Editor’s Note: When Paul Honan ’43 graduated from Drexel University medical school in 1943, he entered a world of medicine in transition, and vastly different from today.
In Boone County Medicine Circa 1948, he shares a series of eye-opening observations that underline the many advances in medicine since his earliest days in practice. Some excerpts:
1.
Several years ago I was examining an 87-year-old patient and mentioned that I had taken care of her father-in-law when he’d had a heart attack: It was 1948 and I had just started in the general practice of medicine in 948 and had become a member of the medical staff at Witham Hospital. A phone call in the middle of the a busy morning office practice requested an emergency house call to see a man who was suffering severe chest pain.
At his bedside I found a man with severe chest pain, perspiring profusely. A heart attack was suspected. The term “myocardial infarction” was not in use at that time. An injection of morphine eased his pain. A sixth or quarter of a grain was the usual dose. Several doses of morphine were needed via house call visits over the next few days.
Today we are amused at the rather primitive method of diagnosis and treatment. There was no EKG, no hospitalization, and no blood tests. This was “state-of-the-art” medicine at that time. The diagnosis was presumptive. Treatment consisted of relieving pain, bed rest for six weeks with no early ambulation. The same treatment could have been provided in the hospital for $6 a day. There was no health insurance or medicare. Hospitalization with an oxygen tent was the procedure if congestive heart failure developed.
There were sudden cardiac deaths. There was no ambulance service. A phone call brought the doctor on a house call. The coroner had to be called and the doctor awaited his arrival.
Dr. Clany Bassett in his mid-70s practicing in Thorntown was coroner in those days. He was very much saddened at the new heart attack “epidemic.” He recalled only rare heart attacks in men under 65 early in his practice.
House calls were the method of caring for medical emergencies. All doctors made house calls. All doctors were in the general practice of medicine. There were no specialists (I was the first board certified specialist in Lebanon in 1959.). Some internal medicine specialists in Indianapolis had special interests in cardiovascular diseases; I do not recall hearing the word “cardiologist.”
2.
There was no blood bank in 1948. In anticipated need of blood, typing and cross matching prior to surgery could make available one or two pints of blood. The GP was responsible for drawing blood from a donor, and the lab maintained a list of people with different blood types. Donors were called to ask if they could give blood.
Later, blood could be ordered in advance from a blood bank in Indianapolis.
Post-partum care and abdominal surgery required seven days of absolute bed rest. A remarkable development of knowledge revealed that post partum pulmonary emboli might be prevented by early ambulation. Meanwhile, all doctors pushed on the toes of bed patients daily to flex the foot to look for and elicit calf pain, which was a suggestion of the possibility of blood clots.
3.
The professional fee for obstetrics care was $50, which included the delivery and all office visits before and after. Open drop ether was used for some deliveries. Some doctors used intravenous barbiturates. Some babies arrived sluggish and partly sedated. Resuscitation was required in some cases. Most doctors did episiotomies. Catgut was the suture material.
Circumcision was universal at Witham Hospital.
4.
The fee for an office visit was $2, and a house call was $3. I had liability insurance from Ft. Wayne Medical Protective; the annual premium was $25 for a maximum of $10,000 for a single occurrence.
5.
Penicillin was available at the end of World War II and was used widely. I kept boxes of individual dose vials. “A shot of penicillin” was widely used for infections. Oral antibiotics were not available.
6.
The first patient I hospitalized in 1948 was an elderly African American lady named Eliza King. She told me that when she was six years old, her mother lifted her up to see the casket of Abraham Lincoln as his funeral train stopped briefly in Lebanon.
7.
In 1950 an article in the Journal of the American Medical Association by a Dr. Morrison presented a two-year study in which there was a significantly greater survival rate in 100 previous heart attack victims who were on a low-fat diet when compared to 100 not on the diet. Ten and twenty year follow up indicated continued benefit of that type of dietary regimen.
It was impressive to me. My wife, Kathleen, and I threw out our kitchen Frency fryer and discontinued eating fried foods, doughnuts, pastries, etc. To fill our stomachs we added fruits and vegetables.
8.
Knowledge of the status of medicine in 2005 renders the opinion that medicine in 1948 was rather primitive. In 1948 we had the same opinion of medicine prior to World War II…