Dr. Jack Holmes
Perspective of Primary Care Practice
242 Baker Avenue
Age 67
Interviewed October 26, 1988
Concord Oral History Program
Renee Garrelick, Interviewer.
Initially the family practitioner was called a general
practitioner, and that included doing deliveries and maternity
care. Along the line this became obsolete in Concord because of
the advent of obstetricians coming into the community, so most
doctors in that type of practice now are called family
practitioners, meaning that they take care of all ages of patients
from newborn to old age but do not do deliveries. The
obstetricians are doing that at the present time. My practice
initially when I came to Concord in 1950 included deliveries and
assisting in operations, which I no longer do. I think it is
important that each family practitioner be associated so that he
has full coverage when he is not available, and this is what my
present status is - being covered by the Concord Hillside Medical
Associates.
When I first came here in 1950, I was associated with two doctors actually, one was Dr. Charles Duston, in Concord, and Dr. Rogers Lord, in Bedford; and I went from one office to the other. Two years after, John Bergen came to Bedford and associated himself with Dr. Lord, and I moved to Concord with Dr. Duston. That association lasted until 1967 when Dr. Duston retired from practice and moved out of the area. From that point on I have been a single practitioner having coverage with other physicians in the community.
I came to Concord from the west coast where group practice was common, and my association on the west coast was when I finished my internship and training. I was in the U.S. Army and was stationed at Ft. Lawton for about three to four weeks prior to going overseas, and at that time talking to the local doctors on the west coast particularly in the Seattle area, they were already in group practices at that time. I think that this also applied to California too, and it was obvious talking to them that when I eventually got out of the service, this was the way that I would like to practice. That is what I did when I came to Concord.
An individual practice with other doctors covering became the norm around here and is very common now. In fact, it might be a loose association, but the coverage is there; that is the people that are involved in each group will plan their vacation time and time off around those of others, so they have to comply with certain things.
When I arrived to set up a practice, I went around to the existing doctors and told them I was here. What happened was my wife had lived in the Concord-Lincoln area, and when I was looking for a site to practice I came out. She knew some of the doctors here, and I interviewed with them. There was some thought about going to Sudbury, although Sudbury had had a succession of seven doctors coming and going within about seven years. The problem at that time with Sudbury was that it was in the midst between Framingham, Waltham, and Concord, and a practice there would have meant being on the staffs of three different hospitals. There was no real center in Sudbury and the rotation of doctors indicated that none of them were satisfied there; and that is why I came to Concord and associated with Dr. Duston, in Concord, and Dr. Lord, in Bedford.
Some of the other doctors that I remember in Concord at the time were, in Concord itself, Dr. Reginald Johnston, Dr. Randolph Piper, Dr. Howard Robinson, Dr. Francis McDonald who was a pediatrician. One other physician who was here at that time was Dr. James Hitchcock who was a cardiologist, but his home was really in New Hampshire and he practiced part-time here. Another physician in Concord who was associated with Dr. Reginald Johnston was Dr. William Dahill who was one of the first anesthesiologists in Concord in addition to doing his family practice. Another physician that was helpful was Dr. Gordon Donaldson, a surgeon at the Mass. General, who lived in Lincoln and was always on call for surgical consultations including weekends, which was very helpful.
Some say that Dr. Johnston had the more affluent patients and Dr. Duston probably had those people who weren't quite as affluent, and besides the Concord people, a major part of the practice was in Maynard. At that time Maynard had three or four doctors, but two or three of them were not on the active staff at the Emerson Hospital, therefore they could not admit patients. So Dr. Duston and my practice together included many patients from Maynard.
Dr. Duston was very aggressive and thought that if something should be done, you should do it and not hesitate and beat around the bush with the patient. He was always cognizant of some people -- that was in the days before there was medicare and so-called welfare, and often times no bill was sent to the patient for that care, and also at the same time Pat Snow, who was administrator at Emerson Hospital, also would give free bed care to those patients who for instance had fractured hips that would have otherwise had to go to Boston for their care.
He was one of the first Catholic doctors in Concord. I think that it didn't mean that all of his patients were Catholic. They weren't, but I think that that was influential in building up his practice.
