Dr. Mark Rockoff - A Historical Perspective: Pediatric Healthcare and the Development of Boston Children’s Hospital

Good morning everyone. As you know this grand rounds is part of the 150th anniversary grand rounds celebration. And there's probably no one better to do this than Dr. Mark Rockoff. I have to keep his introduction brief because he has a lot to say to us this morning. But as you can see from the title slide, Dr. Rockoff is the vice chair of the Department of Anesthesiology, Critical Care and Pain Medicine. But beyond that, Mark has a personal interest in medical history. And in particular the medical history of this hospital. So there's probably no one better to explain where we came from and who we are than Dr. Rockoff. So Mark, welcome. Okay, good morning everyone and thank you Jeff. I'm very grateful for the opportunity to speak here today about a topic that's been a long-standing interest of mine and that is just said history. As we all know working at this hospital gives us an amazing opportunity to care for patients of all varieties with medical and surgical conditions who come with their families from not just the Boston area but from all around the United States and many countries of the world. And they come together in a way that reflects religions and cultures that seem way to one common nowadays. Now Boston got to be such a special place for advanced medical care is really a fascinating story. And this morning I'll try to give you a brief overview, especially as it pertains to children. And I think it's especially pertinent since we're at the end of our hospital's 150th anniversary. We've already heard lots of wonderful talks beginning this summer with Bob Schamberger speaking about the history of surgery and then throughout the summer with my colleagues in anesthesia talking about the history of cardiac anesthesia here and the development of the pain treatment service and most recently Jeff spoke last month on the development of our critical care units. So today I'm instead going to take a different approach. I'd like to describe to you what life was like for children before there were children's hospitals. And then I'm going to go on to describe the evolution of this hospital. Now just one disclaimer I think as many of you may know I've been chairman of the hospitals archives committee for now 25 years. And as part of that we wrote a book several years ago about the history of the hospital picture book and I was one of the co-authors here. But the disclaimer is I get no remuneration for any of my work in the archives committee and all the proceeds from the sale of this book have gone to support the hospitals archives program. Now I want to begin way back. Throughout much of our past hospitals as we know them did not exist individuals when they were ill were cared for in their homes. It was initially via the clergy and the military that the first hospitals were organized in middle ages. Generally these were what we more consider now shelters for the homeless, for the mentally ill and for battlefield casualties. And this is an illustration of such an early hospital in Italy six centuries ago. Children's fair particularly poorly in these days. Virtually all deliveries were performed with the aid of midwives and physicians rarely cared for any infants until they were weaned. Older children and most adults for that matter received their care from physician barbers who were often poorly educated or more learned physician clergymen who were better educated but lack much medical knowledge. The first hospital that I'm aware of specifically for children was founded in the 15th century in Florence and largely treated unwanted and abandoned newborns. If you go there today you can still see the turn style over here. Let's see if I can do this. The pointer right here in the corner. There's a small turn style where unwid mothers would anonymously place their newborns to really receive on the other side by nuns who would then raise them. Also note the beautiful terracotta release that were up on the walls of this building by the famous sculpture Andrea del Robio. The American Academy of Pediatrics which was founded about 500 years later took its logo that you can see here from the symbols of the swaddling bambeenos that were on this building. Similar images can also be seen on the front of our own hospital. If you look up from Longwood Avenue on the Honeywell building up at the top there's a swat, one of these images of the swaddling bambeenos. There's also several on the old lying in hospital, a little farther down the street on Longwood Avenue that's now part of the Grigamin Women's Hospital. Now as you may be aware next year will mark the 400th anniversary of the pilgrims arriving in the new world. As you may recall they mistakenly came here intending to land in Virginia where the first permanent holiday was already established in Jamestown and this is a replica of the vessel that's currently being restored and you'll be able to visit it again next year in Plymouth. Two weeks after the Mayflower first landed initially in Provincetown on November 9th, 1920. After a two month voyage from England the sister of the ship's physician Deacon Samuel Fuller gave birth to a son, Peregrine White. He was the first English child born in New England. His cradle still preserved in the settlers museum in Plymouth only 40 miles from here and amazingly he lived till 83 years of age and you could see his grave in Marshall. However the second child born on the Mayflower a few weeks later after they moved from Provincetown to Plymouth was still born and the mother died too at the height of a winter gale. Actually the mortality overall that year was terrible to quote William Bradford the governor of Plymouth colony. I quote that which was most sad and lamentable was that in two or three months time half their company died especially in January and February being the depth of winter and wanting houses and other comforts being infected with the scurvy and other diseases. He goes on to say so as they are died sometimes two or three a day in the aforementioned time that of the 102 persons scarce 50 remained. The outcome was not much better for subsequent generations. Cotton Mather who was born in a 40 years later in Boston wrote in his journal how only one of his 14 children survived him. He was terrible from accidents especially drownings off of peers or buckets of water or buckets of milk. Scaldings from cooking with open fires and especially from diseases including small pox. Again to quote from William Bradford about an epidemic in Plymouth plantation in the late 1600s. It pleased the Lord to visit them this year with an infectious fever of which many felt very sick and upwards of 20 persons died. And then women besides children and he goes on to say quote in the end after he had helped a much helped others Samuel Fuller who was their surgeon and physician and had been a great help and comfort to them also died. Around the same time a smallpox epidemic in Boston the city of Boston killed nearly a fifth of the population of the city. In the early 1700s of Boston physicians Abdyle Boyleston who his family is Boyleston streets named after he was live pus from a mile of human cases smallpox to inoculate his own child. Incidentally he inoculated his two slaves reflecting at that time even in Boston that there was slavery then. By the