Edward Hand Medical Heritage Foundation
   
 

 

 

 The following article first appeared in The Journal of Lancaster County’s Historical Society, Volume 109, Number 4, Winter, 2007/2008. The article appears here with the permission of the  publisher of The Journal, LancasterHistory.org.


Medicine: The Changing Scene
Wilson Bucher
This article is based on an interview with Doctor Samuel McNeal (Jefferson Medical College, 1925) who practiced medicine in Columbia for over fifty years.

  The Doctor, Sir Luke Fildes, 1891, Lincoln Art Series: No. 30, Published by J. P. McCaskey, Lancaster, PA. The painting was featured in the AMA’s campaign against President Truman’s national health insurance effort. This print of Fildes’ painting hung for about 30 years in the office of Ephrata’s Dr. John H. Bowman, MD., a gift from a patient—Mrs. Charles (Mareta) Beam—and is reproduced here with Dr. Bowman’s kind permission.

In 1891, Sir Luke Fildes, an English artist, painted “The Doctor.” It was an immediate sensation and prints of it later hung in practically every home and doctor’s office in America. Depicted is a little girl, apparently seriously ill— perhaps in a coma—lying on a makeshift bed within a workingman’s cottage. The doctor is seated before her, chin in hand, gazing intently at the child’s face illuminated by the tilted shade of the lamp. In the background stands the concerned father. Seated nearby with her head down on the table is the distraught mother. They wait for words from the doctor which might bring them comfort and hope.

Sir Luke’s picture could not be painted today. On the contrary, a modern version would have to portray a little girl, in an intensive care unit, her bodily processes being monitored by a series of electronic devices. Neither the physician nor the anxious parents would even be in the picture. The parents would be waiting in an air conditioned room. The doctor would be making his rounds but easily reached by methods of communication not dreamt of in Sir Luke’s day.

Would anyone wish to go back to the medical uncertainties of a bygone era? Perhaps not, but Doctor McNeal says, “From the physician’s point of view the personal satisfaction of diagnosis is gone. Before modern laboratory techniques were developed the doctor was trained in the arts of inspection, ausculation, percussion, and palpation.”

In layman’s language this means that the old time country doctor could learn much about his patient’s condition by simply looking at him, listening to sounds within organs, tapping the surface of the body to learn the condition of the parts beneath, and examining the body by the sense of touch. “Some,” Doctor John D. Denney used to say, “could smell a case of diphtheria as they entered the sick room.”

What was in the physician’s bag prior to penicillin and sulfa? Doctor McNeal says that there were many useful medicines, some still in use today. “We had morphine for severe acute pain, digitalis for congestive heart conditions, atropine for spasm, pituitin for hemorrhage, aspirin, and remedies for common ailments such as constipation and diarrhea, among others. But there was nothing for infection.” Doctor McNeal recalls that the late Doctor Frank Alleman of Lancaster prepared and made available to physicians in this area a bromide elixir considered very useful in the treatment of nervous and emotional conditions.

The absence of a specific for infection was a serious handicap to physicians in the pre sulfa and penicillin era. There was nothing in the year 1924 to save the life of Calvin Coolidge Jr., age 16, son of the 30th president of the United States, when he contacted blood poisoning from an infected blister on his heel which developed after a game of tennis. Many now living can recall the days when all a physician could do in such cases was watch the patient, wait for the crisis, and hope that his bodily defenses were strong enough to overcome the infection.

Can we assume that death from infection, like death from smallpox, has been conquered? There is a difference of opinion. Bacteriologists are seriously concerned about recent studies which show the development of resistance factors to antibiotic drugs. These resistance factors not only develop within the organisms themselves but are, by a process of subjugation, passed on from one organism to another. Some bacteriologists predict, gloomily, that if these resistance factors continue to develop we will be back in the Middle Ages insofar as remedies for infection are concerned. The great drug houses, on the contrary, assert that research will always be able to come up with a new drug to meet the challenge of the resistant strains of infecting organisms.

Of course, there are and have been those who decry the use of any medicine or drug. Oliver wendell Holmes, author, poet, novelist and physician, and father of the Supreme Court Justice, in an address before the Massachusetts Medical Society on May 30, 1860, said: “I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind and all the worse for the fishes.”

But even Holmes would have saved opium “which the Creator himself seems to prescribe, for we often see the scarlet poppy growing in the cornfields as if it were foreseen that wherever there is hunger to be fed there must also be pain to be soothed.” He would also have saved “a few specifics” which he did not otherwise identify, and “the vapors which produce the miracle of anesthesia.”

If we were to take literally Holmes’s advice and dump the entire materia medica into the sea, which three remedies would a physician today want to save? My poll shows aspirin without question; a broad spectrum antibiotic; and—a toss up—digitalis, tetanus toxoid, insulin—you name it. Every doctor has his three favorites but aspirin and penicillin are invariably mentioned. Doctor McNeal would want to preserve the preventive vaccines, penicillin and insulin.

Since Sir Luke’s day what have been the greatest advances n medicine and surgery? Doctor McNeal believes that advanced laboratory techniques particularly the new x-ray which detects early breast cancer is the greatest medical advance. As for surgery he mentions the coronary bypass operation which is now a common and relatively safe surgical procedure.

And how has the practice of medicine changed over the years? Most general practitioners agree with Doctor McNeal when he cites (a) abandonment of house calls and the delivery of babies at home; (b) public awareness of the value of preventive medicine and physical checkups; (c) abler physicians and surgeons in the specialties; and (d) improved equipment for diagnosis and treatment. And what do the patients say? Well, they mention the increased costs of medical service. Compare, if you will, the five to fifteen dollar fee for a single office visit with Sir William Galer’s notation in his cash book in 1874 for his first patient—“Speck in cornea— fifty cents.”

How can we avoid the increasing costs of medical services? Doctor McNeal has some helpful hints, his recipe for good health being: “First, have the good fortune to be born into a healthy family. If there is a predisposition towards certain family diseases such as cancer, diabetes, or hypertension, be aware of the value of preventive medicine. Have checkups and physical examinations. Many of these diseases can be controlled if detected in their early stages. Be moderate in all things; keep your weight down and get some regular exercise.” And if we follow the good doctor’s advice we needn’t care if the whole materia medica IS thrown into the sea.

About the Author

The Honorable Wilson Bucher was born 1 November, 1920 in Marietta, the son of the late Wilson G. and Adaline Brandt Bucher. He was graduated from the Marietta High School, Franklin & Marshall College (A.B., 1942) and the University of Pennsylvania Law School (LL.B., 1948). From 1942 to 1946 he served as a captain in the U.S. Army in Europe. Starting a private practice of law in 1948, Mr. Bucher was appointed assistant district attorney from 1960–1964, and was elected district attorney for the term 1964–1968, and in 1971 he was elected Judge of the Court of Common Pleas, Pennsylvania Second Judicial District (Lancaster County). Judge Bucher declined to seek reelection for a second term, and has served since as a senior judge. He is a prolific writer and popular speaker. He married Christine Walther, and they have three children. Judge Bucher is a longtime resident of Columbia.