Iowa History Project

Recollections of Edward Hornibrook -- A Medical Chevalier
by W.E. Sanders, M.D., Des Moines

Dr. Edward Hornibrook

The recent death of Edward Hornibrook of Cherokee at the age of eighty-six years, has taken from among us one of the most outstanding characters of our profession of the last generation.

My acquaintance with Dr. Hornibrook began, when I called him as a consultant to a farm house in Buena Vista county, in a case of diffuse peritonitis resulting from appendicitis, one afternoon in June, 1895. After securing the history, and completing his examination, we strolled out into the apple orchard for a discussion as to what course to persue. My patient was a child about ten years old, who had been ill only three or four days, but was still vomiting frequently and the abdomen was much distended.

As a novice in the art of healing, I had not considered her condition so desperate, but the large experience of my consultant showed him at once the almost hopelessness of the situation. He explained to the family that the chance were overwhelmingly against us, whether we operated or not, but concluded by saying, "If it wee my child I think I would operate." With the consent of the family, and an improvised operating table, he quickly opened the abdomen, which was already full of fluid, tied off some gangrenous omentum and established guage drainage. The patient died in shock ten hours later.

Dr. Hornibrook was at this time in his fifty-sixth year, a man of splendid physique, with a gentle and dignified bearing that impressed me greatly. He wore a blue serge suit with a white vest, and his smoothly shaven face, usually serious, lit up at times with an effusive smile that gave an unusual charm to his personality.

He enjoyed a most extensive practice, traveling the Illinois Central railroad from Ft. Dodge to Sioux City, and north and south from the Minnesota line to Onawa. He must have spent nearly half of his time in consultation work, driving by team night and day in all kinds of weather over the country roads for a radius of thirty or forty miles.

He was a dignified, courteous and skillful consultant, especially expert in the elicitation of a clinical history, and his large and diversified experience made him a master of diagnosis without recourse to laboratory methods, which were rarely applicable to the conditions of country practice.

He was a surgeon of good practical judgment, a master of principles, rather than technique, and its practice he seemed to consider a duty rather than a line to be cultivated for its own sake.

His operations were always done in the home with the attending physician, and any neighbor or friend of the family whom he could press into service as his assistants.

In these days exploratory laparotomy was neither popular with the public nor the profession, and the necessity for a more specific diagnosis than acute abdomen, disease of the biliary tracts, or pelvic inflammatory condition, was calculated to temper one's zeal with prudence, and to make one weigh well the hazards of an undertaking that must reveal more than stringy bile or bloody sponges, and accordingly every operation undertaken was a serious challenge to one's reputation in the community. Dr. Hornibrook was fearless in the face of definite indications and never shirked a responsibility, no matter how desperate the situation.

I remember one evening about twenty-two or twenty-three years ago, I called him on my own initiative to a case of intussusception, which I had just seen a few hours before. He arrived on a late train, and we drove aobut eight miles through the mud, to a farm house, arriving before midnight, much to the surprise of the family. Dr. Hornibrook sat down by the cradle, and with a serious face watched the baby for a half hour or so, scarcely saying a word. We then retired for a private consultation as was his usual custom, and after reviewing the case, he concurred in my diagnosis. We inverted the baby and gave repeated large enemas under high pressure to no avail. He then frankly stated the situation to the family, advising operation, but at the same time assuring them that an operation carried a very grave danger. They refused operation, and as we started home about midnight he remarked; "Doctor, they have relieved us of a very grave responsibility. The expectant mortality is more than 60 per cent, and the surgical not much better." The baby died two or three days later. To have operated by lamp light in a farm house at midnight required courage which he did not lack, but he knew too well the surgical limitations of the situation.

