Kanakanak Hospital marks century of service
The year 2013 should not pass without some recognition that this year marks the 100th anniversary of the opening of a hospital at Kanakanak. In 1913 Doctor Linus Hiram French moved the U.S. Government Hospital for Natives into the school building at Kanakanak. From this humble beginning a system of comprehensive health care is now provided throughout Bristol Bay by the Bristol Bay Area Health Corporation from its hospital facility at Kanakanak.
Our awareness of this history may have gone unnoticed had it not been for a unique gift to the community of Dillingham delivered by a fisherman from Washington to the city office a little more than a decade ago. The gift was a wooden box that once was used to carry dental instruments. The box contained story knives, dolls, tools and beautifully carved ivory buttons and watch chains and a note saying the items in the box were gifts to Dr. Linus Hiram French from his patients; that Dr. French worked in the local hospital, and that his descendants wished to give the collection to the people of Dillingham. Fortunately the note contained the name of Dr. Charles Black of Lopez, Washington. Dr. black was Dr. French's grandson. Dr. French died in 1945.
I contacted Dr. Black to thank him for the gift and inquired about the history of his grandfather. Dr. Black knew only that he was a doctor at Kanakanak in the early 1900's. I then asked whether his grandfather may have kept any diaries, correspondence or photographs. Yes, he said, there were several diaries, a volume of personal and official correspondence and hundreds of photographs. So began the unraveling of a unique story of an ordinary man given extraordinary responsibilities at the beginning of the last century in the difficult and often unforgiving environment of Bristol Bay, Alaska. Here is that story.
Introduction of Western medicine
Prior to the coming of the Russians to Bristol Bay in 1818 the primary healer for the injured or sick Natives of Bristol Bay was the angalkuk or shaman. The introduction of western medicine came with the Russians, but the Russians were more interested in fur and did not really attempt to systematically treat the illnesses they often brought to the local Native population.
Doctors first came into Bristol Bay with the canneries in the 1880s. However, the health care provided to local residents was seasonal and incidental to their primary concern of caring for the multitude of people transported to Alaska each summer to work for the canneries. It was not until the U.S. Government established a hospital in 1911 that the role of the angalkuk as the primary healer for the Native people of Bristol Bay was seriously challenged.
Government Hospital at Carmel
The origins of a government hospital in Bristol Bay lie in the disappointment of the Moravian Church with its mission and school facilities at Carmel. The Carmel mission was established at the village of Kanuluk across the Nushagak river from present day Dillingham in 1886. Kanuluk was the site of the first salmon cannery in Bristol Bay established by the Arctic Fishing Company a few years before. Kanuluk was only a short distance from the community of Nushagak, site of the first Russian settlement in Bristol Bay and the center of the Russian Orthodox Church in Bristol Bay.
The idea for a hospital in Bristol Bay came from Dr. Joseph Herman Romig. In 1904 he proposed to the Society for Propagating the Bible among the Heathen, whose Board of Directors oversaw the Moravian missions in Alaska, that a hospital annex be constructed at the Carmel mission.
Dr. Romig had himself been a missionary for the Moravian Church at Bethel. Romig's vision was a hospital that served local Natives and the influx of people who arrived in the area during the commercial fishing season. He imagined a self sustaining facility that could be operated separately from the mission, but would earn enough from the canneries to actually pay money back to support the mission. The patients attracted to the hospital would also be fertile ground for "propagating the bible." The Moravians gave Romig permission and extended him a loan to start the hospital.
In June 1904, Dr. Romig, his wife and youngest child arrived at Carmel. In addition to his task of establishing a hospital, Romig was also appointed Government School Director responsible for the public school at Carmel and for investigating the need for schools on the opposite shore of the Nushagak - at the villages of Kanakanak and Choggiung.
Romig's hospital venture lasted one winter. In the summer of 1905 he decided the project was not viable at Carmel, in part, because the location was inaccessible to many local people and also because the canneries provided their own doctors and his services were not that much in demand. He abandoned the hospital effort, repaid the Moravian church and resigned from more than 20 years of mission service. He moved to San Francisco to open a surgery practice.
Within a year, however, Dr. Romig was back. In 1906 the Moravians gave up their efforts on the Nushagak in favor of their mission at Bethel on the Kuskokwim, essentially conceding to the competing Russian Orthodox Church that had preceded them by some 70 years.
Dr. Romig stepped in and negotiated a purchase of the complex from the Moravian church. Romig had secured a government mail route contract and intended to open a government hospital from the facilities at Carmel. Romig was also offered the position as the government teacher for the recently established public school at Carmel. Teaching was his primary duty and source of income, although his contract with the government also called for the provision of medical care.
