History of Healthcare in Roanoke & New River Valleys Volumes I & II by OurHealth Media LLC

the history of healthcare

TABLE OF CONTENTS

VOLUME I 11

Intro: Into early 20th Century

Healthcare Development

Life Saving Services

Epidemics

Funeral Homes

Healthcare Heros

Locations

Nursing

Technology

VOLUME II

Intro: Into mid 20th Century

Healthcare Development

Life Saving Services

Epidemics | Polio

Healthcare Heros

Nursing

Technology

the history of healthcare

H E A L T H Y

L I V I N G

L I F E S T Y L E S

McClintic Media, Inc. PUBLISHER

Stephen C. McClintic, Jr.

PRESIDENT AND EDITOR-IN-CHIEF

Angela Holmes ASSOCIATE EDITOR

Josh M. Holmes

VICE PRESIDENT, OPERATIONS

Jenny Hungate

PRODUCTION MANAGER EDITORIAL

Rick Piester ART

AND EDITING LHC PRODESIGNS GRAPHIC DESIGN LHC PRODESIGNS WEB Ryan Dohrn

SALES

Kim Wood 540.798.2504 kimwood@mcclinticmedia.com COMMENTS/FEEDBACK/QUESTIONS Our Health Magazine, Inc. welcomes your feedback. Please send your comments and/or questions to: “Letters,” Our Health magazine, Inc. 305 Colorado Street • Salem, VA 24153, 540.387.6482 or you may send via email to steve@ourhealthvirginia.com. Information in this magazine is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2011 by Our Health magazine, Inc. Reproduction in whole or part without written permission is prohibited. Our Health is published bi-monthly by Our Health magazine, Inc. 305 Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthvirginia.com. Advertising rates upon request.

About the Author Rick Piester’s career has included successful experience as a musician, a newspaper reporter and magazine editor, a healthcare communications executive, a symphony orchestra executive and a freelance writer. He has worked in healthcare communications for more than 30 years, including service as executive communications officer for a large New England health system, and providing communications counsel for the Massachusetts Medical Society, publishers of the New England Journal of Medicine. He is now semi-retired, living and writing in Lynchburg, VA, while he and his wife Patricia make their way through their bucket list.

the history of healthcare

the history of healthcare Courtesy of LewisGale Medical Center

The pathology lab at the Lewis-gale hospital might appear underwhelming by todayâ&#x20AC;&#x2122;s standards, but in 1910, this laboratory was considered first rate.

VOLUME I INTO EARLY 20TH CENTURY

f we are to understand the present and future, we must also chronicle and understand the past.

For more than three years, we at Our Health magazine, with our two editions serving readers in the Roanoke and New Valleys and in Lynchburg and Southside Virginia, have worked hard at fulfilling our mission of becoming a premier resource for healthcare and healthy living lifestyles information. We hope we have done a worthy job of capturing and explaining the here and now. Our work is made easier by the high quality of healthcare we can rely upon in our community. There are lots of good stories to tell, and in the telling we aim to improve the health and the lifestyle of the people we reach. But that high quality we enjoy now did not come quickly, and it did not come easily. the history of healthcare

Courtesy of Carilion Clinic

Mill Mountain Incline and Roanoke Hospital, early 1900s

We believe that to truly appreciate how far we have come, we have to go back to the beginnings. We have to measure exactly how far we have progressed as a community, and some of the paths taken to get us here. That’s the purpose of this project; we want for you to understand some of the people and some of the forces that have shaped the healthcare that we rely upon today. As unlikely as it seems today, progress has not always been a given. It’s a fairly recent notion. Until late in the 17th century, humankind had suffered more than a thousand years of stagnation, bogged in the intellectual mire that followed the collapse of the Roman Empire. Thomas Hobbes, writing in his 1660 treatise on political and social philosophy Leviathan, famously described

the history of healthcare

the contemporary human condition as “solitary, poor, nasty, brutish, and short.” Life expectancy at the time was typically little more than 30, with few people reaching 40 years and fewer still 50. Those who did make it into what was then regarded as old age were wracked by the infirmities and diseases of the very old. Little by little, however, the concept began to gain ground that people could make their lives better, steadily advance scientific insight and improve technological effectiveness. Perhaps most profound of all, the idea emerged that we could come to understand the functions of the human body and thereby enhance our health and extend our lives. More than 200 years later, in Roanoke and in much of the country at the end of the 19th century, not a great deal of progress had been made. Society had learned more, many cities were being industrialized, wars had

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Courtesy of Le

Courtesy of

above left: Mill Mountain Incline

been fought and won or lost, slavery had been abolished; yet in terms of biological understanding of human life and how its quality might be enhanced by science, we were still pretty much in the Dark Ages. Even at the turn of the 20th century, average American life expectancy was about 47 and nearly every family lost one or more young children to disease. Only following World War II have such terrible diseases as cholera, polio, diphtheria and smallpox largely vanished from the American experience. Since then, enflamed by a growing core of knowledge and a dream for better life, bioscience and medicine have bestowed once unimaginable marvels on our age. Our aim with this project is to trace the development of some of these marvels — how they came to the Roanoke Valley, some of the people responsible for

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above right: Mill Mountain Star

bringing them here, and how they affected life in our community. This is Volume 1. It covers the period roughly between the very end of the 19th century up to about 1935. Future volumes — we plan four in all — will explore healthcare in our region, divided by eras right up to the present. We’ll learn how such unlikely events as the 1859 hanging of militant abolitionist John Brown served to boost medical training in Virginia. How a young boy who witnessed a drowning grew up to have a major impact on healthcare, here and nationwide. How a railroad became the catalyst for medical care of early residents, and much more.

So let’s begin. the history of healthcare

VOLUME I HEALTHCARE DEVELOPMENT

t was “A Proud Day for Roanoke,” exulted the Sunday Roanoke Times on July 1, 1900.

The newspaper article celebrated the opening of Roanoke Hospital the night before, saying that “Probably no day in the history of Roanoke has marked a more auspicious event...” The new hospital was indeed the very essence of all that was modern in medicine. But still, this was a time when medical care was very basic and primitive by today’s standards. There were no antibiotics. No effective treatments for illnesses that had not yet been identified. Not many diagnostic tools — the x-ray machine had been invented only a few years earlier, in 1896, and the hospital’s first microscope was still 20 years in the future.

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Courtesy of Norfolk & Western Historical Photograph Collection the history of healthcare

One news account noted that “to lie before one of its windows and breathe the pure mountain air and take in the grand sweep of surrounding country would almost in itself bring health and strength to the sick.” Well...perhaps. Although the hospital was heralded in a local newspaper as being complete “down to the smallest article,” its pharmacy, like every other in America, would have contained only a few dozen rudimentary drugs, all derived from herbs, roots and bark. In one form or another, most of them had been in use among native Americans before the arrival of Columbus. But the opening of Roanoke Hospital in 1900 culminated a decades-long struggle, shared by many in the face of almost overwhelming economic odds and a good measure of public apathy. Modern marvels such as the CT scan and the replacement of human organs were generations away from being imagined, but that hospital opening signaled something of a start of a more modern age for Roanoke and its environs, and it provided fertile ground for what was to follow. In the 1750s, what would become Roanoke had been a settlement near a junction of trails on what was then the country’s rugged western frontier. They were first animal paths, and then rudimentary trails followed first by Indians on the hunt and later by hordes of German and Scotch-Irish settlers making their way through the Great Valley of Virginia between the Blue Ridge and the Alleghany mountains. Not far from the trail junction, near a large marshy area with salt outcroppings that attracted wild animals drawn by the salt, the small settlement became known by the name “Big Lick.” The Great Wagon Road, as it was called, brought settlers down the valley. At what is now Roanoke, settlers would continue into the Carolinas and Georgia, or they would branch to the southwest along the Wilderness Road into Tennessee. The two trails became among the most heavily traveled in 18th century America, making Big Lick something of a transportation hub. The Big Lick settlement, by then a stop on the railroad line between Lynchburg and Bristol, was officially incorporated as a town in 1874. It remained just a busy country crossroads until the early 1880s, when the leadership of the Shenandoah Valley Railroad and the Norfolk & Western Railway were persuaded to connect their two rails lines in the community, roughly following the precedent of the two settler trails more than a century before. With that, growth became explosive, and sometimes harrowing.

above top: Norfolk & Western Railway herald above center: Dr. Newton Lewis, 1908 above bottom: Dr. Joseph a. Gale, 1905

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Big Lick was hardly ready to grow. Streets were unpaved, sanitation was poor, streams ran through town carrying whatever originated upstream. Nevertheless, Big Lick changed its name to Roanoke and became an incorporated city in 1884. It was a small city with a population then of about 5,200. As were many American communities at the time, the new city was plagued by malaria, smallpox, and typhoid fever. There were no true hospitals and few physicians to treat diseases or the railroad-related work injuries that grew as the railroad became an ever more dominant part of the employment landscape. Into this mix came a steady flow of men seeking work, either on the railroad itself or in any of the enterprises that sprang from the railroad’s presence —

foundries, railroad maintenance, tobacco processors, and more. Some brought families, others just brought simply a rough-and-tumble sense of everyday conduct and frontier justice. Most workers were young and living away from home in dormitory settings. When they were sick or injured, their care came primarily from their roommates, who were away at work during the day and exhausted at night. Diseases spread almost unchecked, and even small cuts led to infection. In all, there were slightly more than a dozen physicians serving all of the population of the Roanoke vicinity in the late 1880s. That there were even that many may well be the result of an event several decades earlier that had the improbable result of a new emphasis on physician training in Virginia and in the South – the hanging of militant abolitionist John Brown. In the late 1850s, most southern physicians had been trained in northern medical schools. There were medical schools in the south; in Virginia, the primary schools were at the University of Virginia and at the Medical College of Virginia. But the northern schools dominated, despite arguments from a growing chorus from southern physicians, including those in Virginia, that the practice of medicine was different in the south. The science was basically the same, they argued, but the distinctive-

ness of southern climate, population characteristics and health concerns forced southern physicians to readjust much of what they had learned when they returned home to practice. The winds of change blew from the political arena. In 1859, Virginia students in northern medical schools were shocked and angered by John Brown’s bold raid on the federal arsenal at Harper’s Ferry, in what was then their home state. Although he was white, Brown planned to start an armed slave rebellion in the south. They were further enraged by northern marches in protest of Brown’s hanging on December 2, 1859. Encouraged and financially supported by southern medical educators, the students ‘seceded’ from their medical schools – 300 alone at the University of Pennsylvania and at the Thomas Jefferson School of Medicine — and moved to southern medical schools in Richmond, Charleston, and elsewhere. As a result of what was called the “Philadelphia stampede,” Virginia finally had viable medical schools. But the distinction soon became meaningless.The training of those who had transferred to medical school in Virginia and elsewhere in the south was soon to be tested, and altered, by the coming of the Civil War. Roanoke Hospital, 1900

(Courtesy of Carilion Clinic) the history of healthcare

Modern wars have often become something of an incubator for new methods of treating wounds and illnesses and new therapies for recovery of injured warriors. Not true for the Civil War. In strictly medical terms, the Civil War was fought before its time. Caregivers had not developed an understanding of antisepsis —how to prevent infection by arresting the growth and multiplication of germs and bacteria. There were no sophisticated surgical techniques, and no antibiotics. Medicine did not understand how diseases were caused or spread. What medical supplies might have been available — drugs, instruments, and recently developed chloroform and ether — were in short supply, as were physicians to work on the battlefields or in field hospitals. The Confederate medical corps was underqualified, understaffed, and undersupplied. At the war’s outbreak, the entire Confederacy had but 24 medical officers. Much of the conflict took place on Virginia soil, and some sources estimate that as many as 60 percent of Confederate wounded were treated in Virginia. Some Virginia cities such as Richmond and nearby Lynchburg became wartime hospitals centers, but not Roanoke. If anything, battlefield demands siphoned medical talent away from Roanoke. Although the war did not have much impact on medical advancement, it did have far-reaching influence on some key social issues that would later affect healthcare in Roanoke. While so many men were off soldiering beginning in 1861, more of the domestic medical care at home was being taken up by the women. When the battlefield was in Virginia, Virginia women helped nurse injured or ailing soldiers. Lewis-Gale Hospital on the corner of luck and third in downtown Roanoke, 1909

Courtesy of LewisGale Medical Center

On southern plantations, black men and women also helped take care of patients, and slaves were often hired out to work as attendants and nurses at military hospitals. So it seems that despite the generations of social turmoil and the post-war devastation suffered by both sides, the war did bring a measure of freedom on two fronts: women began to break free from their relegation to purely domestic chores, and slaves were ultimately freed, legally at least, from the chains of bondage. At home in Roanoke, growth of the railroad and attendant growth of the city made the need for some sort of a hospital clear. The site of health practice began to shift from the home to the doctor’s office. In addition — perhaps spurred by the wartime necessity of commandeering homes, hotels, warehouses, and any suitable building for the collective treatment of ill and injured soldiers — healthcare began to shift to the hospital. Going into the 1880s, a few hospital-like sites had come and gone, organized by private physicians and saddled with the double handicaps of a working-class population that could not afford private care, and a persistent public perception that a hospital was a place where one went to die. The railroad, seeking to improve medical care of its employees, began to contract with physicians along its route to care for ill and injured workers. Sudden accidents and maiming injuries to railroad workers were turning into major health care costs and lawsuits that threatened the financial health of the railroad. In Roanoke, the railroad hired Dr. Arthur Z. Coiner and Dr. Joseph A. Gale to head up medical care for railroad personnel. In two histories of healthcare organizations in Roanoke, Dr. R. Gordon Simmons is quoted as reminiscing: “We had no ambulances in those days. All the men injured in railroad shops or otherwise were carried on stretchers. They were frequently operated on in oil houses or other premises of the railroad company, or on a pile of crossties.” In 1890, the women of Roanoke opened the first version of a charitable hospital. Two circles of the King’s Daughters organization established the “Home for the Sick,” a six –bed converted house at 526 Nelson Street (Now 1st Street). Patients were in the care of their own families at first. Everything in the hospital was

the history of healthcare

Courtesy of Carilion Clinic Roanoke Hospital appeared to be in the country in 1924. the old incline up Mill Mountain can be seen at the right.

