Today, Aug. 25, 2014¹, my father
Would have been 100.
But he missed it by 18 years.
I’m the only one left who would possibly remember this.
I just found a cassette in my glove compartment that could inspire a TV episode in the medical drama “House.”
I share this in his memory.
Before it fades more use the DOOR…
My father, John A Knapp, Sr., was a medical doctor, who trained under Dr. George H. Whipple, winner of the Nobel Prize in Medicine in 1934, at the University of Rochester School of Medicine in Rochester, New York, in the late 1930s. Whipple was known for personally emphasizing the importance of making a thorough diagnosis, including collecting a good history of every patient. Immediately upon my father’s receiving his MD and completing some interning, he joined the Army and served as a doctor in a V. A. hospital in Johnson City, Tennessee. At the end of WWII, we moved 7 miles to Elizabethton, Tennessee, where he set up a private general medical practice in the southern mountain area he’d come to love. He made house calls and, among other things, delivered babies at $25 apiece.
The account that follows is an unusual medical experience that he told me about 6 months before he died. I gave copies of this tape, that also contained other stories, to all who attended his funeral. (And yes, my car can handle cassettes, but nothing better–no CDs or anything else.) What follows comes from rediscovering, replaying and–this time–carefully listening to that tape.
Now the story.
Typhoid had pretty much run its course in America by 1950. My father said he’d never even seen a case of it in medical school. Still, water supplies were carefully tested most places, and in Southern communities–generally with good heath departments, he insists–signs were posted at their outskirts whether or not their water supplies had been tested for typhoid and other diseases. Typhoid fever was almost something for the history books. Then, once on a house call in the country, my father encountered a very sick 16-year-old girl. Something was going around and she had a high fever, but examining her more closely, he discovered her pulse was quite slow, not what one expects with a fever. Something else was going on. Then he recalled something he’d only seen in a medical text. Typhoid fever had the unusual characteristic of being accompanied by a lower pulse rate. Nobody knew why, but it did. He immediately administered a broadcast² (his term) antibiotic. Then he took a sterile collection tube from his bag (doctors carried such things then) and collected a sample of her blood to take back to the health department for testing.
It was positive for typhoid.
But where did it come from? This could set off a regional panic. Immediately, the health department took water samples from nearby wells and other water supplies, as well as samples from food supplies and examined them. But they found nothing. Everything came up negative. What to do next? Was it something besides typhoid?
After one, two, or three days (I’m not sure from the tape), my father in the night had a dream. In it a young girl that resembled his patient with typhoid was helping take care of an older woman. My father suddenly awoke at 5AM. He immediately picked a phone, though settling down he waited for a more decent hour. Something else from his earlier studies came racing back: People could be typhoid carriers even for 50 or 60 years without getting the disease themselves.
When the sun rose, he finally made his call. Had the girl had close contact with an older women, he asked? Yes, she had, he was told; in fact, for several days she’d lovingly cared for her sick grandmother who lived nearby. When my father found out who this was, he was jolted to discover it was a patient he himself had treated in the grandmother’s home two weeks earlier! Actually, she’d had a bad gall bladder removed in another city and had come back home. The surgeon had asked my father to do follow-up on her which involved keeping watch over drainage tubes from her surgery. And the 16-year-old had looked after her.
Next, when Dad asked if the woman had ever had typhoid, she said yes, she had, 50 years ago. So, even though she’d recovered from the disease a half century earlier, she had remained a secret, and otherwise healthy, carrier for all those years. And where in carrier’ body does this germ locate? The gall bladder, of course! And when the woman’s gall bladder tissue was tested, sure enough, it was positive for typhoid.
So the girl and her grandmother, in time recovered; the health department was able to relax, and the neighborhood was overjoyed. “Always when making a diagnosis, do a complete history with the patient.”
(Another story of my father’s involved squirrel hunting, and his recommending to his friends wearing gloves when cleaning fresh kill. For that he was smiled at and teased. Then two hunters suddenly got sick, and one returned to a university hospital in Nashville and died, while the other was treated by my country doctor dad for tularemia³ and lived…But I’ll spare you the detail….)
My dad became a hero.
And as I type on third floor of my tower office on what would have been his 100th birthday, this is simply to honor his memory. Thanks, friends, for the extra seconds.
¹ Actually, this was not finished until August 27 before dumping it in my electronic scheduling stack. My poetic license obviously has not expired.
² Aha! here’s another uncommon usage of the word “broadcast” that we earlier explored. In the the search box at the upper left type in “broadcasting” (with the “ing,”) and our whiz-bang search engine should take you right to it.
³ Tularemia is commonly associated with rabbits, but yes, it affects squirrels and other animals as well (and my dad knew that).