end of the century another famous Boston physician Benjamin Waterhouse who helped found Harvard Medical School received from Medward Jenner in London a small sample of a safer form of prophylaxis cowpox not live smallpox and he too gave it to his children and then to many others initiating the entire concept of vaccination throughout the colonies and this led to a mark reduction in mortality from the stredphal disease. Now sadly but also reflecting what science was like at the time Dr. Waterhouse commissioned a carefully controlled experiment in which 19 vaccinated and two unvaccinated boys were intentionally exposed to smallpox. All the vaccinated boys exhibited immunity but both unvaccinated boys died from the disease. No human studies committees at that time were informed consent. In light of all this as well as other immunizations that came from Boston it's especially disturbing to see nowadays the growth of the anti vaccine movement and resurgence of entirely preventable infectious diseases. Now the first hospitals as we know them developed in Europe in the 1700s a few hospitals a little bit earlier among these were the Royal Informerians Edinburgh Scotland which is shown on this slide the Cronkin House in Vienna and Geys hospital and other hospitals in London. The Atcher hospitals began shortly after this but they did very poorly. For example there was a foundling hospital in Dublin, Ireland that admitted 10,000 infants in a 20 year period at the end of the 1700s with only 45 surviving a lethality rate of more than 99%. This was largely because bottle feeding was uniformed and lethal in the days before refrigeration and any understanding of infectious diseases. In America at the time of the American Revolution there were only two hospitals in the colonies. The first was in Philadelphia seen here and was established in part by Ben Franklin in 1751 after Ben Franklin moved from Boston to Philadelphia and it was found from an old domes house. The second was in New York City established about 10 years later. These were the two largest cities in the colonies at the time and not surprisingly the first medical schools in America began in Philadelphia in New York. Later throughout the colonies as in the rest of the world hospitals evolved from home houses, institutions for the insane and orphanages. In Boston there was a small quarantine hospital on an island in the harbor of Boston in 1700s but the first true hospital was not established until 1804 with the opening of a small hospital for sailors in Chelsea seen here. However in 1811 the concept of the general hospital in Boston was proposed largely to care for the indigent but the MGH was not opened until 10 years after sufficient funds had been raised. McLean Hospital which you can see in the background here on the other side of Charles River was opened in Charlestown in 1818 a few years before the MGH obviously McLean since subsequently moved to Belmont. One of the founders of the MGH and the founder of the Harvard Medical School as well was Dr. John Warren, who became the first professor of anatomy and surgery. Dr. Warren had many siblings but his oldest brother Dr. Joseph Warren was also a famous physician in Boston at a time when there were a lot of physicians that were just dozen or self physicians in the city of Boston and he was the highest ranking officer killed at the Battle of Bunker Hill. This is the famous painting by John Trumbo that you can go over and see at Boston's Museum of Fine Arts depicting the death of Dr. Joseph Warren. He was one of the great leaders of the American Revolution. He was the person who sent Paul Revere on his famous ride to warn the people in the country cited the British Army's incursion in Tlexington and Concord. He was so well respected one could speculate whether he would have been a president of the United States had he survived. As you may know Boston was a relatively small peninsula at the time of the American Revolution with a very narrow neck connecting it to land before the city greatly expanded in size. Incidentally if you want to wander around now and see where this neck is it's near what's now the ink block condominiums down by the southeast expressway not far from the theater district in Boston. The population at the time in Boston though only had about 25,000 inhabitants incidentally that's about the same size as the town I live in now with Hingham. However over the next decades the population increased enormously largely due to an influx of desperately poor people fleeing famine in Ireland. Now mortality though at this time still was horrible because living conditions were horrible. There was overcrowding there was poor sanitation there was no refrigeration there was contaminated food and water and there was little understanding of infectious diseases and virtually no treatment for them. Mortality was terrible especially among children. One quarter of babies born in the mid 1800s didn't live past the first year of life and nearly half died before five years of age. By the mid 1800s as you can see on this slide this is just one week's representation of mortality report about half the deaths were occurring in children and you just have to wonder through any cemetery and new and ordinary you'll see all these graves for small babies. Conditions in early hospitals though were not much better than in a lot of homes. This picture was taken from an article published in the New York newspaper in 1860. It regards the words of New York's largest hospital Bellevue. A accompanying text included this statement in my quote. A young Irish woman gave birth to a baby on Sunday night. The next morning the infant was found dead next to her. She had been too weak to prevent rats from the rowering the infants nose upper lip toes in one half of the left foot. This is 1860. The best hospital biggest hospital in New York City. Furthermore there's an interesting quote from a young intern around the same time who was working at the children's arms house in Philadelphia where he lived for six months as the only physician. I quote, a hundred or more children were sheltered there on their way to an early grave to which most of them were destined. Lemuel Shaddock a teacher appointed by the Massachusetts State Legislature to head up a sanitary commission in the 1800s stated at the time that the children of Massachusetts quote seemed literally born to die. Around the same period Louis de Gaire began his pioneering work in what we now know as photography. From this point on there's lots of images depicting the poor health conditions at the time. Here's an early de Gaire type of a mother holding her child after death. These images were important keepsakes for families. This is a picture of Amos Lawrence, a wealthy textile merchant in philanthropist from the Boston area. Mr. Lawrence knew of a new hospital for children that had begun in Paris in 1802 which I think is the world's oldest continually operating pediatric hospital. In the time to create something similar in Boston in 1846, so this is more than 20 years before Boston children's has founded. He bought a building where Boston's theater district is now that was at the time the home of Harvard Medical School before the school relocated to near the MGH. Incidentally the town of Lawrence Massachusetts is named after him and the town of Lawrence Kansas is named after one of his sons who founded the