Chapter 2
Medical School
“I’m going to beat the daylights out of that Dr. Moore just as soon as I get my diploma,” said Chuck Rathmore. He was angry and showed it. He continued to rave about the doctor who was so hard on us students and who had flunked him and made him stay in the summer to take Bacteriology again.
“He was just as mean to the rest of us,” spoke up Bob Vaughan. “Do you remember the day he gave us a question and said, ‘You’ll find the answer to that on page 231’?” We remembered it well. There were other questions on unassigned topics, and he told us where to find the answers.
“Well, I’ve been waiting for this day, to beat his face to a pulp. And I’m going to do it, too.” He could very well do so, as he was a husky fellow. But we had to discourage it.
“Don’t you know you have to take the State Board Examinations, and that would never be allowed if you should beat up a professor?”
We spent the next fifteen minutes convincing him that it wasn’t the proper thing to do. He had worked too hard to jeopardize his future, and he was lucky to graduate, for he was a rather poor student. He was angry and determined to get his licks in, but finally, just as it was time for the ceremonies to begin, he agreed it would be the wrong thing to do.
Graduation ceremonies went off without a bobble, in the big, beautiful Baptist church in Dallas. Baylor University was a Baptist school, although very few of the students were Baptists. Family representatives gathered around the boys and the two girls in the class to wish them well. Then they separated, never to be together again.
Even the doctors on the faculty came by and wished us well and called us “Doctor Harris” and “Doctor Adams” emphatically. To them we were not doctors until the degree had been conferred.
Many students were from Texas, some from New York, New Jersey, Oklahoma, and California. We had met together for the last time.
Medical school was a blast. At least the teachers took great delight in blasting us the first two years. But after that the clinical work was fun and we felt the last two years were much more delightful and more professional.
During the first year, when one of the professors decided to give us a quiz, the same notion ran through the heads of all the others, so on Monday we would have a quiz in histology, one in chemistry, and one in anatomy. You can’t guess what we did over Sunday!
One thing that was rather baffling was the attitude of the professors. After we were accustomed to being treated as gentlemen for a period of years, in medical school we were treated like dogs, or so it seemed to us. It was during the depression, when everyone was broke and tempers were short. Or maybe that was the general type of treatment in all medical schools.
At the beginning of the year, there were 120 first year students, all hopped up and raring to go. At the end of the first year, there were 64 left in the class, a much more solemn group by far. One had dropped out to go into the ministry, one had decided that drama school was his talent, many used the shortage of money as an excuse (and a darned good one it was, too). Many just thought it was too hard, and an untold number just flunked out. Anyway, we were cut down to a more moderate size, so during the second year each prof had a little more time to pick on each one of us. But we survived, and worked Saturdays, Sundays, and holidays on neuroanatomy, applied anatomy, and other subjects like pathology, which would make us understand the problems which would present later.
During the clinical years, the work was much more pleasant. We were working with patients, getting practical knowledge and experience. There was one chap in the class who had a tremendous memory. We called him “Little Cunningham,” for he could learn verbatim the material in the dissection guide, by Cunningham, for his examination in anatomy. He could answer his questions word for word, until interrupted. Then he had to go back, pick up where he remembered it, and go from there. In the clinical aspect of his work he was not so good, as he had to draw on what he knew, instead of on his memory. But he was game, and by dint of hard work he managed, although he never was very good as a practical doctor in the clinic. We found that students with poor memories did better, because they reasoned things out.
The 1930’s were the pre-penicillin days when syphilis was treated by alternate series of injections of Neo-salvarsan and bismuth. Everyone coming to the clinic had a Wasserman test and over fifty percent of them showed positive, indicating the presence of syphilis. We of course had a clinic for venereal disease where such conditions as syphilis and gonorrhea were treated.
There was one good-natured young man who had a large syphilitic aneurysm, an enlargement of the aorta, who had been coming to the clinic for quite a long time for the medical students to study and observe, as well as for the anti-syphilitic treatment. He had been coming for so long, and had been seen by so many students that he had developed a feeling of vast importance, which constantly increased. It was really amusing to see how egotistical he became. He began to brag about his condition and swayed as he talked.
