A Doctor's Memories
Victor C. Vaughan, M.D.

Table of Contents

Chapter 8

The Practise of Medicine

I engaged actively in the practice of medicine for twenty years (1878-1898). After the Spanish-American war I occasionally saw an old friend in consultation, but gave my time to research in my laboratory and to teaching, with an occasional diversion as an expert. On my graduation in medicine it was my intention to devote myself exclusively to scientific work, but this seemed impossible. Dean Palmer was at that time doing some consultation work and he frequently called me in to make analyses and treated me as a consultant. Dr. Frothingham, my beloved preceptor, had a general practice besides his specialty as an ophthalmologist, and he desired to make me his successor in the former. Through these men I found myself shortly after graduation doing a large local practice in the families of my university colleagues. Quite naturally I took care of sick medical students, and this function quickly extended to students in other departments. I soon found that I loved the calling. I do not believe that many young doctors have had a more intelligent clientele than I did during these twenty years. The general practitioner, of that time at least, got near the hearts of his patients.I formed intimate friendships among the professors and their families and among the students which have lasted through the intervening years, and which I number among my richest possessions. I will not deny that the financial reward was pleasing. My charges were less than moderate, but supplemented by my small salary and expert fees, they were sufficient to enable me to provide a comfortable home, educate my boys and entertain my friends in a modest but respectable way. In no one of the forty-five years that I served the University did my salary balance one-half of my family expenses, and still we always lived plainly. I might have been courageous enough to live in poverty in order to devote my energies exclusively to science, but I was never willing to subject my family to want.

In my busiest years of practice I kept some research going, and by adding to the small salaries paid by the University to my assistants from my own pocket I secured competent help. In this way I could direct the work and leave the details to my assistants, while I was out earning the “damned guinea,” after the manner of the famous John Hunter. Besides I was benefiting my helpers by increasing their incomes up to the cost of living. In this way Doctor Mary Leach, now professor in Western College, Oxford, Ohio, and Doctor Sybil Wheeler, now Mrs. Charles E. Keeler, rendered invaluable aid in my work on the “protein poison,” while they won their Ph.D.’s. Both of these women were more skilful in chemical manipulation than I. In earlier years Doctor Charles T. McClintock, now dead, and Doctor Julian McClymonds, now of Lexington, Kentucky, were my efficient helpers. To all of these I gave credit in my current publications.

I first hung out my professional shingle on the house at the corner of North State and Lawrence Streets, near the Catholic Church. My nearest neighbor was Father Van Erp, a charming Belgian priest. He looked after the spiritual health of his flock, and I after the bodily health of such as chose to come to me. In the exercise of my function I had his support while I kept him informed about more material things. Father Van Erp and I spent many hours in his study or on my porch in discussing all things within the range of human knowledge except religion; this was never mentioned between us, but whenever I heard the step of approaching death in a Catholic family I resigned my function in favor of the consolations offered by the Reverend Father. Instinctively we respected each other, and I am sure that if my spirit is denied admission to Heaven’s gate, Father Van Erp will be there to intercede for me. The good Father, returning from an early mass at the alms house, was thrown from his buggy in front of my house and killed. Requiescat in pace.

Then came a German priest, and between him and myself there was a mutual repulsion. We started out badly. A good Catholic lady, under my care, laboring under the delusion that she was about to die, insisted on having the last rites of the church. Knowing that the death rate from hysteria is not high, I postponed from day to day calling the priest. The nurse, a Catholic, told the priest of the condition of affairs and he came to me with unchristian words. The lady did not receive the rites and lived some thirty years longer and died under the care of some other doctor, but not from hysteria. Then there were words between this priest and myself concerning the hygienic or unhygienic conditions of the sisters’ home and school. This controversy brought to me a splendid testimonial worked by the hands of the sisters which I greatly prize.The German priest was replaced by that prince of gentlemen whom I am proud to number among my best friends,Reverend Father Kelley, later Bishop of Grand Rapids; also now dead.

