When Grinnell Got a Hospital...

Having had occasion to visit a hospital recently, I found myself wondering about hospital care in Grinnell a century ago. If today in the US childbirth, septicemia, heart failure, and osteoarthritis are the main reasons for hospitalization, what drove people to the hospital back then, and what did physicians do to help them? Were hospital admissions common or rare? Was surgery a solution to which doctors often turned or not?

Photograph of the binder of Grinnell Hospital Register, 1915-1917
(Courtesy Drake Community Library)

Happily, two hospital registers, covering the years 1915-1919, survive for the last years of Grinnell City Hospital at 1030 Elm Street. Each register provides space to enter the details on 400 persons admitted to hospital in the period that overlapped World War I and the arrival of the so-called "Spanish flu." Today's post looks at the hospital registers to see what brought the men and women of early Grinnell to the hospital and what the local physicians did to help them.

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The surviving registers do not come from Grinnell's first hospital, an eight-bed facility that Dr. Pearl Somers (1870-1952) founded in 1901 in his own home at 1127 Park Street. Not much is known about the patients or practice of that facility, which Somers reluctantly closed in 1904 (Reflections 1967-2007: A History of Grinnell Regional Medical Center, pp. 5-6). Despite the fact that most doctoring at the time took place at the patient's home, Grinnell's physicians and generous community support led to the opening of a new hospital in 1908 at 1030 Elm Street. It is from this second Grinnell hospital that the patient registers referenced here come.

Grinnell City Hospital (ca. 1910)
(https://digital.grinnell.edu/islandora/object/grinnell%3A14514)

The house at 1030 Elm, often called Murray Hall, had functioned for some years as a rooming house for college students. The 1894 Grinnell College directory, for instance, identified a dozen students living there, including four academy students; the 1904 college directory listed sixteen student-residents. But in April 1908, the new Grinnell City hospital opened in this building, refitted to serve its new medical purposes.

Post-remodeling Photograph (ca. 2000) of First-floor Hallway 1030 Elm Street, Looking To Front Door
(Photograph Thomas Grabinski, Courtesy of Drake Community Library, Grinnell, IA)

An enthusiastic newspaper review of the new hospital described the building's layout which seems to have embraced the original plan, adapting it to new uses. Entering from Elm Street, one came into a hall which opened onto a reception room where, one imagines, the hospital registers were maintained. A dining room lay just to the east, and behind that a kitchen and an operating room that faced southeast. "The operating room...is arranged to cause a minimum of trouble in keeping it asceptic [sic]," the newspaper enthused, "from the tile linoleum floor to the enameled walls and glass operating table" ("New City Hospital Opened Yesterday," Grinnell Herald April 10, 1908). Beyond the operating room lay the Men's Ward (whose costs the local Odd Fellows and Rebekahs donated) with three beds, each "adjustable and made so as to be easily kept clean." The Women's Ward, "which is furnished beyond the need of any possible improvement," occupied "one of the best locations, looking out on the southwest..." (ibid.).

Photograph (ca. 2000) of the Door to the Men's Ward, Named for I.O.O.E. (barely visible on door)
(Photograph Thomas Grabinski; Courtesy Drake Community Library, Grinnell, IA)

Six private rooms—previously bedrooms—filled the second story. "From the fine linen of the beds to the beautiful pictures and new furnishings everything was as much as could be desired...," the newspaper continued. Several local organizations—PEO; Pythian Sisters; and Grinnell Hospital Association—underwrote costs of three rooms while private donors (Mr. & Mrs. Wesley Manatt; Mr. and Mrs. G. H. McMurray; and Mrs. D. W. Norris—supported several others. A laundry and drying room along with a furnace room and a new hot-water furnace occupied the basement.

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In the years around World War I Grinnell was home to about 5000 people. The hospital registers count about 200 admissions per year, a figure that included patients from other towns in the area. This means that a hospital visit remained an unusual experience in pre-1920 Grinnell. In this era physician home visits or self-medication was much more common than admission to hospital. Nevertheless, some Grinnell folk found their way into the hospital, hoping for relief from the health issues with which they contended. The hospital registers preserve the history of their visits.

Sample Entry from Grinnell Hospital Register
(Courtesy Drake Community Library, Grinnell, IA)

The registers allowed one page for each admission, detailing the name of the patient, the patient's address, age, occupation, religion, and address of a friend. There then followed space to identify the name of the patient's physician, the room to which the patient was assigned, the "disease" (meaning, presumably, the diagnosis), the operation (when there was one), the anesthetic deployed and by whom, and the name of the doctor or doctors who performed the operation. The last lines asked the dates of the patient's admission and discharge, the size of the fee, and an indication of when the fee was paid.

Compilers of the registers did not respond to all questions for every patient. "Occupation" was often left unfilled as was the address of a friend. Hospital officials also often failed to enter a "Disease," although more regularly provided entries for the type of surgery, type of anesthesia (almost always ether), and the names of the doctors supplying anesthesia and those performing the operation. These data permit a rough understanding of what brought Grinnell area men and women to the city hospital in the years between 1915 and 1919.

