EARL TREVATHAN, M.D.

September 13, 2000

Interviewer: Marion Blackburn

Marion Blackburn: Please state your name and give us some background.

Earl Trevathan: My name is Earl Trevathan and I did serve as Chief of Staff at Pitt County Memorial Hospital in 1971 and 1972 and at that time it was a two-year term.

Marion Blackburn: You probably saw a lot of technological changes during your time as a physician.

Earl Trevathan: Oh yes, a lot of the image scanning starting off with CT scans. These gave visual images of the brain, internal organs, a lot of contrast media improvements. The skills and techniques of physicians had greatly improved. Imaging devices that could do anything but get inside of a human body.

Marion Blackburn: Now all you have to do is hook up the robotic device and it can do just about anything.

Earl Trevathan: That's right. It can do and see so much and it is tremendously enhancing and improving medical skills.

Marion Blackburn: In some of the procedures that I have been involved with I have seen how that has changed. You can put someone on a full body CT scanner and perform that abdominal aortic surgery and, I guess, the whole time they are under some kind of scanning device. They are actually performing the surgery while they are on the scanning device. It is just tremendous.

Earl Trevathan: I am aware of that technology process in addition all sorts of resources that improve every year since I started.

Marion Blackburn: Dr. Trevathan, you were a pediatrician. Tell me a little about when you started to practice in Greenville.

Earl Trevathan: I sure will and I would like to tell you why I came to Greenville because I think it sort of describes what has been the beginning of great things that have happened here in the medical community. I was in training in Richmond in pediatrics and my father sent me a clipping from the The Daily Reflector which showed a picture, a sketch, of a new Hill Burton hospital and that impressed me because the Hill Burton legislation after the War turned medicine around in the United States and it hit first here in Greenville. We had at that time begun to develop, with a Hill Burton grant, a Hill Burton public hospital in this county.

Marion Blackburn: That would be the old Fifth Street hospital.

Earl Trevathan: Yes, it was the old Fifth Street hospital. At that time most of the hospitals, all of hospitals in eastern North Carolina were privately owned and they were working facilities out of which doctors that owned their own practice. Greenville had such a private hospital over on Johnston Street, sure did, and Dr. Pace, Dr. Wooten and Dr. Winstead and two or three others relinquished that, gave it up as a service to the community in favor of our county commissioners accepting the Hill Burton grant and the building of Pitt Memorial Hospital. The reason that was important because I could come here and practice in that hospital and as a specialist I had to work out of a hospital base and set up my private practice and practice here. I could not go to Wilson; I could not go to Goldsboro when I looked at those towns unless I was invited. I was asked to come to Goldsboro but I didn't particularly want to go to another county. My home was in Pitt County and this is where I wanted to come back to.

Marion Blackburn: So you couldn't practice at that time in one of these privately owned hospitals unless you were invited?

Earl Trevathan: Right, well the Hill Burton hospital regulated was stipulated that it had to be an open hospital and we set up our own bylaws and qualifications and had to live within so many miles of the hospital for obvious reasons and at that time it was restricted to physicians from Pitt County. It opened the hospital for black physicians to practice with white physicians and that was new. I think with that Hill Burton hospital being opened we had within two or three years after I arrived a lot of service specialists. We had the first orthopedic surgeon, board trained, East of Raleigh. We had me in pediatrics; we had internal medicine board trained specialists with Dr. Ed Monroe.

Marion Blackburn: What a firecracker he turned out to be.

Earl Trevathan: Yes, all of these people in the town were a few months or a few years ahead of some of the other communities that later in time were public hospitals.

Marion Blackburn: What year was that when you came to Greenville?

Earl Trevathan: I came in 1954 and in 1955 and 1956 we had at least eight or ten specialists here and by specialists I don't mean doctors who just elected to practice here; specialized forms of medicine and specialists who were trained as specialists and board certified as specialists. That attracted people to Greenville for medical care. This hospital and the nucleus of specialists along with family doctors and others widely expanded the physician population in this county.

