Friday, June 19, 2009

Summer reading, and a hiatus in which to do it

I'm not going to the RBMS Preconference this year (due to insufficient funds, not insufficient interest), but I am taking a June break all the same. There will be no posts all next week. Luckily, the library has recently received a passel of books that will help you get your historical "fix", from 18th-century correspondence to military medicine to biography and memoir:

Hunter, William, 1718-1783.
The correspondence of Dr. William Hunter, 1740-1783 / edited by C. Helen Brock.
London Brookfield, Vt. : Pickering & Chatto, 2008.

Garrod, A. H. (Alfred Henry), 1846-1879.
The collected scientific papers of the late Alfred Henry Garrod, M.A., F.R.S. / edited, with a biographical memoir of the author, by W.A. Forbes.
[S.l.]: Kessinger Publications, [2009]

Henderson, Donald Ainslie, 1928-,
Smallpox : the death of a disease : the inside story of eradicating a worldwide killer / D.A. Henderson
Amherst, N.Y. : Prometheus Books, 2009.

War surgery in Afghanistan and Iraq : a series of cases, 2003-2007 / edited by Shawn Christian Nessen, Dave Edmond Lounsbury, Stephen P. Hetz.
Falls Church, Va. : Office of the Surgeon General, United States Army; Washington, DC : Borden Institute : Walter Reed Army Medical Center, 2008.

Ings, Simon.
A natural history of seeing : the art and science of vision / Simon Ings.
New York : W.W. Norton, 2008.

Varmus, Harold.
The art and politics of science / Harold Varmus.
New York : W.W. Norton, c2009.

Warner, John Harley, 1953-
Dissection : photographs of a rite of passage in American medicine, 1880-1930 / John Harley Warner, James M. Edmonson.
New York : Blast Books, 2009.

Wexler, Alice, 1942-
The woman who walked into the sea : Huntington's and the making of a genetic disease / Alice Wexler.
New Haven : Yale University Press, c2008.

Philippon, Jacques.
Joseph Babinski : a biography / Jacques Philippon, Jacques Poirier.
Oxford New York : Oxford University Press, 2009.

Werbel, Amy Beth.
Thomas Eakins : art, medicine, and sexuality in nineteenth-century Philadelphia / Amy Werbel.
New Haven : Yale University Press, c2007.

Cook, G. C. (Gordon Charles)
Tropical medicine : an illustrated history of the pioneers / G.C. Cook.
Paris Boston : Elsevier/Academic Press, 2007.

Myrsiades, Linda S.
Medical culture in revolutionary America : feuds, duels, and a court-martial / Linda Myrsiades.
Madison : Fairleigh Dickinson University Press, c2009.

Nuland, Sherwin B.
The soul of medicine : tales from the bedside / Sherwin B. Nuland.
New York : Kaplan Pub., c2009.

Sigerist, Henry Ernst, 1891-1957.
Socialized medicine in the Soviet Union / by Henry E. Sigerist.
New York, W.W. Norton & Co. c1937.

Luckhurst, Roger.
The trauma question / Roger Luckhurst.
London New York : Routledge, 2008.

Ribatti, Domenico.
History of research on tumor angiogenesis / Domenico Ribatti.
[Dordrecht] : Springer, c2009.

Bennett, M. R.
History of cognitive neuroscience / M.R. Bennett and P.M.S. Hacker.
Chichester, U.K. ; Malden, MA : Wiley-Blackwell, 2008.

Pintar, Judith.
Hypnosis : a brief history / Judith Pintar and Steven Jay Lynn.
Chichester, UK Malden, MA : Wiley-Blackwell, 2008.

Surawicz, Borys, 1917-
Doctors in fiction : lessons from literature / Borys Surawicz, Beverly Jacobson.
Abingdon : Radcliffe, 2009.

Enjoy! And see you back here on June 29.

Thursday, June 18, 2009

"A series of unplanned good outcomes": Beyl on life

Now that the transcript from the oral history interview with Cecille O. (Sunderland) Beyl, MD has been fully edited, we can share some of the wonderful tidbits from Dr. Beyl's look back over her life and career, which she characterizes as "a series of unplanned good outcomes":

On choosing medicine
BEYL: Yeah. Actually my mother, my mother wanted me to be a doctor. She kept talking to me about that. So my pursuing and considering other things was more a rebellion against that. And then I realized, I think that’s probably what I want to do. It’s hard to know exactly why we make these decisions.