“I have decided to write a book about my life and tell all about me so everyone can enjoy it,” he claimed, while we were pretty sure he could not even write.
We could see the pulsations of the blood in his aneurysm in the chest. It was a real lesson for all who saw it. We could see it eroding his ribs in the front and could palpate it gently. A lesson we shall never forget.
This was long before the work was done at Baylor for operating successfully on aneurysms.
While his book was still in the talking stage, the aortic aneurysm burst one night, and it was all over.
Dallas was a smaller city then, and there were many prostitutes from the downtown section who came into our venereal disease clinic for treatment. Some of them recognized us as we walked downtown with our girlfriends. They spoke to us very affably, and naturally the girlfriend wanted to know who that was. The girls and women of Dallas really dressed up when they went out, thus making the prostitutes very conspicuous by contrast.
When I was on gynecological clinic duty, one day I had a girl giving me her history.
“How many times have you been pregnant?” I asked.
“No, sir. I ain’t never been pregnant,” was her quick response.
Then, upon examination of her pelvic, she was found to be torn, and had apparently given birth to several children. She was fairly young, and unmarried. Maybe we were not getting direct communication, I thought. I decided to try to speak her own language.
“How many times have you been knocked up?” was my next question.
“Seven timed, Doctor, seven times, and I have six kids to show for it.”
Another day in gynecological clinic, a middle-aged woman was put up in stirrups for a pelvic examination. She was very quiet. Perhaps she had had other pelvic examinations, or perhaps she was wondering what was coming next. When the examination began, she let out a blood-curdling scream:
“My God, what wickedness is this?”
We had an awful time quieting her down, with the nurses trying to calm her and attempting at the same time to explain what we were trying to do. Our lesson there was for us not to take anything for granted, to always inquire if there had been a previous examination, and to explain what we were trying to do and why.
Interestingly, every patient we encountered in the clinic and who required surgery always had to have some time in order to transact some important business. We later found out it involved buying some insurance prior to surgery.
Naturally, in a medical school clinic, one finds some cases that he never encounters in private. I’m thinking particularly of a case of leprosy we saw in the hospital. He was a very typical case, with the leonine facies, which was a dead giveaway. He claimed he had slept in a flop house with a leper eleven years before in Houston, and that was his only contact with a leper. In those days, there was very little to do for those people, but now leprosy can be controlled much better with a derivative of the sulfas.
We saw, also, a case of pellagra, which condition was prevalent in the South. My dad had many cases in his practice, and the cause had not then been determined.
These poor individuals developed a severe discoloration of the skin, especially where the sunshine hit them. This was called the dermatosis. Later there were sever diarrheas, then changes in mentality—or dementia. Thus, the three diagnostic clues, dermatosis, diarrhea, dementia. We now know this syndrome to be caused by gross dietary imbalance and it is successfully treated with vitamin B complex.
One case that was very interesting and one where I learned a real lesson was that of a Portuguese grave digger, at Parkland Hospital. His name was Tony, and I was assigned to do his history and physical examination. Tony was an agreeable fellow and tried to give answers to the questions that would please me most. He had been in the hospital about a month and the diagnosis had not yet been made.
There were notations on Tony’s chart that every night he was delirious, had high fever, was hard to keep in bed. In other words, every night was a stormy one. But in the forenoon when I called on him he always felt fine:
“Fine, Doctor, fine as can be. Yes, I’ve had a good night’s sleep and everything is all right.”
Tony got worse and worse. His temperature, pulse, and respiration went higher and higher, but he did not complain. Finally, he died, and an autopsy showed that he had a widespread military tuberculosis. Not a soul in the hospital had thought to order an X-ray of his chest, and everyone involved had a real red face. Always order a chest plate as a diagnostic aid.
There was quite a population of toughs and they were especially good with razors, which almost all of them carried. One day we saw a man in emergency with a slit between his fourth and fifth rib, anteriorly, revealing there in plain view his beating heart. It was a beautiful opportunity to see a rare sight, a throbbing, beating human heart.
“What is the name of the girl you were fighting over?” I asked.
