| Summary: | In this address, presented at the first medical staff meeting of the Seattle-Doctors Pavillion, Dr. Bodemer outlines the history of the development of Seattle hospitals, and gives historical context for the merger of Swedish Hospital, Seattle General Hospital and The Doctors Hospital, writing, "My function this morning is to describe the early development of hospitals in Seattle. I shall cast a somewhat wider temporal and geographic net than that, however, in order to provide some insight into the factors that have determined the development of hospitals in the Pacific Northwest and to place the recently accomplished merger into historical context." THE EARLY DEVELOPMENT OF HOSPITALS IN SEATTLE by Charles W. Bodemer Professor and Chairman Department of Biomedical History University of Washington School of Medicine Seattle, Washington First Medical Staff Meeting Seattle-Doctors Pavilion 19 June 1980 THE EARLY DEVELOPMENT OF HOSPITALS IN SEATTLE by Charles W. Bodemer Dr. Ostrow decided that for this initial meeting of the Seattle- Doctors Pavilion Medical Staff it would be appropriate to examine the historical background to the merger of the former Seattle General Hospital, The Doctors Hospital, and Swedish Hospital Medical Center. I was honored to be asked to participate in this meeting, since, like the merger itself, this meeting is, indeed, an historic occasion. My function this morning is to describe the early development of hospitals in Seattle, as prelude to Dr. Lobb's discussion of Swedish Hospital. I shall cast a somewhat wider temporal and geographic net than that, however, in order to provide some insight into the factors that have determined the develop ment of hospitals in the Pacific Northwest and to place the recently accomplished merger into historical context. It's quite easy for those of us under two hundred years of age to conceive of hospitals as we know them extending back into history for centuries on end. This natural tendency tends to obscure the fact that the hospital in its present form has been shaped by the needs of society and reflects not only its attitudes, beliefs and values, but also its economy. It has been shaped especially by the dramatic changes in medicine during the past half century. Thus in order to gain greater historical perspective I would like to devote a few minutes to considera tion of the origin, nature and purposes of hospitals in the United States at a time when the Pacific Northwest was marked on maps as The Great American Desert and the only white presence was an occasional scorbutic Spanish maritime expedition. The earliest hospitals in the United States were primarily social institutions of different orientation and purpose than contemporary hospitals. The first hospital to be founded in the British colonies of North America appears to have been St. Philip's Hospital in Charleston in Carolina. This institution, which was built in 1736 to serve the paupers of St. Philip's parish, was only remotely related to a hospital in the modern sense. It was characterized as "a good, substantial, and convenient Hospital, Workhouse, and House of Correction." In line with its multiple functions the warden was authorized "to take, besides his salary, fees and profits from the inmates or their labour, and to use fetters or shackles or moderate whippings on the inmates, or to abridge them of their food if the necessity arose." The hospital did care for the indigent sick of the parish, and to supervise this service a physician was employed at a regular annual salary. The purposes of the institution were threefold: in part, they were economic: to increase manufactures, provide productive work for the able-bodied, and to end unemployment; in part social: to punish wilful idleness and to maintain public order; in part religious and moral: to relieve the needy, the ill and the suffering, and to provide correction of unacceptable behavior. The first American hospital, then, represented a religious, social and economic institution, with health care an almost incidental part of its role. The St. Philip's Hospital passed out of existence shortly after the Revolutionary War, but the sentiments which underlay its foundation endured and were important in development of some hospitals more than a century later on the Pacific Northwest frontier. The only permanent public general hospital to be established during the colonial period was the Pennsylvania Hospital, founded in 1751. The motives underlying establishment of this hospital are clear from the statement of one of its founders, Benjamin Franklin: "Observing the distress of homeless distempered poor and those disordered in their senses, as those with homes, but badly accommodated in sickness, there being no place except the House of Corrections in which they might be confined, some citizens did charitably consult together on the best means of relieving the distressed, and an infirmary or hospital, in the manner of several lately established in Great Britain, was generally approved." Around the middle of the eighteenth century, in England and Scotland a number of new hospitals were established which adhered to the tradition of caring only for the poor, but turned their attention increasingly to the provision of medical and surgical care, gradually excluding the workhouse and correction house functions. It was this variety of hospital Franklin referred to, and thus the Pennsylvania Hospital was a hospital without workhouse or correctional connotations. Moreover, attending physicians soon began to bring their apprentices with them to the hospital. In time this became formalized, and the hospital acquired a teaching role, providing the first