donated by the public and by members of the King’s Daughters. Patients who could pay were charged rate was $1.50 for the first day and $1 for each additional day, or $6 a week. Long term patients were charged a yearly rate of $300. As activity grew, the King’s Daughters hired a practical nurse, but seriously ill people who were not still treated at home were sent to the Medical College of Virginia in Richmond or to Johns Hopkins in Baltimore. It soon became evident that the city needed more and better facilities, and so the King’s Daughters once again launched fundraising efforts, but these efforts fell far short of the capital needed for a new hospital. At the same time, a small group of Roanoke businessmen formed the Roanoke Hospital Association and began trying to raise $25,000 to establish a new hospital. Public interest and financial support was weak, however. People did not trust hospitals, and other projects of the day commanded more attention and support. Realizing that they wouldn’t raise the amount they needed, the King’s Daughters and the business group combined their assets, finally making a new hospital affordable. The Roanoke Gas & Water company gave the Roanoke Hospital Association 3 acres of land on the west side of Mill Mountain to build the hospital on. Momentum seemed to have been regained, and construction of a new hospital began, but was halted by the financial crisis of the 1890-1892 and the subsequent nearly decade-long depression. The partially built hos-

pital sat, essentially untouched until the last year of the decade. As the American economy began to recover in 1899, public support for the new hospital began to stir. Roanoke’s police chief complained bitterly that his department had nowhere to turn for treatment of casualties. “The best I have at my disposal,” he said, “is a table at police quarters.” A Roanoke newspaper reporter later wrote of seeing a bullet extracted from a wounded man in the back room of a drugstore. The citizens of Roanoke and city leadership had had enough, and they insisted that a way be found to complete the new hospital. The outcry resulted in renewed efforts to complete the hospital, and major assistance came from a company that would prove to be a constant benefactor to healthcare in the city — the N&W Railway, as well as executives associated with the railway. The Roanoke Gas & Water Company agreed that it would complete the partially finished hospital building, if N & W paid the bills. The railway would then lease the building back to a reformed Roanoke Hospital Association for $1 a year. Under the deal, N&W employees were to be treated at the hospital for free. A few months later, the hospital building was finished.The new hospital faced Mill Mountain. It was three stories tall, with a basement, and had 30 beds for patients. This was the hospital that opened with such fanfare on the last day of June, 1900.

the history of healthcare

Over the next decades, activity at the hospital increased steadily, with increased patient load and demand for services alternating with bleak annual financial reports. Population growth (Roanoke had more than 21.000 residents when the hospital finally opened), continuing industrial injuries and the constant threat of diseases such as diptheria and typhoid oftentimes outstripped facility and staff capacities. By 1920, Roanoke was a city of some 50,000 people, its population had gone through the “War to End All Wars,” and there was no question that Roanoke Hospital had to expand if it was to meet its mission, and plans were drawn to add a new “south wing” to the hospital, funded in part by public donations. This, despite the fact that public donations for that entire year had total only $20. And by 1920, Roanoke Hospital was facing some tough competition from across town. Dr. Sparrell Simmons Gale, the son of one of the N&W’s first contract physician in the Roanoke area, had partnered with fellow surgeon Dr. J.N.Lewis to open a private hospital, LewisGale Hospital, which had begun operations in 1909 at the corner of Luck Avenue and Third Street in Roanoke. Although the first years of operation of Lewis-Gale

Hospital were marred by the deaths of Dr. Lewis and later of Dr. Joseph Gale, the hospital gained a reputation for its superior emergency surgical treatment of life-threatening injuries, along with high quality elective surgery. The hospital steadily added new services, rehabilitation of injured workers, a department of radiology, internal medicine and more. The private hospital faced a crisis of sorts with the untimely death, in his own hospital, of Dr. Sparrell Gale in 1927. Dr. Gale had been the firm hand that had directed the success of the hospital, and he himself had speculated that the enterprise would fail without him. But Dr. William Rush Whitman Sr., who had become Dr. Gale’s partner after the death of Dr. Lewis, made an astute management move: he rallied the support of younger physicians on staff, diversifying the practice and conveying part ownership to five younger physicians. “The shared responsibility,” according to a published history of the hospital, “encouraged a unified effort towards institutional success, which has continued to the present.” Across town, Roanoke Hospital was in the midst of a grueling campaign to finance its new expansion.T.T. Fishburn, who had presided over the hospital’s governing board since the beginning and who was also a major private benefactor, had died in 1921. This hospital itself faced mounting deficits, with unpaid bills mounting month by month. The general public, so quick to use the hospital in hours of need, seemed unwilling to shoulder its part in providing money for construction. The building was complete in 1923, but the hospital trustees did not have the funding needed to open, furnish, and equip the new wing. Then along came the person who would be called “the institution’s greatest benefactor” — David W. Flickwir. General superintendent of the Eastern Division of the N&W, Flickwir provided the final $10,000 (roughly $270,000 in 2011 purchasing power) to enable the new building to open in 1924. At its opening, the new south wing was a freestanding building that added room for 85 additional patients. The three-story building was of brick, stone and granite exterior (compared to its wooden neighbor), built from fireproof materials, and included an elevator. In addition to the expanded capacity for patients, the new building also included new operating rooms, and kitchen and dining facilities.

With the new south wing open, the original 1900 north wing paled by comparison. Much had developed in healthcare since the old building was first put into use. Weeks after the new wing opened, Flickwir announced that he would rebuild, furnish, and equip the old wooden building in memory of his deceased wife, and would do so at no cost to the Hospital Association. Renovation soon provided impractical, and Flickwir employed and supervised his own construction crew to demolish the old wooden structure and build a new hospital building in its place.. Construction must have been much more matter-offact during those days. Flickwir made his announcement of his intention to rebuild the north wing on February 21, 1924, to a special meeting of the hospital trustees. The new north wing was opened on February 4, 1925. That same year, Flickwir and hospital superintendent Mildred Elder were married. This was hardly the end of the Flickwir largesse. In coming years, he would be a steady financial supporter of the by-now modern hospital, including personally financing an expansion of the hospital nurses’ residence and establishing a permanent endowment for the operation of the wing named for his late wife. In all, measured in modern day dollars, his gifts to the Roanoke Hospital would total some $7 million, during a time when a dollar could buy as much as $27 today. Although it was now a modern healthcare center, Roanoke Hospital still maneuvered in shallow financial waters. The cost of charity care and the expenses of adding and keeping qualified staff made for a continual nip and tuck with the hospital budget. And then came the Great Depression. Although the railroad employment sheltered Roanoke from the greatest impact of the Depression, times were tough for the hospital as Roanoke’s growth ground to a halt. And new diseases were spreading throughout the population; the causes and cures diseases such as measles, mumps, scarlet fever, influenza, and tonsillitis were still mysteries, and only after World War II would such terrible diseases as cholera, polio, diptheria and smallpox largely vanish from the American experience. The impact of the Depression was also lessened considerably by the construction and opening — on October 19, 1934 — of the Veterans Administration Medical Center in Salem. President Franklin D. Roosevelt traveled to Salem to dedicate the new veterans’ hospital before an opening-day audience of about 34,000 people.

Much of a community’s growth in healthcare is centered on development of its hospitals, but not all of it. Progress was being made on other fronts in the community. In the northern Roanoke County of Catawba, what had been a resort since 1857 was by the early 1900s a state-operated tuberculosis sanatorium. Patients were treated with fresh air, sunshine, rest, and plenty of food. This was the treatment of choice before the development of thoracic surgery in the 1920s, and before tuberculosis was largely eradicated in the US in the 1940s and 1950s. The facility is now a state mental health hospital. By the early 20th century, white citizens of Roanoke were becoming well served by healthcare organizations. But for the 11,000 or so African American citizens of the community, life was not so promising. Until the rise of the civil rights movement of the 50s and 60s, virtually every hospital in America denied African Americans access. Those that did admit African Americans relegated them to wards that were segregated and located in neglected areas of the hospital. In Roanoke, a small group of African American physicians saw patients in their homes, hampered by the lack of medical equipment. Surgery was nearly impossible with inadequate tools and unsanitary conditions, and any African American patient had to be transferred to hospitals in Richmond or Washington, DC. The physicians started making plans for a hospital specifically for the minority community and in 1914 a tworoom apartment in the home of Dr. Samuel Medley was converted to the nonprofit Medley Hospital, which soon moved to a house at 311 Henry Street, which opened as the Burrell memorial Hospital. The name commemorated the early efforts of the late Dr. Isaac David Burrell, a medical school graduate who opened one of southwest Virginia’s only minority-owned drug store, and also practiced medicine. In 1919, the Burrell Memorial Hospital doctors acted on the need to acquire a larger building to care for the growing number of patients they were seeing. The city of Roanoke leased an old school building to the Burrell Association, with the provision that several beds were left open for black city workers free of charge. The hospital relocated in 1921, converting the building to a 50bed African American-operated hospital, one of about 200 in the country.

the history of healthcare

Roanoke Life saving Crew, equipment display, 1933.

Photo by George Davis, courtesy of REMS, Inc.

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VOLUME I LIFE SAVING SERVICES

“O

n a May afternoon in 1909,” according to an article in the Readers Digest issue of February 1945, “ a boy on the bank of the Roanoke River watched helplessly while two men struggled in the water trying to reach their overturned canoe. “Bystanders shouted hoarse advice and tossed branches into the stream. The men kept crying for help -- then suddenly, they were gone.” The boy, Julian Wise, was haunted by the memory of his experience. He went on to take all available first aid and water rescue training offered at the time through the Boy Scouts and the American Red Cross. He became an Eagle Scout and stayed active in the scouting program into adulthood. “I resolved that I was going to become a life saver,” he later said. “Never again would I watch a man die when he could be saved.” the history of healthcare

And he acted on his intentions. As an adult nineteen years later, with nine of his workmates from the Norfolk and Western Railway, he formed the Roanoke Life Saving and First Aid Crew, chartered on May 25, 1928. It was the first rescue squad in America, the model for all others that would follow. In its early days, the crew focused on teaching water safety and performing water rescue. Crew members were trained and certified in first aid. At first, however, the crew did not receive many calls for help because of public belief that it existed only to retrieve bodies, not to rescue living victims. By the end of 1928, the crew had been called out only three times. Crew members continued their training, however, meeting regularly to design and assemble the equipment they would need in their duties, and keeping their training up to date. In 1929, to gain the attention and the confidence of the general public, Wise sank a 250-pound dummy in a pond and staging a mock rescue.The drill caught the attention of city leaders, who appropriated $300 for equipment and first aid supplies.The crew shortly after began to conduct first aid training classes for firemen, police, and other groups of people in the city. Crew members were gaining the acceptance of the people they were to serve. For transportation, the crew relied on Wise’s personal roadster, until the management of the Oakey Funeral Home donated an old Cadillac ambulance, which the crew overhauled, painted and equipped for service as a rescue vehicle. By 1930, interest in the work of the volunteer crew was growing. The crew was recognized by a charter from the Red Cross, and it also gained the approval of the Roanoke Academy of Medicine, an important symbolic milestone that signaled the crew’s acceptance as an important community health and safety asset. By the end of 1930, the crew had responded to a total of 56 calls for assistance, and the crew saved six lives that year. It was an all-volunteer crew, and more evidence of its importance came in the form of agreement by major employers that their employees would be released to respond to calls during their work hours. Membership by then had doubled, to 19 volunteers.

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Courtesy of REMS, Inc. first equipment truck was this cadillac ambulance. Donated by john m.oakey, inc. Courtesy of LewisGale Medical Center

lewis-gale hospital ambulance.

In the meantime, a crew in Salem had been organized along the lines of the Roanoke crew, taking its place as the country’s second oldest volunteer crew. Salem volunteers were drawn largely from the city fire department, police department, street department, and the Leas and McVitty Tannery. The 1930s saw the Roanoke crew gain experience in an ever-widening variety of emergency and healthcare roles. Many citizens of the community and their families were touched by the crew when members started providing portable oxygen tents to patient homes and in the hospitals. Physicians relied on the crew increasingly when ordering oxygen therapy for their patients.

Julian Wise and fellow members of the Roanoke crew also became deeply involved in lending assistance to crews that were by the being organized throughout Virginia. In this time as well, communities in such states as Wisconsin, Michigan and Alabama began organizing crews, based upon the Roanoke model. Julian Wise would die at age 85 on July 22, 1985. Ironically, five hours after his death, the Roanoke Life Saving and First Aid Crew received a call for a possible drowning in the Roanoke River. The thirteen-year-old victim was successfully saved.

Courtesy of REMS, Inc. they organized the first life saving crew. back row: f.p. grimes, allen grasty, julian wise, o.p. britts, herman moorman and e.a. wolfenden. kneeling: c.c. lankford, c.f. britts, harry martin. front: harry avis. below: Life Saving Crew answers a downtown fire at N.W.

Pugh Company, 1935.

