Chapter 3
My First Practice
In between classes at medical school, I had the rare opportunity of working with my father, who was an old-fashioned country doctor in Oklahoma. Those old timers had a lot on the ball. They were practically the only doctors in their part of the country and had to handle every type of case that came up. They would drive thirty miles to treat a case of pneumonia, for which there was no really successful treatment in those days. In summer and early fall there was always an epidemic of typhoid fever. Diphtheria always cropped up in August and there were malaria cases and new babies constantly.
Typhoid fever was a scourge in the summertime. There were old fashioned privies, even in the small towns in those days, and flies were rampant. Consequently, typhoid was easily spread, especially when people did not believe in vaccination and inoculation against many of the kinds of diseases. Typhoid was hard to treat, as there was nothing specific in the treatment of it. The patient was watched carefully as to his medication and diet, and if he was lucky, his Peyer’s patches in the bowel did not rupture, giving him peritonitis. If they didn’t, he would recover. However, he would be so weak for such a long time that he could not harvest his crop in the fall.
Diphtheria was another late summer visitor in the area. Each August there was a sporadic epidemic of it, especially in children, and one summer, 1933, there were ten cows in the area that came down with it. That is the first I ever knew of diphtheria in cattle.
Dad and I would go to the various country school houses surrounding the village, with diphtheria toxoid furnished by the state health department. The people in the communities were notified in advance, and on a Saturday afternoon we would inoculate every child that was brought in. On a Saturday, it did not interfere with their summer school classes, and Saturday was a big holiday in country towns anyway. We had a good turnout. The response was good, for almost every farmer had seen a child die of diphtheria.
One Saturday we were at the Five-mile school house, giving thirty or forty children their inoculations. There was one fellow, who had seven children, who would not have “that poison put in his children’s arms,” he said. Neighbors tried to talk him into it, and we reasoned with him as much as we dared, but he had some kind of cult which forbade him to allow it. He only came out of curiosity and would not accede to our request to protect his children. Later in the fall when the usual outbreak came, he lost four children to the dread disease.
Dad lived not far from some coal mines where there was an occasional explosion or other mine accident. There were no mine safety laws then and the miners had to pay their own medical bills. The men worked all day in the mines, lived in the little houses furnished by the mine owners, and were always kept in debt to the mine stores for their groceries and other household needs.
One day we had a call to come in a hurry. There had been an explosion in one of the mines with a number of the fellows injured. When we arrived, the men had been brought out and were lying in a row with the local doctor already treating them. Some of the men were in such terrific pain that Dr. Scott was giving morphine by hypodermic to afford them some relief. I saw him draw his syringe full of rain water from under the eaves where it had accumulated from a rain the night before. He then put in a morphine tablet with his hand, dissolved it, and gave it to the patient in the arm.
To me, who had been taught to keep everything sterile, this was an abomination, but I could only shudder, as Dr. Scott was a much older man. In fact, he had gotten his training working with another doctor, instead of in a medical school. He was “trained” about the turn of the century and was given his license because he was already in practice.
Anyhow, soon after giving one of the men a hypodermic, the man stiffened out and died. It was probably due to his condition, and had no connection with the treatment. He was burned over ninety percent of the body.
“Lord, he sure did kill him fast,” one of the onlookers ventured, and I saw several heads shaken in agreement.
We cleansed and bandaged the men as best we could, trying to save as many as we could. There was not a hospital nearby, nor could they have afforded to go in, had there been one.
Those coal mine explosions burn a large percentage of the body. It was necessary to visit the men daily, for they required a great deal of care. The burns had to be dressed, the men given fluids and a close check on each man. Sterility was impossible, but those fellows were stalwart individuals, and the Lord was with them. We did manage to save a good percentage of them.
One spring day, as Mr. Brown was preparing the field to plant his cotton crop, his mules became fractious and started kicking around. In trying to stop them, Mr. Brown became tangled in the lines and the mules ran off down the field, dragging the plow right over Mr. Brown’s body, cutting his abdomen open.
