A DOCTOR AND HIS HOSPITAL

Press, Volume XCV, Issue 28180, 19 January 1957, Page 3

A DOCTOR AND HIS HOSPITAL

This Hospital Is My Home. By! Dr. S. R. Cutolo. Gollancz.: 317 pp. Dr. Cutolo is the deputy medical 1 superintendent of Bellevue, one of New York s hospitals, and one* of the most famous hospitals ini the world. In his book he creates' 8 comprehensive picture of the remarkable institution in which he has spent his working life—an| institution for which he has both great pride and deep affection. | A hospital that was founded more than 200 years ago—in 1736 1 —is naturally rich in traditions.: Bellevue’s proudest tradition is of never turning away a patient! in need. Situated in a poor! quarter of New York, a hospital! that asks for payment only from! those who can afford it has heavy* calls on its services in a country where the cost of medical and hospital attention can be high. Cn an average day Bellevue has • about 2700 patients in 84 wards.' The General Hospital, which, in; addition to medical patients- also' houses surgical patients and those; requiring specialised services such! as pediatrics, gynaecology, rehab- j ilitation, and eye work, has a bed; capacity of 1733. The Tuberculosis I Hospital has 383 beds, and the! Psychiatric Hospital. 630. There is an average daily outpatient clinic! of 1500. Bellevue has a very! strong medical staff because it is! associated with four New York! medical colleges—Cornell University Medical School. Columbia j University College of Physicians and Surgeons. New York University College of Medicine, and New! York University Post-Graduate Medical School. All the directors' of services at Bellevue are full! professors at one of the four I medical schools. In "all, Bellevue! has 1000 visiting physicians and a house staff of 459 interns and: resident doctors. There are about! 1400 nurses, including 500 student! nurses. These few statistics give some idea of the medical city that Dr. Cutolo writes about. He ably amplifies the statistics. In the course of a personally-conducted tour the reader learns about the vast range of illnesses that are treated, and the medical facilities that are available. With four! teaching colleges entering the hos-' pital in a spirit of friendly rivalry.! there is naturally a constant am-! bition throughout the hospital to produce something new in the way! of research, technique, and treat-! ment. Among the specialised de-' partments through which Dr. Cutolo conducts his readers are the blood bank, the bone bank, and the eye bank. He gives his reader a* glimpse of Bellevue’s artificial kidney, a rare facility which is at the disposal of doctors and hospitals in other States. Original and vital contributions to medical science that have flowed from Bellevue are mentioned, and some of the present work Bellevue’s doctors are engaged on is described. Dr. Cutolo’s story is enlivened! by a number of human stories.; These include a chapter on the! making of a doctor, a process fori which Bellevue becomes directly j responsible when a chosen doctor] has graduated from a medical ■ school. The story of Bellevue's ambulances earns, and deserves, a! chapter of its own. An incidental episode that gives an idea of the! scope of Dr. Cutolo’s informative' story concerns the uses of sirens] on ambulances. Since 1954, no* New York City has been permitted to sound its sirens. The city's Commissioher of Hospitals said that his long experience in the hospital field had convinced him that the use of sirens on ambulances was unnecessary and dangerous. “I have felt for a long time,” he said, “that this practice is just spectacular stupidity. The minute or two of time that might be saved by an ambulance speeding through traffic with siren shrieking does not compensate for the great risk of serious traffic accidents.” The commissioner's directive, which affected 104 ambulances, was followed by a study which confirmed his judgment. A hospital in a densely popu-i lated area must be prepared not] only for daily emergencies, but for occasional catastrophes. Dr. Cutolo describes Bellevue’s or-| ganisation for dealing with large-! scale disasters, and he points his I story by telling of the Normandie] fire, and of the time when a bomber, lost in a heavy fog over the city, crashed into the Empire State Building. The second disaster provides opportunity to record the poignant case of “Miss Sunshine”—a lift operator in the Empire State Building who was alone in her lift on the 80tn floor when the bomber snappea the lift’s cables and caused it to hurtle to the basement. “Miss Sunshine” was restored to health after 18 weeks in Bellevue. Dr. Cutolo describes other dramatic cases, notably the case of the smallpox patient who threw New York into panic. Demands for vaccination were not satisfiea until 6.000.000 persons had been immunised. Bellevue is well known in New York for its Psychiatric Hospital. Indeed, the hospital resents connotations of the phrase which appears so often in newspaper reports of court proceedings—“sent to Bellevue for observation.” Dr. Cutolo is careful to point out that Bellevue is not a place of confinement but primarily a diagnostic and disposition centre —"a halfway house between the maladjusted individual’s problem-filled native environment and the therapeutic and corrective environment to which he will be assigned.” The Psychiatric Hospital receives 17,000 to 18.000 patients a year. The study of their cases is scrupulously careful. Court procedure necessary before a person may be committed to a mental institution is conducted at Bellevue, where a court presided over by a Justice of the New York State Supreme Court sits. The Bellevue Nursing School is ranked as one of the best in the country. Founded in 1873.! it pioneered training practices ini the United States. Dr. Cutolo’slchapter on the modern methods , of training nurses at Bellevue; is of particular interest m view of proposals to introduce Ameri-| can principles for the training of|j nurses in this country. Bellevue j ( —and the United States as a.i whole—suffers from a shortage of j<

