It’s the wee hours of the morning on a day in 1946 and an exhausted 32-year-old Dr. Ernest Ceriani, pauses with a cup of coffee and a cigarette in the kitchen of the small hospital in Kremmling, Colorado, a town of 1,000 people 115 miles west of Denver, after an operation which lasted until 2:00 A.M.. The nurses on duty beg him to take a rest, but because they’re aware that as a country doctor he cannot, they keep fresh coffee simmering for him at all times. Photojournalist W. Eugene Smith followed Dr. Ceriani through his daily rounds and captured him doing his work as part of one of the most poignant and in-depth photo essays on the vanishing general practitioner, “The Country Doctor,” for LIFE Magazine in 1948. Ceriani serves as physician, surgeon, pediatrician, psychiatrist, obstetrician, dentist, oculist and laboratory technician to people in a 400-square-mile area around the town. To them, he’s a lifesaver.

Since Smith shot his photo essay for LIFE, the practice of medicine has changed a lot. Today, heart transplants and bypasses are common, and doctors cure more patients of cancer than ever before. But managed health care, known as HMOs, rule today’s medicine---impersonal procedures, bureaucracy, high malpractice premiums, and exhausted physicians. Patients are no longer people but numbers and percentages. And throughout the day, the clock ticks away.

And while country doctors like Ceriani still exist, they’re few and far between. The day of the house call is long gone. This can be attributed, in part, to the attitude of medical schools which present specialization as glamorous and general practice as a thankless chore to their students. Also, health clinics, both independently owned and in association with drugstore chains, have begun to spring up all over.

General practitioners, especially country doctors, make far less for covering a dozen fields than other doctors specializing in one. In 1947, when Smith took his photos, GPs earned less then $10,000 a year. And while they earn more today, the fate of thousands of communities like Kremmling, in dire need of general practitioners, depends on whether 22,000 medical students, who each year choose between specialization and general practice, also think it’s enough. But a country doctor’s time is rarely his or her own. The needs of patients come first, many times in the middle of the night. The union of a general practitioner and his or her patients is like a marriage–affectionate, difficult and long-lasting–a type of relationship that goes far beyond the meager pay but offers far greater rewards.

After an exhausting operation in the pre-dawn hours, Dr. Ceriani begins work soon after 8:00 A.M. and will continue far into the night. He serves as physician, surgeon, obstetrician, pediatrician, psychiatrist, dentist, oculist and laboratory technician. Like most rural GPs he has no vacation and few days off, although unlike them he has a small hospital in which to work.

A tourist guide and his baby are the doctor’s first office call of the day. They have come to Kremmling from an outlying ranch. Ceriani's patients are of all ages and income groups and come from areas without doctors as far as 50 miles away.

After taking care of the baby, Ceriani is off on a home call at 8:30 A.M.. He prefers to treat patients during office hours at the hospital, but because a local printer had a fever and symptoms of influenza Ceriani thought it would be unwise for him to get up and make the trip.

Back at the office, he explains an X-RAY, which Ceriani developed himself, to a rancher. In addition to the X-ray machine, the hospital contains about $10,000 worth of equipment, including a $1,500 autoclave and an oxygen tent.

A minor emergency disrupts Ceriani's office routine. A 60-year-old tourist, suffering from a heart disturbance aggravated by a trip through an 11,000-foot pass in the Rockies, came to the hospital to get an injection of morphine.

Next he binds a man’s ribs, injured when a horse rolled over him. Many of his hardy patients walk in with injuries which would make city dwellers call at once for an ambulance.

Another home call, several hours into his day, takes Ceriani to the home of a feverish 4-year-old suffering from acute tonsillitis. Although a large proportion of his patients are children, Dr. Ceriani is still inexperienced in pediatrics and studies it whenever he has an opportunity.

That afternoon, the young doctor attempts to take a much needed three-hour break to go fishing. His moments of relaxation are rare and brief. He asks two employees of the Denver and Rio Grande to take him out on a railroad gasoline car to Gore Canyon. There he fished alone in the rapids of the Colorado, working expertly over the white water for almost 30 minutes. Suddenly he saw the car coming back up the canyon far ahead of time and automatically began to dismantle his fishing rod. Ceriani had no feeling of resentment at the quick end of his excursion. He just stood still waiting for the car to reach him, wondering what had happened and hoping that it wasn’t something serious. When the car arrived Chancy Van Pelt, the town Marshal, hopped off and said, "Little girl at the Wheatly ranch got kicked in the head by a horse. Can you come now?"

Lee Marie Wheatly, aged 2½, was already in the hospital when Ceriani arrived. While her parents watched, he looked for signs of a skull fracture, stitched up a great gash in her forehead and saw that her left eyeball had collapsed. Then he advised the Wheatlys to take their child to a specialist in Denver for consultation on removal of the eye.

Having done his best for the child, Ceriani is worn out and tense as he completes the emergency treatment. He has stitched the wound in her forehead so that she will have only a slight scar, but already knows that nothing can be done to save her eye and tries to think of a way to soften the news for her parents.

After they left, Ceriani was haggard and profoundly tired. He didn’t remember that he had been fishing at all until, on his way out of the emergency room, he saw his rod and reel lying in the corner where he had thrown them.

Pausing to have another cup of coffee, Ceriani gets a call telling him that a young man named Robert Wiggs had been thrown from a horse and injured at a rodeo in nearby Granby. When the young man’s friends arrived with him, the doctor helped carry him into the hospital. Wiggs had a dislocated left elbow. Ceriani X-rayed the arm. He gave Wiggs some ether and pulled on his arm to bring the elbow joint back into place. Then Ceriani applied a cast while the young man murmurs, “Don’t tell my mother,” not realizing that his mother was holding his hand.

A few minutes before midnight the people in Joe Jesmer's house called Dr. Ceriani to tell him that Joe was very sick. Ceriani put on a cloth jacket, went over there quickly and found 82-year-old Joe dying after a heart attack. He was still conscious, but in his pain and bewilderment he felt that he was somehow trapped and needed rescuing. He continually said, "Please, please get me out of here."

In the parlor Ceriani tucks a blanket around the dying man before taking him out into the night. In the kitchen, while the women whisper, Ceriani telephones the priest to tell him that the old man will not live through the night Ceriani and Chancy Van Pelt got Joe onto a stretcher (left), while Helen Watson, a roomer in Joe's house stood watching quietly and without tears. Ceriani called the priest, asking him to come to the hospital. Chancy and he carried Joe out to the ambulance and drove off. There was nothing Ceriani could do except make Joe comfortable and watch him die. At about 2:30 it happened. He left the hospital then and went home, finding his wife asleep and his own house as quiet as all the rest in town. At Midnight Joe Jesmer's womenfolk stand silently around the door to see him taken away.

And so Dr. Ceriani’s day begins all over again, and he hasn’t even been home to see his wife.