Tag Archives: old time doctors

What a Ride!

23 Monday May 2016

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Dr. Blaine in 1910 Maxwell

At the beginning of his medical practice in 1882, Dr. Blaine had few choices for getting around to visit his patients in rural Ohio. He could walk, ride a horse, or take a horse and buggy. By the end of the century, however, a new and exciting means of transportation took center stage: the horseless carriage. And it was a godsend to busy physicians.

By 1905, Dr. Blaine had acquired a small, one-cylinder curved-dash Oldsmobile, the one made famous in song as the Merry Oldsmobile, and drove it around the countryside in all kinds of weather and at all times of the day or night. It was faster than a horse and buggy and cheaper to run. Remembering to fill it up with gas, however, took a while to become a habit. His son Harry remembered vividly one summer night riding with his father back from a house call when the engine started to cough and then died on a lonely country road at midnight. What could they do but walk the four miles into town and retrieve the car the next day! Even in the 21st century, with accurate gas gauges and plentiful gas stations, don’t we sometimes commit the same error?

But one problem we no longer have to deal with is a lack of paved roads. Dr. Blaine at one time kept three cars: the Oldsmobile for summer, a high-wheeled one for winter, and a 1910 Maxwell for general use. And don’t forget the horse as a last resort! The high-wheeled car was probably one of the early autos that were basically buggies with a small gasoline engine attached. The high wheels kept the driver above some of the snow and mud on the roads–that is, if the car had enough power to make it through. Most country roads at that time were nothing but unpaved rutted tracks that transformed into a sticky mud soup after a rain. Any smart driver carried shovels, chains, ropes and other paraphernalia to extricate his car from the gooey mud or high snowdrifts when necessary. The doctor bragged to one of his sons that he had managed to drive 60 miles in one day in the mud in a 1910 Flanders, which had just recently replaced the Maxwell and was, according to the doctor, “the greatest car made.”

With his unquenchable curiosity and love of all things mechanical, Dr. Blaine couldn’t resist tinkering with his cars. The story goes that he completely disassembled his first car in order to understand how it worked and then, thankfully, put it back together correctly. Later, when he had accumulated more than one car, he built a large garage at the back of his house and furnished it with all the tools necessary to repair and maintain his prized possessions. He even installed an underground gasoline system which pumped fuel directly into the autos.

His curiosity and love of excitement also got him into trouble. It had not taken long for early automobile enthusiasts to recognize the potential for car racing as a new sport. Catching their enthusiasm, Dr. Blaine created his own speedster by removing the fenders and windshield on one of his Fords. Nothing was more thrilling than racing around the countryside in his creation, flinging mud in all directions during wet weather! Then the inevitable happened. On the way to a house call, the doctor encountered a farmer backing his hay wagon out of a lane in front of him. Not able to stop in time, the doctor swerved to avoid the wagon and ended up lying in a ditch with two broken wrists. Not a good outcome for anyone, especially a doctor! But it did manage to convince him to put away his dangerous toy and choose safer transportation thereafter.

Watch Out for Miasma!

09 Monday May 2016

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Like “chirurgical,” the word “miasma” comes from an earlier time in medical history. It may sound more familiar, however, because one of its definitions is still in use today. If you want to say something about the dangerous influence of drugs, you could state, “My best friend got caught up in the miasma of drug addiction.” Or if you want to describe how someone managed to change his social status against all odds, you could say, “After many years of hard work and determination, he was finally free from the miasma of poverty.” So this word is still useful to describe “a dangerous, foreboding, or deathlike influence or atmosphere” (dictionary.com) or “an influence or atmosphere that tends to deplete or corrupt” (merriam-webster.com).

But up until the end of the 19th century, miasma was also the name of a popular theory to explain the origin of diseases, especially those that erupted into epidemics: cholera, typhus, typhoid, and others that occurred with regularity, like malaria and tuberculosis. The miasma theory was based on observation, as were many other medical theories of the time. People living in squalid and crowded conditions and/or near swamps seemed
Miasmato be most prone to epidemics and other diseases. Therefore, it made sense that the cause of the diseases was the poisonous miasma (clouds of small particles) in the air coming from polluted water, rotten vegetation, animal carcasses, and human waste. In other words, bad environments generated bad air, which in turn triggered diseases.