in-hospital instruction for medical students. The first two hospitals in this country reveal the ethic underlying the early development of American hospitals and the differences in institutions depending upon time and the prevailing social environment. In each instance the primary motivation toward establishing the hospital was social, not medical. This was true also in the developing Pacific Northwest. * * * It's appropriate for several reasons to begin discussion of the early hospitals in the Pacific Northwest with the development of its first permanent hospital. The early history of what is now Oregon and Washington was dominated by the fur trade and the most important trading post. Fort Vancouver, on the northern bank of the Columbia River. As the fur trade began to decline, missionaries moved into the Oregon country to spread the faith and to encourage immigration of white settlers into the wilderness. Jason Lee, in the Willamette Valley, and Marcus Whitman, near Walla Walla, were especially important in starting the westward migration of the mid-nineteenth century and establishing nuclei of settlement in the Far West. The Pacific Northwest population increased, especially after the California Gold Rush, and at mid-century there was a clear need in the more established communities for some social services. Thus at the request of the Jesuits, five Montreal Sisters of Charity of Providence began their ministry at Fort Vancouver in 1856, performing a variety of charitable works. Two years later, when the Sisters were asked by a multi-denominational group to care for a homeless young tubercular, they conceived the idea of building a small hospital. The lead fell to the Superior, Mother Joseph of the Sacred Heart. This remarkable woman could, with equal dexterity, do embroidery, iron work, wood carving, masonry and carpentry. In Vancouver, with one workman. Mother Joseph remodeled a small building she had just built as a bakery, and in June, 1858, St. Joseph Hospital opened its doors to become the first permanent hospital in the Pacific Northwest. This was, as we'll see, only one of the accomplishments of Mother Joseph. In 1861 the Sisters were asked to care for a homeless, mentally deranged young woman. This led to the eventual development of a complex of public institutions. The historical wheels had been set into motion earlier, two hundred miles to the north. In 1854 a sailor named Edward Moore was found wandering on a beach near the small village of Seattle. His feet were frozen, and he was totally irrational. After several weeks' care in the local hotel Moore was still alive; he was also still irrational, a condition not likely to have been improved by the earlier amputation of his gangrenous toes with Seattle's only surgical instrument, a dull axe. Arrangements for the care of this "non-resident lunatic pauper" were made with a Steilacoom physician, and the Territorial Legislature was requested to assume the incurred costs. This august assembly responded with a resolution, affirming that the "case is one that should touch all the finer feelings of our nature," but declined to pay. The Legislature's reluctance was understandable when it revealed that the bill for Moore's care was $1,659 and the Territory's total income that year amounted to $1,199.50. Moore was then shipped back to Seattle; Seattle's citizens put him on the first ship to San Francisco; the San Franciscans placed him aboard the first ship to Boston, and he no longer bothered anyone in the Far West. The frontier harbored a raw and harsh society, in which Social Darwinism was a reality. The lot of the mentally ill was especially hard in this setting. But the population was growing rapidly, reaching 65,000 in the early 1860s, and the Territorial Legislature recognized that something had to be done. Thus in 1862 the Territory of Washington awarded the Sisters of Providence a contract to provide lodging, board, laundry and medical attendance for the mentally incompetent. The significance of this contract is in the assumption of governmental responsibility for the provision of health care. Thenceforth, the government played an increasing role in this regard, and when, in 1871, the Territory acquired land and buildings from the Army, the Legislature created the Western Hospital for the Insane. In approximately one decade the care of the indigent mentally ill had progressed from a charitable act to the establishment of a Territorial institution and the beginnings of a statewide hospital network. * * * Soon after the Territory effected its contract with the Providence Sisters the first hospital in Seattle and King County came into existence. The institution didn't long outlive its founder, but it was the first step in the development of a county health care system, and its founder, David S. Maynard, M. D., played a crucial role in the development of Seattle. Moreover, Maynard Hospital, the spirit of which resides, once-removed, in this modern complex through the recent merger, was named in his honor. Maynard was colorful, but I can only sketch an activity profile of this medical aurora boreal is. In 1850 Maynard left a wife in Cleveland and headed for the California Gold Fields. Two years later, however, he was located at the southern tip of Puget Sound, a victim of the power of love. On the Oregon Trail Maynard had attended a terminal cholera victim, whose attractive widow, he decided, was "badly in need of doctoring." He thereupon, as his diary notes, "shifted his duds into the widow's wagon," better to provide, one assumes, an early form of comprehensive care. Since the widow was going to Tumwater, Maynard forsook the sunny California skies for the grey overhead