A Hospital for Maine: The History of Maine Medical Center A Hospital for Maine explores the evolution of patient care, education, and research through the microcosm of the state’s first and foremost general hospital.

From the days before antiseptic surgery, when the kitchen table was often safer than a hospital amphitheater, to the robotic procedures of the 21st century, it is a history of progress.

From the decline of diphtheria, tuberculosis, and polio to the rise of diabetes, AIDS, and new strains of influenza, it is a history of public health and patient safety.

From the revolutionary reforms of Florence Nightingale to MMC’s status as a Magnet® recognized hospital, it is a history of the nursing profession.

From the first Obstetrics Department to the Maine Medical Center Cancer and Neuroscience Institutes, it is a history of medical specialties and subspecialties.

From the merger of Maine General Hospital, the Maine Eye and Ear Infirmary, and Children’s Hospital into Maine Medical Center and on to the MaineHealth network, it is a history of collaboration.

A Hospital for Maine is a celebration of the people who have made MMC the award-winning institution it is today, a century-plus snapshot of a history very much in the making. A Hospital for Maine: The History of Maine Medical Center

By Martha Fenton

With research and textual contributions by Susan Dudley Gold and James Hayman A Hospital for Maine: The History of Maine Medical Center

“A tree trunk the size of a man grows from a blade as thin as a hair.

A tower nine stories high is built from a small heap of earth.”

Lao Tzu A Hospital for Maine: The History of Maine Medical Center Contents

Copyright© 2012 by Maine Medical Center. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, Pr o l o g u e : The Long View 01 without permission in writing from the publisher.

Pu b l i s h e d b y : Maine Medical Center Portland, Maine Pa r t On e : The Rise of Maine General Hospital 04 Martha J.M. Davoli, APR, Editor Jocelyn Leadbetter, MLIS, Archivist Chapter 1: Life Before Hospitals 05

ISBN: 978-0-9797394-0-8 Chapter 2: A Hospital Is Born 13 Printed in the United States. Chapter 3: The Founding Physicians 23 Wr i t t e n b y : Martha Fenton Chapter 4: Running a 19th Century Hospital 31 Portland, Maine Chapter 5: The Professionalization of Nursing 47 De s i g n e d b y : Kirsten Schultz Design Yarmouth, Maine Chapter 6: The Reform of Medical Education 54

Illustrations b y : Bruce Hutchison Pa r t Tw o : A New Century, New Challenges 62 Portland, Maine

Pr i n t e d b y : Chapter 7: The Best of Times, The Worst of Times 63 PrintComm Flint, Mich. Chapter 8: Roaring Into the Twenties 74

All images courtesy of Maine Medical Center Archives Chapter 9: Surviving the Crash 87 or Creative Services, unless otherwise noted. Chapter 10: War and Peace 99 Front cover, Maine General Hospital, circa 1876.

Frontispiece, student nurses and house doctors in Maine General Hospital’s surgical amphitheater, 1917. Back row, left to right, C. Earle Richardson, MD, Irene Helf, Jennie Littlefield, Elmira Foote, Jane Monteith, Sybil Kemp, Zilpha Harper; front row, left to right, George O. Cummings, MD, Adelaide Wallace, Maude Quinn, Dorothy Potter, Lillian Jones, Grace Lowry, Edna Nye (partially shown). Contents Contents

Pa r t Th r e e : Three Become One 110 Pa r t Fi v e : A New Millennium 224

Chapter 11: The Birth of Maine Medical Center 111 Chapter 23: Rising to Meet New Challenges 225

Chapter 12: Cardio Revolution and the Roots of Research 126 Chapter 24: Shining a Light on Research 237

Chapter 13: Politics and Progress 133 Chapter 25: Nursing in the New Millennium 246

Chapter 14: The Beat Goes On 137 Chapter 26: The Quest for Quality 254

Chapter 15: The Pace of Change Quickens 146 Chapter 27: Continual Evolution 263

Chapter 28: Toward a Healthier State 280

Pa r t Fo u r : A New Corporate Structure 158 Chapter 29: A New Model for Medical Education 284

Chapter 16: Sea Change: The Andrews Era 159 Chapter 30: The Next Horizon 295

Chapter 17: The New Nurse 166

Chapter 18: L.L. Bean and Beyond 171 App e n d i x A: Clinical Departments and Divisions 299

Chapter 19: Three Spokes Turn the Wheel 181 App e n d i x B: Past Chairmen of the Maine Medical Center Board of Trustees 300 Chapter 20: New Pastures, New Priorities 196 Ac k n o w l e d g e m e n t s 303 Chapter 21: Of Missions and Mergers 205

