[This is the second of a three-part bio of Henry S. Pritchett with a focus on the impact he had on Santa Barbara. To see Part I, go to Part I: Henry Smith Pritchett: A Santa Barbara Legacy. For Part II, go to Part II: Henry Smith Pritchett: A Santa Barbara Legacy.]
Part II: Henry Reinvents Santa Barbara Medicine
As is apparent from the list of bulletins produced by the Carnegie Foundation, Pritchett did not find the ‘Teachers’ or even the education aspects of the organization’s title constrictive. He shifted Carnegie funds, with Carnegie’s permission and participation, to projects and individuals he felt would make a significant difference in American life. One of these projects was a metabolic research lab and clinic affiliated with the New York City Hospital and run by one the day’s medical masterminds, Nathaniel Bowditch Potter, a clinic which Pritchett helped fund in 1916 through the Carnegie Foundation.
Dr. Potter was born in Keeseville, N. Y., Dec. 23, 1880, the son of George Sabine and Mary Gill Powell Potter. He graduated from the College of the City of New York in 1888 and from Harvard in 1890. He earned an M.D. at the Harvard Medical School four years later. Like all the best physicians in the United States, he then studied in Paris and Vienna. Starting in 1900 he was a visiting physician to the New York City Hospital, the French Hospital and the Hospital for Ruptured and Crippled Children, and professor in medicine at Columbia University.
Potter married Mary Sargent, daughter of Charles Sprague Sargent, professor of arboriculture and director of the Arnold Arboretum of Harvard University, on January 31, 1908. On July 15, 1909, the couple had a daughter.
In 1916, Potter organized the Potter Clinic and Laboratory at the New York City Hospital for the intensive study and treatment of the metabolic diseases of nephritis (kidney disease), gout and diabetes. Financing for the new clinic came from friends and family, but the largest endowment came from Henry S. Pritchett and the Carnegie Foundation. Advisors to Dr. Potter were well-known physicians, Professor Theobald Smith of Princeton University, and Drs. Donald Van Slyke, Edgard Stillman, and Alfred Kohn of the Rockefeller Institute.
But Potter himself was ill with nephritis and diabetes, two of the diseases he had set out to study. By 1917, he was so ill that he believed he would have to step away from his clinic and place it in someone else’s hands. But his friend, mentor and financier, Henry Pritchett, convinced him to travel to Santa Barbara. The purpose of the trip was twofold: to restore his health, and to look at Cottage Hospital as a potential host for his clinic. Potter trusted Pritchett, but seriously doubted he would find solutions to either of his problems in a California beach town.
As it turned out, he felt much better in Santa Barbara, and there was some hope of recovery. More surprising to Potter, Cottage Hospital, with its board of millionaires, seemed a reasonable institution to align his clinic with. Pritchett assured Potter that the funding from Carnegie would follow Potter, and as Potter prepared to return to New York, Potter and Pritchett sat down with the board and they drafted an agreement that would bring the clinic to Santa Barbara.
The board was pleased and perhaps bemused, but seemed in the minutes to not fully grasp the significance of Potter or his clinic. The advent of Potter’s clinic to the hospital was assigned to board members Winsor Soule, William Norman Campbell and Miss Elizabeth Jamieson, the hospital superintendent, with “full power to consummate the arrangements.”
The preparations for the clinic were not specified in the board minutes except to note that Dr. Potter was hiring staff and stocking the laboratory, but by mid-December of 1917, the clinic is ready. At the time the hospital consisted of the 50-bed structure that opened in 1913. The implication is that Potter Clinic was originally opened as a lab and office space in the 1913 building, with beds shared with the rest of the hospital.
Dr. Potter arrived in early 1918 and, though debilitated by his ailments, set to work.
Something happened in those first months of 1918. For one, the Potter Clinic was successful. By May, the clinic was running out of space and requested the use of the Dispensary building – a freestanding one-story wooden structure at the northern edge of the property where free and low-cost medical services were provided – for patient consultations. But something else was taking place. Something big.
Up to this point, other than Clarence Black acting as board president, there was not much action at the board level with the exception of Frederick Forrest Peabody’s donations of an air compressor and an ice manufacturing plant to bring the mechanical plant up to date, and the creation of the inexpensive Dispensary building in 1917. Many requests from the staff, the physicians and patients, were reviewed by the board, discussed, and not so much tabled as simply let lie.
One of these requests was for a maternity ward. Pregnant mothers were the most reluctant of patient populations to start using hospitals. Maternal deaths from complications of childbirth still remained high in most hospitals in 1918. Hospitals focused their aseptic and antiseptic practices on surgical events rather than childbirth, primarily because the number of cases was far lower. But those hospitals that were able to apply these practices to maternity wards saw a rise in all classes of patient because the most fearful and cautious patients were seen as willing to be admitted.