“How did you know it was a girl, Doctor?” It almost always is.
One fellow was brought in with his spinal cord severed in the middle of his back. The job was done as neatly as if it had been done by a surgeon. Naturally, he was paralyzed from that level down, with no possibility of improvement. Lila was the cause of this episode. They take their fights seriously and are usually prepared.
On my service at Parkland Hospital I had a well-dressed, nice looking woman as a patient. She was a new patient to me but had obviously been coming to the service for some time. I began taking her history.
“Well, what would you say is your main complaint?” was my first question.
“I have a chronic, bilateral cervical tuberculous lymphadenitis,” was her answer, that almost bowled me over. She hastened to inform me that she had been coming to the clinic for so long and had heard her diagnosis so many times that she had thoroughly memorized it. She was one of the very willing patients who came repeatedly for us medical students to study. There was about her an aura of importance, as well there might be, for it was the only case of its kind I have ever seen, and the same can probably be said of many other students.
In those days, there was a distinct separation of the races. There was a distinct building for the colored and one for the whites. One day a Negro man came to visit Mrs. Walton and we could not find her. The records were searched, the discharge records were investigated, to no avail. But he insisted she had had surgery only a few days before.
“It may help you to know she was a white Negra,” he confessed, after which she was easily found in the “white” hospital, in a word, having a real good time. She was quickly removed.
There was an up-and-coming young blade in the community who sold insurance. He was living with one of the girls in the area, had a car, and was doing well until his company assigned him to a two week stay in Houston to help in opening a company office there.
Soon after he took his leave for Houston, the girlfriend became lonesome and after a week went to one of the fortune tellers for consolation.
“I see you are involved with a tall, handsome man. It looks like he is not true to you. I see him playing around with a red-headed girl. He just ain’t true to you,” went on the fortune teller.
Now the girl put a lot of stock in the fortune teller. This young girl later thought it over, and the more she thought, the more irate she became. Finally, she was so angry she could hardly stand it. But soon the two weeks were up and the young man came home.
“Honey!” he cried as she opened the door to meet him. But without saying a word, she opened fire and shot him twice in the chest. He died two hours after reaching Parkland Hospital, never knowing what it was all about.
My two weeks’ Christmas holiday season was spent on obstetrical duty at Parkland Hospital. That was just as well, as I had no particular plans for Christmas. It was rather bad weather, and really it was nice to be within the confines of a nice, warm place like a hospital. One can understand why a fellow can become accustomed to hospital work when all his wants are taken care of and he hardly has to venture out in the bad weather.
We had over sixty-five deliveries in the two weeks that one of the girls in the class and I were on duty. Really, there was very little we had to do, since the residents did all the deliveries. But we were present for each one, and it reached the point that just being awake was a chore. My sleeping quarters consisted of a bed in the labor room with the moaning and groaning mothers-to-be. They were in various stages of labor and the room must have held about twenty patients. There were curtains drawn between so there was a modicum of privacy. We wore scrub suits (pajama-like) all the time, and when a patient went into the delivery room, the nurse came in, found us and shook our shoulders until we came alive. However, my serenity was greatly disturbed when a student nurse came in prepared to give me an enema!
On outside OB [obstetric] service, which was also for two weeks, we were expected to make every call that came in, and it was necessary to drive to any corner of town. Fortunately, there were two of us on at a time, so if the calls came in too fast, we could split up.
One of the first patients I had was a fourteen-year-old girl who had twins. They were cute things, two girls, and it was an easy delivery. When it was all over, I remarked, “Maggie, you are mighty young to be married, aren’t you?”
“Gosh, Doctor,” she said, “you don’t have to be married to have a baby.”
“Do you know who the father is?” I asked.
“Not for sure,” she replied.
“I don’t see any double-bladed ax under your bed.”
“No sir. I’m young yet and I want to have lots of children.”
We went into a number of homes where we found a double-bladed ax under the bed. Upon asking why it was there, we were told, “That’s so we won’t have any more children around here.”
“This one is to be the caboose?”
“Yes, sir. There ain’t going to be no more.”