Courtesy of REMS, Inc. the history of healthcare

Childrenâ&#x20AC;&#x2122;s ward at Roanoke Hospital, late 1920s

Photo by George Davis, courtesy of Carilion Clnic

the history of healthcare

VOLUME I EPIDEMICS

isease was a frequent visitor to the Roanoke Valley in the late 19th century, especially in the City of Roanoke. Understanding of the cause and treatment of communicable diseases was in its infancy, sanitation was poor, and good health practices were largely unheard of. As people migrated into cities such as Roanoke from the countryside, neither housing nor sanitation could keep pace with the swelling population. The consequence was that disease of all types — malaria, smallpox, typhoid, diptheria — appeared early and stayed long. Typhoid, which almost invariably accompanied poor hygiene habits and public sanitation conditions, was such a frequent visitor that it took on the nickname “Big Lick Fever,” named for the settlement that preceded Roanoke.

the history of healthcare

Roanoke’s first public health board was organized in 1882, primarily as a means to combat frequent and stubborn outbreaks of smallpox. In 1895 an epidemic of cerebrospinal meningitis — an inflammation of the lining of the spinal cord and brain — took the lives of about 50 people in Roanoke. According to historical records, the disease was so virulent that many of the victims died within 12 hours of being stricken. Diptheria and typhoid were constant threats to Roanoke. In 1902, 30 cases of typhoid per month were reported and infant mortality was high. In 1907, there was an outbreak of typhoid that infected much of the Roanoke Hospital staff. A newspaper article from 1911 listed mortalities: 21 from typhoid, 53 from tuberculosis, 23 from heart disease, 35 from Brights disease (not a contagious disease, this kidney ailment would be referred to today as acute or chronic nephritis.). Although unthinkable today, 54 children under the age of 2 died from diarrhea in 1911. But it was an outbreak of influenza in 1918 that set the standard for epidemics in the United States. In April 1901, the country had entered World War I in April, 1917, a that war that had already killed about 9 million people and would kill another 9 million before hostilities ceased. By comparison, the flu epidemic killed as many as 100 million people worldwide, according to modern estimates. World War I did not cause the flu, experts believe, but troops living in quarters and massive movements of fighting men hastened the spread of the disease and made it more lethal. A major factor looked at in today’s pandemics — the spread of disease across large geographic areas, or worldwide — is travel the ease with which people move from place to place. At the outbreak of the worldwide flu epidemic, contemporary transportation methods mad edit much easier for people for soldiers, sailors and civilian travelers to spread disease. According to many accounts, the first appearance of the flu in this country was when an Army cook at a training camp in Kansas reported to the infirmary on March 11, 1918, complaining of a fever, headache, and other typical flu symptoms. He was sent to bed. By noon on the same day, more than 100 soldiers reported the same symptoms. Within a couple of days, more than 500 soldiers were ill, with some close to death. Almost immediately, other military bases made similar reports. Naval vessels docked off the East Coast began to report illnesses, and even the isolated prison on Alcatraz Island in San Francisco Bay — it was a military prison at the time — reported

the history of healthcare

above Health Ad campaigns became prevalent in the 1920s In an effort to prevent the spread of disease, Images courtesy Historical Collections and Services, Claude Moore Health Sciences Library, University of Virginia

Courtesy of American Red Cross, Roanoke Valley Chapter Red Cross volunteers, early 1900s

cases. Wilkin weeks, it was in France, it then jumped to China and Japan, and then Africa and South America. In Salem, according to historian and Roanoke Times columnist John Long, the first outbreak came in September 1918 at the Baptist Orphanage, where the first fatality was the nurse who was attending the sick children. Some 500 cases were reported in the next few weeks, and 14 died by February. On September 11th, several sailors in Norfolk reported ill with influenza. At that time, Virginia officials saw no cause for concern and it was not until nearly two weeks later that officials filed their first report with the Public Health Service. According to that report, influenza had now spread across the state. Petersburg, Newport News, Norfolk, Portsmouth, Pittsylvania and a variety of other places were all now reporting cases of severe influenza. On October 4th, state officials formally stated that influenza was “epidemic in many parts of the State.” Four days later, the disease was so pervasive that authorities closed the Virginia State Fair. And on October 15th, officials estimated “that there were at least 200,000 cases

in the State.” Because state officials were often overwhelmed and unable to track the epidemic effectively, the actual number of cases was probably much higher. In Roanoke at the peak of the epidemic, there were 200 new cases per day. One report says that some 3,000 cases were reported in Roanoke in 1918. The absence of doctors -- many were in the military -- made matters worse. Here, as elsewhere, quarantines were imposed, schools shut down, theaters and churches were shuttered. Hospitals were severely understaffed. Any able-bodied care worker who were not themselves overcome with flu was desperately needed to help the stricken. Roanoke Hospital sought the help of Nurses Aid, a branch of the Red Cross, which established crash courses in nursing to develop a supply of temporary nurse’s aides. the hospital’s female board members volunteered for nursing duties. By the summer of 1919, influenza had begun to disappear from the state. State officials still worried, however, that the disease would return. In the fall of 1919, the the history of healthcare

Virginia State Board of Health released the following statement. It was published throughout the state. “State-Wide Campaign for the Prevention of Influenza: Richmond, Va.,” “October 9-- With a field force numbering ten or twelve, the State Board of Health and the State Tuberculosis Association are driving hard to launch in the hundred counties of Virginia a campaign for the prevention of the influenza epidemic which swept Virginia last year, claiming a death toll of 15,678.” “A year ago last September there were 19,500 cases of influenza reported by physicians, besides a great number that were probably not seen by physicians or otherwise recorded.”

Courtesy of Carilion Clinic Outpatient Department waiting area at Roanoke Hospital, 1930

“During the twelve months ending September 1, 1919, there were 139,000 cases reported, with a total of 15,678 deaths. Of the death toll, about 4,700 were of persons between the ages of twenty to thirty, in the very prime of young manhood and womanhood.”

Going into the 1920s, epidemics lessened dramatically. Typhoid became rare because of an efficient health department, a cleaner city with better garbage disposal, general enlightenment about health conservation, better paved and cleaner streets, and adequate handling of sewage. Typhoid practically disappeared. And vaccination against smallpox all but eliminated the sight of pitted faces of those who had suffered the disease.

“To prevent the recurrence of the tragic story of last year, a determined effort is being made to organize the forces of the state in a great campaign for prevention.”

Red Cross canteen workers at train station during WW I

Courtesy of the Historical Society of Western Virginia

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VOLUME I FUNERAL HOMES

efore the end of the Civil War, we most often buried our dead on the day after death , or two days after death at the most.

Methods of preserving the body of the deceased were practiced in medical schools as a method of making bodies available for students. But the average American family would have been horrified at the idea of embalming. To do so would have been considered an unnatural intervention in the process of decomposition and an invasion the integrity of the body of a loved one. The deceased was usually placed on display in the parlor of the family home, while friends and family came to pay respects. That is the origin of the terms â&#x20AC;&#x153;funeral parlorâ&#x20AC;? that is widely used today. Bodies would sometimes rest on cooling boards for longer periods of time, but no one tampered with the interior of the corpse, and funerals were held in the home, in a church, or at the graveside.

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John M. Oakey, Inc on Campbell Ave. in downtown Roanoke, 1904. Courtesy of Historical Society of Western Virginia

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The war changed all that. With the war and its bounty of death came more widespread acceptance of embalming. Families wanted one last look at their loved one, no matter that the family may have been in the North and the loved one had fallen far away on a Southern battlefield. Specialists emerged to develop innovative methods to preserve a body for the long journey home. And the modern funeral industry was conceived. Acceptance of the notion of embalming was given a further boost by the epic journey of the body of assassinated president Abraham Lincoln to his final resting place in Springfield, Illinois. After his death on April 15,

Lincoln lay in state in Washington, D.C., for about 6 days before beginning the journey “home.” A train carrying the slain president’s body traveled for 13 days through 180 cities and seven states on its 1,700-mile trip to Illinois. (Also on the train was a coffin containing the body of Lincoln’s son Willie, who had died of typhoid fever in 1862. Willie’s body had been disinterred from a plot in Washington after his father’s death, so that he could be buried alongside the president.) Scheduled stops for the special funeral train were published in newspapers. At each stop, Lincoln’s coffin was taken off the train, placed on an elaborately decorated horse-drawn hearse and led by solemn processions to a public building for viewing. Newspapers reported that people had to wait more than five hours to pass by the president’s coffin in some cities. Hundreds of thousands of people viewed the body, and everyone read newspaper accounts of how the body was preserved. In Salem just after the war’s end, a young Confederate telegraph operator named John M. Oakey married his sweetheart Emma L. Woolwine of Dublin, VA, and decided to return to his pre-war craft of making cabinets and coffins. Here as in many other parts of the country where the undertakers’ trade was beginning to bloom, skilled creators of coffins began to take an interest in the preserved appearance of the deceased. Thus it was then John Oakey began to operate his furniture making and undertaking business on Old Main Street, Salem. As a group, funeral directors have led somewhat schizophrenic working lives during the 150 years or so that they have comprised a recognized profession. On the one hand, the industry has been the target of any number of withering attacks on its business practices and ethics. On the other, individual funeral home operators are respected and trusted business people who offer advice and refuge to grieving families and friends.

above top: John M. Oakey and Son in Salem above bottom: A Hall Tree built by John M. Oakey from his furniture making business, late 1800s

Photos courtesy of the John M. Oakey and Son, Salem

the history of healthcare

Activity in Salem grew steadily, and in 1882 a branch opened in Roanoke bearing the name Oakey & Woolwine, with Oakey’s brother-in-law C.W. C. Woolwine in charge of the new location. In 1891, the company erected one of the first buildings in the 100 block if West Campbell Avenue. According to a short history of the company on its Web site, “This site saw many improvements and enlargements through the years. The three-story, red brick structure, with its art glass front and huge, cascading fern inside, was a familiar site. The words ‘Funeral Directors’ are still seen near the roof.”

In 1910, Oakeys became the second funeral home in the south to add a motor ambulance, although for a time the company retained a horse-drawn hearse for families who had not yet become comfortable with automobiles. Founder John M. Oakey died in 1921, and the leadership of the company passed to his son, an act that has been repeated through five generations of the family to the present day.

As the funeral home replaced its motor vehicles, some of them went as gifts to the fledgling Roanoke Life Saving and First Aid Crew, a model for similar rescue organizations in the rest of the United States. Oakey’s also donated generous amounts of funding and space to the rescue organization. The company has grown to now include five locations in the Roanoke area, creating a remarkable record of community service and public involvement since John M. Oakey made his first coffin so long ago in Salem.

Lincoln’s Funeral Train Map detailing route of the train carrying Lincoln’s slain body from Washington, DC to Illinois.

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VOLUME I HEALTHCARE & HEROS

ealthcare is populated by heroes. For some, it is an occupation, a livelihood, and a calling. They work exhausting long hours, balancing the myriad details of life and death. For others, it is an obligation — a young mother sitting up beside the bed of a young child, or a middle-aged man looking after the health affairs of his elderly parent. No matter the setting, it is the vision and the vitality of an extraordinary type of person that is key to providing care of the health of others. philanthropist and the wife of one of Roanoke’s early business leaders, served the community for nearly 30 years as a community volunteer deeply committed to health issues of the day. She was instrumental in the King’s Daughters creation of its “Home for the Sick” in 1890, preceding a formalized hospital by a decade. She was an active member of the first board of trustees of the Roanoke Hospital in 1899, and served that organization until Mrs. S.W. (Alice) Jamison,

the history of healthcare

Photo by George Davis, courtesy of the Historical Society of Western Virginia the history of healthcare

July 1919. She was also an organizer and the first chairman of a Roanoke-area Red Cross, organized in 1916. became the “superintendent” (having day-to-day charge) of the Roanoke Hospital in 1909, the eighth such person to hold the post in nine years. Her service, however, lasted for 11 years. She guided the fledgling hospital through some of its most difficult and demanding formative years. Miss Margaret Ossenbeck

The Annals of the Roanoke Medical Society, compiled in the early 1920s by Dr. Edmund Pendleton Tompkins, contains an overview of some of the early physicians from he area who served during wartime. Among them: Dr. George S. Hurt, in the year between June 9, 1918 and June 5, 1919, established

and operated a total of seven advanced dressing stations in France. In these stations, often in appalling conditions, battlefield injuries were be cleaned and dressed, injections were given and, when needed, emergency amputations were performed. Dr. J. Warren Knepp saw more than his share of military and wartime duty, it seems.

He was commissioned as a 1st lieutenant in the Virginia National Guard in 1915 and was assigned to Mexican border service from 1916-1917. He was discharged from military service on March 1, 1917, but 24 days later was recalled to military service. He served for a time as inspector of military camps and recruit examining officer for southwest Virginia, and was sent to Europe, where he first worked at and then commanded wartime field hospitals until his discharge in June 1919. was a Navy medical corps lieutenant who sailed on three convoys to Europe, but never landed there. During one trip, about a quarter of the ship‘s crew fell victim to influenza (during the worldwide flu epidemic), with two deaths before the sickest crew members were transferred ashore in the Azores. On the same voyage, the Naval cargo freighter U.S.S.Ticonderoga, part of the convoy, was such by a German submarine. Of the 237 soldiers and sailors aboard, only 24 survived. Dr. Waddie Pennington Jackson

henritta lacks

enlisted in the U.S. Navy early during World War I and wound up in charge of coping with the influenza epidemic at the U.S. Marine training base at Paris Island, SC. Dr. C.C. Richards

Dr. Hugh Henry Trout,

the son of a prominent Roanoke family who after medial training returned to his hometown in 1908 to establish the Dr.Hugh Henry Trout Jefferson Hospital in Roanoke, where he served as surgeon-in-chief until his Courtesy of Jefferson Surgical Clinic death, except for time in the medical corps during World War I. During the war, Dr. Trout was assigned to military hospitals in France, and as chief of surgery played an instrumental role in the dawn of U.S. experience with modern battlefield surgery. Back at home, the hospital he founded would grow to become the Community Hospital of the Roanoke Valley. The original Jefferson Hospital was the surgical training ground for four years of physician and best-selling author Frank G. Slaughter, many of whose books explored medi-

the history of healthcare

cine’s heritage from history and the arts. In all, a dozen Roanoke-area physicians served overseas, and another 15 area physicians saw wartime duty in US posts. Two physicians also saw earlier service in the Spanish-American War of 1918. There is one Roanoke native whose contributions to the health of others has been monumental and occurred without her knowledge. Cells taken from her body without her knowledge or permission still live, and they have provided immeasurable benefit to medical and biological research. was born Loretta Pleasant (there is no record of how her first name changed to Henrietta) on August 18, 1920, in a small shack on a dead end road in Roanoke. After her mother’s death, she went to live with her grandfather in the small Halifax County village of Clover. She married David Lacks, and went with him to Baltimore in 1943, during the wartime boom days of steelmaking and shipbuilding in Sparrows Point. She died a horribly painful death from a vicious form of cervical cancer in 1951 and now lies in an grave back in Clover that only recently has been marked with a headstone. Henrietta Lacks

Before she received treatment for her cancer, cells were

taken from her tumor without her consent, standard practice for the time. Her cells proved to be “immortal,” meaning that they did not die after a few cell divisions. The cells were named HeLa, the initial letters of her name. Although Henrietta has been dead for 60 years, her living cells have been used in development of the polio vaccine; they have helped uncover secrets of cancer, viruses and the effects of radiation; they have led to advances including in vitro fertilization, cloning, gene mapping, and more. The story of the HeLa cell line and Henrietta Lacks’ life is vividly told by author Rebecca Skloot, who spent a decade researching and writing The Immortal Life of Henrietta Lacks. Editors’ Note: In its earliest years especially, healthcare was largely a man’s domain. As a result, very little has been recorded of the many individual contributions by women. We eagerly seek information on the role of individual women in the healthcare history of our communities.