I must say something about the nurse mentioned above and how she cured the patient with hysteria. I honored this nurse by giving her the name of “Sarah Camp.” She asked why I so named her I told her that Sarah Gamp was a distinguished personage in the history of nursing, and after that she adopted the appellation with pride. The hysterical patient was given to retching and vomiting. One day as I entered the room, the patient called for the wash bowl. The nurse presented the bowl half full of dirty water. The patient in great anger called out: “How dare you bring me a dirty bowl? I will not vomit in a dirty bowl.” And after that she was well. I want to bear testimony to the efficiency of Sarah Gamp’s treatment of hysteria. It cured when some of the most lauded drugs in the pharmacopeia had failed.

Sarah was rich in devices of her own. I once found her giving a patient an alcohol rub. Her procedure consisted in filling her mouth with Bourbon whiskey, retaining it for an appreciable time, and then ejecting it into her palms. She explained that it was desirable to bring the lotion to the temperature of the human body before applying it.

It must not be inferred that all my nurses, even in the earliest days of my practice, were Sarah Gamps. I had too, a German woman, Mrs. Durheim, and an Irish one, Miss McCarty, who were most conscientious and skilful. Then I had as a male attendant that English gentleman, Doctor Brewer, to whom I have referred elsewhere.In the early nineties came my first trained nurses, bliss and Miss Bowen, quite equal to the best products of the schools of today. I have watched the evolution of the modern nurse, the worthy handmaiden of progressive medicine, have seen her function in civil and military hospitals and in private homes and I revere the memory of Elizabeth Fry, Florence Nightingale and other founders of this most worthy profession.

I had one serious disqualification in the practice of medicine-a lack of self-confidence. I have had the misfortune to go through life in a critical attitude of mind. I never hear a lecture or read a book without a sharp outlook for weak points in argument, partial truths and biased statements. This has detracted greatly from my intellectual enjoyment. I have a strong desire to contest the statements of author or speaker, and the suppression of this has caused me much effort at self control. Openly I have been able to do this for the most part, but inwardly I have often strained at the leash. Fortunately a fairly well developed sense of humor has allayed my disquietude. I have never been a hero worshipper. Indeed I have never been able to make of myself a hero. I have been my own unrelenting critic. I never give a talk before an assembly without spending an hour or more in inwardly reviewing its many imperfections. It has seemed to me that I have simply spluttered without saying anything, or spoken badly u hat might have been said much better. I do not know to what extent this sense of self-criticism affects others, but now that my participation in public affairs is near its end, I am admitting that with me it has amounted to almost a mania, and it was one of the factors that led me to relinquish practice without regret.

Once in a group of fellow practitioners the question arose as to the fitness of Doctor Blank to practice. I said that it was not the fitness of Doctor Blank to practice but my own fitness that I questioned. I had an abnormal fear of making a mistake in diagnosis or treatment, and I have no doubt that this fear was often well grounded. I suppose that modern, more precise and more scientific procedures release the physician of much of this anxiety. I carried but few drugs and generally wrote prescriptions; then I would have horrible dreams in which a certain prescription stood out before me undeniably showing that I had ordered a dangerous dose. I was one of the first to use a duplicating prescription book. This I placed on a table by my bed every night and when a dream testified to a mistake I would turn on the light and read it. The dream was never confirmed, and Freudism has never found a disciple in me.

I know of no better field for the study of human psychology than the practice of medicine. One sees ignorance and credulity in their most diverse forms. At one time a fakir went through the villages and rural districts of Michigan claiming to diagnose tuberculosis in children for from twenty-five cents to one dollar per head. His equipment consisted of bottles of limewater and glass tubes. The child blew through the tube into the limewater. If the water became cloudy the child had the disease. This fakir added many small fees to my bank account. In Ann Arbor I saw the entrails of a black cat, killed in the dark of the moon, bound on the head as a sure cure for epilepsy.

