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Staying Solvent: The Business of TB Treatment

This slideshow contains 16 items
1
Western Maine Sanatorium gate, 1928

Western Maine Sanatorium gate, 1928

Item 23630 info
Maine Historical Society

The Maine Sanatorium Association voted in May 1904 to begin construction of buildings at Hebron for a tuberculosis treatment facility.

The organization contracted with noted Portland architects John Calvin Stevens and John Howard Stevens to design the first permanent building.

To finance the venture, Dr. Estes Nichols, superintendent, was to convince 100 men to give $1,000 each for construction and the organization's Finance Committee also was to make appeals for funding.


2
John Calvin Stevens letter concerning payment, 1908

John Calvin Stevens letter concerning payment, 1908

Item 23536 info
Maine State Archives

From the first construction and admission of the first patients, financing the institution was a challenge.

The privately owned and operated institution, offering what Superintendent Estes Nichols believed to be the most up-to-date care, needed facilities especially suited to tuberculosis care -- ventilation, sterilizing equipment, sewage disposal, construction materials that could be kept clean -- plus medical and other staff, farms to raise food, and an electrical plant.


3
Sanatorium overdraft notice, 1908

Sanatorium overdraft notice, 1908

Item 23547 info
Maine State Archives

A 1909 promotional pamphlet referred to the sanatorium as "a purely philanthropic movement" with funds "contributed by public-spirited persons."

The brochure noted that "we are obliged to charge the actual cost of maintenance."

In addition, patients had to provide their own thermometers, sputum cups, fur coat, heavy blanket, and pay for laundry services, medicine, and extra nursing care.

The financial issue for the facility was simple: it cost more to operate the sanatorium than most patients were able to pay.


4
Letter seeking payment to builders, Portland, 1908

Letter seeking payment to builders, Portland, 1908

Item 23544 info
Maine State Archives

In January 1907, the Maine State Sanatorium Association reported that since it began, it had raised $84,445.

Of that amount, nearly $1,000 was donated by 307 people in amounts smaller than $10 each.

About 17 percent of the funds came from people in Maine.

The largest single donation -- $65,000 -- was from Eleazer Chamberlain of Massachusetts. He gave the money for construction of an administration building that would be named in his son's memory.


5
Hiram Ricker letter to Estes Nichols, 1908

Hiram Ricker letter to Estes Nichols, 1908

Item 23541 info
Maine State Archives

In 1908, the Maine State Sanatorium had three buildings: a men's cottage, a women's cottage, and the administration building.

From July 1907 to June 1908, it served 106 patients.

In 1906, the Maine Legislature appropriated $15,000 to the sanatorium and made another appropriation the following year. But the financial pressure continued.

Architect Stevens had written asking for payment as had the builder. The bank wrote a sympathetic letter listing numerous overdrafts.

Sanatorium Association officer Herman Ricker wrote to Dr. Nichols suggesting a bill to secure state funding was crucial and noting that a number of people had suggested that the sanatorium should be a state-operated facility.


6
Report of aid to TB patients, 1908

Report of aid to TB patients, 1908

Item 23574 info
Maine State Archives

Throughout the early years of the sanatorium's existence, Dr. Nichols frequently surveyed other states to determine how they operated their sanatoriums -- both in terms of treatment and finances.

The Association continued to raise money -- and the need for services for persons with tuberculosis continued to grow.

The Maine State Sanatorium was faced with pressures to grow larger and the need to secure additional financing to do so.

Estes noted that more than 1,000 people a year died of tuberculosis in Maine and that statistics showed that some 75 percent of persons treated in early stages of the disease in "well equipped sanatoriums" got better.


7
Stevens' plan of Maine State Sanatorium, Hebron, ca. 1908

Stevens' plan of Maine State Sanatorium, Hebron, ca. 1908

Item 23550 info
Maine Historic Preservation Commission

John Calvin Stevens and John Howard Stevens had drawn preliminary plans for the whole Sanatorium campus.

It included farm buildings, a power station, cottages that would accommodate patients and staff, most of whom lived at the Sanatorium; a library, chapel, and administration building.

Some of the facilities already had been built and others were hoped for so that the patient population could increase.

A 1907 report suggested the Sanatorium could only accommodate 55 patients at one time.


