Frontier Medicine: Texas Doctors Overcome Disease and Despair

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TMA Sesquicentennial Article -- January 2003

By Mike Cox

The story of Texas medicine begins more than four centuries ago somewhere near the Rio Grande in the vastness of the Big Bend. No monument stands at the site because no one knows precisely where it happened, but what took place there marked the moment in history when medicine in Texas first advanced beyond shamanism.

For several years, Alvar Nunez Cabeza de Vaca had been wandering across what is now Texas, trying to reach the settlements of New Spain in Mexico. He had survived a shipwreck off Galveston Island in November 1528 and Indian captivity. An educated man, his medical knowledge bought his freedom, and word of his curative skills had spread.

Indians, probably Jumanos, presented to Cabeza de Vaca a man in obvious pain after being hit in his right shoulder by an arrow. The wound had healed, but the arrowhead remained lodged near his heart.

Using the knife he carried on his waist, Cabeza de Vaca made an incision in the Indian's chest and probed for the arrowhead.

"The point was aslant and troublesome to take out," Cabeza de Vaca later wrote. "I continued to cut, and, putting in the point of the knife at last with great difficulty I drew the head forth. It was very large. With the bone of a deer, and by virtue of my calling, I made two stitches that threw the blood over me, and with hair from a skin I stanched the flow."

Cabeza de Vaca gave the bloody arrowhead to one of the Indians. Soon, the entire village had seen the object. By courier, the arrowhead went to other villages for viewing.

The day after the extraction, the Spaniard cut the stitches. The wound healed normally and the Indian said he felt no pain.

"In consequence of this operation they had many of their customary dances and festivities," Cabeza de Vaca wrote after he finally made it back to Spain. "This cure gave us control throughout the country." He realized that a bad outcome for the Indian likely would have resulted in a decidedly bad outcome for him as well.

By the 1700s, Spain had established a series of missions and presidios along the Rio Grande and San Antonio rivers and at other scattered locations in its Texas province. Though Cabeza de Vaca had spared one Indian much pain, his countrymen carried smallpox to the New World. The disease took a terrible toll on the native population as well as the Spaniards.

When Spain learned of Dr. Edward Jenner's discovery of the vaccination process in England, the crown ordered that smallpox vaccine be made available in New Spain. The first successful smallpox inoculation program in Texas was carried out in San Antonio de Bexar in 1806.

Physician Freedom-Fighters

Spain was one of the world's great powers, but it could not hold its land in the Americas. Born of revolution, the Republic of Mexico opened Texas to immigration from the United States in the early 1820s. Among the first settlers were physicians. The ayuntamiento of San Felipe de Austin, the ranking local government official, granted the first professional medical license on Nov. 14, 1829, to Robert Peebles. The doctor had received his training at Ohio Medical College in Cincinnati, moved to Texas, and except for a period during the Civil War, he never left. He went on to found Hempstead, a town he named for his brother-in-law, an Ohio doctor.

Doctors like Dr. Peebles did more for early-day Texas than just caring for their patients. Historians have called physician Branch T. Archer, little known today, the father of the Texas Revolution. The 1808 medical graduate of the University of Pennsylvania practiced medicine in his native Virginia before settling in Texas in 1831.

Though trained to heal, it was Dr. Archer's killing of another man in a duel that made it expedient for him to leave Virginia. In Texas, demonstrating the same intolerance to perceived effrontery that got him in trouble before, the doctor was one of the first to call for independence from Mexico.

When 59 men signed a Declaration of Independence at Washington-on-the-Brazos on March 2, 1836, seven of them were doctors, including future vice president Dr. Lorenzo de Zavala. Five doctors died in the fall of the Alamo four days later. Eleven physicians, one of them a declaration signer, fought in the Battle of San Jacinto on April 21 that year. When the smoke cleared, they put down their weapons and treated the injured, amputating mangled limbs, wrapping wounds, and relieving pain with opium.

