Oral History Interview with Edwin W. Monroe

Part 1

Collection Number: Date: July 12, 2001

Narrator: Edwin W. Monroe, MD Interviewer: Ruth Moskop, PhD Transcriber: Janipat Worthington

Copyright 2001 by East Carolina University. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from East Carolina University.

Edwin W. Monroe - EM
Ruth Moskop - RM

RM: It's July 12, 2001. My name is Ruth Moskop. I am here to interview Dr. Edwin W. Monroe. We are in the History Collection space of the William E. Laupus Health Sciences Library, East Carolina University in Greenville, North Carolina. Dr. Monroe, you've made important contributions to healthcare in eastern North Carolina as a physician, as a medical educator, and as an administrator. In light of this, the History Collections of the Health Sciences Library would like to record and archive an interview with you. Do I have permission to record this interview?

EM: Yes, you do.

RM: Thank you. The recording will be transcribed and kept in the Health Sciences Library of East Carolina University where it will be available as an oral history resource for people interested in the history of healthcare. Is that all right with you?

EM: Yes, it is. (01:01)

RM: Great. Thank you. I like to start oral history interviews with asking you to tell us a little bit about your personal background, beginning with when you were born and where.

EM: I was born March 10, 1927, in Laurinburg, North Carolina, which is the county seat of Scotland County.

RM: And why were your parents there at the time?

EM: My parents were there because they grew up there. My dad grew up about seven miles outside of town in an area of the county that was famous for its poor soiL It was almost like sand dunes, so the only thing it was really good for was growing pine trees. My mother grew up in town; she was a city girl. The town had a population at the time she was born of probably

2,000 people. When I was born, the town was up to about 4,500 people. The last time I saw a census, the town was up to about 16,000 people. So, it's been a long period of very slow growth.(02:21)

RM: What has contributed to the growth there, do you think?

EM: Primarily the diversification of major economic interests from one or two families who controlled everything in the 30s and 40s and early 50s with the advent of more manufacturing capabilities, small industries-like there is one outfit that is connected with Owens Glass and Company, another one makes golf club grips called GolfPride-those kind of things. (03:01)

RM: Well, the golf industry is very supportive of the tourist industry in this part of the country.

EM: The other thing that helped was when a couple of small junior colleges closed up in nearby towns to become one senior college-four-year college-called St. Andrews Presbyterian College, and that's located in Laurinburg.

RM: I see.

EM: That's a nice, stable, economic impact.

RM: Oh, yeah. We've experienced some of that here in Greenville as well...

EM: Absolutely.

RM: ...with East Carolina University's growth and development. Tell us about your family. Did you have brothers and sisters?

EM: I had two brothers and one sister. The two brothers are older, and the sister is a year-and-a-half younger. The sister and a brother are still living. The brother is a retired pediatrician in Florence, South Carolina. My sister is a spinster and lives in the home in Laurinburg-the family home. (04:10)

RM: That sounds like a nice arrangement there. What recollections do you have? You were in a family of four kiddoes-you must have some memories of illnesses as a child--either yours or your siblings.

EM: The ones that I remember best were the usual childhood diseases, and back then if you have measles or mumps or whooping cough, you were quarantined for at least two weeks to avoid epidemics. I remember in the second grade having measles and mumps almost all at one time, and at that point I had become a great reader, and I spent the two weeks of required confinement reading books and getting progressively beyond my depth of understanding in books like, All's Quiet on the Western Front, which was about World War I. (05:20)

RM: As a second-grader?

EM: Trying to read 'em, yeah. There was no town library and not really a library at the school where you could check books out to take home to read, so I read what was in the house.

RM: Well, that's a fabulous book, but I'm not sure I would recommend it to a second-grader.

EM: Probably not, but there were a lot of things about it I did not comprehend. But since my dad was a World War I veteran, I was interested in what was going on during the time that he was in the Army.

RM: Sure. Well that tied in. It made sense to you then-more than it would to children now probably in this country. (06:01)

EM: Later in my childhood, one of the doctors in the community decided that the community needed a hospital, so he built a fairly large structure next to our house that became the Laurinburg Community Hospital.

RM: Right next door!

EM: Right next door. And it consisted of three patient-care areas-one for the white folks, one for American Indians-there were a fair number around, particularly in the neighboring county called Robeson County-and one for the black folks. And all of those had to have two separate areas for sexual separation-males and females. So it was a kind of a complicated place.

RM: Sounds like it.