In May of 1918, George Owen Knapp suddenly proposes they add not just a maternity ward but a maternity wing. The board approved a one-story addition and then, the need for and reputation of Cottage both expanding almost daily, added a second story and a basement. Knapp, suddenly fired up, talked the other millionaires into sharing the cost of the building with him.
Then in August of 1918, Knapp convinced the millionaires to build another new wing, specifically to house the Potter Clinic. The Los Angeles Times reported,
“George Owen Knapp, C. K. G. Billings, Clarence A. Black and Frederick F. Peabody are donating to the Cottage Hospital at Santa Barbara, one of the most elaborate clinical buildings on the Coast, for the especial use of Dr. Nathaniel Gowditch [sic] Potter of the Carnegie Foundation, who has been sent to Santa Barbara by the foundation to carry on medical research work. The building will be two stories, and equipped with every essential for the successful carrying on of the expert’s scientific studies. There is no stated amount placed on the cost of the building or equipment, the funds being ready to provide structure and all essentials required for the important work which Dr. Potter is carrying on. It is believed that the completion of the plans now under way will give Santa Barbara the finest clinic and medical research building on the Coast.”
What appears to be missing is causation. Given Pritchett’s residence in Santa Barbara and his involvement with the Potter Clinic, it seems plausible that Pritchett and Knapp spoke in greater depth during the early months of 1918. Knapp could not have emerged from these months a more adept bearer of Pritchett’s flame than if he had attended one of Pritchett’s medical schools.
Everything after this, for the next decade plus, comes at high speed in Santa Barbara medicine.
In April, 1919, the California Medical Society held its convention in Santa Barbara. The physicians from out of town stayed at the Arlington Hotel, and the talks, which extended over three days, were given at the Arlington. The events in Santa Barbara which helped draw the convention that year were the openings of the new tuberculosis hospital on the County General site (still referred to as the Goleta Farm), and the opening of the new Potter Metabolic Clinic building at Cottage.
Dr. H. C. Moffitt of San Francisco gave the dedication speech for the Potter, stating in part, “We are reminded in the work to be done here of the similar work that is being done in the hospital of the Rockefeller Foundation, in the hospital of the Johns Hopkins University, in the Massachusetts General Hospital, in the Peter Bent Brigham Hospital in Boston, in the Sprague Institute in Chicago, and in the Hooper Foundation of the University of California Medical School in San Francisco.” The standard for Cottage Hospital was to be derived from the very best in the country.
Potter attended the dedication of the new building, but he was unwell. He remained in a wheelchair and spoke only a few lines of gratitude. Three months later he would be dead.
In the absence of Dr. Potter, the clinic continued, but on a limited schedule. The new wing was open only two days a week. A new director was an obvious, immediate need. Potter had hired an assistant, Dr. Hilmar O. Koefed, a promising cardiologist, who just prior to coming to Santa Barbara had published an early study on the impact of cigarette smoking among soldiers. But Koefed was a young researcher, and Pritchett, representing the primary funding source for the clinic, appointed Dr. N. W. Janney, a diabetes expert, to take over.
There is no record of whether Janney was intended solely as an interim director, or of how he performed in the role. His scientific interests were well-aligned with the mission of the clinic. In January of 1920, Janney spoke at the Portland Academy of Medicine on “Recent Advances in our Knowledge of the Thyroid Gland and its Diseases,” and “The Problem of the Metabolic Case as Exemplified by Diabetes.”
The clinic slowly gained patients during 1920 and eventually it was opened daily, but it was not the medical magnet that it would have been had Potter been at the helm. By plan or through perceived need, Pritchett and the board decided to find a director who could at some level match Potter’s reputation.
Another influential individual in the history of Cottage was Dr. Franklin R. Nuzum. He came to Santa Barbara as George Owen Knapp’s personal physician, and as a patient recovering from tuberculosis. Nuzum was a graduate of Chicago University and Rush Medical College. During his residency under Dr. Rollin T. Woodyat at Presbyterian Hospital in Chicago, he had encountered a diabetes researcher who was making an impression for his determination and research capabilities, Dr. William David Sansum.
In 1920, Nuzum was appointed the first chief of staff at Cottage, and told the board soon after, “Dr. Sansum is the best qualified man in the country to step into Dr. Potter’s shoes. Providing, of course, that he is willing to accept a position in Santa Barbara.”
