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AFSC Historical Corner:  Federal Medical Services at St. Paul Island (Pribilofs)

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St. George Island
Workers relocate the new St. Paul hospital building in 1914.  Bureau of Fisheries photo.
 

As far back as the late 1800s, the U.S. Government – in support of its harvesting of fur seals and other fur-bearing mammals on the Pribilof Islands (St. Paul and St. George) – had provided a resident doctor for the St. Paul community (as well as for St. George). From that time on, the U.S. Bureau of Fisheries (BOF), and its succeeding agencies, had identified its responsibility to the native Aleuts of the Pribilofs for maintaining their good health, in addition to other social issues. These people were regarded as essential to the sealing operation and were recognized for performing the bulk of manual labor involved (slaughtering, skinning, curing, procurement of byproducts, shipping of pelts, etc.)

In 1910, the Bureau assumed full administration of the Pribilofs and immediately attempted to improve the welfare of the Aleuts, who 50 years prior to this had been living in underground hovels; conditions which the visiting physicians compared to places such as coal mining camps. The BOF became aware of the Natives' initial mistrust of government agents, which included doctors, thus creating the problem of community negligence in following medical instructions as far as tending to the sick.

The Bureau soon identified the need to reform community attitude towards matters of sanitation, hygene, nutrition, morality, and disease prevention to curtail the spread of tuberculosis (25% afflicted in 1913) and other communicable diseases. The number of pulmonary related disorders was also significant. In 1914, the visiting BOF Agent in Charge, Walter Lembkey, reported his concerns over "evil" and immoral behavior among the Aleuts, such as intoxication and "inbreeding".

Improvements in these areas were made gradually by the Bureau, in part, through friendly persuasion and education. School children were provided instruction on fundamental health issues, including exercise. On St. Paul Island, a motion picture projector purchased in 1916 was widely thought to have been a great investment towards the education process. Two years later, another projector was put in use at St. George. In 1918, St. Paul received medical-related slides from the Public Health Service that were shown to the inhabitants during motion picture presentations. Throughout this period, the need for better housing and water supply was also recognized by the acting physicians as being essential to improved health conditions.

In 1917, the authority of the Pribilof physicians over all health and sanitation matters were better defined when St. Paul's Dr. W. Byrd Hunter issued instructions to both islands on 11 September. These instructions identified the physicians’ responsibilities concerning:
  • the condemnation of foodstuffs
  • regular inspections of all housing facilities and live stock
  • reporting of health violations
  • accurate and thorough record keeping for all treated medical cases
  • regular reporting to the Agent in Charge and Fisheries Commissioner of all medical issues and census information
    (births, deaths, names, gender, etc.)
  • limiting the required chores by the physician to those directly relating to his duties

A new hospital

  St. Paul Island dispensary
St. Paul Island dispensary, late 1800s.
Gary and Hereford Photo Collection, ca. 1880, ASL-P185-13.  Alaska State Library photo.
 

When the Bureau of Fisheries took control of the Pribilofs, an old dispensary and physician residence had been in place on St. Paul Island since the late 1800s. A hospital was also required, however, as there were medical cases that required special care or isolation, and the patients' homes were often too unsanitary and poorly ventilated to provide the proper environment for recovery.

Beginning in August 1914, a small but sturdy building used for storing salt was converted into the hospital. Supported on a rockwork foundation, the building was laboriously moved some 200 yards over physical obstacles and uneven ground to the main street opposite the dispensary (see top photo). Throughout the fall, remodeling and preparation of the hospital included a new roof, chimneys, an enclosed front entrance addition, and another addition containing the side kitchen entrance, toilet, and coal room. On 1 January 1915, the new hospital opened, though the current resident physician, Dr. William Byrd Hunter, with knowledge of dentistry, still lacked a needed dental facility.

Shortly after the hospital's opening, Aleut girls were given a thorough education in nursing and participated in surgical operations. By the end of 1915, the Native people on St. Paul had been given physical examinations and instruction on proper bodily hygiene, including dental care. In subsequent years there was a high turnover, often annually, of doctors and dentists for St. Paul. Eventually, each of the two islands had a dedicated physician assigned by the Bureau. It was common for the doctor to also perform dentistry, and at times have his wife assist him as a trained nurse. In summer 1920, Dr. H. A. Swanson became the first of many dentists to visit the Pribilofs. He stayed only a few months, however, being replaced by another dentist the following August who remained throughout the winter.

  St. Paul dispensary and physician's residence
St. Paul dispensary and physician's residence built in 1925.  Bureau of Fisheries photo, 1928.
 

The hospital and well-stocked dispensary were much appreciated, especially during disease outbreaks and whenever surgery was required. In 1918, a major operation was successfully performed at St. Paul by Dr. Hunter on Dr. Harold Heath, a naturalist from Stanford University, who fell 45 feet from a trail and landed upon jagged rocks below. Prompt medical attention saved Dr. Heath after he suffered fractures to both legs and numerous facial bones.

