SURGEONS RECALL: ONCE IT COST $35 TO DELIVER A BABY

Surgery today is dramatically different than it was only a few decades ago.

It's a change that's been witnessed all across the nation, including Cape Girardeau. Today, surgical procedures seem light years ahead of where they were only a half-century ago.

Two retired Cape Girardeau physicians and a longtime local surgeon, who is still practicing, say they have witnessed remarkable changes in the medical profession.

"There's been more progress in medicine, I believe, in my lifetime than in all the centuries leading up to it," said Dr. Raymond A. Ritter Sr, who is retired. "In my lifetime, they are doing surgeries you would not have thought of," he said.

Such sentiments are shared by fellow retired surgeon, Dr. Edward D. Campbell, and veteran surgeon, Dr. Charles P. McGinty, who still practices.

Over the last four decades, medical technology has changed dramatically, said McGinty, who began practicing medicine in Cape Girardeau in 1955. Fiber optics and video technology have entered the operating room, he said.

"The most recent thing is video-assisted surgery," said McGinty, explaining that it allows a doctor to view the operation via a television monitor. "He does it like a Nintendo game."

McGinty remembers making house calls, something virtually unheard of today. "We did make house calls in the 1950s for emergencies in the home."

When McGinty began practicing medicine, every surgeon had to purchase his own operating instruments. Now, hospitals routinely provide the necessary surgical tools.

But while McGinty has seen a lot of changes, the 88-year-old Ritter has seen even more dramatic changes.

Ritter practiced medicine for almost 60 years. He retired about six years ago, although the last five years of his practice were spent doing quality-control inspections of hospitals for the federal government.

Ritter started practicing medicine in Cape Girardeau in 1933.

"We knew anatomy, but we didn't have the means of dealing with some of the things that were wrong with it," he recalled.

"In the '30s, we did not have any antibiotics," said Ritter. Now, antibiotics are "almost as common as aspirin."

There also was no air conditioning. Ritter said he and other surgeons had to operate on critically ill patients in hospital rooms that were extremely hot in the summertime.

Fans couldn't be used because they would stir up the air, which could lead to infections, he explained. "You would try to work early in the morning before daybreak, when there was an element of coolness about," remembered Ritter.

When Ritter became a doctor, there were few specialists. Doctors did all kinds of surgery.

There were no vaccines at the time. "During those days, we had a hospital in St. Louis set aside just for contagious diseases," said Ritter. People regularly died of pneumonia and polio.

"We had very poor anesthesia in those days," said Ritter. Today, there are highly skilled anesthesiologists who have special machines to monitor all of the patient's vital signs.

Years ago, anesthesia consisted of dripping ether out of a metal can.

"In my early days it was not unusual to have an exploratory surgery," said Ritter. Now there are technologies such as MRIs (Magnetic Resonance Imaging) and CAT scans that make it unnecessary to do surgery just to find out what's wrong with a patient.

Back when Ritter was a young doctor, penicillin was a new drug. "I gave the first dose of penicillin in Cape Girardeau," he recalled.

Ritter said he obtained a supply of the drug from an out-of-town doctor and used it on a patient who had a ruptured appendix.

The exciting part of practicing medicine, Ritter said, is watching the advancements in the field.

"There is so much being done today that we just take for granted, that wasn't being done anywhere in those days," he said. Heart surgery, for example, was not even contemplated years ago, said Ritter.

Just 60 years ago, it wasn't uncommon for women to die in childbirth; today that's a rare occurrence.

When Ritter began practicing medicine, bone surgery was a dangerous procedure. Such surgery often led to bone infections. Now there's equipment to sterilize even the air in the operating room, which lessens the chance for such infections, he said.

Elderly patients who underwent surgery for fractured hips, for example, were generally kept in bed for two or three months. Many of them died from blood clots, he explained.

Ritter said that in his early years as a surgeon he sawed through bones by hand "like you would saw a piece of wood." Today, such surgical saws are motor-driven, precision instruments.

Ritter said he believes more charity was done by doctors years ago. "I never turned down anybody whether they had money or didn't have money."

The threat of malpractice suits today has driven up the cost of medicine, Ritter said. Malpractice insurance is now one of a doctor's single biggest expenses, he pointed out.

Malpractice insurance was a very minor cost when Campbell was a young doctor. The retired surgeon practiced medicine in Cape Girardeau for 40 years before retiring in 1986.

A 1941 graduate of the St. Louis University Medical School, Campbell came to Cape Girardeau in 1946 after serving in the Army during World War II. At that time there were approximately 25 doctors here, Campbell said.

In those days, he said, doctors were essentially general practitioners family doctors who handled everything, including delivering babies.

"I delivered a lot of babies," said Campbell, who did a lot of routine, general surgery. In later years he limited his practice to diseases of the colon and rectum.

Because of the lack of air conditioning, surgeries were scheduled for early in the morning at the two Cape Girardeau hospitals. "You just sort of sweated it out. You had a nurse whose job was to wipe the sweat off you and keep your brow dry," he recalled.

Surgery used to be primarily acute surgery. "It was not elective surgery like now."

Campbell remembered, "There was no anesthesiologist in town when I came here."

In those days, patients were kept in the hospital longer after surgery than they generally are now.

His wife suffered appendicitis and was operated on in 1937 while Campbell was in medical school in St. Louis. She was in the hospital for 10 days, he recalled. The hospital bill totaled $25.

Hospital charges have climbed dramatically over the years.

Campbell said that when he went into practice, the doctor's bill was about $100 for an appendectomy, and $250 to $300 for a gallbladder operation. The charge for delivering a baby was $35.

Today, the doctor's bill for an appendectomy alone is around $1,000, Campbell said.

"The price of everything has gone up," he said.

When Campbell began practicing medicine, malpractice insurance cost him about $100 a year. By the time he retired, he was paying $8,000 to $9,000 a year in malpractice insurance, he said.

Doctors used to regularly make house calls. A visit to the doctor's office would cost about $3, a house call $5.

Doctors regularly had office hours in the evening as well as during the day. "When I started I had office hours every night starting about 7:30 p.m."

Most doctors had solo practices; today, most are in group practices.

With solo practices doctors had little time off. They were constantly on call. "You had a telephone in every room (of your home)," said Campbell.

Campbell said the biggest change he has seen in medicine is in dealing with coronary heart disease.

"When I came to Cape Girardeau, that was strictly a bed-rest procedure." Now, heart surgery is commonplace. "That is probably saving more lives than anything else in medicine," he said.

Campbell was raised in the practice of medicine; both his father and grandfather were doctors. He grew up in central Illinois, where his father was a country doctor, traveling by horse-and-buggy to visit patients.

Campbell may be retired, but his heart remains with the profession he loves and the patients.

"I miss the patients and I still have many, many friends who were former patients of mine," he said.

Years ago doctors had time to converse with patients to be their friends, Campbell said. Today, with medical technology, doctors can do more for their patients, but they don't have time to sit down and talk with them, he said.