Given that the bulk of external funding for the clinic was coming from the Carnegie Foundation, it was not wholly in the Cottage board’s authority to make this change. However, by this time, Henry Pritchett, who was essentially synonymous with the Foundation, was also serving on the Cottage board. Knapp was authorized to travel to Chicago and speak with Sansum. He traveled by train and met with Sansum in September of 1920. Sansum accepted the position with a $1,000 monthly salary and had arrived in Santa Barbara with his family in early November.
Sansum was the ideal candidate for an ideal diabetes research institute. In a paper for Modern Hospital, Sansum wrote,
“The Potter Metabolic Clinic is unique in that an ideal unit for the study of a certain unsolved group of diseases was planned and fortunate in that philanthropic friends of the Santa Barbara Cottage Hospital furnished sufficient funds to carry out such idealistic plans. … The objects of the clinic are: 1. To make possible a study of a limited group of more or less closely allied diseases known as the diseases of metabolism. These diseases include diabetes, nephritis, high blood pressure, thyroid diseases, gout, obesity, and various other forms of nutritional disorders. This study is intended to be a concentrated effort to ascertain the fundamental causes of such diseases, better methods of treatment, and eventually cures. 2. To furnish a place where patients suffering from such diseases may receive careful, adequate examinations, and the best treatment known to medical science regardless of their financial circumstances. 3. To afford a center for the special training of physicians, nurses, dietitians, and laboratory workers interested in this type of work.”
Metabolic diseases, and especially diabetes, was a perfect point of focus for the 1920s. In the prior two decades, huge inroads in treating the contagious diseases had been made. Contagious diseases – typhoid, cholera, yellow fever, diphtheria, influenza and tuberculosis – drove very realistic fear through the populace. But vaccines and treatments were overpowering these, one by one. As their impact on society waned, attention would turn to diabetes, and then to heart disease and cancer.
The work of Dr. Sansum is well-documented elsewhere. Suffice it to say in this context that Sansum became the field laboratory to Dr. Banting’s (of Toronto) more fundamental chemistry work with the extraction and purification of insulin. It would be Banting and his team who identified and isolated the extract, but Sansum who made the critical strides in purifying it, manufacturing it, and was the first to administer it to human patients. Banting’s laboratory and Sansum’s were both funded by the Carnegie Foundation – Dr. Henry S. Pritchett.
The Full Henry
With Sansum and Nuzum operating as the head of research and the chief of staff, and with Knapp fully infused with Pritchett’s vision of the scientific and educational hospital, Cottage now had a powerful model for growth and success.
The most effective changes were internal. In Knapp’s letter introducing Cottage Hospital’s 1921 Annual Report, he reported,
“It is being realized more and more that team work in various medical branches by the members of the medical profession results in more accurate work, and consequently, in greater benefit to the patient. In an endeavor to promote this team work among the attending physicians of our hospital, we have secured the services of a medical man, Dr. Franklin R. Nuzum, who was recommended by Dr. Frank Billings of Chicago, and who has had a wide experience both in general practice and in research work. His title is Chief of Staff and Medical Director. Dr. Henry S. Pritchett, President of the Carnegie Foundation and a member of our Board of Directors, assures me that this is a novel idea, and one that is probably not duplicated in any hospital in this country. His presence has already resulted in more consultations and more discussions among the members of our attending physicians concerning the diagnoses of obscure conditions, and the treatment of especially ill patients, with most excellent results.”
This role that Nuzum filled was unique. In addition to the unusual practice of team consultations, he introduced concepts of measuring quality, keeping records on hospital infection rates, and involving patients in discussions of treatment alternatives. In 2014, these practices are being required and enforced both by hospitals and licensing boards, and they feel new and strange to many practitioners. They are in use because they demonstrably improve care and results.
But the role was not unprecedented. The leader in recreating the hospital as a patient-centered institution for healing rather than as laying-in residence for convalescents and for experimental treatments by private doctors, was Dr. William Osler of Johns Hopkins. One could not choose a better mentor to follow. The Chief of Staff role was also prefigured by a similar role, albeit more of a managerial than a quality position, in government-run hospitals and asylums.
Nuzum also launched the medical education program at Cottage and County hospitals, a program which continues in larger scope today.
All of these initiatives were noted or developed as important milestones for a medical institution in Pritchett’s bulletins and articles. Although he did not use the word – it would not be coined until 1935 by Arthur Tansley – Pritchett was a believer in developing a self-sustaining ecosystem. He consistently looked to high standards for education, enabling dynamic leadership of highly effective and knowledgeable individuals, and results-based assessments of success.