Dad was called, so we went out to the farm, which was only about five miles distant. We had the kitchen table hauled outside, had the patient put on it, and started the women boiling water. The light was good outside, but we could make no real effort at sterility. We began to sort out the pieces and put the bowel together with regular sewing thread “sterilized” by soaking it in moonshine (which seemed to be always present). While a grandmother poured ether, we repaired him and cleaned out the earth from his abdomen as best we could. We had no idea we could do him any good, but again the Lord was with him, and he was a very robust individual, and he not only stood the surgery fine, but in evidence of his appreciation of his doctor’s care, he got well. There was very little evidence of blood loss, and he was quite awhile recuperating, but he was able to harvest his crop (which the neighbors had planted for him) in the fall.
As an example of the kind of odds we worked against, let me cite you this case.
A young fellow and his dad were returning home from some wood cutting in the thicket nearby. The young fellow had a double-bladed axe on his shoulder. As he was picking his way under the trees and through the brush, the axe somehow got hung on a limb, raised up, and dropped down on his head. The blade struck a cutting blow through his scalp. It created quite a gash, and bled copiously, as scalp wounds do, so his father promptly took a handful of dirt and rubbed it into the wound. This stopped the bleeding promptly, but when the youth was brought in to us, it was a terrible job to clean up the scalp. There is not only the danger of ordinary sepsis, but dirt contains tetanus, so we felt we should get the foreign matter out. The job kept us busy for quite awhile. They then told us that ashes and good old chewing tobacco were used to stop bleeding, but Dad had left his “chaw” at home that morning, so they had to use dirt.
The first baby I delivered in private practice was also in the country. I had attended deliveries and had studied the principles of obstetrics in school but had not had any training in the actual practice of delivering babies. And believe me, there is a difference.
This patient’s name was Sarah Blake. She was a nineteen-year-old lass and had been married for about a year to a handsome young farmer. The couple lived with Mr. Blake’s parents, and as always there was a passel of women relatives and neighbors around.
The report on the phone was that her pains were eight to ten minutes apart, getting closer together and harder, and the membranes had ruptured. So it looked like it would not be very long before she would need help. Dad didn’t feel well, he said, so why didn’t I go and deliver this baby? It was only five miles down the road and if I should encounter any difficulty, I could send for him.
The girl had never been for prenatal care. That was the usual thing then. It was difficult to entice these farmerettes in for prenatal care. But this girl was said to be very healthy, so I agreed to go.
Dad kept one bag all fixed for OB work, so I took it and struck out for my first delivery. Everyone has to have his first one, and even policemen and firemen can do it, so, knowing that a baby had never gotten away yet, I consoled myself all the way there, and when I arrived the mother was having a hard pain and crying out loudly. I knew, when I heard that, that I was at the right place.
I immediately took charge. I ordered some water heated, mostly to keep some of the women busy. The young husband went out to the wood pile to let off his steam, while the grandmother was right by my side for moral support and to bring anything I might need.
Examination revealed the patient to be doing well. She was a husky, muscular young woman and very cooperative. Her pains were of good quality, so it was no fake alarm. When delivering in the home, one had to depend on the story of the neighbors and relatives to know when to come. One does not have a nurse to tell when the delivery time is near. Consequently, the doctor has to remain with the patient for hours sometimes.
The chopping of cotton, cutting of wood, and pitching of hay had made Sarah a stalwart woman, so she had no trouble. Grandmother poured some either by the drop method, as grandmothers have done for years, and we soon had a fine, healthy boy. I was kept so busy I forgot my worries, and soon it was all over. Everybody was happy, as they always seem to want a boy first. After the clean up, which kept some of the women busy with the water they had heated, the young father ceased cutting wood and came into the house.
“Doc, I ain’t got no money now, but here is a nice Hubbard squash and five pounds of pecans. I’ll drop off a pig at your house as soon as it is weaned.”
When a doctor is new in the business, he takes every opportunity to learn and to practice. That was the case one Saturday afternoon when Dad was on a call, and I was watching the office. Only two or three patients with routine complaints had been in, when in came a pretty little country miss about eighteen years of age. She laid a dollar on the desk and said, “Paw said I should have a vaccination.”