Early in my practice I called him to see a two year old child with an abdomen enormously distended with fluid, with night sweats and a low grade of fever, which I had diagnosed tuberculous peritonitis. On obtaining the history, he remarked that the onset was too acute for tuberculous peritonitis and made a diagnosis of huge appendicial abscess, and advised operation, which was refused. The family was ignorant and poor, and the surroundings miserable. With the zeal of a novice, I remarked to him as we were returning to my office that I would take the child to my own home, and operate it, if I thought we could save it. He replied thoughtfully, "Never begin that, Doctor, you will find that those for whom you do most are the least grateful, and the first to make you trouble when things go against you." A week later the abdomen ruptured at the umbilicus, and discharged a chamber full of pus, and the youngster made a rapid recovery.

A few years later I called him to see a very sick boy with streptococcus phlegmon of the forearm. The treatment in the early stage had been wet packs and watchful waiting, during which period I experienced much trouble in controlling the mother and the neighbors. We opened and drained a deep abscess after which, Dr. Hornibrook expressed the hope that the son would make a good recovery. At this juncture the mother and meddlesome neighbor, both of whom were of a very garrulous type, launched into a lauditory expatiation of the wonderful skill I had demonstrated in the management of the case in which my consultant heartily concurred. I remarked on the unmerited praise of my admirers after leaving the house, to which Dr. Hornibrook responded by saying, "Never refuse a compliment Doctor, for if you put your compliments in one pocket and your cursings in another you will be about even at the end of the year."

About 1896 we were called jointly, he for his skill and I for political reasons, into the northeastern part of the state, to see a middle-aged woman who had been ill a long time. In consultation with the family physician, Hornibrook brought out a strikingly clear history of severe persistent pain and soreness in epigastrium and right hypochondrium associated with jaundice, fever, septic chill, and sweats, followed after some weeks, by a period of pain in the right side, dyspnrea, continuous fever and eventually the sudden expectoration of a very large amount of pus, with slight improvement up to the time we saw her, several months later.

The physical findings I do not recall but the sequence of events as he skillfully elected them, gave me, I thought, a clue to the diagnosis. After retiring for consultation, Hornibrook suggested that, inasmuch as I was the youngest of the consultants that the ethics of the profession allowed me to speak first. I made the diagnosis of biliary infection followed by subphrenic abscess, rupturing into the right pleura and discharging through a bronchus. He complimented me for my diagnosis by saying that I had expressed his opinion so clearly that he could add nothing to my own words.

We made this trip on a bitter cold night arriving about one o'clock in the morning, and finding no accommodations in the only hotel in the village, were assigned to an unheated room over a neighboring store. After getting to bed, Dr. Hornibrook, always very careful of his health, got up and placed his heavy astrakhan overcoat in his bed and wrapping himself up was soon fast asleep. Imagine my surprise, when I awakened about sunrise the following morning to find him up taking a cold sponge bath from the conventional bowl of water that sat on the stand between our beds. He must have broken the ice in the pitcher to do so.

One afternoon in company with a former classmate, I called on him in his office and he invited us to his home for dinner. After presenting us to Mrs. Hornibrook and his children, he led us into his library and gently closing the door, turned with a most serious face and said, "Gentlemen I have just this afternoon passed through one of the most serious trials of my life. A mother and father in one of the best families of our town, and in which I have been the family physician for many years have just brought to me their beautiful daughter whom I have known since childhood, and she is three or four months pregnant." The lesson so well put, and stressed with such evident sincerity could not fail to impress a young man just entering into practice.

Dr. Hornibrook was not a Catholic, but his convictions on race suicide and sex morals was quite in accord with the teachings of the Mother Church. He believed that only the most imminent danger to the life of the mother justified an interference with pregnancy and then only after a concurrence with consul. Acting on his advise I once lost a primipara from pernicious vomiting, after a most stormy pregnancy of three months.