The extant hospital registers report that the two most frequent surgeries performed there between 1915 and late 1919 were appendectomies and tonsillectomies. The registers count 108 appendectomies (along with another half-dozen other operations to which appendectomies were joined) over the four years covered by the books—about two every month or about 13% of all hospital admissions. Tonsillectomies were slightly more usual, the books identifying 119 cases addressed in the hospital. In addition, the registers reported another 19 patients whose  tonsils were removed in the physician's office and a handful of other cases when doctors removed adenoids as well as tonsils.

MacKenzie-type Double Guillotine Used in Late 19th-Century Tonsillectomies
(https://collection.sciencemuseumgroup.org.uk/objects/co175957/mackenzie-type-double-tonsil-guillotine-london-england-1869-1900-tonsil-guillotine)

Although some form of tonsillectomy is reported in ancient times, the operation fell out of favor for a long time until new, more efficient surgical tools appeared around 1900. By the early twentieth century, tonsillectomies became very common, especially for children. In this way, the Grinnell hospital data correlate well with the most modern medical practice elsewhere in America. The great majority of tonsillectomies done in the Grinnell Hospital belonged to Dr. C. H. Lauder (1884-1953), who specialized in eyes, ears, nose and throat. A recent graduate of the University of Iowa medical school, Lauder opened his practice in Grinnell in 1910, and, according to the hospital registers, often performed tonsillectomies within his downtown office (913 Main Street, upstairs), although why these were registered in hospital books I do not know.

Grinnell Herald, October 7, 1910

Appendectomy has a much shorter history, the first cases of appendix removal being reported only in the nineteenth century. Grinnell's doctors, who performed the great majority of surgeries at Grinnell hospital, must have been among the first or second generation of physicians to learn the proper methods for diagnosing appendicitis and for operating to remove the appendix. Older Grinnellians would not have been familiar with the operation which came to prevail in the hospital's operating theater.

The third most-common "surgery" performed at the Grinnell Hospital in the early twentieth century was child delivery. Most Grinnell-area babies continued to be born at home rather than in hospital, but hospital registers identify some 60 successful deliveries over the four years recorded there. Two c-section operations occurred at hospital in these years, and at least one stillbirth. Hospital registers also identify five ectopic pregnancies and six miscarriages, an indication, perhaps, that only mothers whose pregnancies presaged difficulties chose to use the hospital for their children's births. In cases like these, doctors might find it advisable to perform curettage (or curettement), a procedure recorded at least 28 times. So-called "incomplete abortions" and other ailments like pelvic infections might also lead physicians to employ the curette.

A Selection of Curettes
(https://obgynkey.com/dilatation-and-curettage/)

In a community largely dependent upon manual labor it is small surprise to learn that hernias brought to the hospital in these years a dozen Grinnell citizens who found relief from surgical intervention. Hemorrhoids were twice as common a problem in early Grinnell, perhaps a function of the meat-heavy diet and consequent constipation. Here, too, Grinnell doctors were able to provide surgical repair.

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Grinnell Register, January 6, 1916

The Grinnell Hospital, of course, offered help for other illnesses, although the physicians were not always able to do much. Hospital records for these four years report at least 28 pneumonia diagnoses along with another 21 cases thought to be either influenza or pneumonia. These numbers seem surprisingly low, inasmuch as they include the era when the great influenza pandemic blew through Grinnell. Many of the Grinnell residents who contracted flu apparently remained at home, nursed by family members who, not infrequently, themselves soon contracted the virus.

Typhoid was diagnosed in another 21 Grinnell patients. No surgery or then-available medicine was of any use in these cases, so patients either survived or didn't. Similarly immune to surgical help were the persons diagnosed with alcoholism or with some form of debility caused by nerves.

Grinnell Register, September 25, 1916

Tuberculosis, although not common in early Grinnell, was nevertheless deadly; in the absence of antibiotics, doctors could do little, as the case of Joe Canton illustrates. Admitted to hospital on the last day of August 1915, Canton died the next day, apparently having courted tuberculosis previously for some time. Locals knew little about the man, so that, when they discovered among his possessions a notebook with the name of Frank Knute of Little Falls, Minnesota, officials tried to reach the Minnesota relatives. Alas, the Knute family denied any connection with the Grinnell man, so Poweshiek County paid the $3 hospital bill, and the Social Service League covered the cost of the funeral and arranged for Canton to be buried in potter's field at Hazelwood (Grinnell Herald, September 7, 1915).

Extract from the Potter's Field List of Burials at Hazelwood Cemetery
(Drake Community Library Local History Archive)

Perhaps the most unsurprising category of diagnosis included fractures and other body traumas, like scalp wounds or hand injuries. Grinnell physicians were usually able to provide prompt repair for these problems, and most of their patients were soon up and back to their normal routines. Sometimes, however, surgeons had to resort to desperate measures, as happened to William Scofield (1874-1930), for instance. Scofield was part of a 1915 railroad crew at work on a bridge three miles north of Grinnell. When one of the jacks that the men were using to leverage a steel girder into place jumped out of position and struck Schofield on the head, the force of it threw the man twenty feet down the embankment. Trainmen rushed him to Grinnell where Dr. Somers took the man to the hospital, there discovering that the "dislocation of the right knee was so severe that it had caused laceration of the blood vessels and all circulation was cut off in the right foot" (Grinnell Register, November 18, 1915). Somers determined that it was necessary to amputate the right leg at the knee.