EM: It was a one-man operation. He stayed in the hospital-had no outside office-and did major surgery. I assume he had somebody to help him put patients to sleep, but it was probably a nurse that he trained to use ether, which was the anesthetic of choice back in those days. (07:19)

RM: Do you remember his name?

EM: [His] name was Albert James. He had a relative in a neighboring town called Hamlet, which was a big railroad intersection, and his relative, whose name was Bill James, later was a member of the state legislature. And when he found out I was from Laurinburg, a neighboring town-lived next to his uncle Albert, we had instant communication.

RM: An instant bond. That's wonderful, and I know that came in handy. Let's go back a second to the quarantine. What exactly did that mean with regard to your life? It sounded like it gave you some peace and quiet to read, but how separated were you? (08:07)

EM: Oh, you're not separated from your family. You're expected to be confined to your house. The bad thing about it was that it was hard on [my] mother who was dealing with four kids--one of whom was irritable and maybe mildly ill and really fussing a lot about having to stay in the house. It was not very effective because the bugs could be carried outside by your siblings or your parents, so I guess it was more of a token indication of the fact that we're trying to control the spread of these diseases.

RM: Well, you had measles and mumps-you remember that. What about your brothers and sister-did they...? (08:59)

EM: I don't remember them having anything other than the usual childhood diseases. My oldest brother was almost six years older than I, so I don't remember much about him.

RM: What about vaccinations?

EM: Vaccinations were available, particularly for whooping cough, by the mid 30s, at which point I and my siblings had all had whooping cough. I don't remember any other vaccinations occurring. I remember my oldest brother getting a firecracker injury to his hand and having to get tetanus antitoxin-not tetanus immunization but tetanus antitoxin and he had a violent hive kind of reaction to it-swelling up and itching all over, and he was miserable for about 3-4 days. Those kind of things you remember vaguely but don't remember 'em being any big deal. I'm sure it was a big deal to him. (10:15)

RM: And your parents, what did they do?

EM: My father ran a small men's clothing store. It would be in that time and location somewhat analogous to Coffinan's in Greenville today-sort of upscale. Looking back on it, it was very conservative--well-made clothes for very conservative men. He did that from the time I was born until he died. My mother was a homemaker. She had very few outside interests other than her flower garden. (11:03)

RM: Well that's a good one. Did she have any-how should I say-folklore, herbal remedies that she shared with you all when you caught colds?

EM: Not that I remember. If you complained too much about whatever mild illness might be bothering you, you would run the risk of being dosed with some rather strong laxative called castor oil, which was a miserable laxative to use. I was delighted when later on she switched to Milk of Magnesia.

RM: So regardless of what your complaints, you got purged, is that right?

EM: Right. Absolutely. Life in a small town back then was rather simple. We lived about two blocks from Main Street, about four blocks from the Presbyterian Church where we went to church and Sunday Schoo4 about a block-and-a-half from the elementary schoo4 and three blocks from the high school. As a child, you just sort of made the circuit. You'd run errands downtown. Sunday mornings were dedicated to the trip to church and back. You'd walk to school. You'd walk home for lunch. It was a big deal when you got to high school and you were offered the opportunity to eat in the school cafeteria. Food was awful compared to what you could get at home, but it was just the idea of being a big-shot, growing up, and not having to go home for lunch. A lot of fun. (12:57)

RM: It sounds like it was.

EM: No swimming pool. A pond was about four miles from town that had a bathhouse and was operated as a community swimming hole in the summertime, and you could walk, ride your bike, or hitch a ride--with no risk whatsoever-out to that place, spend the day out there, and then get back home the same way they went.

RM: How did you learn how to swim?

EM: I was taught by cousins who lived out in the country, and they had a very interesting method. They tossed you in the water and said, 'Sink or swim.' So you learned to dog paddle very quickly.

RM: How old were you? Do you remember?

EM: I think I was about four.

RM: Four? Oh my goodness! Dog paddling in the country pond. You were right next door to the hospital clinic that you said had all the complicated system of, I don't know, receiving patients. How did you interact with the minorities--the American Indians and the black people? (14:16)

EM: [I was] fascinated to a degree by curiosity about what they were like. I interacted with blacks through having a part-time cook in the house who was black. She got paid I think $2.00 a week plus whatever leftovers she could take home with her. Black people and white people in the 30s had a very hard time. Money was very scarce. Two dollars a week sounds like slave wages, but a lot of people lived on $2.00 a week. We were living on $25.00 a week from my dad's job. Very few people had any spare money. A nickel was a big deal. At local elections around the courthouse where people voted were a lot of shade trees and a little open area, and a friend of mine and I would sell soft drinks as people milled around visiting with each other, coming in from all around the county to vote and to visit. And we would sell 'em for a nickel a piece. We paid four cents a piece for them, so we made a penny profit on each one. Some days I would make a quarter. (15:53)

RM: That was good!

