 good evening good evening I am Mark up to Grove the director of the LBJ presidential library and it is my great pleasure to welcome you here tonight for the last program of the 2016 calendar year I want to just start off by thanking you for your support of the Friends of the LBJ program I there there are so many of you that I've met either here before or after programs or in and around town some on airplanes and frequently on airplanes funnily enough and you're always so kind about expressing your gratitude for this program and what we do and that means a great deal to me and so I thank you for your support we try to do what we do as well as we can possibly do it and we appreciate when you recognize what we put into this program and also we appreciate when you bring new members to the Friends of the LBJ library program so thank you for that as well I also want to thank our sponsors the Moody Foundation St. David's Health Care Frostbank and the University Federal Credit Union we appreciate your support and finally I appreciate the partnership of of humanities Texas my friend Mike Gillette the executive director suggested this program tonight and I quickly jumped on the idea David Oshinsky is an old friend and I'm delighted that he came back to Austin hopefully won't be so quick to leave this time we loved having him as a faculty member here at UT and it's great to see David and his wife Jane back so it's my great pleasure to see the podium to my friend Mike Gillette the executive director of humanities Texas who will introduce tonight's guests thank you thank you Mark it's it's always an honor to join forces with you and your superb staff here at LBJ a mark up the Grove has been humanities Texas host and collaborator at so many of our professional development institutes for classroom teachers where we work together to improve the quality of public education in Texas and believe me when new teachers have an opportunity to spend three days with historians like David Oshinsky and Bill Brands the experience can be transformative now as all of you know mark is a master at bringing the most extraordinary speakers to this library including presidents and Pulitzer Prize winners well tonight is no exception to serve as moderator mark has enlisted the distinguished founding dean of the University's New Dell Medical School Dr. Clay Johnston holds degrees from Amherst and Harvard Medical School as well as a PhD from Berkeley before coming to Austin he spent 20 years at the University of California at San Francisco's fine medical school where he specialized in neurology and epidemiology epidemiology epidemiology I think it is is that right that's closed that's that's why we need him to talk to David Oshinsky right there David Oshinsky comes to us from New York University there he directs a division of medical humanities and serves on the history faculty but he is of course no stranger to Austin having been on the UT history faculty for 12 years his first book the conspiracy so immense the world of Joe McCarthy received this library's DB Hardiman Prize for the best book on Congress in 1984 and it was this prize that brought David to Austin for the first time and David not only writes books that are immensely readable he also writes history that matters that makes a difference his Pulitzer Prize winning book polio an American story is a prime example the book influenced Bill Gates to make the worldwide eradication of polio the top priority of the Gates Foundation David's splendid new book Bellevue three centuries of medicine and mayhem at Americans most storied hospital is also likely to have a powerful impact inspiring our better angels by transporting us to a very special place where there where no one is in need of health care has turned away so please welcome dr. Clay Johnson and dr. David Oshinsky thank you it's a it's a great pleasure to be up here with you David thank you for coming back to us pleasure always good to be back in Austin yeah yeah we as was mentioned you were you know you were here for almost 12 years and I was yeah 12 wonderful years and if we're up to my wife we'd pack up the moving truck and head back yeah well you know we've been thinking about a medical humanities program as part of the medical school so maybe I'll talk to her how we might get you back thank you so the polio book amazing book and you know that really great as an epidemiologist and that's the way you say it the you know reading that book and understanding the impact of epidemiology and medicine on on health and just a dramatic story and maybe we'll return to that a little later but that was ten years ago what took so long what took me so long Bellevue is first a very complicated subject it's a hospital I guess that we'll talk about in a little bit it's when you think about Bellevue you think about numerous things one is it's got a reputation for its psychiatric wards when I was a kid I'm a New Yorker and when I was growing up if you acted a little bit weird your mother would say it's Bellevue you're on your way to Bellevue and that was and and Bellevue also happened to be close to Greenwich Village so an awful an often large number of writers Norman Mailer William Burroughs Alan Ginsburg all for some reason wound up in for psychiatric reasons wound up in in Bellevue and but Bellevue is also a place where the medicine is so good that if a cop is shot in Manhattan he goes to Bellevue if a fireman is overcome with smoke he goes to Bellevue if a construction worker falls off the site he goes to Bellevue if the Pope or the president were to take sick in New York City Bellevue is the place where they would be taken and and the other aspect is that