|
|
Department History (1858 - 2003)
 |
1858-1912 1913-1930 1931-1942 1943-1958 1959-1968 1969-1970 1971-1985 1986-2006 |
1858-1912 A Private Chicago Charity
Blooms into an Illinois State Benefaction
The thirty-year-old physician who founded the Infirmary in 1858 was Edward Lorenzo Holmes (1828-1900), a native of Massachusetts and product of Harvard Medical School (1854) and the Massachusetts General Hospital. Before entering practice in Chicago in 1856, Holmes attended the eye clinics of Vienna, Paris and Berlin in the heady days immediately following the introduction of the ophthalmoscope in 1851. He was a quiet, scholarly, public spirited man whose unusual background included youthful association with the historian, John Lathrop Motley; instruction in German from Henry Wadsworth Longfellow; and summer vacations at Brook Farm, an experimental, utopian, literary community, based on the principles of transcendentalism and shared manual labor. Possessed of great personal magnetism, Holmes, after only two years in Chicago, was able to gather a small but influential group of physicians and philanthropists to join him in founding what they decided to call the "Chicago Charitable Eye and Ear Infirmary."
 |
|
Formally organized under an Infirmary "Association," with Constitution and By-Laws, a slate of officers and a group of twelve Trustees, the Infirmary opened in a single room of a frame building at 60 North Clark Street in May 1858. While Holmes and several young colleagues made up the "Attending" staff (who presumably did most of the work), it is a mark of Holmes' rapid rise that he was able to secure as "Consulting Surgeons" two of Chicago's most eminent local practitioners: Daniel Brainard, founder of Rush Medical College (the city's only medical school, where Holmes joined the faculty in 1859 and later served as President); and Joseph W. Freer, also of the Rush faculty.
Holmes later recalled that the first patient who came ''requiring board in the institution'' arrived ''before a single room had been cleaned and furnished.'' For two successive nights this patient "slept on a blanket on the floor.'' According to the First Annual Report of the Infirmary, ninety-five eye patients, and twenty with diseases of the ear, received care in 1858-59. The youthful population of Chicago in that era (68 % were under the age of twenty-one) produced only one cataract case in the inventory of diseases treated. Infectious conditions apparently predominated, with the most frequent diagnosis listed being "granular conjunctivitis'' (25) followed by ''simple conjunctivitis" (12) and three each of "scrofulous,'' ''pustular," and "morbillous'' varieties (the last a sequel to measles). There were also two patients with "conjunctivitis neonatorum'' and one with "purulent conjunctivitis."
Although paying patients were admitted until 1883, along with the indigent, the Infirmary was essentially a charity, a medical benevolence of the kind that prosperous Americans frequently chose as an expression of their concern over the human misery that accompanies industrialization and rapid urban growth. The misery was especially apparent in Chicago's boom-town population of 91,000, over half of them foreign born, during the economic depression of 1858. A subscription to the "Infirmary Association'' gave the patron a sense of having acted in a socially responsible manner and probably entitled him or her to send several patients—perhaps a domestic servant or a handy man—for free care at the Infirmary.
It may be that Holmes and his co-workers also foresaw that their benevolent enterprise could serve the nation in wartime. Omens of imminent civil conflict loomed on every side in 1858, nowhere more oppressively than in Illinois. Two months before the Infirmary opened, the Senate had voted to admit Kansas to the Union—''Bleeding Kansas,'' where the debate over slavery in the territories had recently given way to violence and murder. It was the Senate's wisdom that the Lecompton Constitution should prevail, legalizing property in slaves already present in the Kansas territory. In June, accepting the Illinois Republican nomination to challenge incumbent Democratic Senator Stephen A. Douglas, an unknown, former, one-term Representative named Abraham Lincoln said, "I believe this government cannot endure permanently half slave and half free." In late summer and fall, as the Infirmary moved through its first year of operation, the entire nation "listened'' by newspaper as Lincoln and Douglas met in seven Illinois towns for what was to become the most famous series of debates in American political history. That autumn, Senator William Seward, who hoped to be the Republican presidential candidate, created a memorable phrase to characterize the dilemma he saw confronting the Union: an ''irrepressible conflict between opposing and enduring forces." John Brown's raid at Harper's Ferry was only a year in the future. Beyond it, in the spring of 1861, lay the beginning of the American Civil War.
The Infirmary was to be deeply affected by the War. In 1861 Holmes moved to other quarters on North Clark Street, perhaps to accommodate a five-fold increase in patients in the year before the War began. In 1862, he found it necessary to close the Infirmary for five months (the only recorded hiatus in its long record of service); his sole remaining Attending had gone to war while Holmes himself travelled to Vienna to marry a woman he had fallen in love with while a post-graduate scholar there.
