Beals: the final cut

After a hiatus in processing precipitated by his death, the transcript from the oral history interview with Dr. Rodney K. Beals, M.D. has now been fully edited.

What begins as a cautious questioning on known facts from Beals' CV blossoms into a deep conversation about the history of orthopedics in Oregon; changes in orthopedic technique, practice, and education; the challenges of modern medical economics; the advantages and disadvantages of sub-subspecialization; and finally, speculation about what the future may hold for orthopedics. Below are a few choice excerpts; the complete transcript is available upon request.

On socialized medicine in New Zealand:

BEALS: The longest time I spent away was in New Zealand where I practiced orthopedics. They arranged for me to be a New Zealand doctor for six months. And I have visited Australia several times, several places, and South Africa and so forth. But New Zealand was where I had the greatest experience. And it was interesting because New Zealand has had socialized medicine since the 1930s.

One of the features of New Zealand medicine is that you don’t go to see a specialist as a first choice. You have to go to see your primary care doctor and then be referred to a specialist. And I was very interested to see what the effect of that was. I anticipated that I would see that patients’ diagnoses were missed because they were seeing primary care doctors and not specialists. I was anticipating that I might see where they weren’t as well cared for.

But the fact is, I didn’t find that. It turned out to be a very good system of medicine. And the key to it was the fact that they have extraordinarily well trained primary care doctors. Their primary care doctors have longer and better training than our primary care doctors here do. And I think that was the key as to how it works. So a place like New Zealand, and that would be true of Canada or Australia or England, they have roughly half as many orthopedists per capita as we do. And the reason for that is that an awful lot of the musculoskeletal complaints in those countries are pretty well taken care of by primary care doctors. And then when they’re referred to specialists, it’s primarily for a surgical procedure. Whereas in this country, orthopedists do a lot of non-surgical care. So it’s a contrast in style. And they both seem to work pretty well.

On the training of specialists v. primary care doctors in Oregon:

KRONENBERG: Can you talk a little bit about the, if you will, the limiting factors on increasing the size of a residency program in terms of the number of residents that are actually in a program? And I think that probably the same thing is true of other specialties. But speaking specifically of orthopedics, what are the determinates that either limit you or allow you to increase the size of a residency program these days?

BEALS: Well, first of all you have to have a certain number of patients available to be involved in a training program. That’s never a problem. Never a problem. We have to have a proper number of faculty to train them well, and that’s never a problem. What is, the biggest hazards are, determinates, first of all, your own institution: there’s a question of who’s going to pay for resident salaries. Residents make enough money that it’s a significant amount of money. Medical schools are given money for training, but it’s never enough. For instance, if we wanted to increase our residency number tomorrow, it would come out of the doctors’ income. Nobody is going to pay for that. So that’s a big drawback.

And then, another big drawback is the residency review committees of the national orthopedic groups. You have to get an okay. And most of those committees are dominated by people from the Midwest and the East. They’re a little reluctant to tell training programs that they can increase their size. So that’s always a bit of a problem. It takes quite a bit of work and a lot of data collection and so forth to convince the regulating bodies that you ought to have more residents. So I would say those are the two biggest handicaps to increasing the size of the residency program.

And then one other feature is, I think, that our medical school and many medical schools have for a long time taken the attitude that what they want to primarily produce are primary care doctors. They want internists, OB/GYNs, general practitioners, so forth, people in primary care. They don’t like to emphasize subspecialties. So I think that has an effect on something like orthopedics increasing size.

On E.G. "Frenchy" Chuinard:

BEALS: Yes. I’d love to. Frenchy Chuinard was the first orthopedist to be fully trained in Portland. He had a year of training in the Shriners Hospital, a year of training at Emanuel Hospital, and a year of training at the County Hospital in Portland. And when he finished training, he was the seventh orthopedist in Oregon. That will give you a little perspective that things were, those were pretty early days.

Dr. Chuinard, as we called him, he was born in a farm up near Kelso. He went to University of Puget Sound. He was student body president there. He was always, always had something to say. And he had strong opinions. Sometimes he defied a lot of his colleagues. I always thought that his most important characteristic was his persistence. He never gave up. And I admire that. For example, when Dr. Dillehunt was the head of the Medical School, the library building was built, the outpatient building was built, the tuberculosis hospital was built, the nursing school was built. There were all kinds of things that were developed under Dr. Dillehunt. And yet, when it was all over and done with, there was nothing up there named after Dr. Dillehunt.

Dr. Chuinard was an extremely loyal person to Dr. Dillehunt. And he felt that was an affront to Dr. Dillehunt’s memory that they didn’t name one of the buildings up there after Dr. Dillehunt. So Dr. Chuinard made it a cause célèbre. And he pursued that year after year after year, and he finally got a building with Dr. Dillehunt’s name on it. It’s just a nice example of if it were not for his persistence, that never would have happened.