A man came to my office with an inoperable cancer. He told me that he had sold his small farm in Indiana for two thousand dollars, and that the doctor who would cure him would get this money. I said, “No, not the man who will cure you because he does not exist, but the doctor who will promise to cure you.” As I have stated, the bull; of my local practice was in the families of the Faculty and among the students. From my patients I learned much, and, best of all, I came to a fairer and higher appreciation of the intellectual life. I saw men and women of the best type, not in a conventional, drawing-room way but in their anxieties and troubles. I knew them in health and in sickness, and I drew from this knowledge an inspiration and reverence which did much to mold my own being. My patients gladly paid the small fees for my services, each according to his ability, but my greatest rewards did not come in the currency of the realm but in their friendship and confidence. I once heard a great man pronounce an eloquent and sympathetic eulogy on a greater man whose home I had visited daily for months and less frequently for years. When the speaker referred to the dead wife of the subject of his eulogy, as one Mary Blank, I came near shrieking with horror. I could have told of a wifely devotion and heroism which would have done honor to a Spartan mother. However, wise old Hippocrates sealed by oath professional lips.

Soon after I began practice in Ann Arbor old students and other medical friends located in Michigan and adjacent states, began to call me in consultation. In a few instances I was able to render valuable service, but in most I could only help the doctor and console tile relatives. During the twenty years mentioned I visited most cities and villages in Michigan and many in northern Ohio and Indiana.When I hear business men tell of their troubles in 1893, I recall that from January first to August first of that year I traveled ten thousand miles on the Michigan Central Railroad, and unknown miles on other roads and did not take in enough cash to pay my railroad and hotel bills. I must add without delay that it was all paid in 1894 and this was just as well. During a long distance call in the first half of 1893, the patient was sure to ask two questions: (1) Will I get well? and (2) Am I going to get well soon enough to go to the Exposition? If I could answer both these questions favorably the patient was willing to have me charge on the books any fee, but he reserved the cash for the Exposition.

My friend Muir Snow was superintendent of motive power on the Michigan Central and he would stop any train at any point to let me off or pick me up in case I was on a medical mission. I had much fun out of this incidentally. In fact I could fill a leaflet with testimonials as to the kindnesses shown the wandering doctor by the railroads in the old days when they were not shackled by the government.

Some of these trips necessitated long drives over corduroy roads and through pine forests. One dark night I was driven over the ice the length of Baraga Bay on Lake Superior. The man who had called me stationed men with torches every few miles to show the way. There were ropes about the horses’ necks so that they might be choked and thus kept from sinking if the ice should break. But now doctors are making consultation trips in aeroplanes and my stories are out of date.

In my class (1878) there was a handsome, elderly Englishman, Robert Henderson, who located at Buchanan, Michigan, a small village, the next station on the Michigan Central Railroad west of Niles. Henderson always wore a high hat, a Prince Albert coat and striped trousers, and would have been wholly in place on Piccadilly. His face had the ruddy glow so characteristic of the English gentleman, and was adorned with gray burnsides while his head was covered with white hair, He was much older than his classmates and reserved in manner, respected by all but intimate with none. From his village home he would occasionally drop me a note of the following purport: “Come over Friday night; see patients with me Saturday; give me the latest medical information and return Saturday night or Sunday.” I would take the half-past ten Chicago train, reach Buchanan about five A. M., walk to the doctor’s residence and enter the kitchen, where I was sure to find him cooking breakfast for us. The aroma of his coffee, bacon, or ham and eggs, have refreshed me many a time when my meal has been too long delayed. After breaking our fast we would attach Galen, a beautiful, smoothlimbed horse, to the gig and make our round among the doctor’s patients, most of whom were farmers.

