Bellevue Hospital Pioneered Care For Presidents And Paupers | KERA News

Bellevue Hospital Pioneered Care For Presidents And Paupers

Nov 16, 2016
Originally published on November 18, 2016 3:40 pm

When he was growing up in New York, All Things Considered host Robert Siegel always knew that Bellevue Hospital was a city institution.

But it wasn't until he read David Oshinsky's book Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital, that he realized the hospital was a pioneering institution for all of American medicine.

The hospital, which grew out of an almshouse founded in 1736, has been in the forefront of many innovations in medicine in the U.S. Advances that started at Bellevue included ambulances, a maternity ward, nursing school, a children's clinic and forensic pathology.

Siegal talked with Oshinsky, a professor of history at New York University, about the hospital and how it reflects the advances and failures of medicine. The interview has been edited for length and clarity.

On Bellevue's origins in colonial New York

Bellevue in the 18th century was really both a poorhouse and a pest house. It was a place you came to die. It really began with the great yellow fever epidemics of the 1790s. At that time the Bel-Vue estate, which became the hospital, was located on the East River, about two miles away from where most of New York was located down by the Battery. And you would send people who really had no chance of recovering.

On hospitals not being very good at saving lives in the first half of Bellevue's history

Most physicians at Bellevue and elsewhere believed in the miasma theory — that clouds of bad air caused all kinds of disease. They had no concept that an invisible organism could cause so much damage, and that was what germ theory was about. Belluevue physicians were really on the forefront, particiularly the younger physicians, in pushing germ theory forward.

You also had a hospital where there was no anesthesia until the 1840s, and once anesthesia comes, postoperative infections are still extraordinarily high. It's only when you have professional nursing and germ care and the coming of X-ray machines and the kind of pathology where you can actually do lab work within a hospital that makes a hospital better at saving a person's life.

On Bellevue doctors who treated two presidents — James Garfield and Grover Cleveland — with very different outcomes

Garfield was hit by two bullets, neither of which was fatal, but the lead surgeon was Frank Hamilton from Bellevue. And Hamilton came down to Washington and he put his finger into Garfield's wound, and put dirty probes into Garfield's wound. He didn't die from the bullets, he died of the kind of infection was brought about by physicians who didn't believe in germ theory.

About 15 or 20 years later, Grover Cleveland had a mass in his mouth which turned out to be cancerous. It was during the Great Panic of 1893, a serious economic depression. Cleveland did not want to alert his critics. So they hired a yacht with a number of Bellevue surgeons and physicians. They sailed up the East River to a very, very calm piece of water and they removed this mass from Cleveland's mouth in a one and a half hour operation using every imaginable antiseptic technique available. Cleveland survived the operation and died of a heart attack many, many years later.

How Bellevue's response to AIDS epitomizes its ethos

Because it was the place that turned no one away, it dealt with anything that came through New York City: cholera with the Irish in the 1930s, tuberculosis with the Jews and the Italians about the turn of the century, the great influenza epidemics. Bellevue treated more AIDS patients than any hospital in the country, and more AIDS patients died at Bellevue than at any hospital in the country. Bellevue was really in crisis mode at that time.

AIDS was one of the big issues at Bellevue and hospitals across the country. Doctors were wary. There were studies done where even a percentage of young interns thought they had the right to determine whether they would treat these patients or not. In the end, and this is the important point, Bellevue prevailed. The Bellevue message prevailed. The ethos that we treat everybody, regardless of their disease, regardless of their social standing. And they did. And I think that people look back at that era with great pride.

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ROBERT SIEGEL, HOST:

Having grown up less than a mile from Bellevue Hospital, I knew from an early age that it was a New York City institution. But until reading David Oshinsky's book about Bellevue, I didn't realize that it's been a monumental institution for all of American medicine.

There are things we expect to see at a hospital - ambulances, a maternity ward, nurses, medical students, forensic pathologists, medical photography, all things that were pioneered at Bellevue, whose roots go back to 1738. David Oshinsky, welcome to the program.

DAVID OSHINSKY: Thank you, glad to be here.

SIEGEL: And first you have to explain that as Bellevue evolved, the very definition of what a hospital is was evolving with it. Describe what Bellevue was when it began in the 18th century and what it became.

OSHINSKY: Bellevue in the 18th century was really both a poorhouse and a pesthouse. It was a place you came to die. It really began with the great yellow fever epidemics of the 1790s. And at that time, the great Bellevue estate, which became the hospital, was on the East River about two miles away from where most of New York was located. And you would send people who really had no chance of recovering.

SIEGEL: A defining relationship that you return to often in your book about Bellevue is between the hospital and the poor. Historically, well-to-do New Yorkers wouldn't have wanted to be in the same building as most of Bellevue's patients. What drove that sense of mission not just to get them out of the way, but what drove the sense of mission to treat the poor of New York?