Marion Blackburn: Already it sounds like you had seen the beginning of a regional medical center.

Earl Trevathan: Exactly. We had a head start and that is why I say the Hill Burton legislation was what has been the stimulating factor as a result of what we are today including the medical school. We did not have difficulty recruiting doctors when we already had a very busy growing regional medical community and many of our physicians practiced region wide and their practice extended over several counties and served community hospitals surrounding this area. We did outreach work. My practice created satellite clinics in Columbia, Williamston, and Windsor and these sort of things I think helped identify us as a regional medical center and brought medical traffic into Greenville.

Marion Blackburn: That hasn't always been without problems, as I understand it. Alot of the community hospitals at the time thought that Greenville was trying to dominate the medical care market. I guess you could call it turf battles.

Earl Trevathan: I think turf battles were later when communities were beginning to compete and were trying to build up their own medical communities in bringing in more physicians and more practitioners which there had always been sort of a shortage of. Doctor's offices had always been busy and people had always felt like we needed more doctors here and there. Later on it was a turf situation as people began to see the drift of change. As you grow a big hospital you need to fill it up; you need to keep it busy.

Marion Blackburn: The revenues, I guess, became more important in all the hospitals. Now I have heard, Dr. Trevathan, that when it came time to build the new hospital, and I am jumping way ahead here, that a lot of people were upset about taking that much farm land out of use; that it was going to have a real adverse affect on the county just to take so much farm land out of use. Maybe that was a joke, maybe not, but a lot of people were still resistant to the idea of the medical community. Do you think that's true?

Earl Trevathan: A hundred acres I don't think was a big issue at that time. The price was $300,000 and at the time I thought it was a great bargain when the Moye family sold that property. No, I think from my perspective and from the physician medical community perspective we knew we had to have space. I thought the hundred acres was very adequate and I argued before the medical group that it was as much as we needed because I said in New York City you could probably build four hospitals on a hundred acres. Dr. Hadley said not really that we probably needed two hundred fifty acres and you know, Dr. Hadley was right. Nobody envisioned the growth here and the needs of facilities that have transpired in these last fifteen or twenty years. You can look out there now and see how they might be squeezed. I don't think anybody that I recall complained of giving up farmland. Maybe they would now.

Marion Blackburn: I think that in going back to the old hospital, I think you have mentioned to me that you have a kind of a special recollection of maybe some of the earlier integration efforts. You mentioned before that black physicians were allowed to practice with white physicians in a Hill Burton hospital. Would you like to talk a little bit about, I guess integration or segregation or black and white relations with physicians?

Earl Trevathan: Well, I think with some degree of accuracy it was separate but equal allegedly when the hospital opened. The first floor was for black patients; we had a black nursery and obstetrical area where black patients delivered and part of the laboratory the services were provided on an equal basis. I think there was also a black cafeteria, segregated cafeteria, I will use that term. When the Supreme Court's decision said we had to end segregation we could begin to sense that some changes had to come about. The Supreme Court had some kind of timetable so we didn't have to do anything immediately and all over the country where problems of integration were breaking out into confrontation and fights and riots. We had some superb leadership in this community and so the physicians and public figures met this problem first by establishing an Interracial Council of ten with five whites and five blacks that dealt with the issue. I think one of the leaders in carrying us through this trying time was without a doubt Dr. Andrew Best. Dr. Best practiced in the hospital and he also was a respected member of the medical community and I am sure when you speak with him you will get some of his observations of those very significant times. There were some clever ways that Dr. Best and Dr. Malene Irons presented this issue to the Medical Society and to the hospital staff.

Marion Blackburn: Was Dr. Irons in the Nursery?

Earl Trevathan: No, she was a practicing community pediatrician at that time. She practiced here since the early 1940s but was a community leader and she would not back off of any good cause for the welfare of people in this town, this community. So she and Dr. Best were very skillful in how they handled these issues. There was no resentment, I think, with the medical faculty itself in integrating the hospital but there was a lot of reluctance and fear from the hospital administration at that time and the hospital board. It was a community-owned hospital so to speak and they had to be very cautious but the hospital, I think, adopted a resolution encouraging a breakdown of segregation in integrating a great number of facilities. They did publish a grievance through this and it was very reasonable. The Interracial Council did. They wanted patients not to be identified by race except if it was part of the needs of the medical history. Little items like referring to white children as little Miss and little Mistress and black children not using that title. There were probably several other grievances also.