One fair October day we had driven many a mile among the highly cultivated farms of the valley of the St. Joseph River, had tarried for short periods at the homes of the sick, when we turned aside into a short lane leading to a dilapidated house. The contrast between the farm we were entering and those we were leaving was striking, although all were in the same rich alluvial soil. The fences along the short lane were rapidly crumbling into Mother Earth. The gate at the end lay on its side; its rusty hinges parted from the rotting posts. In the yard which we had now entered, rank weeds, proclaiming the fertility of the soil from which they sprang, partly hid rusting plows, harrows, hoes and other agricultural implements. About the falling barn stood two lean kine and a crippled horse, all exhibiting the sad visage of pauperism. The house had never known a coating of paint, and half-naked children standing on the uncertain stoop stared at the approaching visitors through cadaverous eyes. The doctor had told me that I would be greatly interested in the case we were to see. The master of the eighty acres of untilled soil was a bleeder and had been bleeding at the nose for twenty-four hours or more. We alighted and threw the rein around a limb of a barren fruit tree, thus hoodwinking Galen into the belief that he was securely tied.

In a bare room in the house, the interior of which proclaimed the destitution of the family more loudly than the exterior, the master sat over a broken bowl into which every few seconds a drop of blood fell. I made a saturated solution of alum, soaked cotton in it and plugged. the nose first posteriorly and then anteriorly. The operation was simple, but Doctor Henderson had never seen it, and was greatly pleased. Leaving the doctor in the house I returned to Galen, relieved him of his phantom tethering, got into the buggy and turned toward the broken gate. After some time the doctor came at a swinging gait through the weeds; his long coat tails and flowing burnsides moving in the breeze, his sill; hat sitting back on his head and his right hand grasping some greenbacks. When he reached the buggy he extended his right hand saying: “I have a small fee for you-enough to pay your railroad fare, at any rate.”

I gave Galen a flick with the whip on the back, causing him to start suddenly. The doctor fairly fell by my side. As soon as he could get his breath he said: “That was a nice trick you did in stopping the hemorrhage.” “Not half so nice as the trick you are attempting to play on me. You are trying to make me believe that that man paid you twenty-five dollars. If you had shown the man that money it would not have been necessary to plug his nose. Every drop of blood in his body would have stood still in astonishment. You are a damned old fraud. You are not only attending this family without compensation but you are feeding them. What did those packages contain which I saw you put into the back of the buggy this morning and carry into the poor man’s house? Do you think that you are the only man who can help the poor? Do you deny me a privilege which you grant yourself? If return the bills to your pocket from whence they came.” Thus I lectured my dear old classmate as I drove Galen down the short lane and turned to more pleasing scenes. The old village doctor and Galen are dead, but I am sure that if there are errands of mercy in Elysium they are on their rounds. I know not what heroes of war it has supplied; what eminent men it has sent to legislative halls, but I do know that the village of Buchanan would honor itself should it erect a testimonial to the doctor w ho once served as a ministering angel to his neighbors. I suggest a Henderson Memorial Hospital.

One night as I sat in my office, the following long distance telephone message was received: “This is Mr. X, of Peru, Indiana. It is now ten minutes of eleven; at ten minutes past eleven a train leaves Ann Arbor for Detroit; take that train; at Detroit take a sleeper on the Wabash; arrive at Peru at seven a.m.; most urgent.”

At seven A.M. I found Mr. X on the platform at Peru, As we took our seats in his car I asked, “Who is sick?” “A poor Irishman, a section worker on the railroad I told him that he should have a good doctor. I am paying all bills.” I found the patient receiving the last rites of the church, and, within ten minutes after my entry to his room, he was dead.

At dinner in Mr. X’s comfortable home, he asked me if I did not want to go to Europe. I replied that that condition was chronic with me. He then stated that he was having the last thing in the way of a touring car built at Kokomo and that he and I, with our wives, would “do” France, adding, “I am paying all bills.” I must have been unusually stupid that day, for even after this speech I did not realize that Mr. X, and not the poor Irishman, was my patient. A few days later Mrs. X called me up from Chicago saying that Mr. X was going through Marshall Field’s great emporium, buying everything, and ordering them sent to Peru, while she was following him, countermanding his orders and that they would arrive in Ann Arbor that night. The next day she and I took Mr. X to a retreat for the mentally disturbed. On the train we had lunch in the dining car. As Mr. X was slow in paying the bill, I drew my pocketbook. Pushing me back into my chair, Mr. X, with a handful of bills, arose and announced to the astonished diners that he was a millionaire traveling with his private physician and paying all bills. Since this experience I have carried a ready made diagnosis for anyone who offers to take me to Europe or around the world. Fortunately I have had only rare opportunity to use it.

