Recipes for Living Dr. C. R. Harken

This autobiography was prepared and presented at the 97th Annual Session of the Iowa State Medical Society, Des Moines, Iowa, April18-21, 1948. It has been preserved by and used here with the permission of the Clarke County Historical Society:

Last Sunday I brought my secretary and her typewriter home and spent hours trying to compress forty years of general practice into half as many minutes. The result so distressed me that I thought either to discard it and just ad lib, or fake an alibi and stay away. Notwithstanding, I’m here. I have my paper and I'll read it to you.

Surely many specialists, who explore only the remote and farfetched fringes of the medical sciences, are often confused and confuse others. Too often they isolate themselves from the main course of medical thought and derive lucidity only from those in their own groups, whose ideas are in the same state of confusion as their own.

Please pardon me if I seem to boast a bit for, after all, I'm away from home and modesty is but egotism turned inside out.

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Recounting "Forty Years in General Practice" comes not as an urge or an inspiration, nor does it spring from idleness or insomnia, but rather as a request and an assignment. Interest in medicine came when infancy was just merging into childhood, when the family doctor was called for occasional family ills and seasonally to lance "Dad's quinsy." On that June morning, now so long ago, the callow youth set his feet upon the tortuous pathway he has been privileged to travel for so long. Nineteen hundred and seven was a year of panic, so to return to native haunts and live under the parental roof seemed better than the hazards of hunger.

Those were the days of lamp flues, roller towels, collar buttons, foot warmers, oil lanterns, coon skin coats, mud roads, frozen ruts, and snow drifts.

Many doctors were in the field and competition was keen and vigorous, our old family doctor not excepted. The world was not yet motorized. Horses were the power for transportation. Nor was it the proverbial old Dobin pulling a bewhiskered M.D. in semi somnolent rumination. Morgans, Hamiltonians, and Hackneys were the breed of choice - Morgans for unfailing service, Hamiltonians and Hackneys for metal, speed, and style. Top buggies with robes and curtains were the vehicles for stormy weather, shining rigs with rubber tires for balmy days, and sleighs drawn by sharp shod horses on snow and ice. Saddles were a convenience and a pleasure.

Those were epidemic days - typhoid fever, diphtheria, smallpox, scarlet fever, whooping cough, influenza, and pneumonia with complicating sequelae such as empyema, pulmonary abscess, etc. Immunization was not yet practiced. Even smallpox vaccination was commonly regarded with suspicion. The cholera infantum death toll each summer was appalling and pathetic. The author almost lost his infant son from this disease but gained a specific interest. In Chicago, he learned of Eiweiss Milch of Finkelstein. Commercial protein milk was not yet available. Pepsin and rennin were added to pasteurized cow's milk, the curd strained through gauze and washed; put through a fine sieve and added to fat free buttermilk. The product, sealed in fruit jars, in buckets of ice, was carried to the young patients. Recoveries were marvelous and gratifying.

My present offices and hospital were established in 1911. In a building on the premises, a secluded room was equipped for the practice of surgical technique. Bones from the butcher were used for wiring, plating and inlay grafts; animal intestines for resections and anastamoses; live animals (usually dogs) for practice and experiment on living tissues. The value and advantages of such an arrangement are obvious.

The first paper written for the local medical meeting pertained to the muscular origin of the heart beat, an unbelievable theory for the time and occasion. It was vigorously contradicted.

Rubber gloves were seldom seen. Solutions of potassium permangate and oxalic acid were used for hand disinfection. Vaginal examinations and manipulations were routine in obstetric practice. Puerperal infections occurred all too often. The literature was reviewed, particularly the pioneer work of the versatile Holmes and of Semmelweiss, and another paper prepared. It was well accepted.

"Considerations Essential to an Understanding of Infections" came next. A paper was written pertaining to diabetes in the pre-insulin days when it was really a problem. Others followed on "Minor Surgery," "Felons, Carbuncles and Other Abscesses," "The Pernicious Practice of Purging in Abdominal Pain/' "Head Injuries," “Haemorrhoids," "Empyemia," "Pernicious Anemia," "The Technique of Tonsillectomy," "Intestinal Obstruction," etc.

