Fort Meyers, Florida, United States
|Illustration by J. Raffensperger|
Few doctors, especially those who practice in small communities across the land, are remembered for their selfless, unstinting devotion to their patients. They are not considered heroes in the usual sense and sadly, for the most part, are now replaced by dehumanizing corporate medicine.
The general practitioner or “GP” delivered babies, sutured lacerations, set fractured bones, vaccinated children, and treated most ailments, often in the patient’s home. They usually worked alone and were on call day and night. This is a story of three small town doctors who literally gave their lives for their patients.
My hometown of Henry is on the Illinois River, 130 miles southwest of Chicago, with a population of 1,700 when I was growing up. The town’s doctors and drug stores served the health needs of a wide area.
The first doctor of this heroic trio was Dr. Edward Cromwell, who graduated from the Chicago Homeopathic College of Medicine in 1896. He interned for eighteen months at the Cook County Hospital and started practice in Henry in 1897. Dr. Cromwell was a horse-and-buggy doctor until he drove the first Model T Ford in town. He was also the first to have a telephone in his office and at home.
In 1916, he and his partner converted a two-story brick building into a hospital that had six rooms for patients, an operating room, X-ray, a room for nurses, and outpatient consulting rooms. Trained nurses looked after patients and assisted the doctors. Room, board, and medical care cost five dollars a day.
The only African-American man in town was the general handyman and chauffeur. His wife was the hospital cook. Hospitals like this in small country towns served rural medical needs. The Henry hospital closed during World War II when the nurses joined the Army.
Dr. Cromwell was on the city council, was active in his church, and remembered as a “beloved physician.” He died during an influenza epidemic in 1928. He had continued to make house calls despite his own illness. His obituary related his final days: “Dr. Cromwell worked early and late during the epidemic, taxing his strength beyond human endurance. He yielded his life on the sacrificial altar, a martyr to the conscientious fulfillment of his professional duties.”1
Dr. Cromwell’s son John was the captain of a submarine at the beginning of World War II. When the Japanese sunk his ship, he chose to go down with the ship rather than risk revealing secret codes to the enemy. There is a memorial to Captain Cromwell in Central Park, but his father, Dr. Cromwell, a hero like his son, is scarcely remembered.
Dr. Benjamin Dysart graduated from the University of Illinois and was a member of the Alpha Omega Alpha honor society. He served in World War I and had practiced in a neighboring town before coming to Henry in 1929. Dr. Dysart and his partner, Dr. Coggeshall, removed my tonsils. I remember the ether fumes, descending through agitation to surgical anesthesia, and then awakening with a dreadful thirst. A few years later, when I was about ten, I fell and injured my wrist. My father took me to Dr. Dysart who examined my wrist under a fluoroscope. There was no fracture. When my dad asked, “How much?” Dr. Dysart waved his hand and said, it is nothing, no charge.
Dr. Dysart wore out two Ford cars each year while making house calls and seeing patients at the hospital in Spring Valley. In those days, country roads had treacherous potholes, were covered with snow and ice in the winter, and were muddy in the spring. While driving, he smoked a cigar; when the cigar was finished, he had a lemon drop and then smoked another cigar. This routine must have kept him awake.
He knew he had gallstones, but did not take time off from his practice for an operation. He died of a gallbladder attack.
Dr. Bruce Ryder served in France during the first World War and then attended the University of Illinois Medical School. He interned at the Cook County Hospital. In 1929, he and his wife and son rented a small house in Henry. His office was in the front living room.
My first encounter with Dr. Ryder was when a dog bit my wrist. He cauterized the wound with nitric acid. Later, Dr. Ryder moved to a larger home with an adjoining office and a small waiting room. He became our family physician. When I cut my hand with an electric saw, the wound healed. Later, pus drained and there was a pea-sized mass under the skin. Dr. Ryder examined my hand and said, “There is a wood splinter in your hand, come back after lunch.”
He injected Novocain, made an incision, and removed the lump. He was right, a wood splinter was inside the mass. He knew that chronically draining wounds are often caused by a retained foreign body. Today, someone would have ordered a CT scan and referred me to a hand surgeon.