Romig lived with his family at Carmel during the school years 1906 - 1907 and 1907-1908. He provided medical services along with his wife who was a trained nurse.
In 1908 Romig was promoted to the position of Superintendent of the United States Public Schools for Natives in Southwestern, Alaska. The position was based in Seward. Seward in 1908 was the main departure point for people traveling to South and Western Alaska. As superintendent he would be required to travel extensively and his government employers recognized that an ancillary benefit of hiring Romig was that through him the government could deliver medical services to the whole region.
Romig remained at Carmel until the late fall of 1908. He assumed his duties in Seward as superintendent in January of 1909. Before leaving, however, Romig arranged for the construction of government sponsored schools for Natives at Kanakanak and Choggiung.
It was through Dr. Romig that the U.S. Government began providing medical care to the Native population of Bristol Bay. In this sense Dr. Romig can be considered the father of modern medical care in Bristol Bay.
Dr. Romig retained ownership of the buildings at Carmel and for a short period of time during the Winter of 1910 these facilities were staffed by Dr. Linus Hiram French. However, it is in 1911 that the U.S. government formally leases Romig's buildings and hires Dr. French to make the hospital a viable institution. The U.S. Government Hospital for Natives was operated by Dr. French at Carmel (or the village of Kanulik) from August of 1911 until July of 1913.
The Visionary of Kanakanak
Dr. French came to Alaska with the Alaska Packers Association in 1908 as the cannery doctor at Koggiung.
At the end of the summer he returned to Seattle to start a private practice. However, the lure of Alaska and a good cannery paycheck convinced him to return to Koggiung the next summer. He remained in Bristol Bay after the fishing season to manage the hospital facilities at Carmel. During his stay in the Winter of 1909 - 1910 he traveled extensively throughout the region as an enumerator for the 1910 census.
For reasons that are not yet clear French left Carmel after the summer of 1910 and returned to Seattle. He may have been concerned that he was getting older and needed to settle. He once again starts a private practice in Seattle.
French did not stay settled long. He was offered the position at the Koggiung cannery and returned to Alaska again for the summer of 1911. While at Koggiung he was persuaded by a Dr. Henry O. Schleben to take on a revitalized post at Carmel. Dr. Schleben was also a cannery doctor at Koggiung and along with his wife taught and provided ancillary medical services in the Illiamna Lake region. Schelben succeeded Romig at Seward as the School Superintendent for Southwest, Alaska.
French was ideally suited to become the person to firmly establish a hospital in Bristol Bay. He was familiar with the country, enjoyed the outdoors, had served at Carmel, was mature in his mid 30's, had his own power boat that would enable him to travel the region in the summer, and he was single.
He [Dr. French] is one of the best-hearted, broad-minded men that it has been my pleasure to meet, and certainly is the right man for the place as evinced by the confidence which the natives have in him, and the loyalty exhibited.
French negotiated with Dr. Romig for a lease of the buildings at Carmel for $300 a year and returned to Carmel in August of 1911. In addition to his duties as doctor he would serve as the defacto superintendant of the public schools on the Nushagak river, supervise the government reindeer herds scattered throughout the region and also serve as U.S. commissioner, the chief legal official in the region.
French described the facilities at Carmel in a letter dated July 1, 1912:
The Nushagak Hospital for Natives was opened September Ist 1911 in the buildings formerly known as the Carmel Mission of the Moravians, located on a high point about one and two thirds miles above the village of Nushagak.
The buildings are large and rambling consisting of two parts, a dwelling and hospital connected by a one story structure which serves as a coal shed and vestibule for both buildings.
The furnishings are old and show the effect of hard usage, and the equipment subject to wear such as stoves and bedding are almost useless.
The hospital beds are simple 'bunks' made of rough boards, and are without / springs, and have probably been made at various times by different persons, as no two are alike in size or design.
The absence of running water, bathrooms or sterilizing apparatus, makes the cleaning up of patients almost impossible, and the performance of surgical work very laborious.
French also noted the breadth of the area served by the hospital:
The Nushagak Hospital draws to it patients from the villages on Bristol Bay and the rivers tributary to it. There are many villages in this region, and but few are indicated on the maps, as an example, there are nineteen on the Nushagak River from its mouth up to the point where the Tikchik (called the Nuyakuk today) enters it, and only three are marked on the map issued with the Alaska report on education. The same is true of the Ugashik, Egegik, Nak Nek, Alockonok, Kvichak and Togiak Rivers. The settlements are small, ranging between fifteen and one hundred fifty.
