I just published another story on my blog at Steemit. The story refers to my brother’s brush with death when he was nine years old. He had severe heart disease. One hospital refused to treat him. St. Francis Hospital, in Roslyn, New York accepted him as a transfer patient. The physicians at St. Francis saved his life.
I think my story is a commentary on the fragility of life and on the importance of seeking care at a topnotch medical facility.
I was five when my brother had his crisis. Everything was clear to me as it unfolded back then. All of us knew, my siblings and I, that my brother might die. Although he came out of his acute crisis that first night, he struggled for months to overcome the heart disease that had plagued him for years.
My brother’s struggle became part of my developing psyche. I don’t think I would be the person I am today without having gone through that early trauma. While I was just a witness to my brother’s struggle, in a family there is no such thing. Each person is part of the event.
If you feel like checking out my story on Steemit, please do. The story doesn’t talk about my brother so much. It deflects the panic of the moment onto an attending physician, who goes through a life-altering crisis of his own.
In 2016, a Johns Hopkins safety review panel reported that every year, 250,000 deaths in the United States are attributable to medical error. That’s a whopping 9.5% of all deaths in the country. As eye-opening as this statistic may be, it pales in comparison to deaths attributable to medical misadventure in previous centuries. According to David Oshinsky, author of Bellevue, eighteenth and nineteenth century medical treatment was as likely to be the cause of death as it was to save life. The evolution of medical care from that dark age occurred in fits and starts. Dr. Oshinsky offers a gripping description of the journey from darkness to the relative enlightenment of today.
This author skillfully blends medical and social history. He demonstrates the knack of a skilled teacher as he weaves anecdotes into a narrative of hard facts. Dr. Oshinsky has so much information at hand, that he doesn’t need to resort to conjecture to enliven his story. Truth, he proves, is indeed stronger than fiction.
Examples of Dr. Oshinsky’s dynamic writing are on display throughout the book, most memorably in his descriptions of surgery without anesthesia and treatment without antiseptics. In the first case, a boy’s leg is amputated. The father is present and aids in restraining his son. The sound of a saw fills the surgical theater as the child, without benefit of anesthesia, loses his leg. Shrieks fill the room. The father faints. We, the readers, are left with an indelible impression.
In another instance, President James Garfield suffers the consequences of medical obstinacy. The President is shot. An assassin’s bullet must be removed. The esteemed Dr. Frank Hamilton of Bellevue is called in. He, confident in his skills, declines to follow new guidelines in medicine that prescribe sterilization before contact with a patient. Garfield dies, month later, of massive infection. It is the medical consensus that this death was due not to an assassin’s bullet but to medical misadventure.
Dr. Oshinsky comes to the task of writing his book with excellent credentials. He is a professor of history at New York University and the director of Medical Humanities at NYU Langone Medical Center. In addition, he has won a Pulitzer Prize for an earlier book, Polio: An American Story.
The current book, Bellevue, is about the history of a public institution, and it is more. It traces the history of health care in New York City. It introduces readers to some giants of modern medicine, including Robert Koch, Joseph Lister and Florence Nightingale. The author’s broad perspective offers insight into the immigrant experience and its intersection with New York City politics. Dr. Oshinsky’s wide lens creates a richly textured tableau in which Bellevue Hospital is the focal point.
Bellevue is an easy read. I recommend it to anyone interested in history, and to those readers who would like to gain insight into the culture of the medical profession.
By A. G. Moore 2/10/17
The picture of Bellevue Hospital (above) is used under a Creative Commons
4.0 International License
It is ironic that throughout history, war has been an effective laboratory for creating advances in medicine. Human beings are the raw material of war. Injured humans, sick humans, cannot carry out the mission of their masters. They cannot win victories if they perish from wounds, or struggle with illness. It is in the interest of nations and the leaders of nations to protect soldiers. And thus, history shows, war has been the environment in which medical innovation and discovery has often occurred.
Of course, there have been idealists who labored, in war and peace, to improve medical care. No slight is here intended to these heroes. I am in awe of often unacknowledged and anonymous benefactors who give their lives to save the lives of others. But even in these instances, it has often been the case that the work of the idealist is sponsored and supported by a less altruistic actor.
For example, Florence Nightingale traveled to the Crimea in the midst of a terrible war because she wanted to save lives. No one has ever been able to impugn the motives of this great nurse and medical innovator. Her actions saved not only British soldiers but countless soldiers of all nationalities who fought in successive wars.
As is typical of medical innovation prompted by warfare, Florence Nightingale’s insight and reforms also extended to civilian populations. She began a revolution in sanitation and nursing that has benefited every generation, civilian and military, across the world.
Not only did Florence Nightingale improve nursing and hospital practices, she also inspired a transformation in battlefield ethics. Because of her example and advice, the concept of neutrality for professional medical personnel evolved as a modern concept in warfare. The Geneva Conventions, which cemented this concept in international law, were a legacy of Florence Nightingale’s influence.
However, without the Crimean War, and without the English Crown’s need for healthy soldiers to carry on in battle, Florence Nightingale might never have gone to the Crimea. The English Crown was in crisis because of the appalling number of deaths suffered by its soldiers in the Crimea. This crisis threatened to deny the English a victory in the Crimean War.
Florence Nightingale became an angel to suffering soldiers in the Crimea and a savior to the English war effort. She became a popular figure to families in Britain whose loved ones were saved and she became a national hero because of her contribution to the war effort. Queen Victoria personally awarded Florence a unique medal, The Nightingale Jewel, in commemoration of her extraordinary service.
Medical innovation in wartime did not not begin or end with Florence Nightingale. In the ancient world, Greek, Egyptian and Indian doctors traveled to battlefields to treat the wounded. Improved surgical techniques were the result.
In more modern times, Jonas Salk worked on an influenza vaccine at the behest of the US government during WWII. It was the successful development of a flu vaccine that helped Salk to understand the direction to take in his research on a polio vaccine.
The carnage of war throughout history has been a prompt for development of therapeutic medicine. This is an opportunistic result: the attention and energies of great powers focus on medical care at these critical junctures because of battlefield imperatives. A true advance would be for state leaders to see the urgency of focusing on medical care in peacetime, when the needs of civilian populations are front and center. This would represent not only a revolution in medical science but also a essential evolution in the human condition.