Bellevue has long been a hospital of immigrants in New York City and by that I mean that every group from the Irish to the Germans to the Jews to the Italians to the African-Americans coming up in the great migration use Bellevue as their hospital it was the poor person's hospital it was the hospital that turned no one away and it's always had that reputation and it's changed now new immigrants have come in but the mission of compassionate care for those who really cannot pay for it has has long been the standard at Bellevue Hospital and then honestly when you throw in the fact that I had to begin a medical humanities program at NYU and we moved up from Austin and if my wife hadn't tied me up for two years literally with rope we would have been in New York City much more quickly again I need to talk to your wife so you know during your time in Austin I know you must have had some some happy memories because this is where you were when you got the Pulitzer it was I was thrilled to win the Pulitzer at the University of Texas and I always tell a number of stories which the I think the audience might enjoy I found out I was one of three finalists for the prize the other was a scholar at Harvard who was working on slavery the second was a scholar at Princeton who was working on democracy and I was at the University of Texas working on polio so I figured my chances of women winning were slim to none indeed my chances were so slim I thought that my wife Jane actually went shopping on the day of the announcement in New Orleans and I called her up and I said Jane we won we won and she was in a store in New Orleans and the salesperson said what did he win and she said my husband won the Pulitzer prize and the salesperson said oh I thought it was Powerball there's there's one more story for those you a long time Austinites when Jane did come back one of the great things that Bill Powers did was that for the first time I think for a non-athletic victory they lit the tower are and that's great and and and my wife and I were walking at the tower and two young women were walking in the other direction and my wife Jane said did you know why they lit the tower orange and the first woman said I I don't have a clue and Jane turned to the second woman said do you have any idea and the young woman said was Vince drafted so we realized there were sort of gradations in yeah in doing this but we had wonderful years I the history department is so strong at the University of Texas I made wonderful friends there one of my best being Bill Brands who's in the audience are great story and every imaginable subject so we just love the life here and and the people and and leaving was very very difficult yeah yeah well I'm sure the startup package at NYU was the similar type to the football coaches and how they would hear yeah it's sort of like a way as well Charlie strong minus all the money yeah so so these last two books both about health epidemiology but really about medicine a transformation of of making the entire community getting involved in in addressing a major health issue maybe even the major health issue of that age in terms of the polio being so so dramatic in its effects and hitting anyone and at any time and then this time another health topic different but with some similarities what draws you to to these topics well I think in the case of polio I had been born before the two vaccines that they we they didn't cure polio but they ended polio basically by preventing it so I really understood what life was like before that and was life was like after that and what I wanted to do was to write a book not only about the race for the vaccines but about how the American people mobilized through the March of Dimes voluntarily without any government intervention to really provide the resources that allowed Salk and Saban and so many others to do what they had to do to end the scourge of polio and I thought that there was a message there particularly in a society even in the United States where vaccination rates are tricky now there are many younger families who have never seen something like polio and wonder why they should vaccinate their children and as you know one of the extraordinary things about vaccines is that they work so well that they sort of people don't understand the problems that they've solved there is no polio because we do vaccinate so there really was a message there and I think in the Bellevue book my message was that health care is a human right and what New York City New York City for all of its problems has always guaranteed free medical care for the indigent and Bellevue as its flagship public hospital was really the engine that drove that dream and that reality for almost three centuries and continues to do so yes I want to I want to talk about that because I think that's a remarkable part of the history that you tell and a remarkable I don't know if it's a legacy of Bellevue I mean it was the first to be set up this way right now there are many many other hospitals across the country with a similar economic base where they receive support from the local government in order to provide care for everyone but but I want to go back to that I mean I just sometimes when you look back in history you're embarrassed you know the racism bigotry and it all comes out in your book as well but in but that lack of mean-spiritedness to recognize oh we should provide health care to everyone it's there from the get-go it's there back in the 18th century it really was one of things that I found most interesting Bellevue was the oldest hospital in the United States I mean there's some debate about that but it goes back to 1736 and it really