Chapter 22: Bringing Pediatrics Home 213 No t e s 306

In d e x 315 Genesis On September 8, 1997, President and CEO Vincent S. Conti convened a group of former chairmen of the Maine Medical Center Foreword Overseeing the development of this publication has been extremely rewarding for me. Board of Trustees to propose As President and Chief Executive Officer of Maine Medical Center, I am a part of the a written history of the history of this great institution, along with countless others. To read and learn of this institution. All in attendance history has been fascinating. thought it a very good idea. As with any historical piece of this magnitude, material for this book was drawn from many sources, including documents and photographs from the Maine Medical Center Archives, histories, journal articles, newspapers, and interviews. We have tried our very best to accurately represent the highlights and many proud achievements of this institution. Accomplishments are rarely attributable to the vision of one person, but involve the talents and abilities of many individuals. Dennis Welsh Photography I am honored to be a member of the Maine Medical Center family. This publication pays tribute to all who have made it great. Dedication To the 6,213 hardworking Former chairmen of the Maine Medical Center Board of Trustees. employees of Maine Medical Center Back row, left to right, Roger F. Woodman, Hugh C. Saunders, Merton G. Henry, Owen W. Wells; front row, left to right, John R. DiMatteo, Bettsanne Holmes, H. Halsey Davis. and the untold thousands who Missing from photo, James L. Moody, Jr. have come before, this book is respectfully dedicated. Richard W. Petersen President and Chief Executive Officer Maine Medical Center 2011 +

Although Casco Bay and the White Mountains remain much as they were, the view from Bramhall Hill has changed a bit since that description appeared in the Transactions of the Maine Medical Association in 1870. The “quiet little villages” have grown into cities and towns, and Portland sprawls well beyond its original area—but when it comes to change, the hospital itself has outpaced them all.

As of 2011, Maine Medical Center was an award-winning tertiary care facility with 637 beds, an acclaimed teaching hospital, and a world-class research institute. More than 6,000 people worked in its employ, on Bramhall Hill and beyond. It was among the country’s consistently highest rated hospitals, judged fourth on a list of “50 Exceptional U.S. Hospitals” by Consumer’s Digest, and ranked among the 50 safest hospitals by the Leapfrog Group. It was among only five percent of U.S. hospitals to achieve Magnet® recognition, and many of its clinical departments have earned accolades in their own right.

But Maine Medical Center wasn’t always as big, as complex, or as widely recognized. Its story begins with a brand new general hospital, struggling to define what such an The Long View institution should embody in the latter half of the 19th century. It is the story of Prologue: committed individuals—doctors, nurses, directors, trustees, philanthropists, visionaries, and volunteers—and of the community that embraced them.

On the one hand, the blue waters of Casco Bay, broadening out into the ocean; on the other, In the words of Winston Churchill, “History with its flickering lamp stumbles along Top to bottom, Maine Medical Center’s Bramhall, Brighton, and Scarborough the trail of the past, trying to reconstruct its scenes, to revive its echoes, and kindle a lovely inland scene, the White Mountains looming up grandly in the distance, woody hills campuses. and verdant valleys intervening, with quiet little villages dotting the landscape, and here and with pale gleams the passion of former days.” This narrative attempts to reconstruct there a glittering lake or winding river…1 some of the scenes that illustrate our hospital’s history, highlighting milestones, leaders, clinical growth, physical expansion, mergers, and more as it traces Maine Medical Center’s evolution along the current of medical advancement.

1 Part One: The Rise of “Th e l i f e o f a m a n c o n s i s t s n o t i n s e e i n g v i s i o n s a n d i n d r e a m i n g d r e a m s , Maine General b u t i n a c t i v e c h a r i t y a n d i n w i l l i n g s e r v i c e .” Hospital

Henry Wadsworth Longfellow A Hospital for Maine: The History of Maine Medical Center

The story of Maine Medical Center is rooted in Victorian America and owes much to the social Life BeforeChapter Hospitals 1: conscience of the times. Great changes were taking place in the years preceding the construction of Maine’s first general hospital. Industrialization, European immigration, breakthroughs in medical science, new public health policies, and the Civil War formed the crucible out of which it emerged. Only 100 years before, such an institution would have been virtually unimaginable.

A Brief History of Hospitals in America The Pennsylvania Hospital, chartered in 1751, was founded by Benjamin Franklin and Thomas Bond, MD, in aid of the “sick-poor and insane who wander the streets of Philadelphia.” Franklin and Bond chose the story of the good Samaritan as the hospital’s official seal, establishing the spirit of social responsibility at the core of the voluntary hospital movement a century later.2 It would be another 40 years before Manhattan’s New York Hospital opened, in 1791. With these notable exceptions, the hospital as an institution dedicated to inpatient care of the sick did not exist in America at the beginning of the 19th century. The physician pays a house call. Apothecary Images, Inc. The nation’s population geography hardly made such an institution feasible. The vast majority of Americans made their living from the land, and farming communities were widely scattered. In 1800, only 322,000 of the country’s roughly five million people lived in towns or cities with a population greater than 2,500.3 Maine (part of Massachusetts until 1820), with its millions of forested acres, was predominantly rural. Transportation was slow. Most people couldn’t travel beyond the distance they could walk in a day; when they were sick or injured, travel was out of the question.

