One Kneeland Street: Fulcrum in Century of Definition

CHARLES B. MILLSTEIN, DMD, MPH, ALM

During the early sixties, Tufts and the three hospitals recognized that they needed to expand in order to survive.

On April 4, 1973, Tufts University School of Dental Medicine dedicated its facility at One Kneeland Street in Boston. Designers positioned the new dental center at the entrance of the New England Medical Center, which connects with the Samuel Proger Health Services Building. Although the dedication ceremony was brief and went smoothly, the road that led to that moment was tumultuous, often clouded by complexities and uncertainties.

A Loose Affiliation

In 1929, an independent consultant advised Tufts College that, for teaching purposes, its medical and dental schools on Huntington Avenue should affiliate with a hospital. At about the same time, a fact-finding committee for the Boston Dispensary concluded that there was a need for full-time leadership, a medical school affiliation, and hospital beds. Due to these suggestions, the Boston Floating Hospital for Infants and Children, the Boston Dispensary, and the Trustees of Tufts College decided to establish an association known as the New England Medical Center (NEMC). This not-for-profit corporation purchased real estate, supplies, and equipment. It would also perform a portion of maintenance and accounting services for Tufts and the individual hospitals.

Players Emerge

Two incidences occurred that expanded the early components of the NEMC. The Boston Floating Hospital, a ship that took ill children into the harbor for treatment, burned in 1927. The directors used the insurance money and, four years later, broke ground for the new, land-based, floating hospital in South Cove. During this time, the Dispensary had added 20 beds for ailing adults. The components slowly began to physically merge.

Soon after adding 20 beds, directors at the Dispensary discovered they would need more beds as the demand for services in internal medicine soared, outstripping the available space. In 1938, the Dispensary's inpatient services evolved into the Pratt Diagnostic Hospital, which was dedicated to adult patients with internal medical complications. Nevertheless, the need still existed for a major surgical facility. In 1949, the Farnsworth Building became the surgical wing of the Pratt. Ten years later, NEMC broke ground for a five-story Rehabilitation Institute on Harrison Avenue. The NEMC could now offer patients services in internal medicine, surgery, and rehabilitation (1).

Tufts Medical and Dental College soon joined the NEMC campus on Harrison Avenue. In 1948, the Trustees of Tufts College sold the hybrid medical/dental building at 416 Huntington Avenue to Northeastern University. The lack of funds inhibited Tufts from building a new medical teaching facility, so they relocated the two professional schools to a rehabilitated commercial building at 136 Harrison Avenue. The NEMC now had direct contact with a medical and a dental school. Nevertheless, the convergence of the two boards of both entities would prove to be complex (2).

A Pluribus Unum: From Many to One

In the early 1960s, the NEMC officially affiliated with Tufts University. Dr. George A. Wolf Jr., a former dean of the University of Vermont Medical School, assumed the leadership role. Wolf was named the executive director of NEMC as well as the vice president of medical and dental Affairs for Tufts University. He thought he could draw on his skills in hospital administration and politics to help merge the university and the NEMC into one unit. The new entity would have a single set of governors along with a single set of trustees.

Wolf's efforts, however, were futile. Executive management of the three hospitals and Tufts (TNEMC) became impossible. Each institution had its own set of priorities and objectives. Wolf listened as each refused to have its goals diluted in the name of solidarity. Tufts University President Wessel and Dr. Wolf believed that Tufts should own and control the integration in order to have a legitimate university teaching hospital. Both the hospitals and Dr. Samuel Proger, chair of the Department of Medicine at Tufts and physician-in-chief of NEMC, opposed the call for unification. Proger and the three hospitals remained entrenched in the belief that their primary function was simply patient care.

In 1966, after five years of painful negotiations, both Wessell and Wolf resigned. Wessell became president of the Sloan Foundation in New York; Wolf assumed the role of vice president of the University of Kansas. Rather than hinder the unification process, their departures served to catalyze the talks. Without Wolf and Wessell, there was minimal friction, and soon one affiliated body known as the New England Medical Center Hospitals emerged. The timing of this proved to be critical. The new board needed to present a united front in order to deal with the city, state, and federal officials considering urban renewal programs in the South Cove area. The hospitals, now owned by a charitable trust, could offer a wide range of health care delivery. By combining their resources, they had leverage and clout, working with, not against, economies of scale. In 1981, the group became the New England Medical Center (3).

