The Philadelphia State Hospital at Byberry: A History of Misery and Medicine (Landmarks) (PA)
Page 6
A big portion of the fighting was over where to build the gigantic fairgrounds that were planned. One location suggested was along the city’s new Northeast Boulevard (Roosevelt Boulevard), near Pennypack Circle. This would showcase some of Johnson’s work along the highway, such as the new Shriner’s Hospital for Crippled Children. It would have also changed Byberry’s course by forcing the city to fund more of Johnson’s buildings and keep a closer eye on Byberry in light of its featured location. But the South Philly–bred Vare Machine eventually won out, and the city chose to hold the fair on swampland south of Oregon Avenue that it would have to pay Vare contractors to fill in prior to any construction. The “Sesqui” was a flop, and the city lost face as well as money.
After the storm the exhibition brought to town finally blew away, the city approved a $1.2 million appropriation for new buildings at Byberry, and the finishing touches were put on. In 1928, the building for tubercular male patients was added to west end of the East Group. The one-story structure featured airy porches, wheelchair ramps and room for two hundred patients, although the hospital needed room for almost eight hundred. Again, a structure designed before the population boom that followed the war, the new building was antiquated, old-fashioned and inadequate for the hospital’s needs.
The Doctors’ Residence followed. Ornate, airy and roomy, it featured luxurious apartments for the doctors and physicians. The Male Attendants’ Home, however, was spared much more expense. Attendants for the East Group lived in a condition similar to that of the patients they cared for: crammed together. Two stories in height and very unaccommodating, the attendants’ home filled up fast. The two new buildings for male staff were located on the east side with the male population, but some attendants still lived in the Carver House, despite the construction of the new quarters.
Female patients in clothing shop, circa 1933. Pennsylvania State Archives, RG-23.
In 1928, Philadelphians elected a flashy, smooth-talking new mayor. Harry Arista Mackey began his career as a football player. He later became a coach and, through his public highlights, finally became a lawyer. Mackey was a Machine man and had gotten elected on the backs of the utility companies. As mayor during the stock market crash and the beginning of the Depression that followed, Mackey was surely dealt a tough hand. But his true strength was his magnificent showmanship. During his first two years in office, he managed to jump around the Byberry situation, but whether or not he had true knowledge of the conditions that were beginning to fester when he took office is not clear. He certainly spun the situation in a positive light when questioned about the hospital’s problems. “I admit we have crowded conditions, but no insanitary conditions,” he told reporters. “The patients get as much care as if they were millionaires.”
Philadelphians liked Mackey. Public sentiment was usually on the mayor’s side, and he played the role perfectly. “Hardly a week goes by that I do not visit the hospital,” he claimed. “The patients will tell you that I am the only mayor who ever went out there and shook their hands and inquired about their health.” For all his talk, however, Mackey proved little more than a showpiece for the Machine, incapable of softening the blow on the hospital’s frail infrastructure.
Mackey, under the guidance from his Machine puppeteers, was pressing for a way to replace Dr. Barr as superintendent and replace him with one of their own. Barr was not interested in the Machine’s gifts, only in running his hospital. He made the siphoning off of Byberry’s budget very difficult for the Machine and thus presented an obstacle. While Mackey turned up the heat on Byberry, making inquests and inquiries, Barr remained confident that his administration would show no flaws. Director of the Department of Public Health Dr. A.A. Cairns had reasons of his own to oust Barr. Cairns came up with Krusen and Johnson and had loyal Gang connections.
After the city controller’s report surfaced, Dr. Barr’s “miscellaneous” fund was brought to light and used as the fatal weapon against him. The miscellaneous fund was made up of cash taken from patients upon their arrival. The fund was supposedly used to disperse money to patients at their request and for their care. However, the city controller’s recent account of the hospital’s books showed that the fund was being used as a personal bank for a few of the top staff. Barr himself was brought into the spotlight, and he was intensely interrogated. The fund, Barr claimed, was only used for patient care and supplies. But the controller claimed that the account was thousands of dollars short.
