Smart, hard work brings superior health care to Union County

So far as medical care is concerned, fate has been kind to Americans during the last hundred years. During that same century, fate has been more than kind, one might fairly say providentially so, with regard to the medical care available in Union County, Mississippi.

It didn’t just happen. Although some of the events that resulted in such good medical care here seem to have been unplanned and random, the situation here is the result of smart, hard work over several decades by some exceptional individuals.

Because of the work of Louis Pasteur and others, germ theory was fairly well developed by early in the 20th century, but its actual application in the practice of medicine was still spotty in Union County and elsewhere in rural America. In 1928, Alexander Fleming discovered penicillin, which would not be put into widespread use until World War II. Nobody had heard of sulfa drugs. Alcohol or turpentine were often the only antiseptics available.

Though the desirability of cleanliness in medical treatment was pretty well established by 1900,  there were many impediments to its actual implementation.

British Army doctors performed the first successful blood transfusions using blood that had been kept in cold storage during World War I. It was many more years before such transfusions would be performed in north Mississippi.

Much “modern” medical technology available a century ago was primitive compared to what we have now, and not generally available to patients in rural areas.

A hundred years ago, roads in Union County were dirt with very little gravel mixed in. There were a few  bridges over the Tallahatchie River. Lesser streams were “forded,” the vehicle driven slowly across through the water, at what was hoped to be a shallow place where  the stream bed would support the weight of the car or mule-drawn wagon .

Doctors made house calls in those early days. They dodged stumps and mud holes driving around Union County to perform surgery on kitchen tables and deliver babies from mothers agonizing on mattresses filled with straw or feathers, surrounded by their female kin and neighbors.

Hugh Norbin Mayes was born in Union County on January 11, 1878. On May 20, 1901, Mayes registered himself as a physician with the Union County Circuit Clerk. He would have been 23 years old on that date, too young to have completed the course of medical training expected of medical doctors today, but not uncommonly young for doctors of his time.

While still a young man, Hugh Mayes established what is believed to have been the first hospital in Union County; in any case, it was the first one to remain in business for very long. Dr. Mayes started the hospital in his home on Main Street at Central Avenue. He and his wife moved to another house two doors farther east on Main Street. Mayes added an additional building to his  hospital operation and ran it successfully until the mid 1930s. Then, at around age 57 or 58, Mayes apparently decided he could no longer tolerate practicing medicine or operating a hospital.

We will return to that thread of the story, but now it’s time to add another character to this narrative about how Union County came to have much better medical care than most all other rural counties in America.

Robert E. Shands was born March 25, 1907. He was raised in modest circumstances in Sherman, Mississippi, about 15 miles from New Albany.

Young Bob Shands wanted to be a physician, finished high school and enrolled at the medical school of the University of Mississippi. Ole Miss medical school did not then have a program that could award a four-year Doctor of Medicine degree. It had a two-year program that allowed medical students to receive a certificate, not a full M.D. degree.

After receiving his two-year certificate in Mississippi, Robert Shands enrolled in the medical school of Vanderbilt University in Nashville, earning his M.D. degree there in 1931. He married  his wife Margaret, a graduate nurse, while in Nashville. Shands then went through further surgical training at Harvard University Medical School, and remained in Boston to complete a surgical residency at the U. S. Naval Hospital..

According to their son, Dr. Thomas Shands of New Albany, Margaret Shands, who had grown up in Murfreesboro, Tennessee, did not meet her in-laws in Sherman until after the marriage. She noted on the trip through Mississippi to Sherman that she “saw nothing but mud and gravel” after they crossed the state line leaving Tennessee. Tom Shands said his paternal grandmother had already picked out a bride for his father, and even had the woman’s photograph conspicuously displayed in the Sherman home. Tom Shands said the combination of circumstances may have made his mother pretty uncomfortable during the early part of her visit to the small house in Sherman.

After his residency in Boston, Dr. Robert Shands opened a surgical practice in Tupelo in 1935. He was among the first ever board-certified surgeons in Mississippi. His exceptional training and skills helped ensure that his surgical practice at the Tupelo hospital was quickly successful. His mother apparently grew fonder of her daughter-in-law.

About 1936, Dr. Hugh Mayes contacted Dr. Robert Shands, saying that he desperately needed a vacation and some rest from his practice in New Albany. Mayes asked Shands to come to New Albany, run his hospital and attend to his patients while he and his second wife went for a vacation. Shands said “no”, that he was busy and happy with his surgery in Tupelo.

But Mayes was persistent and contacted Bob Shands again, pleading that the young surgeon come relieve him for a while in New Albany. Shands said “no” again. Mayes kept pestering him.

Then, not to be denied, Hugh Mayes contacted Margaret Shands and made his case to her. Mayes said that Bob and Margaret could live in his fine, large home in New Albany while Bob ran his hospital and he and Mrs. Mayes took their vacation. Perhaps welcoming the opportunity to escape the small house in Sherman, Margaret Shands persuaded her husband to leave his Tupelo practice and move to New Albany while Mayes went away for a short vacation.

Robert and Margaret Shands moved into the big white house in New Albany. He was 29 years old.