8
Letter concerning opposition to sanatorium funds, 1909

Letter concerning opposition to sanatorium funds, 1909

Item 23577 info
Maine State Archives

Even as the Sanatorium in Hebron made plans to add to its facilities and began accepting more patients, opposition to providing state funding appeared in the Legislature.

In 1909, the Sanatorium Association asked the state for $60,00 for buildings and patient care.

The argument against support of the sanatorium often was that the cost of care -- $15 a week -- was too high and that the state could run the facility more economically.

H. R. Virgin, who was lobbying on behalf of the sanatorium in Augusta, asked Dr. Nichols to gather letters of support from patients and others.


9
Letter withdrawing sanatorium opposition, 1909

Letter withdrawing sanatorium opposition, 1909

Item 23578 info
Maine State Archives

The Cumberland County Committee, one of the opponents of state funding, wrote to the Sanatorium to say they were withdrawing their opposition.

However, Edgar Rounds, a Republican state representative, noted, "While we think the Sanatorium is going great work, there is some question in my mind about the management of it."


10
Estimate for new sanatorium building, 1909

Estimate for new sanatorium building, 1909

Item 23580 info
Maine State Archives

At the same time, Nichols and the Sanatorium Association went forward with plans to expand the facilities.

Nichols wrote in the promotional pamphlet in 1909 that the Sanatorium needed one or two more cottages, a chapel, an endowment for free care, funds to pay down its debt, and entertainment and books and magazines for patients.

The Stevens' firm estimate for building one new cottage was $21,747.


11
Construction estimate, Maine Sanatorium, 1909

Construction estimate, Maine Sanatorium, 1909

Item 23584 info
Maine State Archives

F.W. Keene, an Auburn building contractor, submitted a bid of $23,005 for construction of a cottage at the Sanatorium.

Smith and Rumery, the firm that built several other buildings, bid $22,537.

Rumery is the firm that had previously written to Dr. Nichols asking for payment of a delinquent bill.


12
Sanatorium expenses, Hebron, 1913

Sanatorium expenses, Hebron, 1913

Item 23612 info
Maine State Archives

By 1913, the Sanatorium had built additional facilities, but still faced financial pressures.

Superintendent Estes Nichols wrote to Hiram Ricker, the chair of the Association board, reporting that he had cut the budget by delaying some maintenance, reducing the number of nurses and taken what steps he could to keep expenses low.

He expected to have many patients and said he hoped the Sanatorium could get to a point where it charged $7 a week without state help.

However, he wrote, if that could not be done in the next two years, the Sanatorium might have to be turned over to the state, a prospect he did not relish.


13
Sanatorium Association letter to physicians, 1913

Sanatorium Association letter to physicians, 1913

Item 23608 info
Maine State Archives

As part of the effort to stem criticism of the costs and treatment methods at the Maine Sanatorium, officials of the Maine State Sanatorium Association for the Prevention and Treatment of Tuberculosis sent a letter to physicians in June 1913, explaining the purposes and practices of the Maine State Sanatorium.

The letter urged doctors to visit the facility.


14
Statement of patient account, Maine Sanatorium, 1913

Statement of patient account, Maine Sanatorium, 1913

Item 23610 info
Maine State Archives

A patient's bill, dated in 1913, shows charges incurred in 1911, but does not include details of the charges.

The weekly cost was $15, an amount many in state government and elsewhere found too high.


15
Sanatorium assets, Hebron, 1913

Sanatorium assets, Hebron, 1913

Item 23611 info
Maine State Archives

In 1913, with expenses and debts of the Maine State Sanatorium increasing, Superintendent Estes Nichols and his staff made a list of assets.

The buildings -- about 10 of them -- and their contents were valued at $141,000.

Another house and barn added $1,600 to the value.

The assessment does not include the value of the land.


16
Letter concerning Estes Nichols' resignation, 1915

Letter concerning Estes Nichols' resignation, 1915

Item 23587 info
Maine State Archives

In 1915, the Maine Legislature passed a bill authorizing the state to buy the Maine State Sanatorium in Hebron and a privately operated facility in Fairfield.

They were to be renamed the Western Maine and Central Maine sanatoriums. A new facility was to be built in Presque Isle and named the Northern Maine Sanatorium.

When the state took over, Dr. Estes Nichols, the founder of the sanatorium, resigned.

The state bought the property for $15,000 on Oct. 5, 1915. The land, buildings and equipment were valued at $208,097.

The state set the treatment fee at $5 a week. The financial challenges continued.


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