EM: Very good. I mean you could go to a movie for a dime and sit in the movie all Saturday afternoon. You could buy a big bar of candy for a nickel. You could buy a fountain Coke for a nickel. Everything was re1atively avai1able.

RM: And those soft drinks that you would sell, did they already come in g1ass bottles?

EM: They came in bottles, yep. The old-fashioned Coke bottle for instance, which I think held six ounces. I'm not sure about that. But for a big-bottled drink like an RC Co]a or a Pepsi-Cola, that was 12 ounces--still a nickel. And you could collect the empty bottles and take 'em back to the bottler and get reimbursed a penny a bottle for bringing 'em back.

RM: That sounds terrific! Well, I guess you paid the four cents, which supported the bottle production in some way, and then you got another refund on it. That's pretty good business. How did you carry them back-by just holding on by hand? (17:06)

EM: No, in a little wagon that you pulled along behind you-very useful piece of equipment. You could haul trash in it. You could go to the icehouse and buy ice to take home to put in the icebox and haul that in your little wagon. Of course, a little bit of it melted on the way home.

RM: Tell me about the icebox situation.

EM: The icebox was what was available before refrigerators, and very few people in my town had refrigerators--maybe 10% of the families in town had refrigerators. The icehouse did a good business, particularly in the summertime. They had a sideline in the winter of selling coal, which they delivered. Later, they began delivering ice; however, when I was little, we had to haul the ice ourselves. So, we would trundle on down to the icehouse pulling a little red wagon and buy 25 pounds of ice for probably a dime. The biggest joy in that was occasionally you'd find an ice pick lying around with nobody claiming ownership, and you'd pick it up and take it home with you and play games throwing ice picks at targets-not usually human targets-but sometimes you'd get in a little argument and forget and toss the ice pick at somebody. Luckily, nobody ever got seriously hurt.

RM: What about food preservation? So you have your 25 pounds of ice... (19:00)

EM: ...that goes in the icebox and keeps the contents cool.

RM: In a boxed compartment?

EM: Uh-huh, right.

RM: But your mother must have had ways of preserving food other than the icebox.

EM: Oh, she did some canning and preserving. Grocery stores were available, and they had already? canned and preserved items that you could buy if you didn't have enough produce to do your own. I don't remember that she did a whole lot of that kind of work. The main problem with the icebox approach was that things like milk tended to sour more quickly because they weren't kept cool enough. There wasn't really a problem in preserving leftovers because we ate what we wanted, and then the cook would take what was really leftover home with her, so nothing had a chance to spoil; it got used.(20:01)

RM: Quickly. Where did your milk come from?

EM: The milk came from a dairy.

RM: More or less a local dairy?

EM: Yes, very local. I assume it was safe--pasteurized-but I don't know that for a fact.

RM: Well, you all survived.

EM: Yeah, we did.

RM: And the meat?

EM: The meat came from the butcher shop or from farmers who brought chickens into town to sell. I don't remember farmers bringing any beef or pork. It was handled by local butchers, and you'd go to the store and buy beef and pork and chickens.

RM: Probably daily as it was needed.

EM: Usually about every other day. And the kids did the shopping.(21:03)

RM: Fabulous! Fabulous arrangement!

EM: You'd go with a list, hand it to the grocer-who knew every family in town. He would get the stuff out on the counter and tell you how much you owed, or sometimes you'd have a running charge account and just pay it when you had money available. And you'd put that in your little red wagon and haul it home.

RM: Take it home, yeah. Wonderful fun it sounds to me like. I guess you all thought it was a task.

EM: A chore. But I really think it taught us a great deal of responsibility, and you quickly learned about money because you'd get checked when you'd get home as to whether or not you got shortchanged in any way. (21:57)

RM: Well, you mentioned some interesting aspects of your school. I believe courses were offered that are not offered frequently today-Latin?

EM: In high school, everybody took two years of Latin. The teacher was very practical. If she thought you had a chance to go on to some higher education setting, she would insist that you pass the Latin with some degree of comprehension. If she thought you were through as soon as you got out of high school or reached age 16 and weren't legally required to go, she might just sort of let you slide through because she knew you weren't going to do anything beyond that level of education, but you still had to sit there and take it. My senior year in high school, the football coach was drafted to teach Physics, which he had absolutely no comprehension of. He stayed about two pages ahead of us in the textbook throughout the year, but we did learn some rudiments about Physics. I found out how rudimentary it really was when I went to college and took Physics in college. I was ill prepared for that level of Physics. (23:23)

RM: Where did you go to college?