The concept goes all the way back to ancient Greece and may still be found in some people’s belief that sleeping in fresh air is beneficial to one’s health. The miasma theory did, however, provide some benefits to 19th century citizens. In an effort to control the outbreak of epidemics, towns and cities drained swamps and marshes; sanitary reformers tackled the job of cleaning up the dirty, poorly built, and densely populated city neighborhoods that had sprung up during rapid industrialization and immigration. Their attempts to improve the air quality actually ended up accidentally destroying some of the real causes of the diseases.

The miasma theory, though obviously wrong, died a slow death. Even with the development of the germ theory of infection in the mid 1800s, some people clung to belief in what they could see and smell. It took the work of people like Louis Pasteur, who proved the existence of pathogenic organisms, and Robert Koch, who isolated the bacteria that cause cholera and tuberculosis, to pave the way  for general acceptance of the germ theory. Their pioneering work, and the work of many other dedicated scientists, led eventually to the containment of most of the killer diseases of earlier centuries.

 

Dance with St. Vitus

25 Monday Apr 2016

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St Vitus DanceSt. Vitus Dance — what a strange name for a disease we now refer to as rheumatic fever! Those who suffer from the disease often make involuntary and irregular jerking movements as a result of muscle spasms. St. Vitus is the patron saint of dancers; thus the name.

Also known as Sydenham’s Chorea, the disease is a complication of untreated strep throat. Other symptoms include swollen and painful joints, a rash, and sometimes weakness and shortness of breath. The medical community of the 1800s also observed that St. Vitus Dance was accompanied by “irritability and depression, and with mental impairment.” Another reference book of the period suggested that such cases often ended in idiocy and many times insanity. It was most common in youth under 18. The only treatment at that time was complete bed rest and regular doses of iron and cod liver oil for four to six weeks.

What 19th century physicians didn’t know was that rheumatic fever could also leave behind damaged heart valves and eventual heart failure.

And that is probably what happened to Dr. Blaine’s youngest son, William Gillespie Blaine. At the age of 14, Will contracted St. Vitus Dance. With loving care from his mother and medications from his father, Will appeared to make a complete recovery within a couple of years. He went on to hold jobs on a lake steamer, a railroad, and at the Ford Motor Company in Detroit. When World War I came along, he served almost two years on a hospital train in France and returned home to continue a productive life. But by the time he reached his early forties, he must have slowed down. And in 1932 at the age of 48, he collapsed and died on a couch in his brother’s house. The silent killer had finally caught up with him.

Three years later the “wonder drug,” sulpha, was introduced to the medical community, and the incidence of rheumatic fever and other streptococcal infections decreased dramatically. Sulpha — and later penicillin and other antibiotics — completely changed the landscape of medicine. From that time on, doctors could do more than just treat the symptoms of a disease. They had the power to cure it.

The Death of Private Medical Schools

19 Tuesday Apr 2016

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Medical EducationThink of the amount of formal medical education required to become a medical doctor in the 21st century. Got that in your mind? Now contrast that with what was required in the middle 1800s in America. What a difference!

With the demand for doctors spurred on by the Revolutionary War, medical education in our newly established country forged ahead with the establishment of what were called proprietary medical schools. Founded by doctors and run for profit, these schools had only the bare necessities: a building, desks, maybe some charts of human anatomy, and possibly a skeleton and a few miscellaneous specimens. Students were taught primarily through lecture and memorization.

Entrance requirements for these schools were almost nonexistent. Many of the students had less than a high school education, and some were even functionally illiterate. As long as a student paid his tuition, he was almost always awarded a degree, whether he regularly attended lectures or not, for an equivalent of one year of study. Young men often enrolled without any real understanding of the profession, being attracted mainly by the promise of “an easy road to wealth.” (The irony was that the only physicians who made a decent living from medicine in the 19th century were those who were educated in medical schools attached to universities and who practiced in large cities where there were wealthy clients. See the previous post: “Who Pays the Doctor?”)