Hugh and Frances Mitchell Mayes packed their bags, got into their 4,500 pound, all-steel-and-cast-iron, automobile and took off for their two-month vacation.

New Albany had a population of about 3,500 in 1936.

Overnight, it became one of very few small towns in the U.S. to have its very own board-certified surgeon. His training at Harvard and residency at the U.S. Navy hospital had, indeed, made Robert Shands among the very first board certified surgeons anywhere in the country. In fact, the strict requirements for board certification of American surgeons were established while Shands was still in surgical training in Boston. Even now, 80 years later, there are only 30,000 certified surgeons in the United States, and only about 250 in Mississippi.

The arrival here of a surgeon with those credentials was a watershed event with long-lasting   impact on the quality of medical care in Union County. Shands started to develop a large surgical practice very quickly, while expecting Dr. Hugh Mayes to return soon and reclaim his hospital and medical practice.

But the two agreed-upon months went by, and Mayes did not return to Union County. Shands did not know how to contact Mayes, nor even where the older doctor was. More time went by–four months, then eight months, still no Dr. Mayes. Finally, about a year after leaving his hospital and medical practice in the hands of young Dr. Shands, a well-rested Hugh Norbin Mayes showed back up in Union County in 1937.

Upon his long-delayed return to New Albany, Dr. Mayes told Dr. Shands that he wanted to retire immediately from the practice of medicine and ownership of the hospital. Terms and conditions of the sale are not known, but apparently Bob Shands rather quickly agreed to become a hospital owner at age 30.

“You might say Dr. Mayes sort of tricked my father into taking over the hospital,” Dr. Tom Shands said recently.

While the way he quit his medical practice was certainly unorthodox, there is little doubt that recruiting Dr. Shands to Union County had a favorable impact on local medical care still felt 80 years later.

Mayes left some administrative and other staff in place, most notably a nurse named Grace Porter. According to an article in the 1989 “Union County History,” Mrs. Porter, “ran everything with a stern, disciplined approach.”

From what can be gleaned from the records, Dr Shands was still able to concentrate most of his time and energy on his medical practice, which grew considerably. His surgical practice included patients from Holly Springs, Pontotoc, Ripley, and Tupelo. Other doctors who practiced at Shands hospital included Dr. David Pennebaker, Dr. Sam Houston Liddell, Dr. Hayes Wesson, Dr. Curtis Roberts, Dr. Robert H. Bostwick, Dr. David B. Ellis and Dr. James L. Thornton.

Robert Shands interrupted his professional and business career in New Albany to volunteer for service during World War II. He served as a surgeon with the United States Navy in the Pacific theater.

Back in Union County after the war, Bob Shands developed a new method of surgically treating facial fractures that significantly reduced surgical time and scarring. His paper on the subject appeared in the January 1956 issue of American Journal of Surgery.

Shands was an innovator, and lectured at Harvard Medical School on some of the techniques he developed.

The late Dr. David B. Ellis, who started his own medical practice in New Albany in June, 1956, recalled Robert Shands during a 1999 interview with Errol Castens. “He was the first person I ever saw rip open a chest and massage a heart back to life,” Dr. Ellis told Castens. “He was not only an innovator, but he was a damned good surgeon. I doubt you could have found a better one in Tupelo or anywhere else.”

Not only was Bob Shands an exceptional surgeon, he also apparently had outstanding skills as a businessman. He managed a complex operation that even included a large vegetable garden, which provided a substantial part of the food served at Shands Hospital. He found the time to supervise hospital personnel, control costs and maintain a sustainable bottom line, while also maintaining a large medical practice.

Dr. Shands was offered a position at Mayo Clinic, but turned it down to stay in Union County. Twice he expanded the size of the hospital he’d bought from Dr. Mayes in 1937. Dr. Thomas Shands recalled that his father routinely worked 70 hour weeks and did not like to be away from New Albany for any reason.

There were no dedicated emergency room physicians in small town hospitals in the 1950s. Highway 78 was a dangerous, winding road that carried heavy passenger car and commercial truck traffic between Birmingham and Memphis. “Highway 78 was a trauma highway,” Thomas Shands said. He recalled how his father was often called from his sleep in the early morning hours and would get up, dress and go to the hospital to try saving someone who had been badly injured in a car wreck on Highway 78.

Then in 1961, in his early 50s, Dr. Robert Shands became ill and was diagnosed with pancreatic cancer. “He knew it was going to be terminal,” Dr. Tom Shands said recently. “He recruited Dr. E. E. Bramlitt, another qualified surgeon, to come to New Albany.”

Dr. Bramlitt began his practice in New Albany on June 19, 1963.

Dr. Robert Shands died less than four months later, on Sunday, October  6, 1963. He was 56 years old. Before his death, he had negotiated the sale of Shands Hospital to Union County. He had also discussed with the county supervisors the need to build a new hospital, one designed to deal with the major changes already affecting the American healthcare industry.

Margaret Shands continued to assist the Board of Supervisors in operating the Shands Hospital, while the board considered what to do for the future of medical care here.

This article is Part I of II about how Union County came to have much better health care than most rural counties in America.