“Be no more until this time next year,” I taunted her. But all the patients were good natured and took teasing very well.
There were small children with bags of asafetida tied around their necks to keep away certain diseases, but in one instance there were two small children with tiny bags which did not smell like asafetida. In questioning them, I found that the bags contained red ants. These were for the sole purpose of warding off measles, and I was assured that it really worked. The kiddies wearing bags of red ants were eight and nine years old, and they had not had measles yet!
Another strong belief was that one should always leave by a different door from the one he entered the house by. I was always admitted by the front door but was told if I wanted to have good luck, and to bring luck to the householders, I must leave by another exit. Just as firmly, they believed that it is a must to eat black-eyed peas for New Year’s dinner. This is to ensure one that some day he will be rich. The fact that some of the older people were not yet rich didn’t mean much. “We just can’t afford to take a chance,” they would say.
One of the obstetrical patients I had was so fat and big that she almost covered the double bed on which she lay. She was related in some way to Clyde, the famous outlaw of the time down there. This was her thirteenth pregnancy and she was definitely in labor, but was so big that her uterus was perpendicular to the line of her delivery and the pains or contractions were unavailing. The bed was propped up in very poor condition and there was very little to work with. Finally I had an inspiration. We ripped open a gunny sack the long way so it would be big enough for a binder. Then we put it around her snugly, fastened it together with eight-penny nails, thus putting the baby in line with the outlet. It was an easy matter then to accomplish the delivery, with the help of a barley bag.
There was only one time that I was a bit frightened at a delivery. It was at a home where the father was a little on the belligerent side, and he stated, “My wife, she better not have no trouble.” He stayed in the room, which was a small one, with two double beds side by side. We sat on one bed, while his wife was crossways on the other. Her labor was slow to begin, but it quickly became stronger, and this being her third child, there was no trouble. Believe me, it was a relief to complete that and get away.
I learned there are some people who are not the kind who should be in medicine. There was a student nurse who, when they studied appendicitis, had all the symptoms, and had to have her appendix out. When they studied asthma, she could hardly get her breath, and when she was on the subject of gastric ulcers, she developed all the symptoms of ulcers. Finally, the nursing supervisor told her she would do much better as a stenographer, and advised her to take such a course. Really, she seemed relieved to be out of nursing.
The cadaver we worked on we called “The Sheriff” because he was a big, tall Texan with a moustache, and he looked for the world like a town marshal or sheriff. We started in on the thigh, learning such terms as “fascia lata” and “sartorius muscle.” There were six of us to a table. One would read the directions while one would dissect and the remainder would look on. It was interesting, but we had to stay with it continuously until we tired of it. There was one woman cadaver in the room and we all had to look it over and conjecture as to who it was, where she came from, and so on.
The anatomy quiz was something else. Each of us sat on a stool, in small groups, and were asked individual questions, such as, “Describe the femoral bone,” or “Describe the biceps muscle.” And the questions had to be answered exactly and precisely, for we were graded on every one.
When one professor decided to give an exam, all the others, not wanting to be outdone, decided to give another on the same or following day. We were never without something to do or an examination to study for.
During one series of examinations a fellow I’ll call Chuck was very worried looking, chewing his fingernails. He always had his fingers in his mouth, it seems. Anyway, he was chewing away when I came up to him and asked, “How is it going, Chuck?”
“Three more finals and only one more fingernail,” he replied. We were especially a very serious lot during examinations, which were very frequent. The exams had different effects on different individual students. Besides Chuck, who always chewed his nails, there was Ralph, who had a tendency to twist a lock of his hair with his left hand. That lock had been twisted so much that it stood out in a continual overhanging curl. One of the girls in the class, and several fellows, had to wear a path to the restroom, and one chap became so nervous he could not eat his regular meals. We shall never know how many cases of ulcer developed, but we still see the same effects now in the various universities.
When a series of exams was over and completed, we always determined to sleep all day the following day, but we were always up at 7:00 a.m. from force of habit.
