Dr. J. Wilson Poucher: Medical Pioneer

The memoirs of Poughkeepsie physician John Wilson Poucher (18591948) capture the dramatic changes that swept American medicine at the turn of the 20th century. The excerpts reprinted here from Dr. Poucher's Reminiscences Personal and Professional (1859-1938) reveal a young surgeon of unusual skill boldly practicing modern techniques in what was literally still a "horse and buggy" era. Dr. Poucher's narrative is imbued with a sense of amazement at the transformation of American medical care during his lifetime.

Dr. Poucher grew up in the Berkshire hills where he recalled learning early on to "revel John Wilson Poucher, M.D. in the growth of mountain laurel, arbutus and pinxster blossoms" His childhood on the family farm instilled in him a passion for the outdoors, most especially for wildflowers—a subject about which Dr. Poucher wrote and lectured frequently, though lamenting his failure to write "with the pen of a Burroughs or a Thoreau." His other significant interest was the study of local history where he excelled both alone and in partnerships with others to create an impressive legacy of scholarship still in use today. Particularly notable was his work transcribing over 40,000 gravestones in Dutchess and Ulster counties—many on the verge of becoming illegible. His medical career in Dutchess County began in 1887 and continued until his retirement in the mid-1930s.

J. Wilson Poucher: "I had always been a country boy and the country had a permanent hold on me that I could not shake off. Poughkeepsie, in 1887, was both city and country and now, after more than half a century, I have never a minute's regret that I made that decision [to practice medicine in Poughkeepsie]. After making a short survey of the city, I found a two-room office at 18 Garden Street. The front room, as a waiting room, for patients—if any came, and a rather nice rear room for a consultation and living room. Here I installed my few belongings, a book case, a desk

and a folding couch, which I used for a bed by night and a lounge by day. Here I remained just one year. I bought a fine little horse and a buggy. Of course, I didn't have a lot to do at first but soon patients began to come... I found a very good place, just next door to get my meals; dear old Mrs. Fraleigh was my close friend for many years, until her death. She kept a boarding house for Eastman College students and had a house full. I believe they were my first Poughkeepsie patients...

Vassar Brothers Hospital, a fine new institution, had just been opened and a full visiting staff appointed but very soon several of the older staff members began to ask me to take care of their service cases. It was not long before I was doing more in the hospital than any of the staff members. Modern surgical work was just beginning and quite soon I was doing practically all, especially abdominal work, which was new to the local profession.

One case occurred in Dr. Campbell's service which he turned over to me—a fractured skull, where a portion of the skull was entirely broken loose and where a part of the brain was running down over the patient's face. When this man entirely recovered, my reputation was begun. Everything was not so smooth, however, as it might have been. Some of the older surgeons openly opposed any operations for appendicitis and I was obliged to work against their advice in many of my cases. I had

Early photo of Vassar Brothers Hospital founded in 1887. Dutchess County Historical Society Collection.

early recognized the fact that these cases should be operated before the patient became toxic. The cause of mortality, in so many of these operations, was not the operation but the blood poison which had been allowed to progress too far before operation. Several appendix cases sent to the hospital for operation were told, when they entered that they would surely die if operated and I can remember at least three patients who refused operation when I was ready to operate. Every one of them died in a day or two. They might have been saved by early operation.

I remember my first interval operation. That means an operation between attacks. This was a child who had a series of three or four attacks of appendicitis at short intervals. I had advised the parents the safest time was when the boy was well. It happened that his mother took him on a visit to Denver and while there he had a severe attack and again she

1913 Operating Room, Vassar Brothers Hospital. Vassar Brothhad to stop over in ers Medical Center Archive. Minneapolis while he recovered from another. The doctor there advised her as I had, to have the appendix removed as soon as she arrived home. When she returned, I was summoned and took him to the hospital next day. As I always tried to show my friend, Dr. , Superintendent and Chief of Staff, all the courtesy possible, I invited him to assist me. Of course, the operation was short and simple. The little fellow was sent to bed in fine condition, minus his appendix. The doctor had said nothing during the operation but, while we were washing up, he turned to me with the remark, `If that child dies, this is murder.' Such were some of the difficulties that we had to overcome in those early days of surgery or, I should say, modern surgery....

During those early years in Poughkeepsie, my experience increased in every branch of surgery. I was obliged to do every kind of operation.