Knapp, Sansum, and Nuzum all arrived as dynamic and knowledgeable leaders, but none had written about or participated in a medical institution with the standards they sought to promulgate at Cottage through the 1920s. Starting in 1918, for Knapp, and in 1920 for the two physicians, these men are inspired, and the men around them are likewise inspired.
As a result, Cottage began to attract new buildings and expansion. In 1921, philanthropist Anna Blakesley Bliss, donated $50,000 to add a third wing off the central 1913 building. In 1923, George Owen and Louise Savage Knapp donated the 1923 Knapp College of Nursing. In 1926 and again in 1928, the board added three-story wings to the front of the hospital. In 1929, Dr. Elmer J. Bissell would donate an auditorium in the memory of his wife. And that same year, Max Fleischmann would donate a huge wing and Cottage’s first Emergency Department.
Over this period, Cottage also ascended step-by-step in patient services. From a functional lobby in 1918 that was literally shunted between buildings, Cottage soon added, in the 1927 addition, a lobby worthy of the Biltmore. Today, patient menus with meals served on demand are touted at the new Cottage. In 1927, a high-end kitchen was installed with full room service, all executed by a staff clothed in impeccable white linen. Bedrooms were large and airy, with balconies, wicker or wood desks and chairs, and fireplaces. The original hospital, no longer needed for nurse’s quarters after the opening of the Knapp College of Nursing in 1923, became servant quarters. Patients, sometimes called clientele in the Minutes, came for a month or more. Some repainted their rooms to suit them upon arrival.
When the Santa Barbara Earthquake struck in June of 1925, Pritchett was there. His letter to Charles Keeler of San Francisco is worth recounting at length for the detailed account of the event.
“My personal experience of the earthquake was in a well built wooden house, on a good foundation, which suffered little damage from the earthquake. The first and most severe shock came about 6:45. I was occupying a sleeping porch which looked out both on the ocean and the mountains. I had just been wakened by the morning light and was deliberating whether to pull the shades and have another nap when I heard the ominous roar of the on-coming earth movement. This roar could be heard two or three seconds in advance of most of the heavier shakes, but it was loudest and most terrifying as a forerunner of the first great movement of the earth.
“The roar which preceded the first shock was that of a grinding, crushing process, not a comforting sound to hear. I had barely time to realize that a sharp earthquake was at hand, when the shaking began. The vibrations seemed to come from the north and for a half a minute or such a matter the house rocked and jumped. One felt as if he were on the back of a bucking horse, with no control of the horse. The house seemed uninjured, although. like Muir in the Yosemite, I could scarcely understand why anything remained standing.
“The members of my household made haste to clothe themselves in slippers and wrappers and to reach the garden at the back of the house before the next shake, which came in about five minutes. While not so violent as the first shock, the impression made upon one in the open was more terrifying than that in a well built house. The plainly visible motion of the wave in the ground gave a sense of utter helplessness. These waves appeared to be about twenty-five feet long and one could see them as they crossed the lawn or traveled down a hedge. Trees bent over as the wave came up and returned to an upright position after the wave had passed. The whole effect upon the face of nature was uncanny. The earth seemed to shudder in distress.
“During the first fifteen minutes there were seven of these shocks of diminishing intensity. Thereafter, during the day, 103 tremors of greater or less strength kept coming, but none comparable to those of the first fifteen minutes. On the seismograph 285 vibrations were recorded from the first day to its cessation ten weeks later.
“While the earthquake of June twenty-ninth was not reckoned by seismologists as one of the first magnitude, nevertheless Santa Barbara suffered a great disaster. The business section of the city, built upon rather deep soil, suffered most. The main street was one mass of debris from fallen buildings or from buildings that had been partially destroyed. As it was, some fourteen persons were killed. In half a minute of time a prosperous community in one of the most charming places of the world, and living in a peaceful sense of security, found itself confronted with an overwhelming disaster.”
In a city of millionaires and pundits, it was Pritchett who was asked to chair Santa Barbara’s Reconstruction Committee, responsible for leading campaigns to raise funds for rebuilding. When he resigned his post in September of 1925 to return to his work in the East, he had raised $662,178 ($9M in 2014).
Pritchett participated widely in the Santa Barbara community. He brought in $50,000 from the Carnegie Corporation to build the new central library in 1914, and, provided $66,000 from the same source to rebuild the library after the quake. And at a time when The Community Arts Association needed funding in order to get off the ground, Pritchett arranged a five-year annual grant of $25,000 starting in 1922.