Dr. Chuinard was regarded as a very good teacher. He was chief of the Shriners Hospital for many years. And the residents all had a lot of contact with him. Dr. Chuinard had certain stories that he would tell over and over again to the point that the residents could all tell the stories. And it was a source of a little bit of amusement among the residents that they could replicate his stories.

Dr. Chuinard was a very good leader. He was president of the county medical society and I think the state medical society. And he became the vice president of the American Orthopedic Association which was nationally a rather big deal. His major interests in orthopedics were having to do with dislocated hips in babies. And he wrote a moderate amount about that. And he was a big promoter of certain treatment programs. He was a very important teacher to the residents. Influential within the residency. And was very active politically. And of course his wife was a state legislator. And he was sort of indirectly involved that way as well.

And then he had this interest in the Lewis and Clark expedition. He wrote a book on the medical aspects of it that’s quite a good book, called Only One Man Died. And it was a story of the medical experience of the trip of Lewis and Clark. I knew Bob, his son, very well, and Beverly, his daughter, I knew just minimally. But I knew that Bob and Beverly spent a lot of summers with their summer vacation taken to visiting all of these places that Lewis and Clark stayed. And they didn’t particularly think that was the greatest way to spend a summer. But Frenchy had strong feelings about visiting all these places and learning about it. I know that was a big part of their life.

So Frenchy had pretty strong feelings about it. And he developed great reverence, I think, for Lewis and Clark. And to this day I’ve found it slightly amusing that in his book, he never acknowledged that Lewis committed suicide. Because that would be not the right thing that he should have done. And I think Frenchy just couldn’t bring himself to accept that. And there was question of whether that’s really the way Lewis died. So I thought again that was an example of his stubbornness to accept the reality of what the evidence was.

But Frenchy was really a fine person. I liked him a lot. And he was very good for the training program.

Molar Derby!

Yesterday afternoon, we took possession of several boxes of materials from the office of School of Dentistry Dean (and OHSU alum) Jack Clinton, D.M.D.

Included in this donation are Dental School faculty by-laws and handbooks, directories, catalogs, accreditation reports, clinic manuals and practice plan information; dental instruments and instrument catalogs; 35mm slide presentations on dental practice; a handful of films, on both VHS and 16mm reels (including Demonstration on four-handed dentistry and infection control, by Clinton and Nora Toleser), and other items.

The most colorful and unexpected piece was a children's book titled The Molar Derby by Naomi Dillman Lunt (published by the author in 1982). This whimsical, illustrated history of dentistry is held by only two libraries in WorldCat (the American Dental Association library and Southern Utah University), but who wouldn't want a copy of, for example, this great rendering of Pierre Fauchard and his specimen collection cup, ready to gather the urine for the recommended mouth washing...

Marvelous mushrooms

Today's visit from Dr. Charles Grossman, M.D., brought us a small trove of documents from the Interagency Welfare Committee; a patent application and confirmation of issuance of patent number 3,742,946 (Apparatus for the in vivo treatment of blood containing harmful components resulting from chronic uremia and other conditions); records of a US-China People's Friendship Association annual meeting chaired by Grossman; and a couple of driver's licenses from New Haven (1943 and 1944), among other materials--but the thing that immediately caught my eye was a mushroom.


Galerina venenata Smith has the venerable distinction of having been discovered as the result of an accidental poisoning. On a January evening in 1953, local Portland artists Sally Haley and Michele Russo harvested some mushrooms from their front lawn to mix into an omelette. The mushrooms were not, as they believed, a harmless Amanita species but rather a highly toxic variety of Galerina. Lucky for them, their neighbor was one Charles M. Grossman, M.D.

Interviewing the patients in hospital, Grossman took notes as Mike and Sally scribbled illustrations of the culprit. A later drawing by Sally (above) shows the dangerous fungus in all its deceptive loveliness. The Oregon Mycological Society was unable to positively identify the specimen, so they mailed it off to A.H. Smith, a Galerina specialist. Grossman named the subspecies in Smith's honor in his 1954 paper "Mushroom poisoning: a review of the literature and report of two cases caused by a previously undescribed species" (co-authored with B. Malbin, Ann Internal Med 40:249-259).

In addition to the sketches and some correspondence, we also received today a typescript of a talk on the cases given by Grossman at the 1954 meeting of the Western Section of the American Federation for Clinical Research.

More on Mary Sawtelle

Researcher Steve Robbins, great-great-nephew of the second wife of Cheston M. Sawtelle, has graciously shared with us his extensive research on Cheston and Cheston's first wife, the mysterious Mary Priscilla Avery Sawtelle, M.D.

We've been thinking about Mary since first learning that she was a student at the Willamette University Medical Department who was not permitted to graduate; whether this was due to her poor showing in anatomy or to her gender is a matter of some historical contention.