The little girl next door had tonsillitis, then rheumatic fever, polyarthritis, nephritis, endocarditis, acute chorea, and death. This harassing experience prompted the writing of "The Tonsil as an Etiological Factor," published in the State Journal, 1913, and later in the Journal of Ophthalmology and Otolaryngology, then in Semens Centralbatt Fur Laryngoliagii, translated by Emil Maher of New York, American collaborator. This was the fi.rst paper in medical literature on the subject.

Disturbed thyroid function was confusing. Metabolism machines were not in common use. The layman seemed to know as much about goiter as the average doctor. To simplify and elucidate the subject, a paper was prepared for the State Society in 1926 and published in the Journal. A thousand words abstract was requested by the New York Journal of Neuro Psychiatry. Many salutary letters were received from individuals such as Jelliffe and White, Jackson, Menninger, Olesen, Hertzler, and former professors. "Daddy" Chase in his letter said that it was the first time he had really understood the subject.

Gastric analyses commonly revealed hypochlorhydria in carcinomiatosis, irrespective of organs involved, just as in carcinoma of the stomach. Such evidence of acid deficiency and alkalosis aroused interest. An attempt was made to produce acidosis therapeutically. Carbon dioxide inhalations, paper bag rebreathing, ammonium chloride, hydrochloric acid, ketogenic diets, and radiation were used in advanced and incurable cases. Recessions and prolongation of life were accomplished. The paper, "Cancer and Hydrochloric Acid," appeared in 1931. Correspondence, especially from research workers followed. A discussion was invited at the cancer symposium, state meeting, 1931. Possibly the last word on "acidotic theory" has not yet appeared.

Traumatic cases are generally problems for the general practitioner. Fractures appear without invitation or arrangement. The evolution in treatment during forty years is impressive, particularly hip pinning, skeletal traction and ambulatory methods. Jaw fractures, formerly so formidable, have intrigued me. They are effectively stabilized with eyelet and arch bar wiring. The method is relatively simple and applicable to more than 90 percent of maxillary fractures. Various phases of these problems were prepared and presented to medical and dental societies. In treating fractures, the simple and available means are to be studied and applied. "The biggest fish are usually caught, not with fancy tackle, but by the simple well baited line cast by the experienced angler."

Medical knowledge today is so vast and changing that it can no longer be simplified and epitomized- nor can it be lodged within the confines of a single cranium. Psychiatry and psychosomatic medicine, "the newly hatched baby," which deals with the interrelationships of mind and body, represent a return of medicine to its more humane and psychiatric beginnings. The modem psychiatrist, destined though he is for an important role, is not exclusive in his comprehension of the complexities and inner struggles of the human mind, so essential for an understanding of and service to our fellow man. Such insight is more often observed in artists and poets than in scientists. I have seen it in simple men who spend their days plowing and planting, in thoughtful housewives and intelligent mothers, in ministers, lawyers, bankers and especially in family doctors. Sensitive people are often aware of an inner struggle. A.B. Housman has described it in himself.

The stars have not dealt me the worst that they could do,
My pleasures are plenty, my troubles are two-
But oh, my two troubles, they leave me of rest,
The brains in my head' and the heart in my breast.

0 grant me the ease that is granted so free,
The birthright of multitudes, give it to me,
That relish their victuals and rest in their beds,
With flint in the bosom and guts in the head.

In compiling my paper I am reminded of the simple fellow who purchased a dictionary for light reading and complained that the author changed the subject so frequently.

The greatest writer of short sensational stories is life itself. Certainly the life of a busy and devoted family doctor multiplies this postulate many fold- for he shares so abundantly the fortunes, joys, cares, tragedies, and emotions of so many others. The time allotted can portray but a smattering of the accumulated memories and material which could furnish writers with plots and themes for the rest of their lives.

One person in particular, however, you surely should know - Aunt Het, who at 85 had a fall and a fracture, intracapsular. A reduction and a pin let her walk again as of yore. Two years later, at four score and seven, her intestines tangled with a long pelvic adhesion resulting in obstruction of the ileum. Wangensteen tubes, intravenous glucose, a transfusion, avertin, and local anesthetic, and exteriorization of the gangrenous segment were not too much for old Aunt Het. There followed later resection and anastomosis.