Among the wounded was Sam Houston, leader of the Texans and soon to be the republic's first president. Dr. Alexander W. Ewing, an Irishman who learned surgery at Edinburgh, treated him for a bone-fracturing gunshot wound to the right leg and accompanied him to New Orleans to see that he got further treatment. Interim Texas President David G. Burnet was not impressed with Dr. Ewing's dedication to his patient. He fired him from his position as surgeon general of the Texas army for leaving the state without permission.

Not so eager to practice medicine was Dr. Nicholas D. Labadie, a Canadian who refused Sam Houston's order to care for the Mexican wounded. He finally agreed to do it when Mr. Houston promised him help in collecting $300 the Mexican government owed him. Writing about his experiences in later years, he claimed he never got the money.

Dr. Archer missed out on the fighting, being one of three Texans who went to the United States to raise money, recruit fighters, and obtain supplies for the revolution that solidified Texas' separation from Mexico. Back in Texas, the contentious doctor soon challenged another physician to a duel. Using an acceptable technicality, Dr. Anson Jones declined the honor and lived to become the fourth and final president of the Republic of Texas.

Another doctor, 1828 Yale graduate Ashbel Smith, became surgeon general for the Republic's army in 1837. As the military's ranking doctor, he set up Houston's first hospital, a military facility. When the republic's Second Congress created the Board of Medical Censors -- a licensing entity -- in December 1837, Dr. Smith served as its first chair.

Questionable "Cures"

Dr. Smith and other medical professionals of the era must have scorned claims made by purveyors of patent medicines like James Gillman, who in 1838 circulated a broadside in Houston extolling the curative value of "Texan Universal Pills."

According to Mr. Gillman, the powerful little pills had been prepared "after a careful personal examination of the diseases incident to this climate, and with a particular reference to the health, comfort, and happiness of the Citizens of this Republic."

Available from authorized agents in Galveston, Harrisburg, Houston, Velasco, Quintonia, Brazoria, Columbia, Richmond, San Felipe, Washington-on-the-Brazos, Bastrop, and Matagorda, Texan Universal Pills were recommended for sufferers of bilious fever, congestive fever, yellow fever, cholera morbus, and other ills.

The preparation -- with a maximum recommended dosage of seven pills -- had a laxative effect, vigorously flushing supposed harmful elements from the body, not to mention needed fluid and electrolytes.

Other pills and tonics, laced with opiates and alcohol, made a sufferer feel like he or she was getting better -- at least until the buzz wore off. Though enough gullible people lived in Texas to keep the quacks in business, others viewed them more realistically.

"Pseudo 'M.D.s or 'Drs. are," the Telegraph and Texas Register warned, ". . . more dangerous than the hostile Indians; and not considerably less numerous. . . . We had rather at any time see a company of armed Mexicans in battle array, than a squad of these grave gentry, parading with their 'Pandora boxes' in the shape of pill bags -- which are seldom opened without entailing on the community disease and death."

Doctors, like powerful purgative pills, tended to make things happen in early Texas, sometimes for the good, sometimes not. Dr. Edmund Weidemann could be credited with inspiring Texas' first antipollution law, but not because he cared anything about water quality.

Following the Council House fight on March 19, 1840, in which 35 Comanches were killed when a peace conference in San Antonio got a bit out of hand, the doctor claimed two Indian cadavers for research purposes. He boiled the bodies to remove the flesh, afterward pouring the water into the San Antonio River, where the town got its drinking water. The incident caused such an outrage that municipal officers passed a law prohibiting the befouling of the river. What conclusion, if any, Dr. Weidemann reached in his examination of the Indian skeletons was not reported, but he did have to pay a fine.

On the other end of the republic from San Antonio, Dr. John S. Ford hung out his shingle in the piney woods of East Texas. Beginning his practice in San Augustine in 1844, his fees ranged from $15 for delivering a baby to 75 cents for a preparation to treat an itch. The doctor got $7 for a therapeutic bloodletting. Later, as a Texas Ranger captain, he practiced a different form of bloodletting, often for free.

Not all treatments were as harsh as draining blood from a patient to "cure" him of a fever. Learning from Indians, and using remedies passed on to them by others, doctors and just plain folks ministered to the sick with medicinal preparations using everything from catnip to watermelon. Some of these concoctions worked.