By 1840, twenty-six new proprietary medical schools appeared; thirty years later, there were forty-seven more. The American Medical Association and other professional organizations urged the establishment of uniform requirements for entrance to and graduation from medical schools, but they fought an uphill battle. Then came the Flexner Report of 1910, which sounded the death knell for proprietary medical education.

The report emerged from a grant that was given to the Carnegie Foundation in 1905 to aid teachers in colleges and universities in the U.S. and Canada. But the list of institutions calling themselves colleges and universities revealed no uniform definition. Many so-called “colleges” were no more than secondary schools. So in 1908 the Foundation hired Abraham Flexner to do a study of existing medical schools to determine which, if any, were indeed institutions of higher learning.

Flexner took on the task with vengeance, personally visiting 150 schools in two years. And what he found in most of them shocked him. As an example, the report on the Toledo Medical College, which Dr. Blaine attended and then served as a faculty member for a short time, revealed these conditions. The entrance requirements were “a four-year high school education or its equivalent.” That seemed to be on track. But as for laboratory facilities, “The school has nothing that can be fairly dignified by the name of laboratory. Separate rooms, badly kept and with meager equipment, are provided for chemistry, anatomy, pathology, and bacteriology. The class-rooms are bare: no charts, bones, skeleton, or museum are in evidence. There is a small library in the office …. There is a wretched little dispensary in the college building.”

As you can imagine, Flexner’s judgmental tone raised the ire of faculty members and other supporters. They had been trying, as had other proprietary schools, to obtain more equipment, lengthen the number of required sessions, and tighten up on the entrance requirements. But in that highly competitive environment, increasing the requirements simply drove students to the less demanding schools. Unwilling or unable to spend the money, proprietary schools just couldn’t keep up with the fast-changing climate of scientific progress in medical education. In fact, enrollment in these schools had already begun to taper off  before 1910. Flexner’s devastating report simply drove them all out of business. Only a small number re-emerged as departments of established universities.

In the introduction to the Flexner Report, Henry Pritchett wrote, “Our hope is that this report will make plain once for all that the day of the commercial medical school has passed.” Obviously, their hope became reality.

References:

Duffy, John. From Humors to Medical Science: A History of American Medicine, 2nd Ed. Chicago: University of Illinois Press, 1993.

Flexner, Abraham. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. NY: The Carnegie Foundation, 1910.

 

 

The Railway Surgeon

08 Tuesday Mar 2016

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In the course of research for the biography of my great-grandfather, I often travel down trainintriguing side roads which lead to new vistas of knowledge. Much of this knowledge will never find its way into the book. That’s why I like to share it here in the hope that readers of this blog will find it as interesting as I have.

This side road originated with a brief mention of Dr. Blaine receiving an appointment as surgeon for the B. & O. Railroad after he moved to Chicago Junction, OH in 1905. By that time the B. & O. had rail lines connecting Chicago, IL to Baltimore, MD, with Chicago Junction serving as a division point.

That little piece of information piqued my interest. Was the practice of hiring surgeons limited to the B. & O., or was it a common practice among all the rail lines? Hopping on the Internet, I went on a most fascinating ride, which ended at this website: http://www.railwaysurgery.org. The following information is taken from an article in that website titled “The Train Doctors: A Brief History of Railway Surgeons,” by Robert S. Gillespie.

Did you know that the railroads were some of the first enterprises, along with mining, lumber, and steel, to offer medical care as an employee benefit? Especially with the expansion of the railroads across the continent, injuries to railroad workers could occur in desolate places, far from any medical facility. Consequently, “by the early 20th century, every major railroad listed full-time doctors on its payroll.” Now Dr. Blaine might not have been a full-time employee, but he was still expected to be on call at all times to treat injured workers or even injured passengers or bystanders in the area around Chicago Junction.

To pay for this medical treatment, the railroads charged the workers a fixed amount in the form of payroll deductions and funded the rest themselves. These mandatory payments were unpopular at first and caused some unrest among the workers, but in time the benefits became more obvious and therefore the payments more acceptable. This practice of payroll deductions for medical care continues today for most employees.

