Central Maine Medical Center
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300 Main Street, Lewiston, ME 04240 | 207-795-0111

Central Maine Medical Center: History

A single electric lightbulb hangs from the ceiling by a dropcord, its harsh light causing the people gathered in the attic of the old brick house to squint. The room is warm and stuffy, made oppressive by the group assembled to witness what it knows will be an historic event.

Below, two burly men carry Charles Teague up a flight of stairs to an elevator. The elevator, powered by a hand pulley, lifts the men to the top floor where the others wait. Dr. C.E. Williams had "etherized" Charlie in his hospital room, so the 18-year-old offers little resistance as he is brought into the operating room. For years, the young man has "suffered with white swelling of the knee," and has at last abandoned his fear and pain to faith in his surgeon.

Nurse probationers Nina K. Newell of Durham and Carrie Farrington of Lewiston, attired in simple, cotton dresses, have sterilized the surgical instruments in a pan over a two-burner gas plate. As they wait for the surgeon's orders, they watch nurse Martha P. Parker speak quietly to the patient as he drifts in and out of consciousness.

The surgeon sterilizes his hands and Charlie's thigh and knee with a bichloride solution and alcohol. Dr. Williams, wearing street clothes and a long topcoat, pours ether, a few drops at a time, through a gauze-like material held over Charlie's nose and mouth. Drs. J.A. Donovan and W.K. Oakes, also wearing street clothes and heavy, dark overcoats, stand by to assist. Nearly every man in the room wears a beard. The surgeon's bushy, dark beard flows over his rubber apron.

Surgery is delayed for a few moments while Dr. W.B. Small photographs the scene. And then the operation begins.

A murmur of congratulations is heard later as Dr. Hill completes the final suture and lays his instruments aside. It has taken him about an hour to amputate Charlie's leg above the knee. Damp with sweat, the patient is carried to the men's ward on the first floor where Miss Parker and a student nurse will try to keep him comfortable.

Everyone present in this room on July 2, 1891 knows that what they've just seen was history in the making. They also know what it means to Dr. Edward H. Hill, whose dream of providing central Maine with hospital has finally been realized.

Chapter One

When Edward H. Hill moved his medical practice from Durham to Lewiston in the mid-1860s, he was already familiar with the city, having attended Bates College. Dr. Hill was well educated even by today's standards and his time at Bates and his medical degree from Harvard University Medical School gave him a prominence among his peers. Laws regulating the training and licensing of physicians were not common in most states until the turn of the century, so many of Dr. Hill's contemporaries had much less education and training. Adding to his prestige was his partnership with Lewiston physician, Dr. Alonzo Garcelon, a former Maine governor.

But Dr. Hill's education and political connections were not the reasons why he would be hailed a century later as the impetus in the creation of Central Maine's premiere health care organization. It would be his foresight and single-minded determination that would secure his place in history.

Two decades before CMGH opened its doors, Dr. Hill was the force behind a physician's movement to establish a local hospital. As a member of the Androscoggin County Medical Association, he eloquently argued for the establishment of a hospital. At a meeting in 1871, he advocated a plan for taxing "every mill operative five cents per week to care for patients of their own vocation, while it was hoped to get enough outside contributions to admit others." The plan was the subject of much debate, but eventually failed when it found disfavor among the physicians themselves. This proposal marked the beginning of Dr. Hill's involvement in the struggle to establish a hospital in the Twin Cities, though others had trumpeted the cause before him.

Just a year earlier, Captain Daniel Holland, a Lewiston representative to the Legislature, had rallied support for a proposal that the Maine General Hospital -- then seeking a charter from the state -- be located in Lewiston. Backing the plan were some of the most renowned physicians in Maine. Captain Holland's effort fell short, coming within "three or four votes of securing the prize." The Maine General Hospital was instead placed in Portland.

Earlier still, in 1865, Lewiston Mayor William P. Frye had secured a building he hoped would be used as an "accident room" where doctors could send medical emergency patients from area mills. The mayor thought that physicians might buy the building and begin a private hospital of their own. But the facility was inadequate and was later moved out of the city and converted into a "pest house," a refuge for the poor who suffered with contagious diseases, especially smallpox. In 1876, a smallpox hospital was opened in Auburn in a desperate attempt to control the disease. But this effort to establish a hospital also failed.

In the late 1800s, mustering public support for a hospital was nearly impossible because few Americans viewed a hospital admission with anything less than dread. Hospitals and doctors were suspect because 19th-century medicine was still relatively primitive. Health care was a matter of self-reliance and most people treated their ills at home. Only when all else failed would desperate family members seek a doctor's advice. So it's no surprise that Dr. Hill's early call for a hospital fell on deaf ears.

Meanwhile, Lewiston and Auburn continued to grow, becoming home for Canadian and Irish immigrants who took jobs in the mills that were powered by the Androscoggin River. By 1880, Lewiston was a thriving industrial city of more than 19,000 people. As the mills and factories had expanded, so had the need for emergency care.

In 1881, an event occurred that thrust the need for a hospital before the public. The Maine State Fair, a spectacular agricultural event that drew hundreds of Mainers, was moved to Lewiston. It was inevitable that medical emergencies would arise.

The Lewiston Journal reported several unfortunate incidents that year: a woman "was delivered of a child in a horse stall on the fair grounds" and a man "died on a table in the Lewiston Common Council room," though he "might have been saved had there been a suitable place to take him."

The cry for a hospital rose and Dr. Hill responded. He wrote countless letters to legislators, businessmen and fellow physicians, stressing the need for an accident room. Observing Dr. Hill's efforts, a writer for the Lewiston Journal would later describe the him as "the most enthusiastic and indefatigable worker" for the hospital cause. "Even when Lewiston and Auburn seemed deaf and dead to the necessities of the case," Dr. Hill "talked himself hoarse time and time again."

This time, Dr. Hill's efforts paid off and in the mid-1880s a hospital committee was formed. The committee was headed by J.L.H. Cobb, a prominent businessman who had risen from millhand to management at the Bates Mill in Lewiston. (He later owned the Cumberland Mill.) Mr. Cobb was a philanthropist and visionary who had donated $25,000 to help establish the Cobb Divinity School at Bates College. Also serving on the committee were: Ara Cushman, J.F. Cobb, Royal Mason, Samuel F. Merrill and Frank W. Dana.

The men sought financial contributions from the community, setting up a fund to purchase or construct a hospital building. With the help of Judge Albert R. Savage of Auburn (who would be appointed chief justice of the state Supreme Court in 1913), a set of bylaws and a constitution were written. Dr. Hill and Judge Savage reviewed the bylaws again and again, changing them to meet the needs of Lewiston and Auburn. Nelson Dingley -- a congressman, former governor, and owner-publisher of the Lewiston Journal -- offered his advice as well.

On December 26, 1888, Central Maine General Hospital was incorporated and D.J. Callahan, an Androscoggin County justice of the peace, was named secretary. Ara Cushman, T.H. Huston, Benjamin Sturgis, William Hayes, Charles Gay, Royal M. Mason and E.G. Heath of Auburn, J.L.H. Cobb, William P. Frye, Nelson Dingley, Jr., and L.L. Blake of Lewiston, C.M. Bailey of Winthrop, Jesse Davis of Lisbon and Edwin P. Ricker of Poland were elected members of the corporation. Four days later, J.L.H. Cobb was named president and R.C. Reynolds, C.W. Hill, B.F. Wood, D.J. Callahan, Ara Cushman, L.B. Jordan, George W. Wagg, John F. Cobb, and John Garner were named directors. From the hospital's beginning, corporators represented the smaller, outlying communities of central Maine.

A list of reasons supporting the creation of a hospital was devised to appeal to public sentiment. This list, presenting the problems of a nineteenth-century industrial city, noted that Maine General Hospital in Portland was being used to capacity, and that transportation to that hospital was problematic.

Housing was also cited as a key factor pointing to the need for a hospital. Families were smaller and less likely to live in a large home where a room could be set aside for sickness or childbirth. Furthermore, many people were living in apartments, making home health care difficult.

It was noted that towns devoted to manufacturing and mechanical pursuits produced a much greater incidence of accidents than are expected in other communities. "Strangers from distant places are always visiting our streets and are liable to accident, sudden illness and death. It is a reproach to our humanity that for the accommodation of such cases the Police Station, vacant apartments, and stables have to be used," the document stated. Children who lacked care at home were also seen as deserving of hospital care.

The directors noted that a hospital would maximize efficiency because "with proper arrangements and conveniences, one nurse in a hospital can do the work of twenty distributed throughout the city."

Lastly, the directors indicated that "a provision for a large number of free beds will make it possible for the poor to receive the advantages of the best treatment."

In 1889 the directors twice approached the Legislature for funds and were turned down. The first effort involved a bill authorizing Lewiston to aid CMGH. The second attempt was a bill seeking funds from the state. Both times the state argued that Lewiston had already reached its legal debt limitation.

Frustrated and discouraged, the directors continued to hold monthly meetings.

And then, unexpectedly, J.L.H. Cobb resigned from the corporation. The reason for his resignation isn't known, but he may have thrown his hands up in disgust when a dispute about the hospital's location could not be resolved. The disagreement was political: Auburn members favored an Auburn location and Lewiston members preferred their own city.

For several months, Dr. Hill found himself sitting at board meetings alone, waiting in vain for other committee members to arrive. For a man who had devoted so much of himself to the cause, the rift over a location must have been disheartening. But he had been disappointed before and never lost his resolve. He knew the time had come. The public response to recent efforts had been gratifying and it was imperative that momentum not be lost.

During the impasse, Dr. Hill discovered for sale in Lewiston a house and 100 feet of land fronting Main Street and abutting Lowell Street. He drove his horse and buggy around the property, studying the building and assessing its potential to serve as a hospital. It would provide a sound location: it was central to the city, near the railroad station and on the line of the Lewiston and Auburn Horse Railroad Co. The two-story wooden structure, known as the S. R. Bearce estate, was owned by local ice dealer Oliver Newman and could be bought for $6,000.

He agreed to purchase the building. Even if he had to start his own private hospital, there would be a hospital at this location. He made the purchase with $5,000 of his own savings and another $1,000 that he raised personally. His commitment to founding a hospital was so firm that the day after he made the purchase, he turned down an opportunity to make a profit by selling the property. Instead, he approached fellow physicians, asking them to cosign a promissory note for the full $6,000. Thirteen of his colleagues joined him, and they borrowed the sum from The First National Bank of Lewiston at an interest rate of 5-1/2 percent. A figure of seven percent on the note was crossed out, suggesting that the bank offered the physicians a special rate. The loan was approved on January 15, 1891, and would be due in full a year later. (The loan plus interest of $332.75 was paid by Dr. Hill on Jan. 18, 1892.)

The names scratched on the back of the promissory note would appear again and again in the early annual reports of Central Maine General Hospital. Dr. G.P. Emmons would be the hospital's first resident physician and superintendent. Drs. A.M. Peables, O.A. Horr, M.C. Wedgewood, J.A. Donovan and W.K. Oakes would be among the hospital's first attending physicians and surgeons. Dr. S.G. Bonney would become CMGH's first pathologist. Drs. C.E. Williams, W.B. Small, F.L. Dixon and E.W. Russell would later join the staff. Drs. D.N. Skinner and C.E. Norton would be the first ophthalmic surgeons.

Dr. Hill's persistence had paid off. With a building at hand, the petty dispute among the founders dissolved. They accepted the Bearce estate as the future CMGH and returned earnestly to the task of creating a hospital.

In 1891, a third appeal was made to legislators, but only after subscription papers seeking local contributions had been drawn up. Impressed with the group's accomplishments since its last request for money, the state awarded two $5,000 grants to be paid after citizens had raised twice the amount of the grants. Within three days, the public donated $10,000, meeting the Legislature's condition for the first grant.

The directors used the money to buy from a "Rev. Wallace" the Lowell Estate, a three-story brick house located at the corners of Hammond and Lowell streets and abutting the Bearce estate. After moving the Bearce house to a center position on the combined properties, an enclosed walkway was constructed between the two buildings, creating the first Center Building and West Wing. The two buildings formed a 30-bed hospital which included four private rooms and 26 beds split among four wards.

An historical sketch written in 1926 by Louise Munroe Newton, a 1900 graduate of the CMGH School of Nursing, described the hospital: "The White House (as the Bearce estate came to be called) contained a central hall, on the right of which was the office of the superintendent. ... Just back of this was a small room known as the drug room. ... The Evergreen room at the left of the entrance was a large double room used as the women's ward. The upper floor was occupied by the interns and the superintendent and his family."

In the "whole front section of the upper floor" or attic of the brick house, the operating room was installed. The remainder of the attic rooms, sparsely furnished with beds and trunks, were used by nurses.

Two rooms on the second floor of the brick house were used as women's wards and "the remaining space was occupied by private patients with the exception of one large room where the Superintendent of Nurses lived."

The first floor held the men's ward, several rooms set aside for clinic use, the kitchen, laundry and dining room. The dining room was shared by the nurses and the "hospital family."

After providing rooms for patients, nurses and doctors, trustees pondered the last and least-pleasant decision: where to place the mortuary. It was decided to use an attached wooden ell, until a better location could be found.

In the months prior to CMGH's opening, a group of women scrubbed rooms clean and furnished them with gifts from the community, and stocked the drug room with medical supplies. These women, who had organized at Dr. Hill's bidding, also provided hand-sewn sheets, bureau scarves and napkins. This group would later come to be known as the Woman's Hospital Association.

And so, six months after the purchase of the white house on Main Street, Central Maine General Hospital was open for business. On July 1, 1891, a 27-year-old Welchville woman with "abdominal troubles" was the first patient admitted. Her physician was Edward H. Hill.

Chapter Two

Even though public sentiment favored the opening of Central Maine General Hospital, the doubters remained.

In a Lewiston Journal article written the week after the hopsital opened, a reporter defended the new hospital. "Few people have an idea of the good this hospital is about to do, and do as a charity, too," he wrote. "Many people think the doctors have struck a bonanza. ... They seem to think the doctors will make money out of it, while on the contrary, they give wholly their time and experience for the benefit of the hospital and receive no compensation whatever for their services. ... The real benefit that the doctors are to reap from the hospital will be in systemizing their work and enabling them to do better work in their several departments."

The "systemizing" that would result from organized health care would indeed be an important benefit to doctors and patients alike. But, as Dr. Wallace Webber (CMGH, 1895 to 1945) noted in an April 1963 Journal of the Maine Medical Association article, few people in the late 1800s possessed such foresight. "The general idea of the populace was that the hospital was a butcher shop. ... It was difficult to get people to come," wrote Dr. Webber.

Skepticism about hospitals and physicians was not unusual at the turn of the century. Would-be patients knew that infection and death following surgery was more likely in hospitals than at home. Though discoveries by Joseph Lister had led to the common practice of antisepsis by 1890, it would be a few years before sterile procedure or aseptic surgery would become the norm.

But even as medical technique advanced, hospitals remained a repository for disease. Wallace Webber's son, Dr. Wedgewood Webber (CMGH, 1936 to 1975), recalled in an interview that his father saw less infection in homes "because the bugs just weren't there or the family was already immune to them;" while at the hospital, "people were always in and out. They'd come in with diphtheria and even if they didn't stay, they brought the bugs in with them."

Because cross-infection was such a serious problem, those with contagious or incurable diseases were turned away at hospitals throughout the country. The contagious sick were sent to pesthouses, and the incurable or chronically ill were sent home or to an almshouse.

As if to address people's fears, CMGH directors in 1892 wrote: "Once a hospital suggested torture, doubtful surgery, infected wards, death. Now the opposite. Anesthesia and antisepsis have largely robbed the hospital of its terrors. Education will drive quackey and pretense into the dark corners of credulity and ignorance."

In the face of such reservations, Edward H. Hill and his peers persevered in their efforts to create a hospital that "could expect to receive ... support and patronage from our community and from regions far beyond as would give it the largest usefulness." The words "from regions far beyond" would become a standard appeal in the years to come as the hospital served people from throughout the state, regardless of their ability to pay.

A Charitable Institution

"We place (the hospital) in the lap of an indulgent public and bespeak for it kind treatment and fostering care, and it shall grow up to bless you, your children and children's children to the remotest generation." -- From the report of the directors, CMGH, 1892.

When CMGH opened its doors in 1891 the nation was in an economic depression. Since the hospital depended on philanthropy, hard times for business meant especially hard times for the hospital. As more people lost their jobs, more people applied for charitable medical care, creating an even greater burden on the hospital.

Dependent on charity even as they doled it out, hospitals were vulnerable institutions. From the beginning, CMGH received only $5,000 annually from state funds earmarked to support the poor. By the mid-1900s, this money rarely covered the expenses incurred.

Directors wrote in 1894 that "the hospital is unable to take care of (all) the patients seeking admission." Three years later, they stressed that overcrowding had required that cots be placed in corridors and halls. These observations were a subtle plea for contributions for the construction of the East Wing, which had been postponed because the necessary funding couldn't be raised.

