Friday, January 16, 2009

History of pedology

Yesterday, we received from Oliver N. Massengale, M.D., several histories of pediatrics in the Pacific Northwest--one book (by Gory Babson, shown here), one speech, and two "vignettes" (these by Massengale).

Herein we are reminded that the specialty devoted to the care of children, though officially recognized by the American Medical Association in 1880, did not settle on a widely accepted name until the 1930s. Often referred to as pediatry or pedology, its practitioners were called pediatrists; the terms "pediatrics" and "pediatrician" finally won out after more than 50 years of linguistic wrangling.

The North Pacific Pediatric Society was established in 1919, making it one of the oldest international medical societies in North America. C. Ulysses Moore, MD, Portland pediatrician, was named temporary chairman until the formal election of Spokane's P.D. McCornack, MD, as the first president.

The American Academy of Pediatrics was founded eleven years later, in 1930. And, wouldn't you know it, it was formed because of a falling out between members of another organization--in this case, the AMA itself. The schism arose over reactions to the federal Sheppard-Towner Act of 1921, which aimed to improve maternal and child health through the mandatory provision of prenatal services. Of course, the AMA proclaimed this act of social medicine "Bolshevistic." When the Pediatric Section of the AMA separately declared its support for the Act, the AMA reprimanded the group and forbade its members from publicly disagreeing with any AMA policy. So, they just formed their own group.

See, if we all just got along, there'd be a lot fewer meetings to attend!

Thursday, January 15, 2009

Pirquet reaction

It was with that happy sense of serendipity that I noticed, just this morning, the name of Pirquet mentioned in the typescript speech of one S.E. Josephi, first dean of the University of Oregon Medical School and first president of the Portland Academy of Medicine. Regular readers might remember that we recently made a home for Pirquet's Allergie in the History of Medicine Collection here at OHSU, honoring the scientist who not only coined the term "allergy" but developed a reliable skin test for tuberculosis.

The book collections and the archival collections rarely come into contact, primarily because they tend to come in different donations and represent different collecting interests on the part of donors. So, it's always fun when you can tie a scientific advancement made outside of Oregon (and in Pirquet's case, outside of America) to a reaction by the local medical community.

In his speech as outgoing president of the Portland Academy of Medicine, delivered January 9, 1908, Dr. S.E. Josephi touches on a number of topics that he deemed "events of greatest prominence" in the year in medicine, including outbreaks of cerebrospinal meningitis, bubonic plague, and poliomyelitis; "secret nostrums"; the development of bacterial vaccines; the role of adrenalin in arteriosclerosis; new treatments for thryoid diseases; syphilis; and cancer. But the largest segment of his talk is reserved for tuberculosis, which he calls one of the two "universal scourges of our race" (the other being cancer).

After discussing recent trends in "institutional segregation" and other control measures, Josephi turns to scientific advances in diagnosis and treatment:
Early in the year von Pirquet announced that he had found "that if tuberculin is introduced into the skin of a tuberculous child there will appear at the point of innoculation a small papule not unlike the papule of vaccination, at first bright, later more dark red and lasting about eight days." This was called the cutaneous reaction to tuberculin and was said to be applicable chiefly in the first year of life. Later in the year further experimentation and observation seemed to throw some doubt upon the reliability of this test, yet to uphold a close connection between tuberculosis and von Pirquet's test. A transposition of this test from the skin to the conjunctiva was formulated by Calmette who showed that "if tuberculin were instilled into the eye there would be marked congestive reaction in the case of tuberculous patients, while the healthy or non-tuberculous responded with a very much milder reaction. Calmette makes use of a 1% aqueous solution of the precipitate obtained on the addition of alcohol to tuberculin." Similar work has been done by Chantemese who applied the same method to typhoid fever diagnosis. Should further study and observation establish the reliability of these methods they will prove of great value, not only in the case of the diseases named but in many others.
I don't know about the rest of you, but I'm quite glad that Pirquet's skin TB test won out over an alcohol-and-tuberculin eye wash, which sounds much more intrusive and not a little bit painful. And it's interesting to know that Josephi recommended waiting on either to see whether further study would prove the tests were efficacious, but that he also seems entirely ready to embrace whatever advancement science afforded. Many of his older peers no doubt remained highly skeptical of laboratory medicine and germ theories of disease.

Wednesday, January 14, 2009

New materials from School of Medicine

Many thanks to Kathy Hollosy for bringing us a box of old documents and photographs from the Office of the Dean in the School of Medicine. Included in the donation are many group photographs of student winners of the Selling Scholarship and staff of the Multnomah County Hospital (such as this one, dated 1930-31), as well as several important documents, including a folder labeled "Dr. Holman Lectures - Speeches - Notes and Admin. Diag." Holman was dean of the University of Oregon Medical School from 1968 to 1975.

Tuesday, January 13, 2009

Medical Jurisprudence: Not as dull as you might think

We have just received a transcript from another oral history interview collected by the history of medicine in Oregon documentary project. The interview of Thomas E. Cooney, J.D., by Paul Frisch, JD, was conducted in June of 2005. Cooney is a senior partner in the legal firm of Cooney & Crew, general counsel to the Oregon Medical Association.

