granted medical qualifications insufficiently. New York City benefited from the presence of three well-founded institutions—Physicians & Surgeons, Cornell, and New York University—which had already incorporated many elements of the German model endorsed by Flexner, such as a strong laboratory component, a lengthier curriculum, an affiliated hospital, and the expectation that candidates would possess college degrees. The medical school at NYU, which has a close association with Bellevue Hospital, maintained an open policy regarding the admission of Jewish candidates, reflecting the diversity of the surrounding areas. By the mid-1960s, NYU had formed a partnership with Bellevue that was so close they were essentially inseparable, while Columbia and Cornell focused their resources on New York Presbyterian Hospital and its associated New York Hospital. Their inseparable bond was observed by a healthcare practitioner. "It just seemed inevitable."

Context

• Flexner was an educational reformer, not a physician, which gave him an outsider's perspective on the inefficiencies and inadequacies of medical training at the time.
• The partnership influenced healthcare policies and practices, as both institutions worked together on initiatives that shaped medical standards and protocols.
• This policy likely helped NYU attract talented individuals who were excluded from other institutions, thereby strengthening its academic and medical programs.

Other Perspectives

• The Flexner Report's influence might be overstated; Bellevue and NYU Medical School may have already been on a path toward collaboration due to their geographical proximity and shared goals, independent of the report's recommendations.
• The report could have been biased by Flexner's preference for the German model, potentially overlooking the merits of other educational approaches.
• The focus on these three institutions might overshadow the contributions and quality of other medical schools in New York City that may have offered different but equally valuable approaches to medical education.
• A lengthier curriculum could potentially lead to increased financial and time burdens on students, which might not necessarily correlate with better clinical skills or knowledge.
• The perception of inevitability might overlook the deliberate efforts and strategic decisions made by both institutions to foster their relationship.

Bellevue is the establishment where future medical professionals receive their training.

This part of the text describes how Bellevue established specialized institutions for medical education, such as the esteemed nursing school, and discusses the hospital's changing attitudes and rules concerning women doctors, Jewish applicants, and Black individuals. Oshinsky highlights Bellevue's role as a pioneering entity in a medical community that was often reluctant to accept change.

Other Perspectives

• Bellevue's approach to training may not align with all educational philosophies or learning styles, and some students might find other institutions more conducive to their professional growth.
• The term "esteemed" is subjective and can vary depending on who is making the assessment; different stakeholders may have different opinions on what constitutes an esteemed nursing school.
• Bellevue's changing attitudes and rules may not have been solely pioneering but rather a reflection of broader societal changes that were occurring at the time.