Marion Blackburn: I bet if they referred to children by little Miss and little Mistress they probably also referred to their patients as Mr. and Mrs.

Earl Trevathan: Probably yes and not the Mr. and Mrs. for blacks. Dining facilities were to be integrated, admission areas were to be combined into one admission area; you had admitted black into one area and white into the area. Again, admission by illness categories and not by race.

Marion Blackburn: Were these things seen as normal or were they seen as revolutionary? Were they seen as acceptable, were they seen as absolutely unacceptable? What was the response?

Earl Trevathan: I think they were seen as reasonable and inevitable and people might have had their private thoughts about whether integration ought to occur in this area or that but people rapidly accepted this.

Marion Blackburn: I just recently revisited some of the events that came about during integration and you see some of the photographs of people and some of the beatings that occurred to young black men who would try to go to this university or the young woman in Mississippi and just all the people peering at her and I know that these kinds of transitions were extremely difficult in some places.

Earl Trevathan: Oh yes, these people were seen as defiant, disruptive and there was always somebody who wanted to stand up and take on that kind of misery but this wasn't that case here and I think that is the result of the story we are telling now is how well we came out. It is interesting that the first pitch from the Interracial Council to integrate was the motels. They approached the Holiday Inn and the Holiday Inn said would if you would get all the other motels.

Marion Blackburn: About what year would you say this was?

Earl Trevathan: It was in 1963 and the hospital was completely integrated and it was before the Civil Rights Act of 1964. At the same time, as a sideline, Dr. Best will tell you that he approached Leo Jenkins at East Carolina University and suggested getting a head of the times and going ahead and integrating East Carolina University. Dr. Jenkins expressed to Dr. Best that he was fearful that bring in a black student would mean that the student might have a real difficult time doing their academic work, their passing and preparation for college and so Dr. Best said he would suggest a student and he suggested Laura Marie Leary, I think she was from the Grifton area, as a student and said that she can do the work. So she came to East Carolina as an integrated student, finished here and is now teaching in Maryland, a schoolteacher in Maryland.

Marion Blackburn: This was before the Civil Rights Act?

Earl Trevathan: Before the Civil Rights Act.

Marion Blackburn: That's tremendous. That would have also been in 1963.

Earl Trevathan: Yes and you can confirm that with Dr. Best but I am quoting what he told me. The university was integrated quietly and was the first state institution in North Carolina to do so and without objection and without controversy.

Marion Blackburn: That's a tremendous bit of history that I will bet a lot of people don't know.

Earl Trevathan: That's why I tell them. I should mention one other that I didn't and that is the work of Dr. Ray Minges who I think at that time was Chief of Staff and Dr. Ray Minges was highly regarded in this community as his memory is today for all that he did for it. He was not a bit ashamed or abashed to go to people and kind of shake them up and say let's get on with what is fair and just. He and Dr. Best were good team workers.

Marion Blackburn: You have described a lot of very, very interesting social conditions, tell me a little bit about the practice of medicine during these times as you remember it.

Earl Trevathan: Well, when I came here I had a segregated office and I don't think I had much of a choice. It would have been quite revolutionary in 1954 to combine waiting areas with black and white. It wasn't long as we just said that it was dissolved but I had established a little sit down space with a few chairs in the back door area of my office, which was near the hospital. The blacks would enter in the back part of the office and have a seat in the chair. Of course there was no receptionist back there and my nurse would go back several times a day just to see if there was anyone in back waiting to be seen. I remember one time she walked back and found an infant in her mother's arms that was barely breathing and she called me and we both rushed into my car and over to the emergency room to treat that baby. The memory of that sort of haunts me with that mother sitting back in the back part of my office where there was no receptionist or anyone to greet her with a baby that was near death. We knew all that was inexcusable and thank goodness it was shortly after that we moved into better facilities and we built new offices over at the Medical Pavilion in the early sixties or mid-sixties and they were, of course, integrated. The practice of pediatrics and, I guess, with medicine in general was different because patients were so much sicker.

