A History of Hudson Valley Healthcare
By Anne Pyburn Craig
In Colonial times, doctors were few and far between, traveling from settlement to settlement to offer what treatment they could—which wasn’t much, by some standards. Germ theory and anaesthesia were nonexistent; many of the theories that did exist about the human body were drawn more from philosophy and imagination than from observation or experiment.
Doctors who hoped to actually help people studied up on herbal preparations and anecdotal indigenous knowledge. We don’t know much about most of them, but thanks to historian Brian Altonen, we know a good bit about Dr. Cornelius Osborn, who served Dutchess County and the Hudson Valley in the 18th century. Osborn probably apprenticed with another Hudson Valley-area doctor whose identity is lost to the mists of time; he had no degrees—the first medical school in North America, New York’s Kings College, didn’t open until 1768. He was the first known physician to establish permanent residence in Dutchess County, settling in what’s now Fishkill around 1744. In 1745, he was entering into agreements with neighboring landowners to treat their families for 20 shillings a year. He studied works on chemistry, pharmacy and diagnostics written by royally appointed British physicians, was conversant with the current theory on techniques such as bloodletting and blistering that were believed to re-balance the “humors” of the body, and knew how to craft medicines from local plants; much of his herbal knowledge was passed on to colonials by indigenous residents. Altonen thinks Osborn probably patronized Mary Colden, a doctor’s daughter and acknowledged mistress of North American botany who lived in Orange County.
Well thought of around Fishkill, Osborn wore himself to a shred trying to stave off epidemics as a Revolutionary War field surgeon and died before the peace treaty was signed. He left behind a manuscript outlining for his son his best practices. It demonstrates, writes Altonen, “a proficient working knowledge of botanicals, due to his exposure to the classic herbals along with the teachings he received from local well-trained herbalists.” In that era, a Dutchess County resident with access to a doctor who knew what to do with aloe, Epsom salts and sassafras was a fortunate soul.
As the 19th century and the industrial age took hold, so too did the “professionalization” of medicine, meaning that people like Osborn and the midwives and herbalists he learned from were marginalized. (Mind you, the professionals were still peddling bloodletting and blistering.) The first woman physician was immigrant Elizabeth Blackwell, first in her class at New York’s Geneva Medical College, who went on to found the New York Infirmary for Women and Children in 1857.
Florence Nightingale, who defied her privileged family to go be a battlefield nurse and health educator, brought nursing out of the dark ages and into an awareness of fresh air and sanitation several decades before formal medicine got the germ theory memo. The founding of Johns Hopkins hospital in Baltimore in 1889 is largely considered the beginning of American medicine’s entry into the scientific age.
Local hospitals were taking shape around the end of the 19th century. Vassar Brothers was endowed with $1 million in a bequest from a Vassar heir and opened its doors in 1887. “The million-dollar endowment left by the Vassars meant that no patient had to pay initially for hospitalization, but those who could, paid the full rate of $3.00 per day,” reads the institution’s official history page on the HealthQuest website. “By 1913, over 1,200 patients had received treatment.”
The Kingston Hospital, now the HealthAlliance Broadway Campus, was founded in 1894. In 1903, the Our Lady of Victory Sanitarium opened its doors on Mary’s Avenue in Kingston, funded by one Aloysia and her Benedictine sisters, offering hospital care for the sick and training for nurses and domestics. Also in 1903, Northern Dutchess Hospital saw its earliest beginnings as Thompson House, offering eye care, dentistry, orthopedics and a baby clinic. St. Francis opened its doors as a 30-bed facility in 1914. In our area and across the US, hospitals were recognized as an important community resource, endowed by the wealthy and expanded with funds raised from the prosperous.
Bylaws of the American Medical Association had long forbidden any professional from working with an herbalist, midwife or other such “nonregular”. In 1900, there were 8,000 members of the AMA, which had been founded in 1847; by 1910, there were 70,000. Over in Europe, most nations had legislated health insurance by 1912. United States insurers balked—health was so hard to predict, they said—and the growing power of the AMA was wielded time and time again to oppose any legislation that might limit fees.
In 1913, a doctor earned not much more than a typical manual laborer. As a shiny new age of professional standards, medicalization and hospital care dawned that began to change, and by the time the Great Depression was in full swing that shiny new stuff had become unaffordable to the average person. In a sort of compromise play, Blue Cross and Blue Shield were born as not-for-profits.
Their existence had a lot to do with the tranquil sort of health care many of us remember from our mid-20th-century childhoods. During the Second World War, companies competing for scarce labor began offering workplace insurers, luring private for-profit entities into the game and giving birth to risk pools and rejection for pre-existing conditions, but opponents of universal health care were still able to squash Harry S. Truman’s national proposal by pointing to the nonprofits and saying everything was already just fine. Congress did manage to pass the Hill-Burton Act in 1946, tying expansion funding to a requirement that hospitals serve the needy for free.
LBJ came to Ellenville amid much fanfare in 1966 to dedicate Ellenville Hospital, the 6,635th facility built with Hill-Burton funds. Hill-Burton funding dried up in 1997, but around 140 hospitals nationwide are still obligated to provide free and reduced-cost care.
In 1973, Nixon signed the Health Maintenance Organization Act that allowed health care providers and insurers to function as for-profit entities, and the games began in earnest. Health care, which had been regarded as the sacred trust of service organizations, was now commoditized.
It’s anyone’s guess what will ultimately come of the current noisy debate; in the grand cycle of action and reaction, all this pain may yet lead to the realization that the Europeans, the Big Blues (who gave up their not-for-profit status decades ago), and Harry S. Truman were right: Everyone needs health care, no one can predict when the need will arise, and limiting care to the wealthy is barbaric. The Emergency Medical Treatment and Labor Act, requiring hospitals to at least stabilize and treat anyone who comes in, has existed since 1986—as an unfunded mandate.
Meanwhile, all those herbalists, nutrition counselors, touch therapists, and other such healers marginalized by the AMA have been making a comeback around the Valley. Initiatives like the nonprofit Rondout Valley Holistic Health Community, mobile clinics run by Healthcare Is a Human Right, and Kingston’s O+ Festival attempt an end run around the entire mess. And in today’s Hudson Valley, even the good Doctor Osborn—with the help of ingredients procured for him by early Hudson Valley botanist Jane Colden, not to mention clan mothers whose names are long forgotten—would suggest putting your twenty shillings in the small, hyperlocal column whenever you can.
Stay healthy, dear readers.