Other innovations by the railroads ended up becoming accepted practice. In order to provide safer care for injured workers in remote areas, the railway surgeons developed emergency packs which were carried in the railroad cars and contained medicines and sterile dressings. These were the forerunners of our ubiquitous first aid kits.

Railroads also established their own hospitals in areas where there were no other medical facilities. Some of these became independent foundations called Employee Hospital Associations (EHAs) and gave employees more say in the management of the hospitals. In order to keep costs down, regulations put limits on what medications would be available to patients and what conditions would be treated. These strict limits and centralized approval process were radical ideas at  the time but became the basis for our modern managed care systems.

Other innovations by the railroads included the appointment of women to high positions such as division or chief surgeon. And the railway surgeons not only cared for the injured, they also “advised railroad officials on workplace safety and sanitation issues,” thus providing the foundation for what has become the specialty of occupational medicine.

So even though the last railway hospital closed many years ago and railway surgery is a specialty of the past, their innovations created out of necessity in the age of the railroad remain a vital part of our 21st century medical landscape.

What kind of word is “chirurgery”?

22 Monday Feb 2016

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Looking at WordsIn my research for the biography of my great-grandfather, I’ve come across this word, chirurgery or its related forms chirurgical and chirurgeon, a number of times. It didn’t take long to figure out that it must be a variant form of surgery, surgical, or surgeon. But where did it come from and when did it disappear from common use? I don’t think I have the complete story yet, but here’s what I know so far about this intriguing word.

It’s a known fact that English vocabulary is rife with words borrowed from other languages.And it’s also well known that many of our medical terms find their origin in Greek and/or Latin. The Latin term for surgery was chirurgia, while the Greek form was cheirourgia. But the spelling in Old French was serurghien, which was later modified to surgien. So it appears that the word in Middle English, surgerie, followed the French spelling rather than the Latin or Greek.

Then the Renaissance came along. According to the Oxford English Dictionary (OED), sometime around the 16th century, the spelling of the word in English reverted to the Greek-influenced form chirurgery, with the accompanying pronunciation of the first syllable as a k sound rather than an s, and with the accent on the second syllable. That would make it sound something like “ki-rur’-dgery.” Think of it like the first syllable in chiropractic. In both cases the “chi” means “hand” in Greek.

What I still can’t find is any evidence of when the spelling and pronunciation shifted back to our current form. The latest use of chirurgery that I could find cited in the OED was dated 1846. But I have seen it still used in documents printed in the late 1800s. So I am guessing that by the beginning of the 20th century at least, we had managed to shake off the influence of those Renaissance pundits and went back to the original spelling and pronunciation of surgery. In every dictionary I consulted, the variant chirurgery is now labeled as “archaic.”

If you have any more information about the history of this word, please share it!

Surgery Then and Now

04 Monday Jan 2016

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Dr. Blains Hospital - burned down in 2008 Blaine Hospital, Willard, OH

If you have ever had surgery, you many not recall many of the details of the procedure. The ones that stand out for me are the rigorous antiseptic scrubbing down by the nurses, the pre-anesthetic medication relaxing my body, the glaring lights of the cold operating room, and the slow return to consciousness in a well-staffed recovery room.

Constrast that with surgical procedures in the 1800s in the United States. Since the success rate was very low, surgeries were performed only as a last resort. With no numbing devices other than perhaps hypnotism or a cloth saturated with whiskey clenched in the jaw, the unbathed patient was held down on the operating table by one or two strong men. The surgeon was often one of a small number of doctors who had good hand coordination along with steel nerves. But he probably didn’t wash his hands before  he began because there was no understanding yet of germs and how they are spread. No attempt was made to control the flow of fluids once the skin was pierced. In the case of surgeries like cesarean section, the uterine cavity was not even stitched closed, leading to complications during the healing process.

