If you're old enough, you may remember that sometimes a doctor visited your house to treat a patient; sadly, that practice has long disappeared in many places. In early twentieth-century Grinnell, however, physicians often made house calls, even though they also worked from an office downtown. To keep tabs on patients, treatments, and bills, these doctors—without the staff of receptionists, schedulers, billing specialists, and attendant nurses now peopling doctors' offices—kept "visiting lists." Just as their name implies, these booklets identified the dates of a doctor's visit, the patient, the charge, and sometimes a brief indication of treatment.
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| An example of visiting list booklet provided free to physicians |
Some companies printed these booklets to sell to physicians, and others produced them with advertisements included, donating the booklets to doctors with the hope that they might influence the doctor's choice of medicine or therapeutic apparatus. Most of these "visiting lists" have disappeared, but the visiting lists of Dr. John Love from Whiting, Kansas survive, as do some 45 visiting lists of Dr. John Janvier Black in Delaware, and four volumes of visiting lists from Dr. J. H. Kelley of Parkersburg, West Virginia. No doubt there are others.
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| Title Page of Pearl Somers's 1927 Physician's Visiting List (Grinnell College Special Collections and Archives, US USIaGG, MS/MS 01.131; P. E. Somers Collection, 1914-1927) |
In Grinnell, however, despite the fact that most physicians in early Grinnell almost certainly kept visiting lists, local archives preserve the visiting lists of only one Grinnell doctor—Pearl E. Somers—and for only a few years of his long practice (1914, 1923, 1925, and 1927). These limitations guarantee that we cannot know how all Grinnell physicians operated; we cannot even be sure how typical these years were for Dr. Somers, whose practice began in 1898 and lasted until a few years before his 1952 death. Nevertheless, the surviving physician's visiting lists offer considerable insight into medical practice in early Grinnell, including Dr. Somers's 1920s commitment to radium therapy. Today's post examines Dr. Somers's visiting lists and what they tell us about illness and medicine in 1920s Grinnell.
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| Photograph (ca. 1894) of Pearl E. Somers (Grinnell College Special Collections and Archives,US-IaGG MS/MS 01.75, Dunham/Grinnell Photograph Collection, 1893-1894) |
Pearl Ellsworth Somers was born in 1870 in Green Mountain, Iowa and graduated from Marshalltown High School in 1889. After a year at the Academy at Iowa (Grinnell) College, he enrolled at Iowa College, from which, after an exceptionally successful athletic and academic experience, he graduated in 1894. Three years later he completed Rush Medical college, and in 1898 began medical practice in Grinnell. Member of several local clubs, Somers also served Grinnell College as trustee, was vice-president of the Iowa State Medical Society and headed the Poweshiek County medical society. He established his first office above the old Grinnell Savings Bank on 4th Avenue; later he shared offices in the Grinnell Block with Doctors E. F. Talbott (1873-1943), E. S.Evans (1880-1930), and J. W. Cogswell (1883-1950). In the 1920s he had an office at 825 4th Avenue above Candyland, sharing space with Dr. Edwin E. Harris (1867-1938).
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| 4th Avenue in Grinnell (ca. 1930), showing Candyland, above which Somers had his office (https://digital.grinnell.edu/islandora/object/grinnell%3A6216) |
As local advertising confirms, some doctors opened their offices for limited hours, devoting the majority of their working days to home visits and other obligations. Pearl Somers, for instance, who at various times contracted with Grinnell College to serve the student athletes as well as the college's students, advertised in the student newspaper that his office was open only in the afternoons. The rest of the day, Dr. Somers invested in visiting his patients.
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| Scarlet and Black, November 12, 1904 |
In early Grinnell, hospital visits were rare. Lucille "Sid" Potts (1910-2007), when interviewed for the "Voices of the Past" project in 1992, told her interviewer that
People didn't go to the hospital in those days. A lot of them had their babies at home, and people didn't go to the hospital...You didn't go to a doctor or to a hospital until practically you were ready to die....[Doctors] came to your home. You could call, and they would come to your home. My brother was born in our home on Broad Street.
