From the book "The Country Doctor" by Floyd B. Hay, transcribed and submitted by Lisa Haug.
The older doctors who dated back just after the Civil War obtained their training under some doctor called the Reading Medicine. Then they began seeing patients. Some were not licensed, yet they would treat patients. Others went to school for a limited time and did receive a diploma.
These doctors were gifted. They used the natural senses of seeing, hearing, feeling, tasting and smelling with the bedside manners to obtain a complete history and physical examination of the patient. They would then prescribe the medicine they carried in their little saddle bags. Aspirin, codeine, digitalis, aminophyllin, asafetida, and nitroglycerin were the drugs they mostly carried. There were no telephones and the doctor had to be summoned by horseback or by communication with the last patient as to where else he was needed. The doctor was able to carry only a very limited amount of medicine, and he would have to report back to his home for replenishment of his supply of medicine before he would go on to the next patient. Drug addiction was very rare. Whiskey was used for the treatment of many conditions: washing out wounds, sterilization, for pain, for heart conditions, and keeping people warm when they traveled.
We had fewer bowel problems in the early days. If there were a condition such as peritonitis, it was fatal. Peritonitis was usually caused from a perforation of the gut, and, of course, then we had an obstruction. The patient had a high fever and was markedly distended. Usually with this condition, the patient did expire.
The cough mixtures that were used were of whiskey and brown sugar with mullen and cherry bark which gave it a flavor. The pain in the chest was eased by greased plaster that was applied to the chest with grease, with onions, with turpentine, and sometimes with heat applied with a hot iron or warm rock.
The country doctor would ride in the cold, the snow, and the mud. He would go into a house with muddy and wet feet, and then go on to the next patient until his horse was exhausted. Sometimes he would ask the patient to feed his horse, and he would at times eat and lie down for a few hours sleep; however, it was customary for these old doctors to sleep while riding their horses. Sometimes he would leave his horse at a place and would borrow a horse and go back to his home to replenish his medicine. At night he would often ride the roads with a lantern hanging to his saddle. His charge would probably be 10 cents per mile. He would probably make a call for 50 cents or $1. Many times he took potatoes, corn, chicken, wheat, or whatever he could get for compensation for his services. No hospitals were available except for Nashville and Louisville; however, there was a surgeon in Somerset, 55 miles away, who was transported by car or buggy to assist in surgery on one or two of the patients in this county. These operation were performed on a kitchen table, and sterilization was done by boiling the instruments.
Delivering babies was a specialty done by doctors in the home. The doctors probably had never seen the patient before delivery. It was traditional for the grandmothers and mothers and mothers-in-law to be present on the occasion. Sometimes the midwife would see the patient before calling the doctor; sometimes she would deliver the baby. Water was boiled in pans, and the water was sterilized by using Lysol, which was the major antiseptic used. The patient suffering during delivery was seldom given an analgesic; however, sometimes Seconal a grain and a half or grain three with quinine grains two were given. It was a rare occurrence when this was given to a patient. They usually suffered the pain until it was time for the delivery. The mother was given chloroform by some member of the family or maybe by the midwife who delivered the baby. If a tear was encountered on the perineum, this was just too bad. That was the way it was to happen for the baby to be delivered. The tear was not followed due to the chances of severe infection that would develop. We had no antibiotics to combat the infection. The tear was left open to heal, and nature was good enough that the tear did heal without very much difficulty. Pregnancy followed in the succeeding years without any difficulty.
Some of the families would bear twins. Families would be from two to three and sometimes 15 children. From pregnancy to delivery, the mother never saw a doctor except for the delivery.
After delivery, she would start carrying the youngster on her hip and doing housework, such as cooking, washing clothes on the old washboard, tending the garden canning the season's growth and never losing a day's work. It was a tradition in the early days for each family to have a milk cow. It was the mother who usually milked the cow, strained the milk, and had a two or three gallon churn that was used to hold the milk. It was set by the fireplace to clabber. A dasher was used to churn the milk to make the butter, which was rolled and placed in a dish to harden so it could be put on the table for use.
