Patient and Visitor Information

CMMC 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 firs