"I am still miserable," German nobleman Prince Carl of Solms wrote in his diary on March 24, 1845. "I had to remain in bed for half the day. The Dr. prescribed oak bark with red wine. Things improved."

Prince Carl did not remain in Texas, but Dr. Ferdinand Ludwig von Herff, who arrived from Germany a few years later, did stay. Trained in Berlin and Giessen, the doctor had plenty of work in the new Texas republic. Dr. Herff soon demonstrated that despite the relatively primitive state of the medical art in the 19th century, an intelligent person practicing deductive thinking could do patients some good.

Dr. Herff probably knew nothing of Cabeza de Vaca's early treatment of Indians, but he gained a lot of good will for the Germans when he restored a Comanche Indian chief's vision. Correctly diagnosing the problem as bilateral cataracts, he prepared to operate.

Ahead of his time, but understanding on some level the importance of clean water to a medical procedure, Dr. Herff determined to use cistern water rather than the more readily available but mineralized ground water. Examining a specimen of the cistern water under his microscope, the doctor saw that even it was alive with small creatures he called "animalcules." Before proceeding with his operation, he boiled the water.

On the cutting edge of medical technology, the doctor used ether for anesthesia. Knowing the high flammability of the chemical, he planned to perform his surgery outdoors to take advantage of natural light, thus avoiding the fire danger posed by a lantern. Finally, he waited for a day when no wind was blowing or insects stirring.

The operation was a success. Six months later, the chief returned to the German settlements with a gift of appreciation for Dr. Herff -- a captured Mexican girl. The doctor politely accepted the slave, but as soon as the Indian left he freed the young woman.

Frontier Medicine

Texas' annexation by the United States soon triggered war with Mexico, which still considered the new state its territory. With the arrival in Corpus Christi of an army under Gen. Zachary Taylor, the new state got an influx of medical expertise. Medical surgeons could patch up a minor wound, set broken bones, and knew to put tincture of iodine on hemorrhoids and ulcers, but when it came to treatment of disease, a soldier had about as much hope of surviving with medical attention as without it.

"Desperate diseases require desperate remedies," one antebellum physician declared.

Standard treatment was, indeed, desperate. Bleeding, cupping, leeches applied to the temple, opium, doses of calomel and quinine, frequent enemas, and even arsenic were some of the basic medical practices of the day.

Statistics bear out the lack of effectiveness of these treatments. In the Mexican War, the first part of which was fought in Texas, only 1,548 soldiers and sailors were killed in action, but nearly 11,000 died of disease, accidents, or wounds. The mortality rate was 110 per 1,000, compared with 65 per 1,000 during the Civil War that would follow.

One of the biggest killers during the war and afterward was cholera. Transmitted through water and food and aggravated by unsanitary conditions, the diarrhea-causing disease swept across Texas in periodic, deadly waves. Doctors tried everything from bloodletting to compounds of laudanum, camphorated alcohol, unground pepper, and cologne.

While the war continued in Mexico, the American Medical Association was organized in 1847. Its members approved a code of ethics that enhanced the development of the profession. The organizational movement soon made its way to Texas.

Thanks largely to the leadership of Dr. Smith, Texas doctors were organizing to improve the quality of medicine in the state. Working with 10 other physicians, Smith helped create in 1848 the Medical and Surgical Society of Galveston, the state's first medical society. Five years later, in 1853, he headed the committee that wrote the constitution and bylaws of the new Texas Medical Association.

During a time that one historian called the "heroic age of medicine," physicians in Texas had their successes. In Galveston, the state's first nonmilitary hospital was being run on a contractual basis with the city government by Dr. Samuel Hurlbut. He paid $20 a month to rent the building he used for a hospital, but the city paid him 75 cents a day per patient treated. The number of those patients was anywhere from 250 to twice that each year, with a mortality rate varying between 5.8 and 7.7 percent.