Stub Preston (1903-1999) told interviewers that he had been "born at 823 East Street in Grinnell, May 30th, 1903. They tell me it was on the kitchen table...and my mother would be taken into a hot tub and then brought out on the kitchen table for the delivery...." John Parish (1904-1997), himself a doctor, recalled that when he began practice in Grinnell in 1933 "a large percentage [of deliveries] still took place in the home." Grinnell doctors also went calling on their patients for numerous illnesses and accidents. For instance, Laura Matlack Wieman (1913-1997) remembered her family's doctor having come to their Grinnell home to treat her visiting grandmother: "he treated her on the dining room table." When called down to Deep River or Brooklyn, Dr. O. F. Parish (1873-1947) would sometimes, as his son remembered,
pack up his portable operating table, put it in the trunk, and take a nurse along and packs of sterilized instruments and gauze and so forth and go down and operate in the home...he would occasionally do an operation in the country.
In 1901 Pearl Somers organized the first Grinnell hospital at 1127 Park Street, making provision for up to 8 patients as well as space for surgery. Unable to keep up with both the hospital and his practice, Somers soon closed the Park Street facility, so for a time Grinnell had no hospital at all. But in 1908 Dr. Somers helped organize the Grinnell Community Hospital at 1030 Elm Street, adjacent to Sixth Avenue. The building could boast only a half-dozen rooms whose names reflected local donors' generosity—Knights of Pythias; PEO; Elks; McMurray, Norris, etc. No more than twelve patients at a time could be accommodated there (Polk's Medical Register and Directory of North America [Detroit: R. L. Polk Co., 1910], p. 658). Consequently, until the two new hospitals in Grinnell—St. Francis Hospital and Grinnell Community Hospital—opened their doors in 1919, medicine in Grinnell required house calls, and they remained common in Grinnell until the 1950s or 1960s.
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| 1910 Photograph of Grinnell Community Hospital (https://digital.grinnell.edu/islandora/object/grinnell%3A14514) |
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| 1902 Oldsmobile Runabout (Oldsmobile_Curved_Dash_Runabout_1902.jpg) |
As more powerful automobiles appeared, especially once enclosed sedans came on the market, local doctors found more reliable vehicles in which to do their rounds. Dr. John Padgham was driving a Chalmers coupe roadster in 1916 (Grinnell Register, 20 July 1916); in 1912 Dr. E. F. Talbott drove a 16-horsepower Maxwell (ibid., March 29, 1912); and Dr. O. F. Parish, whose first automobile had been a modest runabout, by 1914 was driving a Studebaker (ibid., 27 April 1914). Automobiles considerably lessened the strain on doctors' house calls, especially when doctors had to visit country farms and travel on muddy or gravel roads.
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| Undated Photo of a Restored 1914 Studebaker Roadster (https://www.texomaclassics.com/1914-studebaker) |
Unfortunately, Somers did not note the time of each appointment, but it seems likely that he was called out at any time of day or night, especially when attending to the delivery of children. At the same time, many calls must have been routine, requiring relatively little time from the doctor, since Somers charged most patients just two or three dollars. These small bills could add up though, as Somers himself showed in his 1914 visit book, in which he kept a running total of his income. Over the course of 1914 he figured that he had billed patients for a total of $5833.50, about $160,000 in today's coin.
Overall, then, a physician in early Grinnell could expect to be busy most days of the week, day or night, except, perhaps, when on vacation. Somers's 1925 visitation list blocked out the six weeks between April 24 and June 11 for a "Florida trip." This, however, was the exception; Like other veteran Grinnell doctors of the time, P. E. Somers was busy with his practice almost every day of the year.