Shenandoah Hospital, located on Campbell Avenue in downtown Roanoke. Courtesy of Norfolk and Western Historic Photograph collection

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VOLUME I LOCATIONS

n addition to the institutions mentioned in other articles in this issue, Roanoke is dotted with sites that were once devoted to healthcare activities.

Most of those are long gone, but here are some of them: The offices of Drs. Koiner & Gale, at 138 Salem Avenue. Dr. Arthur Z. Koiner was surgeon to Norfolk & West-

ern Railway. He was later joined by Dr. Joseph Gale, the father of Lewis-Gale Hospital co-founder Dr. Sparrell Simmons Gale. Dr. Koiner took few rooms near his office and fitted them out to take care of some of his patients. This preceded the drive to establish Roanoke Hospital. The need for adequate facilities may have been particularly keen in Roanoke, however, because of the large numbers of railroad employees and the large number of injuries that working on the railroad entailed. This was perhaps the germ of the idea of a hospital in the region. the history of healthcare

Courtesy of Jefferson Surgical Clinic

Two well-built homes on Franklin Road in Roanoke were joined together to create the 40-bed Jefferson Hospital, 1914.

Sanitarium (1899-1911) located at 121 8th Ave. S. W. This was the first surgical hospital in southwestern Virginia. Opened by Dr. Charles G. Cannady and operated by him until the time of his death in 1908. The hospital was then operated by two associates, Dr. J. Charles Burks and Dr. H.E. Jones, until 1911. Dr. Jones then opened a small hospital at 506 Jefferson Street for use as an office and hospital under the name of Olivia Jones Hospital. He became active in Shenandoah Hospital in 1919 (see below) and discontinued Olivia Jones Hospital. Rebekah

at 527-533 Mountain Avenue, SW. This three-story brick structure served as the private hospital of Dr. J.Charles Burks. St. Charles Hospital (1913)

located near the present day Kazim Shrine Temple (1913). Four physicians opened the hospital in February 1913, with a capacity of 35 patients. The hospital was on Campbell Avenue between Seventh and Eights streets, SW. Shenandoah Hospital,

in Salem. Partly owned by Roanoke physicians, this 30-bed facility opened in May 1914 for the treatment of people with tuberculosis. The main part of the house was originally built in 1890 as a local physician’s mansion. At the time, TB was ravaging the country, and the physician decided to turn his house into a tuberculosis sanatorium. The facility later was devoted to treatment of drug and alcohol addiction. Mount Regis Sanatorium

Dr. Bittle C. Keister’s private hospital

on Seventh Avenue, SW (1900) – now 22 Day Avenue, this small facility operated intermittently before it was turned into an apartment house. on Franklin Road, in the block between Walnut and Allison Avenues. The hospital was founded in 1907 by Dr. Hugh H. Trout, who served as the hospital’s chief surgeon. The building was a Roanoke landmark. During World War I, the entire surgical staff and many of the nurses went to war and the hospital closed temporarily. Jefferson Hospital endured and served as the foundation for the modern day Jefferson College of Health Sciences, the oldest hospital-based college in Virginia. Jefferson Hospital

the history of healthcare

at 711 Jefferson Street. SW (1915). After going through several iterations of medical use, the building now houses some offices of Carilion Clinic. Gill Memorial Hospital

The Roanoke Sanitarium, at 1906 West Salem opened by Dr. Walter S. Slicer and some Roanoke businessmen

oin June 1911, to treat “nervous and mild mental cases” as well as alcohol and drug addiction. In 1913, Dr. Slicer acquired an interest in Shenandoah Hospital and the sanitarium was closed. In the 19th century, smallpox cases were treated at the city’s “pest house” located southwest of the city near Buzzard’s Rock (the present-day sewage treatment plant.) The Roanoke Smallpox Hospital.

In the summer of 1889, a catastrophic train wreck occurred in Thaxton, about 20 miles east of Roanoke. A cloudburst had washed out the tracks, and an eastbound passenger train plunged into the opening, derailing the train and killing and injuring many of the passengers. A rescue train was sent from Roanoke, which transported about 35 of the most seriously wounded passengers. Since the city lacked a hospital in the modern sense, the porches of the hotel were turned into hospital pavilions. The porches of the Hotel Roanoke.

An healthcare advertisement from The Roanoke Daily Times, April 28, 1896. Gill Memorial Hospital on Jefferson Street, 1930s. Photo courtesy of the Historical Society of Western Virginia. Courtesy of Jefferson Surgical Clinic

the history of healthcare

Courtesy of LewisGale Medical Center

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VOLUME I NURSES

ursing is often called the oldest of arts, and the youngest of professions.

Early nursing is intricately tied to the Church â&#x20AC;&#x201C; modeled after the teachings of Christ with regard to caring for the sick, feeding the hungry, and burying the dead.

A nurse prepares a meal for a patient at Lewis-Gale Hospital, 1910.

It is also an almost organic part of motherhood. A traditional female undertaking in the vast majority of its years, nursing in the early 20th century was made up almost exclusively of women, and most nurses were unmarried. Then as now, the primary efforts of nursing were concentrated on patient care, patient comfort, and preventing the spread of infection and disease. During their 12-hour days, six days a week, nurses took care of patients as well as tending to housekeeping duties in their respective hospitals. the history of healthcare

At Roanoke Hospital, the model of modernity in its time, nurses operated elevators by hands, washed floors with buckets and mops, and bathed patients in one of only two bathtubs in the entire building. Throughout its early years, the hospital was chronically understaffed. Non-nursing employees such as kitchen and dining room staff were often pressed into service to move patients in times of nursing shortages. As Virginia’s hospitals became busier and more relied upon by their communities in the late 19th century, the need for skilled assistants and for improved patient care in hospitals spurred the recognition of nursing as a legitimate profession. In Richmond, St. Luke’s Hospital opened a training school in 1886 to educate future nurses in the new medicine. Students at St. Luke’s studied blistering, leeching, and cupping along with anatomy, physiology and anatomy and other modern scientific subjects. Hampton Training School for Nurses began operation at Dixie Hospital in Hampton in 1891 as the first and only facility for black nurses. Roanoke’s Burrell Memorial Hospital would start training nurses in 1925. Just a month after the hospital’s first day in operation — July 1, 1900 — the trustees of Roanoke Hospital approved the rules and regulations for the operation of a training school for nurses, and by that November, three student nurses had been taken into the program. Day-to-day responsibility of running the hospital and the nursing school was in the hands of a graduate nurse, who carried the title “Superintendent.” Turnover of superintendents was an almost annual event until 1909, when Miss Margaret Ossenbeck took the reins as Superintendent and would stay for the next 11 years. Student nurses — and a woman had to be unmarried to go through nursing school — participated in a two-year training program in the first years of the school. As medicine advanced, however, so did requirements for training and hands-on clinical experience for student nurses. In 1905, the term of training was extended to three years, a term that remained constant until 1988. One memorable glimpse of the daily life of a nurse is in a diary kept by a nurse around 1905. In this day of crude equipment and the constant shortage of trained nurses, the hospital’s operating room was typically used just once each day. A specially trained senior nursing student was assigned the details of preparing the operating room with bandages, sponges, anesthetics, linens, and sterilizing instruments.

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above top: A Lewis-Gale Hospital operating room, 1910. Courtesy of LewisGale Medical Center above bottom: Pediatric nurse at Jefferson Hospital Courtesy of Jefferson Surgical Clinic.

Courtesy of Jefferson Surgical Clinic.

above: Graduating class from Jefferson Hospital School of Nursing, 1919. below right: Nursing staff with Dr. James H. Roberts at Burrell Memorial Hospital, 1935.

The diary reads: “A railroad patient was rushed in with a crushed leg for amputation. There were only two doctors available, one for anesthetic and the other to perform the amputation. A senior nurse and I had to assist. She did the sponges and instruments and I held the leg. The man got well.” By the second decade of the 1900s, the need for nurses in Roanoke had become a critical community issue. Lewis-Gale Hospital in Roanoke had been founded in 1909 and two years later, looking to address the nursing shortage, Lewis-Gale began the training program that would produce graduate nurses for the next 50 years and beyond. Also, in 1907, Roanoke medical leader Dr. Hugh Trout, Sr. founded a small, 40-bed facility — Jefferson Hospital — located at what is now 1311 Franklin Road. Trout also recognized the need

Courtesy of Norfolk and Western Historic Photograph Collection the history of healthcare

Nurses tend to patients on the porches of Jefferson Hospital, 1910.

Courtesy of Jefferson Surgical Clinic.

for trained professional nurses, and in 1914 he established the Jefferson Hospital School of Nursing, which would survive in several forms and grow to become the Jefferson College of Health Sciences of today. Roanokeâ&#x20AC;&#x2122;s Visiting Nurses Association took the lead in providing care to patients between home and the hos-

pital. The VNA established and outpatient department at Roanoke Hospital in 1924, geared to treating city residents who were not sick enough for hospital admission, yet needed a level of care beyond what could be provided at home. Convalescence at home was supervised by the visiting nurses.

the history of healthcare

A patient is treated in an iron lung for polio in the early 1950s. Courtesy of Norfolk and Western Historic Photograph Collection

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VOLUME I TECHNOLOGY

he concept of “technology” in the late 19th century, if the word was used at all, would have had a vastly different meaning from today.

In the late 1800s, many physicians were still relying on patients to describe symptoms that they had been experiencing, and not on a hands-on examination of the patient’s body. Modern understanding of the role in healthcare played by chemistry, laboratory techniques and equipment, bacteriology and virology was very much in its infancy. In this time, bleeding was still in use as a therapy, and what drugs had been developed — opium and opium derivatives, digitalis, quinine, mercury, and salicylate preparations (which we now know as aspirin) — were used mostly to treat symptoms. Therapeutic use of drugs to address the causes of disease would not come into widespread use until the development of sulfa drugs and penicillin in the middle of the 20th century. the history of healthcare

Courtesy of Carilion Clinic

The first operation is performed in the new Roanoke Hospital operating room on February 3,1924, one of six performed that day.

It’s not that scientific research that would benefit medicine was not being carried out. It was, but scientific discoveries and their application to medicine were sometimes very slow to be adopted by the medical community. One example: In May of 1863, Confederate surgeon Dr. Hunter Holmes McGuire was struggling mightily to save the life of a very important patient — General Thomas Jonathan “Stonewall” Jackson. Jackson was accidentally shot by his own troops during the Battle of Chancellorsville. Wounded in the right hand by one bullet and in the left arm by two rounds, Jackson was taken to a field hospital, where his left arm was amputated by Dr. McGuire. The operation seemed successful at first, but the utter absence of antiseptic procedure resulted in Jackson suffering infection. He died days later, depriving the south of the leader who military historians agree to be one of the most gifted tactical commanders in U.S. history. At about the same time in Scotland, Joseph Lister was testing whether the application of carbolic acid to surgeons’ hands and instruments and to surgical wounds would eliminate the infection that all too frequently took the lives of patients after surgery. He proved to be correct and published his results in 1867. He visited the United States on a lecture tour in 1876, his lectures heard by several Virginia surgeons who went on

the history of healthcare

to practice the antiseptic techniques he had pioneered. But not everyone was convinced. It was the same Dr. Hunter McGuire who had been treating “Stonewall” Jackson who famously said during an 1884 meeting of the medical Society of Virginia that “Listerism is generally unnecessary, the pure country air of Virginia being in itself quite aseptic.” Lister’s work was one among a number of key scientific discoveries of the late 19th century. Other new findings included the realization that all living things are composed of cells (cell theory) , and that germs cause diseases (germ theory.) Although acceptance of these and other concepts sometimes took years to take hold, once they did they produced seismic shifts in medical and health practices that would pay benefits in years to come. Along with new awakenings in the process of disease and the nature of good public health measures came the development of tools and techniques for diagnosing changes in the human body. Among these were the stethoscope (to detect abnormal sounds in the heart, lungs, and abdomen), percussion techniques (tapping the chest and abdomen to look for changes in the size and location of organs and to detect the presence of abnormal fluids in the body.) Soon to follow was equip-

ment such as the thermometer to check body temperature, the sphygmomanometer to measure and record changes in blood pressure, and more. Medicine also adopted the regular performance of autopsies to examine the deceased and formulate lessons that would help the living. Science was not the only factor shaping the tools and techniques of healthcare at the turn of the century, however. Items as common place today as the telephone and the auto were having a dramatic affect on the way health care was delivered in the late 1800s and early 1900s. Where they were available, telephones helped physicians and other care givers communicate with patients and patient families. The automobile made it much easier for physicians to visit, examine and treat their patients, particularly in largely rural areas such as Roanoke and its environs. Up to this time, physicians would ride horseback or in a horse and buggy to visit patients in their homes. The automobile made it possible for the physician to meet with more people and to get there faster. Families who were early owners of automobiles could reach their doctor’s offices more readily. And more physicians could live in town where they would meet with their colleagues and gain new medical knowledge.

viewing screen that he had developed. It was then that he decided that he would carry out his experience in secrecy, lest his work be discovered to the ruin of his professional reputation if he was in error. He was not in error, and his work led to the invention of the x-ray, which allows physicians to look inside the body without surgery. World War 1 spurred the usage and refinement of the x-ray as well as the electrocardiograph, which monitors heart function,. Both have become indispensable in modern healthcare.

