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Joseph Goldberger, who discovered the cause of pellagra; Thomas
Francis, whose inﬂuenza research revolutionized the study of
virus strains; André Cournand and Dickinson Richards, who introduced cardiac catheterization as a clinical tool; and Albert
Sabin and Jonas Salk, who developed the two successful polio
vaccines still in use today. Two of the most inﬂuential ﬁgures-
William Welch, the father of modern pathology in the USA, and
William Halsted, the era's most innovative surgeon-bonded
as interns at Bellevue in the bitter struggle to bring antiseptic
methods to the profession.
By the early 1900s, Bellevue seemed less a city hospital than a
hospital city, with 2000 beds, a nursing school, the city morgue,
a massive psychiatric pavilion, a special prison ward, top-ﬂight
laboratories, a maintenance force of 4000, and a medical staﬀ
provided by the three best medical colleges in New York. A major
facelift came in 1973 with the addition of a 25-story patient
tower. The impact on New York City was dramatic.
Bellevue today remains a buttress against unforeseen crises
that periodically arise. Its resilience was displayed in the heroic patient evacuation during Superstorm Sandy, the largest
storm ever recorded in the Atlantic Ocean, with a diameter
approaching 1000 miles. It hit New York City full on October
29, 2012, when the hospital became ﬂooded and its elevators
went out of service. The staﬀ began carrying patients down
the stairwells led by medical students and residents holding
ﬂashlights. Houseoﬃcers were dispatched with oxygen tanks to
the beds of every ventilated patient. Intravenous infusions were
converted to subcutaneous injections, and prescriptions ﬁlled
by ﬂashlight were taken by medical student runners to various
ﬂoors. The National Guard arrived, and together with physicians, nurses, medical students, technicians, and secretaries they
passed 5-gallon jugs of gasoline hand-to-hand until the jugs
reached the backup generators on the 13th ﬂoor. If the jugs
stopped moving and the generators died, so would patients.
No patients died. The bucket brigade staved oﬀ disaster, and all
700 patients were saved, including surgical patients, alcoholics,
drug addicts, hundreds of psychiatric patients, and 61 criminal
patients locked up on the 19th ﬂoor. Superstorm Sandy closed
the hospital for the only time in its history. Bellevue reopened a
few months later. The patients it currently serves are every bit as
poor and needy as the patients who preceded them in centuries
past. Those with viable options almost always wind up going
somewhere else. That is what makes Bellevue so comforting
and so disquieting. It stands for all its troubles as a vital safety
net-a place of last resort.
GUNS IN THE USA
Individuals in the USA own far more guns than populations
of any other country in the world (3, 4). In the USA there
are 114 guns per 100 citizens. The US gun-ownership level
in 1968, 48 years ago, was 56 per 100 people, or half of what
it is today. The estimated number of civilian-owned guns per
100 people in other countries is as follows: Serbia, 76; Yemen,
55; Switzerland, 46; Cyprus, 36; Saudi Arabia, 35; Iraq, 34;
Uruguay, 32; Sweden, 32; Norway, 31; France, 31; Canada,
31; and Australia, 22. There are >33,000 gun deaths annually
April 2017

in the US, according to averages from 2014 to 2016. Terrorism
and mass shootings grab the headlines but make up a small
percentage of US gun deaths, numbering 45 in 2016. Other
deaths, by comparison, include armed toddlers, 21; lightning
strikes, 31; and lawnmowers, 69. Since the mass shooting at
Sandy Hook Elementary, an American child under age 12 has
died by intentional or accidental gunﬁre every other day. More
than half of all homicide victims are young men and two-thirds
are black. Among blacks, 82% of fatalities are homicide and
18% are suicide, and among whites, 23% are homicide and 77%
are suicide. Gun manufacturing is big business in the USA. The
2015 revenue from manufacturing guns and ammunition was
$15 billion; that's more than the 2015 combined government
funds for medical research.
Gun deaths in Australia have dropped dramatically since
1996 when its buyback program began (5). Since the massacre that year in Australia, where 35 people were killed and
23 wounded by a semiautomatic riﬂe used by a 28-year-old
man on the island of Tasmania, off the southern coast of
Australia, the country's criminal justice system quickly held
Martin Bryant responsible, and he is serving a life sentence.
Just-elected Prime Minister John Howard, a conservative, led
the charge for a bipartisan deal with state and local governments
to enact far-reaching gun laws. A conservative-led government
action contradicts those who maintain that the gun problem
is unconquerable, that smart laws cannot make a diﬀerence.
Australia put its national ﬁrearms agreement into action within
2 months of Bryant's rampage. The law prohibits automatic and
semiautomatic assault riﬂes and pump action weapons; it also
requires residents who already owned high-powered long guns to
sell them back to the government. More than 650,000 ﬁrearms
were handed in, at a cost of $350 million funded by a temporary
federal tax. The law also made buying other guns more diﬃcult.
People now must pass a safety test, show good moral character,
and wait at least 28 days to make their purchase. And they must
qualify under carefully deﬁned "genuine needs" to own a gun.
Private sales are prohibited, and all weapons must be individually registered to their owners.
In the two decades prior to the reform, Australia saw 13 fatal
mass shootings, deﬁned as those with ﬁve or more victims. In the
two subsequent decades, not another mass killing has occurred!
The law also appeared to accelerate a reduction in ﬁrearm-related
homicides and suicides without prompting a rise of alternative
means of death. Thus, an intervention designed to stop mass
shootings also has limited other gun-related deaths. The daunting size of America's gun violence does not have to paralyze us.
Large-scale change is possible.
GUN-RELATED VERSUS MOTOR VEHICLE DEATHS IN THE USA
For the ﬁrst time in decades, the annual number of gunrelated deaths in the US is expected to surpass the annual number of automobile fatalities (6). In 2013, the most recent year
for which data is available, motor vehicles killed 33,804 people
and ﬁrearms killed 33,636, according to the US Centers for
Disease Control and Prevention. Firearm deaths and injuries
pose a major public health problem.

Facts and ideas from anywhere

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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017