He was at this time professor of gynecology in the Sioux City College of Medicine, and consulting gynecologist of the State Hospital for the Insane at Independence. A year or two later, he saw with me, a huge, stout middle-aged woman with intestinal obstruction, an umbilical hernia, and a history indicating the fourth or fifth month of pregnancy. There was no evidence of strangulation at the umbilicus but she was vomiting frequently, was enormously distended and suffered such pain I had been obliged to keep her under morphine for several days. The distention and mattress-like abdomen made examination very unsatisfactory but we thought we could make out a spherical mass filling the abdomen almost to the ensiform process. On examination under chloroform an elastic mass high in the pelvis was revealed. Dr. Hornibrook made a diagnosis of a four or five months' pregnancy complicated by a large ovarian cyst, in which I concurred, as it seemed quite reasonable.

With his usual conservatism he suggested that we might operate the cyst, and conserve the pregnancy, or spontaneous miscarriage might ensue in which event we could much more safely deal with the cyst later. Adopting the prevailing policy of the day, "When in doubt wait," I continued the morphine and after three or four more stormy days my patient was sudden]y delivered of five months' triplets associated with an extreme hydramnious and made a prompt recovery. In writing him of the happy outcome I facetiously remarked that "the cyst had undergone absorption"; to which he replied with apparent sincerity that, "It had perhaps ruptured during delivery." Dr. Hornibrook had that type of mind, which considered well before arriving at a decision and then held firmly to his convictions. Moreover the reversal of a diagnosis in those days was a mark of heresy which the public could not condone. He not only understood well the science and the art of medicine, but likewise the art of the practice of medicine. He believed firmly in himself, and recognizing his own leadership, was something of a martinet in the formalities of his consultations.

I once wrote and asked him to assist me in an abdominal operation for a large pelvic tumor. In reply he suggested that in justice to himself he first be allowed the courtesy of examining the patient and concurring in the diagnosis. To this I replied that of course, I expected to defer to his superior judgment but that my patient was too poor to pay for formalities, and I had accordingly arranged for other assistance. The affair was passed in the best of grace and we frequently thereafter helped each other in our operative work.

His reputation amongst laymen was so great that he spoke with the authority of the oracle and had a masterly skill in the management of nervous cases. He once saw with me, a snappy black-eyed middle-aged widow who had made a matrimonial pilgrimage to my town and invaded the household of a prosperous recently bereaved brother-in-law. Through some hitch in the proceedings she excused herself from the dinner table one evening and was found in a swoon on the front porch, by the anxious brother-in-law. She immediately fell to "cribbing," passing at times into stereotyped attacks of pseudo angina. In spite of all my skill and reassurance, she kept that quarter of the village in an uproar night and day for forty-eight hours by which time the inflation of her epigastrium and the deflation of my skill were at the antipodes. To stabilize the situation and prevent a panic I called in Dr. Hornibrook at 10 o'clock in the evening. In the seclusion of the counsel chamber he said, "Doctor, this is the class of case upon which a young man makes his reputation, upon the real ones he cannot." Out of consideration for the brother-in-law who paid the bills, I suggested that he frankly state the situation to both the friends and the patient. This he did very tactfully and fortified his statement by an appeal to the pharmocopea, prescribing equal parts of tincture of aloes and tincture of asafetida to be given in teaspoonful doses every two hours until relieved. The result was marvelous. The neighbors soon dispersed, the patient later defecated and by the following noon her deflation had reached such a point that she hastily packed her suit case and departed, saying she was going home where they had doctors who knew how to treat a sick woman.

He was once called to our village to operate a deep seated scarlatinal suppuration of the neck for a medieval-like doctor whose friendship he coveted, but assistance for sanitary reasons he preferred to eschew. Dr. Hornibrook, with that ready tact in which he was never lacking, handed the doctor a paquelin cautery and placing him at a safe distance in the corner of the room told him to "Keep it at a cherry red glow," as he might encounter grave hemorrhage and instantly need it.