In three more years, when four score and ten, some more of her intestine started an excursion through the femoral canal and strangulated. With local anesthesia the strangulated mass was reduced and repaired, Aunt Het undaunted. A few days later when pursuing rounds, bedcovers were thrown back and the doctor's index and second fingers pulled down the inguinal dressing for wound inspection. Aunt Het, amused and interested, remarked, "Doctor, if you'll tell me what you're looking for maybe I can help you find it." Subsequently, thanks to modem medical armamentarium, she survived influenza, pleurisy, pneumonia, and pyelocystitis but finally yielded to "the major involution"- cerebral sclerosis- nephritis- myocarditis.

Though she faithfully followed the scriptures, she feigned a preference for fiction- and facetiously remarked that "she never read her Bible through because she became confused when she got to the begats, and quit." I am wont to believe that "old Aunt Het" with her indomitable courage and grit has won her halo and golden harp and that those sinewy fingers are strumming the chord somehow, somewhere beyond the seraph guarded gates.

Forty years have accorded great satisfaction from associations and friendships with the young men launching upon their professional careers. The list is long, and includes my son, Dwight, from whom the following letter was received:

I shall await news of your class reunion - a significant reunion when one meets his colleagues to recognize their fortieth year out of school. Certainly I am not being sentimental unduly - when I reflect on the obvious. Forty years of sincere hard work do add up to a lot of service. One cannot but wonder how many miles of roads have been covered, how many times you have answered the telephone, how many times the rebellious body and spirit have been overcome in the night and the dictates of conscience given control.

This is no time to tally the score, but it would be a fascinating set of statistics to know the number of lives that have been launched and to know something of the variations in the long series.

One cannot quantitate pain relief, but there has been a lot in forty years, nor can we quantitate the satisfaction that has been derived from providing that relief. It has been great, however, and I am certain that one can never tire of that delightful buoyancy of spirit that every good physician feels when he realizes that a very sick patient has turned onto the road to recovery. You must have had that secret personal reward thousands of times.

My inclination is to ramble on with this sort of stuff ad infinitum, but the point is never made and the flavor deteriorates. If I knew how to express simple sincere admiration, I'd do it and stop the .letter.

Tonight I took a hat pin out of the bronchus from a little 11 year old child. It went smoothly and all the way home I had that "buoyancy of the spirit" that is perhaps peculiar to our profession.

Love, Dwight

Years ago it was said by William Osler that the public bases its estimate of the medical profession on its opinion of the family physician, who is the yardstick by which medical care is measured. Dr. Walter L. Bierring, in his presidential address before the American Medical Association in 1934, predicted that the new type of family doctor or general practitioner would be "the central figure in the field of medical practice, as in ages past," that he would be competent to care for 85 percent of general medical practice, besides being equally competent to seek advice and aid in the other 15 percent. However, the ratio of general practitioners to specialists entering the field is the reverse of these figures.

The creation of a section on general practice as a feature of the annual session of the American Medical Association is an eleventh hour atonement. Thank God they avoided a posthumous recognizance. More than a score of years ago it was asserted that the general practitioner, the family doctor if you please, was obsolescent and within another decade would become completely obsolete- that he was following the dodo, the bison, and the passenger pigeon. The ruthless and merciless manner in which the specialists were dividing his raiment among themselves seemed then, as always, valid evidence of an impending crucifixion. He escaped the tomb, however, and in the speaker's humble opinion is due for a renaissance and not a resurrection.

If the basic law of supply and demand operates through the next economic cycle there will be a flow from the specialties to general practice, yet these men will have been ill trained and ill prepared.

General practice comprehends the practical recognition and treatment of disease. Its greatest stimuli and most abundant rewards come from the active and intensive cultivation of the specialties. A specialty is any part of medicine or surgery in which the physician may particularly qualify himself. Specialties have their roots in the broad field of general medicine, which is at once the richest of the sciences and finest of the arts.

Forty years have given our profession extraordinary privileges and advantages. Western society traditionally grants special privileges to its stronger and more fortunate members, and like every privilege they carry with them certain obligations as a kind of payment. No person or profession has an inherent right to any privilege or advantage except as represented by the acquiescence of society. If we neglect our obligations we most certainly speed the day when these privileges will be curtailed or denied.