Like most hospitals, Central Maine General Hospital charged private patients more than the cost of their care to offset the free or reduced rates given to the poor. Despite the fact that private patients were sometimes paying nearly double the cost of their care, the hospital was left with operating deficits. To cope with this shortfall, the hospital encouraged donations by offering something in return. One practice was the creation of "free beds." For a donation of $250 annually, a person or organization could establish a "free bed;" a lump sum of $5,000 bought a perpetual free bed. To gain use of these beds, a person usually had to have a letter from a trustee or hospital subscriber. Another practice was "naming" a ward, operating room or private room, which brought in donations of $1,000 to $5,000 per room.

Most of the hospital's business was conducted by its trustees. Financial records were kept by the volunteer treasurer; services and goods were donated by business leaders serving on the board; others gave of their particular expertise. Because trustees were often seen as stewards of the poor, their efforts paid off in personal prestige.

Through their affiliation with the hospital, doctors realized a number of advantages: they didn't have to foot the bill for expensive equipment; through consultations with their peers, they furthered their own medical knowledge; and by attending several patients in one location, they could double or even triple the size of their practice by eliminating travel time.

In the early years, CMGH's free patients nearly equaled paying patients, so staff doctors hardly "struck a financial bonanza," as early critics suggested. Until 1898, the "on duty" doctor not only worked without pay, he was not allowed to admit private patients. Finally, Dr. Wallace Webber "raised a rumpus" about this policy.

Recalling the episode years later, Dr. Webber explained that a patient from New Jersey had traveled to Maine expecting him to be her private physician. When she later learned that he was not allowed to collect his surgical fees because he was "on duty," she refused to pay her hospital bill. Later that year, trustees voted to allow private patients to choose their own physicians, and to open the hospital to those physicians.

Besides physicians, the other "volunteer" employees were student nurses who staffed the hospital in return for their education, room and board, and a small stipend. CMGH opened with just two "nurse probationers," though four others were accepted during the first year; one student was dropped. Following a one-month probationary period, students received $7 a month for five months, $8 a month for the next six months and $12 a month during the second year. Books and uniforms were provided free.

While student wages were one of its biggest expenses, the hospital profitted in the long run. Considering the 12-hour days and six-day weeks students logged, they were actually paid a nickel or less per hour. Besides providing bedside care, students scrubbed floors, did laundry and otherwise kept things in running order. They also fattened the hospital's treasury by doing private duty in local homes. The nursing program gave the hospital status of one of the few "training" hospitals in the country.

For women between the ages of 20 and 35 with "common school" education and certificates of "good moral character and good health," nurse's training provided an income and an apprenticeship which would serve them well until they married.

A growing family

In the early years, CMGH nurses received lessons in massage, "sick cooking," application of leeches, dressings, enemas, hypodermic injections and observation of patients. They were taught anatomy and physiology and hygiene and were tested through oral exams every three months. Students learned great self-discipline and were expected to adhere to strict moral codes. They were admonished to "abstain from idle tale-bearing," and to avoid "unnecessary expense in the homes of the poor."

The superintendent retained the right to dismiss students at any time. Reasons given for dismissal (up through 1941) included: "distasteful person," "marriage," "not a desirable person," "unfaithful person," "spoke back," "did not attend church services," "sneaky person," "person with low morals," "late in reporting," "poor manners," "sneaking out of dormitory," and, last, but certainly not least, "caught kissing in entry."

Louise Munroe Newton wrote of the discipline she experienced as a student from 1898 to 1900: "The student could wear any cotton dress which would pass the scrutinizing gaze of the Superintendent of Nurses." This, however, was easier said than done, as Ms. Newton described her first visit with the nurse superintendent. "Arrayed in delicate dimity, with lace-bedecked sleeves and accessories of jewelry, (I) stood under the piercing gaze of that austere individual who was to be (my) commanding officer for two long years."

"After being eyed from head to foot, and having been requested to turn about, that the back effect might also be viewed, this awe-inspiring being produced from her desk a pair of shears. The sight of these did not help to maintain (my) trembling equilibrium, not knowing just what part of (my) anatomy was to be removed. A sense of relief was soon felt, however, when that grave looking personage nonchalantly approached (my) wrists and deftly cut assunder the flowing lace. (My) jewels were next confiscated, and after being told that (I) was round-shouldered and should stand up staighter, (I) was conducted to the women's ward and introduced to the head nurse."

Such rigid expectations followed the nurse off-duty as well. Her behavior in the community was as much the nurse matron's concern as her work in the hospital. Before the 1870s, hospital nursing was "a menial occupation, taken up by women of the lower classes, some of whom were conscripted from the penitentiary or the almshouse." A concerted effort was needed to change that image.

But the strict rules also resulted from the hospital's function as a "family." CMGH nurses, the nurse matron, and the hospital superintendent all lived on the premises. Rooms were later provided for interns, maintenance and housekeeping personnel. In 1904, Superintendent William Smith, who replaced Dr. Emmons, referred to the hospital "family" in his report: "(This past year), the average number of patients was 47. The average number of attendants, nurses and others was 41, of whom 25 were nurses. Thus a family of 88 were cared for, the final accounting of which makes a very encouraging report of progress."

This sense of family would extend to the present day.

Needs prompt growth and growth prompts greater need.

Between 1891 and 1906, CMGH's admissions rose from 135 to 1,001; the number of student nurses grew from five to 32; and other hospital attendants increased from two or three to 20. In their first annual report, trustees complained of overcrowding and the need for more private rooms.

Central Maine General ended its first fiscal year with a balance of $112.26. The year had been a medical success as well. A free clinic to treat diseases of the eyes and ears had seen more than 1,300 during the year. Many of these patients were mill workers suffering with conjunctivitis and hearing difficulties. The hospital treated 36 medical cases and 91 surgical cases.

The second year produced even greater financial and medical triumphs. The number of patients seen at the clinic doubled; three student nurses were added to the work force; 10 patients admitted with typhoid fever during an epidemic recovered. And, trustees reported that "liberal donations by friends" had resulted in a year-end balance of nearly $5,500.

If anything, however, the hospital's success was a reminder that there was "no alternative but the erection of a new building early the coming spring." A building committee, comprised of T.F. Callahan, Seth D. Wakefield and H.M. Packard, was formed.

The coming spring, however, brought the business panic of 1893, and attempts to raise $50,000 for construction of the East Wing were futile. Nevertheless, architect G.M. Coombs drew an artist's sketch of the future Central Maine General Hospital. The plan, which included two wings attached by walkways to a huge central building, looked remarkably like the building CMGH would become by 1931. Directors believed the East Wing and Center Building could be built at once.

In 1895 patients at CMGH hailed from 14 of the state's 16 counties. However, fewer patient were admitted that year because preparations for construction of the East Wing required moving the Bearce House. During the year, workers completed the foundation for the new wing, but two years would pass before the East Wing would open for business.

Meanwhile, attendance at the clinic had jumped to 22 patients daily, and the hospital's full-to-bursting status made for a weary hospital staff. But overcrowding could not be alleviated until money was raised to complete the building project. In 1897 the state kicked in another $15,000 toward the East Wing, but the fund still fell short. In the meantime, clinic attendance doubled again and cots were placed in the corridors to accommodate the sick. The board conceded that nearly $9,000 would have to be borrowed to get the East Wing finished.

Early trials and tribulations

On April 25, 1898 -- the day the United States declared war on Spain -- the hospital's East Wing opened.

A two-day open house followed. At a dedication held in the men's ward on the second floor, building committee chairman T.F. Callahan formally turned the keys of the new building over to board president Seth M. Carter. Music followed, arranged for by the Woman's Hospital Association. Student and graduate nurses gave tours and answered questions. Among rooms that had been named in a charitable response to the hospital's needs were the Neal-Crockett, Shurtleff, Farwell, Sanborn and the Onaway Club rooms.

The East Wing was a fireproof, four-story brick structure that was "up to date, and compared favorably with anything in New England." The "new hospital" boasted "large passenger elevators" and "spacious staircases at each end of the building." An old boiler had been replaced with one that burned a more convenient and less expensive soft coal, and also provided an "indirect system of heating."

The first floor of the new wing, called Ward A, contained 14 private rooms, a separate "serving room" and diet kitchen, a new operating room and "adjacent service rooms" that were also used for surgery, as well as private rooms for the two interns.

The second floor housed the office of the superintendent of nurses, a recovery room, separate toilets and a linen closet, as well as Ward B, the men's ward. The women's ward, or Ward C, was found on the third floor. A private room located near the elevator was used as an examination room for women and as a classroom for student nurses.

The wards were expansive and sparsely-furnished. Narrow metal-framed beds lined each side of the rooms, behind them huge double windows let in framed squares of natural light. The beds did not "crank" into sitting positions, but a patient could be braced upright using a metal arm attached to the upper half of the bed. The hardwood floors were shiny. A wheeled metal cart held medical supplies.

Stark differences between the private rooms and wards illustrated the hospital's policy of catering to private patients. The patient who paid $2 to $5 a day was, after all, subsidizing the care of those who didn't pay.

By the early 1900s, most hospitals had realized the need to lure private patients to help cover growing costs. In CMGH's 1906 annual report, Superintendent William Smith complained that patients admitted from outlying towns and cities were often unable to pay their bills and when these patients were "reported to their home towns, such towns also refused to pay the expenses incurred by stating the patient has no legal residence in such town."

Concern over charity abuse was not uncommon. In most cases, however, rather than turning the poor away, hospitals simply began to provide special services to private patients, such as better food, choice of physician and private duty nurses.

The opening of the East Wing also marked the beginnings of a maternity service. The Women's Reform League had been pressing for a maternity ward. and within a year rooms were set aside on the second floor of the old West Wing for that purpose. Ten babies were born at CMGH in 1900.

The new wing contained an additional 54 hospital beds, which resulted in the need for more nurses. Patient calls for private nurses further strained the tiny nursing staff, and many outside requests for nurses were turned down. The training school would have 21 nurses by 1901, stretching the hospital's facilities to their limits. The new cry from directors that year would be for a suitable nurse's home.

The staff of doctors practicing at CMGH grew considerably, bringing more paying patients to CMGH's doors. Doctors continued to do two-month charity rotations, in addition to caring for private patients. Admissions soared, reaching 487 in 1899 and 751 in 1901. A growing sense of trust in the hospital led to admissions from every county in the state.

By now, more than half of those treated as inpatients received medical care for free or partial payment. Even with an annual $5,000 gift from the state, the hospital could no longer keep pace with the demand for services. Almost immediately following the $59,606.30 investment in the East Wing, the push for more money, space, and nurses was on again.

Progress provokes financial concerns

"It is remarkable that we are given so much advice and so many general suggestions pertaining to changes and so-called improvements that call for a large increase in running expenses, and not even a thought expressed as to where the revenue is coming from to meet them." -- From the director's report, CMGH, 1906.

In 1899 the state earmarked $10,000 for a new boiler house, laundry and kitchen at CMGH. Local businesses such as Bates Mfg. and the Lewiston Bleachery gave money and goods. Small items were given by individuals throughout the year: bed socks, dolls, scrapbooks, robes.

The Woman's Hospital Association had maintained a "free bed" since 1894; other organizations giving regularly were the Onaway Club and the Women's Christian Temperance Union. Individuals such as Dr. M.C. Wedgewood, Mrs. Ellen Shurtleff, W.W. Farwell, the Rickers of Poland Spring, and J.S. Sanborn, of Chase and Sanborn coffee, gave generously as well.

In 1900, directors noted a "handsome purse" of $1,875 from "guests at the Poland Spring," and later, a $5,000 donation from Sanborn. This money was used to help finance the nurse's home in 1902. The purchase of the Lowell house, located on Hammond Street, provided a home for 18 nurses, freeing up West Wing rooms for private patients.

Bequests from local estates, large endowments and investments began to make made the hospital's financial affairs more complex. Hospital trustees were becoming financial managers, rather than "guardians of the poor." And, as younger businessmen replaced older board members, new management ideas followed.

Signs of change punctuated the hospital's annual reports. In 1903, Dr. Hill retired from the staff and was named emeritus surgeon. The following year, the directors solemnly noted his death. No other person, wrote the directors, "devoted as much time in getting the public interested in raising funds and laying the foundations for what we now have in hospital advantages as he did. He was kind-hearted and did a great amount of work for which he received no compensation. ..."

Other changes followed. Nurse Superintendent Eugenia D. Ayers resigned in 1903 after a brief but fruitful tenure. She had extended the nurse's training program to 27 months, increased the probationary period to three months, and planted the seed for a "distinctive uniform" for students and graduates. She had also begun the first public graduation exercises for students. During her term, the school received its first notable donations, assuring its status as a separate entity from the hospital. And, finally, she was involved with the formation of the Nurse's Alumnae Association in 1902.

William F. Smith of New Haven, Conn., replaced Dr. George P. Emmons as superintendent in July 1904. (Dr. Emmons carried on his work at the hospital as an adjunct ophthalmic surgeon for another 18 years.) This change, along with William D. Pennell's appointment as president of the board of trustees, and Ellen Smith's new role as superintendent of nurses, created a new cast of leading characters at CMGH.

Under Smith's leadership, much was accomplished. In 1904, the state gave $15,000 to help finish the laundry and kitchen facilities, and by 1906, that project was complete. The school of nursing increased its enrollment to 35 nurses. In 1906, directors hired a pathologist and routine testings were begun.

Thus Central Maine General Hospital ended its 15th year, facing financial and political struggles not so different from its first. Yet, much had been accomplished and a great deal had changed.

In 1907, both William Smith and Ellen Smith resigned. One person -- Rachel A. Metcalfe -- replaced them. She would prove that medicine, money and management were not just a man's domain, and her foresight and intelligence would shape the hospital for two decades.

"Most any call, back then, was an emergency. He never got called with just a simple appendix, it was always a ruptured one ... at least nine times out of ten. Everything was a last-minute deal. In those days, nobody wanted to be operated on, and, of course, they were about ready to die before they'd call for a doctor. ... Sometimes, and not too rarely, he was called out and would find the patient already expired by the time he got to the house up in Skowhegan or Bingham or sometimes he'd go clear up as far as Jackman. ... Of course, there was nobody in Waterville in those days doing surgery. He was the only one for miles doing nothing but surgery." -- Dr. Wedgewood Webber on his father, Dr. Wallace Webber, and surgery at the turn of the century.

Chapter Three

In April 1909, Lewiston Journal reporter L.C. Bateman interviewed several doctors for a story about the "practice of medicine today." The three-page article noted tremendous progress in surgery and diagnostics, "rapid advances" in pathology, and that "the prevention of disease" had become central to medicine. The article also included an interview with Rachel Metcalfe, superintendent of both the hospital and the training school.

"The medical nurse of today must have a wider scope of knowledge than ever before," she said. "She must have judgement, discretion and the cool, calm nerve to deal with alarming conditions. The surgical nurse must understand bacterial conditions and have technical knowledge in regard to cleanliness."

She stressed the need for public health education and pointed out the work student nurses were doing in this area. Matters of sanitation and diet were considered breakthroughs and Miss Metcalfe noted that "the trained nurse teaches this to every family into which she goes ..."

But while Mr. Bateman's article provided a sketch of medicine and surgery in the early 1900s, it was devoid of the human elements that defined Central Maine General Hospital.

Missing was the "clomp, clomp, clomp" of Sam Sawyer's wooden leg as he made his way through the hospital's corridors, or the image of a bleary-eyed Bates College student named Robert Frost rounding up interns and doctors to perform emergency surgery at midnight. One can't see Dr. Everett C. Higgins, an "Abe Lincoln kind of guy," ambling through the wards. Absent was the sound of cards being shuffled in the room near the switchboard where doctors played high-low jack for 25 cents a point.

CMGH was a family united in purpose. Stories told by veteran hospital staff members have a common theme: a sense of "belonging," of "everyone working together toward the greater good." Dedication and self-discipline were a matter of course. Struggles and triumphs were taken in stride.

One of CMGH's first and most renowned surgeons was Dr. Wallace Webber, brother-in-law of M.C. Wedgewood, one of CMGH's founders. Dr. Webber joined the hospital staff about 1895, soon after his graduation from Bowdoin Medical School, and his work at CMGH would span the administrations of seven hospital superintendents. He remained on CMGH's consulting staff for years after he retired as a full-time surgeon, even volunteering his services during WWII to help develop a war-disaster plan. In his early days, Dr. Webber was as likely to remove an appendix in the kitchen of a farmhouse as in the hospital's operating room. Roads were not plowed or well maintained until the late 1920s, and those living in rural areas were hard-pressed to move a sick or injured person to the hospital. Instead, Dr. Webber brought the hospital to them.

People travelled by horse and buggy or horse and sleigh, and even short trips often took several hours, so when someone rode out to summon a doctor, an emergency was usually at hand. Some of Dr. Webber's journeys to answer these calls were so long that he picked up fresh horses along the way. "It could be 24 hours, sometimes, just to do one appendix," recalled Wedgewood Webber, Wallace Webber's son, who was also a staff doctor at CMGH.

Though he brought with him instruments, as well as sterile caps, gowns, gloves and towels provided by the hospital, when an operating table was required, so was improvisation. "The table of choice for him to operate on was a dining room table that opened up," explained Wedgewood Webber.

Removing the extra leaves, "he'd stand in the groove of the table to operate."