Courtesy of Jefferson Surgical Clinic

In Roanoke, according to the Annals of the Roanoke Medical Society, the first physician to use an automobile in his practice was Dr. Charles Cannaday, who started making house calls via automobile in 1906 or 1907. He was followed by Dr. Jefferson Kinney and Dr. J.R. Garrett. As the Annals tells it, “Those who bought early always held on top their horse-drawn vehicles, mistrusting the ability of the motor car to content with mud and snow.” Although the automobile was a much more efficient mode of transportation, they were no match for the ability of the horse in the event of impassable roads, which would happen frequently in the region. The last to give up the horse was Dr. E.H. Jones, who, according to the Annals, possessed “fine-blooded trotters (that) were always the admiration of his colleagues, and a source of intense gratification and pleasure to their owner...” The Annals makes no mention of when Dr. Jones gave up the horse entirely. In the late 1890s, William Roentgen, a professor of physics in Bavaria, was discovering the ability of radiology to penetrate solid objects of low density — such as the human body. Almost by accident — something that seems common to many great discoveries — he was able to see his own flickering ghostly skeleton on a

above top: Rita Sartini, RT, performs an x-ray at Jefferson Hospital above bottom: A wooden stethoscope; the flat end was placed on the patient’s back or chest and the cupped end is the ear piece.

the history of healthcare

VOLUME II INTO MID 20TH CENTURY

his is the second volume of our history of healthcare in the Roanoke Valley. It covers the years from approximately 1930 to 1965, a time of great tumult, uncertainty and challenge to the people and organizations dedicated to taking care of our health. These 35 years saw the transition of healthcare from a time of severely limited capabilities on the part of healers and care givers (and appropriately low expectations on the part of the population) to the foundations of the extremely capable, extremely expensive healthcare structure we have today. During this era, healthcare organizations were tested repeatedly. The terrible grip of the Great Depression saw the advent of health services that were desired more and more by people who were less and less able to pay for them. This was followed by four years of a nation at war, bringing almost crippling shortages of labor and materials.Together, those forces shaped the ways that healthcare would be practiced for the rest of the 20th century and beyond, not the least of which was the birth of the notion of pre-paid health insurance. This was also an era that marked the emergence of healthcare organizations as major contributors to the life of the community. Employment, training, and local spending by a growing number of hospitals became an important part of the regionâ&#x20AC;&#x2122;s economy, a trend that would grow exponentially in the future. Healthcare organizations would also become important ingredients in the quality of life in a community, a far cry from the way- stations on the path to the grave, as they were viewed not many years earlier. We at Our Health magazine hope that our efforts here interest you, just as we hope that you have found our regular issues to provide an accurate chronicle of healthcare as it is today in our region. We would very much like to have your thoughts on what kind of job we are doing and how we might improve it.

Here is Volume Two. the history of healthcare

VOLUME II HEALTHCARE DEVELOPMENT

s the 1930s dawned, the hospitals of Roanoke had begun compiling their distinguished records of service, gaining the trust of the people they served. During the previous decade, doctors and hospitals had learned enough about disease that people began to feel that they could be reliably treated. People were beginning to feel personal, emotional relationships between themselves and the healthcare establishment. Although the use of penicillin and vaccines for many of the diseases that plagued the country was still in the future, many of the countryâ&#x20AC;&#x2122;s traditional enemies of health, typhoid and diphtheria among them, had been controlled by public health measures. Medicine was by then firmly grounded in science, and work was under way on developing vaccines for tuberculosis, tetanus and, eventually, polio.

the history of healthcare

Lewis-Gale Hospital, circa 1920. Courtesy of LewisGale Medical Center

the history of healthcare

But forces were at work that would change the nature of healthcare forever. Hospitals in Roanoke and elsewhere were still struggling with serious financial shortfalls. As American medicine learned more about how to treat and cure disease and injury, the cost of that care rose to the point that many patients became unable to pay.

During the first year of the Depression alone, people made a total of 7,900 visits to the clinic. That same year, hospital physicians approached the Junior League of Roanoke for assistance. The League agreed to adopt the Free Clinic and spearheaded a fundraising campaign that provided additional examination rooms, a waiting area, medical equipment and furniture, and even a lending library.

And then, in the space of a few days ending on the last Tuesday of October, 1929, the stock market collapsed. Although not the root cause of the Great Depression, the collapse signaled the beginning of a worldwide economic decline that colored every aspect of life for much of the following decade.

Junior League members also worked in the Free Clinic as volunteers providing clerical support and transporting patients to and from their appointments at the clinic. By 1938, the Free Clinic was staffed by 35 physicians and 20 dentists providing health services in a total of 17 medical and dental specialties.

Millions of people lost their jobs as factories closed, businessmen lost their businesses, and farmers were forced off their land. Thousands of families lost their homes. Citizens of the richest nation on earth — many of whom had never expected to have to face shallow financial waters — were forced to learn what it was to be poor.

Medicine in Roanoke was offering an impressive array of services as the 1930s unfolded, but as time went on and as the nation and Roanoke found itself ever more firmly in the grip of the Depression, health care in general became less of a priority for many Americans. Visiting the doctor or seeking help at a hospital was reserved for only the direst of circumstances.

Although railroad employment sheltered Roanoke from the most extreme impact of the Depression, the city’s hospitals were not spared. Hospital officials struggled to help their facilities as they lay in the grip of the Depression. They wrestled not only with monumental challenges in sheer terms of dollars and cents, but also with larger questions — how to provide care for the increasing number of people unable to pay for it, how to maintain employment for hospital employees in the face of plummeting revenues, and how to keep their hospitals in operation as a vital part of the economic life of the community.

In turn, this meant that when people did seek help, they were sicker, and stayed in the hospital longer. And up to 45 percent of the patients who were hospitalized could not pay the bill for a two-week hospitalization, which was the average stay in the early 1930s.

Two hospitals in Roanoke — Roanoke Hospital and Burrell Memorial — accepted patients whether or not they were able to pay for their services.

In many industries, a business decline can be balanced by making fewer products, employing fewer people, operating fewer days, or closing entirely until prosperity returns. Hospital officials had almost none of these options available to them.

Roanoke Hospital’s Free Clinic had been established in 1924 by the Roanoke Visiting Nurse Association, funded by the city’s Community Fund and by hospital revenues. Located on the ground floor of what was then the hospital’s recently completed south wing, it operated as an outpatient clinic, treating people who needed care, but who did not need hospitalization and who could recover at home. There was no way for the Free Clinic’s founders to be able to predict the coming of the Great Depression, but the clinic turned out to be a Godsend for the people hardest hit by the economic collapse.

the history of healthcare

The local Community Fund had been funding a hefty portion of the costs of caring for indigent patients, but by 1935, the Fund has ceased operations, leaving each affiliated organization to fend for itself. In addition, the City of Roanoke had fallen behind on its financial support of the hospital.

By the end of 1932, Roanoke Hospital had less than $300 in its treasury to pay bills. Cost savings had to come from somewhere, and it was time for painful decisions to make ends meet. Cuts in staff and in payroll for employees who were left reduced payroll costs by 20 percent. Interns were paid only $50 a month, with the proviso that payment could be eliminated at any time. In addition, the economy forced the hospital’s board of trustees to cancel enrollment for a spring class of

nursing students in 1933, and graduation exercises were suspended pending an economic recovery.

in 1939 that provided a three-week hospital stay in exchange for a monthly fee.

But no patients were turned away.

As in many communities across Depression-era America, the Roanoke Hospital was kept alive in large part by the participation of community groups and individual volunteers. The Roanoke Junior League continued its support of the Free Clinic at the hospital, and the Roanoke Needlework Guild furnished towels, pillow cases, and baby clothing. The Jewish Sisterhood of Temple Emanuel made hospital supplies during meetings every Monday morning. Christmas trees and gifts for hospitalized patients were provided by the Mill Mountain Garden Club.

People who ran hospitals were caught between their determination to maintain a high level of services for people who needed them, and the need to keep their institutions afloat and able to provide the services. Americans seem to react best in a crisis, however. And out of the misery and fear of the Depression came a fundamental shift in how we pay for health care. Shortly before the economy crashed, Dallas educator Justin Ford Kimbell and Baylor University Hospital tried an experiment — they offered teachers in Dallas free hospital stays in exchange for small monthly advance payments. About 1,500 of the city’s teachers took advantage of the offer, paying fifty cents each month, which entitled them to receive up to 21 days in the hospital should they need it. At about the same time, in the lumber and mining camps of the Pacific Northwest, employers were becoming alarmed at the cost of treating the illnesses and injuries among the workers in those hazardous industries. The employers made arrangements with local physicians, who received a monthly payment from the employers and treated the employees for the one single fee. The approach caught on. Similar plans followed and by 1937, more than a million people were covered. Hospital officials realized that offering pre-paid plans could help their hospitals by furnishing a steady, reliable cash flow.The American Hospital Association, the industry trade group, began to offer prepaid hospitalization plans through its member hospitals. The plans evolved into what we now know as Blue Cross and Blue Shield, which operated as non-profit corporations in every state. Since the plans were owned by hospitals, they were not recognized as insurance companies, which in turned exempted them from state taxes on premiums they collected. Because the plans were offered by individual hospitals, the institutions began to compete with each other, but then they began to collaborate with each other to offer network hospital coverage and to reduce inter-hospital rivalries. In Roanoke, six hospitals — Roanoke Hospital, Jefferson Hospital, Lewis-Gale Hospital, Burrell Hospital, Gill Hospital and Shenandoah Hospital — formed a group hospital plan, the Hospital Service Association,

But not all hospitals were strong enough to emerge from the Depression unscathed. St. Charles Hospital, a private institution opened in 1913 on Mountain Ave, SW, by Dr. J. Charles Burks, closed its doors. Lewis-Gale Hospital was forced to abandon plans to construct a new facility. At the time, the hospital had 66 patient beds, but was facing a new American Medical Association requirement that hospitals operating an internship program have at least 100 beds. The hospital bought a lot on Franklin Road, planning to build the new hospital on that site. Plans were dropped, however, with the coming of the depression. A new wing was added to the hospital, however, which increased bed capacity to a total 166. It opened in 1938. A major hospital construction project in Salem helped relieve the Roanoke area of some of the strain of the depression by providing employment for area workers and something of a boost in civic pride during its opening ceremonies. The Veterans Administration Medical Center in Salem opened on October 19, 1934, with President Franklin D. Roosevelt on hand to dedicate the facility before an opening day crowd of about 34,000 people. As the 1930s wore on, the effects of the Depression eased and things returned nearer to “normal.” The City of Roanoke had resumed payments to Roanoke Hospital and the Community Fund had been reactivated, providing a more dependable flow of income to cover the steadily growing flow of charity services. X-ray and radiography equipment came to the hospital in 1938, and long-delayed building repairs could finally be done. The Roanoke Hospital Association, the body that governed Roanoke Hospital, reported at the end of the decade that it had about $400,000 in assets, although it had never earned a profit. The hospital’s mortgage was retired in 1941, and both patient stays and annual the history of healthcare

President Roosevelt arrives in Roanoke for the opening of the Veterans Administration Medical Center in Salem, 1934. Courtesy of Historical Society of Western Virginia

revenue set records. Financial stability seemed to be in sight, but it would take the massive spending of World War II to fully turn aside the economic damage of the Depression. The day after the Japanese attack on the U.S. Naval base in Pearl Harbor on December 7, 1941, the United States entered World War II.The attack was a profound shock, and entry into the war triggered an almost immediate shift in the political and economic profile of America, and in the American psyche. America was not ready to go to war, and the focus of nearly every aspect of American life was suddenly shifted to accommodate the all-out war effort. Shortly after Pearl Harbor, doctors, nurses, dietitians, and other health care workers began to disappear from American hospitals as they headed for military service. Clerks, maintenance men, housekeeping personnel and other health care support workers became scarce as they too went to war or into more highly paid war production jobs. The loss of nurses was most particularly felt as registered nurses joined the war effort and there were few students to enter training programs. For the first time, waves of women took jobs in industry, working full time while still trying to maintain their homes. Even high schoolers, attracted by waiting jobs, quit school and went to work as federal inspectors ignored child labor laws. In Roanoke, residents and hospitals found themselves short of physicians and other health care professionals, although the number of hospitalizations was still running high. Supplies of all kinds dwindled and prices sky-

the history of healthcare

rocketed â&#x20AC;&#x201D; food by 40 percent compared to 1939, clothing up 23 percent, fuel and electricity up eight percent. With most resources directed to feeding the war machine, there was very little left for new equipment for hospitals, and even the newly-discovered wonder drug penicillin was siphoned away for the treatment of battlefield injuries. Roanoke hospitals were operating under basic conditions. At Lewis-Gale Hospital, most of the obstetrics staff had gone to war and the department was run almost single-handedly by Duvahl Ridgeway, MD. By then, hospitals had become the preferred place to deliver babies, and Dr. Ridgeway delivered an average of 600 babies a year. Very few physicians were left to hold Roanoke Hospital together during the war years. All over the city, physicians were working to exhaustion. Government regulations to freeze pay for employees did not apply to charitable institutions such as hospitals, so to keep pace with demand and to try to retain as many healthcare employees as possible, many Roanoke hospitals raised their room rates as a means to fund pay increases for employees. The same government wage controls combined with very low rates of unemployment left employers desperate to find ways to attract and hold workers. As an enticement, employers began to provide health insurance. By 1945, Blue Cross Blue Shield â&#x20AC;&#x201D; which had been brought on the scene during the recent Depression â&#x20AC;&#x201D; covered 19 million people in nearly every state. Hospitals and healthcare organizations even became an

integral part of the war effort on the home front. The pioneering Roanoke Life Saving and First Aids Crew, the first of its type in the country, was recruited by the War Department to be available for service in the event of any airplane accidents within a 100-mile radius of Roanoke. Although the crew’s numbers had been reduced when members joined the military, the remaining members gladly took up the challenge of training and equipping themselves to serve in that role. Roanoke Hospital was designated as the receiving hospital if there were to be any enemy bombing raids on the U.S. The hospital would receive 100 civilian patients, according to the emergency plan, with the government then furnishing nurses, bedding and supplies, and paying a daily fee for the care of patients. Neither contingency was put in operation.

ognized that a break from fighting, rest in a safe place with good food, can restore troops in battle.Those who carried the mental scars of battle could be treated in military hospitals. All of these lessons and more were full of implications for the practice of medicine and healing after the war. Peace finally came, and with the war’s end came pentup demand for all of the things that America had done without during the past four years. Surviving the crucible of the Great Depression and the war years, America was poised for great development and economic vitality. Servicemen and servicewomen returning from the war went back to life with a vengeance. They resumed their educations, resumed their careers, built houses, had babies, and became active consumers. The air was filled with promise. Pressures on the healthcare community increased, planting the seeds for major hospital construction projects. Physicians had maintained and sharpened their skills during the war service, so they were both eager and ready to return to work in their civilian communities. Hospitals in Roanoke were able to quickly staff up as men and women returned from active duty.The largest nursing school class up to then began their studies at Roanoke Hospital’s school of nursing in September 1948, with student nurses now housed in the newly renovated “Hill House” on the hospital’s campus.

