In today’s standards, surgery is almost always a sterile endeavor, with clean, white rooms, meticulously sterilized surgical gear, nurses and doctors in scrubs, masks and hats to keep the room painstakingly perfect for the procedure. The medical team has every tool, machine and piece of equipment necessary for the task and everything is prepared for the scheduled event. Surgery is generally not as described by one Magoffin County doctor over 100 years ago, when he detailed an amputation he carried out in a kitchen with a dirt floor and no door to keep the animals out of the room.
In records kept by local historian Jimmie Allen, Dr. M.C. Kash tells his story about a time in June 1915 that really tested his country-doctoring skills.
“Be it understood that physicians located in this mountain region, miles away from a railroad or hospital, are frequently compelled to work under adverse circumstances or give up the case entirely,” Dr. Kash wrote in the June 1, 1916 issue of the Kentucky Medical Journal.
Dr. Kash evidently was not one to give up on a case, nor was his colleague, Dr. Skaggs, also of Magoffin County.
On June 30, 1915, the two were called to the head of the Licking River – roughly 25 miles away from Dr. Kash’s home.
“Some half-witted fellow had gone some distance to the nearest telephone and called for the doctor, saying ‘this man had been shot in the wrist and was bleeding to death.’ This was all I got out of his message. So not knowing whether he was shot with a pistol, shotgun, or canon, I started for the place,” Dr. Kash wrote.
Kash rode 25 miles on a “good saddle horse,” without eating any dinner, and carrying only his pocket case of instruments – lacking a saw or any tools fit for an amputation. He had basically no background information on the patient, but figured, like most “shooting affrays that occur in this mountain country,” this situation was probably of feud origin and didn’t expect to get any more context regarding the injury.
When he arrived, a large man, about 35 years old, was lying on some old quilts on the porch of the home, “with one of his arms shot nearly off with a shotgun just below the elbow.”
“One glance showed us physicians that it was more serious than the message gave it.” Kash remembered. “Amputation was now necessary and no time to go 25 or 30 miles for instruments.”
Dr. Kash asked if there were a hand saw in the neighborhood, inevitably sending for a “bucksaw” that was used to de-horn cattle. He also sent for some vessels that could be used to sterilize the surgical equipment.
The operating room was equally as meager.
Kash described the home, a small two-room building, one functioning as a living room and the other as a kitchen and dining room. The dining table, which in this case would function as an operating table, only had two legs and the other end resting on a salt barrel. The room had a dirt floor and the old stove at one end of the room wasn’t capped, so smoke filled out into the room as they worked to sterilize the equipment.
Once the operating room was ready, they carried the man in and put him on the table. Dr. Skaggs had a bottle of chloroform and some absorbent cotton, which he administered to the man as anesthesia as Dr. Kash cut off the old, bloody shirt.
Kash also noted one very important feature lacking from the operating room: a door.
He explained in the article, “There were chickens of all ages and varieties, from Rhode Island Reds to Plymouth Rocks, both roosters, hens and young ones, all in that room, together with three or four large fox hounds. All these domestic creatures being very tame indeed, so much so that we could not keep them out of the room, as there was no door, besides it was a very hot day, being on the 30th day of June.”
Not having any sterile cloths available, Kash kept his tools in the dishpan of sterile water and ordered the neighbors that had congregated to keep the animals away from his equipment as he worked.
“But of course, as the operation proceeded they were so interested in that they did not see what was happening with the instruments,” Kash remembered.
As he turned to pick up a scalpel, the rim of the dishpan – evidently their “ordinary receptacle for food” – was lined with a rooster, old hens and some smaller chickens, now picking at the instruments.
As he shooed away the chickens, two or three of the large hounds decided to rear up on the other side of the table, “trying to diagnose what was the matter with their master while he was snoring under the anesthetic.”
“Then I lost my temper and talked very straight to those natives, that I had repeatedly told to keep the dogs and chickens out of my instruments till I got through with the operation,” he remembered.
Kash seemed to regret losing his temper on the group, though he said no one held it against him.
“No, they did not seem to get mad, as they hardly ever get mad at a doctor, for they don’t know when he may be called on to cut a bullet out of them,” Dr. Kash said.
Despite losing his temper for a moment, the chickens and dogs never really left the room as the two doctors proceeded.
As Dr. Kash prepared to saw the bone of the man’s arm between the elbow and shoulder, he dipped the old bucksaw in boiling water, then attempted to further sterilize the farm tool with carbolic acid on absorbent cotton.
“I did what I could to sterilize it and sawed the bone in two, trimmed the flaps and sewed them with silk thread, no catgut ligatures being at hand.”
They dressed the wound as best they could and put the man to bed, but he woke up from the anesthetic soon after, wanting “a good square meal,” though they thought it best to hold off on food for the time being, given he had just gone through major surgery.
As doctors generally do after they’ve done their job, they gave him some instructions about water and food and went on their way.
At the time the article was written in 1916, a year after the surgery, Dr. Kash hadn’t seen the man since that day, but Dr. Skaggs ran into him about three weeks post-surgery, riding a mule with his “best girl” behind him.
“I am also reliably informed that about a month after the operation he got drunk, fell off his mule and stuck that stump of his arm in the ground,” Kash wrote. “However, I hear from him frequently and he is all right and has his ‘best girl’ with him, yet. The fact of the matter is that this ‘best girl’ was the cause of the shooting, which thing occurs quite frequently among these mountain people.”
Dr. Kash notes that the “surgeons of Louisville,” who operated in conditions that were much closer to today’s hospital standards, would consider them “durned fools and the patient would not live a week.”
“But brother physicians, I will say that I have lived in this county for over 20 years, have done all kinds of surgery, from laparotomy to the removal of ‘ingrown toenails.’ It has been a frequent and common thing to do appendectomies at private houses and the patients recover successfully. Amputations of legs and arms are common things for us surgeons, we do that frequently and do it at their homes with perfect success.”
He goes on to say that mountain physicians of the time would have preferred if the patient could have paid the bill and receive care in a city hospital, but that was not a feasible scenario.
“It is frequently poor people who have not the means, so we have to do the work on the spot or let them die,” Kash wrote. “Blood poisoning and infection are very rare, indeed. Altogether, the mountain surgeons perform their work under conditions that would appall the city doctors, yet they are very successful and hardly know what it is to lose a case.”
Based on the article “Surgery in the Mountains of Kentucky” by M.C. Kash, Salyersville, originally printed in the Kentucky Medical Journal, June 1, 1916. A copy of the article was made available to the Salyersville Independent by Jimmie Allen.
Art by Erin Alise Conley