I did cataract operations and all sorts of eye, ear, nose, and throat surgery as there was no one else to do them. One day, during an epidemic of diphtheria, I found a little patient suffocating and did a successful tracheotomy and from that time on, did many. I remember going early one morning to Rhinebeck to settle a dispute between two of my doctor friends in the diagnosis of a case of suspected diphtheria. When we three arrived at the little patient's home, we found a little two year old girl, black in the face, unable to breathe. I had no instruments but, with a sharp pocket knife of Dr. Van Etten's, opened the child's trachea through which she could breathe, until one of the doctor's boys rushed to the Rhinebeck Hospital for a tracheotomy tube. We left the little patient comfortable and she made a nice recovery. I was calling on a patient in Poughkeepsie, one day many years afterward, when a young lady entered the room, `Florence, I want you to meet Doctor Poucher; my daughter-in-law, doctor.' `The doctor ought to know me. I have his mark on my neck,' as she pulled down her collar, displaying the scar on her throat....

What a difference there is in the practice of medicine between those horse and buggy days when I began in Poughkeepsie and what it is at the present time! Only a few blocks of Main and Market Streets were paved at all, and those with cobblestones. Many of the streets were almost impassable, especially in Spring, even with a horse and buggy. I can remember, one evening, coming down Smith Street, only a block from Main, getting into a sink hole, when both my horse and buggy had to be pulled out by a team of horses. As my practice was largely consulting and extended practically all over Dutchess and Ulster Counties, it is not difficult to imagine what times I used to have getting through the country roads. I remember, one day, when I had to go to New Paltz, Staatsburg and Millbrook, besides my city calls, and then in the evening when I and my two horses were practically used up from wallowing through the muddy country roads, we were obliged to start, in a hurry, to relieve an old gentlemen of a strangulated hernia from which he had been suffering for several days. The trip took me back to Stanfordville and used up most of my night.

I well remember a little child that was very ill, in one of my very best families, at Hyde Park. It being early Spring, the road to Hyde Park was practically impassable and my friends, the parents, insisted on my seeing the patient twice a day. After a day or two, I adopted the plan of going up there in the evening, after my day's work was done, having

my horse taken care of, remaining over night and coming home in the morning,—a plan that was very satisfactory all around.

Probably one of my experiences, most indelibly impressed on my memory, was that of the great blizzard of 1888. I went around the city all the morning with horse and buggy but, as there was quite a snow fall during the forenoon, I went out for my afternoon calls with horse and sleigh. Quite late that afternoon, I found myself about three miles from home where I had gone to visit an old lady, very sick with pneumonia. Although the snow had been coming down very fast all afternoon, I had not given it a thought but when I started for home the wind had come up and the snow, in many places, was up to the shoulders of my little horse. If she hadn't been the snappiest little beast ever in a harness, we would surely have been snowed under, on the road. The only way she could get through the deep snow was to hop along, rabbit-fashion. But we made it and we arrived at her stables much to everybody's surprise. Let me tell you, she got a good rubbing down and a rest in a box stall for the next several days. She had proved that she had been properly named. Her name was Fury.

One of the hardships in those early days of my practice in Poughkeepsie, came from a habit which many patients had of waiting until night to send for the doctor. If a child, or any member of the family, was sick, the idea seemed to be, `If she isn't any better by tonight, she must have the doctor.' It took a long time and drastic measures to break up this habit. One measure was to charge a double fee for night calls. The fees, when I came to Poughkeepsie, were one dollar for house calls and half a dollar for office calls, the doctor furnishing medicines. I well remember, one evening, a man calling on me and when, after examining him, found I did not have just the medicine I wanted for him, gave him a prescription. `What does that cost me?' he asked. When I told him the usual fee of half a dollar, `What! Fifty cents for that piece of paper? I guess not.' He then threw it down on my desk and went out in a huff. Prescription writing, I soon found out, was not at all common among the older doctors. During my four years of association with Doctor Robert K. Tuthill who was one of, if not the leading physician in the city, I don't remember his ever writing a prescription for a patient.

The horse and buggy days are long since gone. Automobiles have taken their place. I loved my horses and missed them for a long time.. .With our concrete and macadam roads of today, we can hardly realize that not

much more than thirty years ago our Post Road and even eastern Main Street were, about half the year, just mire holes.

As I had taken a special training course in obstetrics and had attended over one hundred cases in the outside service of the Berlin Women's Hospital, I came to Poughkeepsie thoroughly equipped for that work and believe I have had my share of it as my record book shows over twenty-two hundred deliveries. Of;these, one hundred and five were Caesarians.