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All Grinnell doctors made house calls, but it appears that only one adopted radium therapy and "took it on the road" with him—P. E. Somers. When the then-new Grinnell Community Hospital acquired its first batch of radium in 1920, Somers and a colleague who soon left Grinnell (L. A. Hopkins) undertook the training necessary to dispense safely this new, powerful treatment.
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| Scarlet and Black, March 17, 1920 |
In March 1920 Somers left town for several weeks, training in Pittsburgh and New York (Marshalltown Evening Times-Republican, March 19, 1920). Exactly when Somers began to practice with radium is not known, but presumably he began to apply his newly-learned technique soon after returning from his training out East. In any case, by October 1923 radium therapy had found a warm reception in Grinnell, as the Grinnell Community Hospital bulletin of that date firmly embraced radium, calling it "the best single agent in the treatment of cancers and should be used in all inoperable cases and is the treatment of choice in cancers of the skin." It seems likely, therefore, that, shortly after his return from the East Coast, Somers began to apply radium in his medical practice, perhaps initially only in the hospital.
Somers's visitation books make clear that no later than 1923 he was taking radium with him on house calls. That year Somers recorded having used radium therapy (denoted by "Ra" in his visitation lists) 35 times—twelve times in October alone. His 1925 visitation list reports another 25 applications of radium before August, after which Somers seems to have abandoned radium therapy altogether: his 1927 visitation list does not mention radium therapy at all. It seems, therefore, that, although Somers originally adopted radium treatment with enthusiasm, by mid-1925 the gloss had worn off. That year for the first time an independent investigation had confirmed that the "Radium Girls," who painted watch and clock faces with a radium mixture, had been injured seriously (even fatally) by radium. Perhaps this news affected Somers's view of the one-time miracle therapy.
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Inasmuch as radium's radioactivity could be damaging to someone carrying it around all day every day, Somers had to have had a safe way of transporting the radium. His kit, whatever it was, does not survive, but it seems likely that he used a carrying case like the one advertised by the Radium Company of Colorado. The velvet-lined box provided a snug fit for a one-inch in diameter, nickel-plated, lead-lined container within which the physician might store the glass tube of radium solution, itself held in a silver container sheathed by a brass capsule (Technique of Radium Application, 2nd ed. [Denver: Radium Company of Colorado, 1921], p. 22).
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| Radium Carrying Case (Technique of Radium Application, 2nd ed. [Denver: Radium Company of Colorado, 1921], p. 22) |
According to the Radium Company of Colorado, radium bromide, radium chloride, radium carbonate, and radium sulphate all might serve the physician's needs, depending upon the intensity of radium thought desirable for treatment (Technique of Radium Application, p. 21). For various skin cancers and other cancers on the body's exterior, experts recommended applying the glass tube directly upon the cancerous tissue for a fixed period of time; to reduce the radiation's intensity, physicians might apply the silver tube within which the glass tube remained, thereby restraining somewhat the active radiation; still less intensive treatment might come by applying the glass tube surrounded by both the silver and brass capsules (ibid., p. 22).
Tumors within the body called for a different device by which the physician could place the radium adjacent to the cancerous tissue. For uterine cancers, for example, experts recommended a uterine sound with a brass container of radium at the end.
In this way the radium can be shifted along the uterine canal, beginning by inserting the radium well up into the fundus and radiating in that location for a period of twelve to eighteen hours...The whole applicator is covered with a rubber dam [to protect adjacent, non-cancerous tissue] (ibid., p. 25).
For vaginal cancers a different applicator was imagined: dental wax moulded around a lead plate permitted the practitioner to insert the glass tubes within the wax but adjusted so that "the tubes are in apposition with the seat of pathology" (ibid., p. 26). A surprising variety of instruments might serve to apply radium to the larynx, pharynx, tonsils, and esophagus; gold and steel-alloy needles also made it possible for physicians to reach tumors below the skin.