University of Kansas and led an important anti-slavery movement in Kansas before the Civil War. Here is that building that was downtown that Mr. Lawrence bought. It was never used as a hospital since it seemed unsuitable to renovate for that purpose. However Mr. Lawrence did lease a house in the same area and soon opened the pediatric hospital there. The building instead of being the first pediatric hospital was used as the Museum of Natural History of Boston before it moved to the back bay. Here's the announcement of the opening of what was then known as the Children's Infirmary. As you can see it too was intended to provide care for the poor who could not be well cared for in their homes. Note the physician in charge over here was William Lawrence who happened to be another of Mrs. Lawrence's sons who recently graduated just a year before from Harvard Medical School. So it appears that he bought him a hospital in which to work after he graduated. Unfortunately after about 18 months in operation the children's infirmally closed. This is an article from the British Journal, the Boston Medical and Surgical Journal before runner of the New England Journal announcing this. Dr. Lawrence in this report summarized the results of what he described as this experiment and the reasons for its failure. And I'm just going to quote from one part here in the middle of this statement. The obstacles to its success are singularly enough not to be found in diminished resources or lessened zeal of its friends but rather from the backwardness of the poor to receive its benefits. And he goes on to refer to and I quote, the deep rooted and commendable feeling which prompts the mother to cling to her sick and suffering child rather than entrusted to those whose motives she has not learned to fathom. In any case as you could see in 1848 this children's infirmary the first pediatric hospital in our country closed after 18 months after admitting 35 patients and interestingly only 22 of them had died. The MGH was still the city's major healthcare facility in the mid 1800s. Here you can see the original MGH building designed by Charles Bolfins with its now famous ether dome on the top. Next to what was the Harvard Medical School where it moved after Amos Lawrence bought the medical school building from downtown and was moved over here. And here next to it too is also the Charles Street jail which a few years ago was turned into the Yuppie Liberty Hotel. The pediatric hospitals however were beginning to develop another city in the United States. In 1854 a nursery was established in New York City to care for sick neonates. A year later the children's hospital of Philadelphia soon began followed by the children's Memorial Hospital in Chicago. In 1869 Boston once again tried to create its own separate hospital despite the failure of the prior children's infirmary and seeing here is a picture of Dr. Francis Brown with his young son. He with a number of his colleagues and philanthropists after the Civil War began children's hospital in Boston 150 years ago. This is the announcement of the plan to establish the children's hospital published in April 1869 before the hospital opens. It notes the failed children's infirmary two decades before. At this time Boston had several hospitals in addition to the MGH. The line in was here. Boston City had already opened. The good Samaritan, Karnie hospitals in South Boston. Interesting but soon after this announcement was published a letter appeared in a Boston newspaper saying a hospital for children wasn't necessary and it was signed by a leading physician at the MGH. This stirred up a great deal of controversy and there's all sorts of fascinating articles reported in the papers at the time. But many Bostonians supported the new children's hospital and felt there was plenty of room for additional medical charities in town. Some would say this competition between the MGH and children's hospital has never fully abated. Just as an example, this is a picture I took just a few days ago of a display currently in the lobby of the MGH where they have rotating history displays. It describes the Ladies Volunteer Committee that is celebrating its 150th anniversary at the MGH now. This is a group of women volunteers who would come into the hospital a few decades after the MGH started and helped care for the patients in the hospital. They still exist. They don't obviously go visit the patients but they actually run the gift shop at the mass general and they do some other things. There was an interesting part of this exhibit that's down here that I just highlighted on this slide because as part of it they say there are several institutions founded within a decade of this organization. Interestingly there's no mention of Boston Children's Hospital. Now whether this is simply an oversight or something else is entirely unclear but the rivalry between these two institutions in many ways just seems to continue. Now in any case a few months after the Children's Hospital founding was announced, this notice appeared, explained that only children between the ages of two and twelve could be admitted just like the failed children's infirmary. In fact this was typical of all early hospitals which left the care of infants to their mothers and midwives at home. The hospitals had nothing to offer children so they didn't admit children under two. Note also the visiting hours for parents were only one hour a day. Now this is the site of the first children's hospital. It's actually the second. It's the first hospital was a little townhouse in the south end of Boston right on the corner of Rutland and Washington streets. It was immediately too small and they moved to the second building. They don't have a picture of the first building. This is the second building moved into shortly after. Right on the corner the front of this is Washington Street now and Rutland Street and it was just a rented townhouse where the first twenty patients were admitted when the hospital opened in 1969. Just to give you a perspective Boston's growing a lot now there's a lot of landfill going on. The south end is getting filled in. The back bay is about to be filled in. The wealthy in Boston moved into the back bay. The beautiful homes being built there. The poor particularly the poor Irish were moving into the south end, that landfill area. Boston City hospital is right down here and Rutland Street is right here. It's not far away. That's where the first children's hospital was built. If you go to that site now this is what it looks like. There's a garden there. It talks about the Rutland Washington community garden. It's about two blocks from city hospital. There's no mention of children's hospital being here but it's a beautiful little place and you can see some of the townhouses around it. The hospital opened in July of 1869, 150, 169 years ago and this is from the original logbook that we have in the archives. It talks about the first patient admitted. You can see July 20th, 1869. First patient was admitted. Ellen McCarty, a seven-year-old girl with a fracture of the radius and what's fascinating is she spent a month in the hospital. Not a typical for patients who came to the hospital. Not only was it for their care but it was also to feed them, get them into better living conditions and to take care of them. Now interestingly the physicians were all volunteers. They