EM: I started at Davidson-a small school outside of Charlotte. It was then men only-boys only. I started in the summer of'44--a week after I got out of high school and I went through that summer session and the fall semester, and then I enlisted in the Navy-a few months before my 18th birthday when I would have been eligible for the draft. I enlisted because I wanted to be a tail gunner on a torpedo plane. I had seen a lot of war movies for the previous four years, and I couldn't wait to get into that heroic struggle. My dad signed the agreement for me to enlist with one condition, and that was that I go to the local post office where the recruiter was and take a test about one's aptitude for being trained as a radar technician. I agreed to take the test so I could get into the Navy. I had absolutely no interest in passing it, so I didn't read the questions. I just filled out the multiple-choice answer sheet. I passed with flying colors? without having read a single question.

RM: What was your father's motivation for having you take that exam? (25:00)

EM: He was very sure that the war would be over within a year because by then, the war in Europe had really started reaching its final stages, and he knew that the concentration then would be on Japan, and he was right. The war in Europe and the Pacific was over within the next few months. He wanted his son to be as safe as possible. He happened to know that tail gunners on torpedo planes had a mortality rate of something like 75%. So, he just did everything he could in his own sly way to keep me from getting into combat, which I would have been too late for anyway. (26:01)

RM: Well good. The hospital next door to you-that must have been a fascinating situation.

EM: It was fascinating because of the strange odors emanating from that setting in the summertime. This was before air-conditioning, and everybody had their windows open. Strange odors like ether, which has a distinct smell, infected wounds, somebody with gangrene-those odors weren't too pleasant. Speculation among the kids in the neighborhood about what happened to the things they took out of people or off of people-limbs, guts, whatever was cut out-what did they do with it? A big trash container was behind the building, which was next to the smaller building for the Indians and the black people, so they got the benefit of that kind of trash next to their building. (27:20)

RM: Closer by.

EM: Closer by. Speculation about what was really in there, but nobody had the courage to go toss around in it and find out.

RM: Probably a good thing.

EM: I think they really incinerated most of the tissues that were removed. It was rare for any tissue to be sent anywhere for pathological diagnosis.

RM: Was it a busy place-the hospital?

EM: Moderately busy. With only one doctor using it, it was not as busy as it could have been if there'd been half a dozen. (28:00)

RM: So I assume he had to go back and forth between two separate buildings then.

EM: Oh, yes.

RM: In the course of a day.

EM: Yeah, but most of the care was done by nurses who worked 12- hour shifts, six days a week.

RM: Ah, and if something happened to you on the weekend, or was that covered by one of the... They would rotate, so the weekends did get covered.

EM: The nurses were there, and the doctor was available most of the time. If he was going to be out of town, he would arrange for one of the local family doctors to cover for him.

RM: Were there other physicians then--local physicians?

EM: Intown?

RM: Yes.

EM: Yes, there were five or six.

RM: My goodness!

EM: But they didn't use the hospital very much. If they had somebody that needed to be hospitalized, they would send that person to the hospital and this Dr. James would then take over their care until they left the hospital. He lived in the building. (29:01)

RM: I see. So I guess the local family doctors were reluctant to turn their patients over.

EM: They tended for the well-paying patients who needed hospital care to send them out of town? like up the road to Hamlet--or down the road to Lumberton.

RM: Was there better care in Hamlet and Lumberton?

EM: A better trained physician doing surgery. The one in Laurinburg was, for his time, pretty good, but I think a well-trained surgeon would have done a better job.

RM: How soon did you become interested in pursuing a career in Medicine? (29:57)

EM: I guess that started basically after I got out of the Navy and went back to college, although while I was in the Navy, I was fortunate to be assigned to a program for officer training that led to my being assigned to an academic institution-the University of Louisville-for two semesters; and while I was there, I continued taking what were basic pre-med courses in addition to mechanical engineering, signaling, semaphore lights, radio transmission-those kind of things that you get a smattering of as an enlisted man in the Navy. French, English? those kind of courses would transfer for credit back to my college. So when I got back to college, I continued taking the pre-med courses along with other things because I wasn't sure what I wanted to do until I started my last semester of college when I decided I wanted to go to medical school. Now, why did I decide I wanted to go to medical school? A brother-a year? and-a-half older-was already in medical school. I visited him one weekend. He showed me around-this is Duke Medical School-and suggested that I might seriously consider this career. He showed me the Anatomy Lab, and I thought to myself, 'I'm really not sure I want to have any part of this kind of business,' but then that memory faded. I got back to my college... (32:07)

RM: Davidson.