Dr. Webber used sterile technique, draping towels dipped in bichloride of mercury and water on the surgical site. As he worked, his instruments boiled on the stove. Ether was administered by an attending nurse, another doctor who may have come along, and sometimes by his son.

During his later years, when he was a patient of Dr. Robert Frost (CMGH, 1941-1978), Dr. Webber shared several stories about the old days and the routine difficulties he encountered.

"He told me about a call he got to go up to Oxford," Dr. Frost recalled. "He and his nurse took the streetcar from Lewiston-Auburn out to Mechanic Falls, where they hired a horse and sleigh. It was the middle of winter and there was a heavy snowstorm, so they drove through these fields of snow until they saw the light of the farmhouse.

"Inside was a woman with an acute gallbladder. The nurse poured the ether and Dr. Webber operated on the kitchen table, and when he was through, he left his nurse there to take care of the patient; then he left in the horse and sleigh. On his way home, it was dark and all he had was a lantern to see by. The road was obliterated by snow and the first thing he knew, his sleigh was down in the bushes. He finally got the horse and sleigh out of the snowdrift and looked up to see this light, and he headed toward it, only to find it was the farmhouse he'd just left behind. Well, he finally did get back to Mechanic Falls that night and found a hotel, but the hotel didn't have any heat. He was soaking wet and tired, but he just dried off and covered himself with a bearskin rug and stayed there the night.

"Another time, it was in the fall, and he had to go out to Livermore Falls. This time, he drove his car. (Dr. Webber always had the latest in automobiles.) But unexpectedly, it came off a bad storm. Well, he made it up there, but since they didn't plow the roads back then, he couldn't get back. He had to leave his car in an apple orchard in Livermore Falls. He went home by horse and sleigh and the car stayed there until the following spring."

These experiences, no doubt, left Dr. Webber preferring to perform surgery in CMGH's East Wing surgical suite, where the equipment was the "best this side of Boston."

In a history written for the Journal of the Maine Medical Association, Wallace Webber described wearing "rubbers" in surgery, his feet sloshing about in a half-inch of water, as the saline solution used to irrigate abdominal cases poured onto the floor. But despite the primitive images such a description evokes, Dr. Webber was a progressive thinker. For example, his son, Wedgewood Webber, reported that Dr. Webber believed, long before it was widely-accepted, that surgical patients should get back on their feet as soon as possible. He held his belief because he had "studied animals" doing the same. His work as a surgeon also became intensely personal at times, such as when he amputated his own father's legs and the leg of his good friend and colleague, Dr. Samuel Sawyer (CMGH, 1908-1942).

Like most doctors practicing rural medicine, Dr. Webber knew that many couldn't afford medical care, so he kept his charges low and often worked for nothing. "My father used to say -- and I have no doubt it was right -- that he'd cross off (thousands of dollars) worth of bills every year from people he knew weren't able to pay," said Wedgewood Webber.

One of Dr. Webber's contemporaries, Dr. Merrill S.F. Greene (CMGH, 1932 to 1989), said his early days as a doctor were particularly lean. Despite an education at Colby College and Harvard Medical School, when he arrived in Lewiston in 1927, he waited three years for an appointment to the CMGH staff. Like some of their patients, many physicians were also struggling to survive financially.

"The first year I practiced medicine, I heard you could go down to City Hall to get help with your income taxes; so I went down with my figures and the man there looked at them and started laughing. He said I hadn't earned enough money to pay any taxes," Dr. Greene said.

Fees were a puzzle to young doctors starting out. When Robert Frost began his practice in the 1940s, he had "no idea" what to charge his patients. After checking with Dr. Twaddle, he set his fees at $2 for an office visit and $3 for a house call. He made $15 the first day and was astounded. "I thought I'd robbed somebody and felt guilty to think I might have overcharged."

Dr. Carlton Rand (CMGH, 1930-1975) recalled doing orthopedic work for a child and sending the mother a bill. The mother paid the bill, but Dr. Rand was later told by a friend that the mother was a widow and "her finances were poor." He returned her money. "If you were a good doctor," he said, "you cared about people. You let them know you were interested in them." Few doctors were as "good" as Gard Twaddle.

Dr. Twaddle (CMGH, 1918-1960) graduated from the Bowdoin College medical school in 1916 and joined the CMGH staff as anesthetist two years later. He became a surgeon in 1923 under the tutelage of Dr. Wallace Webber. During his 44 years as a physician, he care for thousands of patients and "never bothered too much" about whether he was paid or not. He sauntered through the hospital with a "cigarette in one hand and a Coca Cola bottle in the other," his manner putting people at ease. His patients were devoted to him and the nurses adored him.

Dr. Twaddle spoke with colorful and "down-to-earth vernacular," and loved horses and the "long shots" he liked to bet on at the races. His colleagues respected him, never "doubting the sincerity of his judgement," though he was "sometimes dogmatic in his opinions." But above all, he was a generous man. Many in Lewiston and Auburn remember Dr. Twaddle's "G.I. Plan," whereby he "never charged for delivering the child or ministering to the family of any lad who was in the service."

Perhaps Dr. Clark F. Miller said it best, when he wrote in the CMGH annual report: "No patient ever lacked attention from Gard because he lacked money, or because he hadn't paid last year's fees; this fine contempt for the monetary aspects of his practice has become a part of the legend."

Two years after his retirement in 1952, more than 6,000 people gathered at the Lewiston Armory to pay tribute to Dr. Twaddle's "years of selfless service." It was fitting that those planning the testimonial decided against serving a meal in order to "avoid a charge that would keep (those) away who might want to come but could not afford it."

Dr. Twaddle balked at the fanfare, calling it "a lot of golrammed foolishness," but heartily approved the Gard W. Twaddle Nurses Endowment Fund that was created to provide financial assistance to student nurses.

Dr. Twaddle's allegiance to medicine and to the community earned him an unprecedented distinction in the Twin Cities, and "the busiest practice of any physician" for miles. When CMGH's admissions dropped by nearly 300 in 1961, Gard Twaddle's death was cited as the cause.

Working for a living

"Also, Dr. Sawyer had a wooden leg, and because of it, he'd have difficulty shifting gears in a car. So when we got a call for an operation, you could hear him coming up the semi-circular driveway to the hospital, grinding the gears all the way up. And then, clomp, clomp, clomp, down the hall he'd come with his wooden leg." -- Dr. Robert Frost, in a conversation about the old days at Central Maine General Hospital.

Described by Wedgewood Webber as a "jolly guy" who often quoted poetry and literature, Dr. Samuel Sawyer was one of the first physicians in the state to limit his practice to anesthesia. He worked in the CMGH operating room with Wallace Webber for more than 30 years, and during this time became associated with Gard Twaddle, a young physician under Webber's guidance.

Dr. Robert Frost, then a student at Bates College earning room and board at CMGH by answering the switchboard at night, found Twaddle, Webber and Sawyer an impressive trio.

"I can remember we'd get calls from all over the state for Dr. Webber," said Dr. Frost. "We were always glad when it was an appendix because Webber and Twaddle would arrive and as opposed to some of the other surgeons who might have taken an hour or more, they'd be all done in 20 minutes. They operated as a team, and they were very good.

"Dr. Sawyer was usually the anesthetist when Dr. Webber or Twaddle did surgery. I remember hearing them tell stories of how he'd be pouring ether and all of a sudden Dr. Twaddle would holler at him because he'd etherized himself -- he'd fallen asleep during surgery.

Despite this humorous anecdote, Dr. Sawyer's personal resolve was extraordinary, as Dr. Wedgewood Webber related in the story of how the anesthetist lost his leg: "There was something about the furnace that he knew was not just right and he went down to check it, and just as he was standing in front of the furnace, it blew, and the door of the furnace cut his leg right off. But he had sense enough to take his belt off and put it around his leg as a tourniquet. Then he crawled out of the bulkhead, where he got help. My father had to finish the amputation at the hospital."

Although Dr. Sawyer preferred ether as his anesthetic of choice, the substance had its drawbacks, as Dr. Greene pointed out.

"(Patients) would try to get away as soon as you put on the mask. We used to have to strap them down. The operating table had these wide leather straps that buckled across the chest and legs to hold them down. I remember one man who actually got up off the table and ran out of the room. We had to go after him," said Dr. Greene, amused by the memory of the fleeing patient.

On rare occasions as a young surgeon, Wallace Webber saw ether used for other purposes. In 1963 he wrote, "It was astonishing how many patients came in at that time with lice. I have been operating and had Dr. Sawyer stop and pour ether on a spot on the scalp and say `Well, I got that one Wallace.'"

Dr. Frost recalled that as anesthesiology advanced, surgeons had to adapt to changes. When pentathol, nitrous oxide and other anesthetic agents came into use, Dr. Twaddle would often ask anesthetist Gil Clapperton if things were "all right" because he "couldn't hear the patient snoring," as he could when ether had been used.

Besides changes in surgery, doctors at CMGH during the early years witnessed major changes in medical treatment. Those practicing before World War II treated diseases that are rarely seen today.

Tuberculosis or the "white plague" was feared by all. Wards in the East Wing and Center Building were set aside for TB cases. According to Dr. Greene, who worked on the surgical unit for several years, doctors frequently used maggots to "clean up the (surgical) wound," especially in tuberculosis sinuses.

"We placed a number of them on the wound and then covered them over with this wire mesh cage," explained Dr. Greene, "so the worms couldn't get out. The maggots lived on the serum and whatever else came out of these wounds."

Pneumonia was also a dangerous disease. During his days as a medical resident before World War II, Dr. Frost said that 50 percent of those who contracted pneumonia died. At the end of WWII, penicillin would be readily available for treating the disease, though some thought the wonder drug was too good to be true. Pneumonia had posed such a threat for so long, explained Dr. Frost, "it was some time before we got used to keeping people home" after the antibiotic reduced the danger of the illness.

Paralytic polio was a crippler. Until the Salk vaccine became available in 1954, people lived in fear of contracting the virus. Treatment often entailed the use of a respirator, or "iron lung," which helped the patient breathe. Dr. Frost's first memory as a medical resident in 1941 was of walking through wards filled with polio victims, and hearing the sound of the respirators that kept them alive. Pediatrician Gilbert Grimes remembered Dr. Russell Morrissette "spending most of his time upstairs with the iron lungs" even in the early 1960s.

Nursing becomes more important

Ruth Small graduated from Central Maine General Hospital in 1931, a member of the first three-year class. Her classes were often canceled when the wards needed nurses. One student might be assigned the care of an entire ward of 35 to 40 patients and a shift was 12 hours long.

Students made their own "Wagensteens (suction machines) out of vinegar bottles and mayonnaise jars," autoclaved bedpans, and "boiled all the instruments up" themselves. When they had a few free minutes, there were always other chores.

During Miss Small's student years, there were no "general duty" nurses, and graduates often found themselves with an education and no job.

"The only thing we could do was private duty," she recalled. "The hospital gave us our first case, but then we were on our own. And unless there was an epidemic or something like that, you might not work for a while."

During World War II, she served with the 67th U.S. General Hospital for three years in England, then returned to Lewiston and Auburn, where she did private duty for 20 years. She was appointed CMGH's student health in 1966 and held the job until her retirement in 1985.

Six years after Ruth Small graduated, Jean Webster Seawell entered the school of nursing. Irene Zwisler was the director of nursing, and a 3 p.m. to 11 p.m. shift had been established to upgrade the school.

Miss Zwisler was a "strictly military type," and students accepted into her program faced strict rules and regulations. Making rounds with hospital superintendent Dr. Joelle Hiebert each morning, Miss Zwisler was likely to "wipe her finger on the bureau to check for dust," and would sometimes "point at a student" for reasons unknown, creating a "genuine sense of fear."

Mrs. Seawell remembers attending chapel each morning before work, and early curfews for the dorms. She also remembers a different type of patient in the late 1930s, one far less prepared for surgery than today's patient. "There was a lot of fear about it back then," said Mrs. Seawell. "No one explained what was going to happen to the patient. And we didn't have all the pre-op drugs that are available today. It was still a pretty scary thing."

Mrs. Seawell went on to serve as an Army nurse during World War II, and later worked in hospitals in Maine and Virginia.

In 1939, Helen Adams was accepted into the five-year program at CMGH. She remained at the hospital through the war years, and recalled "doubling up" as a result of staff shortages and "blacking the windows out" for air raids.

"Then, everyone was admitted and they stayed until they got well. Today, you get the acutely ill, who only stay a few days, but are very sick. But we were kept busy then, too. We had to improvise and make things as we needed them," she said.

Working first as head nurse of CB4, she moved on to nursing arts instructor in September 1944 and was later named assistant director of nursing education. In 1961, she switched to nursing service, where she remained the assistant director until her retirement.

Of the other notable CMGH figures noted, Drs. Wallace Webber, Samuel Sawyer and Gard Twaddle died long ago. Dr. M.S.F. Greene only recently retired, and still does occasional work as a medical examiner. Dr. Carlton Rand retired about 15 years ago, and lives alone in his home on College Avenue. After a stint in the Navy, Dr. Frost returned to Lewiston and worked as a CMGH staff physician until his retirement a number of years ago. He and his wife are "taking it easy" at their retirement home in The Forks.

CMGH's earliest physicians saw many changes in medicine and surgery. They watched developments in transportation, communications, and education alter the way doctors practiced medicine. But despite these changes, they suggested that practicing medicine today is more difficult because of government regulation and the almost fashionable trend of malpractice suits.

But every age has its own trials and tribulations, and while CMGH's veterans are happy to take a few moments to reminisce about the "old days," they await medicine's future.

Chapter Four

During Rachel Metcalfe's two decades as supervisor of Central Maine General Hospital and its training school, the United States saw polio and influenza epidemics, an increase in deaths from tuberculosis, outbreaks of measles and diphtheria, and a world war. Health care become a hot political issue as medical care costs rose considerably, prompting calls for national health insurance and workmen's compensation reform.

Minimum standards were set for accreditation by national health care organizations and state legislatures began imposing restrictions and guidelines. In 1916, for instance, the Maine Nurse Practice Act was passed, providing for the registration of graduate nurses and the approval of training schools. CMGH was one of the first approved schools in the state. In 1924, the American College of Surgeons recognized CMGH as a Class A hospital.

The world went to war and the call to arms left CMGH short of personnel, though the beds remained full. Miss Metcalfe faced supply shortages, soaring costs for drugs and supplies, and an ever-tighter budget.

Life changed as technology changed. Miss Metcalfe saw the hitching post in front of the Central Building used less and less as automobiles became the primary mode of transportation. She watched more and more emergency surgery performed due to automobile accidents. The hospital installed a telephone. In 1920 radio came to Auburn.

The "Roaring Twenties" ushered in new styles and new lifestyles. At CMGH, the original striped seersucker nurse's uniforms with high collars and long, full sleeves gave way to a shorter plain, blue dress with short, capped sleeves and modern collar topped by an apron.

Rachel Metcalfe played an active role in the advent of public health in Androscoggin County, urging her nurses to teach hygiene and nutrition. She kept abreast of advances in medical science, especially in laboratory science and x-ray, and constantly pressed trustees for more space and better equipment. She supported the CMG nurses' alumnae association and joined the Business and Professional Women's Club. She was instrumental in organizing the Maine Nurses' Association in 1913.

Rachel Metcalfe was the only person in CMGH's history to supervise both the hospital and the school of nursing. During her charge, an orthopedic clinic and x-ray department were established, instruction for nursing students was updated to conform with standards set by leading U.S. hospitals, the laboratory was enlarged and improved, the Central Building was constructed and a nurse's home was built. Plans for the new West Wing were under way before Miss Metcalfe resigned.

She presided through great social changes in medicine. More middle class patients began seeking hospital care, creating a demand for "inexpensive private care" and leading to the creation of semi-private rooms. Admissions increased from 1,012 in 1907 to nearly double that when Miss Metcalfe resigned in 1927.

Providing care for central Maine

The 1906 annual report paid tribute to those who had dedicated themselves to Central Maine General Hospital. The report named six men who had died: Drs. O.A. Horr, A.W. Shurtleff, W.B. Small, M.C. Wedgewood and Edward H. Hill. (All but Dr. Shurtleff had signed the original promissory note for the loan used to purchase the Bearce estate.) The sixth man was Ara Cushman. Fifteen years later, 22 individuals were similiarly listed, including: Drs. Wallace K. Oakes, Benjamin F. Sturgis and J.W. Beede, as well as trustee Seth D. Wakefield and longtime board secretary, Dennis J. Callahan.

As new trustees replaced the old, the hospital's annual reports began offering more detail. The superintendent's report listed the number of patients admitted from each town with the intent of stressing the need for additional state funding for the maintenance account.

The Legislature was appropriating $5,000 annually for hospital maintenance and in 1907 voted to contribute $12,000 over a two-year period toward the building account. Two years later, the state would increase its annual donation to $6,500 per year and vote an additional $15,000 for the building fund. But in 1907 board members were so concerned about the hospital's deficit that they increased ward rates and established an operating room user's fee.

"We have considered the financial question in all possible ways, and, at a recent meeting ... after mature deliberation we decided to increase the ward fees from one dollar to one dollar and one quarter per day. We also decided to charge for use of operating-room a fee of $3.00 to $5.00, to be determined by the superintendent; in addition ... it was unanimously agreed that where unusual luxuries were demanded and furnished, an additional charge should be made."

