Spent Most of Time on the Road, Packed Drugs in Emergency Bag By DR. JOSEPH MORRELL Within the memories of people now living there have been almost unbelievable changes in ail phases of community life. Conveniences unthought of a generation ago are now commonplace and excite little comment. There is probably no field in which greater progress has been made than in the care of the sick. Within a period of 75 years almost all practical knowledge now used for rendering medical care has come through research. Before that time luck and the resistence of the patient were probably the chief factors in determining the outcome of any serious illness. There were many handicaps to the rendering of good medical service in the pioneer period in Utah. Some of these have been discussed in the previous articles in this series. The ignorance of the causes of disease, and of effective means of prevention or cure, was the greatest obstacle to progress. Next in importance was probably that of tlie poor facilities for transportation. There are middle aged adults living today who have never driven on other than paved highways, and who have never traveled in any other vehicle than an automobile. Many doctors are probably in that class. They can have no appreciation of the difficulties encountered by the doctor or midwife of past generations due to poor roads and even worse conveyances. There are few now living who can tell the stories, from personal experience, of the tragedies of that period. CARRIED DRUGS The pioneer doctor had little need for an office, as he spent most of his time on the road. He carried his equipment of instruments and drugs to the homes of his patients. His buggy held a huge emergency bag, much of its contents being transferred to sad dle bags in bad weather. Commonly someone was sent to fetch the doctor by team and sleigh in the winter time. There is a striking picture in Volume 10 of the Utah Historical Quarterly; taken in the early days, of a mud bespattered man on horseback, both horse and rider seemingly in a state of complete exhaustion. The horse, with eyes half closed and ears flopped, seemed to be leaning against a wall. Beside them was the midwife astride another horse, wearing boots and a heavy overcoat. They were ready to start a return trip into the adjoining county. There might be tragedy, or even death, awaiting the midwife when she arrived. The writer has a vivid recollection of the frantic rides to and from the home next door to where he lived as a youth. Grandma Williams, a midwife, lived there, and people came for her day and night, in wagons, buggies, bobsleds, and on foot. They left in great haste, but she might not return for several days. STRENUOUS TIME The doctor had an equally strenuous time. When he left home or office he had little idea when he would return. He left a placard on his door, Doctor Out, and callers waited until he returned. There were no means of communicating with him, even if his whereabout had been known. Many of these long trips, with the unavoidable delays usually encountered, often meant prolonged suffering or even death for the patient. Often deaths occurred from causes which could have been handled easily if the doctor could have reached the home in time. My own experiences with these adverse conditions lasted only a few years, the easiest ones, perhaps, of all that trying period. They were invaluable, however, in that they brought a greater appreciation of the better life when it finally arrived. Entire nights were spent on the road, often many nights in succession. At the destination it might be necessary to prepare the kitchen for some emergency procedure. The time consumed, and the fatigue involved, when it would be impossible to render the best kind of service, certainly increased the risk to the patient, and lessened the chances of a satisfactory outcome. Sometimes the experiences on the road might be equally trying. The horse often found his way home alone when the driver went to sleep. When one wheel of the buggy went off the end of a culvert, during a storm, it was necessary for me to pick myself out of ditch, and to lead the horse for a few miles to avoid a repetition of the accident. Lack of communication and transportation facilities was a serious impediment to all phases of community life in the first in Utah. Ox teams were in common use for many years. The horse and wagon, or buggy, brought faster travel, and added comfort, when they arrived. SPEEDED UP The pony express made for faster communication. The telegraph, in 1861, seemed a miracle to the people. The railroad, in 1869, was the greatest single aid to progress up to that time. The telephone, later, made obsolete the messenger boys utilized by every office and place of business.. Each improvement, as it (came, added something to the ifficiency of medical service, with added comfort and saving of lives for the patients. The automobile was the greatest single improvement in transportation, in its application to medical care. There were trying years, however, and many doctors who bought cars with the greatest enthusiasm, abandoned them in disgust. The automobile was an improvement, even at its worst, but the roads were not fit for such traffic, and it was many years before better roads could be built. Adaptation of the roads to faster traffic was a major job, and came only after years of enduring the agony of cut and punctured tires, broken springs, and being mired in the mud. For a long time it seemed more trying to travel by automobile than with horse and buggy. The roads were completely impassable during certain seasons, and a horse must be available for any emergency. There was humiliation in being forced to submit to having the shiny car pulled out of a mudhole, or in riding through town behind a team, decked out in cap, goggles, linen duster, and guantlets, when something went wrong. More times than I can recall, was I pulled out of the mud of the Ogden streets, principally on South Washington Avenue or upper 25th Street. It had a tendency, however, to induce humility, a desirable asset for a doctor. MEET EMERGENCY Today, when the doctor can speed in a few minutes to any part of the surrounding country, or, as is now more commonly done, send the ambulance to bring the patient to the hospital, emergencies are met with little danger to the patient, and no inconvenience for the doctor. These conditions are accepted without a thought of the difficulties of the past, because there had been no contact with them. Despite the handicaps to rendering good medical service, the doctor of the preautomobile period probably reached his highest peak of popularity with his patients. He had proved that medicine was becoming more sound and dependable. He had also discarded some of the obsolete methods of the old doctor. He still could not do much with the epidemics, but he tried, with such facilities as he had, and his willingness and sense of responsibility gave him a place in public esteem he had never previously enjoyed. He must make up in personal interest what he lacked in technical knowledge. This would inspire hope and confidence, and these, perhaps, were the chief essentials to his success. He became the confidant of his families, and was consulted on many problems other than health, because of the respect he had inspired. He had pride in the service he was able to render. The great change in sentiment toward him had come through 50 years of progress in knowledge and techniques, but even more through his greater sense of responsibility, and a feeling that medicine was primarily an opportunity for service. It would be an enlightening experience for the young doctor of today, with his better training, if by some magic his environment could be shifted occasionally, for only a few hours, to that of the doctor of a few generations ago. He would carry on under the restrictions imposed at that time, and he could exercise his ingenuity in meeting problems unknown in his present practice. The difficulties encountered would give him a greater appreciation of his own infinitely better environment and equipment.