EM: ...Davidson. And I thought well, 'I don't want to go into business. I don't want to go to law school. I don't want to go to the seminary and be a Presbyterian preacher. I cannot make a living as a mathematician,' which was something I was quite skilled in. 'So, I think maybe I'll go to medical school. If l don't like it, I can always quit.' So, I applied and got accepted to the two-year medical school in Chapel Hill.

RM: All the time you were in school... You sold soda pops when you were a child-how did you get through school?

EM: I had some help. I had an uncle-he and his wife had no children. He paid my tuition for the first experience at Davidson before I went in the Navy. When I got out of the Navy, I had the GI bill, which saw me through college and almost the first two years of medical school. My dad would send me money when he had some he could spare. In college, I waited on tables in the fraternity boarding house. When I got back to college after the Navy, I became the manager of the boarding house, which gave me not just board but also a small stipend. (33:39)

RM: A great experience!

EM: Very great experience, yep. Got to be very good friends with the cook.

RM: That helps, too.

EM: Well, I enjoyed desserts, so I got more than my fair share. (34:00)

RM: Well, you had a sweet experience then. What courses did you enjoy particularly?

EM: I mentioned mathematics. Astronomy. These were crip courses, but they were very interesting.

RM: Crip?

EM: Easy, designed primarily for student athletes--even at Davidson-The Theory of Coaching, and that was interesting because you had to learn the rules to all the different intercollegiate sports. I don't understand how a big hunk, fairly dense mentally football player could pass that course 'cause it was not as easy as it sounds. I particularly enjoyed the challenge of Organic Chemistry, which I took the last summer I was in college before starting medical school, and it was 6-112 weeks of concentrated Organic Chemistry covering one year or two semesters' work. You were in class from 8 in the morning until noon, and you were in lab from 1 in the afternoon until you got through-that might be 4:00 or it might be 6:00, and then you crammed all night. It was an arduous experience. The professor knew that I did not comprehend everything about Organic Chemistry - that I had a good memory. He would not give me an A, even though I had a grade point average of something like 96 from the exams, but he would not give me an A because he knew I didn't really know what I was doing; and he proved it by taking me into the lab and going through the proper way to set up the equipment for an experiment versus the way I was doing it because I always ended up with all the glassware teetering on the edge of falling over and breaking, and the final receptacle beaker for the end product usually ended up on the floor when it should have been on the counter for the drip to accumulate in. And mine would be on the floor because if I put it on the counter, it would be higher than some of the equipment I was using, which had been stashed in a drawer underneath the counter. It was ludicrous.

RM: It sounds to me like not so much a lack of understanding of Organic Chemistry as a spacial relation situation. (37:03)

EM: I just really didn't know what I was doing, but I memorized the whole course...

RM: That's amazing!

EM: ...and got a B+.

RM: Yeah? That's interesting.

EM: The dean of the med. school told me when he interviewed me he knew-I'd not taken Organic at that point-and he told me that I had to have a B average in order to get accepted to medical school--a B in Organic.

RM: Well, you got it.

EM: So I got a B+

RM: Yeah. That's doing well. Well how did things go when you got to your clinical years then? I guess we should start with your basic sciences. You had two years of that at Chapel Hill.

EM: Two years at Chapel Hill. Chapel Hill back then was on the quarter system. The last quarter, you got some taste of clinical experience. We learned Physical Diagnosis in the student infirmary-Student Health Center. The faculty consisted of the dean, who was a trained internist but never really practiced-he was the head instructor in the Physical Diagnosis class-and the staff of the Student Health Center. There were two full-time doctors, and they would instruct us for the Physical Diagnosis session. A little later, you got transported to Watts Hospital in Durham, which was the community hospital, as opposed to Duke Hospital, and the staff of that hospital-Watts Hospital-assisted in teaching the Physical Diagnosis using patients. So you learned how to take a history and do what passed for a physical exam. We were not very good, but we tried very hard to learn to be better. By the time I got to my first clinical clerkships in the third year of medical school, I realized how little I knew about Physical Diagnosis.(39:34)

RM: What equipment did you have to use?

EM: We had stethoscopes, blood pressure cuffs, tuning forks, reflex hammers, otoscopes, ophthalmoscopes--that's all I remember.

RM: Tongue depressors.