were called visiting physicians. They came from their offices to help out but the nurses were all volunteers too. This is the first nurse that was recruited to head the nursing corps at Children's Hospital Adelaide Blanchard-Tyler. She was a Bostonian, grew up in Boston. After her husband died she became a nurse, a deaconess and a nurse for the Episcopal Church. She was actually working in Baltimore in 1861 when Fort Sumter was attacked and the Civil War began. Abraham Lincoln called for troops to come down and try to protect Washington DC and the first troops to head down to Washington came from Massachusetts and they took the train to Baltimore and they were attacked in Maryland by people who were by the southern state. Adelaide Tyler ran over to take care of them and then afterwards volunteered her services for the Civil War and she is considered the first nurse in the Civil War. An amazing person. This is a photo taken by Matthew Brady, the famous photographer, who was taken some time during the Civil War. We don't know exactly when but I'd like to thank our nursing department here because Laura Wood and others helped the archives program purchases when we found it on for auction just a few weeks ago. It came up for auction. The original print with her name on the back and as you know Matthew Brady took lots of pictures of famous folks during the Civil War. Unfortunately she didn't live very long. The hospital then recruited a group of nuns from England, the sisters of St. Margaret. They provided all the nursing care here for free like the doctors for nearly 40 years. If you look in the honey well building you can see this plaque which recognizes the sisters of St. Margaret for all the incredible work they did while they were here. Interestingly the sisters had a content in what's now Louis Berg Square. This is a picture I took of that area. This is the corner. This building here was recently owned by Senator John Kerry. But these other buildings here, three of them were the content of the sisters of St. Margaret. Two weeks ago in the Boston Globe one of these came up for sale and you can buy it for 20 and a half million dollars. Now a year after the hospital opened in 1870 it had its first scientific publication because part of the mission of the hospital was not just to care for children but to improve the health care children and to educate the next generation of nurses and doctors. This is that first publication that came out. It's a case of progressive muscular splerosis by two of the founding doctors with Dr. Brown who started the hospital. It shows a patient here with a big curve of the spine. They described the article but it's fascinating because they go on to say a perfect picture of the child can be seen in Duchess textbook in 1861. This is what we now know is muscular Duchess muscular dystrophy and this is just around the time that Dr. Bichain is describing this disease. Now within a few short years just over a decade the townhouse was clearly not adequate in the South End and children decided to build its own real hospital. And this is that first hospital that opened in 1881. It was originally designed for 60 patients. It's soon expanded to a house, almost 100 patients. And this is a photo of that building. It's on the corner of Huntington Avenue right here. And you can see there's not much in this area at the time. Here's a picture 20 years later, turn to the century. You can now see the building. There's a nurse going over to Ketsch to trolley the street card. The first subway system in America built in Boston was now in existence here. There's electricity. There's still horse drawn carts and manure roll over the streets. But you can see a doctor going into the hospital and nurse going to get the subway. You can also see a building over here that's still there that's Symphony Hall built in in 1900. And if you look now, this is a picture of the area there's Symphony Hall but unfortunately the building's not there. There was no Boston landmark commission at the time. And so when that building was when children's moved to this location where we are now, they told the building down. There's just a bunch of fast food restaurants there unfortunately. But there's some great descriptions of that hospital. There's a picture inside the hospital. There were all big wards. There were no semi-private rooms or private rooms. There were big windows and lots of light. The treatment was mainly fresh air and sunlight in those days when there wasn't much else to offer. And there were a lot of orthopedic patients in the hospital. It was largely in orthopedic hospital. As I mentioned, the hospital was originally founded to train doctors and nurses as well. The sisters of St. Margaret started a nursing school here that lasted for nearly a century. But in the early 1900s, the hospital also started to get house officers from Harvard Medical School who would come over for a year after graduation. This is one of the early pictures of the house staff. If they were taking care of patients in the hospital, they were called interns. If they were taking care of the patients in the ambulatory clinic outside, they were called externs. And that's the first group of house officers. We have some wonderful descriptions of that building on Huntington Avenue. The house officers used to live up on the top floor. This is a view out the window across Huntington Avenue. At what used to be the Huntington baseball grounds. This is where the Boston Red Stockings played before they became the Boston Red Sox. And before they moved to Fenway Park in 1912, a great ball field here. This is now Northeastern University. Now even that Huntington Avenue building was inadequate. It was too small. And so the hospital decided it was going to move farther west as the city was developing. This is the place where it was moving to, where we're standing out today. This is the old Francis farm. It was a wealthy philanthropist who donated a bunch of land in this area. This was the suburbs of Boston at the time. You could see in 1903, there's virtually nothing here. A couple of houses, but it's big open space. And he gave a lot of land. So Harvard Medical School was going to move here. Now Harvard Medical School, remember, had moved a lot of places. The start and Cambridge moved to downtown Boston. I showed you where it moved to next to the MGH. But after it left the MGH, it moved to Copley Square. This is Harvard Medical School here before it moved to its current location. This is the Boston Public Library. This is Boston Street, named after the Boyleston family. Trolleyes are still here. This building is no longer here. It was torn down into the library extension to the Boston Public Library. But this is where one of the locations of Harvard Medical School, before located to one that happened. Now children's decided to move next to the Harvard Medical School since it needed to expand anyhow in their open space. So it bought some land next to it. May have been the most important move. Children's Hospital ever made to move adjacent to the medical school to develop an important affiliation with the medical school. And this is the famous photograph taken 100 years ago today, now, in 1919, of the cows grazing in front of the Honeywell Building. A few years after we moved here in 1914. But these cows were, this isn't just a photo or a pasture, the hospital actually