Courtesy of American Red Cross, Roanoke Chapter Red Cross nurses prepare bandages to send overseas during WW II.

Medicine in general gained a great deal as a result of the war. Combat surgeons developed new approaches and techniques that saved countless lives on and off of the battlefields. Orthopaedic surgeons learned how to save injured arms and legs that in most previous wars had simply been amputated. Surgeons worked on perfecting debridement, the art of removing dead or dying skin from burns, and other injuries as a way of healing and preventing infection. Infectious disease specialists gained better understanding of how to treat and prevent diseases such as malaria. Miracle drugs such as penicillin were in wide combat use as a way to prevent infection, and by the end of the war, the drugs were going into mass production for civilian use. Not all wartime injuries are physical, however. Military psychiatrists and psychologists schooled themselves on the effects that combat has on the individual. They rec-

Population growth and demand for health services was increasing across the board, which in turn led to furious planning for expansion of existing hospitals, and early work on establishing hospitals where none had been before. Through their trade associations, hospitals in America agreed that the time was right to press for federal assistance in the planning and construction of new hospital facilities. Two U.S. Senators, Lister Hill of Alabama and Harold Burton of Ohio, introduced legislation in 1945 that would inject Federal funding into hospital construction. The Hill-Burton Act, signed into laws in 1946, influenced the growth of hospitals for most of the next 50 years. The law gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a “reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area, without discrimination on the basis of race, color, national origin, creed or any other ground unrelated to the individual’s need for the service or the availability of needed service in the facility”.

the history of healthcare

In Virginia, state financing was available to supplement the Hill-Burton funds, in localities that were deemed to be medically underserved by existing facilities. A survey completed in 1948 showed that Roanoke was 185 beds short of the total number of beds required to serve the population of southwestern Virginia. Five hospitals in the Roanoke Valley served the white community: Lewis-Gale, Shenandoah, Jefferson, the Veterans’ Administration Hospital in Salem, and Roanoke Hospital. Only the Burrell Memorial Hospital was dedicated to African Americans. With Roanoke Hospital and Burrell the only two hospitals willing to accept any patient, they were eligible to apply together for the state/ federal aid. The two hospitals were required to raise matching funds from their community. In October 1949, facing the fundraising effort and anxious to avoid the misconception that the hospital was city-run, Roanoke Hospital changed its name to Memorial and Crippled Children’s Hospital, paying homage to those who donated in the past and the Society for the Crippled of Southwestern Virginia. The Society had donated money for 30 extra beds in the hospital to treat growing numbers of young people being treated for polio. A total of $2 million was budgeted, with half of that raised locally. $1 million was dedicated to building a new wing at the newly renamed Memorial. The addition would include 100 additional beds, including a new 50-bed department for the care and treatment of crippled children. A total of $500,000 was earmarked to the Society for Crippled Children for expansion of its work, and the remaining $500,000 was reserved for construction of an all-new Burrell Memorial Hospital, with 75 beds. Roanoke had never had an especially stunning track record with regard to fundraising for hospital construction, so for this campaign a separate broadbased not-for-profit organization was formed, with leading citizens of the community serving on its board of directors. The Hospital Development Fund, Inc., would solicit funding throughout southwestern Virginia. An office for the campaign was donated by the Appalachian Electric Power Company, and banks made typists available for the collection phase of the campaign. By 1950, more than $2.3 million in pledges had been secured, and plans for construction began. Collecting on the pledges proved very difficult, however, with the Hospital Development Fund resorting to threats of legal action before all of the pledges could be collected.

the history of healthcare

The surge of new hospital construction spread to much of southwestern Virginia. In the New River Valley, completion of the Claytor Dam hydroelectric project in 1939 and the 1941 opening of the Radford Arsenal to produce ammunition for the war made the city of Radford a sudden boom town. The city had no viable hospital, but passage of the Lanham Act provided hospital construction funds for areas heavily impacted by the war effort. The new Radford Community Hospital opened in 1943, a 68-bed hospital that grew to 85 beds before long. Also in Radford, St. Albans Psychiatric Hospital had been providing psychiatric services since its opening in 1916. A private psychiatric facility struggling with chronic financial shortfalls but still building an excellent reputation for care, St. Albans saw admissions climb steadily after the end of World War II. By 1947, St. Albans was admitting more patients than any other mental hospital in Virginia, aside from Veterans’ Administration hospitals. Serial construction projects in the late 1940s through the 1950s added beds and support facilities and the hospital dropped its private ownership model and became a non-profit institution. In 1960, St. Albans became one of the first hospitals in the country to seek accreditation from the fledgling Joint Commission on the Accreditation of Hospitals. Since 1924, people in rural Giles County were served by the private St. Elizabeth’s Hospital in Pearisburg under the guidance of its founder, W.C. Caudill, MD. In 1948, the Giles County Chamber of Commerce called upon Dr. Caudill to head a board of governors to plan a new hospital, to be known as Giles Memorial Hospital. The Celanese Corporation (later Hoechst Celanese) was the county’s largest employer. The company donated land and a significant amount of funding for the new hospital. Additional funds came from the Federal government under the Hill-Burton Act, from additional local industries, and from a public bond issue. The new 50-bed hospital was dedicated on December 4, 1950, with patients moved from the old St. Elizabeth’s Hospital beginning eight days later. As is the case with many not-for-profit hospitals, Giles Memorial found it difficult to collect payment from patients it had served. Hospital administrator Raymond Hogan, who would later in his career make healthcare history in nearby Lynchburg, spoke of the problem to members of a local Kiwanis club in February 1954. “The hospital...provides service on demand,” Hogan told his listeners. “When people are sick or injured, you can’t turn them away. But if they do not choose to pay, we have no means of recovery. After we’ve taken out

somebody’s appendix, we can’t put it back in if he doesn’t pay his bill.” In 1947, four Franklin County physicians enlisted the help of two local business leaders to establish a hospital serving area residents. E.C. Jamison, MD, James Colley, MD, Frank Bayes Wolfe, MD, and Henry Lee, MD, saw the need for a full-service hospital based in Rocky Mount. When they were unable to obtain funding on their own, they joined forces with community business leaders Charles J. David and D. Clinton Vaughn and together with other citizens laid plans to build a hospital in Rocky Mount. The Franklin County community made the project a priority. Within a year, the community had raised $209,000, more than the amount of local funds that were required to earn matching funding from the Hill-Burton Act. Local participation didn’t stop with the funding. Volunteers made mattress covers, curtains, tablecloths and more for the new hospital.They provided washing machines, flower containers, and coat hangers.They washed every window in the building and they guided tours for more than 5,000 visitors during the hospital’s pre-opening days. Hundreds turned out for the hospital’s dedication on May 2, 1952. William H. “Ham” Flannagan, the hospital’s first administrator, would emerge as a giant in future decades of healthcare growth in the Roanoke Valley. “The building of the hospital,” he later wrote in the local newspaper. “was received in the very beginning with enthusiasm and loyalty by all the citizens within this great county.” As one of two Roanoke hospitals intent on serving everyone who entered its doors, Burrell Memorial Hospital was a partner with the newly renamed Memorial and Crippled Children’s Hospital in seeking federal funding for expansion of the institutions. Since 1921, Burrell Memorial had dedicated itself to treating African American patients, a welcome alternative to a stay in neglected corners of segregated hospitals. But by the late 1940s the hospital was facing extinction, caught

Burrell Memorial Hospital, 1950s

the history of healthcare

in an awful irony: the hospital was fulfilling its mission of serving those most in need of health care, no matter how ill or how poor. Burrell Memorial was treating half of the prenatal care and 30 percent of all illness from an almost exclusively African American patient base, a population that possessed only three percent of the wealth of the community. Still, Burrell did qualify for federal construction funds for the badly needed replacement of its old building. The same slowness in collecting on local pledges that hindered the former Roanoke Hospital was nearly crippling for Burrell Memorial, yet construction on a new, 70-bed building at 611 McDowell Avenue began in 1953 and the new, modern building opened on July 31, 1955. The hospital would navigate through dire financial straits while still providing quality care for the next two decades. Rural Bedford County was approaching its 200th birthday when citizens decided to raise funds for a modern, well-equipped hospital. As was the case in Franklin County, the work of generating support for the new hospital fell to a pair of civic leaders, Mrs. Robert A. Harper and Mrs. Jesse T. Davidson Jr., who gathered other influential Bedford County citizens in Mrs. Harper’s home to “talk hospital.” There were some false starts in creating a hospital for Bedford County. Dissent among factions in the community, some pessimism and apathy among residents, and a Virginia Department of Health opinion that to build a hospital in Bedford would be impractical. Proponents of the idea persisted, however, and in 1950 a board of directors for the hospital was formed. The board’s first task was to raise about $350,000 — to be matched by the same amount in federal Hill-Burton funds — to build a 40-bed hospital. To encourage donations and moral support, the board revived an idea that had surfaced and failed four years earlier — that the new hospital would be a fitting tribute to those from the community who had served in the war. Bedford paid a crushing price in supporting the war effort by the number of residents who went to war in general, but in particular the sacrifices of “The Bedford Boys.” This name was given to the large number of young Bedford men who were among the first to assault Omaha Beach on D-Day, June 6, 1944. By day’s end, 19 Bedford soldiers lay on the beach, dead. Proportionately, the small community of Bedford suffered the country’s most severe D-Day losses.

the history of healthcare

The appeal struck an immediate chord. “In this campaign, Bedford County is going through the most stirring emotional experience of its history,” one newspaper observer wrote at the time, “...this community of nearly 30,000 souls is undergoing a spiritual rebirth.” The formal kickoff of the campaign was celebrated on June 8, 1950, and by July 1 corporations, fraternal and civic groups, and more than 3,100 individual donors had pledge nearly a half-million dollars. Still, it would be another five years before Bedford could open its hospital. Inflation fed by the Korean War halted many government-funded projects, including both state and federal funding for the new hospital, and increases in anticipated construction costs. But careful financial management, determination, and even a lastminute community fund drive resulted in the dedication of Bedford Memorial Hospital on February 20, 1955. As the 1950s ended, hospitals were the third largest employers in the region, surpassed only by the Norfolk & Western Railway and the American Viscose Corporation. Roanoke still needed hospital beds, however, even with the expansion of Memorial and Crippled Children’s and Burrell Memorial hospitals. Officials at Jefferson Hospital, working out of a 1914 vintage building, determined that a new building was needed to replace the aging facility and to answer the need for additional hospital beds. The management of Lewis-Gale Hospital, also looking to expand that hospital, partnered with Jefferson Hospital in planning to build a 400-bed building that would replace the combined 340 beds of the respective partner hospitals. The new hospital would be located in southwest Roanoke and in November 1959, the hospitals agreed to cease their separate operations and merge upon the opening of the new building.