This was my opportunity. I very carefully checked her heart, using my new stethoscope, examined her lungs front and rear (or anteriorly and posteriorly, as we say). I then proceeded to examine her breasts very carefully, making sure there were no tumors. Her ears, nose, throat, and neck did not escape me. I checked her very carefully, except for her pelvis. Then I gave her the vaccination against smallpox and sent her on her merry way.
I had forgotten this young lady, when two Saturdays later she came in, laid another dollar on the desk and said, “I want another vaccination!”
One quiet afternoon Dad and I were talking things over when a farmer came rushing in and said, “Can you take a bullet out of my son-in-law’s leg?”
“Sure, bring him in,” Dad said.
As he anesthetized the area and went to work, my Dad asked, “How did he get shot?”
“I shot him,” the farmer replied.
“What are you doing, out shooting your relatives?”
“He weren’t no relative when I shot him,” was the reply.
Another time, when we were busier, a fairly young woman came in with a six-year-old boy. She held onto the boy by the hand while the boy closed his eyes and swayed back and forth. He could not stand alone and presented a very peculiar picture. His only speech was mumbled and unintelligible. The head was misshapen, and altogether the lad did not look quite right. I had never seen any patient to compare with him. The mother wanted to know what to do about him, naturally. I could see that it was a neurological condition but had not yet delved into that branch enough to allow me to even suggest a diagnosis. I suggested that she take him to the clinic at Baylor, where the specialist might help him.
My Dad seemed abrupt with her and hastened her out as quickly as possible, offering her no hope for the boy. When they were gone, he told me why.
“That is a case where it helps to know the patient. That boy’s father is his grandfather. It is the result of incest. I recall when the boy was born, the neighbors drove them out and they have been away for years. I’m surprised they had the nerve to return.”
A doctor has to be extremely careful what he says to patients. Sometimes, something said in a joking manner will be taken literally.
Mrs. Brown came in with a very worried expression on her face. She got to the subject immediately.
“Dr. Harris, I have been married thirteen years and haven’t been able to become pregnant. My husband is disappointed in me and I’m worried. Soon, I’ll be too old to have a baby, and I wondered if you can help me.”
“You married Ray Brown, didn’t you? I believe you are Mr. Johnson’s girl?”
“Yes, I attended high school here, then went to Ada to school for awhile, then returned here to marry Ray Brown.”
“Well,” Dad said, “when my chickens don’t hatch, I always change roosters.”
With the busy routine of practice, time passed, and several months later, Mrs. Brown came in again, with her face beaming.
“Doctor, I did what you told me to do, and I am now definitely pregnant. Will you take care of me?”
One day we were sitting in Dad’s car, out in the front of the office where we had just driven up. We occasionally sat there while he smoked a cigar and watched the people pass. Most of the people knew him and would stop to chat awhile. Others waved and spoke with a cheery, “Good morning, Doc.” Still others would talk a trade, for my father was a great one to trade—guns, saddles, almost anything.
This particular day, Saturday, was a lovely day and many people came into town. Some farmers brought produce to sell, and others came to buy supplies to last them a few weeks. Still others made it a holiday to see if there were friends or neighbors whom they might recognize. A nice-looking young woman in a newly made gingham dress passed by the car with a shy young fellow, who looked very interested in her.
“Do you see that young woman there?” Dad asked.
“Yes,” I replied.
“She is twenty-two years old, and is not paid for yet.”
In contrast, another older woman soon approached. “There is a woman who went through life without ever having a menstrual period. She was pregnant, or getting over a pregnancy, all her fertile life. Her husband is a very successful cotton farmer, and has paid in full for every one of his children, twenty-two of them; and the kids have been very good help on the farm.”
The office was in back of Dad’s drugstore. The drugstore was a very busy place, with a soda fountain, ticket office for the Greyhound bus, and three tables for the serving of ice cream and drinks, an old-fashioned sweet shop. After school, the kids would congregate there to have sodas, Cokes, and sundaes.