trained nurses. A good deal of I ro ,Y'- Ork ’ such as bed-making and bathing, is done, therefore, by attendants and nursing aides. Comment on the Bellevue nurses’ | uniforms leads Dr. Cutolo to . mention an interesting tradition i in American nursing. The part of their uniform of which nurses are proudest is the cap, and for , a particular reason. A Bellevue graduate wears her cap no I matter where she serves after graduation. Each training school ;has its own distinctive headgear; .all are instantly identifiable to ■ members of the medical profession ; by their caps. Two of Dr. Cutolo’s most hearti warming chapters are those telling i of the voluntary work done at ! Bellevue. The 950 women and ;250 men from all walks of life, : who wear the navy blue smock of volunteer workers on Bellevue’s .adult patient wards, are, he says, ! ' “a vital factor in keeping the : hospital running in a way that benefits an institution with a ■ heart.” Dr. Cutolo describes the ! contribution Bellevue’s organised i volunteers make to the hospital’s | emotional climate.” A separate j organisation of volunteers devotes itself to the well-being of child I patients: the special task of the ,200 women of this organisation is to give some of the “tender loving care” that can alleviate the distress of a child in hospital, j '&&&& Finally, Dr. Cutolo looks back over a quarter of a century of | medicine as he has seen it prac- ■ tised at Bellevue. He makes some • interesting observations as he 'measures the strides medicine has | made in that time. Discussing “new” maladies, he makes a i strange point about Bellevue’s 1 “tremendous ulcer caseload.” It is | a curious medical and social . phenomenon, he says, “that we get our highest percentage of perforated, or bleeding, ulcer cases at two specific times of the year —spring and fall. We think this is because income tax worries are prevalent in the spring and postvacation letdown and the prospect of facing aother year of hard work are predominant mental strains in the fall.” The causes j of the two mental strains Dr. I Cutolo mentions coincide in New j Zealand—just about now. Dr. j Cutolo gives some opinions which will interest the layman about | the appearance of virus infections that were unheard of before i the widespread use of antibiotics. The antibiotics, he thinks, have been killing off most of the bacteria that normally inhabited the body. The “new” viruses were always present, but were dominated by the bacteria. After lying in wait, so to speak, their day came when more eminent bugs had been killed off. Dr. Cutolo’s book is an unusually complete story on a subject of general interest. But it . is not only a good story about a • hospital, it is a very good story ! about a very remarkable hospital. SPANISH LIFE Descent from Burgos. By Peter de Polnay. Robert Hale. 191 I pp - ! It is the remoter parts of Spain I less frequented by the tourist that | Mr de Polnay writes about in this .book—such parts as Valladolid. ] Salamanca and Caceres, all having this in common, namely, that in them the past clings heavily to the present. In countless ways he was able to sense the brooding atmosphere of the past that pervaded these places. What struck him most, for example, about the old walls and houses of Caceres was simply this, "that their stormy past refuses to leave them.” Of the houses which lined the streets of Caceres he was led to write: “If a door opened and Francis de Godoy were to come out through it you wouldn’t be surprised. and if he accosted you and said he was sailing for Peru, where he was Pizarro’s lieutenant, you would simply ask him which boat he intended to take.” The author is no newcomer to the country he writes about. As a youth of 17 he toured Spain with • his governess. Shortly before the (Spanish Civil War he lived there ' for over a year, and he revisited | the country in 1951. Repeated visits thus gained him a familiar- | ity with the Spanish scene, added i to which his being a fluent speaker of Spanish equipped him well for the writing of this book. For only to one thus equipped could the country have yielded up its secrets as readily as it did. By getting into conversation with people in hotel bars, or in queues at railway booking offices, or wherever ■ they might congregate, he was able to discover much about their way of life. Beggars he encountered often as he travelled about. In Andalusia poverty stared up at him from the eyes of small children. And there he saw also women in rags. “That poverty”—he writes—“is the country’s great problem, a problem which it will be difficult to solve; for the poor aren’t disgruntled; they accept their lot; and if you give them a few centimes they are happy and consequently gay.” This observation is cited as much for the attitude of mind it reveals in the author as for the situation it describes. Mr de Polnay is not unmoved by the poverty he encounters at almost every turn of his journey; but he fails to appreciate the manifest incompetence of the Government in handling this problem. There is in this book little trace of his having kept a political ear to the ground as he toured the country. Some scattered evidence of admiration for Franco he notes; but of hostility to the regime he has nothing to say. One could hardly expect him to have encountered open hostility in a country where public criticism of the Government is forbidden. And his very silence on this score might well be indicative of the rigour with which free discussion is suppressed. Of the scars left by the Spanish Civil War the following passage from the book gives evidence enough: “A man with one leg came past me on crutches. The night porter of the hotel had one leg too. Spain is the land of onelegged men. so much so that often if you go to a bar you can find out how may customers are there bv halving the number of the crutches. Also it is the land of the blind.” The author found Spanish newspapers flat and dull reading inasmuch as they voiced only official opinion, there being no freedom of the press in Spain. One chapter of the book he devotes to a cock

fight at which he found himself more bored than disgusted at “this useless cruelty;” while in another chapter he discusses the finer points of bull fighting. Indeed, the book touches Spanish life at so many points as to be almost kaleidescopic in the picture it presents. It is written in a quiet, rambling style that makes it enjoyable reading and it contains a number of good photographs.