MedHum Monday Book Review: Boston Floating Hospital

bostonfloating_coverThe Boston Floating Hospital no longer floats. Now part of the Tufts Medical Center, the Floating Hospital for Children is solidly rooted on Washington Street in downtown Boston. Founded in the late nineteenth century, it started life as a boat. In The Boston Floating Hospital: How a Boston Harbor Barge Changed the Course of Pediatric Medicine (2014), Lucy Prinz and Jacoba van Schaik tell its story with extensive references and illustrations with chapters on its contributions to pediatrics including its development of infant formula and early emphasis on family-centered care.

Departing on fair summer days from its mooring in East Boston to pick up patients at Commercial Wharf and cruise the Boston Harbor, the Floating Hospital served poor Bostonians with free medical care from 1894 until 1927. Its founder, the Reverend Rufus Tobey, had often observed parents taking their children out onto the Dover Street (or South) Bridge in an effort to get them some fresh air during the heat of the summer. As infant mortality regularly peaked in Boston during the summer, Tobey sought a way to help his parishoners’ children improve their health and survive in the face of widespread, life-threatening communicable diseases. Although the Floating began as a charitable foundation, it quickly became a vital part of Boston’s healthcare landscape.

The Boston Floating Hospital is the first full-length history of the Floating up to the present day. Along with Children’s Hospital, located across town in the Harvard Medical Area, it plays a key part in the city’s children’s healthcare network. Over a decade in its writing, The Boston Floating Hospital draws on archival sources, photographs, and oral histories to tell the story of the Hospital and the people who worked in it. The history of the Hospital sits at the intersection of a number of topics in American medical history, including the fresh-air movement popular at the end of the nineteenth century, the development of pediatrics and neonatal medicine as specialties, poverty’s effect on health, and immigrant politics. This book serves as a jumping-off point for research that would deepen and broaden the history and historical context of the Hospital laid out in this volume.

Tobey, a prominent Congregational minister in Boston, was inspired to consider using a boat as a hospital by the success of the Emma Abbott hospital ship in New York City. Operating since 1875, the Abbott provided day trips and medical care for children and mothers. Doctors stationed on the vessel could opt to send children into the hospital if they felt their outpatient services were insufficient. Tobey and his fellow founders followed this example when they purchased the barge Clifford and began their trips in Boston Harbor in July, 1894.

At that time, the ‘fresh air movement’ was enjoying growing popularity at the intersection of Americanization and public health. Started in New York City in 1877 by the Reverend Willard Parsons, the movement was originally a fairly small-scale attempt to get children away from the city’s slums and out into the countryside for up to two weeks at a time. Placed with host families, the children were supposed to soak in the ambience of rural America. According to medical historian Julia Guarneri, the theory was that the children would enjoy the healthful benefits of the time away from their cramped, city homes and at the same time reap the benefits of cultural exposure to “real” America. Since the majority of the children were either immigrants or first-generation Americans, much like the children served by the Floating, Parsons’ idea included a not-very subtle agenda of de-ethnicization for the children who took part.

Although never part of Parsons’ project or the larger organization that was founded as its country trips became more popular and successful, the Floating Hospital benefited from widespread public support for giving children access to an unpolluted (read: non-urban) environment. Given that its patients were mostly immigrants, many of the same anxieties that applied to New York City children were being felt in Boston. Were first-generation children really Americans? Could immigrant children become Americans? What undesirable traits — physical or mental — might they have brought with them or inherited? Medicalizing the problem of immigration and immigrant differences was one approach: medical science could ‘cure’ the children of their ethnic differences while at the same time reinforcing or improving their physical health. Parents could be taught the value of medical science and proper “American-ness” could be, almost literally, given in a pill.

While undoubted concern for the ailing children was evident in many of these projects including Parsons’ fresh-air trips and Tobey’s hospital boat, contemporary worry about the threat to the larger community should not be overlooked. These ill or potentially ill newcomers were a threat to the larger population in more ways than one. Cases such as Mary Mallon’s (better known as Typhoid Mary) were part of the collective imagination surrounding immigrants. Offering low cost or free health care as an attempt to obviate this situation wasn’t always easy to offer, nor was it always easy to get accepted. For immigrants coming from the United Kingdom particularly, ‘free health care’ could be read as ‘workhouse infirmary,’ usually the last and humiliating stop on the way to a pauper’s grave. Making it clear that the Floating Hospital was not a ferry to the poorhouse and that the staff aboard expected to help parents rather than lecture or reform them was an important step in the success of the Hospital’s project.

The Clifford‘s early cruises took parents, mostly mothers, and children around Boston Harbor. Free tickets were issued at the gangplank on the basis case evaluations by volunteer nurses and physicians. A simple lunch was served on board, but sick children were fed more frequently. That the boat’s services were used by 1,100 children during the first year, gives an idea of the need for such care in the city. In 1906, a larger vessel built to accommodate better facilities, more children, and a larger staff, docked at the North End Pier. The cruises were meant to provide basic medical attention for the child and a restorative treat for mothers who had only one or two children. Mothers with more children entrusted their children to the staff onboard. In its second year of operation, the Floating acquired a small surgical ward and could do some minor operations directly on the boat.

Like the fresh-air children sent from New York City into the countryside and the passengers on the Abbott, the children served by the Floating mostly came from the poorer, immigrant-heavy areas of the city, particularly the South End and cheap waterfront housing, notorious for poor environmental conditions. The passengers suffered from a wide variety of conditions: tubercular infections, malnutrition, rickets, and especially diarrheal infections, which so inflated the infant mortality statistics during the Boston summer.

The Floating Hospital came into being at a pivotal time in the medical field when specialties were coming to the fore after a century spent working out the rough dimensions of professional boundaries. Forensics, geriatrics, obstetrics and gynecology, and pediatrics were all beginning to take their modern shapes as fields of study. In addition to providing patient care, he Floating became a site for teaching nurses and physicians. Partnering with Tufts Medical School, it was accredited as a teaching hospital in the late 1920s. Having established an on-shore hospital in 1916, the Floating was forced ashore when its vessel was consumed by fire in 1927. Its position within Boston’s land-based medical-school community only strengthened as it enlarged its footprint. It is now the principal pediatric teaching and research institution for the Tufts University School of Medicine.

This first published history of the Floating Hospital is, if anything, too brief. It is hoped that historians of medicine and hospitals take its publication as an opportunity to further explore the institution and its relationship to the medical histories within which it is inextricably bound.

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