Old-Style Family Physician
Corning's "Doc Mac"
The Making of a Medic: Act Two
How did the graduates of 1882, deprived of the novitiate of hospital internship, ever manage to get their bearings in the field of practical medicine? Knowing that their living as well as their commitment demanded it, they became constant students of developments in medical science. Actually, that science strode mightily ahead during the years 1882 -1927. X-rays and radium therapy, for instance, date from this era, and immunology made great gains. Doctor Mac of Corning answered his professional conscience by wide reading, attendance at seminars, participation in the agenda of the county and state medical associations, and consultations with fellow-physicians on particular cases. He also won election as a county coroner with a two-year term in 1884 and 1890, and this work doubtless sharpened his understanding of human physiology. His GP colleagues learned "on the job" by the same sort of ongoing study.
Papa was especially aware of the importance of two new technologies introduced during his years of practice. One was the sanitizing technique of asepsis. The other was the improved technology in bone surgery that developed out of World War I.
Asepsis, of course, is the careful elimination before surgery of any possible cause of post-operational infection. Up through the American Civil War and the years that followed, major surgery had been very risky because of the frequent contamination of the open wound. Then aseptic hygiene, promoted especially by the British surgeon Sir William Savory, strove to eliminate this danger by having the surgical team wear sterilized garb and use sterilized instruments. Experience gradually won international acceptance for Savory's recommendations. Some events in my father's practice illustrate his conversion to the method.
In 1885, Thomas McNamara had secured appointment as a district surgeon of the Erie Railroad. It was a job that often demanded instant surgery at unsanitary sites. Some years ago, Mason B. Coger, a prominent wholesale grocer in Corning, told me that when he was a boy he had once seen a crowd of men pressing into the baggage room of the Erie station. With kid-like curiosity, he wormed his way inside. When he reached the front line, he beheld my dad, working probably in the light of massed kerosene lamps, busily sawing off the leg of an injured railroader. Coger gagged and ran out for air.
In 1910, on the other hand, Doctor Mac performed what was said to be the first appendectomy in Corning history. This time he took aseptic precautions that successfully eliminated infection. In 1913, using the same approach, and assisted by three local colleagues, he delivered Mrs. Martin Stenger of a son by Caesarean section. A lively fear of puerperal infection had long discouraged the Caesarean procedure in cases where the mother was still alive. Aseptic routines made the Stenger delivery successful and without side effects. The Corning Leader, stating that this was the second such operation in city history, praised the expertise of the collaborating team. Dr. McNamara later delivered a paper on Caesareans before the Coming Academy of Medicine. He urged his audience of medics not to fear Caesarean intervention when circumstances favored it. Asepsis, he said, is the key to success.
Battlefield necessities during the first World War sped the development of new medical and surgical methods. Old Doc Mac was quick to tap his son for information about bone surgery. Young Doctor Tom had enlisted as a lieutenant in the Army Medical Corps. Thereafter the father and son were often consulted by their peers about dislocations and fractures.
Of course, the "wonder drugs" of the World War II era were not yet available to practitioners of my father's generation. The old-style GP was therefore often called on to keep vigil at the bedside of patients battling infection. Once, for example, a lad on Coming's northside contracted peritonitis, with only a 50 - 50 chance of survival. Papa called in an expert nurse, Margaret Petticrew, and the two gave care to the child all night long. At 6:00 am they were finally able to tell his parents that he had passed the crisis.
One of the saddest tasks of yesterday's physicians was to fight for the lives of children who had contracted diphtheria. A frightful epidemic of this paralyzing croup smote Coming in 1887-1888. It took off all the youngsters in some households. From about 1913 on, an antitoxin was available that would gradually eliminate the disease. Even so, there were still occasional cases. Thus around 1915 Mrs. Anna Callahan Barrett asked Doctor Mac to look at her daughter Frances, in bed because of a sore throat As soon as the doctor stepped into the Barrett house and sniffed the air, he said, "It's diphtheria!"
Patrick Mcnamara Of Adrian And His Medical Family
Seated Patrick; Frances (Mrs. William McCarthy); Mary ( Mrs. John L. Shannon );
Standing Doctor Daniel; Doctor Patrick, Jr.; Doctor Alexander; William (ex-medical student); Doctor Thomas Alexander
Photo c. 1890
He was all too well acquainted with the pervasive "mousy" smell that the infection gave off.
The enactment of the XVIII Amendment, which took effect on January 16, 1920, also involved some medical questions. The amendment, sternly forbidding the production, importation, transportation and sale of "intoxicating" drinkables, was understood to allow the limited manufacture of alcoholic beverages for medicinal as well as sacramental purposes. But those who executed the enabling "Volstead Act" sometimes tended to question even these licit exceptions.