EM: They were supplied by wherever we were being instructed. We didn't have to carry them around. But we did have a white coat, which was very important for our image and our ego. (40:13)

RM: Yeah, and each student-did each student have a black bag with those important instruments in it?

EM: If you could afford it, yeah.

RM: How did you come by yours?

EM: I bought a secondhand black bag from the local supply place that you buy equipment from, and for some reason, they had two or three used black bags so I bought one secondhand for about one-third of the price of a new one.

RM: Sounds great! And then the equipment to go in the black bag? You bought that separately.

EM: Yeah, you bought that separately. It was not as expensive as it would be today, but comparatively speaking, it was expensive back then. (41:00)

RM: Dr. Monroe, you were just telling me about a friend who had rheumatic fever.

EM: When I was a youngster, a friend of mine had rheumatic fever, which led to rheumatic heart disease-valve damage, progressive heart failure. The only real treatment available in the way of heart failure medications was mercury-related diuretics given by injection-no oral medications-and low-salt diets. And if the valve problem was severe enough, you could not control the failure very well. So he died when he was about 21-22 years old, and I was sort of... It was impressive to me to think that somebody my age could die of something for which there was no real treatment program. (42:20)

RM: The mercury-the diuretic-was that intended to keep the blood pressure down?

EM: No, it was intended to increase the excretion of fluid through the kidneys. It worked like thiazides work today-or Lasix works today. The problem with it was that you became refractory to its effect after prolonged use, and it had the potential fur kidney damage with prolonged use because it had... I don't know enough about the physiology to describe the exact problem, except that it was not a very effective way of treating heart failure. So later on, it had some bearing on my interest in starting with Earl Trevathan-a rheumatic fever clinic? in Greenville for the kids in this part of the state. (43:24)

RM: Was rheumatic fever a commonly occurring problem?

EM: A lot more common than today because if you had a beta strep. infection back then, before penicillin, you ran the potential of the complications from strep. infection-one of which was rheumatic fever. And then, with some complicating infection later on, you've got a damaged heart valve that the bacteria can lodge into and produce a bacterial infection of the valve, which made the valve that much worse. (44:06)

RM: Jumping ahead a bit, tell me about that-you and Earl setting up the clinic.

EM: Well, there was no heart clinic in this part of the state, and there was help from the North Carolina Crippled Children's Fund and from the state Health Department and the local Health Department to get a clinic started to evaluate rheumatic heart disease and congenital heart disease. So Earl and I staffed it. He was the pediatrician, and I was the so-called cardiologist-so-called because I was not a true cardiologist.

RM: But an internist. (44:53)

EM: An internist-a general internist. And if I needed to be, I was a cardiologist or I could be a neurologist or a hematologist or you name it. The one thing I did not do was stick things in people like subspecialties do today-scopes of various kinds. I had a sigmoidoscope in my office that was the most uncomfortable-looking piece of equipment you could imagine-about a foot-and-a-half long, about an inch in diameter, and rigid-and not too comfortable to have stuck up through your rectum into your lower colon. Things have gotten better.

RM: Well, we got you up through Chapel Hill.

EM: Chapel Hill----two years of med school.

RM: You had some clinical experience...

EM: ...borrowing some money from the dean's special fund after my GI bill ran out-borrowing some money to get through the last quarter of school at Chapel Hill-paying him back later. The dean determined where you went your last two years. We had about 48 or 50 students in my class, and we were called in one by one during the late fal1/early winter of our second year for a counseling session with the dean; and based on his assessment of your performance, he told you where he thought you should apply to transfer for the last two years. This had been going on long enough that if he told you where he thought you ought to go and you agreed to try to go there, acceptance was almost automatic. You did not have to go to that place for interviews. It was all arranged through his letters. (47:02)

RM: That's good.

EM: So he told me--he gave me a list of about five or six places that he thought I would probably do okay with. I picked one, and about two months later, I got a letter saying they were glad to take me and that based on his recommendation, I was awarded a scholarship that paid half of my tuition.

RM: Fabulous! This was to the University of...

EM: ...University of Pennsylvania. I toyed with the idea of Harvard and decided I didn't really want to go stay in Boston for two years. Why Philadelphia seemed appealing, I have no earthly idea. I think I vaguely remember a friend of my dad's-a family doctor-who talked very glowingly about Medicine in Pennsylvania, Medicine in Philadelphia, and the University of Pennsylvania Medical School, which was an old, well-established, traditional kind of school. (48:15)

So, I went there the last two years, along with three or four friends who were with me in Chapel Hill. Three of us roomed together the first year in Philadelphia.