Dr. Ryder established the blood bank at the Perry Memorial Hospital in Princeton, a neighboring town. He was also on the staff of the St. Francis Hospital in Peoria. Like all doctors at the time, he made house calls in town and country. He kept patients with heart attacks at bed rest in their homes and made daily visits. When there were epidemics of measles, whooping cough, and scarlet fever, he prescribed medicine and tacked a quarantine sign on the front door. If the patient was incapacitated, he would stoke the coal furnace and bring a pot of soup. He usually wrote a prescription to be filled by a pharmacist, but he also dispensed cough medicines and other simple remedies. He swabbed infected tonsils with Argyrol, a silver protein colloid that was an effective anti-bacterial on surface membranes. It was also used for conjunctivitis and urethritis. His former patients remembered his diagnostic skill, his sympathy for the poor, and for the many kind things he did over and above his duty as a doctor.
Even though he was overage and had served in World War I, Dr. Ryder volunteered for the Army Medical Corps in 1943. He suffered a head injury while treating wounded soldiers in Normandy and earned four battle stars and the Purple Heart for his wartime service. After the war, he was sharp as ever but within a few years, his once immaculate office was untidy and at times he was confused. His practice dwindled. His death was a result of the injury he sustained while caring for wounded soldiers under fire.
These three doctors were truly of the old school. Many GPs learned surgery by apprenticing with an experienced doctor and by attending postgraduate courses. During the 1950s while I was a medical student working in a suburban hospital, general practitioners delivered babies, performed tonsillectomies and appendectomies, removed gall bladders, and repaired hernias. One night, I assisted a fine old GP with a right hemi-colectomy for cancer. His work was as good as that of a fully-trained surgeon.
Sadly the GP, like the passenger pigeon, is extinct. The specialty organizations, in particular the American College of Surgeons, insisted that only hospital-trained specialists could perform surgery, deliver babies, or care for complicated medical problems. They used hospital accreditation to eliminate the GP. The American College of Surgeons insisted that even the referring doctor who knew his patients could not assist at surgery.
One half of my University of Illinois medical school class who started in 1949 were from downstate Illinois. Many of us planned on doing general practice in a small town, but our professors said, “You can’t learn it all.” Rotations on medicine, surgery, pediatrics, and obstetrics during the third and fourth year, with visits to other specialty clinics and a rotating internship provided a general view of medicine that was good preparation for general practice or the basis for a specialty. The allure of life in the big city overcame hometown nostalgia. I eventually specialized in pediatric surgery, but every bit of my general medical training was useful.
Primary care physicians are now sometimes relegated to the role of gatekeeper and are expected to screen patients for referral to a specialist. They are often excluded even from seeing their own hospitalized patients. Simple lacerations, sprains, and fractures are sent to the emergency room. My wife’s internist said she would refer a patient with athletes’ foot to a dermatologist. There is a dearth of doctors in rural areas. Specialists are unable to treat anything out of their narrow spectrum, few understand the whole patient, and often refer patients to multiple specialists who may focus on a single organ.
Medical reform should include a change in the way we educate doctors. Rather than allowing students to choose and concentrate on a specialty during their fourth year, all students should rotate through the various disciplines and then have a “general” internship. Ideally, young doctors would then serve a year or two in medically unserved areas. After this exposure to general medicine, they could make better decisions about their future careers. Rotation through the various specialties for three to four years should be sufficient to create a new GP who could treat common ailments, biopsy skin lesions, deliver babies, and counsel patients. There could even be a new generation of doctors who become “beloved physicians.”
- Ms. Elizabeth Wild, librarian of the Henry Public Library, provided obituaries from the Henry News Republican.
JOHN RAFFENSPERGER, MD, graduated from the University of Illinois College of Medicine in 1953, interned at the Cook County Hospital, spent two years in the Navy, and returned to Cook County for training in general, thoracic, and pediatric surgery. He was on the attending staff at Cook County until 1970, when he went to the Children’s Memorial Hospital and eventually became the surgeon in chief. He has written textbooks, works of medical history, and novels. After retiring from active practice, he sailed across the Atlantic and back, then served as a voluntary pediatric surgeon at Cook County.