raised its own cows to be disease-free because one of the most common diagnoses in the hospital for its first 50 years was bony tuberculosis. And they didn't get it. The kids didn't get it from, it wasn't pulmonary tuberculosis. They got it from infected cows milk, cows who had tuberculosis, which transmitted tuberculosis to the milk and to the children. The children would get terrible bony tuberculosis. The children's raised its own tuberculosis-free cows. And just as an example, this is from an article Harper's Weekly in the 1870, showing how unscrupulous merchants wore, they would take disease sick cows, couldn't even stand up and still collect their milk to sell. And it was called Swill Milk. And here's a picture from Harper's Weekly 1878, showing almost the angel of death serving to a poor family with their children, diseased milk without refrigeration. Now, at the same time, here's the back of the Honeywell building. But remember, children's hospitals anywhere did not take care of kids under two. So at the same time in 1914 that the children's hospital moved here to where the Honeywell building is, a separate instance hospital was built here. This began in Boston in the end of the 1800s or in the 1880s over near Mass General on Boston Street. But it eventually moved here also to be next to Children's Hospital. The head of this hospital was Thomas Morgan Roach who also was appointed the head of Boston Children's. So it was natural that this hospital would get moved nearby, but there were two separate hospitals. Actually, it was never a very good hospital for children. It was not very practical. Dr. Roach didn't even live to see it. He died right before it opened. And the first event in this hospital was Dr. Roach's funeral that was held there. Now this is what the hospital and medical school looked like a hundred years ago today. Here's the Honeywell building. Here's the infants hospital. Here's Harvard Medical School. Here you could see the Peter Bent Brigham which also moved, which just opened up a year before Boston Children's moved here. And it's located, this is before the Brigham and Women's. It was the Peter Bent Brigham Hospital. You could see at Children's there was the Honeywell Building and the Infants Building, Separate Infants Hospital. But there were also these cottage wards. There was a medical ward, some were two stories. There was a surgical ward. There was an operating room theater. And you had to go outside to move patients between these different places. You could also see over here this is the Lyon Hospital. It moved from downtown Boston to be near the medical school. Now this is again part of the Brigham and Women's now. And you could see Simmons College and the Manual College and the background. A lot of open space there too. Wouldn't it be nice if we had some of that open space now? They had no elevators then. So for the house staff, this was part of your job to bring the patients, largely orthopedic patients up and down. What buildings did have two stories? Most had one story. This is one of the wards looked like even into 1930. Again, no semi-private, no private rooms. Big awards, open windows, lots of fresh air. The area between these cottage wards, here's one of the two story wards. And here's another one was big open space. This was used for entertainment even in the 20s. This is when the Ringley Brothers Barnman Bailey Circus would come and entertain. That's when they still had traveling circuses with animals. But this was used for a lot of entertainment as you know, this eventually contains the Proudi Garden and this site of where a new clinical building's going to be. Now the hospital was still greatly expanding. And this is a building built in 1930 to house our nurses. By now the sisters of St. Margaret retired from Children's Hospital. There was a professional nursing corps and they had their own nursing school. They built this building, the Gardner House, to house the nursing students. And they lived in this building and it was right across the street. Here's the Honeywell Building. And the Gardner House was right across the street, a spectacular old building. This is a picture from the basement of that building. And it was the nursing laboratory. It was fascinating. I remember this very well. The nurses don't get enough credit for this. I think they were probably the first ones to develop simulation training where you before physicians got into it. This is their laboratory where nursing students would learn how to not only make beds but check patients and do vital signs. And I remember this well when I first came here. This is the Gardner House unfortunately was taken down. We needed parking space and this is where our Children's Hospital parking garage is located now. The only thing that's preserved from that building is this cartouche, which was on the wall of the Gardner House. You can see it outside the ender's building now. It's blocked off. But when the entrance opens back to the emergency room and you walk by, you'll see this cartouche was preserved and it's put up on the wall. Now in 1930 also that we needed space for patients in the hospital. And the new building was built. This was the beta building also opened in 1930. And again, if you look at the history of the hospital, pretty much every 30 years the hospital buildings become that antiquated. And they get and you need a new one. This was the beta building and it was a fascinating building. It still exists. The top floor though had a solarium. Because again, many of the patients had orthopedic diseases. They didn't know much about rickets and what it was caused by. But they knew that it could be treated with ultraviolet light before people understood vitamin D and what this was about. So there was a solarium on the top floor and on the first floor, there was actually a swimming pool. Now this swimming pool has been covered up. Radiation therapy has offices there. But the swimming pool is there and it was great for the physical therapist to be able to treat kids with neuromuscular disease and the buoyant water of a pool. And so a lot of physical therapy occurred here, particularly in the 30s when many of the patients had polio and neuromuscular diseases. And polio is one of the incredible stories that had such an impact on this hospital. In this hospital, it had such an impact on the world. As you may know, this famous article was published in 1929 in JAMA, describing a patient taken care of here in 1928, in the fall of 1928, the first patient with polio to be treated with mechanical ventilation. It was a young girl who was dying of polio, had respiratory failure. And one of the pediatricians here at Charles McCann went next door to the Harvard School of Public Health. This was now the infant's hospital was sold when it merged with children's hospital in 1922. It was sold to the Harvard School of Public Health. And that became the first Harvard School of Public Health site. On that building was where Philip Drinker was working. He was a chemical engineer and not a doctor. But he was doing plethysmography on cats and animals and doing respiratory studies. Dr. McCann said to him, gee, if you could do these measurements in animals, can you build one of these big plethysmagrassarats? Because maybe we could ventilate a child in it. And in fact, this is a picture taken on the roof of what was then the infant's hospital, the