of Puget Sound. After several misadventures, Maynard chopped 400 cords of wood, sold it in San Francisco, and with the proceeds bought hardware goods, returning to open a store in Tumwater. Such exotic business practices as giving away his goods toward the end of the day, when the full effect of the grape was upon him, neither aided his business nor endeared him to competing business men. Everyone thought things would improve when he left in 1852 to help found the city of Seattle. The first building in Seattle was Maynard's log cabin, the "Seattle Exchange," from which he practiced capitalism, boosterism and medicine. When the Territory of Washington and King County were created, Maynard acquired various offices and his Seattle claim was designated the county seat. He married the Widow of the Wagon and occupied himself with various legislative and administrative matters, marriages, prosecutions, trials, supervising the school district, managing a store, practicing medicine, serving as Indian Agent, and manning the blacksmith shop. It's not surprising that Seattle originally developed on Maynard's claim. In 1863 Maynard opened the Seattle Hospital on First Avenue, between Main and Jackson Streets. He was chief surgeon, and his wife, who had no formal training, was in charge of the lying-in department. The institution, like Maynard, was a financial child of sorrow, and it closed soon after his death in 1873. In 1887, his widow, signing herself Mrs. Dr. Maynard, opened the Maynard Hospital one mile from Ellensburg. Except possibly in spirit, it was not related to the 20-bed Maynard Hospital that opened in Seattle in 1933, functioning on the premises of the earlier Martha Washington 8 Hospital on Summit Avenue until it was acquired by Seattle General Hospital in 1971. * * * Between 1863, when the Territory awarded the first contract for medical care, and the time of Maynard's death in 1873, significant changes occurred in the Pacific Northwest. The frontier was becoming settled, and the population had begun to accept the need for tax-supported social services The idea of public Territorial institutions, maintained through public agencies, had gained credence, and an environment was emerging which was fundamental to the further elaboration of a more complex and inclusive social welfare program. It was a developmental process, occurring in the presence of attenuated traditions, where abuse and error accompanied the freedom of the frontier. But as the frontier evolved so, too, did the sense of community and social responsibility. It is evidenced not only by the development of the Territorial Asylum for the Insane, but by the development of hospitals at the local level. King County early acknowledged some responsibility for the indigent sick by payment to individuals for their care. Maynard and his hospital were a part of this arrangement. Four years before his death, however, an event transpired which was destined to change this primitive system. In 1869 the county fell heir to a farm in Georgetown, along the Duwamish River. It was originally a white elephant, and the county was therefore amenable to leasing it to John W. Pinell, a figure who, for reasons that soon will be apparent, it not hailed as one of the City Fathers, but who looms large in the early history of Seattle and the county medical system. Pinell arrived in Seattle in 1861, when it had 600 inhabitants, 500 of them young, unmarried and masculine. Even the newspapers lamented the rather sorrowful state of the men in the village: if they had any libido at all, they were faced with a problem. The town was too small for adultery and there were few unattached white women. The only feminine companionship available was Salish Indian girls. The cultural background of these girls made them easily available, but their cosmetic and hygienic practices made them less than appealing to the young men of Seattle, who were hardly models of personal hygiene themselves, but thought they smelled better. Pinell, fresh from San Francisco's Barbary Coast, was astute enough to recognize the potential for profit in this little town by Elliott Bay, and within a month after his arrival, there arose on the sawdust fill immediately south of what is now Yesler Way, a frame building named the Illeah and offering music, dancing, drinking, and well-scrubbed Salish girls. The Illeah soon resounded with the stomps of hobnail boots and caulks, and Maynard's claim was on its way to becoming Skid Road, truly rivalling in debauchery and reputation San Francisco's Barbary Coast. Afew years after opening the Illeah, Pinell secured a lease on the county farm in Georgetown. Soon thereafter the more bourgeoise residents of Seattle were obsessed with stopping the metastatis of vice from Skid Road, and there was a call for a moral clean-up. The county wasn't terribly interested in keeping the Duwamish farm, but it was interested in securing a new location for the county building. It was also concerned about the way in which Pinell's tract near the Mill had become the growth center of what were called squaw dance halls. Thus in a strategem intended to accomplish all its goals, it was ordered that the county buy Pinell's land for the purpose of building thereon a court house and jail, with the 10 provision that Pinell not sell or dispense liquor on that block in Maynard's plat. The exchange of deeds was effected; Pinell cleared $2,000; the county owned a whorehouse. Pinell and the county commissioners were happy, but the courts weren't, so a new order resulted in the county regaining the farm and Pinell his land and a retail liquor license. No longer a corporate madam, the county now had the Georgetown farm back on