Tattered and torn

Our ongoing assessment of every single volume located in the OHSU Library's offsite storage facility continues, unearthing uncataloged titles, misshelved volumes, and many MANY items in need of a little tender loving care.

One such item, with badly cracked hinges and a cumbersome staple-n-glue binding, came to my attention today: Collected papers on eugenic sterilization in California, published by the Human Betterment Foundation in 1930. Noticing that our catalog record for the title lacked any information about the individual pieces contained in the collection, I decided to quickly enhance the record to allow better retrieval of the book by those researching eugenic sterilization.

It didn't take long to confirm that the vast majority of the collected papers were, unsurprisingly, written by members of the Foundation's board: Paul Popenoe, Otis Castle, Justin Miller. Two essays are by Joseph Mayer, the German eugenicist and Roman Catholic theologian. Somewhat unexpected (at least by me) was the inclusion of a piece by Robert Latou Dickinson, the obstetrician/gynecologist, who wrote extensively on human sexuality. To his credit, Dickinson's essay addresses the challenge of "sterilization without unsexing," but he does nevertheless seem to support wholeheartedly the forced sterilization of certain populations.

In his introduction to the collection, E.S. Gosney sums up the Foundation's position:

If the student draws the same conclusions that we have drawn, he will recognize that eugenic sterilization is no cure-all; that it is not a short-cut to any eugenic millennium; that it is not a measure which supplants or renders unnecessary any of the present machinery for dealing with social problems. He will, however, recognize it as an invaluable and necessary supplement to all these recognized protective measures ...

One wonders here how many demonstrable "cons" would have been required to outweigh the "pros" of eugenics for members of the Foundation, given the easy admissions made here.

For the curious among you, here is the complete list of essays contained in the collection:

The insane / Paul Popenoe -- The feebleminded / Paul Popenoe -- Success on parole after sterilization / Paul Popenoe -- Changes in administration / Paul Popenoe -- Economic and social status of the sterilized insane / Paul Popenoe -- Marriage rates of the psychotic / Paul Popenoe -- Fecundity of the insane / Paul Popenoe -- Menstruation and salpingectomy among the feebleminded / Paul Popenoe -- A study of patients coming to California state institutions for sterilization only / Paul Popenoe -- Attitude of the patients' relatives toward the operation / Paul Popenoe -- Attitude of the patients toward the operation / Paul Popenoe -- Social and economic status of the sterilized feeble-minded / Paul Popenoe -- Marriage after eugenic sterilization / Paul Popenoe -- The number of persons needing sterilization / Paul Popenoe -- The law and human sterilization / Otis H. Castle -- Sterilization and criminality / Paul Popenoe -- Effect of salpingectomy on the sexual life / Paul Popenoe -- Effect of vasectomy on the sexual life / Paul Popenoe -- A statistical study of the patients of a psychiatrist in private practice / Paul Popenoe -- Sterilization without unsexing / Robert L. Dickinson -- A Roman Catholic view of sterilization / Paul Popenoe -- The Human Betterment Foundation -- Civil and criminal liability of physicians for sterilization operations / Justin Miller and Gordon Dean -- Postoperative changes in the libido following sterilization / John Vruwink and Paul Popenoe -- Outline of essential provisions for the two types of sterilization law / E.S. Gosney et al. -- Eugenics in Roman Catholic literature / Joseph Mayer, trans. by Paul Popenoe.

The future of medical education, as seen in 1961: town v. gown

As I have previously mentioned, the archives recently received a collection of papers belonging to the pioneering Oregon neurologist Robert S. Dow, M.D., back in February of this year. Part of that collection is a series of bound volumes containing (apparently) all of the papers and presentations delivered by Dow during his career, from 1938 through the 1990s. It's a fascinating compilation of documents outlining the course of Dow's research efforts, as well as his interests in the broader field of medicine.

In 1961, Dow gave an invited talk on Medical education in the United States: past, present, and future, to the Sellwood Moreland Lions Club here in Portland. After a disparaging glance back at the spotty early years of American medical education, he moved on to a consideration of the challenges facing American medical schools. Even then, in 1961, Dow saw an impending physician manpower crisis, a need for schools to produce more physicians to care for an ever-growing, ever-aging, ever-prospering population. He noted that a nationwide increase in medical schools, from 76 in 1931 to 85 in 1959, was helping address the problem, but wondered "What further can be done locally in this respect, short of increasing federal and state taxes to enlarge the tax-supported institutions now primarily responsible for the training of physicians?" (I wonder what he would have thought, had he lived to see the steady and precipitous decrease in state financial support of the medical school at OHSU. I don't think he would have been at all surprised.)

His suggestion: "One action would be to strengthen and utilize to a greater degree private non-tax supported hospital facilities in certain centers. Some of our private hospitals in Portland are already rising to meet the demand for more educational opportunities for post-graduate medical education. I am proud of the progress that my hospital has made in the last few years and I speak now of Good Samaritan Hospital."

He continued: "I think these non-tax supported, privately endowed institutions should be encouraged by all who can do so to broaden their activities in this field. A great deal of teaching and research talent can be gleaned from the private physicians in this community who formerly donated many hours to the medical school and whose services are used less and less as the school continues to expand its 'full-time' salaried faculty."

