Old-Style Family Physician
Corning's "Doc Mac"
The Doctor Is In/Out
Medical practice in today's America is highly specialized. When the family physician, usually engaged in "internal medicine," encounters in his patients more complicated physical ailments, he refers them to doctors who have concentrated on the treatment of those maladies.
Passing a patient on to special experts certainly makes sense. But as we grow accustomed to this policy, we are liable to forget that in past centuries, and, indeed, up into the first half of our own century, most family doctors were "general practitioners," who professed themselves ready to deal with any medical need of their clients, as physicians, surgeons, or obstetricians, without transferring the case into other hands. The remarkable fact is that these "GPs" often dealt very well with a wide variety of physical problems.
I wish that I might write a history in praise of general practitioners before the breed becomes extinct. Unfortunately, even a history of upstate GPs, or, for that matter, of Corning GPs, would be beyond my present powers.
What I can do, however, is set down for the record a brief account of the medical career of one typical general physician who worked in Corning from 1882 to 1927. I knew him well, for he was my father, Dr. Thomas Alexander McNamara. I do not apologize for being proud of him. He was a loving parent; an honest, if only spare-time entrepreneur; and a principled holder of public office. Most of all, he was a tireless and compassionate healer whose expertise became part of the family lore of his many grateful patients.
In 1986 I wrote a memoir of my dad for circulation only among his descendants, who knew little or nothing about their talented forefather. I called the typescript "Good Old Doc Mac." Luckily, some written sources were available to me: his account books, a few letters, several clippings and records referring to his term as mayor (1908-1909) and as chairman of the local World War I Draft Board (1917-1919). My own recollections of him were warm though undetailed, since I was only 16 when he died. But the rest of the family were able to fill many gaps in my information. Most impressive of all were the anecdotal data that his former patients and their families hastened to communicate to me when they learned that I was collecting stories about "Old Doc Mac."
He was commonly called "Old Doc Mac," and I must explain why. Actually, he was only 70 when he died. But he had sired another son, Thomas Leo McNamara, who followed him into the profession of general medicine. From 1913 to 1920, Thomas Leo had his office at the same address as Thomas Alexander. Some distinction had to be made between the members of this team, and the most natural one was to call the father "Old Doc Mac" and the son "Young Doc Mac." Incidentally, "Young Doc," a chip off the old block, would continue in general practice until his death at 93 in 1981.
I intend to describe the route that Old Doc took to becoming a medical doctor and his subsequent evolution into a skilled scientist who won the devoted respect of a wide-ranging clientele. But first I want to narrate the daily routine of the doctor as we of his family knew it. Part of the time he was IN, receiving callers in his office. The rest of the time he was OUT, occupied largely with home calls and hospital services.
Let me first introduce you to his center of operations, the office. Its image is engraved indelibly in my memory.
In 1888, Doctor Mac bought, for both professional and residential use, the "Italianate" frame house at 32 East First Street in Corning. He added a wide front porch; and having chosen the right-front parlor for office space, he replaced the porch-side bay of the bay window with a special entrance. White enamelled letters glued to the window of this door announced that it led to the "OFFICE." The caller would turn the gravel-voiced twist bell set below this window and step inside.
The Doctor's sanctum had no reception desk, for there was no receptionist. It had no nurse's station, for there was no nurse. Nor was there a waiting room. Overflow visitors would simply be shown into the dining room behind, or to the steps of the front stairs, or, in mild weather, to the front porch itself. The three windows in the office were without curtains, but they did have interior half-shutters of oak to provide a little privacy.
The whole chamber measured only 12 by 20 feet, and all its furnishings were visible from the threshold. Scanning the scene clockwise, you would first behold an oak grandfather clock dutifully ticking off the years. Then the door, closed, that led into the hall of the residence. Then the physician's oaken roll-top desk and swivel chair, illuminated by a brass goose-neck lamp. Above the desk was an amateur painting of a quaint old peasant couple. Next south of the desk hung a small photo of one of my dad's heroes, the "peerless" Chicago surgeon Dr. John B. Murphy. (In 1892 Murphy invented the "Murphy Anastasmosis Button," a metal snapper that abdominal surgeons long found an effective substitute for sutures.) Then came THE DIPLOMA, enshrined on the canted chimney wall above the handsome black marble mantel. A huge sheepskin, now rippled by age, it testified in Latin to my dad's doctoral rank, and bore the names, signed with many a flourish, of his med school professors.
Lower than the diploma, and a little to the right of it, was a decorative item that delighted my childish fancy. It was a polychromed plaster cast, in high relief, of a swarthy, bearded Arab. He had piercing black eyes and a toothy smile, broad but not very reassuring.
A heavy double door on tracks closed off the south end of the room. To its immediate right was a multi-purpose cabinet of oak that housed medical books, dressings and supplies. Next north of this cabinet was a case, also of oak, with glass on three sides. It contained a microscope and assorted surgical gear, including some dreadful-looking bone-saws.
Now, atop these two cabinets stood an army of large bottles containing pills of various sizes, colors and types. During his early years as a medic, Papa rolled and cut his own pills, or at least some of them. By my time he was purchasing them wholesale from pharmaceutical manufacturers. I suppose that most of the remedies used in the 1920s have yielded place to others. Some of these older medicaments remain in my word-store. Rhubarb and Ipecac, for example. Heroin Tablets (then less stringently controlled by law). Blaud's Pills for anemics. Migraine Pills for brain-aches. The cathartic with the pretty Spanish name, Cascara Sagrada. Asafetida Tablets, whose bouquet was like rotten garlic. One of the few items ever administered to me from this collection of medicines was called "Brown's Mixture." It was a divine, licorice-based cough drop that made having a common cold almost a pleasant experience.