Doctor’s Home, 1935. Pennsylvania State Archives, RG-23.
Although he was cleared of any knowledge of the fund’s misuse, the heat ultimately led Barr to resign, along with assistant superintendent Stephen L. Smith. Barr transferred to the Chester County Hospital at West Chester, where he received a marked increase in salary. Both men cited tight constraint and lack of cooperation from city hall as their reasons for transferring. Smith addressed the decision, stating, “Both Dr. Barr and I wanted to make Byberry the finest hospital of its kind in the country, and if they had only let us alone, I think we would have done it.” Smith continued, “I’m a little heartbroken about it, I suppose. But when it comes to the point where a man in charge of an institution like this cannot engage an assistant of any kind without getting a ward leader to vouch for him, it’s pretty bad.”
Smith was aggravated by the Machine’s hold on the hospital he so desperately wanted to mold into a top-notch institution. Smith also cast some of the blame on Dr. Cairns for not having a stronger grasp of the situation. He stated that Cairns honored political favors, although probably forced to do so. Giving some examples of political favoritism, Smith referenced at least seven instances he had documented of staff connected to the Machine.
In 1927, according to Smith, an employee was discharged for drunkenness and failure to report to work. He was re-hired a year later and, after only months, was discharged again for improper conduct to hospital guests and, again, drunkenness. Hired back yet again, the employee was finally discharged a third and final time for being intoxicated on the job. “Many of the clerical employees are out-and-out political appointees, sent here with absolutely no regard for their ability to do the work they are intended to do.” Smith said. “One of the younger physicians, who was without his license, was ordered to remain. His brother-in-law was a member of the state legislature. He was not only permitted to stay, but he was given the maximum salary increase as well. In this particular case, this man’s wife was kept on the payroll as a laboratory technician, yet she is here very little, perhaps ten or fifteen minutes a day.”
In March 1929, the new Nurses’ Home was dedicated on Southampton Road, facing the West Group. Almost identical to the male attendants’ quarters, this building graciously housed the hospital’s nurses, due to the fact that there were but a small number on staff. There was no building for female attendants. They lived on designated wards in the patient dormitories on the West Group. This became a problem as more attendants were hired, forcing the patients to live in attics, basements and hallways. It also prevented attendants from ever having visitors or much of a home life at all, contributing to their sinking job performance. Once completed, the new staff buildings were already inadequate to the hospital’s staff population. Additional buildings were already being asked for.
Still without a permanent administrator since Barr’s resignation, public health director Cairns recommended Dr. James P. Sands for the superintendent position at a salary of $5,500 a year. Sands had been the clinical director at Friends Hospital. He was renown as a caring psychologist and was a personal friend of Cairns. It seemed the Machine had found its next figurehead. On November 18, 1929, his appointment was approved by Mackey and Cairns. Meanwhile, Mackey denied any political motives for Barr’s resignation, but it seemed like a smokescreen. “I want to assure you that the despoiling hands of politics will never enter the hospitals in the city,” Mackey said. “No multi-millionaire could purchase more science or care than is being given at the Philadelphia Hospital at B
yberry.”
In 1929, Mackey made a bold request to the Finance Committee of City Council for $5 million for the erection of new buildings. He received only $650,000, enough to construct an additional residence for physicians, an addition to the nurses’ home for female attendants and an enlargement of the sewer plant. It was still possible to request funding from the City, but the Wall Street crash would soon slow it to a drip. The fragile public was nearly recovered from the shocking stories coming out of Byberry when it shot to the front page again.
Three patients died under circumstances that the coroner called “mysterious.” One was a twelve-year-old girl, Mary Matysik, who became tangled in her restraints and choked to death. The other two seemed less like “accidents,” as classified by the hospital. One was twenty-three-year-old Anna Alter, who plunged from a roof. Dr. Cairns demanded a deeper probe and told investigators, “Press the investigation to its end regardless of whom it hurts.” The lack of staff proved to be the reason for Matysik’s death. The attendant in charge of her ward admitted tying Matysik “to prevent her from biting herself.” The first investigation showed that a number of patients had been placed into attendant positions to fill the gap. Apparently only one paid employee was in charge of the children’s group. The majority of the children’s caregivers were patients themselves.
