George Dunea, MD

This venerable hospital still exists, but in some ways it exists no more, because in 2002 it was renamed, rebuilt, and drastically reduced in size.  But some half a century ago it was one the largest hospitals in the world. It had a bed capacity of 4500, almost 100,000 admissions each year, and large crowds in the emergency room and outpatient clinics.  Its history dates back to 1832, when Chicago had 400 inhabitants and the city fathers built a simple wooden structure to isolate indigent patients with cholera, smallpox, malaria, typhoid, and scarlet fever. Two years later this burned down and had to be rebuilt. Other arrangements followed, including a general hospital in 1847 in a warehouse; a cholera hospital in 1854 when the city’s population had grown to 30,000; and in 1865 a larger hospital on its present site. This soon proved inadequate as thousands of immigrants were streaming into the city each month, mostly without resources and many in need of medical care. Additional pavilions were added as the population of Chicago continued to grow, to 100,000 in 1860 and one million in 1890. After 1912  more buildings were gradually added, notably a large main building that eventually became the center of a sprawling campus containing  separate buildings for pediatrics, psychiatry, infectious diseases, men’s  and women’s medicine, outpatients, research, nurses’ residence, a free-standing morgue, a power station,  a laundry, a garage, and a library housed in a residents’ dormitory  where generations of residents lived or took call from tiny rooms with no air-conditioning.

Almost from its inception the hospital became a training ground for future doctors. At one time almost all doctors in Chicago trained there, all leaving immensely proud of the practical experience they had acquired at “County”. The diversity of cases (“clinical material”) seen in this huge hospital was enormous; and doctors from other hospitals would come came to “walk the wards” and see illnesses they had never seen before. By the 1960s the hospital had a huge population of alcoholic cirrhotics, benign and malignant hypertensives, and a particularly virulent and noisy form of delirium tremens.  Later the complications of heroin and cocaine began to prevail, and in the late 1990s came the AIDS epidemic. Cook County Hospital established one of the earliest clinics for treating HIV.

 

Students serving clerkships at County traditionally received an excellent practical education. They took call every third night when they might have had to work up as many as ten cases, take a history and perform a physical examination, then in the ward side-rooms do a blood count, a urinalysis, and a bacterial stain before presenting the case to the attending in the morning. They and the interns were supervised by experienced chief residents who bore the major brunt of clinical decision-making, organization, and education. By necessity the interns and residents became tough and resilient, and learned to work the system.  In 1966 each intern still had only one syringe that he would use on everybody. They had to draw all the blood samples and walk them across the hospital grounds to the laboratory. To obtain a timely x-ray interns would write fictitious names in the appointment book, such as Joe Smith, then substitute the name of their patients when they needed the test, and then push them on carts through long subterranean tunnels to a central location in the main building. For blood transfusions they had to meet with the patients’ families and convince them to donate their own blood. Until well into the 1970s’ there were periodic shortages of needles, intravenous tubing, blood culture bottles, biopsy needles, and even soap and towels.

Supervising the house staff were the attending physicians, mostly voluntary until the late 1960s and in private practice at other hospitals. At one time appointment to the hospital had required passing a competitive examination. It was an honor to be a County attending physician, a County man, also a way to keep up with medicine, become known to younger doctors, develop a referral base, and establish a successful practice. Some of the professors were memorable for their rounds and legendary for their pithy sayings, such as that “from the ashes of lupus erythematosus arises the phoenix of nephrosclerosis.”

Over the years County attracted many great doctors. Among the earlier ones were eminent surgeons such as Nicholas Senn, John Murphy, Gideon Wells, and Frank Billings. Christian Fenger, surgeon and pathologist, came in 1878 from Denmark via Cairo, where for helping stage Verdi’s Aida at the opening of the Suez Canal, the khedive reportedly gave him two mummies that he later sold to buy an appointment at the hospital. Fenger was followed as hospital pathologist in 1895 by Ludwig Hektoen, who made many contributions to the nascent discipline of immunology. James B  Herrick, a prominent physician first described sickle cell anemia and coronary thrombosis. Bernard Fantus developed the world’s first blood bank; and for over half a century Karl A Meyer ran one of the greatest surgical services in the country.  County had a famous burns unit, one of the first trauma centers, and famous departments of hand surgery, congenital heart disease, pediatric cardiology, and liver disease.