Charles Eastman (1890-1917) fared worse. An employee of the Rock Island Railroad, the twenty-seven-year-old was up a utility pole, stringing wire along the railroad track. For reasons unknown, Eastman fell about 35 feet, landing at the foot of the pole; "the skull was fractured at the base of the brain and both bones of the left arm were broken" (Grinnell Herald, January 9, 1917; Grinnell Register, January 8, 1917). Others at the site rushed Eastman to the Grinnell hospital where he lingered for about three hours before dying; doctors could do little.

Another patient who died in hospital was Elmer DeCamp (1845-1919), who operated a farm two miles north of Snow's Corner (intersection of 6th Avenue and Penrose). Since DeCamp lived alone, the stroke he suffered at home in February 1919 went unnoticed until Frank Sturgeon arrived to conclude some business. Sturgeon discovered DeCamp unconscious in his chair, but the situation could have been much worse: Sturgeon also found a kerosene lamp, which had been knocked on the floor, and had burned and scorched some papers before burning a hole in the wooden floor.  Surprisingly, the house had not caught fire. Taken to the Grinnell Hospital, DeCamp proved unable to recount the details, since the stroke had deprived him of speech. He remained in hospital for several days before death took him. Doctors were powerless to remedy the work of the stroke.

One of the more surprising reports in the Grinnell hospital records concerns circumcision. Presumably new male babies born at the hospital were all circumcised, as the practice had become increasingly common in the US at the time. By one estimate, around 30% of American males born in 1900 were circumcised. But if, as seems likely, most babies in the Grinnell area at this time continued to be born at home, many without the presence of a doctor, most boys would not have been circumcised at birth. This circumstance helps us make better sense of some other cases that appear in the hospital registers. Take, for example, the case of Donald Dawley (1901-1980), who was sixteen years old when admitted to hospital in August 1916. The spare wording of the register reports only that the reason was circumcision, which Dr. O. F. Parish (1873-1947) accomplished on the same day that Dawley was admitted.  Released later that day, Dawley paid the $3 fee and resumed his life.

Everett Graham's case was more complicated. Twelve years old when admitted in November 1916 with a diagnosis of appendicitis, Graham had Drs. Parish and C. E. Harris perform an appendectomy. However, while the scalpel remained in hand, the Grinnell physicians proceeded to do a herniotomy and, finally, a circumcision. We may speculate that young Everett or his parents figured that, so long as a crisis had brought the boy to surgery, they might just as well have the surgeons take care of that other, more minor matter. 

Howard Hafkey (1912-1980), 1929 Grinnellian

Two additional cases offer a more routine course leading to circumcision. Howard Hafkey (1912-1980) was only three years old when he entered the hospital in June 1915. Drs. Somers and E. F. Talbott (1873-1943) circumcised him, and released him the same day. Kenneth Palmer (1913-1979) was two when he entered the Grinnell Hospital where Dr. Parish circumcised him. It seems likely that both cases attempted to remedy the absence of circumcision from at-home deliveries that no doctor had attended. We may hypothesize that, in an era in which circumcision was increasingly common, parents opted to have the procedure done as soon as possible so as to spare their boys from the operation when they were older.

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A wide variety of other ailments brought patients to the Grinnell Hospital in the World War I era, although often doctors were not able to do much to solve the problems. The registers contain one or two entries for asthma, colitis, dementia, emphysema, erysipelas, gonorrhea, neurasthenia, pyloric perforation, peritonitis, salpingitis, sciatica, and varicocele, among others. Hospital patients also presented impacted teeth, ingrown nails, hammer toes, and similar lesser problems to which Grinnell physicians might readily apply their skills. All sorts of accidents—including in one case a man who fell from an airplane (A. C. Beach who came to Grinnell to fly Billy Robinson's monoplane after Billy Robinson's death [Grinnell Register, April 3, 1916])—brought Grinnell's men and women to the hospital where doctors did what they could to repair the damage.

Grinnell Community Hospital (Opened in 1919)
(https://digital.grinnell.edu/islandora/object/grinnell%3A11318)

But the times were changing, and medicine itself was changing. As I have written elsewhere, the arrival of radium in town initiated an entirely new form of therapy for a wide variety of illnesses which had been largely immune to earlier treatments. Following hard on this was the appearance in Grinnell of the x-ray machine which soon supplanted the direct application of radium to the affected area. Moreover, x-rays gave physicians a view of the patient's insides unlike anything they had previously had, providing better diagnoses and opening new forms of surgery. But these new technologies and treatments had to await the building of two new hospitals in 1919 Grinnell.

St. Francis Hospital, Grinnell (Opened in 1919)
(https://digital.grinnell.edu/islandora/object/grinnell%3A6529)