As the 1950s ended, hospitals were the

third largest employers in the region

Later, however, heeding the ever increasing need for hospital space for the growing Roanoke area, Lewis-Gale decided to continue as a separate hospital, with the agreement of Jefferson Hospital officials. Their “separation” agreement stipulated that Lewis-Gale would contribute $400,000 to the new hospital, and that the new hospital would assume Lewis-Gale’s services in obstetrics and pediatrics, and would become the “owner” of Lewis-Gales’ school of nursing. After a planning and construction period of some seven years, the new building would open in 1967 as Community Hospital of the Roanoke Valley. Before the Jefferson Hospital ceased operations, however, it gave inspiration and its name to at least one group medical practice that still thrives today, still proud of its insistence that member physicians be among the best trained in the country. When he founded “the Jefferson,” trailblazing surgeon Hugh Trout, MD, determined that he would be surrounded by physicians who were at least as well-trained as he. Having been educated at the University of Virginia, he completed his surgical training at Johns Hopkins in Baltimore. He went in search of equally well-trained practitioners, bringing them to Roanoke to staff the hospital he had founded in 1907. His two sons, both surgeons, mirrored their father’s dedication to high quality, and one of them, Hugh Trout Jr., MD, with four other surgeons founded the Jefferson Surgical Clinic, established to perform surgical services for the Jefferson Hospital. The practice continues to this day, now consisting of nearly 20 medical and surgical specialists who staff a total of six locations. Robert L.A. Keeley, MD, the last living founder, recalls that there were but “two rules by which all members of the practice conducted their professional lives; one, that we would never take a new partner unless we were willing to have the new partner operate on our family members, and two, that should one of your partners call for help — no matter what time of day or night — the only question to be asked will be ‘Where are you?’.” “And that, along with our dedication that the patients always comes first,” says Dr. Keeley, “are the only two rules today as well.” Meanwhile, at the Memorial and Crippled Children’s Hospital, William H. “Ham” Flannagan had been lured from Franklin County to become the Roanoke hospital’s administrator. Early in his 32-year tenure, Flannagan had convinced the board of his new hospital to change the institution’s name to avoid misconceptions that its only mission was to treat children. The hospital became Roanoke Memorial Hospital in April 1955. Although not insignificant, renaming the hospital may have been the least of the advances at Roanoke Memorial during the Flannagan years. A cancer tumor clinic was opened in 1952, followed the next year by a dedicated service for the treatment of the devastating disease, polio (please see the accompanying article.) Nurses saw the advent of the 40-hour workweek, every department of the hospital was expanding and being modernized, a school of practical nursing began operations in 1957, a new building and dormitory for student nurses was opened in 1959, and a rehabilitation center aimed at treating chronic diseases was opened in 1962. At Roanoke Memorial Hospitals and in every other health care facility in the region, the pieces were nearly in place for the explosive growth of medicine and healthcare that began in the 1960s.

Equipment display from Roanoke Life Saving and First Aid Crew, 1936. Courtesy of REMS, Inc.

the history of healthcare

VOLUME II LIFE SAVING SERVICES

ince its founding in 1928 as the first organized volunteer rescue squad in the United States, the Roanoke Life Saving and First Aid Crew had continued to pioneer emergency services on several fronts. The work of the crew touched many families in the region when the crew began providing portable oxygen tents to patientâ&#x20AC;&#x2122;s homes and area hospitals. Physicians relied on the crew increasingly when ordering oxygen therapy for their patients, and the community rapidly gained confidence in the quality of services the crew was furnishing.

the history of healthcare

Photos courtesy of REMS, Inc.

Crew founder Julian Wise and fellow members of the Roanoke crew also became deeply involved in lending assistance to crews that were by then being organized throughout Virginia. In this time as well, communities in such states as Wisconsin, Michigan and Alabama began organizing crews, based upon the Roanoke model. A Cadillac hearse donated by Oakey’s Funeral Home had been converted into a rescue vehicle, but by 1934 the organization was getting enough calls with enough diverse needs that the crew needed a larger equipment truck. Its first vehicle purchase was a Ford panel body truck, which they outfitted with cabinets and partitions and kept in service until 1946.

above top: Construction of new Roanoke Life Saving headquarters on Day Ave, 1954. above middle: The Crew’s first vehicle purchase - a 1932 Ford. above bottom: Oldsmobile 78 sedan, purchased in 1947.

the history of healthcare

The number of calls for help the crew received corresponded to the growing awareness and confidence that the crew inspired in the community. In 1930, the crew received a total of 56 calls for help. Five years later, during the two-year period 1935-36, a total of 356 calls for help were answered by the crew, and the crew provided “light” first aid in more than 3,000 cases. “Light” first aid included treating cuts, bruises, sprains, fainting, and other non-critical incidents. Just a few years later, in 1937 and 1938, they were credited with saving 74 lives in 398 calls. They also launched a program of safety inspections at municipal swimming pools, gave safety lectures at the pools, and conducted a constant program of safety talks, first aid lessons, and first aid training for Boy Scouts.

In 1940, the crew received an emergency call for the transport of a polio patient from a hospital in a neighboring city to Roanoke. The patient was critically ill and needed an iron lung. But at that early date, there was not an iron lung to be found in Virginia. Crew members made frantic calls into nine neighboring states, finally found one, and had it rushed to the patient. It arrived too late, however, and a life was lost. Shattered, the crew members started raising funds to buy an iron lung even though, in the normal scheme of things, the machine was considered to be something that hospitals would buy.The lifesaving crew went to the people of Roanoke for the $1,500 needed to buy one machine. The people responded, giving enough money to buy three of the machines. It was well-timed generosity. Almost upon arrival of the first machine, it was pressed into service in continuing waves of calls for help through the 1950s. With the coming of World War II, a large number of lifesaving crew members went off to fight, but those left behind continued to provide unbroken service. The crew not only answered a growing volume of calls from the community, but they also answered calls for help from the U.S. Government. Enemy attack on the United States was considered a possibility, and crew members taught first aid to countless Civil Defense rescue groups. The Roanoke crew was also key to organizing Civil Defense rescue squads, organized and drilled in effective procedures during blackouts and possible enemy attack.

In 1943, the Roanoke crew was commissioned by the Departments of the Army and the Navy to organize, train, and equip themselves to be available in the case of an airplane crash within 100 miles of Roanoke. The crew set to work gaining the training they would need and equipping a special crash trailer with all of the specialized gear and clothing that would be needed for heavy rescue missions of this type. Post-war, much of the same equipment proved invaluable in instances involving train or bus wrecks, building collapse, and any other catastrophes that would outstrip the capabilities of many crews. In the 1950s, crew members found themselves increasingly challenged by the limitations of the space that had been provided by Oakeyâ&#x20AC;&#x2122;s Funeral Home for so many years, and they went looking for their own space. They bought a vacant lot at 374 Day Avenue. Construction began in 1954, and their new home was ready for move-in in 1956. Many of the construction materials were donated by suppliers, the local bricklayers union donated its service, and American Iron and Bridge furnished all metalwork. Until the early 1960s, members of the crew responded to rescue calls, but they had no ambulance vehicles. People who needed transportation to the hospital from the scene of an illness or injury were transported by Oakeyâ&#x20AC;&#x2122;s, by Lotz Funeral Home, or by the American ambulance service. However, by the end of the 60s, the crew owned three Cadillac ambulances with four-wheel drive, all equipped for patient transport and ready to carry the lifesaving crew into the future.

REMS truck

the history of healthcare Photos courtesy of REMS, Inc.

VOLUME II EPIDEMICS - POLIO THE â&#x20AC;&#x153;SUMMER TERRORâ&#x20AC;?

s America moved through mid-century, it gradually became free of the eruptions of illnesses that had so frequently frightened and ravaged communities. Widespread outbreaks of disease were not eradicated, however. Tuberculosis continued to be a menace, to the extent that the Catawba Sanitarium in northern Roanoke County had on its campus a cottage especially for nurses who had contracted the disease while treating TB patients. Funded by a nursing association, nurses who could not afford to pay for treatment could go there for treatment at little or no expense. In addition, the influenza made an annual visit, often closing schools until the danger had passed.

the history of healthcare

Catawba Sanitarium Courtesy of DBHHS, Commonwealth of Virginia

the history of healthcare

But after World War II, the most virulent killer diseases —cholera, diphtheria and smallpox — had largely been banished from the American health landscape. But then, often during the warmer months, young people started coming down with vague flu-like symptoms— a headache, red and sore throat, perhaps a fever, and maybe even vomiting. Symptoms often disappeared in three days or so. Others, however, became sicker.They developed pain or stiffness in their legs, back, neck, or abdomen. Some had muscle spasms or found it extremely painful to be touched. Then later, some would find it difficult to swallow or breathe. Very soon after, their limbs may have become weak and then become paralyzed as their families looked on. It was polio. And it brought a reign of terror that changed the lives of many and triggered profound cultural changes. Polio was a dreaded disease, not only because of the damage it inflicted on its victims. It was dreaded because for many years medicine did not understand what caused it or how to cure it and because young people were the most frequently infected. It separated children from their families for long periods of time. It struck fast, it was indiscriminate, and it crippled some of its victims for life. Polio is the result of one of three kinds of viruses. We know now that the viruses are spread via contact among people — through nasal and oral secretions and through contact with contaminated feces — and the virus enters the digestive tract. In most cases, symptoms of the disease are rather mild, akin to mild influenza.

Nurse working with Polio patient, 1950s

In a minority of cases, the virus leaves the digestive tract, goes into the bloodstream, and attacks nerve cells. In a small but heartbreaking minority of cases, polio causes paralysis. In more severe cases, the throat and chest become paralyzed, killing the patient if there is no mechanical breathing support. That’s what we know now. We didn’t know it in the post-war years. How polio worked and how to treat it was unknown. As a result, communities practiced the age-old remedy of isolation. Social gatherings were canceled, schools closed, swimming pools were drained, county fairs were canceled, and victims were strictly quarantined. Towns all over America became suddenly, eerily quiet without the daily background music of children playing and people going about their normal business. Only the fear surrounding AIDS in recent times can approximate the panic caused by polio. One of the worst-hit communities in the nation was Wytheville and Wythe County, in Virginia’s southwestern corner. From a population of about 5,500 people in 1950, 184 were felled by polio and at least 17 died. In the 1940s, Roanoke Hospital was the only health facility in southwestern Virginia capable of treating polio victims. The hospital’s outpatient department maintained an active program of staffing rural clinics throughout the region established by the Society for Crippled Children of Southwest Virginia. Parts of southwestern Virginia were rural, remote areas where people lived far from medical expertise. The Society coordinated medical help for children in the region suffering from malnutrition, birth defects, diseases of the bones and joints, and other infections. Volunteer physicians from Roanoke staffed the clinics on a rotating basis. The Society for Crippled Children and Roanoke Hospital were in the process of planning for a children’s ward at the hospital when, on a midJuly Friday in 1944, hospital superintendent Ruth Hardy received a call from Roanoke Health Department Director Alford G. Evans, MD, and Roy Hoover, MD, an orthopaedist who specialized in polio and who was one of the volunteer physicians working with the Society. The doctors were calling to ask the hospital to create an isolation area for people with polio, believing that the disease would become epidemic in the region. That conversation touched off a round of weekend meetings of hospital physi-

the history of healthcare Courtesy of Historical Society of Western Virginia

Courtesy of Carilion Clinic

A patient is treated in an Iron Lung

cians, senior personnel, and the board members to discuss and plan how the hospital and region would respond to the imminent health crisis. By Monday, plans were being put in motion. The isolation ward would be completely blocked off from the rest of the hospital. There would be two entrances — one for physicians and hospital staff, the other a locked, guarded entrance for the few visitors who would be permitted. They would enter through a “clean room,” where they would don protective clothing and face masks. The planning proved providential. By the end of August, 76 young people had been admitted with polio, also called “infantile paralysis” at the time. Patients would spend about two weeks at Roanoke Hospital, before they were transferred to special wards in Charlottesville or Richmond. Inside the ward, there was nothing to be done to cure polio, because there was no cure. Hospital staff worked to exhaustion, however, because there were many children to be bathed, fed and clothed, and multiple physical therapy sessions for each patient. A common treatment was use of a “hot pack” to relax muscles and relieve pain. Hot woolen strips were wrapped around affected limbs, topped with a layer of oiled silk, and wrapped again with hot woolen strips. The heat lasted for about two hours, then the process was repeated. Some of the young patients’ long days in the hospital were filled by the books, toys, games, and other amusements donated by many Roanoke residents. In 1949, the hospital established a classroom and hired teachers to help the patients keep up with their schoolwork. Patients of all ages whose paralysis from polio made normal breathing impossible were placed in an artificial respirator that quickly came to be known as the “iron lung,” the chilling symbol of polio’s attack.The device was invented the history of healthcare

in Boston in the late 1920s, with trial versions powered by two household vacuum cleaners. In the 1930s, the device had been refined to resemble a large metal cylinder that surrounded a person’s entire body, except for the head. The iron lung maintained respiration, forcing the patient to inhale and exhale, until the patient was able to breath on his or her own, if ever.

Patients sometimes stayed in the hospital for months. Medical and surgical beds were turned over to polio victims, patients in iron lungs were in the hallways, and nursing school classrooms were pressed into use to house patients in iron lungs. Power failures were frequent, and hospital personnel would operate the iron lungs by hand until power was restored.

The Roanoke Life Saving and First Aid Crew, already broadly respected because of its pioneering work in emergency medical care, performed heroically during the polio epidemic. The crew purchased iron lungs to be available for use in the Roanoke hospital and in Lynchburg as well. Sometimes respiratory paralysis came on very swiftly, and the lifesaving crew was called upon countless times to deliver an iron lung to remote locations for use while the patient was transported to the hospital. The crew also maintained the machines.

Patients needing more specialized, intensive care were transferred to Children’s Hospital in Richmond. Transfer of patients in an iron lung was complicated, and the process stands today as a prime example of the level of community cooperation that prevailed at the time. An extralong electrical cable was used to power the iron lung while it and the patient were wheeled to the doors of the hospital and into a special genera t o r- e q u i p p e d truck provided by the Pitzer Transfer Company. The truck would transport the patient and iron lung to the Jefferson Street passenger station of the N&W Railway. There, the immobilized patient rode to Petersburg in a specially equipped freight car provided by the railway. In Petersburg, the special fright car was transferred to the Richmond, Fredericksburg and Potomac railway, which would transport the freight car to Richmond. There, the process would be reversed to get the patient and iron lung to Children’s Hospital.