its hands, and the Commissioners attempted to make it less a liability by placing it in the service of the indigent and sick. Thus the county advertised in an 1877 edition of the Weekly Intelligencer for bids for "a lease on the county farm for one year, conditioned that the leasee will board, nurse and care for the county poor at a stated price per day for each person—said leasee to have the labor of said poor when they are able to work—the county to furnish medical, medicinal and surgical aid and suitable buildings, beds and clothing for said poor." Two local physicians were awarded the contract for medical and surgical attendance, and Emil Kauten was awarded a contract for lease of the farm to care for the county poor. In this second contract the stage was set for the eventual emergence of the county medical system. Kauten was the young assistant to the Reverend Prefontaine, pastor of Our Lady of Good Help, Seattle's only Roman Catholic church. He immediately called for that combination of the Little Red Hen and Johnny Appleseed, Mother Joseph. Soon thereafter three Sisters of Providence arrived in Seattle, took possession of the farm, and accepted their first patient. The county farm had room for only ten patients, so in 1878 the Sisters moved to Fifth and Madison into a residence which had been converted into a hospital. The building was still referred to as the poor house, and to 11 improve its image the Sisters nailed to the front wall a sign reading Providence Hospital. In 1885 a building was erected at the county farm, and the Sisters were again given the contract to provide care, which they did at both the farm and hospital until 1887, when the physician-superintendent of the farm contracted to provide medical services. Providence Hospital expanded, with Mother Joseph as architect and general contractor, for the rest of the century, and in the early 1900s it was the largest hospital in the Pacific Northwest. Then, in 1910, this time without Mother Joseph, a new Providence Hospital was erected at its present site bounded by Jefferson and Seventeenth. Meanwhile, back at the farm, a new King County Almshouse and Hospital was erected in 1893. King County Hospital remained at the Georgetown site through different phases until, as a result of the concerted action of the King County Medical Society and others it was possible to lay the cornerstone of Harborview Hospital in 1930. The old building was abandoned in 1956; by that time Harborview and the entire county medical system had developed into a large enterprise serving more than the indigent sick alone. * * * Not every hospital founded in early Seattle was a success story. Witness the Grace Hospital: born 1886, died 1893. The hospital was quite successful at the outset, and it was supported actively by a number of local physicians. Its main interest to us is that in this region, which pioneered in prepaid health schemes, the pattern was established 12 as early as the 1880s. To recruit would-be patients, the administrators of Grace Hospital undertook a program of selling bonds in exchange for possible future hospital care. Under the arrangement, the bonds could be purchased for $5 or $10 a year, authorizing the purchaser in case of illness or injury, full and complete "free" hospital care, without any additional costs. Nonetheless, Grace Hospital didn't prosper, and even though it eventually offered free medical care, it never saw the twentieth century, when prepaid health plans would become commonplace. The devastating fire which swept Seattle in 1889 destroyed some thirty key business blocks, but it also turned the city in new directions. Still lusty, its frontier spirit intact, the city was rapidly rebuilt, this time with brick and mortar rather than wood structures. This gave the town an air of permanence that hadn't been indicated clearly when it resembled a fly-by-night logging camp and Skid Road competed with the Barbary Coast for the Sodom and Gomorrah award. Seattle was gaining on Tacoma and Portland: in 1890 Seattle's population stood at 42,837, compared with Tacoma's 36,006 and Portland's 46,385; moreover, it appeared the city's complexion of trade was becoming less reliant upon exports alone. Part of this was due to James Hill, builder of the Great Northern Railroad, who hated hauling empty boxcars east after carrying Midwest goods to the ports. Hill arranged, as only the nineteenth century railroad barons could, to have products flowing in both directions. Between the Great Fire and the Alaska Gold Rush at the turn of the century Seattle's population grew to about 60,000. The city's medical 13 needs were served by over one hundred physicians, the King County Hospital and Providence Hospital. During that period the third hospital in Seattle came into existence, its fortunes, like so many enterprises in Seattle, destined to be greatly enhanced by the Gold Rush. There had long been an interest in establishing a non-Roman Catholic hospital in a predominantly Protestant city not known for its racial or religious tolerance. Thus it was that in 1894 a group of civic-minded women began to work toward that goal. The following year, they, physicians and businessmen rented Avon House, at what is now First and Broad Streets. It was a three-storied frame structure, constructed five years before to accommodate fifty patients. As the new Seattle General Hospital, it became a private Protestant institution. Three years later the hospital moved into the Sarah Yesler home on Second Avenue North and Republican Street. It was not doing exceptionally well. Then, in 1899, the Deaconess Home Association was formed as an affiliate of the Methodist Church, with the purpose of founding