 

Attached to the hospital was a school of nursing which graduated many generations of practicing nurses; the medical staff also operated a postgraduate school that prepared doctors for specialty boards examinations; and in 1934 the Hektoen Institute was founded as the operating research arm of the hospital, with its own laboratories and clinical investigators working on basic science and clinical projects. For patients admitted to the hospital conditions were far from luxurious and in earlier days compassion was often lacking, especially on the surgical services. The wards were large and malodorous, fifty to seventy patients in one large room, often with no curtains for privacy, no air-conditioning during the hot summer months, and nurses in the operating room using a fly swatter to keep out the flies. The casualty department, sometimes staffed by new arrivals with rudimentary English, was swamped with patients waiting interminably, admitted only in the early hours of the morning, their beds then placed in middle rows in the ward or in side rooms to be first evaluated by students and interns. There was no intensive care unit; drugs were restricted by the formulary committee; and a second white cell count required a hematologic consultation.    

Several books have been written about County: old ones glorifying the good old times and the city fathers who were running it in close conjunction with the Chicago political machine; angry ones, attacking the political establishment; and liberal reformist ones, glorifying their more recent struggle for better patient conditions. There were also plentiful stories and anecdotes told about the old hospital, many apocryphal, some the figment of someone’s imagination, most by now by now impossible to confirm.  All intravenous infusion bottles were supposedly so connected by tubing that none could run out until all the others were also empty.  Surgical residents were said to have had to sacrifice their own stomach if unable to produce a suitable patient for the Saturday morning surgical demonstrations. The hospital superintendent allegedly walked his dogs through the surgical suites and held lively parties with the surgical nurses in his penthouse on the top floor of the hospital. Interns caught smoking were forbidden to use the hospital elevators for several weeks (personal confirmation); and a resident, when  asked by the big chief if the cigarette butt on the floor was his,  allegedly replied “do you want it, sir ?"

Since its inception, Cook County Hospital’s career has been punctuated by periodic scandals, even dating back to Upton Sinclair's 1905 The Jungle. Appointment to the hospital’s non-medical staff generally required the appropriate connection (“I don’t want nobody nobody sent”) and admission to chronic facilities was also by special letter. Some employees were rarely seen, certainly not on election days; and even the elevator drivers on that day were bringing in the votes. At least one medical resident was known to make his rounds at seven in the morning, then disappeared for the rest of the day. Nursing was often inadequate. During the night many nursing aides and clerks slept in the ward side rooms, and during the day they were traditionally surly and unhelpful.

 

Until World War II the patients were largely poor whites. After the large migrations from the South they were mostly African Americans, many of whom thought of the hospital as a place to die or be cut up, but also which had the best doctors. Since the 1990s the number of Hispanics, mainly Mexican, increased substantially, currently accounting for perhaps half of the patient population.

The hospital’s reputation began to decline in the 1950s as Chicago’s medical schools built their own hospitals, and private hospitals proliferated and expanded. The early 1970s were years of trouble and conflict in the face as increasing demands for better patient conditions; house-staff or nurses strikes; and in 1971 the dismissal of four physicians followed by a massive exodus of staff. Crisis followed upon the crisis, as the very survival of the hospital was in doubt, and depressed doctors wondered what would happen to County. They have now mostly retired from this world but the hospital did survive. By the 1990s conditions for the patients had markedly improved, overcrowding having abated and a new generation of socially conscious doctors having taken over from the old.

Then in 2002 a massive open air assemblage of young and old said goodbye to the old hospital as operations moved to a much smaller modern facility. The old building with its large open wards was shuttered, and to this day the city fathers have not decided what to do with it. So there it sits, boarded up, an architectural landmark, its Selfridge-like columns witness to an era long gone. Only the rats visit regularly, and the occasional entrepreneur looking to steal old copper wires at the risk of electrocuting himself. But for the many born, treated, or trained there, County remains an indelible part of their life and of Chicago history.

Selected reading

  • Johnson, CB.  Growth of Cook County, published by the Board of Commissioners  of Cook County, IL
  • Report of the Illinois Legislative Commission. Cook County, November 1972
  • Guinan, PD et al: A History of Surgery at Cook County Hospital. AMIKA PRESS, 2015.
  • Ansell, D: County. Academic Chicago Publishers, 2011.
  • Lewis’s: Hospital. Berkley Books, New York,1994.
  • Bonner, TN: Medicine in Chicago 1850-1950. University of Chicago Press, 1991.
  • Raffensperger JG: The Old Lady of Harrison Street, Cook County Hospital, 1833 1995. Peter Lang Gmbh, Internationaler Verlag, 1997.

 


George Dunea, MD, Editor-in-Chief