Still north of these two cases, and just below the side window, was a typewriter desk. The last few feet of floor space next to the wall provided space for the gilded, cast-iron hot water radiator. Over this radiator Dad had put up two other appropriate pictures. The smaller was a lithographic caricature distributed by some medical supply firm. It showed an ancient, spare, top-hatted physician striding up the walk towards a small house. In one hand he carried a doctor's handbag; in the other, a furled umbrella. The sun, shining on his back, threw his long shadow before him, and its silhouette was that of a stork! So that nobody would miss the point, the printer had attached the label, "Coming Events Cast Their Shadows Before."
The more important picture was a framed print of "The Doctor," a well-known genre painting by the British artist Luke Fildes (1843 - 1927). It shows a seated physician carefully observing a beautiful little sick girl who lies sleeping on a makeshift bed, while her parents grieve silently in the back-shadows of their tiny rural cottage. I am sure that Doctor Mac chose to display this picture because it symbolizes the devotion to duty expected of the general practitioner. But there was also a personal aspect to his choice. My father might have served as a model for Fildes' physician, so striking was their resemblance in the earliest 1900s when he wore a full beard.
An Axminster rug covered most of the hardwood floor of Doc Mac's office. Of the several chairs provided, the eye-catcher was a well-padded, iron-framed throne set under the central electric-cum-gas chandelier. It was, of course, the examination table, convertible from vertical to horizontal by the twist of a screw. It could also be used as an operating table or delivery table. By the time I was born, however, Papa practiced little surgery and less, if any, midwifery at his office address, and those surgical instruments in the nearby case were tarnished from disuse. For Corning had acquired its own hospital in 1900. Thomas A. McNamara had given the project his strongest backing, and he was selected as the first chief of its medical and surgical staff. Thenceforth he performed most of his major surgery there; there, too, he delivered more and more of his patients' babies. That was true for his own family, as well. My older brothers and sisters had been birthed at home. I saw the light of day in 1910 on the second floor of Corning Hospital.
This, then, is what Papa's professional headquarters looked like. Were the offices of his Corning colleagues equally Spartan? Perhaps not. But surely no other local doctor's quarters would have measured up to the standards of today's medical office in appointments and amenities, and certainly not in its excessively elaborate records-keeping system. Yet it was in this single room that my father, as late as the mid-1920s, held office hours daily from 2:00 to 4:00 and 7:00 to 8:00 P.M. By that time he was charging $2.00 per office call. However, as his ledgers show, he often gave a discount, particularly to immigrant families. Sometimes, when he knew that his clients were low in funds he would simply hand them his bill marked "paid in full." (Like most medics in family practice, he did much charity work. The only debtors he consigned to bill collectors were the few "career" skinflints.)
Although the old-time GP received patients in his office, he spent most of each day, and often much of each night, in house calls and hospital service. For Doc Mac the "speaking tube" that ran up from the front porch to his master bedroom symbolized that "round-the-clock" availability.
What mode of transportation Father used initially beyond the radius of shank's mare I do not know. I find a vague reference in my notes to his owning a primitive bicycle with wooden spokes. Eventually, however, he had to acquire a horse-carriage. His first buggy was a Stanhope; his second, a Phaeton. His first horse was a slick sorrel named Dan. After Dan came Ned, a retired brown race-horse that his colleague Dr. George Lane purchased for him.
Lane assured Dad that Ned would be an ideal horse for a medic, and so he proved to be. He was gentle and so reliable that he often knew where to go without specific direction. Thus, when the Doctor set out on his morning run, Ned would make straight for the customary Stop No. 1, the home of Mrs. Ray Young, a housebound invalid. While he waited for the physician to come out, he would placidly munch the green grass at the kerb. It was much the same when his master sallied forth into the countryside, around Spencer Hill, up Caton way, or over to Coopers Plains. Ned knew the roads so well that the Doctor could take catnaps in route. Of course, the old trotter doubled his speed on the home-stretch, always eager to get back to the stall and the oats.
House calls in winter could present more problems. I believe that Papa owned a cutter. I recall a strap of sleighbells hanging in the barn, and a heavy black carriage robe bearing the image of a great yellow tiger with glass eyes. More often than not, however, the families of his patients who lived beyond the town line would pick him up in their own sleighs. Sometimes it was a bobsled they brought. Once, at least, it was a large box. Snowdrifts could make the journey difficult. On one occasion the drifts were so deep that the driver had taken his vehicle clean over the top of a buried fence before he realized he was off side.
Once, and once only, was I given the privilege of sitting in our buggy on my father's lap, and of holding the reins and "steering" the noble Ned. I must have been only two years old, for in 1913 Ned was put out to pasture.
That same year Papa chose to replace his horse and buggy with a "Model T" Ford roadster. It cost him $559.41. He bought two other "Model Ts" after that. His last car was a Dodge coupe. The Fords had had to be ignited by cranking; the Dodge had the luxury of a "self-starter." While my father might still speak of "hitching up" his automobiles, there was no turning back from horsepower to horses once he had made the break. Always a mettlesome man, he demanded much of his motorcars. He regularly bypassed first gear, and loved to whip around corners on two wheels. You might say that he drove his Fords like a horse and his Dodge like a Ford.
Here, then, is an outline of the daily professional schedule of one general practitioner of the old school. The routine followed by his fellow-physicians in Corning and elsewhere would not have been much different. But now we must examine how young aspirants of a century ago broke into the medical profession, and then went on to acquire a sometimes notable proficiency in healing spirit as well as flesh.
© 1991, Robert F. McNamara