RM: What was the composition of your class in Chapel Hill like? Were there any women in it?

EM: There were about five or six females--one of whom is living in Kinston now-Rose Pulley.

RM: Oh!

EM: Delightful person. She went to Pennsylvania with us.

RM: Did she? But she wasn't one of your roommates.

EM: No, she was not one of my roommates. She was--don't tell her I said this-she was sort of a mother figure for us.

RM: Is that right? (49:00)

EM: [She was] a little bit older than most of us. She had worked as a medical technician in a lab before she decided to try to go to medical school. Very warm, outgoing personality-very feminine person but not somebody that you felt anything other than friendship toward. The other females in the class--one of whom started dating a fellow medical student... They got married and she dropped out of medical school, kind of reinforcing the dean's outlook that women had no business in Medicine. He was very firm about that-old-fashioned.

RM: Nevertheless, he had... (50:00)

EM: But he had five females in that class, yeah, and it was about like that as long as he was the dean--just a handful.

RM: At what point did you turn to Internal Medicine, latch onto it?

EM: That was during my internship in Richmond, Virginia, at the Medical College of Virginia Hospital. The rotating internship consisted of two months' experience on the major services, and I started out with OB-that convinced me I did not want to be an obstetrician. Then I had two months of Emergency Room service-one at the white hospital and one at the black hospital--they were next door to each other, but the difference between them was understandably enormous: Size, facilities, resources, cleanliness-everything was different. (51:08)

RM: Can you be specific? Can you help us visualize the differences?

EM: Well, the black hospital was about three stories high, and the white hospital was 17 stories high. The black hospital was full of wards-no private rooms. The hallways were jammed full of patients on stretchers and gurneys. The emergency room was a boiling mass of humanity? lots of unpleasant odors and dirt. It was not a very good place to get care or to work, and it was a blessing when it finally closed up. But it was the only source of hospital care for black people in Richmond, Virginia. To have that as part of a state-owned institution was not just a tragedy, it was a sin for the state to be that neglectful of that segment of the population. (52:18)

RM: When that hospital closed, where did the black patients go?

EM: They were integrated into the white hospital. This would have been some time in the early to mid 60s.

RM: [Were there] separate facilities in the white hospital or were they admitted by diagnosis?

EM: No, I think they were admitted by diagnosis by that time. But, back to rotations. I did Medicine the last rotation-my last two months. I had been through OB, Pediatrics, Psychiatry, Emergency Room, Surgery-I didn't really want to do any of those things. That left Medicine. I wasn't sure what an internist was-I had a pretty good idea. But I didn't know one personally until I got on that rotation, and I liked the approach that they were following in taking care of their hospital patients. They were logical, rational, non-impulsive, and deliberate. There were a lot of things they couldn't do much about, but they seemed to spend an inordinate amount of time figuring out what was wrong with people-even though they couldn't necessarily do much about it, and that just kind of appealed to me for some reason. So then, we had heard that Chapel Hill was ready to open their new hospital for their newly authorized and developing four-year medical schooL so we thought, 'Wouldn't it be great if we all go back there?' So, several of us applied and were accepted into the initial house staff programs at NC Memorial Hospital. I was a first-year assistant resident in Medicine and went through that year and the next year. During that time, the average daily census of the hospital had gotten up to about 130 patients at any given point in time. That's the whole hospital-not just Medicine. They really got a workup. They got worked up by the third-year student on his clerkship, they were seen by the fourth-year student on a specialty clerkship rotation, by the intern 'cause we still had interns back then, by the first-year resident, and then by the second? year resident on specialty rotations; and they might get lucky and be seen by the chief resident if it was really something interesting or complicated. Then, the faculty would come in and go through all that and decide whether they agreed with it or not. So the patients were by nature very complicated problems that had gone through local medical resources and hospitals and ended up being sent there because nobody could figure out what to do with 'em. Didn't necessarily mean they were physically very sick, but they believed they were. They were referred to as crocks many times because all of their complaints were crocks. They still got worked up, and efforts were made to help 'em get straightened out. A lot of times, you ended up doing psychiatric counseling rather than physical counseling. (56:31)

RM: How much of that do you think was--how should I say it-was not having the diagnostic tools and equipment to understand?

EM: Those kind of people-very little of it was due to the lack of those resources locally. It was the fact there was a new place opening with a new bunch of doctors who were superspecialties, !!!!4 it was owned and operated by the state, and some of' 'em just insisted that their doctors send them there because they had exhausted all the doctors in their own hometown. (57:12)

RM: Completely!