Marion Blackburn: More tertiary care by the time they got to your office?

Earl Trevathan: Well, people didn't come into the office until things were pretty bad. That was just the way it was and I don't know whether it was the lack of dollars or fear of what it would cost, I like to say I never turned anybody away from my office because they couldn't pay. You had to badger to get paid sometimes and make all kinds of threats and it was very hard to collect. When I first came here our office fees were $3.00 and the next year we went up to $4.00 and that sounded like a tremendous jump but people often came to the office with very sick children and it took a lot of time and a lot of work and in those days we did not have house staff; we had nobody to help us with our nurses and we had to do a lot of hands on care that doctors today defer to nurses and residents and interns and technicians.

Marion Blackburn: Can you describe maybe an instance of that type of care?

Dr. Trevathan: Well, we would pick the baby up and take the baby ourselves to the emergency room because the child had been dumped off by somebody who had come to town to sell tobacco and go over and do procedures that doctors today don't have to do quite so often and for spinal puncture we would have to get into a vein which can be extremely difficult on a small infant and often times necessitated what we call a cutdown and that is actually opening the skin and getting into the vein with a thread or catheter and that takes time. You see, I am over there an hour trying to save a life and my office is filled with screaming babies and sometimes screaming parents. It was very intense in those years when you were practicing alone and I think that most of us all started out alone.

Marion Blackburn: That's a stark contrast in a way to today's medicine where there are so many people-you have your phlebotomists drawing blood and you've got the nursing with vital signs and patients who have to be seen immediately.

Earl Trevathan: You refer a patient right now for admission and they should be met in the emergency room by a trained staff of physicians and skillful people who could do things and get them in intensive care. It is an entirely different world of practice. Not only is this baby very sick and you come back to your office to direct a little traffic over there or see a patient or two and then you rush back to the hospital as we were all at that time practicing near the hospital, at least most of us were, when you got to see this family that needs to be talked to that this baby was not going to live or is in critical condition. You had to talk to the minister and you have to rush back to the office and in the meantime you would get a phone call that there was a child who was coming in from Windsor who was snake bit or having some disease that we don't even see today.

When I first came here I treated tetanus, at that time lockjaw, I treated snake bites and we treated diseases I don't even think you hear of today and a lot of nutritional related disorders; children deficient-scurvy was very common. Tuberculosis of the bone and teeth-I guess I could name twenty or thirty diseases that I suppose our residents have never even seen or we will probably never see again. Polio was a thing of our early practice because we would have several cases each summer and we would have them on respirators and we would have them paralyzed and thank goodness in 1956 or 1957 Salk vaccine came and turned the world around. Suddenly polio just about vanished. It hasn't, of course, but it certainly has nearly in this country.

Marion Blackburn: One of those things like we just kind of take for granted today like my smallpox vaccine and the fact that I don't ever have to worry about polio.

Earl Trevathan: Smallpox has been literally wiped off the face of the earth and in 1954, 1955 and 1956 I was treating a few cases of diphtheria and as I mentioned also tetanus. Now we are immunizing children for all of these diseases and six or seven more. These diseases are under control. They were horrible diseases because we had several children who developed measles encephalitis with dire consequences and we don't see those things now. One of the largest health problems which I saw for years, which bothered me for several years and I suppose bothered all pediatricians, was bad teeth. When we began to fluoridate it has been years and years now of better dental care through health departments and through vigorous community-conscious periodontists and dentists that we can now look in children's mouths and things look a little better.

Marion Blackburn: Let's get back to a really interesting point which you brought up which is just the very difference between the base level of health of the people who came into your office then compared with the base level of health of people now.