Sick and wounded soldiers soon began to appear at the Infirmary in such numbers that Holmes acquired a "large attic'' which he subdivided into "several comfortable rooms" to hold the influx of boarders. Soon afterward, he raised the building, Chicago-style, in order to build a brick basement beneath it. (To meet the new grade levels set to assure proper drainage in the 1 850s, entire sections of Chicago streets were raised from four to seven feet. George Pullman engineered the lifting of many buildings to meet the new grade, reportedly without so much as disturbing the occupants. )
Holmes had formerly supported the Infirmary primarily by various forms of contributions—many of them, it is said, out of his own pocket. He now began to receive subsidies from the Governors of Illinois, Minnesota and Wisconsin for the care their disabled veterans received. Large sums, for similar considerations, came from the United States Sanitary Commission, the Northwest Sanitary Commission and the Christian Commission (all of these were Civil War agencies doing work comparable to that of the Red Cross in later years). Thus the Infirmary, a bare fledgling at the outbreak of the War in 1861, emerged during the nation's great trial as an institution whose worth was recognized far beyond local and state boundaries.
In 1864, Walter Newberry had given the Infirmary the ten-year use of a large lot at 16-18 East Pearson Street. For $2,000 Holmes bought an ample, two-story, frame house and had it moved to this lot from a neighboring block. As the patient roster continued to grow, he built a large, additional structure at the rear of the Pearson Street property in 1869.
State aid to the Infirmary continued at the rate of $5,000 a year, even after the War, until the new Illinois Constitution of 1870 forbade appropriations to other than state-owned institutions. In 1871, in response to a petition from the Infirmary's founders, the General Assembly took the Infirmary under state ownership and changed its name to ''Illinois Charitable Eye and Ear Infirmary.'' Doctor Holmes' private benevolence had become a public institution.
In 1871 the Great Fire that swept across the city reached the Infirmary at 3:30 in the morning of October 9, leveling the Pearson Street buildings. The staff managed to rescue every patient, taking most of them to Blatchford's shot-tower on Kinzie Street, where they stayed for several days. With the help of a special legislative appropriation, Holmes was able to resume service ''soon after this calamity" (he recalled) in rented quarters at 137 North Morgan Street, a "western'' location untouched by the Fire. This temporary home—the Infirmary's first respite from the clatter and bustle of the city—housed an average of twenty-six inpatients.
As Americans everywhere responded to Chicago's tragic circumstances, subscriptions and donations poured into the Infirmary: from Brooklyn and Boston and St. Louis; from towns and counties all around Illinois; even from community organizations in Chicago. The Chicago Relief and Aid Society gave $20,000, most of which Holmes and his colleagues decided to spend for a large corner lot at West Adams and South Peoria Streets. After the Fire both Cook County Hospital and Rush Medical College decided to rebuild in this same West Division section of the city, thus seeding the area which became the Medical Center District in later years.
In October 1874 the Infirmary opened in its own building, an imposing, four-story fireproof structure of brick and limestone, with mansard roof and elegant, wrought-iron grill work. Of the total construction cost of some $42,000, $28,000 came from the State of Illinois. Subscriptions, donations and interest on Infirmary funds furnished the balance. Holmes proudly relayed the opinion that the new facility "excels in its arrangements that of any similar institution in the world." It boasted such modern touches as plumbing and heating for its two large treatment rooms and single operating room. There was space to board 100 patients, with a staff expanded to include five consulting surgeons, seven attending, ten assistants attending, and—much ahead of the times—a medical microscopist. In the next two years the Infirmary treated some 2,400 eye patients, boarding more than 300. In 1877 the legislature appropriated $10,000 for the purchase of additional ground and nearly $ó,000 to erect a boiler-house, a kitchen, a dispensary and another operating room.
There can be no doubt that the Infirmary, at the tender age of twenty, was a roaring success. Some doctors in this pre-professional stage of the development of American medicine apparently thought it was too successful. The post-Civil War decades witnessed what would now be called a physician glut, with hundreds of regular and sectarian medical schools flooding the market with graduates who were free to practice any kind of medicine, anywhere they wanted, unrestrained by licensure laws. With many medical graduates reduced to selling real estate to support themselves, there was great concern about preventing alleged "abuses of charity" by those who could afford to pay for such services. By the 1880s, Infirmary officials found themselves forced to require that applicants for free treatment sign an oath of indigency (the "means test" of that day), swearing that they were "without means to defray the expenses of board and medical or surgical treatment." A certificate from the applicant's town supervisor or county commissioner was also required, corroborating the sworn statement of "indigent circumstances." As a further precaution against "abuse" of its facilities by secretly affluent patients, the Infirmary printed its tickets with the giant motto: For the Poor Only.
