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From Dispensary to Hospital From Dispensary to Hospital: Public Service Medicine in the American Northwest, 1900-1926 A Thesis Presented to The Division of History and Social Sciences Reed College In Partial Fulfillment of the Requirements for the Degree Bachelor of Arts Isaiah Silvers May 2019 Acknowledgments This project was made possible in part by support from the Oregon Heritage Fellowship and from Reed College’s Initiative Grant in Undergraduate Research. Additionally I wish to thank everyone who has given me friendship and support over the past few years, of whom an incomplete list follows here: First of all, my parents, sibling, aunts, uncles, cousins and grandparents have been with me every day in their love and care. Mom, you taught me the value of hard work and of clear writing. Every day I try to be as thoughtful, kind, and tough as you are. Dad, I learned from you to say the things that I believe. Thank you for always reading my papers. Rosie, you remind me all the time how important family is. Everyone knows how formidable you are, and every day I’m honored to be family to you. I am extraordinarily grateful to all the people I have met at Reed who have made it interesting to be here. To Estella and Grace, two of the most fun people I know, to Oskar, a wonderful conversationalist and San Francisco tour guide, and to Rosie, an excellent director. And there are, of course, many more who deserve mention. Of my professors, I must first thank Jackie Dirks, who has guided me through the work I have been most proud of and who brings compassion to every meeting. I am grateful to Michael Faletra, a nurturing humorist in the classroom, and Doug Fix, whose calm advice and high expectations I cherish. And with all my heart I thank all the history professors whose courses I’ve taken—Margot, Radhika, and David—it has been one of the pleasures of my life to learn from you all. And Carrie, I cannot imagine what my time at Reed would have been without you. You are a comedian of the first rate, a discerning advisor, a confidant, and a co- conspirator. I cannot thank you enough for your eagle-eyed readings of my papers, for your infinite kindness, and for all the ways you challenge me every day. Tu es “mon meilleur ami,” and we are thick as thieves. I wouldn’t have it any other way. Finally, I want to thank the archivists at the Oregon Historical Society and the Oregon Health and Sciences University, as well as Kris, Mary, and Ellen, and all the nurses of OHSU. Your work is a true public service. Table of Contents Introduction ....................................................................................................................... 1 Medicine in the Early Twentieth Century....................................................................... 4 Oregon and the American Northwest ............................................................................. 9 Notions of Public Service ............................................................................................. 12 Chapter 1. The Portland Free Dispensary: Moral Reform and Clinical Care ......... 19 The Origins of the Portland Free Dispensary ............................................................... 24 Expanding to Regular Clinical Care ......................................................................... 27 Defining Public Service Medicine ................................................................................ 30 The Deserving Patient ............................................................................................... 31 A Step Beyond Public Health ................................................................................... 35 Immigration and the Health of the City .................................................................... 38 Sexual Health in Wartime ............................................................................................. 42 Syphilis as a Civic Emergency ................................................................................. 43 The People’s Institute and Prewar Sexual Morality ................................................. 45 The Shift to Clinical Care ......................................................................................... 47 Chapter 2. “Her Unspoken Creed”: The Making of Civic Ideologies in Nursing .... 55 Imagining the Frontier Nurse........................................................................................ 60 The Visiting Nurses ...................................................................................................... 67 Civic Nursing Before the Free Dispensary ............................................................... 69 A Contested Alliance ................................................................................................ 72 The Base Hospital ......................................................................................................... 78 The Return of the Wartime Nurse ............................................................................. 87 Chapter 3. From Civic to Individual Care: The Expansion of the Marquam Hill Campus ............................................................................................................................ 93 A Crisis in Healthcare Delivery .................................................................................... 97 The Limits of Dispensary Care ................................................................................. 98 The Public Call for Hospital Construction.............................................................. 101 2 The Hospitals on the Hill ............................................................................................ 104 Contesting Pediatric Care ....................................................................................... 107 The Hospital as ‘Fairyland’ ........................................................................................ 111 Conclusion ..................................................................................................................... 121 Bibliography .................................................................................................................. 127 Primary Sources .......................................................................................................... 127 Secondary Sources ...................................................................................................... 134 List of Figures Figure 1: View of Ships in the Willamette in the Portland Harbor (1904). ...................... 10 Figure 2: Portland Waterfront and Downtown Looking West (1918). ............................. 12 Figure 3: Wayside Mission Hospital at the foot of Jackson Street (c. 1907).................... 20 Figure 5: Portland Free Dispensary Tuberculosis Clinic. ................................................. 23 Figure 6: People’s Institute Albina Branch Mother’s Club. ............................................. 40 Figure 7: People’s Institute Boy’s Cooking Class. ........................................................... 41 Figure 8: Correctional Exercises—Nutritional Clinic. ..................................................... 47 Figure 9: Portrait of Grace Phelps in Red Cross Uniform (1918). ................................... 62 Figure 10: Parade of Personnel from Base Hospital 46 (1917). ....................................... 81 Figure 11: Occupants of Barracks 4, Base Hospital 46 (1918)......................................... 82 Figure 12: Base Hospital 46 Personnel in Formation (1919). .......................................... 82 Figure 13: San Francisco Training School for Nurses Class of 1895 (1895). .................. 85 Figure 14: University of Oregon Nursing Students (1900). ............................................. 85 Figure 15: Portland Free Dispensary Infant and Pre-School Clinic (c. 1919). ............... 101 Figure 16: Duniway Park Area Looking Toward Marquam Hill (1920). ....................... 110 Figure 17: U.S. Veteran’s Hospital Southwest Portland, Marquam Hill (1930). ........... 110 Figure 18: The First Christmas at Doernbecher Memorial Hospital for Children (1926) ................................................................................................................................. 116 Abstract This thesis explores the use of public service rationales to define the means and ends of charitable care in the urban United States during the early 20th century. Using Portland, Oregon as a case study, I examine the development of several voluntary and charitable health associations. The public service rationales present in these associations included defining of deserving patients, centering industrial efficiency, and connecting clinical care treatment of individuals the wellbeing of the city as a whole. I separate charitable medicine from contemporary public health practices in order to evaluate charitable healthcare in the first decades of the 20th century as a distinctive social and professional formation. In this period, commercial health insurance was not widely available, and those who could not afford physician care had to rely on ad hoc systems of medical delivery. Meanwhile, many social reformers took up the cause of health reform and medical delivery, using medicine as an implement in their attempts to build a more efficient civic body. I argue that in forging alliances with such reformers, medical professionals, and especially nurses, derived novel ideologies of public service medicine by which they construed the city
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