Polio Vaccine poster

Polio was a tragic and heartbreaking reality throughout the late 1940s, but the summer of 1950 pushed the hospital — now known as Memorial and Crippled Children’s Hospital — almost to the breaking point. Where polio admissions had totaled 135 cases in 1944, they soared to about 500 in 1950. “It was awful,” recalled Louis Ripley, MD, one of the orthopaedists caring for polio patients at the time. “Whole floors of the hospital were full of patients — infants to adults. And many died.”

the history of healthcare

Work by Jonas Salk, MD, resulted in a preventive vaccine in 1953. Salk was hailed as a miracle maker, who further endeared himself to the American public by refusing to patent the vaccine because he said he had no desire to profit personally from the discovery. The basis for confirming the effectiveness of the vaccine involved

the now-famous HeLa cells, the “immortal cells” taken from Roanoke native Henrietta Lacks without her knowledge. The HeLa cells were highly susceptible to the polio virus, Salk learned, and he and his researchers used these cells as a test medium for the vaccine. If the vaccine was successful in killing the polio virus in the HeLa cells, it would be successful on a mass scale with humans. Mass vaccinations began in the US in 1955, and in 1961, Albert Sabine refined an oral vaccine, the vaccine contained in the pink-tinged sugar cubes many remember from the mass vaccinations of the 1960s. In April, 1957, local health agencies led by the Roanoke Academy of Medicine launched an ambitious campaign to eradicate polio from the Roanoke Valley, urging vaccinations for everyone under age 40. Polio shots were available in physicians’ offices, and teams of physicians, nurses, and PTA volunteers traveled to schools, stores, and industries to dispense shots, and they staffed polio shot moving vans stationed at busy intersections in the region. More than 65,000 people received the polio vaccine through the effort. In Roanoke, no new polio patients were being hospitalized by 1963, and the disease was no longer considered a threat. Though it was a national nightmare at the time, polio and the damage it left behind have now become faded history to many. But the effects of the waves of polio epidemics are still very much being felt today. The March of Dimes campaign, with its roots in the struggle against polio, gave rise to grassroots fundraising that has revolutionized healthcare philanthropy. The modern field of rehabilitation therapy gained much of its early knowledge from experience with polio. And the survivors of polio still constitute one of the largest groups of advocates for the disabled. Polio has been eradicated in the Western Hemisphere, but that does not mean that the disease is completely dead and gone. Outbreaks still occur in a handful of countries, Afghanistan, India, Nigeria and Pakistan chief among them. And even in America, there are still an estimated 750,000 polio survivors who live with the physical and mental reminders of how their lives were shaped by the “summer terror.”

the history of healthcare

Courtesy of Carilion Clinic

Dr. Melchionna examines a Polio patient.

VOLUME II HEALTHCARE HEROS

y its very nature, the world of healthcare is populated by some very extraordinary people. They care deeply about their patients, their problems, and their pain.They have a highly refined sense of collaboration because healthcare is most often a team sport. They understand their role in collaboration, and they are accountable for it. They adjust to change, because no two days in healthcare are exactly alike. They are compassionate, determined, intelligent, and honest. To rise above the â&#x20AC;&#x153;ordinaryâ&#x20AC;? in the world of healthcare takes an extremely rare sort of person.These are some of the people who made a major difference in shaping the healthcare of the Roanoke Valley between the 1930s and the 1960s. the history of healthcare

William H. “Ham” Flannagan Courtesy of Carilion Clinic

When Memorial and Crippled Children’s Hospital board president Charles Lunsford and young Franklin Hospital administrator “Ham” Flannagan met for lunch on June 30, 1954, it’s doubtful that they could have known the 32-year legacy of leadership that would grow from that seminal moment. Flannagan became administrator of the hospital, building it into the dominant healthcare organization in the region and later creating one of Virginia’s first healthcare systems. Olin Melchionna, MD

In 1941, a time when physicians who were also in the military reserves were being called for war duty, Dr. Olin Melchionna graduated from the Chicago Medical School and came to Roanoke Hospital as an intern. Dr. Melchionna was one of the few doctors who stayed behind, working to near exhaustion in the severely understaffed hospital. On a rare leave, for Thanksgiving one year, he traveled home to New Jersey and there volunteered for the draft, thinking that the rigors of a doctor’s life in the war could be no worse than his schedule at the hospital. Returning to his quarters after the trip, he found the hospital chief of staff waiting for him. “You’re not going anywhere,” chief of staff Linwood Keyser, MD told him. “You’re needed here.” Dr. Melchionna had to list his supervisor on his enlistment papers, and the supervisor had to clear the young doctor’s availability for service. The idea must have stuck, because Dr. Melchionna remained to practice in the Roanoke Valley for 52 years. Courtesy of Carilion Clinic

H.H. Wescott, MD; Roy Hoover,MD; Philip Trout, MD; Louis Ripley, MD; Charles Bray, MD

These five physicians, among the few orthopaedists in Virginia in the 1940s and 1950s, fought on the front lines during the worst of the polio epidemic of the 1950s. In 2006, the two surviving physicians — Drs. Ripley and Bray — were given The Roanoke Valley Academy of Medicine lifetime achievement award for their work with polio patients in the 1950s. “We practically lived together” at the hospital during the 10 weeks the epidemic raged, Dr. Ripley told a newspaper reporter. David G. Williamson Jr.

During the late 1950s and early 1960s, Lewis-Gale Hospital struggled with the question of how to best approach the growing need for more space and possible restructuring to address the new age of healthcare in America that many saw coming. David Williamson joined the hospital as its administrator in May 1961 and would

the history of healthcare

lead the hospital and its healthcare community for the next 13 years. During his tenure, he guided his organization through complex phases of expansion and relocation, the delicate matter of separating the hospital from the Lewis-Gale Clinic, and affiliation with a for-profit hospital organization, while at the same time being the hospital executive that everyone knew and everyone loved. Julian Wise

In 1909, he was a helpless bystander, a boy watching as two men drowned in the Roanoke River. Haunted by the memory, he vowed he would never watch someone die if they could be saved. He learned everything he could about emergency rescue procedures. As an adult nineteen years later, with nine of his workmates from the Norfolk and Western Railway, he formed the Roanoke Life Saving and First Aid Crew, chartered on May 25, 1928. It was the first rescue squad in America, the model for all others that would follow in Virginia and many other states, and a national pacesetter in almost every area of emergency care. LEFT TOP: William â&#x20AC;&#x153;Hamâ&#x20AC;? Flannagan LEFT BOTTOM: Dr. Ripley works with a patient BELOW: Julian Wise

Courtesy of REMS, Inc.

the history of healthcare

Student nurses receive instruction, 1960s Courtesy of Carilion Clinic

the history of healthcare

VOLUME II NURSES

merican nursing came into its own during the World War II years. For years, nurses had been caught in a perceptual tug-of-war between being a loving but simple provider of tender care on the one hand and being a trained and competent professional medical specialist on the other. In Roanoke, nursing students were confined in both their working and personal lives, fulfilling expectations that they be innocent, virginal and obedient handmaidens in the hospital and in the community. All students were unmarried young women, who lived together in dormitories with strict visitation rules and curfews, all under the watchful eye of housemothers. Nursing student clothing was mandated, even when venturing outside the hospital. Even into the 1950s, a part of the history of healthcare

nurses’ duties included caring for the penned laboratory animals that were kept on the roof of the hospital building. Early in the story of nursing in Roanoke, it was customary for almost every hospital to train its own nurses as a way to keep a fresh supply in the face of chronic nursing shortages. Roanoke Hospital had conducted nurses training since shortly after its founding in 1900. LewisGale Hospital started training nurses in 1911, followed by Jefferson Hospital in 1914 and by Burrell Memorial Hospital in 1921. By today’s standards, the early days of nurse training in Roanoke were modest. Students were no longer required to bring their own bandages and make some of their own clothes, as they had been in earlier years, but some aspects were still rudimentary. Area hospitals, for example, often depended on physicians to give lectures to student nurses. With frantic schedules, the physicians were often late to their own lectures, came unprepared, or did not appear at all. But over the years, the people directing nursing schools realized that many types of improvements were needed. Hospitals started adding full- or part-time instructors and started making arrangements for proper facilities, both for nursing education and for student nurse living facilities.

changes in the manner in which nurses were educated and trained. Creation of the corps made nursing an attractive career field once again. Women who were accepted received a government subsidy covering the costs of their education, along with a small stipend. Nursing schools in the region beefed up their training programs. At Lewis-Gale Hospital, for example, three classes per year went into nurse training (compared to the single class that was enrolled each year) and the length of the training period was trimmed from 36 months to 30 months. When the war ended, the military nurses came home schooled in what was then cutting-edge medical techniques and technology. They had learned to find their way in the complexity of military bureaucracies, and they had exercised independent, lifesaving judgment during crisis after crisis. They had lived life as officers, with a taste of equal pay for equal work. They were not the same nurses, or the same women, who left home to serve their country. Lewis-Gale School of Nursing, 1961

With the Unites States’ entry into World War II, wartime demand for nurses changed much about the way nurses were perceived and the way they perceived themselves. Many nurses joined the military, both out of a sense of patriotism and because they sensed that doing so might be a route for elevation of their careers. In the military, enlisted men handled routine care of the sick and wounded. Nurses were considered specialists, and they were supervised by physicians. Military nurses were officers, and they supervised enlisted men. The flow of nurses into the military created shortages in civilian hospitals — nearly 40 nursing alumnae of the Roanoke Hospital alone went into the service — and the value of nurses ramped up even higher. Young women were not coming into nursing schools in sufficient numbers, so the Red Cross became involved in a program to train nurses’ aides, and the federal government created the Cadet Nursing Corps. The purpose of the corps was to make sure that the United States had enough nurses to care for citizens on both the home and war fronts. The results of the Cadet Nurse Corps included a dramatic rise in the number of nursing students, a greater public recognition of nurses, and

the history of healthcare

Courtesy of LewisGale Medical Center

Courtesy of Jefferson Surgical Clinic

ABOVE RIGHT: Class of Jefferson Hospital School of Nursing RIGHT: The Hill House

The difference was noted in ways large and small. During the war, for instance, nurses at Roanoke Hospital were no longer required to wear the high-topped, low-heeled boots that had been compulsory for many years. Instead, nurses could shop at a local department store, Heironimus, for white hose and for the white oxford shoes designed for them by Roanoke orthopedist H.H. Wescott, MD.

Courtesy of Carilion Clinic

The Roanoke Hospital board gave consideration to allowing married women to apply to the School of Nursing, although the notion was not implemented. The nursing school class beginning their training at Roanoke Hospital in 1948 was the largest to date, a total of 31 young women. The perennial problem of living and instructional space for student nurses had been solved temporarily just the year before, when a home and property adjoining the hospital grounds became available for purchase. The hospital bought the building, renovated it, and it became â&#x20AC;&#x153;Hill House,â&#x20AC;? still discussed with fond memories on the part of nursing school graduates. But still, space at Roanoke Hospital continued to be a problem until 1959, when the hospital opened a nursing school building that had been designed for the purpose from the ground up. The new building, next to the hospital, was built with the help of federal Hill-Burton funding. It included living space for 124 students, along with modern and expanded classrooms, laboratories, an auditorium, and a library. It set the standards for nursing school facilities for years. In the meantime, Lewis-Gale Hospital and Jefferson Hospital had been exploring the idea of merging their institutions. Although the merger did not take place, the two hospitals did merge their nurse training programs, which then came under the banner of the new Community Hospital of the Roanoke Valley. the history of healthcare

the history of healthcare

VOLUME II TECHNOLOGY

any of the medical and technological advances of mid-century came from battlefield and military hospital lessons learned during World War II and the Korean War. Physicians and nurses returned from the war with new knowledge that would not have been available anywhere else. Combat provided testing grounds for medical evacuation procedures, the use of blood substitutes, advanced surgical techniques, new miracle drugs, preventive medicine practice, and the treatment of psychiatric disorders. Peacetime applications of new methods and new technologies would continue to enhance American healthcare for generations to come. Penicillin became largely available to the civilian public around 1946, and it or its derivatives were critical in preventing the spread of many communicable diseases. the history of healthcare

Roanoke hospitals added new services, new equipment, and new technologies as soon as they could be accommodated. At Memorial and Crippled Children’s Hospital, as it was known until it became Roanoke Memorial Hospital, a cancer tumor clinic was established in 1952, along with the attendant radioisotope therapy for the diagnosis and treatment of cancer. Also in the mid-1950s, the hospital started using electroencephalograph technology, used to measure electric activity in the brain, and equipment to diagnose and treat breathing disorders. In 1958, the hospital opened Virginia’s first rehabilitation center for people being treated for chronic disease, a three million dollar facility built with the assistance of federal Hill-Burton funds. Lewis-Gale Hospital established a department of plastic and reconstructive surgery in 1958, and in 1963, established its own use of radioactive isotopes, along with a hydrotherapy program. Hospitals in Roanoke were keeping pace with the times, but research all over the world was bearing fruit in innovations and developments that would be found in Roanoke in just a few years. In Holland in 1945, a dying patient was treated successfully with an “artificial kidney,” a rudimentary kidney dialysis machine made of laundry tubs, cellophane tubing, and wooden drums, capable of removing the patient’s blood, cleansing it of impurities, and restoring it back into the patient’s body. Work along several fronts in the United States and abroad would eventually lead to the development of the hip replacement materials and surgical techniques now used on more than 200,000 Americans each year. Paul Zoll, MD, developed an external cardiac pacemaker at Boston’s Beth Israel Hospital in 1952. Early models had to be plugged into a wall socket, but further refinements produced an implantable pacemaker of the type available today. The possibility of open heart surgery using a heart-lung machine got a boost as a result of work by surgeons at Jefferson Medical College in Philadelphia. Pioneering work in kidney transplantation at Peter Bent Brigham Hospital in Boston in 1954 lead to solutions to the problem of organ rejection and earned a Nobel Prize (1960) for pioneer Joseph Murray, MD. above top: Hospital Radiology Department of Gill Memorial Hospital, 1951 Courtesy of Carilion Clinic above bottom: Crobuks Drug Courtesy of Roanoke Public Libraries

the history of healthcare

The 1950s saw the dawn of computer use in healthcare. The work of keypunch operators in hospital billing and accounting departments in the early 1950s slowly morphed into computerized records-keeping, and by the end of the 1950s, healthcare organizations were seriously looking at ways in which the new machines could be put to use in the industry. According to PC Magazine, a gigabyte of computer memory cost about ten million dollars in the mid-1950s. Today, the same gigabyte of memory can be had for about a dollar.

DELTA DENTAL

the history of healthcare