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"Coal Mountain, West Virginia:  The medical situation down here is so primitive I can't believe it.  Almost no sterile technique possible for anything, including OB.  I get an ulcer thinking about it.  I had to buy a bottle of Lysol to use as an antiseptic for the present and salve my conscience a little.  I haven't had a delivery yet, but there's one woman who should have crashed through ten days ago, so I expect a call from her any minute.  My stomach churns whenever I think of it, and I toss for hours at night trying to figure out how to do a delivery here safely.
    "That [first] afternoon... I damned near panicked.  I didn't know what was in the office, who any of the people were, or anything about their medical problems.  [My predecessor] had given me a quick tour of the office, what there is of it.  He just waved his hand airily toward the shelves of drugs in the little lab - all proprietary names that meant not a thing to me after using the USP terms... It seems the doctor here runs a regular drug store and is supposed to dispense all medications except vitamins and what comes out of a needle without charging anything extra... He didn't have much in the line of patient records - a few cards in a box.  I asked him about sterilizing equipment, and he said he bought all his bandages sterile, and not to bother with anything except boiling up needles and syringes in the little electric sterilizer.  For deliveries I should just use the cleanest gloves in the OB bag and things would work out all right!"

This excerpt is from a letter written in 1949 by Dr. Bonta Hiscoe, who worked as a physician in the coalfields of southern West Virginia.

Source: Helen Hiscoe, Appalachian Passage (1991).