was started as part of the poor house it was a wing of the poor house so it was associated with helping the poor but it was also associated as being a place for people who had no other options they basically that's where they had to go and then what happens is New York City is hit with a bunch of devastating epidemics and in the 1700s those epidemics are yellow fever smallpox but particularly yellow fever which comes up on the slave ships and reaches Philadelphia in New York and Philadelphia as you may know yellow fever was so bad that the young American government which was located in Philadelphia at the time actually disbanded and Washington and Jefferson fled to their native Virginia Thomas Jefferson actually thought yellow fever wasn't so bad because he feared the growth of big cities and he thought that an epidemic made people understand that being close together caused very very serious problems but in New York City what the city fathers did was to try to increase the size of Bellevue to take care of the victims of yellow fever now if you picture New York City at this time the entire population was down at the battery which is now where the Staten Island ferry is so they wanted a place about two or three miles north far enough away so that you could bring yellow fever victims they would basically die and you could isolate them and the belief was that you wouldn't get yellow fever of course was wrong but the first doctor at Bellevue was a man named Alexander Anderson he was 21 22 years old he had apprenticed with another physician he went to take the job as the physician at Bellevue to take care of yellow fever patients because he believed it was his Christian duty to do so and Alexander Anderson stayed at Bellevue with these dying patients and in the time he was there his son died of yellow fever his brother died of yellow fever his mother and father and wife all died of yellow fever and Alexander Anderson for the most part stayed the course and when his last diary entry for that year 1798 he said the Lord has tested me the Lord has tried me but this is what he wanted me to do and I always look back on Alexander Anderson as providing the compassion I wouldn't say the medical knowledge because what he was doing was bleeding and purging palliative right exactly which was what you did in those days but it was the notion of providing kindness to these people of understanding the pain they were in and staying the course while people around him were dying of the disease and to me that was sort of the credo of what would become the flagship hospital of New York City yeah that's a that's a wonderful way of talking about it I mean it's the the the concept of the hospital embodies those principles and then it draws the people who who gain strength from that who recognize that as that is right now doctors would come to Bellevue for a number of reasons one was they believed it was their duty to do so as you know clearly by the by the Civil War Bellevue was attracting some of the greatest medical minds in the country particularly young people who wanted to come there to be interns and residents because a when you were at Bellevue you saw everything there was no disease that was not part of the hospital existence and these doctors perfectly well understood this and the other was that these doctors were interested in experimentation and what you had at Bellevue were uncomplaining bodies these were poor people and and this was an era an era before informed consent and the like and so doctors could pretty much have their way they weren't doing Frankenstein like experiments they were doing things that they really thought would help the patients but when you look back upon it you can see that one of the reasons they came was the belief that they would see everything and also the belief that they could try everything on these pages yeah well you know and they're the issues of consent of course or one of those embarrassing things in history that you look at and you say wow didn't can't believe we ever did this on the other hand they're they're interested in doing a better job was so critical and I mean some of the descriptions of how we were treating people in the 17th 18th even 19th 20th centuries if we didn't have people pushing that boundary that is right we we would still all be going to the doctor to be forced to vomit and to be bled out that is absolutely true and and when you look at Bellevue you can see the kind of medical improvements that are occurring elsewhere in the country that are being experimented on at Bellevue yet what's your favorite I mean I say it would be antiseptic medicine in the by the Civil War era they had anesthesia which was enormously important on the other hand what anesthesia did in the old days before anesthesia you basically had to take an arm off in nine seconds I'm not kidding you you had to saw that arm off immediately or the patient would die of pain and would die of shock and another remarkable thing about the book is how much it is focused on trauma and trauma treatment that is correct because at least there was some treatment that was offered in a hospital that couldn't be offered elsewhere that is we didn't have treatment from pretty much anything else but anyway go back here so basically what you had at Bellevue were surgeons who with anesthesia you know could now look further into the body because the patient was not in pain and you could experiment more and do other things the problem was without antiseptic medicine half the patients who are operated upon at Bellevue would die of postoperative infection and that was a huge issue and what you see at Bellevue in the 1860s and 70s is a