In San Antonio, residents and visitors were getting good care from Dr. Herff, who had begun his practice there in 1850. To the delight and amazement of the crowd that gathered around to watch, the doctor in 1854 performed an open-air perineal lithotomy on a snoring Texas Ranger suffering from a pair of large bladder stones. The operation was a success.

Arriving in San Antonio about the same time as Dr. Herff was Dr. George Cupples, a Scot trained in Edinburgh. Dr. Cupples and his wife had settled in Castroville near San Antonio in 1844, but by 1850, like Dr. Herff, he had a busy practice in the Alamo City. From 1850 to the mid-1880s, the two doctors performed about 25 percent of all surgical procedures reported in Texas. Numerous surgical firsts were attributed to Dr. Cupples, including the first use of ether and chloroform as anesthetics.

Many early Texas physicians believed alcohol had curative as well as anesthetic qualities, but not Dr. J.J. Riddle. He settled in 1846 at the old Indian village on the Brazos that became Waco and quickly made it known that he would not treat anyone in a place where whiskey was consumed. In fact, he would not even enter such a place. If he needed to talk to someone inside an establishment that served alcohol, he asked a third party to deliver the message for him. Despite that self-imposed barrier to some patients, the doctor believed he could help the body and the soul. He continued practicing medicine, but hoping to do even more for his patients, he became an ordained minister as well. 

A doctor in 19th-century Texas did not necessarily have to wear a collar, but he had to be more than a skilled practitioner. He needed to be a jack-of-all-trades. Here's how someone described Dr. Johnson Calhoun Hunter, who had come to Texas in the 1820s: "He could deliver a baby, ride a plow, go hungry, trade with the Indians, run a traverse, pilot a scow, adjudicate a case, please a woman, cut a bull, teach a school, sire . . . children, and deliver mail."

Not every person called doctor, whether the term was a self-description or conferred by some institution of higher learning, could be considered as well rounded and educated as Dr. Hunter. But Dr. Gideon Lincecum came close. He was a healer and a thinker. Not everything he thought necessarily made sense (his proposal that the state castrate all criminals and persons with dangerous ideas, such as opposing slavery, got nowhere in the Texas Legislature), but he clearly was a man of ideas.

Before arriving in Texas from Mississippi in 1848, Dr. Lincecum experimented with what today would be called electroshock therapy.

"I have often used it in paralytic cases, indeed, in nearly all I ever treated," Dr. Lincecum wrote in 1860, "and I cannot now say that the patient ever derived any advantage from its application. I am sure that I never succeeded in relieving a case of any form of disease by doing violence to the patient, either by the use of poisons, abrasions or shocks. . . . Health is the positive and disease the negative condition, we must draw near like a friend, and warm them up into the positive -- if we can, without violence in our action."

In the spring of 1860, Dr. Lincecum wrote his sister in the then-frontier settlement of Hondo, hoping to put her fears of Indian depredations into perspective. "While we are . . . horror stricken at the calamities which are occasionally befalling our distant frontier friends, we forget to look around us in our comparatively safe homes and to number the victims that fall prey to the king of terrors, in almost every family; while the Indians are dispensing the fiat of death to six men in your country, five times as many are killed by scarlet fever and the doctors in this."

The doctor handily summarized the truth about 19th-century Texas as opposed to the following century's Hollywood-inspired vision of constant warfare with Indians and shootouts and outlaws. While many a Texan did die a violent death or suffer trauma at the hands of man, the biggest killer was disease.

"Last summer," the doctor continued in his 1860 letter, "while the Indians were killing an occasional man on the frontier country, to the number of 20 or thirty souls, and stealing a few thousand horses, the yellow fever killed as many thousand people."           

A Cruel Killer

In 1867, seven years after Dr. Lincecum wrote that letter, Texas experienced its worst outbreak of Yellow Jack, as some called it. Doctors did not yet know the cause, but they knew more about it through the work of Dr. Smith, who treated many patients during a deadly 1839 outbreak of the disease in Galveston. The doctor wrote articles on the epidemic for a Galveston newspaper and later published more detailed information on the disease in An Account of Yeller Fever in Galveston, 1839 , considered the second English language medical work published in Texas. (A paper by Dr. Theodore Leger, published in 1838, was the first.)