Joseph Lister, an English surgeon, promoted the use of antiseptics in surgery beginning in 1865, but his method was not completely adopted in the U.S. until the 1890s. Even though the first surgery using ether was performed in 1842 in Georgia, over thirty years passed before anesthesia came into general use in America. Many physicians refused to use it because to them it brought the patient too close to death. Others rejected it because they were convinced that pain was part of the healing process, especially in childbirth. It wasn’t until the early 1900s that the U. S. began to emerge as a leader in medicine.

It was during that time that my great-grandfather, Harry G. Blaine, pursued his dream of opening a hospital in Willard, Ohio, where he could specialize in surgery. In preparation, he went to Europe in the spring of 1914 to take a post-graduate course in clinical surgery at the University of London. The Blaine Hospital opened in 1915, with Dr. Blaine as the Surgeon in Charge. In a booklet describing the hospital, Dr. Blaine made sure to mention that out of 628 operations performed, there were only 4 deaths, a mortality rate lower than many hospitals of the time. Some of the most common surgeries listed included appendectomies, tonsillectomies, tooth extractions, and repairs of a variety of abscesses and fractures, hemorrhoids, and lacerations from labor.

With x-ray machines, electrical devices, antiseptic procedures, anesthesia, and sterilizers all in place, surgery in the U. S. had finally  made the transition from a bungling, desperate procedure to a successful tool for the medical profession.

***

Sources:  Duffy, John. From Humors to Medical Science: A History of American Medicine, 2nd Ed. Chicago: University of Illinois Press, 1993.

Ludmerer, Kenneth M. Learning to Heal: The Development of American Medical Education. Basic Books, Inc., 1985.

A Perspective on Christmas

21 Monday Dec 2015

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Christmas Clip Art      A Perspective on Christmas

With all the hype surrounding our 21st century version of the Christmas holiday, it’s hard to remember a time when Dec. 25 was just another day on the calendar for many people. Of the seven entries my great-grandfather, Dr. Harry G. Blaine, made in his diary on Dec. 25 from 1877 to 1883, only three mentioned getting together with family or friends on that day. The rest of those years – and probably many more – Dr. Blaine spent Christmas at home on the farm doing chores or visiting patients or working in his office. One of those years he was in medical school in Indianapolis and spent the entire day in his room reading and writing a letter to his wife. No mention of gifts or lavish decorations or sumptuous meals anywhere.

Granted, as a man in that society, most of those duties might have been relegated to his wife, if indeed they happened at all. But I think the point is valid: We have made Christmas into a monster of commercialism. The bigger and more expensive the gift, the more your family will love you. The day must be perfect, from the wrapping paper down to the last piece of gourmet chocolate.

So as you celebrate your own version of this holiday in 2015, take a step back and find some perspective. For many people out there even today, Dec. 25 will be just another day on the calendar. Doctors and hospital personnel will be working to ensure that your medical emergency is treated. Police and firefighters will stand ready to aid at a moment’s notice. Nursing home employees will show up to care for their residents. Our troops at home and abroad will be on alert to protect our freedom. Families living under a bridge in Anytown, U.S.A., will somehow survive another day.

Remember — and whisper a prayer of thanks for the people in your life, not the things that Santa may bring.

A Perspective on Childbirth

07 Monday Dec 2015

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WARNING: The information in this article is medically accurate, as far as I have been able to research, but could be unsettling for some people.

From the beginning of the human race, childbirth has been fraught with danger. Infections, diseases, deformities in the woman’s anatomy, malformed or badly positioned fetuses, and many other causes have made successful delivery of a healthy child by a healthy mother a gamble at best. Thankfully, with all the advances in 21st century medicine, the mortality rate for infants 28 days old or less is calculated at only 4 out of every 1,000 births. (McDorman, M., Hoyert, D., & Matthews, T. J., 2013). The development of safe Cesarean section techniques, the emphasis on prenatal care, the availability of antibiotics and other medication to combat infection, the early diagnosis and sometimes treatment of problems even before birth — these and many other tools of modern medicine have helped to lessen the dangers of childbirth for both the mother and the baby.

But now transport yourself to the late 19th century, when most of these tools hadn’t even been conceived of yet. When during a difficult delivery, if a choice had to be made between saving the life of the mother or the child, it was the mother who won out. The life of the child was sacrificed through craniotomy or embryotomy.