In January 1931, a case was brought before assistant director of public health George Knowles that he called “incredible—almost like fiction.” Sixty-year-old Charles J. Lewis, of Baltimore, was found wandering the city in 1926 in a “dazed condition” by police and sent to Byberry. He had wandered from his home in 1924 and was pronounced dead. His identity only came to the attention of Dr. Cairns when he found a set of safety deposit box keys and bank account information for one Charles J. Lewis of Baltimore. Lewis’s family was notified, and they were ecstatic. He was finally released to them, along with his property, in 1931. No hospital official was linked to a plot to withdraw Lewis’s $3,724 upon learning of his deceased status…but it was an unmistakably Byberr-ian move.
Dedication of Nurses’ Home, 1929. Temple University Urban Archives.
As construction continued on the new staff buildings, Dr. Cairns tried to raise public awareness of the overcrowding by giving an interview with the Evening Bulletin. He spoke of firetrap buildings, lack of food and, perhaps for the first time, the ever-increasing overcrowding. Cairns gave some specific examples of the hazards of life at Byberry. “Hoseington House, where a number of old men are cared for, is a disgrace to the city,” he said. “It is really nothing more than an old barn. It would go up like powder if a fire started there. It is not safe to use it another day, but we have no choice, because there is nowhere else to put the patients who occupy it.”
Aside from dozens of instances of fire hazards, Cairns noted that the population of the hospital increased by about 350 patients a year and that the situation was getting dire. “It is difficult for persons not familiar with conditions at Byberry to realize just how bad they are,” he said. “A casual examination would shock almost anyone because of the overcrowding. There are other effects of the overcrowding that are just as serious, although not quite so obvious. We are obliged to keep in the infirmary of the men’s hospital idiot boys of fifteen and sixteen who have no business there at all.”
The hospital’s reputation was beginning to circulate, and as it got stronger, it repelled more would-be attendants from applying. Dr. Cairns took note of this early, and his prediction that soon it would be next to impossible to find anyone willing to fill the needed positions was more true than he knew. “With the conditions as they are now, when there is no provision for the medical staff and doctors are forced to sleep with patients, it is impossible for us to get physicians. At the present moment there are seven vacancies for physicians at the hospital. Although we have appropriations to pay these salaries, we cannot get men to take the posts because there are no suitable quarters for them.”
On March 31, 1931, Cairns’s meeting took place in the mayor’s reception room. Present at the meeting was Dr. Sands, Welfare Secretary Nellie Orr, architect Philip H. Johnson and director Cairns, who was receiving a good portion of the blame for Byberry and was anxious to clear the air. He still had a strong desire to see Byberry thrive and was not altogether devoted to the Machine. Mackey, however, had finally been cornered on the issue by a pressing group of civic leaders. In February, the Reverend Dr. Harry Burton Boyd, pastor of the Arch Street Presbyterian Church, slammed city officials for Byberry’s condition from his pulpit. Speaking to his congregation, Boyd’s statement was printed and subsequently broadcast on the radio. It reads as follows:
The mattress shop on the East Group was one of the only forms of recreation for male patients, not to mention the hospital’s only mattress supply, circa 1940. Pennsylvania State Archives, RG-23.
No one is interested in cleaning up the mess, insane folks do not vote. The conditions at Byberry are a disgrace to Philadelphia. For several months Byberry has rested under a cloud. Charges both veiled and open have been made about conditions there. Two patients died under circumstances that call for investigation. The Director of Public Health promised to make any change necessary, then backed away from the mess. Mayor Mackey stated that the helpless insane should not be exploited. He promised to remove the lid. He did—took one look at the mess and then retreated. A committee of doctors was asked to investigate and report. Their report was naive and politic. In the meantime the City Controller began an audit of the books and uncovered irregularities and suggested changes in the personnel. His suggestions have been ignored.