Although this decision netted the hospital more revenues, it fell far short of meeting the hospital's expenses. The plea for more money continued.

Trustees were daily reminded of the need for further expansion. Though plans for the Central Building had been in underway almost since the opening of the East Wing, directors were disappointed again and again by a Legislature unwilling to approve the amount requested for construction.

In 1913 the state passed a law requiring hospitals to charge "all patients for board an amount equal to per capita actual cost." In all likelihood, this law was passed in response to concerns that patients were abusing hospital charity.

That same year, trustee wrote in their annual report: "There is no good sound argument for asking the State to appropriate funds to pay for hospital services or for the Hospital to shoulder the burden, when it is absolutely certain that the individual is financially able to meet the necessary expense themselves, and it is, as it seems to many, decidedly unfair to the Surgeons as well."

For CMGH, the new law was good news, since the hospital had traditionally charged ward patients less than the actual cost of room and board. In keeping with the law, directors determined the weekly cost of care per patient at $11.50, but for other reasons set the ward rate at $10.50 per week, an increase of $1.75 per patient per week.

Another niggling concern was the complaint of doctors not associated with any hospital that the competition created by "free care" was putting them out of business.

In the meantime, the hospital struggled for survival. Expansion work was done piecemeal, beginning with a new boiler house, followed by a separate kitchen and laundry. In 1909 the foundation for the Central Building was poured.

With the addition of staff pathologist Harold E.E. Stevens in 1906, laboratory testing of urine became routine, although blood counts were done only when doctors requested them. Some "examination of surgical material" was also conducted for "cases of cancer, sarcoma, fibroma, tuberculosis." By 1913, Dr. Stevens was doing throat swabs for diphtheria and using the reaction tests to diagnose typhoid. Many of these tests were still in their infancy, but would become valuable diagnostic tools in the years to come, increasing the doctors' dependence on expensive equipment housed and maintained by the hospital.

An orthopedic clinic, headed by Dr. Thomas F. Conneen of Portland, was established in 1912 for the treatment of congenital or acquired deformities. The clinic was set up as an outpatient service, offering free examinations to the poor. This clinic hastened the need for an x-ray machine to help the doctor diagnose orthopedic disorders.

A year later, a Wappler apparatus was installed in the basement of the Central Building, and an x-ray department under the direction of Drs. E.S. Cummings and C.H. Cunningham, was born.

And yet, with each new piece of equipment, with each new department, another need appeared. Patient admissions rose steadily and soon cots were being placed in the halls of the "new" hospital or the East Wing to accommodate the overflow of patients.

So great was the need to complete the Central Building that trustees in 1914 agreed to "incur a debt," rather than wait to finish the project. According to the annual report that year, a gift of "$4,000 to $5,000" from D.D. Stewart of St. Albans inspired them to borrow the rest, "having full confidence in the ability of the general public to provide the necessary funds to finance the affair."

Hoping to further secure CMG's financial position, the board invited the state Commission on Charities to inspect the hospital and review plans for the Central Building. The committee approved the hospital and building plans "unanimously," causing trustees to note they would be "sadly disappointed" if a "liberal appropriation from our incoming Legislature" was not secured.

And so construction continued. The old Bearce estate was then setting on the Central Building foundation and had to be moved again. It would be a move that Miss Metcalfe would never forget.

"Having been subjected to so many changes, (the Bearce house) had become weakened, and in taking it from the stone and brick foundation, it fell and became a total wreck ... It was almost a miracle that none were seriously hurt. Our Superintendent, Miss Metcalfe, was incapacitated for several weeks by reason of the shock and great scare occasioned by the fall, she being in the building at the time." After several weeks in the hospital, Miss Metcalfe, recovered, but the old wooden building met its end.

The Central Building opened in 1915, providing better operating rooms, more administrative offices and private rooms, and carrying a mortgage the state was not willing to subsidize. Despite seeming support from the Commission on Charities and the efforts of doctors, trustees and the superintendent of the hospital, who appeared before the Legislature, the state would not assist. In a summary of the events, trustees vented their anger at having been turned down once again.

"If such an action on the part of the appropriation committee was contemplated, it did seem to us to be unfair and unbusinesslike to grant a hearing that caused so many people to devote their time to attend it and be subjected to the necessary expenses, such as railroad fares, hotel bills, etc. It seemed ... inconsistent with the dignity that should be associated with our General Court ... (And) subsequent events have justified the feeling so frequently manifested since, that we were not fairly dealt with."

As if to make up for the state's stinginess, generous endowments poured in from the public that year, providing the hospital with $19,844.09, as well as gifts of furniture and bedding. Still, contributions weren't enough to eliminate the hospital's debt -- the Central Building had cost $122,677 to build.

For the next two years, the hospital seemed almost too big: though admissions were up by more than 100 patients each year, directors had expected a greater increase and had taken on a bigger staff of student nurses. Thus, with bigger payments on an interest account, higher wage expenses, and the increased cost of supplies due to the war, CMGH's finances looked bleak in 1916 and 1917.

"Had we known just the number that would knock at our doors during the year, we could have avoided some of the expense," wrote trustees in the 1916 report. "If we had kept our force down, and the calls had been greater, we would have been subjected to criticism. The matter of carrying a larger force to meet an emergency was freely and fully discussed by the Board of Directors, and after mature consideration unanimously agreed upon, and it could not reasonably be called an error in judgement as we view it."

The year before, trustees had asked the state to increase the maintenance account from $7,000 to $9,000. And, again, they had been turned down. In addition, the amount deducted from the state appropriation had increased to $311. Philanthropic donations had dwindled. It's little wonder, then, that the following year, the board approved a fee increase for both ward and private rooms. New charges were set at $14 a week for the wards, and $2.50 and up per day for private rooms.

Improvements and expansion added to expenses. For example, in 1916, the x-ray department reported "234 Roentgenograms had been made" and that Barium meals were being done as well. A fee was charged for "x-ray examinations," but may not have offset expenses. That same year, the hospital's revenues were $42,320 and its costs were $48,655. CMGH's debt reached $97,000.

The war effort complicated matters further. Hospitals had been asked to prepare for an emergency. In 1917, the trustees wrote: "We have been called upon by the authorities at Washington to report as to the number which we could provide for in the event of a demand for accommodations for wounded soldiers, and our Superintendent ... has given the proper persons such information. It is sincerely hoped we may not have occasion to provide for the boys, but, if the call comes, we shall do everything in our power to provide for their comfort."

Though the call never came, there were disruptions during the next two years. Doctors were drafted, and nurses volunteered for military duty. The 1918 Spanish influenza epidemic that raged across the country proved an even greater challenge. Between 1918 and 1920 the hospital admitted 253 flu patients, dozens of whom contracted pneumonia, prolonging their stay. Seventy-one died. Nurses and doctors worked around the clock, many of them falling sick with the flu as well.

Financially, the hospital faced another crisis. A large percentage of the flu victims were charity cases. Costs for medical supplies had risen substantially, and electricity and fuel costs had nearly doubled. The state came through with an $8,000 donation that year, but little money was forthcoming from charitable donations. Even as the board determined to ask the state for $10,000 for the next two years, they made the decision to increase rates again. Ward fees were set at $17.50 per week, private rooms at $3 and upwards per day.

The words of the directors in the 1918 report are historically significant, indicating a subtle change in the nature of the hospital as a charitable institution: "Hospitals should be run on business principles, and we felt fully justified, after careful consideration, in re-adjusting our list of fees and prices for rooms, to avoid an increase in our debt." Their decision paid off: the hospital ended the year with a balance of $168. Any elation the board might have felt, however, was short-lived.

Trustees were stunned in 1919 when the state not only turned down the request for an increase in the annual appropriation, but decreased the amount by $2,000. President William J. Pennell, after noting that 10 percent of the hospital's services had been given for free, expressed his dismay at the state's decision.

What it all added up to that year, was a deficit of $2,800. Fortunately, several large bequests were made in 1919. The following year, a $20,000 donation, the largest ever, was received from longtime board member Col. Charles H. Osgood.

Shortly after accepting Col. Osgood's gift, President Pennell died. A man of determination and great energy, he had served the hospital for 26 of its 28 years.

In spite of the financial gloom and doom, changes and improvements had been made. By 1920 more women were choosing the hospital for childbirth. The maternity department was expanded and moved to the Central Building. A dark room had earlier been installed in the x-ray department, but Dr. Cunningham noted the pressing need for a screen to do flouroscopic work and a "portable coil" for use at the bedside. As usual, one improvement inspired the need for another.

Meanwhile, the hospital's growth had spurred the growth of the training school, as more patients requested private rooms and private nurses. Even so, fewer students were admitted than Miss Metcalfe would have liked. Miss Metcalfe continued to press for better housing for the student nurses. She suggested that the construction of a home "large enough to permit each nurse a separate sleeping-room and sufficient bath-room accommodations, as well as an assembly-room and class-rooms would (benefit) the work very materially." In the same report, she noted that the second floor of the West Wing had been renovated and equipped for maternity work, a puzzling decision, given that 14 nurses were sharing eight beds -- possible only because the nurses worked different 12-hour shifts.

The opening of the Central Building in 1915 did little to relieve the problem. The school admitted more students, but the few rooms set aside in the new building didn't meet the school's needs. Eight years would pass before the nurses would finally have a home of their own.

At long last, a proper nurse's home

"During the crash of 1929, as I understand it, Charles Wilson was in quite strained financial circumstances. Everyone said it was a pity; he gave all that money to the hospital and ended up without anything." -- Lucy Webber, former CMG trustee and WHA president, in an interview, April 1991.

When Charles C. Wilson and his bride moved to Lewiston in 1875, they set up housekeeping in a small apartment in a buidling that set where Central Maine General Hospital's Central Building would one day be located. It owned by R.C. Pingree, the same man who owned the Pingree Mill, where Mr. Wilson worked for 10 years.

A few years later, Mr. Wilson watched with interest as the S.R. Bearce estate was sold to a group of doctors intent on starting a hospital. It wasn't long before Wilson joined the hospital's board of directors.

By 1920, as a senior member of the 10-man board, Wilson had struggled with money and management matters longer than any of the trustees, and was well aware of the overcrowding the nurses had faced since the hospital's opening. After the Central Building opened and the nurse's situation was not improved, Mr. Wilson took matters into his own hands. Concerned as well about the hospital's rising debt (in 1920, it was $91,000), he challenged other trustees to raise $50,000. In an article appearing in a special edition of the Lewiston Sun-Journal in 1931, Mr. Wilson explained his motives: "I had seen mothers come to the hospital with their daughters to make inquiry about having the latter take up the training to be nurses. They seemed to be impressed, in many instances, until the old quarters for the nurses were shown them. These were inadequate. The women and girls would leave, and we never heard from them again. So I realized how great was the need for an up-to-date nurses' home."

In the fund drive that followed, headed by board president Amos Fitz of Auburn and A.B. Ricker of Poland, more than $60,000 was raised, decreasing the hospital's debt to $31,000.

The nurse's Home -- later named the Wilson Home -- cost $100,000 to build and for years was the marvel of the hospital. The four-story brick building boasted semi-private dormitory rooms and separate bathrooms, classrooms, special quarters for the director of nursing and her assistant, and a "living room" which nicely housed the piano purchased by nurses in 1902.

Mr. Wilson's hope that the building would provide incentive for young women to enroll in the school was well-founded. In 1921, 32 probationers were admitted.

As for Mr. Wilson, he later become president of the board in 1926, and was named president emeritus in 1928. He and his wife both died in 1934.

Life before the crash

In the 1920s the Twin Cities were home to some 50,000 people. Three steam railroad lines and three electric train lines carried freight and passengers into the cities. Automobiles were becoming increasingly popular. A Maine Medical Journal advertisement in 1917 promised an issue devoted to the purchase and care of automobiles, because "every physician owns one or more automobiles." At the hospital, the growing automobile traffic meant more auto accident victims requiring treatment.

Between 1920 and 1930, the only thing the CMGH board could count on was higher operating costs. By 1920, the hospital staff had grown significantly. Technological advances also boosted costs, as evidenced by the installation of a modern "x-ray plant" in 1923 and a new laboratory in 1924. Other new expenses included the reinstatement of the orthopedic clinic in 1925, and the 1929 construction of a fireproof building for storing "dangerous nitro-plates" from x-ray.

Costs for building repair and improvements mounted: a new "mangle" was purchased for the laundry department and the open corridors between the Central Building and the East Wing were enclosed in 1923. In 1924 the roof of the Central Building was replaced and a new laboratory was constructed and furnished. A "refrigerating plant" was installed in 1927, and repairs were made to both boilers in 1929. Throughout the hospital, wards and rooms were being painted and refurbished at all times.

By 1923, the average weekly cost per patient had slightly more than doubled since the hospital opened, from $10.42 per week to $22.26. An increase in rates in 1924, to $21 per week for wards and $4 and up per day for private rooms, did little to offset costs; in 1926, the board reported a deficit of $12,000. Just a year earlier, directors had asked the state to double its $8,000 donation. They were turned down.

Directors couldn't help but point out that - despite a $50,000 gift from the Frank A. Munsey estate in 1925 -- the endowment fund was the smallest of the state's three general hospitals. A plea in the 1926 annual report suggested that "a fund of $500,000 is needed to perpetuate the institution and provide for all time the continuance of this refuge for the unfortunate and afflicted, and everyday blessing to humanity."

A banner year in 1927 only led to an even bigger deficit in 1928 -- $14,970, due to repairs and equipment. In 1929, a $100,000 bequest from Horatio G. Foss would increase the endowment to $137,069. New board President Samuel Stewart reported "financially, the past year has been encouraging." Ironically, it was the year of the Crash.

Rachel Metcalfe's legacy

During her last seven years as superintendent, Rachel Metcalfe continued the quest for a children's ward, a maternity ward, and an isolation ward. She noted in 1924 that the type of patient had changed considerably in five years, requiring "changes in ward management and arrangements for their care." While the bulk of those admitted were between 20 and 30 years old, some 200 children sought hospital care each year.

The other change was the switch to the "semi-private" patient, the middle-class person who wanted his own physician, but couldn't afford private rates. At Miss Metcalfe's bidding, "cubicles" were created out of Wards B and C in the East Wing. At her request, a room was converted into a doctor's library to help the medical staff with recordkeeping efforts.

A rash of contagious diseases in 1926 required the opening of the West Wing for several months. Miss Metcalfe used the occasion to again, press for a separate isolation ward, citing overcrowding at the hospital. She also began advocating for a physiotherapy department.

Rachel Metcalfe resigned November 1, 1927. She accepted a post as director of the woman's residences at Bates College in October 1928, the same year Norman E. Ross was appointed bursar of the college. (Mr. Ross would soon become a CMHC trustee and chairman of the hospital's building committee.) Miss Metcalfe remained at Bates until her retirement in 1940. Dr. Lewis F. Baker served the hospital as superintendent until Joelle Hiebert took over in 1931.

The resignation of Rachel Metcalfe marked the end of an era for Central Maine General Hospital. According to the 1929 report: "A committee was appointed to study the needs of the school as an educational institution not purely concerned with the temporary service of the hospital, but with the permanent service of the public ..." The next year, the school program was lengthened to 36 months, the workday shortened to eight hours, the case-study method of teaching was employed, and affiliations were begun with St. Mary's Free Hospital for Children in New York City and the Augusta State Hospital. Applicants were required to have a high school education, and an optional five-year program of study was also begun.

Social and political changes in medicine

By the 1920s, the middle class had begun to feel the pinch of rising medical costs. But though the costs and distribution of health care were a growing concern throughout the decade, it would take the hard times of the Depression to spur private health care plans.

Workman's compensation laws inspired a debate over the injured worker's right to choose his or her own physician. Most mills employed doctors who treated all injuries that occurred on the job.

The indiscriminate manufacture and sale of drugs also came under fire during this period. In Maine, the Owen Health Bill of 1912, addressing the concerns of physicians, sought to control the unrestrained practices of the nostrum-makers.

Nationally, hospitals employed extensive public relations campaigns to bring in more patients. Hospitals used the country's involvement in World War I for self-promotion by singing the praises of doctors and nurses who had joined the military to serve their country.

And, as medical organizations and state legislatures became more involved in the regulation and standardization of health care, the practice of medicine became more complicated. The American College of Surgeons required better medical records, and members of the Maine Medical Association put in a bid for more detailed "charting."

The issue of malpractice also became a concern. A bill before the state Legislature in 1911 attempted to "prevent physicians from carrying a policy insuring against malpractice suits."

Eighty years later, malpractice would still be an issue of concern.

Chapter Five

On July 24, 1931, nine days after Dr. Joelle C. Hiebert was named superintendent of Central Maine General Hospital, the West Wing was dedicated.

Though two of the major donors to the building project had already been named, the identity of a "mysterious" donor whose gift made the four-story brick addition possible, was withheld. At the dedication, a "tablet" naming William Bingham 2nd, Charles H. Osgood and Charles Horbury, was ceremoniously unveiled. The donation from the Bingham heirs, kept secret until the dedication, exceeded $300,000.