The children grew; their medication was very little. They used warm cloths, mustard plasters, and sometimes mullen syrup and cherry syrup. Catnip tea was used for colic, ASA for fever, and sometimes asafetida and sassafras tea was used. These were also used for high blood pressure and for thinning the blood.
Despite the fact that deliveries were done at home, that sometimes the doctor was slow in getting there (sometimes he even had to wait for the small stream to run down before he could cross), and there was no checkup before delivery, there were not many deaths from childbirth. You seldom heard of a birth injury or a mother bleeding to death. There were no hospitals to go to; the mother and baby recuperated at home. The delivery fee was usually from $2.50 to $10.00.
Broken bones were common. The orthopedic surgeons without hospitals, without x-rays, without specialists, and without anesthetics exercised great skills in setting bones. By their expertise in touch and lining up bones, the break was reduced, then a splint of cardboard or wood was used. Most bones that were reduced and splintered grew back perfectly; however, there were a few fractures that did not heal. Especially if the bones were in the lower extremities this was true. This was crippling to the patient because he did not seek medical advice or because it was impossible to reduce the bone and hold the bone in place. Very few fractures of the hip were noted in early days. We wonder why because today there are so many that are referred to surgery for reduction and pinning.
The older doctors are to be commended for the good work that they did under the circumstances in which they worked. They did make themselves available so that the patient could discuss the disability with them. They also applied themselves by putting forth the senses. The older doctor relied on smell, taste, touch and feel and did not have the sophisticated x-ray, lab work, SMA, and the many other lab facilities we have today. Today we have forgotten the bedside manners that the older doctors also had. I have said that the younger doctors coming out of school today have a little bit of an advantage over the patient, but they do not sell themselves. They do not make themselves available in a friendly term so they can talk to the patient. It doesn't matter how much education a doctor has, if the patient doesn't like him, he will fail.
It is useless to try to treat a patient if he does not have confidence in or does not like the doctor. It is my advice that we apply the five senses, communicate with the patient, try to understand the patient, and let the patient also understand us. I have made the statement on several occasions that when some of the older doctors are gone, they will throw away the mold, the pattern, and we will not be made anymore. The younger doctors will not make calls like we are doing today and in that way they will miss some of the valuable experiences that we had. We will have to pay tribute and honor to the older doctors for the good work they did. They saved many lives and eased many patients. They did not have the hospitals to go to; they did not have an office to go to in the morning; yet they rode horses and buggies, or boats, or whatever means they had to get to their patients. They did strive with all their might to get to their patients to take car of them. Under the hazardous conditions of wading mud, snow, sleet and all, they did see their patients and gave them wonderful care under the circumstances.
I would not want to go back to those days, but I would like to see more concern, more interest in the patients than is shown today. Doctors should not cast the patient off as someone that is sick in the head, so to speak. He should sit down and let the patient know that he is interested in him because any patient that comes to see a doctor is sick in one way or another. They should be seen carefully. Their condition should be evaluated, then they should exactly what is wrong with them. They should not be cast off as a psycho or a neurotic or something to that effect.
Also facing us today we have the drug and alcohol problem. These patients should be treated and shown that we have an interest in them. Most of these people are longing for love and advice and for help. With the proper medication and help, these people can be saved from further destruction. We must say that a doctor can cure more ills with a kind, sympathetic, understanding voice than with all the highly sophisticated knowledge that a doctor may have.
After four years of college, and four years of medical school, a doctor is beginning to learn his art. Can it be said that the new crop of doctors studying today are sending work ahead that they are no longer numbers, but people again; that they will sit down and be patient and sympathetic with the sick? If so, the doctors will grow, they will learn the healing art, they will learn to be better doctors, they will gain the confidence of their patients, and they will gain financially. We hope that they will become better doctors as they go along. We hope that they shed some of their mechanics and gain some of the magic. This is the hope and the prayer that we have for the future doctor.
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