Harvard School of Public Health, with Dr. Drinker himself in one of his prototype iron lungs with his technician showing how you could put a patient in just the head sticking out, create negative pressure and ventilate a patient. This is from his article in 1928 showing the first patient in the world at children's hospital in Boston, who had polio who received an iron lung. He describes in dramatic fashion, this was a young eight-year-old girl who was dying of respiratory failure. She became blue and cyanotic. This was in the days, no pulse oxymeters or blood gases. But she was blue and she became unconscious. And they put her in this prototype iron lung and she immediately woke up and became pink. In fact, a few hours later, she was asking for ice cream. And the reports are that people in the room were crying because it was very dramatic. Unfortunately, she did not live. She died about eight days later of pneumonia. This was in the days before penicillin. But it proved to the world that you could use mechanical ventilation. And in fact, the second patient was a patient. Drinker brought his iron lung over to the Peter Bent Brigham hospital, ventilated a young man over there and he was a survivor. And within months, these iron lungs were all over the world. As you know, we have one out in the lobby. It was moved today. It was actually moved yesterday, just for today, for tonight's Champions dinner. The iron lung that we have out there is moved to downtown. It'll be put back tomorrow. But when we restored this iron lung that's out in the lobby, we made a little video about it, how it works in history. You could find it on YouTube if you just Google Children's Hospital and iron lung. We actually put a respiratory therapist in it and showed how you could ventilate people and have a whole thing works. And then of course, we're in the Enders building now. And this is John Enders, who was here. Not a physician, another non-physician. He was the head of microbiology here in the 1940s. He's the one who did the pioneering work that led to culturing polio vaccine in tissue culture, human tissue culture. Before that, you had a culture in monkeys, pass it through in animals. It was very complicated and expensive. He's the one who did it in tissue culture. And he's the one not so all can save. And John Enders, you've got the Nobel Prize in medicine for this pioneering work was led to the polio vaccine. He got the award in 1954. Interestingly, he shared the award with two of his pediatric house officers here who were working the lab with them at the time. They obviously went on to pretty distinguished careers themselves, Thomas Weller and Frederick Robins. Now, this is what the hospital looked like in 1951. A few people in this audience were actually even alive then, who might remember this. The Honeywell Building, again, with this cottage ward still here, the Infants Hospital is now the school of public health, because the Infants Hospital now was that they built another ward to house the infants when it became part of children's hospital. But the wards are here. The beta building still here. An extension was put on. The Peter Ben Priggum's back here. They haven't put the big Brigham and Women's Tower yet. Here's Harvard Medical School. Here's Vanderbilt Hall, the dormitories. Here's the Gardner House. Where the hospital's main building is now was a power plant. But this is what it looked like in the main entrance to the hospital was over here. Now, it was pretty crowded even then 1951. This is what it looked like in the clinics. And this is a traffic jam outside what's now the Honeywell Building. You can see this is the Gardner House. This is right under where now the bridge, the Skywalk, connects the hospital. But we had traffic jams even then. And again, 30 years later, the hospital needed new facilities. So by the end of the 1950s, the Farglie buildings built. Most of the cottage wards were torn down. This building was bought back by Children's Hospital from the Harvard School of Public Health. When the Harvard School of Public Health moved farther down the street, this became the Wallbach Building, the hospitals administration building. This became the new building to house most of the new patients. And then this eventually became the Prairie Garden. Children's also had a lot of other facilities though. When patients here needed long-term care, they shift them out to the suburbs. And patients often needed to stay in the hospital long time. Not a whole month for a broken arm, but they'd often stay weeks after a simple operation to get fed and recovered. And recovery, this is the Wellesley Convalescent Home that children's owned. It used to take care of its patients. This was another building children's eventually merged with. This was the Goods Mariton Hospital across the street where now the Dana Farber is. This building doesn't exist. But it took care of a lot of patients with heart disease, including children with rheumatic fever. And this is a patient with an early EKG machine. Children's also merged with the Sharon Sanatorium in the suburbs who were taking care of a lot of tuberculosis patients. And so a fuller house, it was a house taking care of death children. They all kind of merged into children's hospital. And in fact, as you probably know the name of this place has changed many times. Remember before there was the failed children's infirmary in 1847-48, then we had the real children's hospital. When it merged with the infant's hospital, and it became children's and infant's hospital, then became the medical center, as it was absorbing some of these other hospitals and these little community things. It became the CHMC medical center, when officially most of these things were absorbed. This is where you get, when you hear CHMC, anesthesia foundation, other things. This is where this came from. The hospital's name was changed in 2000, not too long after the new clinical building opened in what, 1987, to children's hospital Boston. Then we again changed the name to Boston Children's Hospital in 2012. Now I just want to end. I know there's not a lot of time left, but I just want to, since we are on surgery and anesthesia ground, just highlight some of the leaders of the surgery and anesthesia department. And those Bob Shamberger's talked extensively about earlier this summer. There were some incredible surgical innovations that have occurred here. This is William Ladd, the first chief of surgery here, the Children's Hospital, around the time of World War One. He was actually one of the first pioneer physicians to give up his own practice and move into Children's Hospital and conduct this full practice here. He began the Department of Surgery here formally, became a chief of surgery, and obviously is very famous for doing a lot of neonatal surgery and phallic yields and esophageal adresions. Things had nobody else was touching at the time. Ladd's bands were named after him and as the surgeons undoubtedly know, there's an annual award given out for distinguished pediatric surgeon by the American Academy of Pediatrics every year called the William Ladd Medal. His chief resident and subsequent successor was Robert Gross. Another amazing physician, another Harvard Medical School graduate, who worked with Dr. Ladd and was a pioneer, really started cardiac surgery. He did the first successful congenital heart surgery, became a chief