One summer day I was in consultation at Rensselaer, Indiana. When through with my professional call, a son of the patient drove me to the station. A train from the East was approaching. The boy told me that was my train and as his horse was frightened he turned for home. I walked down the platform meeting the slowly approaching train. I put a foot on the step; then to my horror the train moved faster. It did not stop and soon was going at the rate of sixty miles or more per hour with me standing on the only accessible step of a vestibule car. I clung to the vestibule door, shouting for help, while the telegraph poles barely missed my back as they rushed by. Finally I was rescued by a porter who was passing from one car to another. I blessed that negro and he seemed satisfied with the more material reward I transferred to his possession. When the train finally rested at the Chicago station both my pulse and respiration rates were above normal.

A preacher whom I had once heard and who had been a guest in my home confided to me his trouble. While a student in college some one recommended a proprietary medicine known as savapnia for a catarrh. He tried it and finding its effects agreeable, continued its use. In crossing to Europe he found that he had not laid in a sufficient supply and asked the ship’s doctor for some. The doctor told him that he had no savapnia but had a plentiful supply of opium and that the two were identical. Thus the preacher found that he was an opium addict. As a rule the stories of opium addicts are not to be credited. Most of them prefer falsehood to truth even when the latter would serve them better, but I never found cause to doubt this story. My patient had tried various advertised opium cures and found satisfaction in all so long as he continued their use, but on discontinuance he was as miserable as ever. One of these poison vendors had recently threatened to expose him and the poor preacher was in great distress. After talking the matter over, we made a contract that he was to place himself absolutely under my control. I rented an isolated farmhouse about two miles from Ann Arbor and installed in it the patient, his wife and two reliable attendants. I visited the house daily. On going into his room I would find him with a colored bath robe over his shoulders, his long hair hanging down, pacing to and fro in the greatest disquietude. He would fall on his knees and say: “Just one more dose! I would sell my soul for one night with morphin.”

On this patient I perpetrated the only intentional and gross fraud I ever practiced on a patient. In providing for his comfort I made one serious mistake. I permitted a telephone in the house. This discovery of modern science was then new, and but few of those who used it knew anything about its mechanism and operation. One cold, rainy night, I had just returned from the house when my telephone called me most peremptorily. My patient told me that his heart was going all to pieces. I asked him to put the receiver over his heart and hold it there for one minute when he could return it to his ear. I assured him that the heart beats were perfectly normal and hung up my receiver. The patient, after some months of confinement, was really well again after years of physical and mental torture. He passed out of my orbit, became the efficient and inspiring president of a denominational college and passed some twenty or more years in this position.One day I received a telegram asking me to come to him immediately. I found him dying of cancer of the stomach. His physicians wished to give him morphin, but he would not take it until I came and relieved him from his oath.

During my patient’s imprisonment I obtained and analyzed every advertised opium cure in the United States and published the results. There were then about twenty, and I found that all except one contained opium in some form. The exception was advertised under the taking designation of the “double chlorid of sodium and gold.” Analysis shouted that it was the simple chlorid of sodium. The gold part of it passed from the gullible victim to the vendor. If I remember correctly, the price was ten dollars for an eight ounce solution-quite dear for table salt. This led me to devote much time for some years to the exposure of patent and proprietary medicines. This crusade was later greatly aided by the facile and biting pen of Samuel Hopkins Adams in Collier’s Weekly and by the propaganda department of the American Medical Association. I am, however, today (July 25, 1926) informed by my local druggist that he still has frequent calls for these panaceas. No respectable newspaper now admits their advertisements to its columns. This is another feather indicating the current of civilization is moving in the right direction.