younger generation of people coming in like the great surgeon William Halstead and they understand Pasteur and they understand Lister and they understand that you can't as a surgeon ride your horse to Bellevue get off in the same clothes you were riding in not wash your hands and begin to operate on a patient what they wanted were sterilized instruments they wanted very careful hand washing they wanted starched uniforms and there's this enormous battle at Bellevue that is fought out over these issues with the younger generations winning out and as I think as you know you know I think one of the things I hit upon very hard in the book is to take this arc of antiseptic medicine through the lives of three presidents yeah yeah yeah you want to talk about that so so comparing contrast I shall be treatment and outcomes I mean because it's really remarkable it tells such a great story well there are some of you may not know that the young physician who rushed to Abraham Lincoln after Lincoln was shot at Ford's theater was Charles Augustus Leal who was 23 years old and had graduated from Bellevue Medical School about three months before the war was ending he went down to Washington to be an assistant surgeon in a military hospital Leal actually at the theater heard the shot saw John Wilkes Booth jump to the floor of the stage and run out and then he heard the cry literally is there a doctor in the house and Charles Augustus Leal rushed to Lincoln's side and as a 22 23 year old doctor literally held the fate of the Republic in his arms Lincoln was mortally wounded but Charles Leal did everything he was told to do that he had learned at Bellevue he gave brandy and water to Lincoln he wrapped Lincoln in a blanket he told them not to move Lincoln back to the White House because the trip would kill him so they just moved him across the street and he also began to put his fingers near Lincoln's wound and one of things clarifying very interesting is that Charles Augustus Leal believed in patient confidentiality and rarely if ever talked about what had happened that day on the anniversary of Lincoln's hundredth birthday about 50 years later Leal was asked to give a speech about Lincoln and he gave this remarkable speech in which he said that he had given CPR to Lincoln that he had worked on Lincoln's chest and breathed into Lincoln's mouth but he made no mention of touching Lincoln's wound and what often happens is that an historian rummaging through the Library of Congress just a couple of years ago came across an interview that Leal had done in 1865 the certain general wanted to know what the hell happened I mean I want to you know blow by blow and Leal sat down and gave this interview and in the interview in 1865 Leal made no mention of CPR because it no one was doing it at that time and he did talk about putting his finger deep into Lincoln's head to look for bullet fragments and this of course was an unwashed finger and the question then remains why would there be two versions and the answer is that when Leal gave the speech in 1909 he really wanted the public to think that he was using all the methods of a 1909 physician including antiseptic medicine in the book I give Leal a kind of a pass because he was young he did everything right in 1865 and his final line is so poignant he stayed with Abraham Lincoln right till the end holding Lincoln's hand and this was for 19 hours and he was asked why did you do that and he said about the president in his blindness I wanted him to know he had a friend and that was the Bellevue credo and I always think about that when I think about Leal now to just delve a little bit further Leal's mentor was Frank Hamilton the great Civil War surgeon and as some of you may know in 1881 James Garfield was shot by an assassin in Washington and Frank Hamilton was brought down from Bellevue and this was you know he was the great Civil War surgeon and the first thing Frank Hamilton did when he looked at Garfield was to put his finger into Garfield's wounds and use dirty probes and this was after Listerian medicine had begun to take hold Frank Hamilton was from the old school immediately Garfield began to have these enormous infections of fever and he died three months later and it was clear that he had died from massive infection and if that Frank Hamilton and other physicians had just left poor Garfield alone he would have easily survived and that is a really interesting story and it got the public very interested in antiseptic medicine I will say with Frank Hamilton the one thing he did do after he was somewhat responsible for Garfield's death he did remember to send a bill to Congress for twenty five thousand dollars which is about six hundred thousand dollars today let me finish the story and the arc fast forward 13 years to 1893 and Grover Cleveland as president of the United States goes to see his doctor who is a Bellevue physician and the doctor sees that Cleveland has a mass in his mouth and he thinks it's cancerous they send it to the Army Medical Center it comes back as cancer what these these Bellevue doctors now do is they outfit a yacht because Grover Cleveland did not want anyone to know that he had cancer was during the Great Depression of 1893 he didn't want his enemy to alert his enemies and his critics they outfitted a yacht as an operating room it was done with every imaginable aspect of antiseptic medicine everything was sterilized they took the yacht along the East River as they went by Bellevue Hospital they lowered the shades the yacht went out into the Long Island Sound in a very calm part of the water they removed the mass from Grover Cleveland's mouth Grover Cleveland died but it was 