The Sixth Charity Rises

The Charity of the 1920's and 1930’s would be unrecognizable to medical students today. At that time, the Charity Hospital complex stretched from its current location at Tulane Avenue and Lasalle to where Interstate 10 now stands. In the rear of this block, on Gravier Street, was a shabbier building that housed black patients; Charity was still very much segregated. In between was a beautiful courtyard, full of balconies, palm trees, and a fountain.

Inside the hospital, prevailing medical knowledge and poor conditions reigned. Patients were frequently boarded two to a bed, with some sleeping on the floor. Babies were kept two to a crib. Infectious disease, especially sexually transmitted diseases, were extremely prevalent at this time. Charity was one of three locations in the country to conduct research on childhood congenital syphilis. In one study, over 150 children with congenital syphilis were enrolled. Treatment of adult syphilis at that time, prior to antibiotics, consisted of weekly injections of arsenic and bismuth for eighteen months. One physician that ran the venereal disease clinic estimated he treated around 500 patients with syphilis each day.

In 1937, Charity Hospital began its first modern postgraduate residency program, replacing the old house physician and house surgeon system. This reflected the growing trend towards medical specialization and growing authority of specialty certification boards. Medical students at Tulane and LSU competed fiercely for internship spots at Charity. Postgraduate students at Charity had a now-rare degree of authority, as well as a huge patient population from which to learn. In 1936, Charity’s admission rate over the year exceeded that of Cook County in Chicago, Bellevue in New York, and Los Angeles County Hospitals. The daily patient census was 2,781, in spite of a bed capacity of 1,814. One physicians, remembering Mardi Gras in 1937, said, “In trying to make rounds at night, I literally stepped over bodies of the sick lying in the aisles. It was not unusual for one of two patients in a bed to go tell the nurse, ‘My bed mate has just died.’”. These conditions received national attention via Time Magazine and the AMA, and the need for a new Charity was widely accepted.

No plans could be drawn up, however, until Huey Long was assassinated in 1935. Long was a fierce opponent of Roosevelt and his New Deal, and had gone so far as to ensure passage of a law in Louisiana that forbade any use of federal funds for any reason. After Long’s death, his successors healed the rift with Roosevelt, the law was repealed, and Works Progress Administration grant funds were approved for a new Charity hospital in September, 1936, and the 1832 Charity Hospital building was demolished.

The construction of the new Charity Hospital, completed in 1939, was rife with political favors and shoddy construction. Political favors and monies were taken out of the Charity construction budget and architects were forced to cut corners to pay for such handouts. These shortcuts ranged from buying second-hand, dilapidated electrical equipment to completely eliminating fire escapes in the original building. The new structure was in the shape of an H, modified to comply with the segregation laws of the time. Each wing belonged to Tulane or LSU’s medical service.

Immediately problems became apparent with the structure. In a disquieting parallel to substandard Army Corps of Engineers construction of the levees that gave way during Hurricane Katrina, there were several thousand less pilings used in the Charity construction than were called for, and those that were used extended only 28 feet into the soft New Orleans ground when plans called for them to be driven to a depth of 43 feet. This resulted in the settling of Charity almost 18 inches by 1943, along with massive bills for repair of resulting cracks in the walls and other structures.

Two of Tulane’s most famous surgeons were on the staff of Charity during these war years: Alton Ochsner, and Tulane School of Medicine graduate and Ochsner’s student, Michael DeBakey. Their personalities could not have been more different: Ochsner was understanding and calm-natured, while DeBakey was nicknamed “Black Mike” by surgery residents for his hard-nosed attitude and lack of bedside manner. Ochsner, as chair of surgery, conducted Grand Rounds and “bullpen” sessions with medical students. The tradition of bullpen continues today. Perhaps Ochsner’s most famous sayings was “Early to bed, early to rise, work hard and publicize.”

Around this time Ochsner lobbied the Dean and Board of Tulane to build a private, academic Tulane hospital and to create a surgical clinic headed by Ochsner. The University Board as well as the School of Medicine felt a separate clinic would be criticized by alumni and create discord in the faculty, and rejected the idea. Ochsner then decided to form his own private clinic. With local financial support and federal funds, the Ochsner Foundation Hospital and Clinic was opened in 1954.

Tulane faculty made many medical advances with the help of Charity patients during these years. Grace Goldsmith, a nutrition researcher, established minimum dietary requirements for niacin and tryptophan. Oscar Blitz and Louis Monte, both at Charity, were the first to describe bagassosis, a severe respiratory disease first described in sugarcane farmers. The first heterologous kidney transplants, from a monkey to a human, were performed by Tulane surgeons at Charity. George Burch, an internist at Tulane, was instrumental in the discovery of hemoglobin SS. William Castle, a Harvard hematologist who discovered intrinsic factor, suggested to the famous chemist Linus Pauling that he study why red blood cells assume a characteristic sickle shape in those with sickle cell anemia. Pauling asked Burch to supply blood of patients with sickle cell anemia and then analyzed the hemolyzed samples in a gel that separated hemoglobin based on size. This experiment was the beginning of modern molecular biology, and the blood samples that made it possible came from Charity patients.

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