One morning, during my first year in Poughkeepsie, when I had delivered a young woman of her first baby, I remarked, `There! You got rid of that big tumor pretty easily.' The lady who lived in the flat below and who had been lending a helping hand, remarked, `Wish I could get rid Vassar Brothers Hospital Nursery, 1941. V issar Brothers of my tumor so easily.' Medical Center Archive. She then told me that she had been told by two prominent physicians that she had a rapidly growing abdominal tumor and must have an operation. As she was a woman nearing forty, the tumor age, I thought it very likely they were right. When I saw her again next day, she said she had heard that I knew a lot about such things and would I examine her and advise her what to do about it. We went down to her rooms. When I had finished my examination, she wanted to know what I thought about her case. I smiled and answered, `Just wait a few months and you will get rid of your tumor just as easily as Mrs. W. did hers.' As she had a family of four children, all nearly grown up, she could hardly believe it. But she did and I delivered her not only that time but twice afterward.

Just one more obstetric tale. One evening, after a strenuous day, three obstetric patients were on the wire, almost at once. All three were special friends and I must try to take care of them myself. One was a young

woman whom I had helped into the world about twenty years before and who had come all the way from her married home in Ohio to be attended by me and have her mother's care. The other two were old patients whom I had attended several times before. One of the patients was a farmer's wife about three miles from town. I went, two or three times, from one to the other of the city patients, finally delivered one and then dashed out to see my country case. When I entered the house, I was saluted, `Hurry doctor! I have waited hours for you but can't wait another minute.' She didn't. I had arrived just at the right moment. When I got back to my third patient, I had very nearly the same experience.

In my early days in Poughkeepsie there were no specialists in the sense that we look upon them at the present day. There was an eye specialist but he did only refraction work, fitted glasses and so forth. One day, when a lady patient from out of town called on me with cataract of both eyes, which were on long standing—a proper case for operation, I sent her to Vassar Hospital and then called Dr. K., who was on the hospital staff as eye specialist and told him about the patient. His answer was, `They have no facilities at Vassar for such operations. Send her to New York.' As I had all the facilities required and although I had never done a cataract operation, I decided to operate myself, which I did, assisted by Dr. Bayley and with a very satisfactory result. From that time I did several eye operations that came to me but after Dr. William G. Dobson became established here, turned all eye work over to him.

.But what changes have taken place since those early days of my practice of medicine and surgery, when I used to do most of my operating in the homes of the patients—when all the babies were born in their mothers' homes. Hospitals were only thought of as places for emergency cases, accidents or for people who had no homes where they could be cared for. The training of a medical student was two or three short terms in a medical college and a three years registration with a licensed physician brought him a diploma. It is only comparatively a few years ago that a law requiring a higher general education for students of medicine was adopted.

Training schools for nurses had hardly been thought of. For many years of my early practice, we hadn't a single trained nurse in Poughkeepse and several times I can remember when it took two or three days to get one from New York. How the idea had grown! In 1887, when Vassar Brothers Hospital was opened, it had not one single room for private pa-

tients and no place for obstetric patients. Look at the change in just one generation. Practically all surgical work is done in our hospitals. Every hospital of any pretension has its training school for nurses. The profession of medicine and surgery is divided into many specialties.

...I well remember my first Caesarian operation. Driving around town, one day, visiting patients, I met one of my doctor-friends, Dr. John S. Wilson. `Looking for you.' I went with him to see a patient who then had been sixty hours in severe labor, trying to give birth to a child. There were two other doctors already there when we reached the house. I very soon found an obstructed, deformed pelvis and no chance for either mother or child except by a Caesarian operation. We took her to my private hospital and in a few minutes (Dr. Wilson says nineteen minutes), delivered a fine baby boy. Both mother and babe did finely. That was my first,—the first ever done in this vicinity, the first of my series of one hundred and five.

How I did wish, that day, that I had time to go to my library and just have five minutes to look up the technique of that operation. I had never seen the operation performed and had to follow my own ideas of just where and how to operate and how to close the wound, afterward. That evening, when I found time, I looked over several authors and found that I had an altogether different technique, both in my incision and my suture material. I, however, liked my own plan so well that I always followed it in all my operations. Two or three years later, I was asked to read a paper, on my Caesarians, at the District Branch Medical Society held at Yonkers, where I reported eleven operations, done up to that time, and told my experience and results from having done a somewhat dif- John Wilson Poucher, M.D. ferent operation. When I had finished, I expected a lot of criticism. Who should stand up but my friend, Doctor Asa B. Davis, Chief in the New York Woman's Hospital, whose only complaint was that I had adopted the `high' incision about three

months ahead of him, so I had done, what he was calling his operation, before he had, himself.

