John Salvaggio. 406 pages. Baton Rouge, Louisiana: Louisiana State University Press; 1993. $45.00.

Is the large urban public hospital an anachronism destined for decline or a resilient institution poised for rebirth? Dr. John Salvaggio sets out to answer that question in his new book, emphasizing Charity Hospital of New Orleans, one of the nation's venerable and famous city hospitals. As an administrator, researcher, and professor of medicine at Charity, Salvaggio is an insider well versed in the intricate details of the hospital's past.

Charity's story is a long and fascinating one. The hospital traces its origins to French colonial America in 1736, when Jean Louis, a French sailor employed by the Company of the Indies, founded L'Hopital des Pauvres de la Charite. Over the course of the next two centuries, the hospital grew tremendously and established itself as an important teaching and research institution. The past quarter century has been less auspicious. As public expenditures have dwindled, the institution has contracted in size, the standard of care has deteriorated, and its once sought-after residency positions have lost prestige.

Caught in the raucous maelstrom of Louisiana politics and the fractious rivalry of two medical schools jockeying for control, Charity's fate has been star-crossed. The hospital has often been underfunded and overcrowded, even in the glory days of the mid-twentieth century. Salvaggio successfully captures this colorful and complex past in his crisply written narrative.

The author has made good use of hospital records, newspapers, journals, and previous histories of Charity Hospital. He has interviewed many important figures and effectively incorporated the information. He provides an extensive bibliography and excellent index. A small but satisfying selection of photographs is also included.

As the only comprehensive, single-volume account of one the nation's oldest city hospitals, Salvaggio's book deserves to be read. However, his obvious love for the institution impairs his objectivity and leads him to a more optimistic analysis and conclusion than the historical evidence suggests. What is missing in this book is sufficient consideration of the extensive secondary literature on the history of the American hospital and the implications of Charity's story for that history. Its demise is not unique. In light of a rekindled interest in health care reform, which would eliminate the segregation of indigent patients in the present separate, unequal system, the great city hospital may indeed be nearing extinction.