Cesarean section as an option was slow to be adopted, especially in the United States, because of the high mortality rate. In many early surgeries, there was no attempt to control the flow of blood and other bodily fluids, or to sterilize the environment. Early experiments with Cesarean section involved similar problems. The surgery was only resorted to as a last resort, often after the woman had already endured a long and exhausting labor. And after the child was removed, the uterus was left to close itself. This left the possibility of the mother dying of shock, hemorrhage, or peritonitis. Thankfully, after surgeons finally realized that the womb had to be cleaned and the uterus sutured, more mothers — and their infants — survived Cesarean section (Sager, J., 1890).

In a report from the American System of Obstetrics in the late 1800s, out of 149 Cesarean sections performed in 11 countries worldwide, 108 women and 136 children survived. The figures for the U.S. alone were not as encouraging: Only 9 women and 19 children survived out of 22 operations, but improvements were continually being made (Sager, J., 1890). Compare that with the fact that in 2013, 32.7% of all deliveries in the U.S. were made by Cesarean section (Martin, J., Hamilton, B., Osterman, M., Curtin, S., & Matthews, T.J., 2015). Now that’s a remarkable development in our medical history!

References:

Martin, J., Hamilton, B., Osterman, M., Curtin, S., & Matthews, T.J. (2015, Jan. 15). Births: Final data for 2013. National Vital Statistics Reports, 64(1). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf

McDorman, M., Hoyert, D., & Matthews, T.J. (2013, April). Recent declines in infant mortality in the United States, 2005-2011. NCHS Data Brief. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db120.pdf

Sager, J. (1890, May). Craniotomy. The Medical Compend, 5(10), 124-128.

 

The Remarkable Dr. Blaine

30 Monday Nov 2015

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I never met my great-grandfather Harry Gordon Blaine. He died 11 years before I was born. Yet his presence pervaded my childhood. He was a medical doctor, after all! None of my other relatives — teachers, postal workers, furniture makers, laborers, farmers, office workers — had such an illustrious occupation. No others had saved a life as Dr. Blaine did when he performed an emergency appendectomy on one of his grandsons.

And what made this man even more fascinating were the objects he had left behind. We were the only family in our neighborhood who had a real skeleton in our attic and a real set of 19th century surgical tools in a back closet.

We also felt Dr. Blaine’s presence in a voluminous collection of photos and written records. As a young man, he had kept a diary for ten years which chronicled not only the mundane events of his life as a farmer, but also his growing passion to become a medical doctor and the steps he took to reach that goal. A stack of letters written to and from other family members and  a biography written by one of his sons filled in more gaps in his life.

All of this information, as I read it now, reveals a man whose enthusiasm for knowledge, especially for things mechanical, was unquenchable. And the new discoveries and inventions  of the early 1900s fed that enthusiasm: the first horseless carriages (early name for automobiles), telephones, phonographs, incandescent electric lights, airplanes, and so much more that we now take for granted. It was the age of belief in the forward progress of mankind, and Dr. Blaine was an ardent believer.

Yet, like most people, this remarkable man also had his dark side. Some of his letters contain disparaging remarks about minority groups — an attitude I am sure he shared with most of the society around him. Never a good manager of money, he drove his wife to sue for divorce on grounds of nonsupport of his family. And a family legend about his addiction to morphine was finally substantiated in a copy of the divorce decree. After his death, his estate was so tangled that it took many years to unravel all the details.

Even so, in his lifetime Dr. Blaine contributed to the well-being of countless patients in rural northwest Ohio, was a valued colleague in the medical community, and made his own mark on the society around him. I feel honored, as a descendant, to have him in my family tree.

Remarkable people may be hiding in your family tree too. Even if you never write a book about them, don’t miss the opportunity to make the acquaintance of any who pique your interest. Just as important, be sure to pass down family stories (including your own) to the next generations. As Russell Baker so eloquently put it: “We all come from the past, and children ought to know what it was that went into their making, to know that life is a braided cord of humanity stretching up from time long gone, and that it cannot be defined by the span of a single journey from diaper to shroud.”