Pittsburgh’s Long Been A City For Medical Innovation
Pittsburgh is home to dozens of hospitals and medical facilities, from Level I trauma centers to neighborhood health clinics. Nearly one out of every five workers in the city is employed in health care.
The region is often celebrated for its transition from manufacturing to higher education and medicine, but it’s long been a place for health care innovation, even if it didn’t look exactly like it does now.
“Hospitals, as we know them today, are very much 20th century institutions,” said Anne Madarasz, director of the Heinz History Center Curatorial Division, chief historian, and director of the Western Pennsylvania Sports Museum.
In many countries, medical caretakers were members of religious institutions. Men and women of the cloth decided that caring for the sick was part of their duty as faith leaders. They created special wards for people with diseases like leprosy or mental illnesses. Patients were brought to these facilities and treated within them until, Madarasz says, religious women in the mid-1800s began going into communities.
“They actually call them the ‘walking nuns’ because they would go out and walk among these destitute and care for them,” Madarasz said.
The Sisters of Mercy are the most well-known group to take this approach. In Ireland, Catherine McAuley founded the organization in 1831, with the goal of gathering “like-minded companions and [devoting] her considerable inheritance to serving the poor, especially women and children.”
This idea spread throughout the world and made its way to Pittsburgh in the 1840s, after the Catholic Diocese of Pittsburgh designated Irishman Michael O’Connor to become its first bishop. Madarasz said O’Connor enlisted some seminarians and seven nuns from the Sisters of Mercy to come with him to the burgeoning city.
“They found schools first,” Madarasz said. “[Shortly afterward] they found the first hospital in the City of Pittsburgh … Mercy Hospital.”
The institution opened in 1847 on Penn Avenue downtown. In 2006 it merged with UPMC, and is now located in the city’s Uptown neighborhood, near Duquesne University, and is expanding its campus.
In 1849, protestant Lutheran immigrants opened a clinic that would become Passavant Hospital on the North Side, followed by West Penn Hospital in Bloomfield and St. Francis in Lawrenceville. As the city grew, so did its medical facilities.
As disease spreads, doctors learn why
Medical care in the late 1800s was still relatively rudimentary. Vaccines were not yet discovered for every disease and drugs like penicillin wouldn’t be discovered until 1928. Madarasz said as more research was conducted throughout the world about how disease spread, medical facilities began implementing somewhat simple changes, especially around hygiene.
“You begin to get the understanding that if you don’t overcrowd people, you don’t have beds next to each other, you put at least three feet between them, people, for some reason, tend to get better,” Madarasz said.
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Opening windows, for example, helped air flow through tuberculosis wards. Madarasz said there are images from this time showing patients wrapped in layers of blankets because the windows were kept open even during Pittsburgh’s winters. Doctors began keeping records and data about patients to better understand how disease spread and what treatments were most effective.
These fledgling hospitals were put to the test during the region’s first major health crises: outbreaks of cholera and typhoid. During a two-week span in September of 1854, more than 800 people died of cholera.
“It’s interesting to see because people [didn’t] really understand what’s causing cholera,” Madarasz said.
Cholera is a bacterial infection typically caused by consuming contaminated food or water. The city’s drinking water at the time was supplied from its three rivers, which Madarasz said weren’t known for their cleanliness.
“The rivers are a place where sewage is going and where industry is dumping its refuse and waste,” Madarasz said. “So you get these huge outbreaks of waterborne disease here.”
A Sept. 29, 1854 edition of the Pittsburgh Gazette included comments that the disease had been spreading here more rapidly than in larger cities like New York, “a proof of the dreadful severity of the plague.”
A few decades later, the bacterial infection typhoid hit the region hard.
“You had a three times better chance of dying of typhoid in Pittsburgh in that period than any other city in the country,” Madarasz said.
As the city moved into the 20th century, it developed its first water filtration system in the form of a slow-sand filtration plant along the Allegheny River near Aspinwall, which meant these waterborne diseases could now be tamed.
Innovation and consolidation
In the following decades, Pittsburgh researchers and physicians made history in a variety of medical specialties: Jonas Salk at the University of Pittsburgh developed the polio vaccine in 1953; Thomas Starzl performed the first liver transplant in 1963; George Mcgovern became well-known for his successful open-heart surgeries; Freddie Fu pioneered sports medicine in the 20th century.
The University of Pittsburgh had formed the University Medical Center in the 1930s, which at the time included the facilities now known as UPMC Magee-Womens Hospital, UPMC Presbyterian and UPMC Children’s Hospital. The university system was formalizing its training of medical workers and starting to specializes, like dentistry and pharmacy.
In the 1970s, psychiatrist Thomas Detre moved to Pittsburgh and recruited top talent from around the country to work within the university and hospital systems. In her 2009 book Beyond the Bounds: A History of UPMC, author Mary Brignano said Detre and others in the city fostered a culture of shared medical knowledge. People were able to approach their work with more creativity than they were at other hospitals, she wrote.
“...these recruits were thrilled by the freedom Detre offered -- the freedom to unleash their ideas, break down walls between disciplines, and ‘bring down the tyranny of dominant paradigms’ in order to advance science, education and health.”
As Pittsburgh moved into the mid-20th century, its well-known manufacturing industries including steel and glass started to merge. Madarasz said the same thing began happening within Pittsburgh’s hospitals and clinics. Many hospitals already had understandings with each other -- Allegheny General Hospital on the North Side frequently partnered with West Penn Hospital, for example -- but these systems began to consolidate as a way to save money and spread talent.
“There’s this sense that we can be stronger as an economic arm if we bring together multiple systems,” Madarasz said.
The city itself was undergoing changes, too, as the steel industry slowly departed in the 1970s and '80s. UPMC Presbyterian Shadyside President John Innocenti remembers conversations about consolidation when he was working at Montefiore in 1989.
“We were still steel, still looking at everything you know about Pittsburgh and what occurred at that time and moving out of that steel environment into the meds and eds process that we are today,” Innocenti said.
Pitt, in 1980, was 36th on the list of National Institutes of Health grant recipients. The school has since reached the top 10 consistently since 1997. This growing strength, Innocenti said, was in part due to consolidation efforts.
“We got better and better. We tried to eliminate a lot of the silos, a lot of the duplications [in] ... back-office functions,” Innocenti said. “We tried to create efficiencies in terms of how we provided the care.”
Since then, dozens of hospital systems have joined the UPMC network or affiliated with them in some way. Now there are about 40 hospitals within UPMC and 700 clinical locations. Allegheny Health Network has 12 hospitals within its network. Both also have insurance arms.
More than 133,000 people work in health care in Pittsburgh. While the eds and meds economy has been touted in recent years for the city’s comeback after steel, it’s been an important part of the city’s fabric for much longer.
“We look at this culture of medicine in this part of our economy as being a very recent thing,” Madarasz said. “But the seeds of it were sown a long time ago.”