Earl Trevathan: Oh yes, you know I suppose with vitamins and immunized children and Head Start, visual screening, now hearing screening at birth required, my land we have made such tremendous, tremendous strides. In over thirty plus years of practice I have seen the trends of concerns shift from physical infections and ailments and disorders to more behavioral, social failures, broken families, stressed children, unloved children and that's created the public pathology among the children population today. Of course, nutrition has shifted now to the extreme where the greatest health concern is being overweight. That is one of the hardest problems in terms of health care to tackle in the world. Nutrition or food substance that is not available from the parents, or the community or society or school cafeterias or what, if you see how much is consumed and how much junk food that represents.

Marion Blackburn: Do you think that we are only now noticing these sort of emotional or social problems because we have got so many of the physical problems under control? Do you think they were always there or do you think these are new problems?

Earl Trevathan: I think they are new. I think society is different, home structure is different. In society now everybody leaves at 8:00 and the house is empty. The TV is on if anybody wants to leave it on, there is nobody at the door waiting for a happy child to come and that is that area that I think the problem is rooted to some extent. That doesn't mean that somebody can't carry on their profession or jobs and still serve their family well and be great parents. I have seen people do that because they were so capable in knowing what children need and being good parents but I do think it is in that area where we have fallen down and can not offer any excuse or apologies for it. It is just a fact. It is not the parents' fault that there is so much stimulation and stress put on children today to succeed to do this and be separated from communities now to different in the neighborhood environments sometimes. Small towns and small schools and small churches and groupings of caring villages, I don't think are as available today as they for the children of my day and, of course, and from my years and perspective I look back on what was so rich in my youth and it certainly wasn't money. None of us had that but boy did we have everything else in terms of neighborhood baseball teams and church-community activities and family things. You couldn't go anywhere but maybe Greenville to shop every month.

Marion Blackburn: Were you from the County?

Earl Trevathan: Yes, rural Pitt County in Fountain.

Marion Blackburn: With the time we have left, let's move forward to the new hospital and your experiences there and how maybe your practice changed there with all the space, equipment, support staff and in general more modern kind of approach.

Earl Trevathan: Yes, along with this marvelous new hospital everywhere you would turn would be somebody who had extremely capable skills to help you in your work. That was probably to some extent even before the medical faculty arrived because when they arrived and brought cardiologists, endocrinologists to help you with your diabetes problems, pathologists who came in the late 1960s and helped us with autopsies and instructing us in what went wrong or what a patient died of and what the findings were. As we mentioned a while ago, the imaging diagnostic skills of the radiologists who were so wonderfully trained and knew so much in what they brought to that new hospital.

We had more meeting space, more continuing education opportunities and they were partly provided by the hospital and by the AHEC state supported health education programs of which Dr. Monroe was involved in.

Marion Blackburn: And, of course, the School of Medicine in 1977.

Earl Trevathan: Yes, the School of Medicine and they had so much faculty. Of course, in 1978 I joined the medical school.

Marion Blackburn: I guess you pretty much believed in the medical school from the beginning?

Earl Trevathan: Yes, I had a lot of thoughts on that. I know when the first idea came forth and I knew a little about what was going on and I served on a Search Committee with Dr. Laupus so I think some of that was picked up on Wayne's book on the history of the medical school, I guess. I would like to read that book to see what information is in book. I hear it is worth reading and I shall get it. I intend to buy it to see what he said about the beginning of the medical school to see if it corroborates with my memories. I have a lot of information I will give to you now which was all in the newspapers, establishment of the nursing school, liaison committee.

Chris Fordham appointed me to a liaison committee so I served both ways. At that time he was acting as Dean over this school until they got accredited and it was some kind of a forced marriage and very uncomfortable for some people. Ed Monroe was tenacious and I think that is why we have gotten where we are today. At the time there were several issues and some fears which people probably don't quite realize. The University at Chapel Hill thought it is was a tremendous threat when they were up there beating the Legislature over the head to get a few more dollars for this and for that to make themselves better and they were afraid to face competition that somebody would be ciphering off some of those funds so I understood their position.