Nearly two years after the Depression had begun, CMGH had raised the money to build an addition hailed as one of the "most modern" in all of New England, an addition that expanded the hospital from 115 to 194 beds.

The economic conditions surrounding the construction of the West Wing weren't unlike those of the business depression of the 1890s, when funds were desperately needed to equip and operate the fledgling CMGH. Nevertheless, it appeared that no expense had been spared in the West Wing's design or construction.

Headlines in a 24-page special edition of the Lewiston newspaper saluted the new wing: "In Every Way, A Hospital Made For These Cities," and "New West Wing Equipped With Most Modern X-ray Apparatus Available To Medical Science."

The local architectural firm of Coolidge and Carlson (in conjunction with H.S. Coombs) had kept in mind patient's needs. Floors were made of "rubber tile," and the old-fashioned system of "call bells" had been replaced with more efficient "call lights." Delivery room and operating room equipment was on "rubber, noiseless casters." Special lighting was installed at foot-level in the corridors, allowing attendants to see their way at night without casting a glare into patient rooms.

Constructed at a cost of $364,000, the West Wing was CMGH's most expensive addition yet, providing space for mothers, newborns and children as well as patients requiring isolation.

Bassinets in the new nursery were of "Presbyterian ivory finish." The old boiler had been demolished and a new "vapor system" installed, as well as a separate heating system for "24-hour service in the operating room, delivery room, nursery and corridors." A fully-equipped diet kitchen was provided for each floor, vastly improving meal service. Each private room shared a connecting bathroom.

A floor plan of the original West Wing shows the ground floor with four isolation rooms, an emergency room with a Hammond Street ambulance entrance, four rooms for clinic use, an outpatient waiting room, the x-ray and housekeeping departments, five private rooms, two utility rooms, a "plaster work" room, a record room, and the superintendent's office.

The second floor housed private rooms, the children's ward, two sunrooms, a sunporch, nurse's station, utility room, superintendent's dining room, pantry and nurse's station. The third floor was reserved for medical and surgical cases, offering private rooms and semi-private wards. The fourth floor provided eight private rooms and one five-bed ward for maternity patients, a labor and delivery room, a nursery and several sunrooms.

Among those who worked toward the making of the West Wing was Samuel Stewart, who joined the board of directors in 1924, and was named chairman just two years later. He retired from his position as an agent for the Bates Manufacturing Company the year the West Wing opened, but remained chairman of the CMGH board until 1948. He held the position of president of the CMGH Corporation from 1927 until his death in October 1953.

Born in Lewiston, Mr. Stewart had watched CMGH evolve, and credited the hospital's early leaders "who so wisely planned the hospital building years ago." He noted that the West Wing was "simply a following out of the original plan" and that there was "much yet to be done ... to ... realize our ideal of making this institution a medical center."

Even as the addition was hailed the "finest constructed, practically arranged and scientifically equipped hospital unit" ever seen, Mr. Stewart was aware of the hospital's ongoing need for improvements. He cited the need for $5,000 to purchase radium to "properly treat cancerous cases," and the need for a "modern operating suite" planned for the fifth floor of the Central Building.

Those needs were identified in a survey conducted by Dr. Henry M. Pollock, superintendent of the Massachusetts Memorial Hospitals, and Dr. Joseph P. Howland, superintendent of the Peter Bent Brigham Hospital.

Among other things, the Howland-Pollock study suggested the employment of a full-time roentgenologist, who was "studied in the scientific application of radium." The survey recommended that an electrocardiograph be purchased and that the laboratory and operating room be expanded. As a result of this study, Dr. Charles Cunningham, who had long served the x-ray department on a part-time basis, was appointed as the roentgenologist, and Dr. W.J. Renwick was hired to do electrocardiographs.

With these changes, the time had come for a superintendent dedicated to the hospital's growth in new fields. As a former instructor of clinical obstetrics and clinical medicine at Boston University, Dr. Joelle Hiebert came well-prepared to lead the hospital forward.

The mind and spirit of Joelle Hiebert

"I was very sorry to learn that you were ill during the last part of my stay in the hospital and hope by this time you are improving and will soon be able to resume your duties, which I know are arduous and oftentimes perplexing. I can fully appreciate how difficult it is to meet the varied demands of directors, doctors, staff, patients and their friends, and the general public. To keep everything running smoothly requires almost super-human strength and a great deal of tact and patience." -- Rachel Metcalfe, in a letter to Dr. Joelle C. Hiebert, March 1, 1940.

Dr. Joelle Hiebert once defined "character" as choosing to do the right thing even when "nobody will ever know, except you, what you did."

That kind of thinking led Central Maine General Hospital through the Great Depression and a second world war, through the new challenges of medical "specialization," and through a nursing unemployment crisis.

Letters and notes written by Joelle Hiebert during his years at CMGH are unpretentious and gracious, expressing concern for others. Following his death at the age of 51, an obituary appearing in the Lewiston Journal said: "Though eminent in medical circles, Dr. Hiebert by nature was a modest and unassuming individual, a characteristic which endeared him to those who knew him."

The stories of Dr. Hiebert's deeds portray a man who was first a humanitarian, and then a businessman. They portray a man of intelligence and vision, a man whose love of education was evident in his work and his family life, a man who each morning recited poems and Bible verses to his children. (After suffering a myocardial infarction, Dr. Hiebert was hospitalized at CMGH. The nurse in attendance told family members that he was reciting Shakespeare when he died.)

During his tenure as CMGH's superintendent (1931-1944), the Bingham Associates Fund was set up to support post-graduate studies for CMGH physicians. This was followed by the Bingham Hospital Extension Service, which provided laboratory services and consultations to smaller Maine hospitals in Rockland, Bath, Brunswick and Rumford. Later, weekly x-ray consultations were offered as well.

Ward walks and round-table discussions were conducted each month under the direction of a physician from the New England Medical Center. At post-graduate teaching clinics, New England's most respected physicians and surgeons offered daylong instruction to CMGH's staff doctors.

In 1937, the Frederick Henry Gerrish Memorial Library was established in honor of a former professor of anatomy at the Bowdoin College medical school. A $1,000 grant from the Bingham Associates helped establish the library, but donations of books, reprints and journals from staff doctors helped fill the library's shelves.

Dr. Hiebert was instrumental in making CMGH a teaching institution for senior medical students of Tufts Medical School. At the same time, he saw to it that affiliations for the nurse's training school continued. He worked with the superintendent of nurses to better focus the role of students at CMGH. During his administration the Central Maine General Hospital Training School, a one-year program for medical technologists, was founded.

Dr. Hiebert's efforts did not go unrecognized. After his death, the hospital's first designated lecture hall was named the Joelle C. Hiebert Assembly Room, though it was more commonly called Hiebert Hall.

At the dedication ceremony in December 1944, Samuel Stewart noted that the naming of the lecture hall was "particularly fitting that because of Dr. Hiebert's great interest and active participation in the education of the student body that the faculty and students will assemble day after day in this room which bears his name."

Evidence of Dr. Hiebert's true self is perhaps best illustrated in a story shared by his son, Dr. Clement Hiebert.

Shortly after his father's death in 1944, Clement Hiebert was admitted to the Central Maine General Hospital for an appendectomy. Among his visitors was a woman who had long been employed in the hospital's housekeeping department. She remembered the elder Dr. Hiebert as a man unimpressed with his own importance.

"She came to tell me that my father had once helped her carry a laundry basket up the stairs," recalled Hiebert, and she never forgot that "my father knew her as a human being, and not just a cleaning lady."

During the early 1930s, as the hospital struggled with financial problems brought on by the Depression, Dr. Hiebert called the employees together and asked them to consider a temporary reduction in salary. According to his son, he set the example, volunteering "without fanfare" to take the most significant pay cut of all.

"His first concern was always the patient," recalled Priscilla Thurlowe, secretary to Dr. Hiebert during his latter years at the hospital. In stating the hospital's "purpose" in the 1932 annual report, he listed eight tenets; among them was: "To comfort all who are made sad by illness."

One of Clement Hiebert's earliest memories is of trips after church each Sunday to the Lewiston Post Office, where his father picked up the hospital's mail and delivered it for distribution among the patients. Dr. Hiebert believed that "sick people should have their mail," even on Sundays.

Dr. Hiebert didn't limit his work to the hospital. He helped establish the Maine Hospital Association in 1937 and hosted its first meeting at CMGH. He served as president of both the MHA and the New England Hospital Assembly. He realized that hospitals must present a united front against inchoate federal efforts to regulate the health care industry. Medical care had again become a political issue, and joining the din for relief programs was a renewed cry for "state" or "socialized" medicine.

American medicine's alternative to national health care was private health insurance. In 1939 the hospital became a member of the Associated Hospital Service of Maine, a non-profit state organization established to help wage-earners budget for illness. The idea slowly took hold, and in 1941 the hospital admitted 62 patients with insurance offered through the Blue Cross plan.

Dr. Hiebert also designed insignia for CMGH and the Maine Hospital Association. Clement Hiebert remembers a family discussion about the pine tree that today fills the center of the MHA seal. "My father asked us if we thought the pine tree should portray a nice, little Christmas tree or an honest Maine pine," he recalled. The honest pine won, hands down.

In designing the CMGH seal, Dr. Hiebert kept in mind four Latin words: Levare (to relieve pain), consolari (to console), curare (to heal) and docere (to teach). Different symbols represent the donations made to medicine by animals and plants; a lamp represents knowledge and continuing education; books signify medical records; an ether container signifies the contribution of chemistry; and a microscope, the work of the laboratory. The upper field of the seal is blank, "showing that the agents to conquer disease are not complete, and representing the principle that certain qualities in the treatment of disease" have no symbol.

Hiebert's medical background commanded a certain respect from his peers and allowed him closer contact with hospital patients as well. He routinely made hospital rounds, sometimes with his son, Clement.

"He'd ask the patients how they were getting along, whether the food was OK. ... He tried to get the perspectives of the patient. And he did it in a way that didn't offend the nurses, in a way that didn't appear to be snooping. He always phoned the nurses ahead to let them know he was coming."

This diplomacy served him well. In response to questions from the patients or in discussions with staff physicians, Joelle Hiebert, as a doctor, "was wary of giving advice, but when asked, would readily give an opinion." As superintendent, he was, "direct and fairly authoritative," able and willing to address conflict head on, and yet, did so with great tact and understanding. He was, above all, his son recalled, "a gentle man."

"People would go into his office fighting mad about something and would leave thinking that the decision that had been made was their own idea."

Dr. Hiebert was CMGH's last long-term doctor-administrator. Following his death, three physicians acted as superintendent for short periods of time. But by 1951, Dana Thompson, formerly the comptroller, would assume the role of executive director of the hospital.

Specialization expands hospital horizons

Specialization in medicine blossomed during Dr. Hiebert's tenure, prompting administrative and departmental changes at the hospital. By 1934, a medical board functioned separately from the hospital's executive board, electing its own officers. In 1936 the medical hierarchy grew even more complex when medical, surgical and specialty services were established. Dr. E.C. Higgins was named "physician in chief," Dr. J.W. Scannell, "surgeon in chief," and Drs. George Young and Lester Adams as surgeon and physician "in charge" of the specialty service.

During the early 1930s some 51 physicians from outside of Lewiston and Auburn were appointed to an associate staff. These doctors were invited to regular staff meetings and monthly teaching clinics. They were not, however, allowed to vote on hospital matters.

Other staff changes enhanced the hospital's status as a teaching institution, such as the appointment of resident physician Dr. Leroy Gross to oversee the hospital's four interns from Tufts Medical School. Dr. Gross later became CMGH's first staff obstetrician. Later, Dr. Charles W. Steele became the first physician to serve as assistant resident.

Within a year of the West Wing's opening, a cardiologist, urologist, pediatrician, epidemiologist, two oral surgeons and two orthopedic surgeons were added to the staff of attending and adjunct physicians and surgeons. Just a few years later, seven departments had been formed, each headed by a physician. Specialty services evolved, including a harelip and cleft palate service, thyroid, cancer, and neurological surgical services. By 1940, bronchoscopists, dentists and obstetricians had also joined the staff, and anesthesia had become a separate department, with Dr. Gilbert Clapperton in charge.

As doctors specialized and health awareness changed people's attitudes, hospitals saw a gradual change in the type of patients admitted. The number of cancer patients was on the rise. In part, this was because of longer life expectancy and the greater likelihood of cancer developing in older patients, but could also be attributed to improvements in diagnosis and treatment. Much of this progress was due to rapid growth in the field of x-ray technology. As early as 1931, CMGH was on the leading edge of those improvements.

The x-ray equipment purchased for the expanded department in the West Wing was deemed so "modern" that the 1931 special edition of the Sun-Journal devoted an entire page to an explanation of the new "apparatus."

Photos and text celebrated the "motor-adjustable" x-ray table -- the first of its kind manufactured by the General Electric X-ray Corporation. Describing in detail the wall-mounted fluoroscopic and radiographic unit and 140,000-volt Snook X-ray machine, the article hyped the equipment as "second-to-none in the country for diagnosis by means of the x-ray."

Improvements in x-ray eventually led to the purchase of radium and a "200,00 volt deep x-ray therapy" machine for cancer treatment. A cancer service begun in 1934 studied the "prevalence of cancer in this larger community" and surveyed "diagnostic and treatment facilities available."

Elsewhere in the hospital, an entire floor of the West Wing had been devoted to maternity cases. Annette Ketchum, who had been named supervisor of the new maternity unit, noted that death during childbirth was still all too common, and that it was due largely to "ignorance and carelessness." A pre-natal clinic was established.

Treatment for tuberculosis changed, and by the fall of 1932, the state's sanitoriums could no longer provide the best care. The state asked general hospitals to accept TB patients. At CMGH, the fourth floor of the Central Building was renovated and prepared to accept 16 tuberculosis patients. Drs. M.S.F. Greene and Morris E. Goldman were placed in charge and Dr. Carlton Rand treated the orthopedic cases placed on that ward.

This broadening scope of medicine spawned the concept of "total patient care" and could be seen at CMGH in the appearance of physio-therapy, occupational therapy and social service departments.

The call for social service in hospitals had long been discussed as a means of preventing charity abuse. The Woman's Hospital Association had also promoted social service. Wrote Esther T. Cooper, president of the WHA, in 1936: "It is imperative that a social service worker be engaged to see that patients carry on as they should (after discharge) and to see that contact with the hospital be unbroken." The next year, the WHA earmarked a $2,000 gift for social service at CMGH. The department, under the direction of Beatrice Macaulay, helped determine eligibility for state aid, assist patients with payment plans, and provide discharge follow-through.

Medical specialization led to other changes. The hospital encouraged physicians to become "board-certified." Many doctors disdained the need for certification and the controversy divided new and older members of the medical staff. But the debate subsided as older doctors retired.

During Dr. Hiebert's administration, the hospital's practices and purchases followed the innovations of the times. Electric refrigeration, a dishwasher, and an automatic icemaker made life in CMGH's kitchen more convenient. Air conditioners were installed in the operating rooms, an "instrument sterilizer" and a "gas oxygen machine" were purchased, and each unit boasted "bedpan washers," and beds with new, innerspring mattresses. An all-night telephone service, operated by students at Bates College in exchange for room and board, improved emergency service. (Maine Supreme Court Chief Justice Vincent McKusick worked his way through college by working CMGH's switchboard.) In 1936, CMGH purchased its "first complete set of instruments for brain and thoracic surgery," and pathologist Julius Gottlieb performed his work in a brand new "post-mortem operating room."

Although the nation was in the throes of the Great Depression throughout Dr. Hiebert's first decade as superintendent, because of sound planning and investment, CMGH experienced less financial trauma than it did during the 1920s.

Medicine as a business

Central Maine General Hospital operated for its first 40 years without a budget, but in the 1930s, its financial operation began to change.

A year after the West Wing opened in 1931, hospital admissions increased by 600 patients. However, the hospital's success that year was overshadowed by money worries. Directors noted a deficit of more than $7,000 in 1932, due to "extensive improvements in other parts of the hospital" and the "unusual amount of free service" sought by the poor and unemployed. Hoping to curb the problem, they devised a multifaceted plan: a "Pay As You Go" capital improvement policy deferred "extraordinary" purchases until money was available; employees accepted a 10-percent salary reduction; better record keeping was initiated to assured a larger state appropriation for charity cases; and small changes were implemented to reduce operating costs.

Despite facing a personal drop in income, staff physicians support the hospital, insisting that patients pay hospital bills first. Doctors also agreed not to accept private patients who had outstanding hospital bills, and asked patients to make deposits for two weeks of hospital care in advance. Stipends for incoming students in the school of nursing were discontinued and savings were applied toward improvements in the school.

Aside from these measures, the hospital sought ways to increase its income. The new TB ward, set up in 1933, for example, brought in almost $9,000 from the state that year.

CMGH also became a part of the Community Chest's annual efforts to raise funds for the community. Hospital employees each donated a full day's wages to the campaign in their very first year of involvement.

Recognizing that fewer people had money for hospital bills, CMGH began accepting goods or services in exchange for health care. In lieu of money, one patient donated the awning that graced the first floor of the West Wing. Some gave fruits and vegetables. Others gave of their skills. Dr. Hiebert noted in 1934: "In order to help ... those out of work, most of the carpenter work ... has been done by men unable to meet their hospital obligations. The usual wage is allowed and a reasonable sum is deducted each week, which is applied to the old bill."