During the 1920s, however, the need for more modern well-equipped medical facilities resulted in new construction. The building of a 28- by 48-foot cement replacement dispensary, which contained a laboratory and physician living quarters, began in 1924 and was completed and occupied in the following year. From 1929 to the winter of 1930-31, a larger 28- by 40-foot hospital was also built, with concrete basement walls and new frame construction. In 1935, sod was planted around the new hospital and dispensary with a cement walk created between them.

Disease

The isolation of the Pribilof Islands helped to protect the inhabitants from contagious and infectious diseases occurring in other parts of the region, however, the frequent threats of outbreaks required the St. Paul physician's active involvement in prevention. In October 1917, an epidemic of influenza at St. Paul adversely affected many villagers and their ability to continue the normal sealing work. The following year, diphtheria broke out aboard the Bureau's Pribilof Islands transport tender Roosevelt, which prevented the vessel from bringing much-needed supplies to the islands. During the Roosevelt's quarantine at Unalaska on Dutch Harbor (the nearest port to the Pribilofs), the St. Paul physician was able to provide antitoxin to prevent the disease from affecting the Pribilof Islands.

Influenza broke out in the region again in 1919, killing nearly 40 people at Unalaska. Once again, vessels from Unalaska were barred from arriving at the Pribilofs, an action which undoubtedly spared the islands from the disease. In 1922, there were several cases of impetigo on St. Paul Island, a contagious acute skin disease. Scarlet fever hit St. Paul in July of 1936, resulting in 17 cases – all of which fully recovered after antitoxin was rushed to the island by the U.S. Coast Guard cutter Alert.

More recently

  St. George Island
The "Old Clinic Building" in 1985, consisting of the physician's house, dispensary, and hospital joined by an addition in 1974.  National Marine Mammal Laboratory Photograph Library photo.
 

Over time, the relationship the Pribilof Aleuts had with federal agents changed as they assumed full rights as American citizens and gained more control over their own political, social, and personal affairs. Following Alaska's statehood, the Bureau – now the Bureau of Commercial Fisheries (BCF, as of 1956) – discontinued sealing at St. Paul Island on 7 August 1960 and limited their involvement to fur seal research.

In cooperation with tribal government, the BCF continued to administer the use of several structures, including the two medical buildings. Certain areas on the islands, including several buildings, became known as the "Seal Island Historic District"” and were designated a National Historic Landmark on 13 June 1962.

In 1970, the BCF evolved into the National Marine Fisheries Service (NMFS), as part of the new National Oceanic and Atmospheric Administration (NOAA). The dispensary and hospital were then connected in 1974 with an enclosed addition that served as the clinic. The joined medical facility on St. Paul, known as the "Old Clinic Building", along with other structures, were placed on the National Register of Historic Places in 1986,.

Agreements between NMFS and the Department of Health, Education and Welfare, followed by the Indian Health Service/Bureau of Indian Affairs, allowed the historic St. Paul clinic to continue operating as the island’s medical center until 2006, when a new health facility was built. In 2009, a structural engineering contract was made to assess the physical condition of the "Old Clinic Building"” and provide alteration plans for the potential use of the building by NMFS as a research facility.


Sources:

  • U.S. Bureau of Fisheries. Alaska Fisheries and Fur Seal Reports. In Report of the United States Commissioner of Fisheries for (Fiscal) Year (1908-1940).
     
  • Jones, Lester, E. 1915. Report of Alaska Investigations in 1914. 155 p.
     
  • Faulkner, S. M. 1986. National Register of Historic Places Inventory – Nomination Form: The Seal Islands (Fur Seal Rookeries National Historic Landmark). Anchorage, AK: National Park Service, Alaska Region. Document on file at Alaska Office of History and Archaeology, Anchorage.
     
  • Scheffer, V. B., C. H. Fiscus, E. I. Todd. 1984. History of Scientific Study and Management of the Alaskan Fur Seal, Callorhinus ursinus, 1786-1964. NOAA Tech. Rpt. NMFS SSRF-780. 73 p.
     
  • Robson, B. W., and S. J. Insley (preparers). Towards a Pribilof Islands Research Center: Background Information and Feasibility Assessment (Draft Report). For presentation at the Pribilof Islands Collaborative Meeting January 19, 2008.
     
  • Building Physical Condition Assessment of the "Old Clinic Building" on St. Paul Island, Alaska. Solicitation Number: NOAA-NMFS-AKR-09-0723. DOC/NOAA/NMFS Combined Synopsis/Solicitation Notice.
     
  • Department of Commerce Performance and Accountability Report, Fiscal Year 2007. Financial Section - Note 22. Stewardship Property, Plant, and Equipment. Deptartment of Commerce website (last accessed 4-11-13).
     

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