DESAI: Sure. Sure.

BEYL: And that’s why I feel very fortunate that I did make that decision. Because, and even though this sounds rather emotional, I’m really sincere when I say I feel so fortunate that I have had the opportunity to be a doctor, with a life of constant learning, constant challenges, constant thinking. And also make a difference in the world and help people. And you know, when I started in this, I wasn’t thinking in terms of being in an academic position all my life. But in reality, I feel very fortunate that that is the way that my professional life was directed, because in an academic position, one, I’m constantly interacting with my colleagues. And there is a certain amount of peer review that goes on with that. And I’m not saying that in a negative way. We were constantly challenging each other to stimulate thinking, and encourage new ideas in ourselves and in our colleagues. And it’s this constant interaction, so that I’ve been constantly teaching, constantly doing research, presenting papers at meetings. I feel very fortunate that that is how my life direction went.
On medical education at OHSU
BEYL: Yeah. I don’t know if that’s true everywhere, which then leads me to here at OHSU. And this is also what I tell medical students whom I interview who are applying to medical school here. One of the things that all of us medical students felt in Syracuse at that time, was that teaching was not a high priority. And in many ways, we felt that we were in the way. And it wasn’t just I as a woman medical student; it was all of us. And that the professors really were focused on their teaching efforts and so forth on the subspecialty fellows, and so forth.

And when I started here in 1967, and of course I was in pediatric cardiology, what impressed me was the concern for teaching, the focus on teaching, that everybody was important. And this included medical students, nursing students. I mean, even the public. So that the medical students and the faculty were in a collegial relationship. And what that did, that collegial relationship meant medical students didn’t have to compete with each other. You know when I was going to medical school, there was this old tradition of you have to see who’s going to fail so that the others will remain. That wasn’t the philosophy here. It was a collegial relationship, which makes for a more positive learning environment. And this is part of also what I tell medical students, you know, the applicants to medical school, that we have a collegial relationship.

And actually I and others of my colleagues became good friends with medical students when I was pediatric attending. At the end of the rotation, I would take my team on a hike. [laughs] Somebody was talking about that the other day, whom I met someplace, I don’t remember where. But it’s a collegial relationship. And I think that’s very special to OHSU. And I think, it wasn’t called OHSU in those days. But I think that dedication to teaching continues.
On OHSU as a pioneering medical center
PIASECKI: So when you came to OHSU, did you have a sense in the ‘60s that it was a place that was an exciting place to be?

BEYL: Yes.

PIASECKI: It sounds like you did.

BEYL: Yeah. No, I mean even before I came here, I knew that it was an exciting place to be for a couple of things. One was the primary intracardiac repair in early infancy of tetralogy. The Starr-Edwards valve was well known. I remember as a medical student in Syracuse, a woman came in that they brought in when I was a medical student, and she had a Hufnagel valve. I don’t know if you’ve even, did you ever hear of the Hufnagel valve?

DESAI: I have.

BEYL: I mean, it was a valve placed in the sort of the aortic arch, a little bit proximal to the aortic arch, for a severe aortic insufficiency. You could hear this valve across the room. But the woman was alive, anyway. Albert and Edwards sort of figured out this valve, and it revolutionized the treatment of aortic valve disease in adults. So of course I’d heard of that. And of course I worked with Albert and the other surgeons who came and worked with Albert. I don’t remember if I was taller than he, or he taller than I. [laughter]
As always, the full transcript will be available through the OHSU Main Library after processing (indexing, abstracting, cataloging) is complete.

Wednesday, June 17, 2009

In memoriam: Melvin W. Breese, M.D. (1914-2009)

A visitor to the History of Medicine Room today shared with us news of the passing of Dr. Melvin Wilson Breese, M.D., in Arizona in April. We had missed the brief notice in the Oregonian, which ran on April 8.

Breese graduated from Oregon State College (now Oregon State University) in 1936 and received his medical degree from the University of Oregon Medical School in December of 1943 on the accelerated wartime schedule. During his dual residencies in gynecology & obstetrics and pathology at UOMS, Breese, together with UOMS pathologist Howard L. Richardson, M.D., developed an Atlas of gynecological & obstetrical microscopic pathology for the use of fellow students.( The work was never published, but we have a copy of it in the PNW Archives Collection.)

After finishing his residencies in 1948, Breese immediately joined the clinical faculty in the Dept. of Obstetrics and Gynecology at the medical school. He remained on the volunteer clinical staff through 1994.