The word "decimated" often is misused as a synonym for wiping something out. The word's precise meaning is the removal of one out of 10, and that's what happened in Huntsville when Yellow Jack -- some called it Bronze John -- visited the town. Before the September!!-October 1867 epidemic ran its course, an estimated 10 percent of the East Texas town's population was dead.

The outbreak was the most severe in the state's history, but not the first or the last. An outbreak in 1853 swept the Trinity River town of Cincinnati in northern Walker County. No one knows for sure how many died -- some accounts say as many as 250 -- but in addition to putting most of the town's population in hastily dug graves, yellow fever killed Cincinnati itself. Survivors of the epidemic simply left and did not return.

Medical historians say the disease had a mortality rate of 85 percent during the 19th century. And it was a cruel killer, capable of claiming even a young, healthy person within three days of onset. The first symptoms were headache, body ache, and fever. After about three days, many sufferers thought their prayers had been answered when they began feeling better. But the respite was like the eye of a hurricane, with the worst to follow. Liver damage gave victims a jaundiced appearance. Projectile vomiting of blood clots, a condition then called "the black vomit," followed. After enduring fever-induced delirium, sufferers eventually lapsed into coma and, finally, death.

At the time, even the best medical minds thought yellow fever was contagious, that it came from "miasmata," airborne particles associated with unsanitary conditions and stagnant water. Quarantines and rapid disposal of victims' bodies offered only false hope.

Sam Houston's widow, Margaret Lea, had moved to the Washington County town of Independence after her husband died in July 1863. Life had been hard on the 48-year-old woman since her husband's death, but her religious convictions and her children sustained her.

The 1867 epidemic began in the late summer in Galveston, where 725 were dead by early September. By October, Independence was a virtual ghost town. White sheets hung from the houses of those who had come down with the disease. Baylor College had shut down.

Margaret stayed inside her home with her children as much as she could. After receiving a letter from her older daughter, Maggie, saying that she was coming to visit, Margaret went to see her instead. When word came that the disease seemed to have run its course, Margaret decided to go stay with another daughter in Georgetown.

Stopping by Independence to pick up some things before the westward journey, she was bitten by a mosquito. She surely thought nothing of it, but soon she became sick. A second wave of the epidemic had begun and that caused justifiable panic. Riders galloped out of town, followed by buggies and wagons as people cried out, "Yellow Fever! Yellow Fever!"

But the warning was too late for Margaret. She died on Dec. 3, 1867, after two days of delirium.

Because the disease was believed to be infectious, there was no opportunity to take the body of Mr. Houston's widow to Huntsville for burial at her husband's side. She went into a quickly dug deep grave. Margaret had been a very religious woman, but the local Baptist preacher would not even preside at her brief funeral for fear of infection. Ironically, though medicine failed her at the end, a skilled surgeon had successfully removed a cancerous tumor from one of her breasts 20 years before. That operation was performed by Dr. Ashbel Smith.     

Send in the Cavalry

After the Civil War, the U.S. Army regarrisoned some of the frontier forts abandoned at the onset of the conflict and established other posts elsewhere. Most of these forts had a post surgeon.

These Army doctors may not have had all that high a cure rate, but they were getting better at understanding some of the things that made soldiers -- and other people -- sick. Scurvy, they realized, could be prevented if soldiers ate more fruit and vegetables. Those two food groups often being in short supply on the edge of settlement, Dr. A. Taylor at Fort Phantom Hill, near Abilene, suggested that pickles be added to the soldiers' rations. Military surgeons also began to better appreciate the importance of good water to good health.

The public also benefited from Army doctors. The post hospitals often were the only medical facilities available. But most medical treatment in 19th-century Texas occurred in the patient's home, the doctor's home or office, or on a quickly cleared table in a saloon with the black powder gun smoke still hanging in the air.