The buildings at Carmel served as a hospital for three years, but were in very poor shape, needed lots of coal and wood to heat, and were, in French's opinion, larger than needed for a hospital in Bristol Bay.
In April of 1912 French suggested to his superiors that the facilities at Carmel should be abandoned and the hospital moved across the river to the school house at Kanakanak that Romig built in 1908:
After a little experience in this region I find that we do not need a large hospital, but a small house with two wards with three beds in each, an operating room, bathroom for patients and a laundry is all that is required. Of course there must be some residence part for the physician and the nurse. One of the school houses such as we have on the Nushagak with a few slight alterations would answer very well, and could be conducted very cheaply. A small detached building would be best for a laundry and could be used by the Natives at large reserving one or two days each week for bathing.
It took a year, but by the Spring of 1913 the decision is made to move the hospital into the school building at Kanakanak that summer. French describes the move that took place in July and August of 1913:
This has been quite a trying summer on me, there has been lots of work, and I have had little help excepting the month Mr. Mullins was with me. The moving has disorganized everything, and entailed a lot of hard labor on account of the long distance the goods had to be carried to load on the lighter. The two Nushagak canneries were very kind in loaning lighters and towing them across the Bay. We had three large loads, but part of this was the planking from the wharf of the old cannery at Kanulik which the Alaska Packers gave me to use in constructing a walk from the cannery wharf to the Kanakanak building, without which it is extremely hard to get anything up the hill.
French remained at Kanakanak and operated a hospital from the old school house for another three years before asking to take leave in 1916. An excerpt from one of his letters written during the winter of 1916 suggests why he might want a break:
The Kanakanak Hospital has proved to be a useful institution, and during the fiscal year 119 patients were entered as hospital cases, of whom 53 recovered, 37 improved, 25 discontinued treatment, and 4 died. These cases required 1,718 days of hospital treatment, as compared with 1,232 of the previous year.
In addition to the above cases which were kept in the hospital, a much larger number were treated in the dispensary as out-patients. Attention is called to the fact that the Kanakanak Hospital is really not a hospital, but is a school building and, owing to lack of funds, it has never been changed or improved in any way to provide the proper means of doing medical or surgical work. This, of course, has made the handling of patients so very difficult and dangerous that only the medically necessary and unavoidable surgical cases were attempted.
During the past five years I have been working under conditions which have been discouraging in the extreme. This is a rather large area, with nothing but the crudest means of transportation, necessitating travel by small, unseaworthy boats, launches, or native "kayaks" (one-man canoes, covered with skin, and tipping over with the slightest cause), and, during the winter, by deer or dog sleds.
No successful treatment of serious medical or surgical cases can be attempted in the native hut, so that such cases must be moved, if possible, to the hospital. Here we have an absolutely inadequate institution for the work, with no water system, no sewers, no heating plant except stoves, and insufficient room. I have used as my chamber the small, narrow storeroom, with slanting ceiling under the roof. The dining room, originally designed for the teacher and his family, did duty as office, reception room, nursery, and living room. In the school room we had 8 beds, but we occasionally accommodated 12 patients.
During the winter I traveled continuously through the months of January, February, and March, visiting all schools and reindeer camps, except Togiak and Kulukak. For the most part of this trip I used reindeer, but on account of the rains and thaws during the fall, followed by freezing, the moss was glazed in, rendering it very difficult for deer to get sufficient food. Therefore we were compelled later in the winter to abandon reindeer and use dogs.
On my return from Ugashik, while passing through Egegik I received word of a murder committed over at Nushagak, to which I was summoned immediately for the purpose of making an autopsy. The trip required two weeks' time, and on account of a heavy snow falling about the 17th of February I was compelled to walk on snowshoes the entire distance from Koggiung to Nushagak. I then made a trip up to Lake Iliamna, visiting the three reindeer camps and the school at Iliamna Village.
While on leave in his native Ohio French met and married Susan Brown of Cincinnati. The couple returned to Kanakanak in the Spring of 1917 and remained until the fall of 1919. Mrs. French gave birth to two of their four daughters at Kanakanak.
The 1919 Spanish Influenza Epidemic
The departure of Dr. French in 1919 was not made easy. That spring he would confront his most difficult challenge as a doctor - the worldwide influenza epidemic of 1918 / 1919 reached Bristol Bay. He was the only doctor available in Bristol Bay, until the cannery ships arrived, to confront the epidemic.