He was orthodox in his practice and seemed to firmly believe that if a patient died under the recognized treatment for his condition that the results could not have been otherwise. He was surprised that a teacher in the Homeopathic School at Iowa City should have said "That this school had no need for pathology, that they only treated symptoms anyway." The complacent disregard for pathologic groundwork and the present vogue for disfunctional diagnosis and treatment with its Hellenized hyper-, hypo-, ortho-, meta and para-syndromies might almost seem to justify the professor's opinion and to suggest that for the first time the Greek Renaissance is upon us.

Indeed the never changing principle of cause and effect in the philosophy of events is endangered when we begin to speak of physical sequence without regard to physical antecedence, and place function above structure.

These mere verbal consolations by which indefinite and hypothetical concepts are so glibly hitched up to clinical medicine are but the smoke screens behind which we conceal our ignorance; the reflections, as it were, of an effete Spencerianism. They serve better to appease our pride than the frank acknowledgment like our Roman forbears, that "to seek the final cause of things is futile and like a virgin consecrated to the gods bears nothing."

While Dr. Hornibrook was sectarian in his faith and practice, he once said, "I always grant to any man the right to select his own religion, his own doctor and his own wife." While he recognized his own skill and was jealous of his own right, he was none the less, fair and just to others. When in the late nineties, Dr. William Jepson was admitted to examination without preparation and granted the degree of
L. R. C. S. Edinburgh, Dr. Hornibrook seemed to appreciate the honor almost as much as if it had come to himself. A few years before he had made his only trip abroad and had visited some of the leading clinics of England such as Lawson Taite and Frederick Treaves, but was much impressed with Allendale's work in Edinburgh and related that in his clinic he saw a student administering a general anesthetic with difficulty and being somewhat chagrined by the jibes of his classmates, Allendale rebuked them by saying, "Gentlemen, this doctor is performing one of the most important operations in surgery."

Dr. Hornibrook took his work and his profession seriously, and was little given to levity. Notwithstanding his gentility he had a certain austerity of manner which forbid familiarity, yet marked him as a leader of men. He seemed to follow the counsel of Washington, "to be courteous to all, but intimate with few, and let those few be well tried before you give them your confidence." His Canadian birth and education made him more the type of the English physician than the American. Although his life and training covered the period of the development of the evolutionary thought, I rarely heard him give expression on philosophic, political or religious lines.

He was a member of the Episcopalian Church and a Democrat, but he seemed to leave to the church the affairs of the spirit and to statesmen the functions of government, believing as he was wont to say "that to know one profession was enough to engross the mind of any man." During the middle part of life he suffered a break in health probably of a nervous character, for he once told me that for two years he was completely cut off from professional duties and that this break in his medical reading, he felt he had never quite made up.

He once dropped a remark that suggests the philosophy of life to which he probably held. He expressed the desire before retiring to make a leisurely trip around the world and when on entering New York harbor to drop dead on deck.

Those who knew him thirty years ago, will recall the pock mark on his face which he carried from his student days in Toronto. While in quarantine, with eyes swollen shut and attended only by a negro mammy, he asked her to get him an ounce of laudanum which he took with suicidal intent as soon as left alone. He said he was much disgusted when he awakened thirty-six hours later, with the same wracking pains and the same distracting rattle of the wagons on the cobblestones below his window. "I reasoned I was going to die anyway, and that medicine was intended to relieve pain, therefore suicide was justified."

Although his long drives and broken rest was a severe strain on the physical endurance of any man, he rarely complained of fatigue. He was generally careful of his health and had for many years his buggy box swung at each corner on coil springs to break the jar of the rough roads. He had a sheep-skin bag, into which he put his feet and legs when driving in winter and a built-in space on either side of his seat where he often kept lanterns burning to warm his hands by. To one of the bows of his buggy top was hung a small bag containing tobacco, matches and his pipe, which he indulged in strict moderation.

