Today, Heartland Health provides the people of greater St. Joseph a level of care undreamed of just a generation, even a decade ago: our physicians now extract diseased gallbladders through a dime-size hole and spare the patient a world of pain; cataracts are removed even more easily; kidney stones are shattered and passed without surgery; imaging technology lets our physicians explore the human interior with uncanny precision; rehab technology breathes new life into shattered bodies; babies, born no bigger than a mother's hand, survive and prosper. All is done promptly and passionately. The overnight hospital stay has become, for many procedures, obsolete. And those patients who stay overnight inhabit an environment as clean, as private and as comfortable as the world has ever known.

But it hasn't always been this way in St. Joseph. Not by a long shot. In 1860, when St. Joseph emerged as the most prominent city between St. Louis and San Francisco, when its fabled Pony Express captured the imagination of the world, there was no hospital at all. In those days, the full cycle of human drama, from birth to death, played out in the family home. And the home was where virtually all health care was administered.

When St. Joseph Physicians drew up a standard rate card in 1845, the "home visit" topped the list. The price? $1.00. Like contemporary cab drivers, these early docs charged an extra 50 cents for every mile they had to travel beyond the first and doubled the rates for a visit at night. A "simple" birth back then cost a family $5.00; twins cost $10.00. Amputated fingers and toes went for $5.00 a digit. This was tough work. These physicians may have had one foot in the past: a "bleeding" cost 50 cents, but they also had one foot firmly in the future: "vaccination" cost 50 cents as well. In 1861, the year the Pony Express ended and the Civil War began, St. Joseph launched its first hospital, a humble affair known as the "City Hospital," located on the West end of Robidoux, on the slope of Prospect Hill. The hospital was designed not so much to heal the sick as to protect the community from their diseases. In 1875, when improvements were obviously needed, St. Joseph drew on the "city dog tax," the only real source of city income, to make them.

How much do we take for granted today? Consider this: in the beginning, City Hospital administrators knew nothing of anesthesia or even antiseptics, and it was not until 1891 that the hospital had either electricity or indoor plumbing. In 1902, the city contracted with St. Joseph's Hospital to care for its charity patients and converted City Hospital into a "pest house" for smallpox patients. "City Hospital is not a thing to be proud of," admitted a town historian in 1904. "It answers the purpose, and that is about all."

In 1872, the State Legislature approved $200,000 for either a "Northwestern or Southwestern Lunatic Asylum. " Apparently, the St. Joseph citizens convinced the legislature that there was more need of such an institution in this part of the state. And so "State Hospital for the Insane No. 2" opened its doors here in 1874. More charitably known as "State Hospital No. 2," this institution survived for many years in St. Joseph, but like City Hospital, never really thrived. Today its substantial campus has been converted to a state prison with construction of a much smaller (108 bed) chronic care facility just being completed.

In the 19th Century, nurses bore the brunt of the work at City and other hospitals. Typically, one nurse would be responsible not only for the care of a 50-person ward, but for sweeping, dusting, lamp lighting, coal stoking and window washing as well. To accomplish this, nurses routinely worked seven-day, 90-hour weeks, with "an evening off each week for courting purposes" if well behaved and so disposed. Intolerable behavior included drinking, smoking, wearing rouge and getting one's "hair done at the beauty parlor."

In 1869, the Daughters of Charity of St. Vincent De Paul opened a small hospital and school on Felix Street between 6th and 7th Streets. Although the school remained open, there seemed little need for a hospital, and it shut down in 1872. By 1891, as the city's population swelled, the Daughters reopened a hospital - St. Joseph's Hospital - on Powell, between 9th and 10th Streets, and there it would stand for the next 90 years, known affectionately as "Sister's."

Over time, St. Joseph's Hospital kept adding, kept adapting. In 1895, a nursing school opened its doors. In 1900 came a state-of-the-art operating suite. In 1908, a new hospital was built on site; and in 1921 and 1957 new additions. In 1973, the Daughters of Charity turned the hospital's operation over to a volunteer board. In 1981, the hospital enjoyed a $25 million reincarnation at Riverside and Faraon.

Looking back, what impresses the outside observer about St. Joseph is the unstinting individual and community effort that has inspired the hospitals. Prominent among these good citizens is a father and son team, Drs. William T. and James Weir Heddens. In 1879, the senior Dr. Heddens founded the city's first prominent medical school, the College of Physicians and Surgeons. While serving there in 1882, his son James performed an autopsy on the most famous man ever to reside in St. Joseph, in fact, the most famous man of his time - Jesse James.

William, however, was treating a patient who would do the city more lasting good, attorney Samuel Ensworth. Inspired by Dr. Heddens, Ensworth left his entire estate to promote health care in the city, and the result was the Ensworth Hospital Medical College into which the College of Physicians and Surgeons was merged in 1888. In 1891, the school graduated three women physicians, the first in Missouri.

By 1914, Ensworth College had run out of money, but the hospital endured. In 1924, the Methodist Episcopal Church absorbed Ensworth into the new, state-of-the-art Missouri Methodist Hospital, a $1 million, 200 bed testament to the generosity of the St. Joseph citizenry. In 1930, Methodist absorbed Noyes Hospital, an ambitious, but short-lived charity oriented hospital willed to life through the generosity of shoe manufacturer Charles W. Noyes. Methodist added a nursing school, expanded in 1948 and again in 1956, took over Sunnyslope's isolation function and technology in 1950, purchased Mercy Osteopathic Hospital in 1957, and emerged as Methodist Medical Center in 1972.

Although Sister's and Methodist formed the backbone of community care, many smaller institutions helped sustain the health of the city. The very names of these institutions speak volumes about the era that spawned them: Northwestern Colored Hospital and Orphanage, for instance; or Sunnyslope Isolation Hospital; or The Home for the Friendless; or poignantly named "Home for Little Wanderers." Others, like Emergency Hospital, St. Joseph Sanitarium for Rectal Diseases, or St. Joseph Hospital and Lying-In-Chamber no longer met a health care need efficiently. One more casualty, General Osteopathic Hospital, cited "high costs" and "unreasonable government regulations" for its demise. But that was nearly 20 years ago - Heaven knows what General's administrators would think about today's costs and regulations.

Times have changed. St. Joseph no longer has a medical college. These functions have centralized elsewhere. Methodist Medical Center and St. Joseph's Hospital joined together in 1984 to form Heartland Health - a sophisticated regional health care delivery organization serving some 21 counties - an organization that would certainly leave the good Drs. Heddens awestruck were they to see it today.

But the more things change, the more they remain the same. The good citizens of St. Joseph continue to sustain community well-being through their generosity and their countless hours of volunteer work. Collaboration and cooperation are the hallmark of local health care. Area providers of children's health and mental health services have teamed with state resources to satisfy unmet needs. Health care technology continues to advance at a dizzying rate. And once again, more and more, people choose to receive their health care at home.

Where will we be 100 years from now? Impossible to say. But rest assured that Heartland Health will be there providing quality healthcare to those in need.