He was interested in the professional medical society. We had our district medical society included with Arlington and Cambridge, and he worked very diligently to establish a new district medical society based in the Concord, Acton, Maynard area, called the Middlesex Central District Medical Society, and he was very active in organizing that and became the first president of the local society.
A lot of his patients were from Maynard. The mills were still slightly active at that time when I first came here, and then they all closed; but various manufacturers, such as toy manufacturers took over some of the buildings, and so until the advent of Digital a lot of the patients in Maynard lost some of their jobs and they could not move South with the textile industry.
There was a large Finnish population and Polish. It was a mixture. There was a large Italian population in Maynard. Each ethnic group had its own club. There was the Italian-American Club, the Finnish-American Club, and those are still in existence. So the town really began to change in the 1970's I would say.
When I started to practice, it was still a time of house calls. The person who was sick at home was usually seen at home, and with two of us working at the same time one person could be at the office and the other one might be out on house calls. On one particular day we made twenty-two house calls. What happened after that time was that people migrating here from the middle west were astounded that this was still going on. They said that out there, if they were sick, the doctor said, "Okay, go to the hospital and I'll meet you there." I think now that is happening. The only people that I see at home are those elderly people that can't really get out and those who are disabled, and I have probably about five patients that are seen on a rotating basis at home.
I served other towns on these house calls initially besides Concord. We went to Acton, Maynard, Littleton, and then I was in Bedford with Dr. Lord, Billerica, and so it was spread over a wide area.
In 1958 the standard office visit was $2.00 and a housecall was $3.00, and our obstetrical fee at that time was $50, that included all the pre-natal care and the post-natal care and the delivery.
Dr. Duston was the one who started the Concord Professional Center. That was the medical building. It is now the professional center. It was called Concord Medical Center at that time, and he and Casper Jenney, who was a builder in town, were the two principles in building the building, and that attracted doctors of other specialties to move to the area. Before that time, all the doctors' offices were in their houses, and that opened up a place where we could attract opthamologists or cardiac people and other specialists, even if they were here only part-time.
Before professional buildings, a doctor would try to live on a main street. I know that Dr. Johnston's office was actually on Main Street, Dr. Duston was on Main Street, Drs. Piper and Robinson were on Sudbury Road next to each other. Dr. Leroy Houck had his office in his house on Lowell Road right near the Colonial Inn.
When I came during the 1950's I saw a much more smaller town than today, and the hospital at that time consisted of what is called the old cottage front of the hospital -- it is now not in existence. The operating room was right in front of the hospital, and the delivery rooms were upstairs just above that area, and gradually the hospital expanded. The first real large expansion was 1962-63. I was aware of that because I was president of the staff at that time. That was when the Wheeler wings were built, and just prior to that time they built the operating room, a taller building to the left of the hospital, it was upstairs, and the emergency room also moved up there at that time.
The big breakthrough in medicine during the 1950's was the Salk vaccine. That was in 1954 or '55. Salk vaccine preceded the Sabin vaccine. The Sabin vaccine was an oral administered vaccine. It lasted for life. Salk vaccine shots had to be given on a yearly basis, and there have been some problems with that in other parts of the world in which the Salk vaccine has been the only thing being used -- there have been outbreaks of polio within the past two years. So the oral vaccine is the thing that is used at the present time.
I was on the Board of Health and chairman of the Board of Health for two years, and that was at the time when the Salk vaccine came out and we made arrangement to have clinics give the shots. If someone wanted to have the shot in their house, we would give a supply to the doctors to give in their office.
There was a fear of polio. Well, every year certainly during August, every stiff neck or every sore back and everything else had to be evaluated. Polio was the main disease problem. Once the polio vaccine came along, we just didn't see that anymore. I think in most of the countries that have used the vaccine, they just don't have polio anymore, and especially with the Sabin vaccine. In Finland they did have an outbreak I think of 450 cases about two years ago.
Christian Scientists who seem to resist medicine have been somewhat of a problem, not so much around here probably, but in California it has come up numerous times, just recently again, in which they resisted all medical treatments and sometimes it involves children who are minors. The state of California, I believe, has taken the stand that this is essential to the health and they can now put a judgment down that the child has to have this done. So I haven't heard too much about this around the Concord area recently.
