By Richard P. Holm MD
I first met Dr. Alonzo Peeke (AKA Doc Peeke) when he was already in his late 80s. It was 1982, just before the holidays, during a District Medical Society meeting in Flandreau. The meeting started with Christmas carols that were accompanied by Doc Peeke playing on his violin.
I later learned how Doc Peeke had been one of South Dakota’s truly rural doctors, practicing his whole professional life in the small town of Volga. He was entirely familiar with delivering babies at home and performing minor surgery on kitchen tables. He had to drive early automobiles on dirt roads and figure out ingenious ways to make house calls during dreary winter storms. He was famous for inventively transforming a car into a snowmobile so that he could provide home visits to patients when other doctors couldn’t make the trip. There are many stories about how he earned the trust and respect of many families in that small town and the surrounding farming communities; how he even started a hospital in Volga so that patients could receive their medical and surgical care there. The picture of his life was almost like a Terry Redlin painting.
It was a time when doctors knew their patients from the cradle to the grave and had a general knowledge of all medicine, only referring to specialists for especially complicated or peculiar cases. For Doc Peeke, this meant consulting the experts at Mayo clinic, the now world-renowned Minnesota based medical center.
Doc Peeke was a “General Practitioner” who provided rural health care in the Midwest. It was the end of an era. When many of these small-town doctors retired, there was no new doctor to replace their practice. And though the rural landscape has changed, the lack of competent doctors has remained the same. Patients now have increased mobility; the General Practitioners have become Family Practitioners, Pediatricians, and General Internists; and in this new era, we have expert sub-specialist doctors right here in South Dakota with specialty care centers in our cities, providing some of the finest advanced health care there is.
But with all this good, something important has been lost. The picture of a rural, all-knowing, and personal Doc Peeke is not to be painted again except by memory.
The Beginnings of the Mayo Clinic
William Worrall Mayo had a curious and remarkable life, which included influencing the development of the prestigious Mayo Clinic. He was the descendent of famous English chemist John Mayow, who in 1668 first discovered spiritus nitroaereus, a component of air that would later be known as oxygen. W.W. Mayo was born in England in 1819 and before moving westward to the Americas, Mayo would study under John Dalton, the scientist best known for developing modern atomic theory.
Mayo left for New York City to work as a pharmacist but soon moved west to attend medical school. He first trained in Indiana but finished his medical degree in Missouri. There, he was troubled with recurrent bouts of malaria, which he blamed on the southern heat. This brought him to move north to Minnesota for a healthier climate.
He lived in several Minnesota towns including St. Paul, Duluth, and Le Sueur, before finally moving to Rochester. During those times, W. W. supplemented his medical practice by tailoring, farming, operating a ferry service, serving as a justice of the peace, and publishing a newspaper. He was called to serve as a physician during the devastating Dakota Indian War of 1862, which ended near New Ulm, Minnesota and concluded with the hanging of 38 Dakota Sioux Indians.
Dr. Mayo then moved his family to Rochester in 1864, bringing his wife Louise, their three daughters and a young son. He came for a job with the draft board, performing examinations for the Army. After the Civil War, Dr. Mayo, often called “the little doctor,” due to his height of only 5’ 4”, set up a medical practice of his very own and welcomed the addition of a second son to the family. While W. W.’s practice continued to grow, he also found time to serve as an alderman, a school board member, the mayor of Rochester, and a member of the Minnesota State Senate.
In 1883, a destructive tornado came through Rochester and Mayo turned to the Sisters of St. Francis for help, a teaching order with little medical experience. His eldest son, Will, had just returned to Rochester after medical training, and his second son Charlie, still in medical school, both joined W. W. to care for tornado victims. In response to this experience, the Sisters later built St. Mary’s, a twelve-bed hospital with the three Mayo doctors as surgeons and the Sisters of St. Frances as nurses.
The success of the Mayo Clinic is said to have happened because of W. W.’s early concept of a group practice and his appreciation for collaboration. It all started with the dad and two sons working together, along with the Sister-teachers turned nurses and the research and education that follows the shared work of a team.
The Man with the Bulbous Nose
By Richard P. Holm, MD
Despite the man's caring conversation, I heard very little of it because his large, rosy, bulbous, and bumpy nose had stolen my attention. Years later, when I met him again, he looked like a different man. The rosacea and rhinophyma skin condition, which had made his face so red and nose so massive, was calmed down with medication, and the excessive growth of skin over the nose had been trimmed away by laser scalpel. This time my eyes were no longer drawn to that globular and swollen proboscis and instead were charmed by his kind and wizened eyes.
Acne rosacea, or more commonly called just rosacea, affects 14 million people in the U.S., or five percent of the population, and is sometimes said to be an adult version of acne vulgaris. We see rosacea more often in 30 to 50-year-old women, and it can flair as menopause approaches. When it does affect men, it can be severe, and in a percentage of cases, rosacea can cause an ever-growing piling up of skin over the nose, called rhinophyma.
Rosacea usually targets fair-skinned, freckle-faced, blond or redheaded, blue-eyed people who flush easily. It seems triggered by sun exposure, hot drinks, hot baths and showers, hot spicy foods, stress, exercise, and steroid medications. Of course, one way to prevent rosacea is to try to avoid such triggers.
Acne vulgaris, or more commonly called just acne, is similar to rosacea, and seems also related to hormonal swings. Acne affects about 85% of all U.S. adolescents and, more often than rosacea, causes whiteheads and blackheads. Adolescents living in western modernized civilizations struggle with acne, however it rarely affects anyone living in non-industrialized societies. This has led some experts to believe acne and rosacea might be made worse by soap, excessive cleanliness, antibiotic use, and anything that alters the normal-flora living on our skin, which protects us from invasive bacteria. It’s like how grass on a lawn protects against weeds.
The two conditions of rosacea and acne have common methods of treatment. Over-the-counter lotions like benzoyl peroxide, prescription antibiotics, and Vitamin A, each in lotion and pill form, are still the mainstay of therapy.
In contrast, recently there is a trend to move toward supporting one’s normal flora, avoiding antibiotics, cleansing agents, or oil removing methods, and even trying probiotics. This is all in an effort to re-establish a lawn of protection to fight the invasion of weeds. Treatment is effective in most people, but not all. So if you don’t find relief with typical treatments, or your nose starts growing, it’s time to see your doctor and/or the dermatologist.