Memory Vignette

For a change from the trials and tribulations of Plainfield politics, today I am posting a short vignette of what life (mine) was in the learning days for the practice of medicine in the  early 40s. The intern now called a first year resident in the "teaching hospitals" received only room and board for his services. 

After graduating in March 1943, Helen and I, after a short visit to Plainfield, went to Syracuse NY where I was to do a rotating internship. Why Syracuse? New Jersey in the 40s required a rotating internship for a license, And Syracuse was one of the few Medical Schools that offered that type training. Syracuse University Medical Center consisted of several small separate hospitals in a contiguous area.  There was the old University Hospital, a new Memorial Hospital, a small acute psychiatric hospital, and an isolated small infectious disease hospital.  On a block between the University hospital and Memorial, was Crouse-Irving hospital which, at that time, was not part of the center. St. Joseph Hospital on the other side of Syracuse was also affiliated.

Helen received a pay increase from $99.00 a months as a head nurse at UVa hospital to $199 month as a delivery room staff nurse at Memorial. One of the first things she did was to buy an affordable beaver “fur coat”, a necessity in Syracuse.

Memorial was a remarkable "skyscraper" of about 8 floors.  The obstetrical unit occupied the top 3 floors, with the delivery suite on the top floor. In 1943, two of Syracuse obstetricians were among the country’s pioneers to use caudal anesthesia.

Since women in labor had to be brought up to the delivery suite by elevator, it was not uncommon to have, upon arrival, a delivery in the elevator. One day a woman in active labor arrived in the delivery suite. On the prep table for the delivery room the nurses discovered the broken umbilical cord protruding from the vagina. Apparently between her car and the hospital door she had a severe contraction and had spontaneously unknowingly expelled the baby, who was found lying unharmed in a snow bank.

Syracuse, like most medical schools, had formed a hospital unit, which had departed before I arrived. Most of the top notch physicians had left with that unit. Among those who remained behind was one surgeon who suffered from a recent stroke. Not only was his dexterity impaired, but often the intern was his only assistant during major surgery. Never in my life did I feel so alone in the operating room.

.

Anesthesia in those days was very primitive compared to today’s methods. The standard was open drop ether or rarely chloroform on a nose cone (mask). Anesthetist also used the Heidbrink machine which had two tanks each of oxygen and nitrous oxide The gas mixture could be passed through a container of ether. This was a semi-closed system with one tube and a rebreathing bag. However the vapors were also released into the air. Under both techniques the anesthetist also inhaled vapors. There was no true anesthetist specialists in those days, most were general practitioners who considered that as part of their practice. Unfortunately it was easy to hook the tanks up improperly and the gas mixture could be fatal if the anesthesiologist was not vigilant.

One time an orthopedist wanted me to administer inhalation ethyl chloride, a dangerous procedure, so he could reduce a fractured bone. I brazenly refused. Fortunately, internships, for the first time, were a buyer’s market or otherwise I probably would have been discharged.

One of my duties as an intern was riding the ambulance on emergency calls.  In the winter this could be quite thrilling in icy cold snowy Syracuse, a city of many hills.

One other interesting note; penicillin was just beginning to be available in small amounts. A particular fatal disease was sub-acute bacterial endocarditis, an infection on the heart valves which resulted in septicemia. The only drugs we had were the sulfonamides (circa 1935) which alone were ineffective. To supplement them the practice was to produce a high fever in the patient by the intravenous injection of killed typhoid vaccine or sterilized milk protein. There were rare successes from this treatment to an otherwise fatal disease. We were able to get 20,000 units of aqueous penicillin for intravenous injection from Boston for a young woman and to our delight apparently obtained a cure.

Scarlet fever, polio, meningitis, diphtheria, small pox and all the childhood contagions were all treated in the small isolated quarantine infectious disease hospital. These “pest” hospitals, in buildings separate from the main hospital, were standard for the pre-antibiotic era. A major complication of Scarlet Fever was Rheumatic Fever which damaged heart valves. The damaged valves, which were often the site for sub-acute bacterial endocarditis, hastened heart failure and early death.  With the discovery and use of penicillin scarlet fever has become a rare, mild disease. Vaccines have eliminated all the other contagions so the quarantine infectious disease hospitals became dinosaurs. If any of these diseases occurred today, for the first few cases the diagnosis would in all probability be missed. This would be especially true for diphtheria or small pox  and could create a serious pan-epidemic.