In an earlier post, we had speculated that perhaps Mary had run afoul of the Methodist ethic at WUMD, and Mr. Robbins informs us that Mary had come from Baptist stock (her father and step-father both having been preachers). Interestingly, C.M. Sawtelle was a well-known atheist who "lectured and wrote publicly against the Bible and Christianity." C.M. was granted his degree from WUMD, so it would seem that religion was not a likely factor in Mary's difficulty.

A tantalizing tidbit revealed by Robbins' research is Mary's first encounter with Judge Matthew P. Deady. Deady was one of the founding stockholders in the Oregon Medical College and a key player in early efforts to locate a medical school in Portland. He also presided over the divorce proceedings between Mary and her first husband, C.A. Huntley, in 1858 and granted sole custody of the couple's three children to C.A. Was Mary seen by some in the medical establishment as a divorcee and unfit mother?

Another potential source of conflict between Mary and her medical colleagues may be hinted at in an 1878 article that she wrote and published in the journal she herself edited, the Medico-Literary Journal. The paper, titled "The foul, contagious disease: a phase of the Chinese question: how Chinese women are infusing a poison into the Anglo-Saxon blood" sterotyped female Chinese immigrants as syphilitic prostitutes who were a danger to American men. While racial prejudices were certainly present to a degree among some members of Oregon medical community, inflammatory claims based on unsound science may have been more likely to arouse scorn and derision.

But can any of these things really explain why Mary ran afoul of the faculty at WUMD? Was it Mary herself who presented a problem, or was it truly a case of gender discrimination? If the latter, one would need to explain the aboutface in the policy for admission of women to the medical school that ocurred less than a decade after Mary's expulsion. If the former, one would need to reconcile Mary's inability to make it through anatomy class with her successful education at a different (albeit homeopathic) medical school, her successful attempt to launch and maintain a medical journal, and her ambitious (though short-lived) plan to open and run the Woman's Medical College of the Pacific Coast (in operation 1881 to 1883).

That's the fun of open questions in history: you can speculate wildly about the possible causes and effects of events and then go investigate more to support your crazy theories....

Life of Gory

This week, Dr. Jim O'Dea, M.D., retired Portland pediatrician and OHSU alumnus, brought us more materials for the archives of the North Pacific Pediatric Society (originally donated by Dr. Oliver Massengale in January).

The collection includes financial ledger books from the 1970s to the late 1980s (when the society went digital for its accounting), member directories, meeting programs, updated by-laws from 2005, and a wealth of correspondence including... printouts of email! (It just warms my heart to see folks acting on archivists' advice to keep the really important documents in paper.)

Unexpectedly, the collection also contains a copy of an unpublished autobiography of Dr. S. Gorham Babson, M.D., known as "Gory" to friends and colleagues. Titled The Full and Wonderful Life of Gorham Babson, the memoir is short but sweet. The table of contents includes:

"Prologue--My fascination with travel"
wherein we learn that Babson's father's fourth brother was named after Sir William Morton Stanley;

"European junket with the family--1924"
wherein we hear that Babson's father was so annoyed by the pigeons in Italy that he wanted to write to Mussolini to propose "a great pigeon shoot";

"Back to Oregon through the Panama Canal--1927"
wherein we find young Gory on a stopver in still-rustic Acapulco, watching cock fights;

"Again to Panama Canal, across South America and up to New York--1938"
wherein we get a glimpse of the locum tenens in North Portland that Babson took right out of medical school: it paid $200 a month, and came with a small office library but no R.N. to turn to for advice ("fortunately patients were not of litigious mind");

"How I married Ruth Lambert--1939"
wherein we hear that their first date was watching Sonja Henie skate at MSG, and that Guy Lombardo's orchestra provided the dancing music for their wedding day;

"How I started my practice--1940"
wherein Babson gets his start, even though "opportunities to practice the art for a living were not frequent" in Portland;

"Shirley Thompson: Supervisor of Doernbecher Hospital--1950"
wherein we hear of the efforts of "this innovative nurse" to establish the first nursery for premature babies at Doernbecher;

"How I became a professor of perinatology at OHSU--1961"
wherein we hear that the reason Babson gave up one of the leading private practices in Oregon was that his clinic was about to be demolished to make way for an expansion of the I-5;

"In search of Petra, our first trip around the world--1963"
wherein we hear of the ancient practice of the "open" airline ticket that allowed travelers to make up their itinerary as they went;

"Director of the OHSU Neonatal Center--1965"
wherein we hear about nurse Katie Simpson's technique for teaching staff to intubate neonates by practicing on cats;

"Epilogue"
wherein Babson thanks his daughter Jane for awakening in him an interest in creative writing, "restricted by years of inscribing medical manuscripts";

"World trips of the intrepid traveler"
which presents a chronological list of the highlights of a footloose life, one of the more intriguing of these being "An Eunoto, a jungle campsite where Maasi boys are admitted to manhood" (1979).

These materials, and the rest of the NPPS Records, are now available for research. But you'll have to wait until after July 4 to have at them; Historical Collections & Archives is closed Friday July 3 in observance of the federal holiday. Happy Independence Day!