We were mighty serious, too, while classes were in session. Every Monday our instructors had a meeting and discussed each individual, his record, his actions, and everything in general. Of course, there was a lot of scuttlebutt as to the outcome of the meetings, who was talked about the most, and what was decided. Of course, we never knew, but everyone ventured an opinion, all of which kept us on our toes and made things more interesting.
I learned one thing about doctors’ handwriting that was an eye opener to me. The general opinion is that the poor doctors are so overworked and so busy that their penmanship suffers as a consequence. But the trouble begins long before medical school. Penmanship simply is not taught in our public schools. In the case of my own boys, when we attended conferences with their teachers in third and fourth grades, I always brought up the subject with the teachers.
“How is it the boys are graded on their handwriting, yet there is no class in it?” was my perennial question.
“Here is a small book on penmanship which you can have the boys practice, and it may help them.”
So the blame is on our institutions of learning. When I attended school, we all had to go through the push-pull exercises, as well as many others, to develop a type of handwriting that was neat.
Many of our medical students wrote atrociously. I heard one of the professors say one day to one of them, “How am I going to give you a grade when I can’t read your paper?”
One chap always wrote two quiz-books full. He was asked by the professor one day, “Do you write so much because you know so little, or do you want to impress me with your verbosity?”
There were times when the grade depended on the professor’s interpretation of the paper. In two instances, one pupil had to go to the office to read the paper for the professor, and he told me later that he had some trouble reading it himself. It seems that every medical school professor should be lined up with a pharmacist to interpret difficult writing.
The Arlington Racetrack, between Dallas and Fort Worth, opened while we were sophomores, and a surprising number of the fellows showed an unusual interest in racing. In fact, many decided that a certain nice spring day could be better spent at the racetrack than in a stuffy old classroom studying pathological slides. The class was rather conspicuously small that day, so Dr. Caldwell decided it would be a very good time to give a quiz. Pop quizzes were not unusual, but this one had to be made up, and it was made more difficult than usual for the absent offenders. Some of these boys learned their lesson the hard way and did not repeat the performance.
I pledged Theta Kappa Psi and necessarily went along with their Hell week and other activities of fraternity life. Although there were many activities I didn’t approve of, I considered pledgeship as a part of it, having been through it before in academic college.
As a part of the requirements, it fell to me and Bill Zimmer to make a directory of the prostitutes on Akard Street. I had not noticed before all the semi-dark stairways with a Hotel sign above them, so had thought nothing about what they led to. It was pointed out to us that these would be good places to start (some of the fellows knew quite a bit about them, it seemed). And it proved to be true. There is invariably a matronly woman sitting in a rocking chair at the head of the stairs, usually reading a Bible. With the dim light present, we wondered if she really was reading the Bible, or was it just a front? She may have picked up the Good Book when someone started up the noisy stairway. Since we had to have a story to tell, we decided to tell them that we represented a fireman’s group that was coming to Dallas for a convention, and there would be about thirty firemen. That night we received an education.
In one place there were three girls, all about seventeen or eighteen years old. We were told they could have thirty girls in thirty minutes, just a phone call away. In another place, the girls asked, “What do these firemen do?”
“They put out fires.”
“We have two fires they can’t put out.” They agreed they alone could handle thirty firemen. In another place, there were two girls who talked to us. One lay down on a cot and made a semi-display of her merchandise, saying, “It is clean and you can make it good!” There wasn’t a place on the street which was not a “House,” and we went to seven or eight houses. We got names of the girls (which may or may not have been authentic), addresses and prices. There was an air of being stifled in those places. We were glad to get out into the clean air and be on our way. The fraternity members said we had the best “directory” that had ever been made, as they seem to have sent two pledges every year on the task. While we were there we saw several individuals who were regular patients at our venereal disease clinic.
Another duty during “Hell Week” was to be taken to a local cemetery outside of town, with no money, and to look up some certain headstones. As a precaution, I put a couple of dollars in my shoe and one of the brothers took me away out somewhere north of town, about eleven o’clock. It was a cool night. There was a wind blowing, and it had just rained a day or two before, so the ground was wet, and in some places it was quite muddy.