Certainly the introduction of antibiotics has been a dramatic change. The major cause of disability and death was infectious disease. When anyone got pneumonia, and someone said, "You have passed the crisis" -- you lived or died. With the advent of antibiotics, the first thing was sulfonamides which came along in 1938-39, and then penicillin followed that just from the advent of World War II, and then there has been a whole rash of various antibiotics that have made a big difference in the survival of patients. Rarely, you can't say never, do you get someone dying from pneumonia, but it is fairly rare right now to have someone get pneumonia and not be able to be cleared of that.
Also, coronary disease has had a lot of progress, by-pass operations, the balloon operations, diet, medication, a whole group of medications now that weren't available even let's say ten years ago.
With all the specialists now, the patient has to make so many choices and sometimes it is difficult for the patient that has just had a backache for instance -- should they go to an orthopedic surgeon, should they go to a neurologist, or a neurosurgeon? In the HMO's that are available there is one doctor, they call him the gatekeeper, and that patient can't go on their own to someone without seeing him, so that the doctor is in charge of saying, "Yes, you need to see the back doctor or somebody else." So that has helped out in that I think.
What's happening is that the schools that were giving RN's now are all degree schools. It used to be if you went to the Mass. General or Newton-Wellesley in three years you were an RN, but those are going out of existence now. Most of them you have to have a degree. That again takes the nurse away from the bedside and she is sitting at a desk doing a lot of paperwork. The licensed practical nurses, we used to have a lot of them. You read in the papers today there is a great shortage of nurses everyplace, at least in Massachusetts anyway, and in the Boston area particularly. So with transportation being what it is, you are also competing with adjacent hospitals for your personnel.
Today with the AIDS problem, there is an incubation period for AIDS in which the person might have it but it just doesn't test, so you have to address the person and say is the person's lifestyle subjected to AIDS, and that has to be done in the blood donor centers in some manner, but you are apt to get a false negative test and this person doesn't have the disease but is carrying the virus, so those are hard to track down. Usually what they have done, if someone gets AIDS and it is from a transfusion, they try to backtrack and find out where the blood came from.
People are more likely to want to give their own blood now. This has been done in the past, not as much as it is done now, where a person can go in three weeks in advance and give a unit of blood each week for three weeks. There are a lot of operations where you would like to have a couple of standby units of blood. I think now that more and more people are doing that on major surgery things giving their own blood, or they could possibly have some member of the family having the same type.
When I first came to Emerson Hospital, there were as I recall looking back thirteen doctors, that included Maynard, Acton, Bedford, Concord, Littleton might have had one doctor. There are about one hundred fifty-four I believe now. That was the last count that I was aware of.
Originally the emergency room had no emergency room doctor working there. There was a nurse, and each doctor covered the emergency room for a two week period. That is, he was supposed to be available for that two week period or someone he would designate, and at that point in time the emergency room was nowhere as busy as it is now, so it was able to be handled; and then as the staff grew, they decided to make it one week, and then it got down to one day, one 24-hour period. When we did the 24-hour coverage, the doctor had to stay in the hospital that 24 hours, he couldn't go home or be in his office. He knew that he was going to be there, so he slept there that night in a room downstairs. Eventually there was the advent of getting a full staff of emergency room doctors who were rotating through, and that is the way it is right now. The doctors on the staff are still responsible for coverage in that, if someone comes in with a heart attack they call Dr. X and he has to respond to that; or a fracture, the orthopedic doctor, or a surgical thing. At least the emergency room doctor can get things started now. That is much better than it was in the past.
Another thing that shows changes as well, when I first arrived here and went to purchase land on Lowell Road, I was able to get between eight and ten acres for $6500 and went through the land court for $1000, and I don't know what that is worth now -- I hate to think about it. That was about 1955-56.
Things have certainly changed. Acton was very small. I think the population was around 3000 at that time. Bedford was small. They both were. The number of communities that were part of Emerson Hospital were a smaller number than now. It covered Acton, Maynard, Carlisle, Concord, Bedford. In Lexington people tend to go to Symmes Hospital. We had doctors from Lexington on our staff, but there were two or three that would have liked to come here all the time rather than splitting between two hospitals, but they never voted for that. Also, if a town then became part of Emerson Hospital, that town was obligated to raise funds in their community chest. Things go to that hospital.