Retrospect: The doctor is in

The legacy of pioneering physician Lloyd Noland

Lloyd Noland Hospital in Fairfield, shown here in 1963, closed in 2004. Photo courtesy of Alabama Department of Archives & History.

Giving the presidential address at the Southern Surgical Association in 1938, Dr. Lloyd Noland was at the top of his profession. After a quarter-century attending to the health care needs of Birmingham’s largest employer, Noland was a well-respected physician and administrator. He told his fellow practitioners that he entered the study of medicine out of a “craving for adventure into unknown realms.” From the Isthmus of Panama to the steel mills of Birmingham, Noland was a pioneer in industrial medicine. It was his life’s work.

A native of Virginia, Noland received his medical degree from Baltimore Medical College in 1903. After a year in private practice, the young physician joined the American Medical Mission. He set sail for Panama, where Alabama-born physician William C. Gorgas was combating malaria and yellow fever amongst thousands of Canal Zone workers. The physicians worked in aging, often-inadequate facilities with little funding. Still, Noland quickly made himself indispensable. In 1905, Gorgas promoted him to chief surgeon of the sprawling Colón Hospital.

Dr. Lloyd Noland.

After nearly a decade in Panama, Noland embarked upon another medical adventure. He relocated to Birmingham, where many mine and millworkers were afflicted by the same ailments as those in the Canal Zone. The man who lured Noland from the Isthmus was George Gordon Crawford, president of the Tennessee Coal, Iron and Railroad Co. (TCI), a subsidiary of U.S. Steel. Since arriving in Birmingham in 1907, Crawford had pursued a wide-ranging campaign to improve working conditions at the mines and mills under TCI’s control. It proved to be among the greatest challenges of his long career.

Existing public health and sanitation efforts could not keep pace with Birmingham’s rapid industrial expansion. As a result, many newly arrived workers lived in squalor. Outbreaks of typhoid fever and smallpox roiled the mill camps, as did bouts of enteritis, hookworm and dysentery. At TCI, Crawford battled an astonishing 400% turnover rate. To reverse these conditions, Crawford launched an expensive, multifaceted campaign. Shantytowns were bulldozed and replaced with new constructions. Social workers established nutrition and housekeeping programs. TCI built community houses, libraries and schools.

The “Old Hospital” of the Tennessee Coal, Iron and Railroad Co. Photo courtesy of Alabama Department of Archives & History.

Crawford’s ideas for the medical care of TCI employees were no less revolutionary. Confident in Noland’s abilities, Crawford named him TCI’s first superintendent of health, a title he held for the next 37 years. TCI allocated $750,000 to the health and sanitation program. This was, to put it bluntly, real money. At the time, the entire budget of the state’s public health initiative was but $25,000. Thus, with the blessing of his superior and a treasury at his disposal, Noland was well armed for the task at hand. Deploying many of the same methods he learned from Gorgas in Panama, Noland set about his sanitation efforts with dispatch. Among his first targets were the damp places where Anopheles, the dreaded, disease-carrying mosquito, thrived. Areas with stagnant water were redeveloped. New sanitation measures were quickly implemented.

- Sponsor -

To meet the needs of TCI’s employees and their families, approximately 40,000 people, Noland hired a coterie of physicians and nurses. He established two base hospitals, as well as a series of 12 on-site clinics, called dispensaries, at TCI properties located around Birmingham. In 1914, these facilities treated nearly 130,000 patients. Noland’s doctors made almost 85,000 house calls.

Infection statistics bore out the rapid results of Noland’s wide-ranging health and sanitation program. TCI reported 4,850 cases of malaria in 1912. By 1914, the number of cases had fallen almost 92% to 400. By 1918, there were fewer than 100 cases. Instances of pellagra, a disease which could render a person immobile for months, fell from 280 cases in 1915 to just 7 the following year. 

The replacement hospital built during Lloyd Noland’s first year on the job shows the improvement Noland made almost immediately. Photo courtesy of Alabama Department of Archives & History.

In March 1917, TCI broke ground on its Employees Hospital. The new facility, built at a cost of $1.5 million (roughly $26 million today), sat atop a hill in Fairfield, overlooking the steel mills. The hospital opened in the fall of 1919 and treated almost 4,000 patients with various ailments during its first full year in operation. The hospital ran a nursing school, training African American and white students, from 1919 until 1931. By the late 1950s, more than 350 interns and resident physicians had trained at the hospital, many of them under Lloyd Noland’s expert tutelage.

Birmingham experienced an epidemic outbreak of meningitis in 1937 and few hospitals in the area had the capacity to treat afflicted patients. Noland opened wide the doors of the Employees Hospital, a compassionate decision which earned him the respect of central Alabama and the American medical community. At one point that year, there were more than 100 patients, many of them children, at his Fairfield facility. 

The best institutions, in any field, are made to outlast their founders. So, it was with the hospital and health program of TCI, which continued on after Noland’s death in November 1949. In April 1950, Employees Hospital, a place made possible through the vision of Lloyd Noland, was renamed in his honor. His successor as superintendent of health was E. Bryce Robinson Jr., who had practiced under Noland since the 1930s.

The following year, U.S. Steel turned the facility over to a newly created foundation. It became a community hospital. Soon thereafter came a timely expansion of a new outpatient wing, paid for largely with a donation from U.S. Steel. It featured state-of-the-art clinics for obstetrics, orthopedics and gynecology, as well as a new emergency room and x-ray lab. There were subsequent additions in 1965 and 1973.    

Late in his own tenure, reflecting on the history of Noland Hospital, and the demanding heritage left by its crusading namesake, Robinson said, “Dr. Noland’s example is ever before us.” Today, eleven decades after a young doctor left the Panama Canal Zone to care for miners and millworkers in Birmingham, that heritage continues. Though the hospital no longer stands, the legacy persists as Noland Health Services, a nonprofit company of 1,300 medical professionals operating skilled nursing centers, long-term acute care hospitals and assisted living facilities throughout the state.

Historian Scotty E. Kirkland is a freelance contributor to Business Alabama. He lives in Wetumpka.

This article appears in the June 2023 issue of Business Alabama.

The latest Alabama business news delivered to your inbox