I searched until around one a.m. and decided that was long enough to spend alone in a cemetery, so I called a halt to the nonsense. I trekked into the edge of town to a filling station. It was about one and a half miles, I guess, from where I had been searching among the tombstones.
Cold and shivering, I went into the filling station to warm up and talk with the attendant there. He was cordial, with true Texas hospitality. I guess he was glad to have someone to visit him. While there I saw headlines on the paper, “Earthquake Wrecks Long Beach.” It was March 10, 1933 and the date of the devastation in Long Beach where I had taken a couple of courses in German and zoology. From the news report it sounded as though the entire city lay in ruins.
I was tired and wondering how I was go get home. It was miles to town, and I felt like another mile was too much. However, the gentleman there said he was ready to close the station and could take me to town. He took me to the door, as he lived only a few blocks from my address, so that part of “Hell Week” turned out fairly well.
While I was in Dallas at medical school, one of our social workers was called out to see about a family in great distress. It was located down in the Trinity River basin near the viaduct. There were numerous families living in cardboard shanties and other shanties made by nailing together opened tin cans, snuff signs, signs advertising Lydia E. Pinkum’s Vegetable Compound, SSS and Clabber Girl Baking Powder, to keep out the weather.
The social workers found a family consisting of a father, mother, two daughters, and a son, all the children teenagers. They lived in one of the patched up shanties, with no floor, no beds, no dresser, no bathroom. All they had was a small place to cook, a wash basin, a small broken mirror, and some ragged blankets.
Feeling that they were in a rather desperate condition that called for heroic action, the workers made arrangements to build a wooden floor, bring two beds with mattresses and a dresser, along with some minor items such as clothing, dishes, etc. This made the folks so happy their eyes filled with tears in anticipation. The things arrived in due time and were installed, making the place much more homelike.
A few weeks passed and the social worker decided to call on the family to see how they were getting along. She was quite surprised to find the place just as it was originally, with all the furniture gone, the floor missing, and even the surplus clothes disappeared. The father was there reading a magazine.
“What in the world happened to your furniture?” the social worker asked.
“We sold it to our neighbors. Didn’t rightly need it, nohow,” said the old man. “Took the money and used it right smart. The girls each got a hairdo. Burt took his gal friend to the movie, and Ma and I bought some new shoes.”
There was another social service story that was told me by the same worker. She went to call on another family that was reputed to have absolutely nothing. When asked if there were anything the worker could do, or anything she could send out to make life a little easier, the woman thought a minute, ejected a huge amount of tobacco-filled material from her mouth, and said, “Naw, I jest don’t believe there is anything I need.” Which proves that there are many, many things in everyday use, which to us are almost indispensable, but to some are of absolutely no value.
There was a woman who had a houseful of children and was pregnant again. The social worker visited her to arrange for birth control facilities. She explained in full, told her it would not cost a cent, and wanted to arrange everything for her. The woman pondered the question, then slowly drawled, “No, mam. I don’t believe I’ll subscribe at this time.”
There was a rare and interesting case of Hirschsprung’s disease associated with the clinic. Each twenty-five to twenty-eight days this patient, who was a young man, would come in and weigh, have a bowel elimination, and weigh again for the benefit of the medical students.
In Hirschsprung’s disease there is an enormous distention of the colon where there is a storing up of the feces for a long period of time. In the case of our patient, it averaged twenty-six days. He became quite distended and toward the last, very uncomfortable, but only insofar as the weight and size were concerned. He used his condition as an excuse for not working the last week or so and I guess he couldn’t be blamed. There were no headaches, no dizziness or other signs of so-called “auto-intoxication” and at the time he was my patient in the clinic, the difference in weight was thirty-eight pounds. In the meantime, he seemed to enjoy his connection with the clinic. This is a rather rare condition and I saw only one patient later in private practice with the disease. Surgical help is possible.
At the parting class in Medicine, our professor told us, “You are going to be on your own from now on. Ten percent of you will end up as alcoholics, ten percent as narcotic addicts, and ten percent of you will die from septicemia [this was in the days before penicillin and antibiotics]. I hope the other seventy percent of you will go ahead to become good, honest doctors, and make the medical profession proud of you.”