25 years later of a heart attack and what you can see is that in some degree the mistakes made on James Garfield probably helped save the life of Grover Cleveland and what is extraordinary from Charles Augustus Leland Lincoln to Frank Hamilton and Garfield to the Bellevue doctors with Grover Cleveland you see the arc of antiseptic medicine and what antiseptic medicine did was to give people a sense that hospitals could do good I can go to the hospital and be cured of something I'm not going there to die anymore you know a lot of had to do with coming in of technology nursing x-ray machines but antiseptic medicine was absolutely crucial yeah yeah the it's so interesting to the you know Hamilton was such a hero is a war hero and best surgeon in the country he was and in he was obviously resistant to some of these new ideas about antiseptic practices and a single case so public really helped to drive a much more rapid and dramatic change that you put it very very well Joseph Lister the father of antiseptic medicine who believed in the theories of Louis Pasteur when Joseph Lister came to America Frank Hamilton was brought to the speech that Lister gave to stand up and criticize Lister and Frank Hamilton's argument which was a very American argument was speaking of Pasteur and Lister he said why in God's name would an American listen to a Frenchman whose ideas have been taken on by an Englishman and that that that was his argument I hope he did that for humor and not as an actual argument but I suspect that's another example of an embarrassment from yeah from history so that the whole notion of Bellevue is a madhouse mm-hmm it's a it's really interesting I mean obviously it has a psychiatric wing it has for four decades and decades but tell us a little bit more about that the namesake for your prize and some of the work that he did in establishing that that sense of what Bellevue is yeah well it's cost Joseph Pulitzer and Joseph Pulitzer came to New York and and he bought the New York world one of the big newspapers and the Hearst Empire was basically his competition and they went to what historians have later called the kind of yellow journalism very sensational journalism and what Pulitzer did was to hire a young female journalist reporter named Nellie Bly some of you may have heard of Nellie Bly she was a daredevil reporter who would do anything when Jules Verne's wrote around the world in 80 days Nellie Bly traveled the world in 76 days she was incredible but but one of her first big assignments was to act like a quote-unquote crazy person get arrested by the police and get sent by a judge to Bellevue and Nellie Bly went to Bellevue and fooled the doctors there into thinking she was crazy and then wrote this extraordinary expose called 10 Days in a Madhouse about her experiences at Bellevue and then moving on to another mental hospital but from that point forward Bellevue would be associated largely with a single affliction and that would be mental disease yes yeah it's quite it's quite extraordinary I don't believe in the great man or great woman theory of history but Nellie Bly had an enormous impact upon Bellevue yeah I thought that was fascinating and it's interesting Bellevue has to you know when you look at the economics of Bellevue it's always sort of at the cusp of being underfunded yes and then sometimes it's not just at the cusp it is well below that cusp and so that kind of press sometimes can have a positive effect it can and so it was interesting to see or to think about Bellevue's interactions with the press I mean her the press that she provided was just not helpful at all but through the years there were a number of other articles and stories that came out that probably helped to reinvest in Bellevue it did obviously even the Nellie Bly story was showed that Bellevue needed more money it needed needed more psychiatry so we're called alienists it needed more alienists it needed more space and the other thing that Bellevue has that virtually no hospital in America has is Bellevue has gigantic prison wards the entire 19th floor of the hospital is taken up with I'm sure most of you have heard of Rikers Island the big prison in New York City any time a Rikers Island inmate has a medical or psychiatric issue that patient the men are brought to Bellevue so there's a psychiatric wing to the hospital and there's a medical wing to the hospital and what the city realizes that we are going to have provided a certain amount of funding Bellevue is always underfunded and understaffed but in other words if we want to protect the city we are going to have to put money in and also as Tammany Hall grew up and there was greater participation by particularly the Irish but other immigrant groups Bellevue was the hospital they were sending their people to so they wanted a larger amount of funding and one of the incredible things is that McKim Meaden White which is the great architectural firm of that era puts the designs together for the new Bellevue my problem is that this was done in 1900 I have an office there in 2016 and it's the same building right but I should say we it was painted in 1934 so yeah yeah and in Mopton right so there are a lot of great characters in in the book and that's one of the wonderful things about your writing is you really you follow a character you get into the game teaches so much about them and how they're interacting with places and events of the time so which is which is your favorite I you know Alexander Anderson was one one of my favorites I think Stephen Smith the father of modern American public health what Steven Smith did in 1863 there had been horrible draft riots in New York City and