I Remember When

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Reflections on Medicine - October 2008


Tex Med . 2008;104(10):13.

By Herbert L. Fred, MD, MACP

All things are changed, and we change with them.
― Lothair I, Holy Roman Emperor, circa 840 AD

During my career as a full-time medical educator, I have witnessed many changes in our profession, especially the way we teach students, interns, and residents. Please join me as I remember things from almost 60 years ago:

  • House officers had no formal contracts, and unless they demonstrated unflagging commitment, they were fired -- sometimes on the spot and without warning.
  • Except for two weeks of vacation, interns worked every day and at least every other night, all year long.
  • Compensation for interns ranged from room and board only to $50 a month.
  • Medical students, interns, or both, did all of the initial and follow-up blood counts, urinalyses, stool guaiac tests, sputum stains, and electrocardiograms.
  • Interns on call drew morning blood samples from all the ward patients -- usually about 30, sometimes more.
  • Serum potassium levels and blood gas determinations were available only from research laboratories, and only once or twice a week.
  • Syringes were ill-fitting, made of glass, and easily broken.
  • Needles were not disposable and were frustratingly blunt.
  • Intensive care and coronary care units were nonexistent, and life-support equipment was crude.
  • Only house officers wrote orders for the patient.
  • The referring physician and the consultant met at the bedside to examine the patient together.
  • Monitoring seriously ill patients required use of one's mind and five sensory faculties, coupled with frequent trips to the bedside and long bedside vigils.
  • Pacemakers were bigger than car batteries, housed next to the patient's bed, and with each electrical impulse, the patient's entire body jumped.
  • Intravenous fluids were made in the hospital and administered through reusable rubber tubing.
  • Southey tubes were inserted subcutaneously to relieve intractable peripheral edema.
  • Measuring the venous pressure in the antecubital space and determining the circulation time were standard procedures for all cardiac inpatients.
  • Rheumatic heart disease was as common as coronary artery disease.
  • Syphilitic aneurysm of the thoracic aorta was a leading cause of superior vena cava syndrome.
  • Poliomyelitis was rampant, and patients in iron lungs occupied much of the house officer's time.
  • Weekly grand rounds consisted of two or three case presentations in which the patients were present for everyone to see and for a privileged few to question and examine.
  • Autopsies were an indispensable teaching tool, required for hospital accreditation.
  • Radiologists wore red goggles.
  • House calls were still part of some practitioner's daily routine.
  • Health insurance was affordable and easy to get.
  • Medical malpractice suits were virtually unheard of.
  • An ECHO was something you might hear after shouting in a canyon, MRI referred to moderate renal insufficiency, and a CAT scan meant catching a glimpse of your feline pet.

Finally, I remember when medicine was a highly respected calling, the noblest of professions.

Dr. Fred is a professor in the Department of Internal Medicine at The University of Texas Health Science Center at Houston.            

Editor's Note: This is the latest in a series of essays by members of the TMA 50-Year Club .


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