The hospital evolved etymologically from its Latin roots as a place of lodging for pilgrims, entering the 19th century in most manifestations as an adjunct to the municipal almshouse. No one who had any choice would willingly have sought treatment in such an establishment, which offered little in the way of care. It was a place to isolate the sick until they either died or got well on their own, catering to the homeless, the destitute, and the luckless traveler who fell ill and had nowhere else to go. Almshouse hospitals were regarded with dread by the general public, and rightly so. With diseases like cholera, smallpox, and typhoid rampant, they were dangerous places.4

Right, 19th century hospital. Corbis Images

5 A Hospital for Maine: The History of Maine Medical Center A Hospital for Maine: The History of Maine Medical Center

The Kitchen as Surgical Theater Portland Bustles an advantage in the transatlantic trade in Canadian timber, and agricultural and Throughout the 19th century, the home served in lieu of a hospital for family Exploiting the state’s ample timber resources, Portland became a major mining products. The rising tide of Canadian staples stimulated development members who were sick or injured, and was by far the most hygienic setting. In shipbuilding center. Portland-built ships circled the globe and could be of wharves, piers, stockyards, grain elevators, coal facilities, warehouses, and 8 one 19th century study, Scottish obstetrician Sir James Young Simpson showed that found in all the world’s busiest ports. The city boasted one of the largest shipyards, transforming Portland into a major Atlantic port. mortality rates among surgery patients increased in direct proportion to the size of the commercial fleets on the eastern seaboard and was home port to roughly Portland’s population, barely 3,700 in 1800, reached facility in which the surgery was performed, ranging from one in seven in hospitals 20 percent of the entire U.S. merchant marine in the 35,000 by 1866, thanks to an influx of immigrants with fewer than 36 beds to one in 2.4 in hospitals with more than 300 beds.5 As late 1830s. Ships carrying fish, produce, livestock, and who found work on Maine’s railroads and in its as the 1880s, patients had a better chance of surviving surgery or disease in a private other cargo to the Caribbean returned with sugar shipyards, lumber yards, and textile mills. Rapid home or rural dispensary than in a large city hospital. “In those years [prior to 1900] and molasses. Portland capitalized on the trade by growth produced overcrowding and often squalid many operations were performed in patients’ homes on the dining room or kitchen building sugar refineries and rum distilleries.7 conditions. Urban workers lived close together in table with any available person pouring ether,” George O. Cummings, MD, recalled tenements and boardinghouses, frequently sharing in his historical sketch of Maine General Hospital. “The surgeon sterilized his gowns Portland entrepreneur John Bundy Brown, who beds. Portland, like many cities, experienced increases in an Arnold Steam Sterilizer and boiled his instruments wrapped in a towel in a would become the first president of Maine General in infectious diseases and had mortality rates that kettle on the stove.”6 Hospital, made his fortune in the molasses trade. After developing a process for converting molasses to were considerably higher than in rural settings. Doctors plied their trade by making house calls or treating patients in their own sugar, Brown became one of the largest manufacturers Injuries on the job were common. Railroad work was offices. Even in the second half of the 19th century, many lacked formal medical of granulated sugar in the United States, and the particularly dangerous. Since there were no hospitals, training. Some learned from preceptors; others were self-taught. They had few tools richest man in Maine. He was a prominent art patron the working, or “worthy,” poor had no place to go for The Agnew Clinic by Thomas Eakins. University of Pennsylvania and were not able to offer many treatments that were significantly more effective and had a gallery in his mansion, Bramhall, located Art Collection, Philadelphia, Pennsylvania. care except to the almshouses. Americans of means than home remedies. Bloodletting, cupping, and purging were time-honored on the Western Promenade. The Portland Company, a fabricator of locomotives and parts for soon began to see this as an unacceptable option. techniques for ridding the body of illness. As the century progressed, some medical practitioners continued to practice these ships, contributed to Portland’s rapid industrialization in the late Through the 1840s, Portland’s infrastructure was 19th century. The Maine Historical Society methods, even as others made important discoveries regarding the nature of disease and the science of medicine. Public sanitation was another problem. Excreta from geared to the West Indies trade, until a local lawyer horses and oxen was everywhere. The milkman poured named John A. Poor helped the city diversify. Poor promoted a rail link to The Industrial Age in Maine milk from a two-gallon can into containers left on residents’ doorsteps without a Montreal, which became landlocked when the St. Lawrence River froze over The industrial revolution that started in England in the late 1700s began spilling across the Atlantic in the 1820s. New manufacturing thought for bacteria or milk-borne disease. Culverts emptying into the sewers were each winter. The Atlantic and St. Lawrence Railway was completed in 1854. techniques led to the creation of vast complexes of textile mills in Maine and other parts of New England. The development of railroads, seen as convenient receptacles for “spoiled brine, the carcasses of animals, rotting Portland was 100 miles closer to Liverpool than Boston, and so enjoyed the rise of river-borne steamboats, and the construction of canals to connect America’s waterways facilitated commercial transportation. vegetables, and other refuse.”9 With the rapid growth of trade, Maine’s lumber, quarrying, and shipbuilding industries flourished.

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