In the fall of 1898 I became quite alarmed at the discovery in myself of a persistent light albuminuria. I was lecturing one day a week in Sioux City and I stopped off one evening, between trains, at Cherokee to consult Dr. Hornibrook about my condition. He assured me that I need not be alarmed that it was only the constant setting in my buggy driving over the rough roads and suggested that I arrange my rig as he had his and frequently change my position, sitting for a time like Abraham Lincoln, well down on the base of the scapulae, then changing occasionally, resting my elbows on my knees. As usual he reinforced his psychotherapy by prescribing three grains of Extract of Colocyuth Compound after meals, saying that a little stimulation of the liver after the hot summer would help me. The result was gratifying, after a few days of purgation my albuminuria had disappeared completely and has remained so.

He had a masterful command of terse English which made his address and writings clear and forceful. His medical history of the Pomeroy cyclone was very well done indeed. Many will recall the sanity of his remarks, when at the Sioux City meeting of the State Society in 1912, he was pressed for a discussion of a paper on the Teachings of Sex Hygiene, in the course of which he declared that he was in full accord with the expression of Arch Bishop Farley of New York, "that the less said about sex matters the better." Certainly the last decade of sex hygiene propaganda has justified his opinion.

He was always a very busy man and must have had little time for outside reading, though his memory seemed to retain all that he had ever read or heard. The long country drives gave much time for serious reflection and judicious consideration of his cases and whether at the bedside or in discussions in medical societies he gave the impression that the question for consideration was one to which he had long since given serious study and decided for himself.

One stormy night, when returning from a consultation in the outskirts of our town, my village colleague was leading the way along a path, with a lantern, when Dr. Hornibrook broke out quoting from the 119th Psalm, "Thou art a lamp unto my feet and a light unto my path." When John Watson brought out his Scotch Idyls in the middle nineties, under the title of "Beside the Bonnie Briar Bush", Dr. Hornibrook was much impressed with the character of the old Scotch doctor in which he must have seen many reflections of himself. He also liked Burns. He remarked on one occasion, while we were being served dinner in Storm Lake, that our waitress strikingly recalled the face of Burn's Highland Mary. Indeed she had a rustic beauty so well expressed in the couplet, "Those rosy lips and sparkling glance that dwelt on me so kindly." Dr. Hornibrook possessed to high degree the spirit of self-mastery and was neither moved by flattery, nor adversity. He lived largely for his profession and his family. Though he enjoyed a large and lucrative practice for forty years he did not amass a great fortune.

On the occasion of the surprise celebration of the fiftieth anniversary of his doctorate, after he had been feted and toasted by his friends and fellow colleagues, he extemporaneously responded to the toast of "How It Feels", in a most masterful and dignified manner. He began by saying that he was at first somewhat at a loss to understand the purpose of the occasion, "Whether it was a reminder that the time had arrived for him to retire: whether it was an attempt to tickle the vanity of an old man, or whether it was rather, the token of a sincere friendship from his colleagues with whom he had labored so long; but that after listening to the felicitations of those who had preceded him he had resolved to accept the latter as true. He spoke for about fifteen minutes and concluded by saying, "When at last my work is done and I am laid away, I shall be most pleased, if upon the stone that marks my resting place shall be inscribed this simple epitaph. "Here lies a man who never shirked a duty." Few men are more worthy of such a remark.

I last saw him when I visited Cherokee in the interests of the Selective Service Draft in September, 1918. He was then in his eightieth year and his intellect seemed as clear as ever. Mrs. Hornibrook was then hopelessly ill and he spent much time with her. He took me out to the new city hospital and showed much pride in its construction and appointments, in which he had played a large part.

He spoke of retiring soon and I urged him as I had done before to write his memoirs, suggesting that his experience had been so full, so great, and so diversified, and that the relation of the physician to the public was so rapidly changing, that it would be a rich treasure for the generation of doctors coming on. He replied with a smile that he did not know that anyone would be especially interested in his experiences and so I presume, without a written record, there passed to his reward this great and noble man.

(pg 292-307)