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Archive for November 2nd, 2009

beforetheageofmiracles

Before the Age of Miracles: Memoirs of a Country Doctor by William Victor Johnston, M.D. Fitzhenry & Whiteside Ltd, 1972.

Dr. Johnston was born in rural Ontario and left his family’s farm to study medicine in Toronto, graduating with his M.D. degree in 1923. He subsequently began his practice in Lucknow, Ontario, a small village not far from his birthplace. In Before the Age of Miracles, Dr. Johnston recounts the challenges and satisfactions he experienced as he ministered to patients through the years of the Great Depression and a time when many of our “wonder drugs”, vaccinations and modern treatments lay, as yet unknown, in the future. Dr. Johnston’s book provides a portrait of a compassionate and thoughtful man, deeply interested in the welfare of his patients. His story serves as a reminder of how lucky we are to be able to take for granted much of modern medicine.

Dr. Johnston begins with a brief history of the Lucknow region and its pioneers. Many of its early inhabitants were from the Scottish shires of Argyll and Sutherland, whose Highland troops had won fame by crushing the Sepoy Rebellion of 1858 at Lucknow, India. Other pioneers in the Lucknow region included Irish settlers escaping the potato famine, Englishmen from Devonshire, and a sprinkling of Germans and other nationalities.

Dr. Johnston tells of his experiences from his early days in practice in the 1920s, when many babies were delivered at home, tonsils were removed on the kitchen table, and in winter, visits to patients were made by horse and cutter. Several cases of pernicious anemia were diagnosed each year and the disease was a death sentence. Victims presented dry yellow scruffy skin, lost weight and vigor and experienced numbness and tingling of the fingers and toes. Then, in 1926, two doctors discovered that a diet rich in liver would save the lives of pernicious anemia patients. They received the Nobel Prize for their work in 1934. It wasn’t until 20 years later that the life-saving substance in liver was identified: Vitamin B12.

In May of 1921, Banting and Best made their discovery of insulin as a treatment for diabetes and it was made available in limited quantities to doctors late in 1923 by Connaught Medical Research Laboratories in Toronto.

In the 1920s, the treatment of pneumonia consisted of rest in bed, good food and lots of liquids, and aspirin. Dr. Johnston describes the moment, anxiously awaited by the doctor and family, when the crisis marking the turning point of the disease was reached, the moment when the resources of the patient finally overcame the infecting germs. The patient would suddenly start breathing quietly, stop sweating, and go to sleep as their temperature returned to normal. It wasn’t until 1945 that the mass production of penicillin changed the course of the disease.

Tuberculosis also carried away many victims. It was called consumption because the disease seemed to consume the whole body. Sometimes it was called galloping consumption, an indication of how quickly it could kill. The disease was well-advanced before it could even be diagnosed because such limited facilities for skin tests or chest x-rays were available. The search to control tuberculosis lead to the pasteurization of milk and the sale of Christmas seals, a drive to raise funds for research.

Even something as simple as a cut finger could lead to a serious, even deadly, infection and required careful treatment. Calvin Coolidge’s son, Calvin Jr., died of such an infection in 1924. It was the result of a blister on his heel that he acquired playing tennis. Sulfonamide drugs, developed in the 1930s, were the first antimicrobial drugs, and paved the way for the antibiotic revolution in medicine.

Before the Age of Miracles offers many interesting anecdotes. In the last chapters of the book, Dr. Johnston looks at the future of medicine and prescribes needed changes. As the book was released in 1972, it is interesting to compare his views with what has come to pass in the last 30 years. Some of his conclusions are as relevant now as they were at the time of writing. Dr. Johnston believed strongly in the importance of the family doctor and played a role in the founding of The College of Family Physicians of Canada. The College celebrated its 50th anniversary in 2004 and a history provided on their website reads:

The fledgling National College soon took up residence at 174 St. George Street in Toronto, and later 150 Bloor Street, under the able leadership of its first Executive Director, Dr. W. Victor Johnston, who immediately began to establish the organization’s Provincial Chapters and increase its membership, focusing on providing training and leadership in the tumultuous post-war period. Soon the hundreds of members of the College blossomed into thousands as Provincial Chapters were established in all ten provinces and began ensuring the provision of quality continuing medical education for family doctors.

In the 1960s, Canada transformed public health under Medicare, celebrated its centennial, and, by the mid-1970’s, had witnessed a transformation of social and political values across the country. Dr. Johnston retired in 1965 and was succeeded by Dr. Donald I. Rice as Executive Director, who moved the organization to 1941 Leslie Street in 1969, and then to 4000 Leslie Street in 1974.

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