The hospital also decided that the time had come to pass on the growing costs of medical care and set specific rates for each x-ray and laboratory test. Electrocardiograms were $10 and physio-therapy treatments, $2. X-rays ranged from $5 for any extremity to $45 for a complete spine. Anesthesia cost $5 to $10 for gas oxygen and $2 for avertin. The hospital charged $5 to $10 daily for private rooms, $4 for semiprivates and $3 for a bed in the general ward.

CMGH's scrimping and planning paid off within the year. In 1933, despite a $10,000 increase in operating costs and an inevitable rise in free care, CMGH poster a modest surplus.

And as more and more people had become aware of the hospital's good works -- often as patients themselves -- CMGH's endowments grew from $407,383 in 1933, and $449,597 in 1940. Donations from social groups like the Kiwanis Club, Rotary Club and Woman's Hospital Association helped offset charity costs, especially for needy children.

The 1930s marked a turning point in CMGH's financial history. By 1940, when Charles A. Litchfield retired after 35 years as CMGH's treasurer, the hospital's growth had resulted in an increasingly complex budget, prompting directors to hire comptroller Herbert Turner. Stephen D. Trafton of the Manufacturer's National Bank replaced Mr. Litchfield as treasurer.

CMGH's graduate nurses can't find jobs

By 1930, the nursing staff and training school had increased in size proportionate to the hospital's expansion. Nine graduate nurses were employed as supervisors, while 61 student nurses provided the bulk of the nursing care. Other personnel included two dieticians and two orderlies.

During the Depression, as the school of nursing turned more nurses into the community, there were fewer jobs for them. Knowing that the hospital depended on students to staff its wards, those in charge must have worried that such widespread unemployment would eventually affect enrollment at the school.

An article in the March 1932 edition of the Maine Medical Journal argued that training schools should accept fewer students and employ more graduates "or the morale of the nursing profession will break down completely." The writer cited a study conducted in 1930 which showed that a graduate nurse in Bangor would not work more than 77 days in a year.

In partial response to the concern, the Board of Directors offered a $250 scholarship to a senior student who wanted to further her education and thereby increase her opportunities for employment. But the long-term solution lied in providing a better undergraduate program, a project Miss Alice Westcott (superintendent of nurses, 1927-1932) had already begun.

Under Miss Westcott's direction, the school employed "theoretical" and "practical" instructors and increased the hours of instruction. The training school committee studied "the needs of the school as an educational institution not purely concerned with the temporary service to the hospital."

Keeping in mind that hiring graduate nurses could have the double benefit of solving the unemployment problem and freeing students for more classroom time, Florence B. Stanfield (superintendent of nurses, 1932-1938) followed Alice Westcott's lead in pressing for educational reform. The first indication that graduates were being hired by the hospital appeared in her report of 1935: "The General Duty Nurse represents a new group at the Central Maine General Hospital this year. Young graduate nurses have been employed on 8-hour ward duty to cover the lapses in service caused by class and by the larger number of patients."

Miss Stanfield also advocated for better student housing, better class equipment and more ward teaching. She called for older students "with more background" to meet the "changing demands of medical service." She later warned that nursing schools "are leaving the hospital and affiliating with the college," noting that "more and more emphasis is being placed on the mental ability of the student."

Miss Stanfield's efforts were rewarded by the school's 1938 accreditation by the State of New York Board of Regents. Full accreditation paved the way for an affiliation with the University of Maine in July 1939, when the first group of five-year students were admitted.

Miss Stanfield also established the school's first science laboratory and student dining room. Throughout her six years as superintendent, she expressed concern about student illness, and promoted better health practices among the students. A student health program was devised in 1939, requiring yearly physicals for students and reducing the ward schedule to six 8-hour days.

In a letter written in April 1991 from her home in Petersburg, Alaska, Mrs. Florence Stanfield Bell highlighted her years as superintendent, stating that the biggest change she witnessed was the recognition of a nurse as a "professional woman." She described Dr. J.C. Hiebert as "a real supporter of nurses and education," adding that with his help, graduate nurses had been hired, teachers added to the staff and class became a necessity, not "something that was called off because of work."

Only a few years after Florence Stanfield struggled with the underemployment problem, a world event would turn the surplus of nurses into a shortage.

Chapter Six

As the nation anxiously watched World War II rage in Europe, it reaped a benefit: Jobs became available in war-related industries, and people began spending again. The Great Depression was finally over.

What proved beneficial to the national economy, however, caused new problems at Central Maine General Hospital. The cost of doing business rose rapidly, and though the state had increased its commitment for the care of indigent sick, CMGH directors anticipated shortfalls. In 1941, even before wartime price increases, the state paid less than half the cost of indigent patient care.

Complicating matters was a dwindling staff. Some left for better paying jobs in the defense industry, others joined the armed forces. In 1942 some 12 doctors, including Merrill Greene, Wedgewood Webber, Mike J. Harkins, Gilbert Clapperton and Robert Frost, left for military service. Superintendent of nurses Irene Zwisler also joined the service, as did 30 CMGH nurse graduates. Hospital management was asked to prepare for "any possible emergency" and these efforts were time consuming. Meanwhile, the hospital's beds were nearly always full.

The 1941 annual report shows that admissions had doubled in 10 years, and directors registered their concern that many had been turned away because of insufficient space.

"If funds were available," they wrote that year, "it would be feasible by adding three stories to the Annex of the Central Building to obtain quarters for 20 patients on the third and fourth floors. ... There would be opportunity to establish a new Surgical Unit and an improved pathological laboratory."

But the new unit would cost some $100,000, and the hospital also needed a second home for student nurses. More than $4,000 was being spent annually to rent apartments for those who couldn't be squeezed into the Wilson Home, a problem exacerbated when the school admitted an additional 20 students to comply with the Surgeon General's wartime call for more nurses. Plans for an elaborate new home set costs at $250,000.

Money worries notwithstanding, CMGH prepared for war.

Directors granted those entering the service a one-year leave of absence. Dr. E.C. Higgins was named medical director to "unify the direction of all services due to the loss of doctors and nurses to the armed forces." A free refresher course was offered to older graduate nurses and nine returned to the medical community in the program's first year. School of Nursing students taught first aid to the community and trained "ward helpers" to supplement the nursing force.

The hospital's buildings were fireproofed and windows were blacked out to protect against air raids. Extra coal and medical supplies were laid in. Students were placed on call and drilled in air raid precautions.

A medical defense committee headed by Drs. Wallace Webber and E.C. Higgins devised a disaster plan that provided an additional 10 beds in an emergency ward created from the West Wing auditorium. The plan named an on-call volunteer force for the classification of disaster victims. Staff members identified beds that could be made available in an emergency by keeping an inventory of patients who could be readily moved.

In the Twin Cities, 2,300 people were trained as air raid wardens, and sirens were installed on the tower at City Hall. Bates College became the site of a naval training school. Local mills turned out raincoats, parachutes, sleeping bags and camouflage cloth.

The hospital's defense committee set up casualty stations at five area churches. Each station was prepared to accept 25 patients, with nursing care to be provided by graduate nurses living near the centers. Later, another seven stations would be equipped in outlying communities. The Woman's Hospital Association worked to secure blood donors and help equip casualty stations. In 1942, its first year, the group donated $750 to purchase cots, made slings and sheets, and folded piles of surgical gauze.

The Central Maine Blood and Plasma Bank was established in April 1942. Blood was collected, bottled and frozen for emergency use. Two years later, more than 3,800 donors had stood in line to give blood.

The war escalated. By 1943, as a team at Los Alamos, N.M., worked secretly on the atomic bomb, CMGH had been designated a base hospital by the United States Public Health Service, and directors grappled with growing labor shortages and supply rationing. Dietitians worked with limited supplies of meats, fats, cheese and processed foods. A gasoline shortage restricted travel and the all-day teaching clinics were replaced by bi-monthly ward walks and conferences.

Nurses took on greater responsibilities to compensate for the loss of three more doctors. To assist the nurses, the local Red Cross sponsored the Gray Ladies. For the first time, CMGH trained aides.

The hospital relied on volunteers to a greater extent than ever before. In 1945 the directors reported that "young businesswomen who had already completed a full day's work had come to the hospital to assist in the unglamorous activity" of food preparation. Volunteers snapped photos of mothers and infants to send to fathers overseas.

Meanwhile, the U.S. Public Health Service campaigned to enroll 65,000 students in the nation's nursing schools. Congress passed the Bolton Nursing Law, which created a nurse cadet corps. When CMGH agreed to participate, student nurses received financial assistance from the federal government. The School of Nursing began offering a five-year collegiate nursing program in conjunction with Bates College. The hospital continued its five-year program through the University of Maine at Orono, and added a psychiatric rotation at the New Hampshire State Hospital in Concord. Superintendent of Nurses Mildred Lenz wrote that the latter was especially important because "the post-war era will see much mental illness." In the midst of war-related activities, the Edward Curtis True Memorial Library for student nurses had opened in June 1941.

Blue Cross continued to grow. There was a rise in the numbers seeking more expensive accommodations at CMGH, as least partly because Blue Cross patients didn't have to pay bulk sums at the time of admission. This prompted some patients to make contributions to the hospital instead. Directors pointed out that 10 percent of patients would not have been hospitalized without Blue Cross, 80 percent would have sought less costly rooms, and 30 percent would have sought ward service. The "miracle of averages," said directors, had made hospital service more available to all, "without burden to any."

During the early 1940s, however, inflation drove hospital costs up, and pre-inflation insurance contracts fell short of paying bills. Even as health insurance emerged as an employment benefit, and more people sought medical care, hospitals lost money on third-party payments.

The war also took its toll on Lewiston-Auburn's social life as directors of the Woman's Hospital Association voted to forego the annual Charity Ball, which had become the social event of the year. The ball was not resumed until war's end.

Social Service Director Beatrice Macaulay's noted a "marked increase" in the number of unmarried mothers. Several nurses from that era recalled that the war fostered a new morality in men and women facing an uncertain future. Births at CMGH hit 840 in 1943, double those in 1936.

Dr. Joelle C. Hiebert died in 1944, on the eve of one of medicine's greatest achievements: the discovery of penicillin. As a man devoted to physical and spiritual health, he surely would have joined the world in celebrating the remarkable new drug.

Following Dr. Hiebert's death and the appointment of William Brines as superintendent, CMGH geared up for the post-war era. Doctors and hospital administrators began thinking about incorporating the advances medicine had made during the war. They also knew that diseases such as malaria and parasitic infestations could become epidemic when soldiers returned. In 1945, CMGH was a 221-bed hospital with 38 bassinets. A connecting building had been constructed between the East Wing and Center Building, providing an employee dining room, administrative offices and private rooms. More than 100 students were enrolled in the School of Nursing. The hospital purchased the Breen-Lange-Curran property near the East Wing and in 1946 remodeled the building and opened it as the Rachel A. Metcalfe Nurse's Home.

Even as the hospital prepared for the war's end, 1945 was deemed by directors the "worst war year yet." The resident staff had been cut from seven to three interns by the War Manpower Commission and yet the government urged medical institutions to prepare for a national program of postgraduate instruction for returning veterans.

By 1945, the Legislature had passed the Hospital License Bill, setting minimum standards for the 42 hospitals receiving state aide. In 1946, hospital construction assistance was seen by the federal government as a political alternative to national health insurance, and the Hill-Burton Bill was adopted. Over the next two decades, Hill-Burton would provide millions of dollars for expansion to hospitals throughout the country.

In 1946, CMGH celebrated the return of all but two of its doctors, and directors announced that the Cadet Nurse Corps was "in the process of being liquidated." The last class was accepted in September 1945 and graduated in 1948. The Blood and Plasma Bank created under the office of Civil Defense became the responsibility of the hospital.

As staff doctors returned, Mrs. Macauley reported increased numbers of patients seeking help. Franklin D. Roosevelt's Social Security Act had extended the federal government's role in public health by promising states matching funds for needy mothers and children. More patients qualified for maternal and child health benefits and more crippled children qualified for rehabilitation help. Other patients sought treatment at CMGH through a federal program that offered vocational rehabilitation.

Despite the numbers of medical personnel returning from the war, industry remained a competitor for workers, and staff shortages continued. Prices remained inflated. Overcrowding continued, and by mid-year 1946 the daily patient census was up to more than 200. Directors reported a pressing need for a new surgical unit and an expanded maternity department. The Baby Boom had begun.

The pathology department that year reaped the benefit of a $40,000 gift from Mr. and Mrs. Allen L. Goldfine, which was used to remodel the laboratory. Tissue pathology, bacteriology, hematology and chemistry departments were created. Dr. Milan Chapin, who had been hired through the Bingham Associates Fund to direct the program of residency and intern education, helped establish a research division in clinical chemistry.

Also in 1946, William Brines resigned as superintendent and director Samuel Stewart took an office in the hospital and became "heavily involved" in day-to-day management. Dana Thompson, who had served in the Navy, returned to the hospital as comptroller. He was named assistant executive director in 1947, the same year that Dr. Glidden Brooks would take charge of the hospital, serving as its first "executive director."

As the country enjoyed the relative affluence of the post-war years, residents of Lewiston and Auburn saw an increase in public and private construction, as well as a renewed period of public spending for schools and city works projects. In 1947 more than 500 individuals and businesses donated nearly $400,000 to the Stewart Wing building fund. Still, the hospital needed continuing financial support to survive.

CMGH directors warned in the 1947 annual report that costs had risen 89 percent since 1941. Although the hospital had survived without a funded debt and bed rates had been kept at a pre-war level until 1944, directors stressed that the return to "normal employment," fewer volunteers and the rising costs of food and supplies could undermine the hospital's financial well-being. While admissions were up 20 percent, patient days had only increased by three percent. The number of non-paying patients also rose, and the workload grew as well.

A poll conducted by CMGH in April 1947 showed that most central Maine residents believed hospital costs were fair. Respondents said they would support medical improvements and additions, even if meant an increase in prices. This knowledge probably bolstered the director's enthusiasm over plans for the new wing.

Auburn architect Stanley S. Merrill's plan called for a three-story extension that would "stretch back to Lowell Street from the East Wing." A third floor would be added to the Center Building Annex. Among other things, the new building would house the Radiography and Central Supply departments and six new surgical rooms.

As building plans progressed, the hospital underwent management change. Director of Nursing Mildred Lenz, who replaced Irene Zwisler during the war, resigned. She was succeeded by Reva Haskins. Dr. William Cox and Dr. Milan Chapin were named surgeon- and physician-in-chief, positions created to assist Dr. E.C. Higgins, then medical director.

Dr. Gottlieb indicated in the 1947 annual report that while hospital admissions had tripled since 1927, the lab was conducting 10 times the number of exams. He noted that the demand for medical technicians had led to a new training program for assistant technicians.

Beatrice Macaulay's 1947 social service report pointed out the difficulties surrounding pediatric cases requiring long-term convalescent care. Largely due to advances in orthopedic and rehabilitative medicine, the hospital was admitting larger numbers of children than ever before, and many of these children remained on CMGH's pediatric ward longer than necessary.

As the type of patients served at CMGH changed, the cost of patient care continued to rise. In 1948 directors pointed out that the 1943 patient cost per day of $6.12 had reached $10.89. Wages had gone up 116 percent, food, 60 percent, and supplies, 136 percent. Charges to patients had only increased by 40 percent.

Inflation impacted plans for the new wing. Directors reported a 45 percent increase in building costs since the original estimate was made. Plans to break ground during the summer of 1947 were abandoned.

In April 1948, the hospital applied for a grant under the Hill-Burton Hospital and Survey Construction Act. The grant would cover one-third of the construction costs if the hospital raised the other two-thirds of the necessary funds. By August 10 construction of the Stewart Wing had begun -- it was "Project No. 1 in Maine under the Hill-Burton Act."

The making of a new wing didn't keep other projects from coming to the fore. Plans for remodeling the East Wing, now half-a-century old, called for eliminating the last of the open wards.

Things were hopping in pathology too, as the lab made the switch from rabbits to frogs for pregnancy tests. "The frog," wrote Dr. Gottlieb, "has proven to be a much more satisfactory test animal from the standpoints of accuracy, speed of reaction, convenience of storage and handling, and availability." The lab also started doing Pap smears.

Director of Nursing Reva Haskins reported a notable drop in student enrollment in 1948, blaming the decline partly on other "vocational fields of advanced education." In response, the Board of Trustees established a fund for the CMGH School of Nursing. The school still grappled with housing problems, and renovations were made to student residences.

The hospital's practice of relying on volunteers, begun during World War II, continued. A separate volunteer service had been created, consisting of the Gray Ladies and members of the Junior Red Cross. Girl Scouts were recruited to serve as hospital aides. Members of the Woman's Hospital Association also continued to work for CMGH. The WHA was a successful social organization, but fund-raising remained its focus.

Central Maine General Hospital ended the 1940s by opening the new wing. The project cost about $650,000, and increased the hospital's capacity to 235 beds and 36 bassinets.