No matter the venue, a considerable amount of surgery was being performed in Texas. One of the most important pieces of 19th-century medical history is Dr. Cupples' 1886 report for the Texas State Medical Association's Committee on Surgery. The document described 4,293 operations performed by 138 doctors. These procedures had an overall mortality rate of 8 percent. Nearly half of the operations were described as major. The mortality rate for those was 15.9 percent.

Men of Action

With Indians long since relegated to reservations across the Red River, the Army started shutting down most of its forts in Texas in the mid-1880s. These closings continued through the early 1890s, leaving only installations along or near the Rio Grande and at Galveston. But the west was still wild up in the Panhandle, where one doctor, listed in later accounts only as a Dr. Ashby, demonstrated the importance physicians attached to peer acceptance.

Amarillo's own "Doc Holliday," Dr. Ashby was known to mix whiskey with gunpowder, in addition to his more routine medical preparations. Still, he was an MD and he applied for admission to the Potter County Medical Society. His application was denied.

At the society's next meeting, he showed up in person. Setting a .45 caliber Peacemaker down on the desk before him, the doctor asked for another vote. This time, he was unanimously elected.

Clearly, credentials had become important. Dr. Cupples, later described as "a master in his profession, laborious, careful in all his practice, his reports, his cases and private records," had played a major role in the creation of the State Board of Medical Examiners. That entity, the first of its kind in the United States, had begun licensing doctors in 1875.

No matter the quality of his medicine or his skill as a surgeon, the mere presence of a doctor offered a patient psychological comfort. More astute physicians recognized the yet-to-be-named concept of the placebo effect, in which a patient believing he or she is getting help often improves.

Dr. Howard Gilmer, of Turkey, clearly understood the power of providing hope along with treatment. Standing at the bedside of a 6-year-old girl suffering from double pneumonia, the doctor promised to give her a new kitten when she got well. She did, and she got the kitten.

Thinking positively, however, could not stop smallpox, the disease Dr. Jenner had called "the most dreadful scourge of the human species."

Not only could outbreaks kill one out of three who contracted the disease, smallpox turned citizens against each other. In October 1898, doctors in Laredo began seeing an outbreak among children that they at first took for chicken pox. But these doctors soon realized they were dealing with smallpox. By the first of February 1899, more than 100 cases had been reported in the border city.

Dr. W.T. Blunt, the state health officer, went to Laredo from Austin to lead the fight against the epidemic. He set up a field hospital to isolate patients, ordered the burning of clothing and bedding, fumigation, and door-to-door vaccinations.

When he realized that Laredoans were not fully embracing the quarantine program, especially the mandatory inoculation, he asked the governor to send in Texas Rangers. A contingent of rangers under Captain J.H. Rogers arrived on March 19, 1899, and began enforcing the health official's orders more vigorously than some of the city's residents thought proper. Milling protestors pelted rangers and health workers with harsh words and harder rocks, leading to a couple of minor injuries.

The next day, when the rangers got word that someone had telephoned a local hardware store to order 2,000 rounds of buckshot, the officers began a house-to-house search of the part of town where the order had come from. The situation soon deteriorated into a riot, with the rangers killing two citizens and wounding 10 others. It took cavalry from nearby Fort McIntosh to restore order.

The inoculation and fumigation program continued, and by May 1, Dr. Blunt lifted the quarantine in the border city.

Though quarantining did no good in treating diseases carried by insects or caused by bad water or food, it was a useful, if harsh, tool in dealing with smallpox. By the turn of the century, most Texas counties had "pest houses," publicly owned houses where sufferers of smallpox or other contagious diseases could be isolated.

The pest house in Martin County stood on the other side of the railroad tracks. Surrounded by a fence, the house was off limits to anyone but a doctor. Food was left on top of the steps leading over the fence.

"It was a lonely place and struck terror to small children," as one writer later described it. "Inside the house were beds, chairs, a table and a stove. An apple box was nailed to the wall as a cupboard. When a doctor visited a patient there, he would discard his clothes and put on clean clothing before leaving. When patients recovered, the 'pest house' was fumigated."