One day Dad was leaning against the counter when a young, well-dressed fellow entered, took off his hat and wiped his brow.
“Whew,” he said. “It’s hot. Could you spare me a glass of water?”
Dad poured him some water.
“I wonder if I could use your restroom?” he asked. He was directed to the Chick Sale in the back and was given the key. Soon he returned.
“Could you spare me three two-cent stamps?” That was in the day when a two-cent stamp meant something. Dad sold him the stamps and put the money in the cash register.
“Real nice business you have here,” the fellow said.
“Yes,” replied Dad. “Trading water for urine and selling stamps at cost. We are doing all right.”
Still another summer afternoon when the kids were thick as peas in the sweet shop after school, three very young schoolgirls came in a sat at a table. One girl said, “I’ll have a root beer.”
Another said, “I think I’ll have a douche. Mother says they are so refreshing.”
One day a farmer came into the office looking for Dad, who had been up so much the night before that he was at home taking a catch-up nap. Since the farmer had come in from some distance, he agreed to see me. The problem was that he had a large, painful abscess forming on the anterior surface of his right thigh, but it was not yet ready to incise, as it had not yet “come to a head.” I explained to him the situation, and informed him that he would have to apply heat in order to bring the abscess to a head. Then it would either open spontaneously or I could open it. He took my bits of advice under consideration, and then went across the street to the other doctor in town and came out with a prescription. That was when I learned that when a patient comes to a doctor, he wants a prescription, in addition to any advice, no matter how essential the advice might be.
On a hot summer afternoon, two men drove up in front with a team of oxen, pulling a cart loaded with cross ties hand-hewn out of oak, for the railroad. One of them had suffered a cut on the back of his hands. It required several sutures. We always used silk for sutures in a case like that, and they could be removed in six or seven days because they were not absorbable. In other words, they remained as a foreign body if not removed.
The men were going to deliver the cross ties and collect their money, after which they promised to return and pay the bill. However, as they left, I heard one chap remark, “I hope Doc doesn’t wait up for us to come back. Doc has lots of money and won’t miss this anyhow.” Consequently, I never did see them again, and don’t know who ever might have removed the sutures. But that is a remark I have heard so often since then: “Doc has lots of money, so he won’t even miss it.”
In the thirties and forties there was the “focus of infection” theory, which I think is a good one to this day, to some extent. I have seen patients with infected gums and teeth, with pains in the joints and elsewhere, given a great amount of relief when the “focus of infection” was removed. A mouthful of infected teeth can cause a patient to feel miserable all over. Tonsils can be another source of infection. A gallbladder or an appendix can harbor toxin-making germs, but we cannot, on suspicion, remove a gallbladder or appendix unless clinical symptoms or X-rays point definitely to them as culprits. However, we always searched for a focus of infection, and occasionally we found one we could eliminate and the patient improved.
People were always easily excited and had a tendency to exaggerate things. One could not always believe what was told to one, but on the other hand, one didn’t want to take any chances on a patient’s story and let a person go into shock, a coma, or some condition that could be avoided.
An example of this was brought to my attention one day when a thunder shower came up. There were flashes of lightning, accompanied by rolls and claps of thunder, and then the rain began in earnest. About fifteen minutes after the rain, the phone rang. A young lady called about her mother, saying she had run to the window and closed it with such force because of the tremendous rain that it broke the glass. The glass fell and cut her foot off. Now, there was a real emergency, and as bad as the storm was, we rushed out to the car, slipped in and slid our way over there (the roads in the town were not yet paved). We ran into the house, wet as could be, and were surprised, happily, to find that there was only a small cut on the dorsum of the foot. It was bleeding profusely, but it was a cut that required only a few sutures and a bandage. The story of her foot being “cut off” was very greatly exaggerated.
There were many instances like that. The patients and their relatives became unduly alarmed and frequently gave exciting reports.
When a child has a really high fever, it will go into spasms, which really is a frightening thing. A little blood looks like a great deal and is rather frightening, of course, but people should evaluate a condition before giving a report to a doctor.