The opening of the new wing signalled the start of another era for Central Maine General Hospital. The year 1949 saw Dr. Glidden Brooks resign as executive director. He was replaced temporarily by Dr. Dean Fisher. Samuel Stewart stepped down from his long-time role as chairman of the board. Dr. Julius Gottlieb resigned as chief pathologist. Reva Haskins was replaced by Eleanor Melledy as director of nursing.

Dana Thompson would soon take over the hospital's administration. His impact on the hospital would be immense.

Chapter Seven

Shortly after Dana Thompson returned from the war, he was approached by Jane Bradbury, who had worked as a clerk for Central Maine General Hospital for more than 30 years. She was upset because she was about to lose her "home" in the hospital. She told Mr. Thompson that when she was hired in 1912, she was promised room, board and a wage, but that her room on the fifth floor of the Center Building was being taken to make room for the laboratory expansion. Jane Bradbury's plight was symbolic of the changes occurring at CMGH.

In 1951, directors had to replace Dr. Dean Fisher, who was returning to his former post as head of the State Department of Health and Welfare. They named Dana Thompson as executive director.

During the early part of the century, CMGH's "business" was medicine and its finances were managed by its directors. Keeping track of bills and receipts wasn't a complicated task. But by the late 1940s, the complexities of state aid and the advent of health insurance made finances more complicated. CMGH's success was dependent on good business practices.

Dana Thompson's background in industrial engineering and his experience as comptroller served him well as executive director. His style as a manager constituted a "one-man show," and was characteristic of the times. As one former employee recalled: "If you needed something, you went directly to Dana, and he gave you a yes, a no, or a maybe. But you didn't have to wait for an answer."

Dana Thompson oversaw the construction of the Memorial Wing, a medical office building at 10 High Street, a new dormitory for student nurses on Lowell Street, and a nuclear medicine facility. On his retirement, he witnessed the opening of the Thompson Wing.

Dana Thompson led CMGH through the implementation of Medicare and Medicaid. He saw dial telephones installed throughout the hospital, and watched typewriters and adding machines "go electric." He heard doctors first paged through an audible paging system, and when medical records became too numerous to store, he approved the purchase of a microfilm machine. He also pondered a new problem: parking. Before his resignation in the mid-1970s, he noted the passing of the general practitioner and the arrival of women physicians.

Following World War II, America basked in its role as world leader, and science was seen as a way of maintaining this power. Backed by the federal government, scientific and medical research exploded.

Middle class America began showing its telltale signs in the Lewiston-Auburn area. Suburbs appeared. Bates College expanded and the Lewiston Industrial Park was born. The Central Maine Youth Center was built. The Elm Hotel and Auburn Theater were razed to make room for parking. The Maine Central Railroad by 1960 abandoned passenger service to the Twin Cities. The Androscoggin Mill closed and shopping centers opened. Sometime during the 1950s, a sign at the "back entrance" to CMGH, admonishing doctors not to "park horses in the driveway," disappeared.

A hospital's changing philosophy

CMGH entered the 1950s with no debt. The Stewart Wing had been built and property acquired at 316-318 Main Street for student housing. A new laboratory kept Dr. Charles F. Branch busy.

CMGH was approved by the American Medical Association for the training of interns, residents and technicians. Dr. John Carrier became the hospital's first resident in radiology in 1952. A residency was established in pathology and the school for x-ray technicians increased its enrollment. Directors noted the importance of training programs "as a means to the end result of better patient care."

Although finances were sound that year, directors were concerned by an upcoming $25,000 reduction in state aid. They sent out a plea to the "more fortunate" for the gifts that would be the "greatest bulwark against encroaching Federalized medicine."

To garner support, CMGH worked to let people know what it was about. Services and equipment were featured in radio broadcasts on WLAM and in local newspaper stories. The Woman's Hospital Association sponsored "Know Your Hospital," a public lecture series by staff physicians.

By 1952, admissions had reached 8,000 annually and the length of stay had dropped to 9.2 days. Accompanying the shortened hospital stay was a trend toward outpatient services. This could be seen in radiology, which reported a gain in volume of more than one-third since 1950.

Medical advances changed the type of patient being admitted. Penicillin and other antibiotics allowed doctors to treat many patients at home, so the hospital saw greater percentages of elderly patient and people with diseases such as cancer and heart ailments. The emergency room volume grew in proportion with the number of automobiles on the road. Maternity volumes echoed the baby boom.

A significant addition to the hospital in 1953 was the coffee shop, a WHA project inspired and directed by Lucy Webber and Henry Thacher. Located on the first floor of the Center Building, the tiny enterprise sold coffee, sandwiches and pastries, and became the hub of hospital social life.

Directors reiterated their financial concerns in 1953. The hospital's operating income and expenses were over the million dollar mark, and some $300,000 in free care had been given, resulting in a deficit of almost $15,000. Rate hikes were approved.

The next year, directors worried that the hospital had "failed to reach the usual seasonal levels of income, and monthly deficits were being created." The problem, they said, rested in the fact that many insurance companies were paying "cost," rather than "charges."

Despite a rate hike, directors reported a larger deficit in 1955. Expenses had mounted as the hospital added a radioisotope program, a cancer registry and recovery room. The hospital's work had become more complex, took more time, and required more help. A nursing and personnel shortage had prompted wage increases. In 1956, the deficit was a whopping $119,582.

Directors released a 10-year hospital cost study showing that emergency room visits were up 268 percent. Emergency care often called for x-rays, and the workload in radiology had doubled. Lab exams were up by 51 percent, transfusions by 162 percent, and clinic visits by 178 percent.

Good news came from the Ford Foundation, which presented CMGH a $112,400 grant for improvements or additions. The general endowment fund received a $300,000 donation from the Edward Kennedy estate. The hospital's decision to open a cafeteria would also bring in revenues. But Dana Thompson cautioned patrons that the cost of nursing education was driving up costs.

"A few years ago," he wrote, "most administrators acknowledged that a school of nursing in a hospital more than paid its way in terms of service to the patient; but a recent study showed that a student's education exceeded her contribution of both fees (tuition) and services by $700."

The nursing education problem was nettlesome. A shortage of nurses kept CMGH struggling with staff problems, so the need to train more nurses was apparent. And yet, the cost of training them was becoming prohibitive. Students spent less time "on the floor" and more time in the classroom, reducing their clinical value to the hospital. But to keep up with the constant advances in medicine, students needed more classroom hours.

In addition, the nurse's job had changed: new medications and equipment required closer observation of the patient. Patients required more care, because they were sicker. As the hospital employed practical nurses and aides, other nurses had to acquire supervisory skills.

CMGH would continue to wrestle with the nursing dilemma, and "on-the-job" training would remain part of the curriculum. In 1959 the CMGH School of Nursing was the first in the state to receive national accreditation from the National League of Nursing.

Meanwhile, the Department of Pathology struggled with its need for qualified technicians. Although the training school still functioned, Dr. Branch complained that "year after year, our graduates marry or move to the larger medical centers. This, despite the fact that since 1950, lab wages have increased more than 30 percent."

Dr. Clark Miller announced that a new diagnostic unit in his department had brought "body-section radiology" to CMGH. To keep x-ray technicians well trained in a rapidly-expanding field, the training program had been lengthened to two years.

Another problem facing CMGH and other smaller hospitals was the loss of prospective interns to larger hospitals connected with medical schools. CMGH continued to offer residencies in pathology, radiology, surgery and medicine, and for a short period, received interns and residents through the efforts of the New England Center Hospital and the Bingham Fund.

By the end of the decade, the CMGH family had grown to 100 student nurses, 350 employees, 136 staff doctors and 150 volunteers. New faces in the halls included those of Dr. Daniel Rock, CMGH's first neurosurgeon, and Director of Nursing Mary Ann Burn. Losses had been felt in the deaths of Charles Litchfield, Dr. Samuel Stewart, Rachel Metcalfe, Dr. Julius Gottlieb and Dr. Leroy Gross.

New to the hospital were a dental clinic for underprivileged children, a cardiac clinic and electroencephalography, the latest diagnostic tool. An apartment house had been purchased to provide housing for married interns and residents. And, here and there, throughout the hospital, fluorescent lights and electric beds had appeared.

The Woman's Hospital Association had provided funds for a cardioscope, heart monitor and infant isolette, and donated $9,000 for a chemistry lab. Patient rooms were brightened by paintings purchased and hung by the WHA, which had moved into its own office within the hospital.

Learning from the past, looking to the future

"Dana did it all. He and Priscilla Thurlowe did it all." -- Dr. John James, Chief of Obstetrics, CMGH, 1959-1979, in a conversation about the old days at the hospital.

Priscilla Thurlowe was "discovered" by Dana Thompson in 1943 as a replacement for Dr. Joelle Hiebert's secretary, who was leaving to be married. Ms. Thurlowe accepted the job and over the next 44 years, worked side-by-side with six hospital administrators.

Priscilla Thurlowe is one of many people who remember Central Maine General Hospital as a place where each individual played an important role in the hospital's success. Contributing to that feeling was the hospital's physical structure: a stately, brick building, big enough to house 200 patients, yet small enough to preserve a sense of family. Some of those with long memories of the hospital say the modernization of CMGH changed the organization's "nature," as though the metamorphosis of the original structure somehow heralded a new vision of the future.

The times were changing. As people marched for civil rights and the government declared a war on poverty, the cry for national health care rose again. Medicare, and later, Medicaid were created. For American hospitals, these programs meant more money to cover the costs of providing care, but they also meant more federal regulations.

The federal Hill-Burton program remained a boon to hospital construction and would provide some $920,000 for the $3.2 million Memorial Wing. But this program wouldn't last forever. By 1964, empty hospital beds and duplicated services would prompt a national conference on health facility planning and set the tone for future restrictions.

As CMGH entered the 1960s, directors saw the need for long-term planning, as future additions would be needed. An investment of $100,000 bought property east of the hospital, bounded by Lowell and Main streets, as well as a strip of land opposite the hospital on Lowell Street. A Boston architectural firm was hired to prepare a plan for a new building.

Changes were also happening in various hospital departments.

Director of Nursing Mary Ann Burn turned nursing service upside down. Patient safety measures in 1960 included the installation of supporting bars in bathrooms, the purchase of electric beds with side rails, and the use of McDonald belts for possibly confused patients. She instructed head nurses to conduct regular inservice programs and encouraged supervisors to attend educational program. She announced that an intensive care unit was in the planning stages. (When the unit opened in 1961, it would be the first of its kind in the state.)

Mary Ann Burn was ahead of the times. In 1965, her contributions she was "spontaneously recognized" for her "work in maintaining and achieving high standards in the school of nursing."

In the emergency room, fewer residents and interns were available for staffing as patient volumes were quickly rising. Volunteer coverage was being provided by staff doctors. The dwindling numbers of interns at CMGH was reflected in the change of use of the Central Building-First Floor Annex; once used for intern housing, it was converted to office space.

The pathology department, still frustrated by a shortage of technicians, started a one-year program for lab assistants.

Dr. Clark Miller's 1962 report foretold a coming change in radiology: "With improvement in transportation and the insurance-financing of such prolonged course of treatment as are required in cancer cases, it seems quite logical that this type of patient should be treated at special centers that are endowed, equipped and staffed for today's increasingly complex radiotherapeutic procedures."

By 1963, construction of the new Metcalfe Dormitory was underway. At a proposed cost of $350,000, the dorm would house 60 students. Plans for the Memorial Wing were complete and estimated costs were $2.4 million. A subscription campaign to raise $600,000 was begun. The community response was generous. The hospital "family" posted nearly $300,000, which included a $45,000 pledge from the Woman's Hospital Association.

The following years saw the beginning of a cardiac catheterization service, a major expansion in radioisotope diagnostic services, and the opening of a six-bed coronary care unit.

On a cool day in February 1966, Mrs. Lucille Dingley took the controls of a bulldozer and broke ground for the Memorial Wing. The hospital's first woman president of the corporation and the first woman to chair the board of trustees, Mrs. Dingley was not one to let others do for her what she could do herself. A pilot, skeet-shooter and race car driver, she approached her role as head of the board with enthusiasm and imagination.

The hospital continued to purchase property for future use. The former home of Dr. Wallace Webber was acquired for office space and storage, as was another home at 346 Main Street.

Ironically, as the hospital expanded in size, admissions dropped. The birthrate dropped to its lowest rate in 20 years. However, patient usage of the emergency room and other outpatient departments increased.

By 1968, the hospital had an annual budget of more than $3 million and employed 415 full-time people and 144 student nurses. Dr. Charles Branch had resigned. Training programs had been developed for nurse anesthetists, obstetrics technicians, and surgical aides. A building on High Street had been renovated for office use, and the nurse training program had been shortened from 36 to 33 months.

The biggest change of 1968 became apparent on February 7 when the 137-bed, four-story Memorial Wing opened. Those touring the new building saw electric beds, a nurse-patient intercom system, and a central nurse's station with rotating chart rack and separate medicine room. They saw the new emergency room, maternity and pediatrics departments. A new Centrex telephone system allowed direct dialing. On hot summer nights, air conditioning would keep patients in the Memorial Wing cool.

Immediately following the opening of the new wing, operating rooms were moved to the emergency room so the suites on the Stewart Wing could be enlarged and renovated. Plans were soon underway for the enlargement and modernization of the boiler plant.

In 1969, Dana Thompson noted that "the task of finding and obtaining sufficient sums to underwrite needed and desirable new buildings with related equipment and for the replacement of worn-out or obsolete items is major and looms larger with each passing year."

His concerns were echoed in the 1970 president's report: "The providing of services to patients under Medicare and Medicaid is a classic illustration of the axiom, `he who pays the piper calls the tune.'" The president pointed out that while the program originally paid cost plus two percent to voluntary non-profit hospitals, the government had since eliminated the profit margin and would pay only "reasonable" costs.

Still, Central Maine General Hospital ended the '60s with a growing inventory of "firsts" and additions. A vascular clinic had been established under Dr. Louis Fishman, and a family planning clinic under Dr. John James. Four physicians, including Emergency Department chief Dr. William Spear, were appointed to work in the emergency room. Dr. Robert F. Kraunz, a full-time cardiologist, was hired. A burn service was established with Dr. Ross Green in charge. More land was acquired and the parking capacity was increased. Plans for a new nuclear medicine unit were approved.

The next decade would bring Watergate, an oil embargo and a nation of consumers ever more aware of health care costs. Hospitals would fall under intense state and federal scrutiny. Dana Thompson would retire, leaving Bill Young at the helm.

"The hospital's mission has not changed since 1891: We turn no one down who needs care, regardless of their ability to pay. To day, that free care is costing well into the millions every year and CMMC sustains greater losses in day-to-day care than it ever has." -- William Young, president, Central Maine Medical Center

Chapter Eight

When President Lyndon B. Johnson articulated his vision of the Great Society and declared a war on poverty, Americans began to see health care as an undeniable right. The cost of this right would be staggering.

Some have pointed to Medicare and Medicaid as the cause of the superinflationary rise in health care costs during the 1970s. Attempts were made to trim the programs, but the simple fact was that health care providers had little incentive to control costs because they were reimbursed for what they spent. Some charged that health insurances insulated patients from expenses, making it unlikely that they would shop for low-cost services. Finally, the average income level of Americans had risen throughout the 1960s, creating a tolerance for price increase.

Medical specialization was also a contributing factor. Medical advances often involved expensive equipment and required trained workers to perform complex procedures. In order to keep highly-skilled employees, hospitals had to increase the wages they paid.

Hospital construction programs spurred on by the Hill-Burton program contributed to a surplus of hospital beds, and therefore excess overhead expenses. Critics charged that patients who could have been treated less-expensively at home were admitted to hospitals to fill beds.

The rate of growth in health care costs rose from 3.2 percent a year during the seven years before Medicare's creation in 1965 to 7.9 percent a year during the next five years. (The annual inflation rate for other services during these periods was 2 percent and 5.8 percent, respectively.) Between 1965 and 1970, government spending for health care rose from $10.8 billion to $27.8 billion. The call for health care reform was heard throughout the nation.

At Central Maine General Hospital, trustees and administrators had long warned against government regulation of health care, and yet, had come to depend on government dollars. Still, the hospital had generally been allowed to make its own decisions regarding matters such as expansion, equipment purchases, and health care charges. The hospital's decision-makers were concerned about losing their autonomy.

As new regulations and requirements mounted, directors lamented the hardships they imposed. Plans to build the Thompson Wing were delayed for two and a half years in the bureaucratic quagmire of a regional planning agency. In 1974, Executive Director Dana Thompson argued that if the hospital was to continue offering quality care within the government's ever-more-rigid guidelines, the unrestricted endowment would become its greatest safeguard against crippling operating losses.

In 1971, CMGH Board of Trustees President Stephen Trafton announced that in keeping with the call for a cost-effective health care system, the board had recommended the "formation of a new corporation which would own and operate both hospitals (CMGH and St. Mary' s General Hospital) through a single board and medical staff." The leadership of St. Mary's General Hospital turned down the proposal. Nonetheless, within five years, the two hospitals would conduct a joint fund-raising campaign for construction purposes.

