Monday, January 28, 2008

The Anatomy of Nineteenth Century Medicine

The primitive state of nineteenth century medicine frequently made surgery a frightening experience for patient and physician alike. In the fall of 1864, Dr. Robert H. Rice of Fremont, Ohio, and his young patient Miss Long of Tiffin found themselves in just such a predicament.

For more than two years Miss Long had been aware of a steadily growing tumor. She had consulted several area physicians who advised her to ‘watch it.’ But with the tumor increasing in size and becoming more painful each day, Miss Long turned to Dr. Rice for help.

Graduating from the University of Michigan medical school two years earlier, young Dr. Rice had received the best medical education available in the United States. But human anatomy, the function of organs, and the germ theory still were poorly understood. Rice's surgical education consisted of merely observing operations performed by other physicians.

Without laboratory tests, X-rays, or CAT scans to aid him, Rice was forced to rely on Miss Long's description of her symptoms and his examination of the tumor. In a letter to his brother, Rice described the tumor as "hard, irregular in shape… as large as his watch and surrounded with a mass of fibrous bands".

He informed Miss Long that if the tumor were not already cancerous it would become so soon. Miss Long needed little convincing. Despite Dr. Rice's inexperience and the risks of hemorrhage and infection, she made the decision to undergo surgery. Rice agreed to meet her several weeks later at the home of a Mr. Ginn in Fremont, where he would perform the operation.

Rice described the operation as a "formidable" undertaking. He brought along two local physicians to assist him. Rice judged one "too timid" and the other "too ignorant" to perform the surgery. Despite his inner fears, Rice remained "cool" and proceeded with a "steady hand." He confronted repeated episodes of blood spurting into his face from a half dozen little arteries that he perhaps never knew existed. He then excised the tumor from the attached skin and fibrous bands and removed the surrounding tissue. Rice later admitted to his brother that it "was almost the first cut I have ever made."

Without the benefit of antibiotics, blood transfusions, or intravenous fluids, Miss Long regained her health during a three-week period at the Ginn home. To the great relief of Dr. Rice, Miss Long returned to Tiffin just before Thanksgiving "in the enjoyment of hope." History does not record the eventual fate of Miss Long. But for the immediate future, Dr. Rice had given his brave, young patient hope and a chance at life during a time when the practice of medicine was more art than science.

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