here as well. And when here's Dr. Gross in his later years before he retired and cardiac surgery was then taken over by Aldo Castaneda, an amazing human being who came from Minnesota, where Cardiopominary bypass was invented and took over the Cardiac Surgery Division here. And Judith Folkman took over the General Surgery Division. Julia came from the MGH and another amazing human being. Judith was the chief here of General Surgery when I first arrived here in the early 80s until he gave up his clinical position to focus more on his pioneering work in angiogenesis in the laboratory. He was succeeded by one of Dr. Gross's former trainees, Hardy Hendren, shown here. And this is one of my favorite pictures of some of the people who are in this audience now who Hardy Hendren trained and who have subsequently gone on to lead the department. So here next to Dr. Little, a young Dr. Lilahai was Dr. Hendren's successor, Dr. Bob Schamberger. And looking down here you can see some other familiar faces including a young Dr. Steve Fishman. There's all these folks who went on to very, these are Hardy's chief residents, amazing group of people who led lots of plays. J. Vicante headed the children's surgery division at the MGH for many years. And Scott Adziak is still the chief of surgery at CHOP now as well, but all of them tremendous group of people. Now Hardy shared this with me. It's one that some of you may have seen this. When Hardy was the senior resident here in 1955, this was his paycheck. He got $9.40 a week. They basically lived in the hospital. There were no duty hours. So Hardy calculated that was eight cents an hour. He was getting paid as a house officer. So just a little house officer here, keep in mind when you're having a bad day and you think you're working. You're thinking you're working too hard. Now just a couple of comments about anesthesia too. As you know, anesthesia really was introduced to the world in Boston. It's probably Boston's greatest contribution to medicine. The ability to relieve the pain of surgery with ether. This is from the famous painting that's now in the county library, but it describes the first anesthetic given at the mass general in 1846, one year, just a few months before the children's hospital and firm are opened in downtown Boston. Here's William Thomas Green Morton, a dentist who's shown holding a glass bottle with an ether sponge in it. Here's the chief of surgery at mass general at the time. John Collins Warren doing this operation on the patient. With now the ether dome, you can still go visit. If any of you haven't seen the ether dome, you should. It's really an amazing and amazing place. It looks just like this. One of the surgeons in the audience, Henry Bigelow, a few weeks later, wrote up in the Boston Medical and Surgical Journal, this event. And within weeks, this was carried on ships to England and around the world. And within a few months, ether was being used all around the world. It was such a great advance. Imagine having surgery. What little surgery could be done in a few minutes with patients who were not anesthetized and how this was such a revolution in medicine. What's fascinating to me, though, is this is 1846. And you never hear about who was giving anesthesia after this. But it turns out when you read the early reports, Bigelow himself, the surgeon, started giving anesthesia after Morton showed his demonstration. So he took a neithers sponge and he would do it. But he didn't want to do this. He said, when the leading surgeon is at the MGH. So he passed it down to his junior surgeons. And they passed it down to some miles. They didn't want to do it. No one wanted to hold an ether mask. Here's a picture from our operating rooms in the early 1900s and over and hunting to the Huntington area. We still had the sisters here working with our nurses. You can see it's an orthopedic case. It is early 1900s. They're wearing gloves. They're not wearing masks, but they're at least wearing gloves. So it's the early 1900s. After the surgeon halted, he introduced gloves that John Hopkins mainly because his girlfriend and future wife was getting her handschapped from from washing her hands so much that he got e-mater's and gloves and they caught on everywhere. It was reduced infections. Here we don't know who this guy is doing the anesthetic. It's probably the intern could have even been the medical student because no one wanted to do this. They always passed it to the least qualified person in the room to hold the ether on. And actually this is a famous surgeon. You may recognize Dr. Harvey Cushing. He was a medical student here at Harvard in the end of the 1800s. He went on to go do his surgical internship at the MGH and then went down to John Hopkins where he basically invented the field of modern neurosurgery. Was recruited back to Boston in 1912 when the Brigham opened, Peter Ben Brigham, to be the first surgeon in chief there. But there's an amazing article and I have a moment. I just want to read it to you. From Cushing's biography, he's one of my heroes. He's an amazing human being. He's not only a great surgeon invented neurosurgery. He's an incredible historian. He wrote a biography of his mentor. Will you most like that? One of Pulitzer Prize. That's really a remarkable book too. But I want to quote to you from Cushing's autobiography because he described something his experience in 1894. So this is almost 50 years after ether was being used at the mass general all around the world. He's describing his experience as a medical student at Harvard being told to give an ether anesthetic and I'm going to quote. My first giving of an anesthetic was when a third year student I was called down from the seats. He's talking about the ether dome and sent into a little side room with a patient and an orderly and told the patient to sleep. I knew nothing about the patient whatsoever. I proceeded as best I could under the orderly's direction and in view of the repeated urgent calls for the patient from the amphitheater. Surgeons are screaming what's taken so long. It seemed to be an interminable time for the old man who kept gagging to go to sleep. We finally wheeled him in. The operation was started and at this juncture there was a sudden great gush of fluid from the patient's mouth, most of which was inhaled and he died. I stood aside burning with chagrin and remorse. No one paid the slightest attention to me. Although I suppose I had killed the patient. To my perfect amazement I was told it was nothing at all that I had nothing to do with the man's death. That he had a strangulated herniad been vomiting all night anyway and that sort of thing happened frequently and I had better forget about it and go on with medical school. He concludes I went on with medical school but I've never forgotten it. This is anesthesia for the first 50 years. Finally in the early 1900s a doctor in Boston, another surgeon Freeman Allen decides to devote himself to anesthesia. He became the first anesthetic physician anesthesiologist in the whole city. He was working at childrens, he was working at mass general, he was working at the forerunner of the Peter Bentbury them, the free hospital for women. This is his portrait that changed up at the MGH. This is from the annual report at Children's Hospital describing 1903. It's the first time there's a niecesist listed Freeman Allen. This is Freeman Allen as