Meanwhile, it was business as usual at CMGH. On May 3, 1971, the Guy L. Smith Nuclear Medicine Center was opened. Funded through a bequest from a former patient from Auburn, the underground facility would allow CMGH to offer diagnostic and therapeutic procedures using radioactive materials. Another benefactor, Henry Martin Luscomb of Bridgeport, Conn., had helped finance a $500,000 boiler plant and maintenance center. Mr. Luscomb had never been personally connected to CMGH, and knew "the hospital by reputation only."

The hospital had also acquired more property, including the Lutheran Church on Main Street, the Calcagni and Blais properties, also on Main Street, and the old Higgins warehouse on Lowell Street.

Mr. Thompson reported in his 1971 annual report that an average 9.1 day stay in 1970 had dropped to 8.4 days by June 1971. Admissions had increased to 9,380. That year, CMGH had an operational income of about $5.5 million, and endowments totaling $725,728 were reportedly the "largest ever received in a single year."

Educational activities continued to thrive at CMGH. The School of Nursing had shortened its diploma program to 27 months, another step in the plan to initiate a two-year associate degree program. Central to CMGH's future as a teaching institution was the announcement that the hospital would participate in a three-year residency training program for family practitioners funded by the federal government.

In 1971 the hospital accepted the resignations of Dr. Charles Steele, Dr. Gil Clapperton, Dr. Wedgewood Webber and Dr. Robert Frost.

As trustees prepared an updated modernization proposal, smaller projects were already underway: a joint venture between doctors and CMGH had resulted in a plan to create a professional building at High and Lowell Streets. The building, called simply 10 High Street, would open in January 1973, providing offices for 20 physicians.

In 1972 two major personnel changes occurred: Mary Ann Burn asked to be relieved of her responsibilities as director of nursing and was replaced by her long-time assistant Helen A. Adams. Mrs. Burn would stay on as director of the nursing school. Dana Thompson would hire a young man from Texas as his assistant, signaling his intention to retire.

William W. Young, Jr., an administrator at the 1,200-bed Baylor University Medical Center in Dallas, had an enthusiasm that greatly impressed Dana Thompson. Indeed, many of those associated with the hospital have identified Mr. Young's enthusiasm as the crucial element to CMGH's success in the tumultuously changing health care environment of the '70s and '80s.

Government Pressures Mount

By 1973, the government's greater emphasis on cutting costs had led to the Economic Stabilization Act, which placed controls on hospital charges, but permitted increases in the cost of such items as supplies, food, insurance, utilities and other services. Hospital regulation was tightening.

Dana Thompson suggested that hospitals were no longer able to "give any assurances to lending agencies that they will be able to increase charges sufficiently to cover debt service costs on construction loans." He criticized the "intense regulation in terms of utilization review by Medicare," reporting that the hospital was often refused Medicare payments. CMGH would lose $100,000 that year to payments withdrawn by Medicare. Put simply, Medicare was deciding after the fact whether a patient admission was necessary and how much the care should have cost.

Under new laws, hospitals were required to form a Professional Standard Review Organization to review the "need and quality of services provided under Medicare, Medicaid and Maternal and Child Health programs." Other laws told hospitals how much free care they had to give, even though reimbursement for free care wasn't allowed by Medicare.

Medical Staff President Dr. Daniel Shields blamed the government for the loss of nursing home beds, claiming that denial of payment to nursing homes had caused them to withdraw from federal health insurance programs. As a result, patients needing long-term care had no place to go.

A more promising product of the federal government's involvement in medicine was realized in July 1973, however, when three residents joined the hospital staff through the Family Medicine Residency Program. (In July 1978, the hospital would establish its own Family Medicine Residency program and a Family Practice Center.)

Dana Thompson wrote in the 1974 annual report that it had become routine for income and expenses to increase substantially each year. The problem was exacerbated that year by the "energy crisis" which tripled fuel prices.

After finally getting the go-ahead from regional health care planners, trustees cautiously proceeded with the construction of a new patient care wing. They hoped to reap huge savings from the decision to finance the project through a $5.7 million bond issue under the Maine Health Facilities Authority Act. A capital fund-raising effort undertaken with St. Mary's General Hospital sought to raise $1.5 million from the public.

For members of the Board of Trustee's Building Committee, the new project touched upon emotional as well as financial issues: In order to build the new wing, the East Wing had to come down. The East Wing was the hospital's first construction project and the oldest remaining part of the hospital. Furthermore, once constructed, the new wing would obscure the hospital's stately central entrance.

According to Norman E. Ross, a long-time member of the Building Committee, reason prevailed. "It was a matter of being practical. If we wanted to provide the best medical care for our community, we had to expand, and we had no place else to go."

The new wing would provide the "most modern diagnostic laboratory facilities," two medical-surgical nursing units, and an updated 19-bed Coronary and Intensive Care Unit. Renovations to the Memorial Wing would create a new main entrance. Plans by the Hospital Building and Equipment company of St. Louis estimated the cost at $7.2 million. The hospital family had already pledged more than $500,000 for the project, and within the year, the fund-raising campaign raised $1.4 million, of which CMGH employees had given $830,139. Some $192,000 in federal money was provided through the Hill-Burton program. On July 8, 1974, after six years of planning, construction of the new wing began.

Meanwhile, CMGH's outpatient services continued to grow, especially inhalation therapy, which showed a 576-percent increase since 1969. A new speech and hearing clinic, wrote Mr. Thompson, "would undoubtedly result in new highs being established for outpatient care."

In 1975, Dana Thompson announced his plans to retire on Jan. 1, 1976. Bill Young was named as his successor. That same year, trustee James Longley resigned from the board to become governor of Maine and was replaced by Dr. Daniel Shields, the first doctor to be named a CMGH trustee. Elsewhere in the hospital, baker Richard Sagner celebrated his fiftieth year of service, and visited his native Germany, courtesy of his co-workers.

Three months before his retirement, Dana S. Thompson witnessed the dedication of the new wing in his name. In an demonstration of New England Yankee humility, upon learning of the board's decision to name the wing after him, Mr. Thompson had written to each member asking that the board select someone "more worthy" of the honor. Mr. Thompson would later say: "No words can express my feelings with this recognition of my contribution over the decades to CMGH."

When the Dana S. Thompson Wing opened, the rest of the modernization project was near completion. The laundry was moved to the National Guard Armory on Hammond Street, a structure that had been presented to the hospital by the state Department of Health, Education and Welfare.

As the decade passed, government control of health care took a new form: a new Comprehensive Health Planning Act phased out Hill-Burton and the Regional Medical Program, replacing them with one organization that would have new rules and restrictions.

A Broadening Focus

Feeling that it was time for CMGH to claim its place as a regional medical center, the Board of Trustees on September 16, 1976, unanimously voted to change the hospital's name to Central Maine Medical Center,.

The state that year also granted approval for the hospital's associate degree in nursing program, the first of its kind in New England and only the fourth in the nation. Mary Ann Burn was credited with bringing about the nursing school's remarkable change. Dr. Burn retired in August 1976.

As new faces replaced the old, so did new policies change the structure of the hospital's management. The days of a one-man administration gave way to an administrative team. In his first year as executive director, Bill Young established a seven-person management team. During the next four years, he would initiate a three-phase plan for the hospital's growth.

Bill Young realized that central Maine was the state's second-largest population base and yet the composition of CMMC's medical staff "fit a small community hospital." There were not enough specialists to meet the "complete regional referral" needs of the area. As phase one of his long-term plan, Mr. Young began a physician recruitment project to attract specialists in oncology, arthritis, cardiology, urology and radiology.

"We had the population and the expertise to build a more sophisticated medical center," said Bill Young in a 1991 interview. "Although we were getting referrals for pediatrics, obstetrics and general surgery, smaller hospitals already had those physicians, and we weren't getting our share of the business. We identified 17 physicians that we needed to recruit immediately."

In order to recruit specialists, CMMC agreed to help them establish a practice. The board also knew that the physicians' success would require the best facilities, equipment and programs. This realization led to many innovations, including CMMC's 1979 purchase of a computerized axial tomography scanner, popularly known as a CT scanner, a piece of equipment which would create "the single greatest change in radiology" since the department's establishment.

CMMC's first efforts to acquire at CT scanner were turned down by state regulators under the newly-created Certificate of Need Act, which required hospitals to prove the need for new equipment or construction. The act was enacted in an effort to cut health care costs by requiring hospitals to gain authorization for construction, capital expenditures of more than $150,000, and for new health services. Following numerous hearings, CMMC's second application for the CT scanner was approved.

Bill Young's recruitment strategy paid off, and within a year, 17 new physicians had arrived. Among them was the area's first neonatologist, Dr. Barry D. Chandler. He would head the hospital's new Neonatal Intermediate Care Unit for sick and high-risk infants beginning in June of 1977.

Childbirth at CMMC changed as families began to see the event as something that should not occur in an excessively clinical environment. This would eventually lead to the development of CMMC's birthing center, where a mother could have her baby in a home-like environment.

By the end of the 1970s, CMMC had become the resource hospital for emergency medical services in the tri-county region. The medical center had also established an agreement with the Sidney Farber Cancer Institution in Boston through which cancer patients could receive the latest drugs and methods of treatment. The Family Practice Center had been established at 76 High Street and was serving more than 5,000 patients yearly. Day surgery had contributed to a reduction in the average length of a hospital stay to 6.5 days in 1979.

Plans had been approved for a $400,000 12-bed physical rehabilitation unit, with a target opening date of 1981, and the hospital was seeking approval for a radiation therapy center for central Maine's cancer patients.

Winning the bureaucratic war

While the costs of medical care had become the topic of much debate and regulatory activity during the 1970s, the medical community was astonished still by the draconian cost control efforts of the 1980s.

Yet, Central Maine Medical Center would not only survive the changes, it would flourish. By the end of the decade, the hospital would celebrate its first century of existence and complete its largest-ever expansion-modernization project.

In October of 1982, as part of phase two of Bill Young's plan for the CMMC's future, the medical center became a subsidiary of Central Maine Healthcare Corporation. Mr. Young and the Board of Trustees saw the need to position the hospital to meet the region's health care needs despite government restrictions. "We needed flexibility in the decision making process," recalled Mr. Young. "We could not deliver services because we were controlled and we needed to find a way around that control."

When the decade began, CMMC had recruited 30 doctors. The hospital had received approval to construct a cancer treatment center. A certificate of need for an expansion project had been filed. Admissions and births were up. The Family Practice Center had doubled its service volume. Outpatient visits totaled 160,000, and the Emergency Department had provided care for 35,000 people. The hospital was thriving.

But of the $23 million billed for services in 1981, CMMC was unable to collect nearly $3.5 million. This shortfall was due primarily to the reimbursement practices of Medicare, Medicaid and Blue Cross. The hospital clearly needed to find a way to bring in revenues.

That year, George F. Liming, chairman of the board, reported that a committee was working with national experts to "determine the proper corporate structure in light of changing national circumstances."

"A single corporation no longer provides the necessary tools to meet growing challenges," the committee later reported. A new structure would permit "corporate segregation of non-regulated activities from the highly controlled functions dealing with patient care."

A recommendation was made to create Central Maine Healthcare Corporation, which would act as a holding company for CMMC. The board approved the recommendation and received approval from corporators at their annual meeting in October 1982.

The changing nature of health care was evidenced in Dr. Frederick Holler's 1982 report. "In my view, reduction of costs by reducing utilization has gone as far as possible," wrote Dr. Holler. "Health care providers are subsidizing the delivery of health care to the extent that it's no longer possible. Cost shifting is no longer a just or practical solution. Due to these pressures, the traditional roles of hospitals and medical staffs is changing. Society must decide how much health care it can afford."

As society deliberated that very question, state and federal governments picked up their cost-cutting axes. Aurele J. Bosse, the first chairman of the Central Maine Healthcare Board of Directors, reported in 1983 that "action taken by Congress at (President Ronald) Reagan's urging and by the Maine Legislature at Governor (Joseph) Brennan's insistence will have a profound impact on the health care delivery system."

Chairman Bosse was referring to the federal government's decision to shift from cost-based reimbursement practices to a prospective payment system based on diagnostic-related groups (DRG) beginning July 1, 1984. Mr. Young explained that the DRG system lumped "some 7,000 possible diagnoses of various illnesses and conditions into 467 categories." Reimbursement was based on the government's determination of what treating those illnesses should cost. If a hospital's actual cost for providing care was lower than what the government had determined, the hospital benefited. If costs were higher, the hospital absorbed the loss.

Under Governor Brennan's proposal, a newly-created Maine Health Care Finance Commission determined how much money a hospital received.

In his 1984 annual report, Chairman James Saunders echoed Mr. Bosse's concerns that the new law "transfers power over hospital operations, which have traditionally been the responsibility of local boards and physicians, to a state bureaucracy."

Medical Staff President Dr. Louis Fishman lamented the recent changes in medicine: "They now call physicians 'providers' and patients 'customers' or 'clients,' a distasteful connotation on both sides which can only breed suspicion when trust and understanding in illness is needed. ... Society will have to awaken to the fact that all that is done in their name is not necessarily done for their benefit."

On June 9, 1984, the Medical Center dedicated the new cancer treatment center to former board member and civic leader, Cynthia A. Rydholm of Auburn, president of the Seltzer and Rydholm bottling company. Dana Thompson praised her community involvement and "fierce pride in the state of Maine."

Also in 1984, a new telecommunications system replaced the "obsolete" telephone switchboard that was marveled over in 1967. Laser surgery was introduced that year, as was a cardiac rehabilitation program.

By 1985, CMHC included the Medical Center, the School of Nursing, Advanced Health Services, Inc., Central Maine Real Estate Management Corporation, Integrated Health Services, Inc. and Central Maine Community Health Corporation. The holding company would purchase the Greene Acres health care facilities by the end of the year.

Chairman Marcel Bilodeau reported an all-time high in outpatient visits of 137,850 and an eight percent increase in emergency care visits. He also reported that as a member of the Voluntary Hospitals of America, Inc., CMMC had expanded its group purchasing capabilities and access to low-cost capital, which helped the Medical Center purchase equipment and make minor renovations less expensively.

He confirmed that the board's worst fears regarding the state's new commission on health care had materialized. "Under the guise of cost control, the commission has created a regulatory morass that consumes a staggering amount of the Medical Center's time and resources," wrote Mr. Bilodeau. He cited the commission's refusal to allow the Medical Center to recover losses from soaring liability insurance costs, and reported that a complaint had been filed in the Androscoggin County Superior Court, asking for a judicial review of the commission's decision.

Medical Staff President Dr. Gilbert Grimes urged his colleagues that year to support a "strong partnership" with the Medical Center to combat the "intrusion" of government regulations. He welcomed 11 doctors to the active staff and noted that a newly-formed Staff Development Committee would research the area's needs. Following the committee's recommendations, another ten physicians joined the staff in 1987.

Ground was broken in August 1988 for the hospital's latest expansion-modernization project, and 89,000 square-foot building that would house new Emergency, Radiology-Medical Imaging and Surgical Service departments, outpatient treatment areas, an Education and Conference Center and a new lobby. The project also included renovations to some 55,000 square feet of existing space.

By 1990, Central Maine Healthcare Corporation was providing consulting services to Northern Cumberland Memorial Hospital in Bridgton and Rumford Community Hospital. Central Maine Imaging Center, located in a newly-renovated medical office building called 287 Main Street Plaza, was offering magnetic resonance imaging services. CMHC was sponsoring the area's Retired Senior Volunteer Program and had created Horizons/55, the state's first seniorcare services program.

At a ceremony held in September 1991, the new building was dedicated in honor of trustee Norman E. Ross of Lewiston, who joined the CMGH Board of Directors in 1941. Norman Ross had been a member of the board's Building Committee throughout his service to the hospital.

A former treasurer for Bates College in Lewiston, Mr. Ross served the hospital with six administrators, helped oversee four expansion projects and the construction of the cancer treatment center and 10 High Street professional building. At 93, just seven years younger than CMMC, he is considered "an institution" at the Medical Center.

As Central Maine Medical Center looks to its second century of growth, Bill Young and the Board of Trustees assert that the hospital's mission has never changed: CMMC remains dedicated to providing the best possible health care to central Maine residents.

A tertiary medical center evolves

In the mid-1990s CMMC also began establishing a dedicated trauma program that would eventually be designated as one of three such programs in Maine. This program would be bolstered in 1998 with the creation of LifeFlight of Maine, a medical helicopter service jointly administered with Eastern Maine Medical Center in Bangor.

In 1999 Northern Cumberland Memorial Hospital and Rumford Community Hospital merged with Central Maine Healthcare. The facilities soon changed their names to Bridgton Hospital and Rumford Hospital. In addition to the many healthcare services that Central Maine Healthcare has helped develop at the two organizations, the holding company has also assisted in plant development at the facilities. In December 2001, Bridgton Hospital dedicated an entirely new state-of-the-art facility constructed next to the old structure.

CMMC's long-time effort to establish itself as a tertiary medical center offering a comprehensive array of the highest level healthcare services began to take a tangible form in October 2001 when the hospital broke ground for the Central Maine Heart and Vascular Institute. CMHVI opened in the spring of 2003 and offers open heart and cardiac angioplasty services to a population base of some 400,000 people in central and western Maine.

As Central Maine Medical Center continues its transformation to a tertiary medical center, its mission remains unchanged: providing the best possible healthcare to the region's residents.


 

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