This mid-century perspective on the town-gown tensions within the Portland medical community, from the viewpoint of "the town," serves as a nice compliment to the implicit assumption in many contemporary university documents that the educational establishment must be confined to sanctioned classrooms and/or clinical settings. Indeed, the ideal educational environment is most likely situated somewhere right between wholly private and wholly university-based settings, and many OHSU postgraduate programs seek to find the best of both worlds by mandating rotations through a variety of local healthcare settings, as well as the university hospitals and clinics.

A Trio of Web sites

What better on a Monday morning in May than a trio of web links for a little edification and entertainment?

Many thanks to John Lienhard for bringing his web site, Engines of Our Ingenuity, to my attention last week. Though Lienhard's main interest is in the history of engineering, there are stories aplenty for medical historians, including vignettes on the Broad Street pump, the Black Death, and blood banking, among others.

Only a few days remain in the Wellcome Collection's very interesting exhibition Life Before Death, with photos by Walter Schels and text by journalist Beata Lakotta.

And keep your eye on the development of the online Bassett Collection from the Stanford University School of Medicine. The images, originally created by anatomist David Bassett and View-Master photographer William Gruber, became instant classics when they were published between the 1940s and 1960s, with physicians reportedly lining up to hear the men speak at conferences. While the full collection will, apparently, be available by subscription only, the sample images alone are worth a look.

Streaming video of lecture now available

For those of you who were unable to attend Monday's excellent talk by Dr. John L. Cameron, M.D., titled "William Stewart Halsted: Our Surgical Heritage," the streaming video is now available. (Free RealPlayer software required.)

Among other things, you will hear about Halsted's pivotal role in the development of American football--don't miss it!

This was the last presentation in the 2007-08 season of the OHSU History of Medicine Society Lecture series. Stay tuned for the 2008-09 season, which kicks off in the fall. Three of our four talks have already been scheduled--please join us!

Friday October 24, 2008
Michael J. Aminoff, M.D.
Professor of Neurology; Director, Parkinson's Disease Clinic & Research Center;
and Executive Vice Chair, Department of Neurology,
University of California, San Francisco
Brown-Sequard: The Man and his Work


Friday November 23, 2008
Joseph B. McCormick, M.D.
Regional Dean and James Steele Professor,
University of Texas Health Science Center
Viral Hemorrhagic Fevers: Yesterday and Tomorrow

Friday January 23, 2009
Kenneth R. Stevens, M.D.
Professor Emeritus, Department of Radiation Therapy,
OHSU School of Medicine
History of Radiation Oncology in Oregon

[Spring Lecture TBA]

A Sackful of walnuts

I came across another wonderful memoir of Oregon medicine recently, Dr. Robert Langley's tantalizingly titled memoir A Sackful of Walnuts, completed circa 1974.

Langley was born in 1894 in Cripple Creek, CO, where his father supervised operations at a large gold mine. At the age of 12, he moved with his family to Everett, WA, where he got a job in the local drugstore. He recalls:

I watched as the clerks filled prescriptions, mixed cold creams, ointments, pastes, lotions; as they filled pint whiskey bottles from a fifty-gallon wooden barrel; mixed tempting syrups for the soda fountain or poured liquids from a gallon jug into a half-ounce bottle, with no funnel and without spilling a drop. That required skill and a steady hand. Because of their adroitness and the stature assumed by the doctors who came to visit the store, and the respect accorded them in the community, I decided I would become a physician!

Moving to Portland two years later, Langley attended the Emerson School and the University of Oregon before matriculating at the UO Medical School in 1916. He immediately obtained a position as student assistant in the anatomy lab. He writes: "In the Department of Anatomy my duties as an assistant were to catalog cadavers: to assign cadavers to all freshmen students for their dissection laboratory, two students per body."

Angling for a summer position that would help defray the cost of the second year's tuition, Langley approached the Dean. He recounts the conversation thus:

"Why don't you get a couple of energetic helpers and clear the ground on Markham [sic] Hill where the new medical school is to be built," [the Dean] suggested.

I followed this suggestion and made a verbal agreement with two of my dependable classmates. We hired a pair of stalwart horses, rented band saws, sharp axes and sturdy shovels and proceeded to clear the land on which the new Medical School now stands. We felt a real sense of accomplishment when we completed our job and leaned on our shovels to view the cleared area; our visible contribution to the new building site.

Apparently, this experience of working his way through UOMS did not have the most positive impact on young Robert, and he left Oregon in 1918 to complete his medical studies at Rush Medical College. After an internship in California, he was casting about for direction:

In a quandary then about what to do next, I consulted one of my former teachers at the medical school. I shall long be grateful to him for the best advice I ever received.

"You have had the best medical training it's possible to obtain in the United States, but you know nothing about the practice of medicine," he told me. "I'd advise you to give up any idea of specialization for the present, go to a small country town and take up general practice to see what it's all about. But don't stay longer than three years, for by that time you will know something about people right in their homes and daily lives and will be able to make up your mind about your future."

Langley took this advice and established a private practice in Riddle, OR, serving the nearby communities of Myrtle Creek and Canyonville and other points in between. He stayed in that area precisely three years before moving on to--of all places--Catalina Island, where he was physician to the Wrigley family.

So, what's with the title? Langley closes his autobiography with a poem:

So here it is "in a nutshell,"
The harvest of my life.
Each walnut shell has a tale to tell
Of happiness or strife.
God gives to each a race to run
With breath of life and job well done.
I'm glad the life He gave to me
Encompasses
this world and thee.