an infant. He's a remarkable guy. He's here with his grandmother, Harriet Beecher Stowe, the famous abolitionist who wrote Uncle Tom's Cabin, the most popular American book sold in the 1800s around the world from America. It's when Abraham Lincoln met Harriet Beecher Stowe at the time of the Civil War, he allegedly said to her, so here's a little woman who wrote, who years a little woman who wrote that book that started this war. She was from the distinguished family and this is her grandson Freeman Allen who went on the Harvard Medical School and became the first anesthetic physician in Boston. A few years ago a couple of us wrote up his amazing story because it really is an amazing story. Not only did he come from the Harriet Beecher Stowe family, but he married the great granddaughter of John Collins Warren, the surgeon at the mass general who gave it was there for the first ether operation. So he comes from two of the most famous prominent families in Boston, went on to an amazing career. But the problem was he couldn't interest. He would do complicated cases at these hospitals, but he couldn't get any medical students interested in anesthesia. So he did what he needed to do, which was to train nurses to do it. And in 1914 you see, children's hospital logbook, we have our first nurse Edna Fryer as an assistant. And in fact nurses were doing most of the anesthesia here for the next couple decades. That was true at mass general, all the hospitals in Boston doctors didn't want to do this. Here is the children's hospital chief nurse in nested system, the 1930s Betty Lank, an amazing woman. She was here when there were no physician giving anesthesia. She did some amazing operations with gross and some of these pioneering operations. She lived to 95 years old, I interviewed her when before she died in 1999, she had an incredible memory, was a remarkable person, describe what it was like trying to do some of the surgery here with with ether. I wasn't until after World War II that a physician was appointed to be chief of anesthesia here at Boston Children's Hospital. And this is Dr. Robert Smith, the first anesthesiologist in chief here. He too was a surgeon. He was a Harvard medical graduate, had a surgical practice in cohasit. When World War II started he volunteered to be a surgeon in the army, but the army didn't need surgeons. They had a lot of surgeons that were drafted and volunteered. They needed an anesthetist. So they did what they did for a lot of surgeons. They sent them to what they called 90 day wonder courses. They sent them down to a military hospital in 90 days to a anesthesia and then appointed them chief of anesthesia of patents army in Europe. And he spent the war years in Europe doing anesthesia mainly for war victims. Came back after World War II didn't have a job like anesthesia. So they appointed him to be the first physician chief here and he worked with Betty Lank until her retirement in 1969. She taught him a lot about pediatric anesthesia. Indeed taught her a lot about the science of anesthesia and how to advance the field. A really remarkable guy. And just like there's a Robert William Ladd award for a pediatric surgeon. There's a Robert Smith award by the American Academy of Pediatrics for Distinguished Pediatric Anesthesiologists that we were named after Dr. Schmitt. Now interestingly at the other hospitals in town surgeons also with a first anesthesiologist. At the mass general after Freeman Allen died he died in 1930 of a tragic death. Henry Edward Churchill the chief of surgery at the NGH appointed Henry Nol's feature one of the surgeons young surgeons to be an anesthetic chief and he became the first professor of anesthesia in the United States and led the Department of Anesthesia at the NGH. The first surgeon at the Peter van Brigham Hospital the first anesthesiologist was also a surgeon. We were Ivan and Tam who had been at the BI who got blind to develop the disease and blinded in one eye and he decided to leave surgery and go on anesthesia. So there's this long standing history of close association with surgery in anesthesia. In fact the development of the field of anesthesia is largely due to our surgical colleagues. And after Dr. Smith Robert Smith stepped down in 1980 the second anesthetic chief here was Dr. Milk Alper he was appointed in 1980 he was the chief of anesthesia at the LINE in hospital. He was an OB anesthesiologist not in pediatric anesthesiologist but he was a wonderful man, great administrator. He was hired here when the Brigham merged and the LINE in no longer existed. He was out of a job. They appointed him here and he recruited a young department at the time. This is the early 1980s. There were four nurse anesthetists in the department. You can see this young staff some of whom are still in the room. Some of us even had hair then. A couple had dark hair including the next chief of the department who took over for Dr. Alper, Dr. Paul Hickey standing here in the back. So the anesthesia department has only had a few chiefs in its history. Now in the I know our time shorts so I'm just going to end with these last couple slides. This is one of my favorite stories of all of children's also many of you have seen this. This was the famous Lorraine Sweeney Nicole, a young girl seven years old in 1938 who was dying of congestive heart failure. Had a patent ductus arteriosus and Robert Gross the chief resident knew he could fix this. His boss William Ladd refused to let him do it. He said you'll violate the sanctity of the human heart. No one's ever done congenital heart surgery. So what is Dr. Gross do? He waits till his boss is on vacation in August of 1939. He brings the young patient into the operating room and does the first successful operation for congenital heart surgery. This is from Dr. Gross's up note. He wrote this is his picture that I copied of the PDA and when he put a ligature on it. This is a copy of Betty Lang's anesthetic record. Case took a little over an hour. No a lines, no pulse oxymeters, no endotracheal tube lateral position by mask cyclopropane. She was terrified. She told me when I showed her this record she remembered the whole case to see when the PDA got ligated the pulse pressure comes down. In any case this is a picture I took just this summer at Fenway Park. This is that patient Lorraine Sweeney Nicole. She's going to be 89 next month. The first successful survivor of congenital heart surgery at Fenway Park when Boston Children's was honored and Kevin threw out the first pitch and Sandy and Kevin were out in the field with a number of patients. She came in. This is her with one of her sons, her grandchildren, and her two great-grandchildren. So to me it's a wonderful example of the impact made by those who work at Boston Children's which extends far beyond the treatment of just our patients to actually to many generations and provide so much hope for the future. So in conclusion I wish there were time to tell more stories and talk about so many of the other people who've done so many things. But I want to conclude by just saying what a great personal pleasure it's been for me to work for the past 38 years with such amazing colleagues who've contributed in so many ways to the care of children and to this remarkable institution. Thank you very much. I know time's late so if I'm happy if anybody has any questions to stay here at the end. Thank you.