In 1961, Breese served as president of the Multnomah County Medical Society, and was elected to the presidency of the Oregon State Medical Society the following year. In 1968, Breese made a splash in the national news when, as chair of the OMA's council on medical education, he bucked medical tradition and shepherded a bill mandating continuing medical education for all society members through the House of Delegates. The OMA was the first state medical association to adopt such a rule, following the lead of the American Academy of General Practice, which was the first medical organization in the United States to require CME.

The September 2, 1968 issue of Newsweek wrote:
The new program, insists Dr. Melvin Breese, chairman of the OMA's council on medical education, is not intended to be a disciplinary 'big stick', but a way of helping members to be more effective physicians. Yet he admits that one reason the requirement was adopted so readily was to head off action to monitor the competence of physicians by the government or agencies outside organized medicine. [emphasis added]
Breese is survived by his wife, three children, seven grandchildren, and 13 great-grandchildren.

Tuesday, June 16, 2009

New uses for old techniques

This week's issue of New Scientist (13 June 2009; 2712) includes a fascinating article about the return of the old, old surgical technique of trepanation as a treatment for dementia, titled "Like a hole in the head: the return of trepanation" -- the idea being that if you lower the pressure on the brain, blood flow will increase. We have several examples of early trephines in the Medical Museum Collection (including the one shown here), should you wish to try this at home on those days when you're feeling a bit foggy...

Monday, June 15, 2009

The "Why" of Hospital Costs, Present and Future

In a presentation delivered before the North Pacific Society of Internal Medicine in the fall of 1959, University of Oregon Medical School Dean Charles Holman, M.D., discussed in eerily modern terms some of the causes for the meteoric rise of health care costs in America and addressed the question of what could be done to control them. A typescript of "The 'Why' of Hospital Costs, Present and Future" in Holman's Biographical File preserves the text of his speech. It reads, in part:
Before going further I want to make the categorical statement that the upward spiral of hospital costs is going to continue throughout the immediately foreseeable future and cannot be stopped by any measure which any of us, operating in a free society, would wish to see adopted. [page 1; emphasis added]

Hospital personnel no longer accept the idea that because they are concerned with the care of the sick they should donate some of their services to the community by means of accepting lower pay scales. They now rightly feel and are demanding that they be paid the same rate as other workers.... Many hospitals practiced a considerable amount of paternalism in relation to their employees in that employees were required to accept meals and housing as part of their stipend. This was accomplished at considerably lower cost to the hospital than would have resulted from payment of a full salary for the work performed. [page 2; emphasis added]

The increase in national income has had an important effect. ... Rising standards of living are also reflected in increased demands for the niceties associated with hospitalization. These include such things as air conditioning, piped radio and television, drapes on the windows, phones at the bedside, a selective menu, all things not essential to the welfare of the patient, but all adding to the cost of hospitalization. [pp. 3-4; emphasis added]

[and yet]... the biggest single factor in the increase of hospital costs is the advance in medical science which has made better care available for our patients. [p. 7]

You may be interested to know our financial experience in performing open heart surgery. The cost per case, including diagnostic cardiac catheterization, an average of 21 days hospitalization, additional personnel beyond that needed for the usual extensive major surgical procedure, special laboratory work, special nurses, disposable supplies and of cleaning and retesting the pump oxygenator and other equipment between cases, averages approximately $1,800 per case. This does not include a penny for the services of any doctor involved. It does not include $18,000 worth of special equipment purchased for this procedure, nor does it include approximately $30,000 spent in salaries and supplies perfecting the technique and developing and training a team on over 100 dog procedures before the first patient was operated upon. This is an average cost of approximately $88.oo per day during a period when the average cost per patient per day in our hospital for all patients including open heart was about $31.00. [p. 8-9; emphasis added]

We now turn to the commonly heard question, "What are we going to do about the increased costs?" The answer is that we are going to do very little that will affect the upward spiral. [p. 9; emphasis added]

There is of course one way that hospital and medical bills can be held down. That is for an agency backed by or with governmental authority to impose by rules and regulations limits upon services which can be rendered to patients. This would hold hospital bills down, but it would also severely limit medical progress and its application to sick people. [p. 10; emphasis added]
Dean Holman sees what modern commentators are calling "rationing" as the only means of lowering healthcare costs, which is his "measure which any of us, operating in a free society, would [not] wish to see adopted." I guess we in the free society need to think about what we would wish to see adopted, should we be unwilling to part with drapes and television....