It was not long before, through the few friends I had known when I came to the city, I could count among my friends and acquaintances many of the finest people and could spend all the time I could spare from my professional duties, enjoying myself with the young people. I was invited to join their assemblies, parties and clubs. As I had spent two winters in Germany, where skating is a favorite outdoor pastime and exercise, I especially enjoyed the skating parties in winter and tennis in summer.

One afternoon, while playing tennis on a private lawn with one of the young ladies, we were driven to a shelter on the house porch by a severe thunder storm. During our conversation, the lady remarked that we should have a tennis club like other towns in our vicinity. We finally agreed to call a meeting and broach the subject. A list of desirable people was invited to meet and the Poughkeepsie Tennis Club was the result. That was fifty years ago and this club has prospered. At the present time

Poughkeepsie Tennis Club courts, Northeast corner of Market and Montgomery Streets in Poughkeepsie (circa 1892). Dutchess County Historical Society Collection.

it is a popular resort for all our young people. .[By 1914] I had been spending my vacations, for the past year or two, in a work that greatly interested me—copying old tombstone inscriptions throughout Dutchess County...

This work ofpreserving old tombstone inscriptions began in 1911 when, one Sunday afternoon, Miss Helen W. Reynolds, in one of our historical talks, mentioned the old family burying ground of the Livingston family, in the Livingston Woods, and what a pity it was that the stones were being scattered and destroyed. We finally got into my buggy, drove down and copied the inscriptions. Then we decided to copy all the old grave yards in the City and Town of Poughkeepsie and later the rest of Dutchess County Livingston Collection. Woods (1886). Dutchess County Historical Society (Once part of the Livingston estate of "Linlithgow" was added to our (south of Shipyard Point in Poughkeepsie), Livingston Woods task. The result was a large book of over was that part of the Livingston estate cut off from the Hudson River by railroad tracks. It contained the ruins of the Livingston family burial grounds which inspired Dr. Poucher and historian 19,000 tombstone in- Helen Wilkinson Reynolds to begin their work recording gravescriptions. This was, a few years later, folstone inscriptions. For many years, an unofficial public park.) Livingston Woods served as lowed by another book of 25,000 inscriptions from the older County of Ulster. These collections can now be found in many of the libraries in the country and will become more valuable as the years pass by and the old tombstones are destroyed or become illegible.

In the early days of my student life, in my profession, I adopted the motto—Believe in Your Job And Then Give Yourself Up To It—and whatever degree of success I have achieved has come from living as closely to it as possible.

Mayflowers, also known as Trailing Arbutus—a particular favorite of Dr. Poucher who spent the last years of his life trying to raise public awareness about the impending local extinction of these plants and other vulnerable wildflowers.

I have always found some time to spare for my two hobbies, acquired in my early childhood—my love for the wild flowers and all things that grow in the fields and my weakness for the study of history. During all the years of my professional life, most of the hours that I could spare have been spent among my little friends, in the woods and fields of Dutchess County and in trying to protect them from extermination by writing and working in their behalf. Much of my exercise in late years, has been working in my wild flower garden, which has given me both the exercise I needed and great pleasure.

Many years ago, a party of my friends met, one evening, to discuss the idea of a local historical society. The result of this discussion was the formation of the Dutchess County Historical Society which, I believe, has been a great success and has ranked high among the local historical societies in the country and state. It has brought together many of our citizens who are interested in knowing how our county has developed from the days when their ancestors first came here.

Our Year Book, edited by Helen Wilkinson Reynolds, has contained many items relating to the history of our county and our ancestors, which are not only of interest to us but will interest posterity. This society has honored me, for many years, by electing me as its secretary. Several years ago, I was honored by being appointed City Historian of Poughkeepsie.

When my dear wife died, leaving me alone in my home, as both my son and daughter were happily married and living in homes of their own, I decided that as four score years were creeping upon me, to retire from my professional work. I have greatly enjoyed these past two or three years that I have devoted to working in my flowers, writing historical sketches and attending to a few other duties which I enjoy. One of my most enjoyable past times is the time I can spend at the happy homes of my son and daughter and their children—three wonderful grandchildren. What a blessed pleasure, for which I cannot be too thankful, to have them to care for and to care for me."