the draft rights had been led by immigrant groups particularly the Irish who saw it as a rich man's war but a poor man's fight and there the riots had destroyed large parts of the city and Steven Smith was a medical reformer and it was obvious to him that the bubbling over from the lower classes was going to affect the entire city in other words what had happened is you really were now having two cities one was a city of immigrants who were very very poor had no medical care who were dying early from alcoholism and industrial diseases and the like and the other were the comfortable parts of the city but what Steven Smith tried to convince and he did the comfortable parts of the city was that you better provide some money or you are going to have problems bubbling up from below that are going to keep this city in turmoil and we're gonna have one draft riot situation after another and what the city did with Steven Smith's help was to set up really the first major board of health for New York City in one of the first in the country and this was a board of health that talked about vaccinating children it was a they actually put urinals in different parts of the city they did away with they used to drive cattle through various parts of New York they would leave their waste everywhere this no longer could be done tanneries had to be moved outside of the city so swill milk dairies that was selling inferior milk were closed down so Steven Smith is clearly one of the one of the heroes to some degree I think you know they're amazing people who went through Bellevue as students and you know Walter Reed went through Herman Biggs the father of bacteriology William Halstead the probably the greatest surgeon of that era two of the people I focus on are Salk and Saban both of whom went to NYU medical school and both of whom did stints at Bellevue Hospital and the reason they are important to me is whenever I teach a class and undergraduates as I did the University of Texas the students would always say to me isn't it really a coincidence that the two pioneers of the different polio vaccines both went to the same medical school NYU and I have to explain to the students that it was no accident that when Salk and Saban were coming of age in the early 20th century virtually every major medical school in the east had Jewish quotas Yale had one Harvard had one Penn had one Columbia had one they were everywhere Cornell had one the only school that did not have one was NYU NYU did not have a Jewish quota indeed about half of its medical students were Jewish so it's no accident that Salk and Saban went to NYU medical school for them it was largely the only game in town and that to me is important for people to remember that that there was something about the Bellevue NYU experience that was not an exclusive experience and it kind of represented the larger city as a whole and if we had time if we have time I'd also like to bring up Clay Catherine Hinnett this is a an extraordinary story Catherine Hinnett was a young pregnant pathologist at NYU in the late 1980s and she was raped and killed by a homeless man in her office in the hospital the question then became was this something that could happen at any public hospital or was there something unique about Bellevue that brought this about and the facts of the case were that Steven Smith a different Steven Smith and the one we talked about the homeless man had been living in Bellevue for weeks in a machinery shed he had stolen Dr. Scrubs he had a stolen ID and he wore a stethoscope around his neck and he walked through the hospital and Bellevue was only two doors down from the largest homeless shelter in New York City and the 1980s were a time of a homeless explosion and Bellevue had always been so compassionate that it just turned no one away and what happened is that the homeless began to use the public areas of the hospital as sort of an extension of the shelter they were everywhere they were in lounges they were stealing foods off patients plates and the question then became is Bellevue a hospital or is it a bus station is it a place where it will deal with homeless people who have real medical problems but try to despite its compassion and its love and it's trying to see that everyone gets a meal and a free coat and some shoes that it has to have limits and draw the line and Bellevue actually did draw that line yeah yeah terrible that it's an awful story yeah can you tell us about Loretta Bender I can excuse me Loretta Bender if you would Google her today for those who are who would remember her at all she is seen by many as kind of the Nazi Dr. Mengele of the 20th century in America Loretta Bender ran the Children's Psychiatric Ward at Bellevue and she actually was a loving compassionate physician she was also one of the early pioneers in autism and she believed unlike others at that time that autism was not caused by the quote on quote cold mother autism had biological genetic and deep psychiatric roots but what Loretta Bender did was to take children as young as four years old and give them electric shock treatment and that was and she didn't hide it she wrote about it in psychiatric journals obviously there was no parental consent because most of these kids did not have parents who took care of them they just wound up at Bellevue but what Loretta Bender believed was that electric shock which was coming into being at this time and was seen as highly successful with many adults that what electric shock might do was to clear the child's brain to the point where the child would be more readily adaptable to traditional psychiatric responses so what she was trying to do was to see if we give the