Redevelopment of a City

John B. Hynes's mayoral victory marked a turning point for the city of Boston. His predecessor, Mayor Curley, had engaged in a costly bathe for financial clout and political power, and the city had suffered as a result. It turned ragged and corrupt. A drive through inner-city neighborhoods was marked by large potholes and looming slum tenements. The city had virtually no first-class office space for businesses, thereby decimating the tax base. The city government was in shambles. Hynes began to revitalize and stabilize the city. His two-term successor, John F. Collins (1959-1967), continued the progress.

Collins demonstrated his talents for restructuring a decaying city. He expanded the Boston Redevelopment Authority (BRA) and hired a city planner, Edward Logue, to chair the Authority. Logue had experience in urban planning and set about restructuring the decaying city with the help of MIT-trained architect I. M. Pei. Logue and the BRA began redeveloping 25 percent of the inner city, including Government Center, the waterfront, Quincy Market, and the Christian Science Center. The BRA also targeted for redevelopment South Cove, which included Bay Village, the Theater District, and the New England Medical Center. At the same time, the NEMC began to consider its future in Boston (4).

Hermann Field

During the early sixties, Tufts and the three hospitals faced serious challenges. They recognized that they needed to expand in order to survive. They commissioned Hermann Field, an urban planner, to study the facilities and then make a recommendation either to rebuild in the present location or to seek a larger site outside of Boston. Field concluded that the move would be economically taxing and could block emerging programs in community health. In addition, he noted that recent extension of the Massachusetts Turnpike to South Station made the NEMC's location desirable. Field discussed the need for intelligent planning coupled with foresight that included local community participation. His medical center planning office soon was ready to cooperate in collecting data for the federally funded programs (5).

Field lobbied for Louis Calisti to fill the void created when Dean Hein resigned to become the director of Forsyth. Calisti, a professor of public health policy at the Dental School, had impressed him with his vision of a modern medical campus in Boston. Field realized that they could work in harmony and help the NEMC actualize the potential that existed in the area. Calisti won the appointment. One of his first duties was to build a new dental school within the existing medical area (6).

New Medical Center Becomes a Reality

The dental school at 136 Harrison Avenue was ill suited for professional education and possessed few amenities for students. The outdated clinic housed stand-up, slow-speed dental units that offered little privacy for the operator or patient. The lunchroom and bookstore were in a small dank space in the basement of the building adjacent to the room in which cadavers were stored. In addition, departments such as pediatrics, oral pathology, and social dentistry were located outside the building. These proved to be a continuing inconvenience.

In 1964, Dean Calisti released the results of a government-subsidized study, "Blueprint for the Future." This study was critical since it catapulted dentistry into the field of medicine. The profession would now be included in the medical side of care. "Blueprint for the Future" proclaimed that the new dental school would become an integral component of the New England Medical Center. The study envisioned a new dental curriculum with teaching programs, social outreach, tenure, and retirement plans for full-time faculty (7)

Hermann Field's Planning Office soon matured into an interdisciplinary planning, research, and design resource. All four of the NEW buildings would merge and share one integrated facility. The Trustees chose The Architecture Collaborative (TAC) to design the center. TAC's responsibilities included developing a master plan and an approved design for the new facilities. In addition, TAC acted as the force behind the transformation of the collapsing and fragmented neighborhood around the Medical Center and turned it into a viable in-town community. TAC's efforts were effective. They resulted in housing initiatives, community development, recreational and health care facilities, a new elementary school, reduction in the impact of traffic, and creation of better local access to the regional transportation network (the South Cove Transit Station and the adjacent Tremont Street Parking Garage.

Such extensive integration proved difficult at times. TAC resorted to creative means for solving complications. One example involved TAC's Herbert Gallagher, who spent six years on the job. Together with TAC's design team, Gallagher helped solve issues surrounding NEMC's presence on an already busy Washington Street. As traffic and commotion increased, would the community resent the modern, nine-story building? Gallagher and his team implemented a highly innovative solution. They built a megastructure that passed over Washington Street. The ground floor showcased a new shopping center as well as pedestrian walkways. The community welcomed both improvements. This type of innovation allowed TAC's design to express the concept of growth on minimal land with a great deal of integration into the fabric of the neighborhood (8).

