Alfred Worcester

Alfred Worcester (1855–1951) was a general practitioner in Waltham, Massachusetts, known for pioneering work in patient care, the treatment of appendicitis, and the use of Caesarean section.

Alfred Worcester ca. 1878

Biography

Alfred Worcester was born in Waltham on June 22, 1855. He earned AB at Harvard College, Phi Beta Kappa, in 1878 and MD at Harvard Medical School in 1883. He entered practice in Waltham in 1884 and founded the Waltham Hospital and Training School for Nurses the following year.[1] He married Elizabeth Joy Hill (1854–1951), the daughter of a former president of Harvard College, in 1886. They had no children. Other accomplishments included: founded the Rutland Sanatorium (for care of tuberculosis), 1895; admonished the physicians of eastern Canada to allow the founding of the Victorian Order of Nurses, 1897; president of the Obstetrical Society of Boston, 1899; founded Waltham Baby Hospital, 1902; Major in American Red Cross, Switzerland, 1918–1919; president of the Massachusetts Medical Society 1919–1921; professor of hygiene, Harvard College, 1925–1935. He died August 28, 1951, and his wife died six days later at their home in Waltham.

Accomplishments

He was called a pioneer in the organization, practice, training, and science of medical and nursing care.[2][3][4] He originated the concept of teaching about the care of the patient that would be applicable to all medical specialties.[5] He was an early adopter of appendectomy for appendicitis and of Caesarean section for complicated labor. He advocated for compassionate medical care and counseling for college students and was Harvard College's second Professor of Hygiene. He was a prolific writer and speaker and was deeply religious. He gave lectures and sermons across the United States and Canada.

Because of his innovations, he was often involved in controversy. He suffered several life-threatening illnesses, including appendicitis, which informed his approach to patient care. Scientific medicine was on the rise while he advocated preserving humanistic medicine.[6] Including practical experience in home care during nurses' training, which he organized at the Waltham Training School for Nurses, was frowned upon by hospital-based nursing school administrators of the day.

APPENDECTOMY: In the 1880s, appendicitis was treated expectantly, by waiting for a walled-off abscess to form, with incision and drainage via anterior or posterior approach, and was often fatal. The innovation that Worcester adopted was to operate earlier and earlier in the course of the disease and to enter the peritoneum to do so. At first, this was by open lavage of the peritoneal cavity and removal of what was left of the ruptured appendix. Later, he found that he could usually operate before the appendix had ruptured, and prevent generalized peritonitis and abscess formation, and greatly reduce morbidity and mortality. The reports of his cases and the controversy between him and the surgeons of Boston demonstrate the evolution of medical and surgical practice and the contribution of generalists to specialty care.[7]

GERIATRICS, PALLIATIVE CARE, PATIENT CARE: Dr. Francis Peabody's noted statement, "the secret of the care of the patient is in caring for the patient,"[8] was delivered in a series of lectures initiated by Worcester. Some of the lectures, including Worcester's on the care of the aged and the care of the dying, were published in a collection in 1929.[9] Worcester's lectures were then published on their own in 1935, together with a third lecture on the care of the dead. This book went into a second edition and several printings, the last being in 1977. Dame Cicely Saunders, the leader of the palliative care movement in the United Kingdom, was inspired by Worcester's book during her training.[10] In this book, Worcester states,

The relief and comfort of our aged patients should be our aim, rather than the prolongation of their lives. But this is hardly a true distinction, for the relief and comfort given to an aged patient often effect the prolongation of life if only by restoring the willingness to live.

— Alfred Worcester[11]

… discomfort and suffering are only too possible in the earlier stages of dying. Much of this is avoidable. Some of it, as we have seen, is due to lack of proper treatment or to wrong treatment of the patient. In the latter case the harm is generally from failing to recognize that the treatment needed is radically different from what is appropriate when restoration is possible… It may be easier in such a case ... for the physician, against his own judgment of what is best for the patient, to surrender to the prejudices or desires of agonized relatives who do not understand and so cannot accept the facts. All of the physician's patience, tact and sympathy are then needed, and, above all, his firmness. If he is unremitting in his attention to the patient he will eventually win the confidence and gratitude of the family; and meanwhile, what is of far more worth, he will have the satisfaction of knowing that he is doing as he would be done by.

— Alfred Worcester[12]

Worcester's consult on a case in a memoir of turn-of-the-century Malden, Massachusetts, includes this observation:

Dr. Worcester said, and I have also noticed, that when one member of a family is cracked, some other member is the one who breaks down…

— Elliot Paul[13]
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References
  1. O’Hara D and Gallupe HQ, eds. (1925). Alfred Worcester: A Tribute to a Physician of Massachusetts. Boston: The Four Seas Company.
  2. Obituary: Alfred Worcester. NEJM. 1951:245(13):510-511.
  3. Kerr D. Profiles in Caring: Alfred Worcester: A pioneer in palliative care. AM J HOSP PALLIAT CARE. 1992;9(3):13-14,36-38.
  4. Freeman JT. Dr. Alfred Worcester: Early Exponent of Modern Geriatrics. Bull NY Acad Med. 1988;64(3):246-251.
  5. Reminiscences of Alfred Worcester 1938, http://thegardencottage.files.wordpress.com/2012/08/dr-alfred-worcester-reminiscences.pdf. Accessed November 7, 2014. Manuscripts preserved at the Harvard University Archives and the Francis A. Countway Library of Medicine
  6. Crenner, Christopher (2005). Private Practice: In the Early Twentieth-Century Medical Office of Dr. Richard Cabot. Baltimore: Johns Hopkins University Press.
  7. Worcester A. The Treatment of Appendicitis. BMSJ. 1892:127(5):101 and ff.The Boston Medical and Surgical Journal as published by The New England Journal of Medicine.
  8. Peabody FW. The Care of the Patient. JAMA. 1927;88(12):877-882.
  9. Emerson LE, ed. (1929). Physician and Patient: Personal Care. Cambridge, MA: Harvard University Press.
  10. Saunders C. Letter. AM J HOSP PALLIAT CARE. 1992;9(4):2.
  11. Worcester, Alfred (1935). The Care of the Aged, the Dying, and the Dead. Springfield, IL: Charles C Thomas. p. 6. Read online at http://babel.hathitrust.org/cgi/pt?id=mdp.39015012537695;view=1up;seq=7. quoted also in Geriatrics--The Care of the Aged. JAMA. 1937;109(26):2143-2144. reprinted JAMA. 2014;312(11):1159.
  12. Ibid, pp.43-44
  13. Paul, Elliot (1947). Linden on the Saugus Branch. New York: Random House. p. 247.
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