Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, 1937-1948 (review)

Robert Skidmore Ecke. Snowshoe & Lancet: Memoirs of a Frontier Newfoundland Doctor, 1937-1948. Portsmouth, N.H.: Peter E. Randall, 2000. xvii + 334 pp. Ill. $24.95 (0-914339-85-0).

Organized sequentially around journal entries, these memoirs focus mainly on the author's medical exploits. He first went to Notre Dame Bay Memorial Hospital in Twillingate, Newfoundland, in 1934, to spend the summer after his third year of medical school at Johns Hopkins. He was lured by the prospect of gaining more clinical training and finding a way to escape the stifling heat of Baltimore. The Hopkins connection at this hospital was firmly in place: when the Notre Dame Bay Memorial Hospital officially opened in 1924, its director was Charles Parsons, a 1919 graduate of the Johns Hopkins medical school. Parsons had initially gone north to join Sir Wilfred Grenfell in the work of his Labrador Mission. Concerned by the lack of medical facilities on the northeast archipelago of Newfoundland, Grenfell spearheaded the formation of this hospital. After Parsons became head of the hospital, he returned from time to time to Hopkins to recruit physicians, nurses, and medical students for his staff. John Olds, one of Parsons's most promising student recruits, returned in 1931 to Notre Dame after receiving his medical degree from Johns Hopkins; when Olds became director in 1935, he continued to draw upon Hopkins for staff, and Ecke was one of his recruits.

After graduating from medical school in 1935, Ecke spent two years in Baltimore, first as a surgical intern at Baltimore City Hospitals and then back at Hopkins as a fellow in the poliomyelitis laboratory of Howard Howe. Frustrated with academic medicine and uncertain about his future, he embarked upon a mission to find a career track that suited him, and he headed back to Newfoundland to rejoin the staff of Notre Dame Hospital. A tall and robust youth, Ecke was well primed for the challenges of Newfoundland's climate: although born and reared in Brooklyn, he had grown to love the outdoors while at summer camps in Maine and during his undergraduate years at Bowdoin. He spent eleven years on Notre Dame's staff, where he gained extensive experience in primary care, enjoyed the rugged outdoor life, and ruminated over the direction of his career and his abilities as a surgeon. He stated that "surgery was so emotionally difficult for me that I needed it to be forced on me" (p. 209). In his journals, he struggles over his difficulty in asserting himself. He did not set priorities for either his personal or professional life. On call twenty-four hours a day for long periods, he lived by the flow of medical emergencies.

In addition to spending long hours in the hospital's clinics and operating room, Ecke also participated in its house-call service. He reached home-bound patients by whatever means the season would permit--from horseback, motorcycle, and dogsled to boat, snowshoes, and skis, and by foot at last resort. During the summer months, after ice had thawed in the waterways, he sailed aboard the hospital's ship, the Bonnie Nell, to neighboring communities to conduct clinics. Although his accounts of encounters with patients are brief, they do yield a wide range of comment. He decries the grinding poverty in which most of them lived, and their lack of education. He laments the poor hygiene of their households and their poor nutrition. Beriberi and other conditions related to nutritional deficiency were common. Tuberculosis was the most rampant disease and ranked as a major killer. Appendicitis was ubiquitous, and appendectomies, therefore, were the most frequently performed surgery. In his practice, Ecke appears to have been resourceful, skillful, and adept at diagnosis. He wrote that he had "an intuitive way of diagnosing bellies and my success is reasonably constant" (p. 266). Sometimes he seemed overwhelmed by the problems of patients and...