No one can dispute that the hospital is overcrowded and understaffed with nurses and physicians. New buildings are needed and a larger support from city funds required. No one doubts that its complement of employees is filled with political hangers-on. Members of City Council go out of the way to destroy the morale of the police department. They publicly and in disgraceful fashion vent their political spite on the Director of Public Safety. In the meantime, the insane poor of the city and their relatives hold out their hands for pity. No members of City Council will champion their cause. The Mayor and Director of Public Health have abandoned them to their fate. Will the church members of Philadelphia keep silent any longer?
Mackey responded to Boyd’s charge with a somewhat pushy letter inviting Boyd to city hall to discuss the matter. He acted as a true Machine man, totally unafraid. Mackey almost threateningly told Boyd he would invite “the committee of ten physicians, who have just investigated those conditions,” to “hear your criticism so that you may point out to them wherein their report was ‘naive and politic’ as you stated yesterday.” Seeming to get angrier while dictating the letter to his stenographer, Mackey continued:
Thomas Boyd (left), acting for Philip H. Johnson, gives Nurses’ Home keys to Mayor Mackey in 1929. Dr. A.A. Cairns looks on at right. Temple University Urban Archives.
I will ask the Controller to be here also, so that there will be no mistake about what his report to us is, and you can point out to Director Cairns and myself wherein we have “abandoned the insane patients and their relatives to their fate.” You can point out in the presence of these responsible officials the facts upon which you base your conclusion, as you are quoted in the papers, that “no one is interested in actually cleaning up the mess,” and that “the dependent insane have become victims of political jobbery.”
Boyd’s response was humbler:
Permit me to suggest that you act on the evidence directly in your hands before you call another conference. I do not question the kindness of your heart. I merely desire that you translate sentiment into action. When you are ready to act on the evidence you have I shall be glad to assist you to the best of my ability. Until then I respectfully decline to attend any conference on Byberry.
Boyd wasn’t the only one, however, who wanted an investigation. A loyal reformer, Dr. Cairns pressed for his own personal investigation. He called for changes in staff
, new buildings and an accurate system of patient records. The results of his investigation turned up new cracks in Byberry’s infrastructure. The number of staff proved highly inadequate for a hospital of 5,400 patients. The total number of qualified physicians on staff was fifteen. On the female side, it was found that only two physicians were in charge of 2,300 patients. There were no clinical positions on file, and the clinical duties were handled by the chief physician and his assistant. There was no consulting staff. With a total of 216 attendants, the attendant turnover rate was 40 percent. There was no adequate pharmacy department. The hospital’s drug supply was handled by a single part-time employee who was only there several hours a day. There were three Hydro-Tubs for 2,300 females and six for 3,100 males. Pressing further, Cairns demanded city controller S. Davis Wilson—a seemingly loyal Machine man—to report on Byberry’s financial situation.
The controller’s report showed what everyone knew it would: gaps and shortages. The “effects fund” was made up of money taken from patients upon their commitments. It showed a shortage of over $1,600. The storeroom was terribly mismanaged, with no accounting system in place at all. When the auditors of the investigating committee requested a copy of the 1929 inventory, they were told it had disappeared—yet it mysteriously showed up two years later. It was found that $24,000 in supplies from the storehouse was stowed away in the basement of one of the farmhouses in the East Group, conveniently located only feet from Southampton Road. The payroll system was being taken advantage of, having only required a signature—apparently anyone’s signature—to collect an attendant’s wage. Wilson alluded to charges that Byberry had become an open market for the sale and use of alcohol. But whether Wilson felt any awkwardness is a curious point. Just a few short years earlier, Wilson himself had been palling around with the same men who had been dipping into Byberry’s lifeline of funding for their own personal gain, and almost assuredly he had benefited in one way or another from the hospital’s misery.