Without the influence of Henry Pritchett, Santa Barbara might be a very different place. Pritchett, and the dynamic leaders he inspired in the 1920s, got Cottage onto a foundation of continuing success. But Cottage Hospital fell hard during the Great Depression of the 1930s. Where other top-notch hospitals were fueled by the large population centers where they were located, Cottage had reached a near-perfection in a town of 33,000.
By 1933, the Cottage board lacked millionaires and they found themselves sending out fundraising letters under their personal signatures. They were able to raise just $19,000. In 1934 the situation was dire. “We are faced with immediate financial problems which cannot be delayed, and have decided that a preliminary appeal be made to a small group of the hospital’s most loyal friends, asking that they join together in now subscribing $10,000 which we need to carry on the hospital, financially, until the local campaign is launched. I wish to convey to you that our Board of Directors is reluctant to make this appeal to you under any circumstances except those of extremest urgency. Frankly, the very continuation of the hospital depends upon the response to these few letters we are writing.”
The campaign that year brought in just $7,550.
White-coated room-service was gone. Over half the hospital was essentially shuttered. The nursing and medical education programs limped along, but team diagnosis and quality initiatives were dropped.
Cottage would not begin to emerge from the slump until 1956 when Rodney Lamb arrived as Hospital Administrator with a vision as potent as Pritchett’s. Only in recent years does it appear that Cottage has risen to the level of organizational maturity that Pritchett hoped to see in any institution: consistent selection of dynamic and knowledgeable leaders, a basis in best practices and scientific findings, and results-based assessments of quality and success.
Henry Pritchett was vital and involved throughout his life. He always had ten irons in the fire and was committed and productive with each. One of his first acquaintances in Santa Barbara was Edward Payson Ripley, president of the Atchison, Topeka and Santa Fe Railway. Knowing nothing of railroads, Pritchett listened well, asked probing and insightful questions, and Ripley soon asked Pritchett to join the company’s board.
Pritchett served on the railroad’s board for over 20 years, attending meetings, taking inspection journeys, and writing incisive reports and articles.
In his later years he served on the boards of the National Broadcasting Company, the New York Public Library, the Metropolitan Museum of Art, and the Huntington Library and Art Gallery.
In the presence of Robert de Forest, president of the Metropolitan Museum, one of Henry’s sons asked Henry, “Father, what do you know about art?” It was de Forest who replied, “We don’t need your father as an authority on art. That is in the hands of the technical staff. We do need his counsel on large matters of general policy.”
Dr. Max Farrand, director of the Huntington, wrote of Pritchett, “He understood better than anyone else on the board what we were striving for and became my strongest ally and backer. He had no particular knowledge of art but he recognized the integral part that art must play in the study of culture of any time.”
His friend, novelist Henry James recalled, “Whenever I happened to meet or encounter him, he was always a welcome sight as he came stepping forward with his unhurried, vigorous stride. His figure was compact, his clothes were well-cut, his beard neatly trimmed, and even in old age he looked as if his body were close-knit and hard. His steady blue eyes gave you a friendly greeting. They were observing eyes.”
William M. Gilbert who served as secretary for the Carnegie Institute, worked with Pritchett behind the scenes for many years. Though CFAT was the first, there were eventually twenty-three separate Carnegie foundations and institutes. Pritchett, a close friend to both Andrew Carnegie and his widow after Carnegie passed, helmed several of them, and advised all.
Gilbert said of Pritchett, “I came to have a high regard for his knowledge and wisdom. One had a feeling in his presence that the world could not go very far astray.”
To see Part I, go to Part I: Henry Smith Pritchett: A Santa Barbara Legacy.
For Part II, go to Part II: Henry Smith Pritchett: A Santa Barbara Legacy.
 “Sargent Engagement,” The New York Sun, December 29, 1907.
 “Daughter Born to Dr. Potter,” The New York Sun, July 15, 1909.
 Cottage Hospital Minutes, January 19, 1918.
 Cottage Hospital Board Minutes, September 21, 1917.
 “Santa Barbara Citizens Donate Cottage Hospital to Dr. Potter,” Los Angeles Times, September 2, 1918.
 California State Journal of Medicine, Volume XVII, No. 6, June 1919.
 Northwest Medicine, Volume XIX, No. 12, pg 310, 1920.
 Tompkins, Walker, “Continuing Quest,” 1977, pg 23.
 Sansum, Dr. William David, The Potter Metabolic Clinic of the Santa Barbara Cottage Hospital, Modern Hospital, Volume XVII, pg 264, 1921.
 Annual Report, Santa Barbara Cottage Hospital, 1921.
 Board Minutes, Santa Barbara Cottage Hospital, March 5, 1934.
 Flexner. pg. 160.
 Ibid, pg. 172.
 Ibid, pg. 193.