Robert B. Brigham Hospital records

The Robert B. Brigham Hospital for Incurables, established via the philanthropic legacy of Robert Breck Brigham at the beginning of the 20th century, became the first American teaching hospital devoted exclusively to the care of arthritis and rheumatic disease. Coming of age during a time of far-reaching changes in the role of the modern hospital and patient care, “The Robert” matured into the Division of Rheumatology, Immunology and Allergy in the Department of Medicine of Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School, by the beginning of the 21st century.

The intention to create a free hospital for poor citizens with chronic or incurable diseases was articulated in the will of Robert Breck Brigham in 1900. Like his uncle Peter Bent Brigham, Robert Brigham made his fortune as a restaurant owner and real estate developer. And similar to his uncle, whose endowment founded the Peter Bent Brigham Hospital, Robert bequeathed the majority of his estate to several charities. A trust was established to use part of his bequest for the creation of a hospital for the “…medical and surgical treatment of those citizens of Boston who are …incapable of obtaining a comfortable livelihood by reason of chronic or incurable disease or permanent physical disability.”

Elizabeth Fay Brigham, Robert’s sister and the director of the corporation organized to create the hospital, died in 1909 adding one-and-a-half million dollars of her estate towards the construction. Although the Robert B. Brigham Hospital for Incurables was chartered in 1903, and 10 acres of land was purchased as a building site on top of Mission Hill in Boston in 1905, the construction was not completed until 1914.

The hospital opened on April 1, 1914 for admissions with 115 beds, and soon thereafter began to focus on those patients with arthritis and rheumatic diseases—well before rheumatology was a recognized medical specialty. “Incurable” patients received free care and many remained in the hospital for months without charge. Advances in medical technology, surgical repair of deformities, and drugs to manage inflammation, all tested and put into practice over the years at the Robert B. Brigham Hospital, led to more and more of the formerly “incurable” patients resuming normal or near normal functioning in their daily lives. Success led to an increase in requests for treatment. The mounting monetary burden of providing free care for poor patients exceeded the income from the Brigham legacy and financial pressures constantly threatened the hospital’s survival.

In 1917 the hospital was leased by the government for the care of sick and wounded military personnel, causing a suspension of the Robert B. Brigham Hospital’s normal operations and scattering the staff. The suspension paradoxically led to a financial reprieve for the struggling hospital and it was reopened in 1923.

The successful treatment of many chronically ill patients and the hospital’s need for more income than that provided by the Brigham charitable trust led to the practice of admitting some paying patients. A lawsuit in 1925 resulted from a claim by one of the hospital’s trustees that treating curable patients and taking paying patients violated the stipulations of the Brigham will. By court decree in July of 1926 the argument that Robert B. Brigham’s intention was to create an “old-folks home,” not a paying hospital or a research hospital, failed in favor of the other trustees’ interpretations that allowed them to treat patients who did have hope for a cure, and to admit some paying patients. Declining income in the 1930s caused the beginning of the end of free care and the idea of the hospital as primarily a charity. To avoid closing the hospital, private paying patients were cultivated. By 1949 all patients were charged for the cost of their care.

It was not until another court proceeding in 1954 that the “for Incurables” was legally dropped from the name of the hospital, although the term had not been not used for many years.

Significant practices in the rheumatology specialty evolved at the Robert B. Brigham Hospital, including the use of cortisone to manage rheumatoid arthritis and the notion of having separate occupational and physical therapy departments. The Robert B. Brigham Hospital established the first hospital based occupational therapy department. Orthopedic nursing was professionalized at the Robert. B. Brigham Training School for Attendant Nurses. This school produced licensed practical nurses from 1924 through 1951. Sub-specialties, including neurology, ophthalmology, dermatology, roentgenology, pharmacy, artificial joints, documentation standards, and community outreach, as related to orthopedics and rheumatology, were rooted and grew in importance in the research departments, clinics, and wards of Robert B. Brigham Hospital. As a teaching hospital, the Robert B. Brigham had close ties with the doctors and patients of the Peter Bent Brigham, Massachusetts General, Children’s, and the Beth Israel Hospitals. By 1944 the relationship between the Robert B. Brigham Hospital and the Peter Bent Brigham Hospital had formalized with a rotation for residents at the Robert B. Brigham Hospital. In 1966, the Robert B. Brigham Hospital became an official Harvard teaching hospital.

The Robert B. Brigham Hospital’s mission and evolution were shaped for over 60 years by many noted individuals, among them, medically progressive orthopedic surgeon, Joel E. Goldthwait (1866–1961), one of the original trustees of the corporation, who guided the hospital towards a progressive (at the time) philosophy of multidisciplinary approaches to treating, not just symptoms, but patients as a whole, considering their family and social context, and their post-discharge well-being; and chief orthopedic surgeon (1917-1935) Loring T. Swaim, who brought a psychosocial approach to patient care and established an arthritis clinic at the Robert B. Brigham Hospital. Other notable “firsts” to practice and teach in the new specialty of rheumatology were Theodore B. Bayles, appointed to head a permanent research program in 1939, and Sydney Stillman, who along with Goldthwait, organized the Clinical Treatment Center for Juvenile Rheumatoid Arthritis in 1963, a prototype in the field for other specialized services for children. Arthur Hall and Peter Barry were early clinician teachers at the Robert B. Brigham Hospital who deeply influenced the following generations of rheumatologists, including Ronald J. Anderson, Director of Clinical Training Programs from 1971 to 2003. Also in the modern era, Clement B. Sledge, Chief of Orthopedic Surgery, was a pioneer in joint replacement surgery; and Physician-in-Chief, K. Frank Austen, played a central role in the merger that created what is known today as the Brigham and Women’s Hospital. His team elevated the Robert B. Brigham Hospital immunology research program to international stature by working out the key mechanisms of allergy and inflammation.

In 1975 the era of the small specialty hospital in Boston ended when the Robert B. Brigham Hospital merged with the Peter Bent Brigham Hospital and the Boston Hospital for Women forming the Affiliated Hospitals Center. (Boston Hospital for Women itself was the result of a 1966 merger of the Boston Lying-in Hospital with the Free Hospital for Women.) In 1980, at the time of the opening of a new state-of-the-art facility, the Affiliated Hospitals Center became known as the Brigham and Women’s Hospital, a teaching affiliate of the Harvard Medical School. The original buildings of the Robert B. Brigham Hospital located at the top of Mission Hill in Boston, as of this writing, are part of the New England Baptist Hospital complex.