In both my local and long distance practice I saw many Jews, and I wish to say that I found them most desirable patients. Were I compelled to resume the practice of medicine. I should select a Jewish community. They want the best service; they follow the physician’s directions most implicitly; they are never given to quackery; and as a rule, they pay their bills without a murmur. For years the largest clothing store in Ann Arbor was Jewish. I was almost daily at the home of the proprietors in a professional capacity. In January I received the yearly bill. I took mine to settle accounts. The proprietor compared the two bills, his and mine, and said: “Doctor, what is the use of keeping details. You doctor my family and I will clothe yours.” As I had five growing boys this proposition was quite acceptable. Recently, my wife and I have been most hospitably entertained by the children of these families in two of the larger cities of the Pacific coast.

I had despaired of meeting the so-called typical Jew until I had the following experience: The doctor who had called me met me at the station, and as we drove down the street, he told me that the patient was a young lady, a Jewess; that her father was a dealer in secondhand furniture, but that her uncle was the richest man in the county; that the young lady had been infected with a pin in a bolt of cotton which she as a clerk was handling in her uncle’s store, and that as soon as she recovered she was to be married to a Jewish millionaire from Chicago. The doctor concluded by saying: “Make your usual charge and it will be paid.” When my return train time was near I went from the sick room into the parlor. There I found the father and the rich uncle. The father asked my charge and on my reply he fell on the sofa calling, “Rachael, Rachael.” The wife, Rachael, came. “Say it again, doctor, I just want Rachael to hear it. I never saw so much money in my life. I go on to the street and see if I can borrow it.”

Then Rachael took up her lamentation which ran something as follows: “Ach Lieber Gott, Herr Doctor, wir haben so viele Kinder. Sie kosten so viel! Sie mussen die Piano immer spielen! - but I put my trust in you and God.” When she had exhausted herself the father renewed his psalm of lamentation. I felt like a thief, and said that I would make no charge. Then the father began with offering me fifty per cent. and slowly going up. I shook my head, and the doctor and I were leaving the room when the father opened a drawer, pulled out a roll containing more than twice my fee, and paid me in full. Evidently the uncle had brought in about what he thought I would charge and told the father to beat me down. As among other people, there are all kinds. I was once traveling with a well-to-do man, not a Jew, who annoyed me by petty and persistent objections to every charge. I remonstrated. Then he put it to me in a new light. He said: “Your business is science and you delight in making discoveries and you welcome even little ones. My business is to accumulate money, and I live to save it, even a little at a time.”

There is a common prediction that the family physician, especially the village variety, is doomed to speedy and certain extinction. I do not believe this, and I certainly hope that it is not true, though I admit that his present position is precarious. He has been a most potent factor in civilization. Take from scientific medicine the contributions made to it by the country doctor and you rob it of half its glory. I stand ready to support this affirmation, though I have not the space here to do it. Through the centuries the country doctor has been the most learned man in his community, often the only one. The old Latin proverb, “Where there are three doctors, there are two atheists,” taken literally may be regarded as a term of opprobrium, but it means that among every three doctors there are two who contend with superstition. The promising medical graduate of the present will not locate in a village because he does not have the facilities to practice his profession as he has been trained in it. Give him these, and many of his kind will prefer the country to the city. Some years ago a wealthy man, who practically owned a Michigan village in which his manufacturing interests lay, came to me and insisted that I prevail upon some bright man in the senior class to locate in that village. He admitted that he did not live there because it was not a fit place in which to rear his children. Indeed he shamed himself by his own admissions. I told him to make the village a fit place for a man of education and refinement to live in and rear his children in, and promised him that when he had done this I would find a suitable physician. This has been done, and a good doctor now has charge of the small but well equipped hospital, and as his children grow up they will attend a model and a modern school. I hope that worthy men of this class will multiply, and if they do, the village doctor will continue.

A Doctor's Memories
Victor C. Vaughan, M.D.

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