BUTLER HOSPITAL of Rhode Island … plus connections

By Steve Lippmann, M.D.

Well, seems like maybe we are getting over the pandemic. We have lessened coronavirus fears, attenuation of COVID-19 illness severity, and my wife and I are fully vaccinated. Great. With restrictions on travel eased in April 2021, we visited our eldest daughter in Rhode Island. A Brown University emergency medicine faculty member, she was our tour guide; Butler Hospital was among the first things she showed us in Providence. Yes, she took us to the beach, town, medical school, and other affiliated hospitals, too.

Butler Hospital is a very old psychiatric facility and now affiliated with Brown University. What about Butler?

The hospital was founded in 1884 as one of the earliest mental health facilities in this country. It is a huge institution sitting on a surprisingly massive, yet attractive campus that houses numerous buildings, a park-like environment, and even a two-century old farmhouse. Besides the expected many in-patient facilities for psychiatry and addiction medicine, it also hosts a day hospital, and services for social work, a wide variety of offices for other out-patient medical specialties, research facilities, and legal aspects, that include a courthouse. A network of campus roads and parking lots link the numerous buildings.Butler is a base for Brown University’s Psychiatry Department and remains a famous, award-winning mental health hospital. The focus is on psychiatry, addiction medicine, research, and movement disorders, like Parkinson’s disease. They serve adolescents and adults; children, too, had been included, but kids these days go to another affiliated facility. The hospital campus also has a psychiatry emergency evaluation and treatment center with close ties to Brown’s two main Emergency Medicine Departments. Butler Hospital also has an interesting history.

One prominent story is about Dr. William Halsted. He was a famous, early leader in aseptic surgery, use of anesthesia during operations, and numerous innovative surgical techniques. Dr. Halsted was admitted as a patient to the Butler Hospital because of his being addicted to cocaine. At Butler, physicians back then prescribed opiates to attenuate cocaine drug withdrawal, as was the accepted medical practice in those days. Thus, Dr. Halsted got “switched” from cocaine dependance to became opiate addicted; hard to imagine now adays … sad, but true.

Together with the Oxford internist, Sir William Osler, Dr. William Halsted was one of the founders of Johns Hopkins Medical School. It offered excellent, up-to-date physician education. Here now follows a Louisville connection.

Back in those days American medical schools were generally not up to European scientific standards. They were unregulated, often proprietary, and without academic requirements, faculty, or credentialing. Our own Louisvillian, Abraham Flexner was part of a movement that evaluated all American medical schools, closed them, and only allowed reopening only if they met the Johns Hopkins role model for educating new doctors. That included having faculty on-staff in all specialties, providing clinical care to patients, while actually teaching medical students. This reform greatly improved US medical training. Oh, Abraham Flexner Way, a road named in his honor, is in Louisville, running between Jewish Hospital and the University of Louisville of School of Medicine.

By the way, Johns Hopkins Medical School was originally conceived in the 1890s to be built with a big economic donation of railroad stock shares. It was to be a public hospital without race or other restrictions for patient admissions. However, a stock market decline left insufficient funds. The donor’s daughters agreed to help fund the new school, but IF and ONLY if women students were to be admitted under the same criteria as men. The administrators initially refused, but short on money, they finally agreed. Johns Hopkins was then established offering a top-quality medical education as the national role model for all US medical schools to copy. Hopkins also helped begin the concept of admitting women to study medicine in this country. So be it.