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| Suggested Applicator for Vaginal Cancers (Technique, p. 26). |
It seems unlikely that Somers carried all this equipment, and therefore unlikely that on his house calls he applied radium therapy to all cancers. Inasmuch as Somers did not note the diagnoses that prompted him to apply radium, we cannot be sure exactly how extensive his radium therapy was. Moreover, he may well have treated some patients at the hospital instead of at their homes, a fact we cannot confirm until the Grinnell community hospital register for the 1920s surfaces. However, Somers did identify the patients, some of whom endured radium therapy numerous times. He also indicated the charges, which proved to be variable, an indication, perhaps, of how intensive was the therapy.
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| A Page from February 1923 Visiting List of Dr. Pearl E. Somers (Grinnell College Special Collections and Archives, MS 01.131 P. E. Somers Collection 1914-1927) |
Mrs. Henry Booknau (Somers used this variant of his patient's name, which in other documents appears as Buchenau), for instance, received two radium treatments in February 1923 at her home at 834 Summer Street, and three more in March that year. Her name disappears from the visitation lists until May 1925 when Somers returned, beginning an intensive course of radium treatment. May 14, 15, and 16, 1925 he applied radium to Mrs. Buchenau, then again on the 20th, 24th, and 29th. Two last treatments occurred on June 3rd and 8th. Since Somers's 1924 visitation list does not survive, we cannot know how often she saw Somers that year, but from the books that remain we know that altogether Mrs. Buchenau had perhaps a dozen close encounters with radium.
To judge by the charges Somers made, Mrs. Buchenau received the maximum dosage: initially he charged her $35 for each application (the most he ever charged for radium) and $25 the other times. All this medical attention makes one wonder what was Mrs. Buchenau's affliction and how the radium affected her. Unfortunately, I could find nothing to identify her illness, but the radium treatments apparently did her little harm, as she died of a stroke only in January 1956 when she was eighty years old. Just 51 when she received her first radium treatment from Dr. Somers, Rose Buchenau lived thirty years thereafter, despite—or perhaps because of—her intensive experience with radium.
No other Somers patient received so much radium. Mrs. Warren Kroh (1030 Pearl Street) and Mrs. Otto Broders (Malcom) both received a half-dozen serious treatments: $25 for each application. Both lived some years after having received the radium, although not so long a life as Mrs. Buchenau enjoyed. Carrie Kroh (1873-1943) died in 1943 of an unspecified "lingering illness," but Catherine Broders (1873-1932) perished in 1932 from "carcinoma of the ovary and small intestine." It seems unlikely that Carrie Kroh, who lived twenty years after her encounter with radium, suffered deadly injury from the treatment. Even Catherine Broders's death, nine years after Somers applied radium to some part of her body, seems difficult to blame on radium therapy. Indeed, it may be that the cancer that killed her was the very reason that Somers treated her with radium, and might thereby have helped extend her life and delay cancer's victory.
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| 1930 Death Certificate for Joseph McConnell ("Iowa, County Death Records, 1880-1992," database, FamilySearch (https://www.familysearch.org/ark:/61903/1:1:XV3N-NFQ : 9 September 2021) |
Somers's visitation lists identify another sixteen patients whom he treated with radium. Joseph McConnell (1861-1930) had Dr. Somers bring the radium kit to his Brooklyn home a half-dozen times in April and May 1925. Each dose, billed at $25, was presumably maximum exposure, and may have been directed to carcinoma of the face, a condition noted on McConnell's death certificate as having been diagnosed in 1927. However, doctors attributed McConnell's death primarily to an "acute intestinal obstruction," a vague expression that might reference a tumor. When he died in April 1930, McConnell was still five years past his radium treatment documented in Somers's visitation lists.