OSHINSKY: There had always been a kind of group of physicians who believed it was their Christian duty to treat the poor. They also believed that if they wanted to do surgery or other kinds of medicine, it would be very easy to do it on uncomplaining bodies.

SIEGEL: There is that dark side - that the poor are often considered useful subjects for experiment.

OSHINSKY: That is true, and that is part of our medical history. On the other hand, it did push the needle forward. Medical reform and great medical discoveries also came with what you would consider today to be sort of outlandish assaults upon the bodies of the poor.

SIEGEL: To read your book about a hospital that started out in the 18th century is to be reminded that for the first virtual half of Bellevue's life, doctors really didn't know much about disease or help much for that matter. I mean is it only when germ theory comes over from Europe in the mid-, late-19th century that Bellevue becomes a scientific institution that's guided by people who know what they're doing?

OSHINSKY: That is correct. Most physicians at Bellevue and elsewhere believed in the miasma theory that virtually clouds of bad air caused all kinds of disease. They had no concept that an invisible organism could cause so much damage. And that was what germ theory was about.

And Bellevue physicians really were on the forefront, particularly the younger generation, in sort of pushing germ theory forward. You also had a hospital where there was no anesthesia until the 1840s, so if you...

SIEGEL: It didn't stop them from doing surgery, though.

OSHINSKY: It certainly did not, but you had to do it within nine, 10 seconds when you cut off a limb or that person would die of shock and pain and blood loss. And even once anesthesia comes, post-operative infections are extraordinarily high.

It's only when you have professional nursing and germ care and the coming of X-ray machines and the kind of pathology where you can actually do lab work inside a hospital that makes a hospital better in terms of saving a person's life.

SIEGEL: You relate the stories of two presidents in the 19th century whose medical and surgical care illustrated how much medicine changed during a very short period of time - in 1881, the death of President James Garfield not directly from an assassin's bullet but from the infection that set in during treatment versus Grover Cleveland's cancer surgery in 1893. Both involve physicians who are connected to Bellevue.

OSHINSKY: They did. Garfield was hit by two bullets, neither of which was fatal. But the lead surgeon was Frank Hamilton from Bellevue. And Hamilton came down to Washington, and he put his finger into Garfield's wound and put dirty probes into Garfield's wound.

About 15 or 20 years later, Grover Cleveland had a mass in his mouth which turned out to be cancerous. It was during the Great Depression of 1893. The country was panicked. Cleveland did not want to alert his critics.

So what happened is they hired a yacht with a number of Bellevue surgeons and physicians. They sailed up the East River to a very, very calm piece of water. And they removed this mass from Cleveland's mouth in a one-and-a-half-hour operation using every imaginable kind of antiseptic technique of that era. And Cleveland survived the operation and died of a heart attack many, many years later. So there really is a continuity...

SIEGEL: Yep.

OSHINSKY: ...Not only with germ theory but with the Bellevue physicians.

SIEGEL: There's a dynamic that recurs in your book about Bellevue that is - yes, germ theory is brought over from Europe, and it revolutionizes medicine at Bellevue and elsewhere. But there's also great resistance to it and people - senior physicians mocking the idea that little microscopic beings are creating disease.

Yes, they innovated with women nurses, but there also was tremendous resistance against them. In the end, when these innovations arrived and there was resistance, somehow the progressive side prevailed. The story of female doctors like Edith Lincoln are stories in Bellevue's history where it was just a more open place.

OSHINSKY: You know, there is resistance in medicine to new discoveries, new aspects of research at all time. At Bellevue, it would often take the perspective of younger physicians pushing newer reforms. But that's what Bellevue was all about. You're absolutely right. It was a continuum.

Because it was the place that turned no one away, it dealt with anything that came through New York City - cholera with the Irish in the 1830s, tuberculosis with Jews and the Italians around the turn of the century, the great influenza epidemics. Bellevue treated more AIDS patients than any hospital in the country, and more AIDS patients died at Bellevue than any hospital in the country. And Bellevue was really in crisis mode at that time but courageously prevailed.

SIEGEL: It was an emotive ethical crisis during that time as well, a professional crisis. What do you do if you're treating a disease whose transmission you don't really understand? And if the physician is at risk, is it ethical to say, I'm out of here?

OSHINSKY: That was one of the big issues at Bellevue and hospitals across the country. Doctors were wary, and there were studies done where even a percentage of young interns at Bellevue felt that maybe they had the right to determine whether to treat these patients or not.

In the end - and this is the important point - Bellevue prevailed. The Bellevue message prevailed, the ethos that we treat everybody regardless of disease, regardless of their social standing. And they did, and I think people look back upon that era with great pride.

SIEGEL: David Oshinsky, thanks a lot for talking with us.

OSHINSKY: My pleasure. Thank you.

SIEGEL: David Oshinsky's new book is called "Bellevue: Three Centuries Of Medicine And Mayhem At America's Most Storied Hospital." Transcript provided by NPR, Copyright NPR.