Cooney discusses notable cases and trends in Oregon medical law, including legislation on physician-assisted suicide, pharmaceutical regulation, malpractice, and universal healthcare. He also touches on town-gown relations between OHSU and "downtown" practitioners, outlines some of the differences between rural and urban practices, and gives his views on the changing nature of the physician-patient relationship. Here, he gives listeners some idea of why he went into law, and not medicine:

Frisch: Well you did such a good job with that. I’d like you to tell us
about your success in picking juries, especially women.

Cooney: There was a time when as young lawyers we were taught that we were not sensitive enough to the body English that the jurors were trying to, body language, rather than body English, were trying to communicate to us. And in fact, they had
seminars on that subject that in order to be an effective trial lawyer you were supposed to be able to read all that stuff.

So I went to one of those seminars. And one of the things they talked about was that women tended to be more expressive than men, and you would question them, and you had to be alert to that. So, being smart and young and thinking I knew everything, I had a case to try, and I thought I’ll try this out. And as we drew the jury from the panel, they would walk from the rear of the courtroom to the front, and we would watch them and try to analyze what they were trying to tell us.
And this one lady, who was obviously eight and a half months pregnant, went to the jury box and sat down, and the plaintiff’s counsel started to question her. And never once mentioned the fact that she was pregnant. So I seized the opportunity, because I knew that this would give her something to tell me about. And I said, “Ma’am, when’s the baby due?” And she paused, and everybody looked at her and kind of smiled. And she looked down at me and said, “Mr. Cooney, I’m not pregnant. I’m just fat.” And you could have killed me right then, and I would have been thankful. But as things worked out, she was the forewoman of the jury and found in our favor. And called me afterwards and she said, “We felt, and I felt, that you were so humiliated by that stupid question that you asked that we couldn’t do anything but find in your favor.” And I’m sure that the lawyers’ roles don’t pay that much, and it’s really the clients’ case. But that was an experience that taught me to keep my mouth shut a little bit more.

Complete transcripts of interviews are available; contact OHSU Historical Collections & Archives directly for more information.

Monday, January 12, 2009

In memoriam: Robert L. Bacon, Ph.D., 1918-2009

We have just received word that Dr. Robert L. Bacon, PhD., Emeritus Professor of Anatomy, passed away this past Saturday, Jan. 10, 2009. Information about memorial services will be announced in time.

A 1940 graduate of Hamilton College, Bob Bacon received his doctorate at Yale University. He joined the faculty at Stanford University in 1944, and remained on staff there until 1951. After a single year in Memphis, he went on to Johns Hopkins. Finding Baltimore a bit too dangerous for his young family, Bacon agreed to interview for a position in the anatomy department at the University of Oregon Medical School. He remained on the faculty in Portland from 1955 to 1988.

Dr. Bacon was gracious enough to sit for an oral history interview with us back in 2003, with his good friend Dr. Reid "Sam" Connell, PhD, as interviewer. Dr. Bacon was still in the process of editing the transcript when his health began to fail, but the following excerpt needs no correction: it perfectly illustrates Dr. Bacon's arrival in 1955 and explains his love of the Pacific Northwest:

So I came out from Baltimore, and I had never been in the Northwest before. I’d been at Stanford, stayed pretty much close to home, San Francisco and Stanford and down to LA for a visit with friends, that sort of thing, but didn’t really explore the coast. I came out from Baltimore—of course, I took the train, which was the way to do it then, and the Great Northern Empire Builder was like traveling in a nice hotel, you know. A fantastic way to travel. Well, I woke up in my little roomette, little bedroom thing, on the train, and in the morning—on the Washington side of the river, Columbia River, coming in—and looked out—I had a window, and there was Multnomah Falls across the river, and the peak of Mount Hood, dazzling snow-white above the forest, and I woke up sharply, and then came into Portland.

Dr. Pearson arranged for me to stay at the University Club for a few days, and I stayed here for about a week. I came up the Hill the first day, got out of the cab at the foot of the stairs, which are no longer there, where the street currently goes past the parking lot down the hill here, just around on the corner, and got out of the cab. At that time, that whole slope was covered with Douglas firs, the biggest trees I’d ever seen in my life up to that point. And it was May, the first week in May, and it was—all the rhododendrons were in bloom, and Dean Baird—I didn’t know at the time, but Dave Baird was a real gardener. He had the place beautiful, every spot of it. The campus was, I think, easily the most beautiful in the United States, except possibly for Duke. But just an amazing place. No medical school had anything like this.

I walked up the steps, nice beautiful stone steps, to the upper level there, turned around and looked out, and the University Hospital had just been completed, and I could see out between University Hospital and the outpatient clinic there, and there was—it was a National Geographic blue sky, and Mount Hood was dazzling white, as it was before the present days of smog interfering with it so much, and I just couldn’t
believe my eyes.

A true gentleman, Dr. Bacon will be greatly missed.