An example. In July 1921 a bill was presented to Congress that would have forbidden medical doctors from prescribing beer for medicinal use. Coming's Evening Leader polled local physicians on their opinions of beer as a healing agent. Some of them declined to reply:
the popular favor for prohibition at that point may have made them cautious. Twelve doctors did respond. None of the twelve objected to the bill, because they believed that beer had no remedial value. Three did object, and Dr. Mac became their spokesman. He said that in his 39 years of experience he had found beer an invaluable medicament for cholera infant-urn, cholera morbus, and extreme hemorrhage. In support of his view he cited an article from Britain's leading medical journal, The Lancet.
As for alcohol in general, he pointed out that the pharmacopeia had always included it; and he lamented that many physicians of his day, yielding to the pressures of national prohibition, were shutting their eyes to its benefits. Some time before the passage of the XVIII Amendment, he said, the noted Dr. Jacoby (probably Dr. Abraham Jacobi, 1830 -1919, one of America's outstanding pediatricians) had warned against the surging "movement of extreme prohibition." Dr. Mac considered that warning prophetic. "We are not dealing here," he insisted, "with a moral issue."
My father had no illusions about the addictive potential of alcoholic drink. He had observed the ravages of alcoholism not only in many a patient but within his own Adrian family. Perhaps for that very reason he used it sparingly as a beverage. His only programmed indulgence was a bottle of Hammondsport champagne at the family dinners on Thanksgiving and Christmas. What he did see clearly was that the peril of alcohol was not in its use but in its abuse. When his fellow Americans finally reached the same conclusion in 1933, they cancelled the XVIII Amendment with the XXI Amendment. Alcoholism still obsesses this country, but we know now that legal prohibition alone will not exorcize it.
Although "Old Doc" was by profession a "specialist" in all forms of medical service, he loved obstetrics best. During the 45 years of his practice he delivered over 4,000 babies. He was said never to have lost a child in a confinement case that he had supervised from the start. Himself the father of eight, he found the human child a constant subject of fascination. Sometimes he would draw up by a playground just to observe the youngsters, fancy-free as they engaged in the important business of play. "All children are beautiful," he used to say.
As a lover of children, Doctor Mac disagreed strongly with the movement for birth control, eugenics and euthanasia, that was vigorously currying public favor during the last years of his professional life. He viewed its proposals as contradicting not only his Catholic moral convictions but the terms of his Hippocratic Oath.
Being also of a philosophic turn of mind, the doctor did not hesitate to deliver, in the early 1920s, two public lectures highly critical of eugenic ideology.
Contraception, he said, used to be discussed only behind closed doors. It has now become the subject of public discourse. For him it posed a threat to the great virtue of mother love, for it could only inhibit spontaneity, and it erred in representing child-bearing as something calamitous, and to be shunned. Euthanasiasts boldly favored mercy killing for the unfit, whether newborn, disabled, or aged. The physician did not question the sincerity of those eugenicists who hoped to improve the human race, but he pointed out that the methods they advocated were destructive and could be enforced only by tyrannous laws. The eugenic outlook, he declared, is basically antihuman. It proposes to improve the quality of the race by techniques developed to breed cattle. But we human beings are not mere cattle. We are also mental, moral and social beings. Admittedly, there are many evils in contemporary society that need correction, among them infant mortality, inebriety, insanity, and various constitutional diseases. The way to counter these evils, however, is to destroy their causes, not their victims.
In these two thoughtful conferences, Dr. Mac anticipated, without realizing it, some of the mad eugenic experiments of Nazi Germany. He also envisioned, at least vaguely, some of the dehumanizing aspects of today's genetic engineering.
In the America of 1920, abortion was still forbidden by consensus and by law, but the spread of the contraceptive outlook would inevitably promote it as a fail-safe means of birth control. However, there was a radical difference between contraception and abortion. The first prevented a human conception; the second destroyed a child already conceived. Unmarried women who became pregnant unexpectedly would sometimes ask the doctor how to be freed of their embarrassment. Dr. McNamara would reply with a gentle talk about the real issues involved. When he had touched their hearts (and he usually succeeded), he would urge that the mother and father marry, if that was practicable. Otherwise he would put the mother into contact with a beneficent institution that would assist her throughout the pregnancy with the minimum of distress.
There was one fact that Doctor Mac learned full well over his decades of midwifery. A mother may find it difficult to feel affection for the tiny being growing invisibly in her womb. But once the child comes forth and lies on her breast, it has a magic way of making itself wanted and loved. Then the long wait and the travail seem to have been very much worth one's while.
© 1991, Robert F. McNamara