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| Undated Photograph of Grinnell College President, J. H. T. Main (1859-1931) (Scarlet and Black, April 8, 1931 |
Similarly unaffected by the radium was Mrs. James Rule (1849-1932) who lived at 1410 4th Avenue. Dr. Somers applied radium treatment to her twice in April 1923; both applications were evidently less than maximum intensity, as Somers charged only $17.50 for each. In mid-October of that year Somers was back with his radium, this time charging $25 for what was evidently a maximum dosage. When Isabel Rule died in April 1932, nine years after her radium treatments, Dr. E. E. Harris, who signed her death certificate, gave as cause of death both "old age" (she was 82) and "cancer of the scalp." Certainly Somers could easily have attempted radium treatment for cancer of the scalp, but no extant record allows us to confirm this suspicion.
George Mason (1881-1967) also had three radium treatments in 1923, but he survived more than forty years afterward. His wife, Martha Ann Mason (1887-1939), submitted to an apparently mild ($15) radium treatment just once around the time her husband received his last dose. Dying in 1939, she did not live so long as George, but still lived sixteen years after having experience with radium.
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| Undated Photograph of Professor Roy H. Perring (1874-1943) (Scarlet & Black, October 15, 1943) |
At least five other Somers patients received two radium treatments. Roy H. Perring, for example, a Professor of German at Grinnell College who resided at 605 Tenth Avenue, received intense doses twice in May 1923. But when he died in 1943, twenty years after his encounter with radium, it was a heart attack, not cancer, that took him.
A few of Dr. Somers's patients died soon after treatment, but not necessarily from the illness for which Somers prescribed radium. John S. Miller (1857-1926), for instance, received two doses of radium in March 1925, and died at his West Street home in September 1926. But it was pneumonia that killed Miller, a disease for which radium was no help and an illness that cannot be blamed on radium. Many other Somers patients died long after their encounter with radium. Virgil Adams (d. 2006), for instance, who seems to have had a light dose of radium in July 1925, died more than eighty years later (Des Moines Register, November 12, 2006). William Dodge, who lived in the Brande Apartments in Grinnell, had Dr. Somers treat him in spring 1923, but he died an octogenarian in 1955, more than thirty years after Somers packed up his radium tube.
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The extant visitation lists of Dr. Pearl Somers, despite their limitations, describe the wide-ranging activity of a small-town doctor early in the twentieth century. It would be interesting to compile a list of all Somers's patients to see what part of the town the good doctor served. Even better would have been details about what illnesses or accidents convinced Grinnellians to summon the doctor; regrettably, Somers did not find it necessary to commit this information to his visitation lists. Consequently, we can only surmise that, as he jumped into his old Oldsmobile or whatever automobiles he later owned, he set out day or night, weekend or weekday to serve patients in the greater Grinnell area. We can only suppose that other Grinnell doctors of the time did the same.
What definitely distinguished Somers's practice from his medical colleagues, however, was his commitment to radium therapy. The lack of detail in the surviving records prevents us from establishing a clear picture of what illnesses Somers treated with radium and how broad a selection of applicators he used. All the same, the 1923 and 1925 visitation lists confirm that Somers embraced the new technology; not only did he agree to leave town to undertake the necessary training in Pittsburgh and New York, but we know from his visitation lists that he pursued radium therapy with some enthusiasm, at least until August 1925 when circumstances persuaded him to drop it abruptly.
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| The Cover of a Recent Study of Women Poisoned by Radium |
Studies like that done on the Radium Girls make clear that radium, irresponsibly handled, could be destructive. As follow-up of Pearl Somers's patients makes clear, however, the Grinnell doctor exercised admirable care with this powerful element. No doubt he was anxious to cure the cancers he treated, but he seems not to have allowed that high-minded motive to overwhelm good judgment, as the later lives of his patients demonstrate. Most lived many years (in some cases, decades) after their encounter with radium. And none seem to have suffered serious injury as a result of the radium Somers applied. It seems unlikely that the men and women who entrusted their health to Dr. Somers fully understood the potency or appreciated the danger that radium constituted. But they trusted their doctor who recommended the therapy and the results—whether or not the therapy cured the original problem—seem to have vindicated their confidence in the Grinnell physician who journeyed to their homes to treat their illness.
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