Health officials would have done better fumigating areas with standing water. U.S. military doctors finally discovered that yellow fever was borne not of the air, but what flew in the air: specifically, the female Aedes aegypti mosquito.

 By spreading oil over open water and otherwise attacking mosquito-breeding areas, the disease was finally controlled. The last major outbreak in the United States occurred in New Orleans in 1905. In 1937, a vaccine was developed, and the disease all but disappeared in developed countries.

Educating Doctors

The prospect of free land and, later, cheap land brought many people to Texas. But so did the allure of regaining health. Conventional wisdom had it that the best thing for a tubercular to do was to seek a drier climate. Dr. Sherman Goodwin, afflicted with the disease, moved with his family to Texas from Ohio in 1849. His condition improved and he practiced medicine in South Texas until he died in 1884.

"Lungers," as they were called, traveled to Texas by ship and train, heading as soon as they could to high and drier country in Central and West Texas. San Antonio, Kerrville, San Angelo, and El Paso were particularly popular destinations. Native Texans suffered from the disease as well. For a time after the Civil War, 20 percent of all deaths in the state were attributed to tuberculosis, compared with 14 percent nationally.

Doctors in Texas had no monopoly -- many Texans relied on home remedies or turned to folkhealers or purveyors of patent medicines -- but when available, general practitioners usually got the call for treatment involving more serious intervention. They called on their patients by horse, buggy, or train, carrying their equipment and medical supplies in their saddlebags or black grip.

With the growing recognition, as Dr. Herff and others had demonstrated, of the importance of aseptic and antiseptic conditions in treatments, recovery rates increased. A patient could go to a doctor in Texas for repair of a hernia or even removal of the ovaries and have a reasonable chance of improvement and recovery. A doctor in Fannin County performed what may have been the nation's first successful appendectomy.

Scientific discoveries, including the development of crude x-ray technology in the mid-1890s, began to make it more difficult for a doctor to extend full treatment outside the office. The importance of hospitals began to grow. By the turn of the century, AMA listed 19 hospitals in the state. Two pioneer facilities, both still in operation today, were the Temple Sanitarium (now Scott and White Memorial Hospital) established in 1904 by Drs. Arthur C. Scott and Raleigh R. White, and John Sealy Hospital, opened in Galveston in 1890.

Texas doctors contributed to medical knowledge by publishing papers in professional journals and by writing books, but any Texan interested in pursuing a career as a doctor had only limited opportunities in his home state until The University of Texas Medical Branch opened in Galveston in 1891.

The first medical school, the Galveston Medical College, operated from late 1865 to 1873, when it was reorganized as Texas Medical College. Dr. Smith served as the college's president and was active in promoting a state-run medical school. When the legislature passed a bill in 1881 creating a state university that would include a medical department, the Texas Medical College closed its doors. But with state funding not immediately available, the private school reopened in 1888 until the university was up and running.

Dr. Smith died in 1886, five years before the new medical school began training young doctors in Galveston, but its main building -- a structure that survived the devastating 1900 Galveston hurricane -- came to be called "Old Red" in the red-haired doctor's honor.

A New Century

Texas had better educated doctors -- male and female -- but newspaper and magazine advertisements and traveling medicine shows continued to offer its residents false hopes of cures for virtually everything, from "nervous weakness" to cancer. Though Texas doctors had succeeded in getting some antiquackery legislation passed in Austin, the death knell for the patent medicine industry came in 1906 with the enactment of the federal Pure Food and Drug Act.          

When war broke out in Europe in 1914, the beginning of what would grow into the world's deadliest and most widespread conflict, Texas had two strong medical schools -- The University of Texas Medical Branch at Galveston and Baylor University College of Medicine, as well as several other less prestigious and more poorly funded schools -- along with several thousand doctors who thought they were pretty good at what they did.

But in the fall of 1918, something that medical science would not fully understand for decades, and that would profoundly affect them and the rest of the world, occurred in Kansas. Somehow, an avian virus was transmitted from a bird to a pig. When the pig's immune system automatically declared its own war on the invader, the virus mutated. This new strain moved on to another host: human beings.