EM: Completely. And I don't mean that they were all like that, but there was an inordinate proportion of them-initially.

RM: We do need to wind up fairly quickly before I wear you out-but for today. I hope we can continue another morning.

EM: Wecan.

RM: That'll be terrific. A couple of questions came to mind. Of the patients who did have physical problems, medically diagnosable problems, what sorts of things did you see?

EM: We saw strange things that I'd never seen before. Lupus was not uncommon among that patient population, particularly in black females. Some of the less common venereal diseases. (58:11)

RM: Like what?

EM: Like advanced syphilis.

RM: Ah.

EM: ...or a cousin of gonorrhea that wasn't gonorrhea; tuberculous peritonitis; tuberculous meningitis; a lot of rheumatic heart disease end points, like my friend who had died three or four years previously.

RM: Children? Did you see them at all?

EM: I didn't see children much because they were admitted to Pediatrics. Polio-not just children but also young adults and teenagers that Medicine looked after. We had a Polio Unit with-! don't remember how many-iron lungs operating, each of which contained a human being. (59:20)

RM: Approximately?

EM: Ten or twelve--but not all in one room Usually, if the patient wasn't critically ill but still needed respiratory assistance, then they might combine two or three same-sex iron lung patients into one room. It required a tremendous amount of nursing care. Not much the doctors could do. It was mostly nursing care.

RM: This may be a silly question, but when a patient's in an iron lung, how are their bodily functions taken care of? Did they have catheters? (01:00:04)

EM: If they had no bladder control, they had catheters and periodic enemas for bowel movements.

RM: But if they did have bowel control, then would they leave the iron lung and go to the bathroom?

EM: No. They could be put on a bedpan in the iron lung.

RM: In the iron lung?

EM: Uh-huh. Those were interesting machines, and one of the things they ought to do with medical students today is--every medical school ought to have one of those machines stashed away, and at some point in the first or second year, they ought to parade it through the student body and let it be known that this is the way it used to be, and look what you've got to be thankful for.

RM: And the replacement these days would be? (01:01:01)

EM: A self-contained breathing apparatus. You know, there would be a tracheostomy and assisted breathing devices that are very easily portable.

RM: What we call respirators.

EM: Uh-huh, yeah.

RM: Well, this can go on the record. I'm hoping that we can bring an iron lung under the auspices of East Carolina University through the Country Doctor Museum connection.

EM: That would be a good way to do it.

RM: They have one, and Dr. Newell is very proud to have what she calls one of the last ones around.

EM: I believe it could be one of the last ones around.

RM: Let me ask you one more question before we close today. Through all this decision-making you had to go through-thinking back to the time when you visited your brother when he was at school at Duke, and you visited the Anatomy Lab and you said, 'That's not for me,' but you got over it-did you have contact with your brother? Was he already practicing Pediatrics by the time you got to medical school did you interact with him when you were doing your rotations? (01:02:12)

EM: No. He graduated from Duke before I got beyond the first year at Chapel Hill. He was on the accelerated program [that] started during World War II, so he got through in about a little less than three years. He went on to an internship.

RM: Where did he go?

EM: He went to the University of Cincinnati.

RM: Oh, Midwest-far from home.

EM: And [he] did an internship and one year of Pediatrics when he was called to active duty in the Navy, who had paid his way through medical school, and he was called to active duty when the Korean War erupted in early 1950. (01:03:07)

RM: So, you really didn't have...

EM: We corresponded but not much physical contact.

RM: Did you talk about healthcare in your correspondence?

EM: No. I'd tell him what I was doing, he would tell me what he was doing, and we did not evaluate each other's experiences.

RM: It's good that you kept in touch, though.

EM: We did. And when I ran out of scholarship support and needed money starting with my third year of medical school he was on active duty, and he sent me $50.00 a month from his pay with the understanding that someday I'd pay it back, We kept track of how much it was, and after the first couple years of practice in Greenville, I was able to start paying him back. (01:04:07)

RM: That's a wonderful story of brotherly love and support! Shall we close there for today?

EM: That's fine, yeah.

RM: Thank you very much. (01:04:07)

Oral History Interview with Edwin W. Monroe
Dr. Edwin W. Monroe worked in Greenville, N.C. as a general internist. He was also a medical educator and administrator at East Carolina University. Dr. Monroe played an important leadership role in founding a medical school at ECU. In this interview, he discusses his childhood in Laurinburg, N.C. and how he was influenced to study medicine. He also talks about his experience in medical school and during an internship and residency. Approximately 64 minutes
July 12, 2001
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oral histories
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