kid electric shock will the kid do better under psychotherapy what she didn't really understand at the time or maybe didn't want to understand was that there were consequences to giving a child this young that kind of treatment so it's really a mixed bag with Loretta Bender I think you know she was in many ways a psychiatrist ahead of her time but she also used kind of the lack of informed consent and other things that we have in place today to her own advantage to do experiments on very very vulnerable kids yeah but it you know it's interesting to like Hamilton she was at the cusp of a of a change that was going on in society where in the case of Hamilton it was not using antisepsis in the case in her case it was not using informed consent that is correct and these were very difficult cases and and she thought she had a treatment that worked and it does work and for some adults and kids no understanding of long-term impact of course correct so it's interesting to think about I I thought your story of her was just so fascinating the other thing about her that was amazing is you know as a woman she she had an incredible career in academic medicine she did until she reached the point at which she she didn't adapt quickly enough and recognize that that is absolutely right she was what you would call a spousal hire she was brought to Bellevue because her husband was a great psychiatrist her husband was a German Jewish refugee extremely brilliant extremely eccentric the kind of person who would walk across 1st Avenue with a huge stack of books on his arm and just signal to traffic to stop and one day it didn't and he was killed and she was left with three young children we have students like that around here by the way yes yeah exactly but she was in many ways ahead of her time on the other hand you're absolutely right that that when new certainly new protective mechanisms for parents came in and for patients came in Loretta Bender was looked at as an anachronism yeah and perhaps the dangerous one so you're this is my last question but you're I just as as one reads the book you you know you're a historian and you're telling us about the history but your voice comes out it does and in it's quite clear that you love Bellevue I do and you start to hear it back in the 1700s and you continue it builds and builds throughout the book you know I don't know if that you wrote it that way but regardless you it at least for the reader grows as one gets through the book so I just want to finish up by asking you about about your overall you know how do you feel about this place I feel very close to Bellevue your office is in my office in Bellevue and it's unbelievable to be in a building where eight pieces are going up to doctors and medical waste is coming down in the same elevator you know it's a very schizophrenic in in in many ways it really is a remarkable hospital it was ground zero for the AIDS crisis more patients died at Bellevue and were treated at Bellevue than anywhere else in the United States when we had our lone Ebola patient in New York City there was no doubt where that patient was going to be taken it was to Bellevue and all of those things really mean a lot I think what means the most to me as a child of immigrants is that the old immigrants are gone now very few Irish in the hospital Italian Jews but what the hospital is filled with now are people from Latin America and Africa and Asia more than a hundred languages are translated at Bellevue when a patient comes in very few of them speak English they put on headphones the doctor puts on headphones and they speak through an interpreter who has a great sense of not only of the language but of the cultural intonations of that language to be perfectly honest with you a large percentage of our patients today are undocumented undomiciled and uninsured they are the patients that other hospitals will either dump in our lap or will take for a while and then see if they can send them elsewhere Bellevue is the ultimate safety net it is the place for people who have nowhere else to go and the beauty of that is that they get quality medical care you know there's an affiliation contract with NYU they provide extraordinary care to these people and what really worries me and I think worries everyone you know public hospitals are dying out some of them the difference between many of them in Bellevue is not only the Bellevue tradition but that Bellevue has you know first-rate medical people and first-rate nursing care at this institution so the patients are really really taken care of New York City still through its tax base provides finances for Bellevue to do what it has to do but when you're in a financial crunch you're always underfunded and understaffed the state provides some money and the federal government provides some money where they have what is called the disproportionate share hospital plan where hospitals that take in lots of homeless people undocumented people get extra money we're always worried that that budget is going to be lowered and lowered and lowered it's so what we have is a medical staff ready to take care of these people forever but we are never sure that the funding will last forever and to see a flagship hospital like Bellevue which has taken care of so many millions of people and which has been the home for so much medical innovation and and just extraordinary generations of physicians coming through and young house staff today who was so dedicated to that mission to see that missing in any way injured or demeaned or lessened is something I do worry about yeah well thank goodness for Bellevue in places like it thank you we're drawing our attention to it