An Army cook at Camp Funston, Kan., was the first to come down with this new strain of influenza. Through the military, the virus quickly spread across the nation and "over there" to the trenches in Europe. A false impression that the disease originated in Spain gave it a name, the Spanish flu.

The pandemic was in full force by October 1918. Health boards in Texas closed schools and other public places, isolating military installations with armed officers. Hospitals were full but short-staffed, the disease hitting doctors and nurses hard. Coffins were in short supply, as were funeral directors and gravediggers.

Enforcing quarantines and wearing facemasks helped some, but other methods employed to fight the virus were ineffective or dangerous in their own right, such as toxic chemical sprays.

Before it ran its course, the virus infected more than a quarter of the American population, claiming somewhere between 675,000 and 850,000 lives, thousands of those in Texas. Worldwide, an estimated 20 to 40 million people died, the worst pandemic in history.

The killer was not the flu itself, but secondary infections -- bronchial pneumonia or septicemic blood poisoning. With antibiotics not yet developed, a large percentage of those patients did not survive.

Unorthodox Ideas

Texans and the rest of the nation soon forgot about the Spanish flu and plunged into the Roaring Twenties, followed by the not-so-roaring Thirties. Many went broke during the economic Depression that began with the stock market crash in 1929, but not Dr. John R. Brinkley, of Del Rio. He was a legitimate doctor with unorthodox ideas.

In 1931, broadcasting from a super-powered radio station in Ciudad Acuna, Mexico, the doctor began offering Texans more than recovery from sickness. What he had to sell was the essence of life itself, sexual energy. For $750, he would restore a man's sexual potency by implanting goat testicles. The Del Rio area had a lot of goats, and the United States had a lot of gullible men willing to pay for the hope of renewed vigor. Dr. Brinkley died a rich man in 1942, having performed 16,000 operations.

In 1929, another Texas physician had what some considered an unorthodox idea and ultimately played a role in developing a system that both revolutionized the practice of medicine and came to be one of its biggest headaches: health insurance.

The doctor was Justin Ford Kimball, a former school superintendent. He had just become administrator of Dallas' Baylor Hospital. Like most hospital executives, he had a problem with unpaid bills. Looking over the outstanding accounts, he recognized that a lot of those owing money were schoolteachers. Realizing they probably would never have a lot of money, he started the nonprofit Baylor Plan, a system in which teachers could pay a half-dollar a month into a fund that guaranteed up to three weeks of hospital time at Baylor.

Dr. Kimball may not have appreciated it at the time, but he had just invented health insurance. The Baylor Plan was merged in 1944 into the company now known as Blue Cross and Blue Shield of Texas.

Meanwhile, a second European war had drawn in the United States. This war gave the "Great War" its lasting name of World War I, but this time most of the killing was on the battlefield or in saturation-bombed cities. Still, nothing comparable to the Spanish flu epidemic occurred during World War II, the first clash between nations at least having the benefit of sulfa drugs.

Midway into the 20th century, the possibility of the Cold War turning into a nuclear war loomed over Texas and the rest of the nation like an approaching thunderstorm. But the same radioactive particles that could be harnessed to kill millions were beginning to be used to save lives though improved x-ray equipment and radiation treatments. Not that some Texans did not go a little overboard at the dawn of the atomic age. One entrepreneur bought a bunch of old commodes and a supply of uranium and went into the hemorrhoid-curing business until health officials shut him down.

The progress of medicine in Texas was as chartable as a patient's blood pressure and temperature: In 1905, a white male born in Texas could be expected to live an average of 47.5 years; a female, 50.2 years. A quarter century later, those life expectancies had increased to 59.7 and 63.5 years, respectively. By the mid-1950s, the numbers were 67.2 and 73.7.

As TMA ended its first 100 years and Texas and America entered the 1950s, many challenges lay ahead. To many Texas physicians, they posed bigger threats to the health of Texans than even marauding Indians and the scourge of disease.

Mike Cox is an Austin author and historian.

January 2003 Texas Medicine Contents
Texas Medicine Back Issues


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