a hospital. This organization arranged to assume the assets of the Seattle General Hospital and agreed to keep its name. Enter now Thomas F. Lippy. Lippy had been a physical training instructor at the Y.M.C.A. before he was caught up in the Gold Rush. Returning from the Klondike with nearly two million dollars—when dollars didn't have their present high rubber content--he devoted his fortune to investments and charities. His imagination and Methodist loyalty was caught by the energetic supporters and the fine staff of the Seattle General Hospital, and he was instrumental in having a new brick Seattle General erected at Fifth and Marion in 1900. The hospital prospered so that 14 within five years it was necessary to add a wing. This was especially rewarding to members of the medical staff like Drs. Smith, Eagleson and Coe, who earlier had leased the ill-fated Grace Hospital. It's significant that Seattle General Hospital established a School of Nursing in 1900. The School survived only thirty-eight years, but its establishment reveals a phase in the development of American hospitals, begun during the latter part of the nineteenth century. Seattle General also gave birth to another hospital. The accouche ment was midwifed in 1907 by a group of volunteer women who, upon learning that there were no facilities available, pledged themselves to "establish and maintain a hospital for the care and treatment of children. To make useful members of society out of those afflicted or deformed from birth or as a result of accident or disease." A dozen physicians volunteered their services, and a seven-bed "Children's Orthopedic Ward" was established in Seattle General Hospital. The following year a separate hospital was built on Queen Anne Hill. In 1953, having long since outgrown its facilities. Children's Orthopedic Hospital opened a new facility at its present location in the Laurel hurst area. The early decades of the twentieth century were a time of increasing interest in children and child welfare in the United States. It was a dramatic time in the development of a variety of programs, ranging from free milk in the schools to psychiatric clinics, all aimed at improving the lot and social utility of American children. Seattle's Children's Hospital is a prime example of that force operating throughout the country; indeed, the pledge of its founding volunteers reads like a manifesto of the child welfare movement of the Progressive Era. 15 At the beginning of this century there were three hospitals in Seattle; now that number has almost trebled. Population growth and urbanization help to explain the increase. Thus, the third of the hospitals involved in the recent merger, The Doctors Hospital, arose primarily in response to the tremendous influx of armed forces personnel into the Seattle area during World War II. It was established in 1944, aproximately forty years beyond the period my presentation is supposed to include. I may note, however, that it's indicative of the vigor associated with Doctors Hospital that its founders were able to secure government release of controlled materials to construct a new hospital at a time when Genghis Khan would have had difficulty getting release of so much as an extra food stamp. Furthermore, although by the standards of antiquity I have dealt with today. Doctors Hospital developed late, it always had close association with Seattle General, and its location at Ninth and University was the site of a former Denny family home. These two associations provide a kind of link between Doctors Hospital and pre-twentieth century Seattle. Urbanization and population growth are important, but they alone don't suffice to explain the modern growth of hospitals. During the nineteenth century hospital care was mostly nursing, and the hospital remained essentially an institution for the sick poor. Not until late in the nineteenth century could hospitals be said to benefit any substantial number of patients, and this was the result of the dramatic advances in medicine. During the first half of the twentieth century the hospital 16 gradually moved toward a central position in care of the sick. Many factors contributed to this, among them, a better control of intramural infections by antiseptic and aseptic methods, the increase in the amount and complexity of surgery and the consequent need for well-designed, well-equipped, and competently staffed operating rooms, a recognition of the importance of well-organized and skilled nursing care, the need for centralization of expensive laboratory and X-ray equipment to serve many physicians caring for many patients, and the change in the hospital's image from that of a death-house to that of a haven where illness could be cured and lives saved. In the past half century scientific and technological developments have contributed so heavily to the diagnosis, treatment and prevention of disease that the physician can no longer work effectively without the modern apparatus and the specialists and technicians centralized in the hospital. The emergence of the hospital as a health center has thus been occasioned by the success of medical science, and the physician has changed from an intuitive, independent artist far removed from the hospital to a scientific artist, heavily dependent upon the hospital with its centralization of specialists and expensive machinery. The consolidation of services and the evolution of major tertiary care medical centers, such as this Swedish Hospital Medical Center complex, has been an inescapable consequence of the changes in society, medicine and the role of the hospital occurring during this century.
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