Politics, Economics, and Health Care

In the 1960s, Congress viewed health economics from a new angle. More competition was necessary to lower the escalating price of health care. In order to receive a government grant for dental education, Calisti promoted the concept of the larger facility and a new curriculum that would take less than four years to complete. Calisti thought that if the $15 to 20-million facility was part of a health center, it would be logical to keep it open the entire year. The new education center would produce more dentists, thereby increasing access to care and competition. If students completed the training in three years, tuition would cost less. In addition, students could spend their fourth year in a hospital residency program. This would mean both the students and the hospitals would reap earning benefits. Calisti argued that he would need a modern facility staffed with a full-time faculty to accomplish these goals.

The Trustees of the NEMC needed additional funds for the Health Services Building. Calisti took the issue to Washington and explained that this new arrangement would allow for the best education and the best patient care. Calisti had hoped for an additional $2.5 million. He returned from Washington with $7.5 million. Tufts and the NEMC matched this amount. Calisti, in effect, raised $15 million. The new plans included several important additions, such as 48 hospital beds on the eighth floor of the dental school for teaching and diagnosis, a large seventh-floor cafeteria, and a new design for the school that would connect with the Health Services Building (9).

Barr and Barr Construction Company completed the Samuel Proger Health Services Building in 1970 and the nine-story school of dental medicine in 1971. Both were dedicated in 1973. The buildings showcased a new design concept invented by TAC's engineering team. Because of changes demanded by research teams, TAC conceptualized floors with no vertical divisions. This arrangement allowed flexibility and encouraged informal contact among specialists. A state-of-the-art grid for plumbing, air conditioning, and heating within the ceiling of each floor helped make the modular concept functional. Field envisioned the complex would grow in stages and change internally to meet demands over a 20-year period (10). However, this dream met with resistance.

During the seventies, the NEMC suffered an economic downturn. New administration entered the picture, altering the overall integrated planning for care delivery, teaching, and research. The Trustees, the hospitals, and Tufts no longer agreed with Field's holistic strategy of the sixties (11).  In addition, not long after the new dental school and the Proger Building found their roots, the Vietnam War caused several changes. The government's attitude toward health care shifted. Where money had once flowed into domestic health fields, including dental medicine, it now tricked. The three year dental curriculum proved to be impractical. Directors reinstituted the traditional four-year program. The general unrest that rippled throughout the country permeated the dental school. Student angst and rejection of the war effort embroiled the campus.

The NEMC Today

A walk through the NEMC of today reveals the planning, dedication, and foresight of a handful of leaders. South Cove, the area surrounding NEMC, is visibly different as well. The Theater District, adjacent to the Medical Center, is now bustling, while the "combat zone" has slipped into an anemic state due to the escalation of real estate values in the area (12).  South Station, the aging train depot revived by the now defunct TAC and HNTB architectural groups, is nearby. Once a stark and disjointed terminal, it is now home to an attractive central bus station. Commuter lines, bus lines, the MBTA's red line, and Amtrak all converge within the newly remodeled site (13).

Many years ago, Samuel Proger chose to keep the New England Medical Center in Boston rather than move it away. He recognized the potential that surrounded this location. Hermann Field's early studies on long-range planning reflected the same conclusion. Although the process that led from the theoretical to the actual proved to be winding and gnarled, the reality is quite clear. A handful of men helped transform the landscape of Boston by remaining true to their vision. In the process, they transformed the dental profession.

References

1. Black H. Doctor and teacher, hospital chief. Chester, CT: The Globe Pequot Press 1982; p. 116

2. Ibid. p 104.

3. Ibid. p. 128-31

4. Whitehill W. Boston: A typographical history. 2nd ed. Cambridge, MA The Belknap Press of Harvard University Press 1968; p 223-4

5. Field H. Evaluation of hospital design - a holistic approach. Tufts, New England Med Center 1971, p. 3-5.

6. Interview with Dr. Louis Calisty, Boston, MA, 1996 July 30

7. Blueprint for the future. A report of the workshop session from June 18 to July 17, 1964. Unpublished. Tufts Univ School of Dental Med, Boston MA

8. Dixon J. New dimension in urban renewal, the architectural forum. Urban America, Inc. 1968 Sept: 44-56.

9. Videobiography of Dr. Louis Calisti. Tufts Univ School of Dent Med. Boston, MA 1996 Aug 29.

10. Interview with Herbert K. Gallagher, Boston, MA. 1996 Dec 5.

11. Field H. Evaluation of hospital design - a holistic approach. Tufts New England Med Center 1971, p 23-5

12. Now playing: a boom; thater district is a scene of a hot economy. Boston Globe 1996 Nov 27;A1, A16.

13. Campbell R. Catch this bus stop. Boston Glove 1996 Aug 16;D1, D2, D12.