At its 1882 opening, the College of Physicians and Surgeons already possessed a tiny ophthalmic facility of its own, at the West Side Free Dispensary located within the school. John E. Harper, who was "Professor of Ophthalmology and Clinical Diseases of the Eye" in the College from 1882 to 1891 and again from 1898 to 1913, also served as "Surgeon-in-Chief of the Department of Eye and Ear Diseases" in the Dispensary. The College's major facility for instruction in ophthalmology, however, was the Illinois Charitable Eye and Ear Infirmary, which was listed in College catalogs from the start. Despite the Infirmary's distance, about a mile east of the College, P. & S. students probably spent some time there during the tenure of Boerne Bettman, who was on the faculty between 1891 and 1900. Bettman, formerly an assistant to Elkanah Williams (who introduced the ophthalmoscope into the United States in 1855) had been one of the Infirmary's assistant surgeons in 1888 and later served for several years as its "Surgeon-in-Chief." Other ophthalmologists on both the Illinois faculty and the Infirmary staff at this period were Mayer Lebensohn, who taught "eye surgery" to Illinois students at the Infirmary between 1907 and 1914, and Ephraim Kirkpatrick Findlay, an Illinois faculty member from 1913 to 1917 and at the same period Chief of the Executive Staff and Surgeon in the Infirmary Eye Department.
 |
John E. Harper, first Professor of Ophthalmology and Clinical Diseases of the Eye, 1882-1891 and 1898-1913, and Corresponding Secretary in the early 1890's, College of Physicians and Surgeons of Chicago |
Infirmary Rules and Regulations near the end of the century suggest that P. & S. medical students who did get to see patients treated there probably had a lively time of it. Rule Number One enjoined "inmates" to observe "strict decorum" in their relations with one another: specifically, it forbade the use of profane or obscene language. Other rules put the dining room, the store, the bakery shop, the kitchen and the laundry off-limits to patients, except with special permission. Under no circumstances were patients to enter "rooms not allotted to their respective sexes." Lights-out occurred at 9:00 p.m., after which "all unnecessary noise and talking must be avoided." A set of rules from 1897 reflects the current popularity of chewing tobacco, the bane of hospital administrators and medical educators alike:
"Patients must not spit on the floors or stairs; they are not allowed the use of tobacco in any but the sitting room; smoking and the use of liquors is absolutely prohibited."
In a later issue of Infirmary regulations, even chewing tobacco was forbidden, "except in the men's sitting room and grounds." "Inmates" were additionally forbidden to "visit saloons or other similar resorts." ("Resorts" was a common term at that time for houses of prostitution, a field of commercial endeavor in which Chicago was then astounding the country, just as it was doing in the development of skyscrapers.) By the time of World War I, patients were forbidden to "sleep in their underwear; night shirts are furnished." And a constructive regulation began to appear: "Patients must bathe at least once each week unless otherwise ordered by the surgeon."
After 1885 Holmes began to spend less time at the Infirmary as he grew more involved at Rush Medical College, where he was President at the time of his death in 1900. With these events an era closed in the history of the Infirmary and of ophthalmology in Chicago. Although it is often said that Holmes' successors carried on the traditions of concerned professional care which he established, the Infirmary declined in the late 19th century, and politics began to take precedence over medicine.
In 1898, the Trustees found Infirmary conditions generally ''demoralized," "dilapidated" and "neglected,'' with "abuses" and open "irregularities" evident in both medical and surgical departments. Infirmary facilities had again become obsolete. Overcrowding exacerbated frequent outbreaks of infectious diseases among inpatients (a third of them trachomatous), and there were no municipal contagious disease facilities to receive them.
Under the direction of William Wilder (a later founder of the American Board of Ophthalmology), the Infirmary made a valiant effort to catch up, adding electricity, X-ray and the sterilization equipment required as surgical procedures became more frequent following the introduction of local anesthesia (cocaine) in 1884. Individual file cards for each patient replaced old ledger books. At his own expense, Wilder equipped an eye pathology laboratory, said to be the first in Chicago. In 1907 an addition to the Infirmary building provided new out-patient quarters and made room for surgical space on the wards.
Despite these improvements; despite an increase in out-patients from 15,000 per year in 1900 to 26,000 in 1916; despite expansion to six trainees in a rather casual and informal resident training program begun (with one resident) in 1887, the Infirmary during the first two decades of this century remained isolated from the mainstream of medical education and professional specialty training. The explanation usually given for this is "inertia" at the Infirmary: a "prevailing atmosphere of rigidity and parochialism." We now know better, thanks to recent scholarship focused on events of the twenties, when the University tried—and failed—to bring the Infirmary into the era of modern medical education. The University failed in this, and nearly lost its other Research and Educational Hospitals in the bargain, because of an ophthalmologist-villain, an arch-enemy of the College of Medicine, disguised—of all things—as a University Trustee! But that comes later in the story.
 |
|