French learned about the influenza epidemic in December of 1918 from a messenger sent by the Governor who traveled to Kanakanak by dogteam from Marshall on the Yukon River. French was authorized to set up quarantines and restrict travel between villages.
Health officers were established in each village with authority to prevent people from leaving or entering the village. French was hopeful that the isolation of Bristol Bay would protect the region. His hopes were apparently dashed by a Russian Orthodox Priest who came to the region for Easter celebrations and unknowingly brought the infection with him. The desire of the people in the region to attend Russian Easter celebrations was too strong for any travel restrictions. The disease spread.
Once infected the Spanish influenza ran its course quickly. The verdict of death or survival came within days. So many people were dying that burials became perfunctory. The following is a description of the horrific consequences of the flu as reported by the government Bureau of Fisheries official, a Mr. Shirley Baker, sent to oversee the fisheries in Bristol Bay. He arrived on May 20, 1919:
Upon my arrival at Nushagak Bay, I found the "flu" had made its appearance in the native villages, and for a time threatened the utter extinction of the entire Eskimo population of all that section of the Bering Sea region. In fact, the entire Bristol Bay region was in a demoralized condition. From the very onset it was apparent the natives had no power of resistance to fit them to cope with this malignant type of pneumonia. The government hospital was crowded with victims, and the whole hospital staff was sick with the disease. The dead were lying unburied in the barabaras, and in many instances half-starved children were found in homes with the badly decomposing bodies of their elders about them. Strange to say, these children died only in rare instances. It was the young people and adults that felt the full force of the plague, there appearing to be a complete breakdown of their physical resistance whenever struck by the "flu" infection.
For the first three weeks after my arrival - there being nothing of pressing importance in the Bureau's work to be done - I put in my time in assisting off and on at the Government hospital and Kanakanak Village, but principally in burying the dead. With little assistance, the U.S. Deputy Marshal and I interred almost the entire adult population of the village of Kanakanak, and also organized the burying party that interred the dead at Dillingham. Many of the bodies were far gone in decomposition; ravenous dogs had been feeding upon them, and the conditions were too harrowing to narrate in this report in detail.
By July of 1919 the disease had run its course. The newspapers at the time reported hundreds of deaths in the region, but the actual number was probably much larger because many villages could not be reached for medical care. To this day unmarked mass graves around Bristol Bay hold the victims of this tragedy.
Despite the widespread infection, the flu, as Mr. Baker observed, was somewhat selective. Adults and older children often died, toddlers to early teens survived. In its wake the influenza left many orphans. The canneries provided care and housing for many of these orphans, but as the fishing season drew to a close they were anxious for the government to find other accommodations for them. The hospital at Kanakanak was the only alternative. Orphans from around Bristol Bay and Southwestern, Alaska were brought to Kanakanak . On the eve of their departure Dr. French and his wife found themselves surrogate parents for an extremely large family.
As the Frenchs departed Kanakanak in August 1919, the hospital was being expanded to serve as an orphanage. For the next two decades medical services would still be provided to Bristol Bay from Kanakanak, but its role as a hospital would be secondary to providing a home and an education for the orphans of the 1919 flu. In this respect the hospital at Kanakanak is also the symbol of Bristol Bay's rebirth. Many if not most families in Bristol Bay now trace their origins to orphans raised at Kanakanak.
Dr. French never returned to Bristol Bay after 1919. His oldest daughter returned briefly sometime in the 1960's to visit the place of her birth. Through her some copies of Dr. French's photographs found their way into local family albums.
Dr. French's grandson, who returned the box of artifacts, reconnected the people of Dillingham to a apart of their story. In 2003 Bristol Bay Area Health Corporation invited Dr. Charles Black to Dillingham to celebrate the 90th anniversary of the hospital his grandfather founded.
Establishing a hospital in Bristol Bay and providing health services in a region so vast and isolated was a large undertaking. Such great enterprises often stand or fall on the character of one person.
For this enterprise a doctor was needed who was not only a skilled practitioner and surgeon, but who was also adventurous and willing to endure the hardships that came with traveling to remote villages in the early 20th century. Dr. Linus Hiram French met these criteria. But the venture would not have succeeded without the compassion that Dr. French had for the people of Bristol Bay. That compassion endeared him to his patients and made it possible for the great enterprise of providing health care to take root in Bristol Bay.
The author wishes to thank Dr. Charles Black for the use of diaries, correspondence and other materials that helped piece this story together and to Dr. Robert Fortuine and his book Chills and Fever for an understanding of the context in which the story occurs.