Friday, May 09, 2008

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]

Thursday, May 08, 2008

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
this world and thee.

Wednesday, May 07, 2008

More spring cleaning: mystery item

An upcoming open house event this Saturday has reinvigorated the campaign to clean up some long-standing piles. Having gone through the complete volumes contained in the odds-n-ends pile, sending some to cataloging and some to better homes outside of OHSU, I am faced with remains--not only remains of the pile, but remains of broken items. Here is the mystery leaf du jour. Any thoughts on its origin?

Tuesday, May 06, 2008

Sam Jackson Guild Luncheon presentation

I'll be spending the bulk of the day today at the Sam Jackson Guild Luncheon, an annual affair held to honor the members of the Guild and, this year, to celebrate the Pohl Scholarship winners. I have been invited to give a short presentation on Esther Pohl Lovejoy, MD, who established the scholarship fund many years ago. Her gift keeps on giving--as will those of the current Guild members.

For those of you not attending the luncheon, I include my remarks here.

[Slide 1: AWH 1917]
I was given, as my task today, a discussion of the life, career, and accomplishments of Esther Pohl Lovejoy. In thirty minutes. Perhaps twenty. Or, better yet, seventeen, to provide time for questions. Let me say at the beginning that this is an impossible task.

I could recount a list of Esther’s accomplishments, awards, and honors, but to what end? My voice would grow tired, you would grow weary, you would begin to pick at your food, half the talk would be over, and you would lose interest in hearing any more. I would rather try to give you some sense of the character of this woman, who has worked behind the scenes, and from beyond the grave, to bring us all together in this spot, to honor her memory and her husband and son, Emil and Frederick Pohl.

(And you must excuse me if I refer to Dr. Lovejoy as “Esther”; once you’ve gone through someone’s papers, you can’t help but be on a first-name basis with them.)

Esther had a wonderful sense of herself and of her own place in history. She was keenly aware of the challenges faced by women physicians and the importance of addressing those challenges through an examination of what women physicians had accomplished in the past. In 1939, she wrote the book, Women Physicians & Surgeons; nearly twenty years later she compiled Women Doctors of the World. Both books became classics in the history of women in medicine.
She also established the Pohl Scholarship, stipulating that one third of the awards be given to women.

With the same eye to history, Esther had the foresight to donate her papers to the archives at OHSU; and so, I am able to share with you today some of Esther’s own words, and the words of her friends and colleagues. And to share some of these wonderful photographs.

In 1974, in the introduction to the publication of Esther’s memoir “My Medical School,” her friend Bertha Hallam, Librarian of the University of Oregon Medical School, wrote:
“Esther Clayson Pohl Lovejoy was a remarkable woman who gave of herself and her skills all her long life for the betterment of humanity in many places and many ways. She was mentally alert, high-spirited, with a zest for life and fondness for people, a sense of humor and drama, idealistic and generous with others, but penurious with herself. She was a splendid organizer, an inspiring writer, a persuasive and eloquent speaker, determined and forthright whether talking to individuals or groups.”
[And we expect that all Pohl scholarship winners are—or will be—just as dynamic and charismatic: No pressure!]

[Slide 2: graduation 1894]
The daughter of Edward and Annie Quinton Clayson, Esther was born in a logging camp in 1869. Later in life, she would write: “Washington Territory was a forest primeval where births were not registered at the time I was born”, insisting that “the date is a matter of hearsay.” She spent her early childhood in Seabeck in the Washington Territory, moving with her parents to Oregon when her father purchased the Golden Rule Hotel on the east side of Portland. There, hotel resident Dr. John Murphy tutored her in a variety of subjects, including Latin.

Esther would later write: “Practically all the traffic between east and west Portland, including the Chinese funerals, passed the Golden Rule Hotel and there at an early age I was first attracted to the medical profession. It was not because I felt the traditional urge to relieve suffering, but because of a beautiful young lady who used to pass every morning on her way to the Stark Street Ferry. She was a medical student at the old Willamette School, and if that’s what women doctors looked like after they grew up I wanted to be one." That student's name was Belle Schmeer, and she did, in fact, go on to graduate from the Willamette University Medical Department in 1886.

Esther had other opportunities to observe women physicians at work.

Dr. Callie Charlton—who had graduated from the Willamette University Medical Department in the Class of 1879—delivered Annie Clayson’s sixth child. Olive Burt, in her imaginative biography of Esther, Physician to the World, gives voice to Callie advising young Esther: “A doctor works hard, but the pay is good. I really love my profession. It is about the best thing there is for a woman. It lets her serve others, which is rewarding, and lets her be important in the community. … You are fortunate to be living here in Oregon, where women have always been accepted in the medical school and by the public. Back East, it is more difficult for a girl to get medical training.” Esther would later write: “On the Northwest Pacific Coast medicine had always been coeducational. The old Willamette School, a Methodist institution, had been open to women from the start in the sixties, and everyone knew that they were better doctors than men.”

And so, her career chosen, Esther set out to medical school.

She arrived at the doors of the University of Oregon Medical School in 1890, then located at NW 23rd and Lovejoy Streets. Being in possession of only half of the tuition fee, Esther was concerned that she would be rejected. She later recalled the scene thus:
“With sixty dollars in my pocket (half the yearly tuition) and a new dress (home-made) on my back, I called upon the Dean, Dr. S.E. Josephi, and told him I wanted to go to his medical school and that in the spring I would get a job and pay the rest of the fee. With an encouraging smile he took the money and gave me a receipt. And THEN he asked about my qualifications for admission.
“Qualifications?” I echoed.
“Yes, educational qualifications. Did you bring your high school diploma or other certificates?”
“No,” I answered, inwardly praying for guidance.
“What school did you attend, and what subjects were covered in its curriculum?”
Curriculum! –That long Latin word gave me pause and time to think.
“I was educated mostly by private tutors,” I answered truthfully without explaining that I had never attended any school except the little red one at Seabeck, and that my occasional private tutors had been homeless men-of-letters who were in arrears for their board at our hotels. Professor John Murphy came in for honorable mention, and the Dean opened his eyes, for John Murphy was known and respected as a scholar, although he died in the County Hospital as the result of alcoholism.
While I had no papers to prove my fitness for the study of medicine I had learned a good deal in the way of diagnosis and prognosis before I had ever heard those words, and I knew from the objective symptoms of the Dean that my case was not hopeless. What I didn’t know was that the school was in desperate need of students and funds, and that sixty dollars looked as good to him as it did to me.
Lacking credentials I was obliged to take an examination for admission and the Dean didn’t waste any time in getting through with it. First, he asked a set of questions which he answered himself, and then he told me to write a thesis upon a subject with which he was familiar. This was a poser. My pen refused to move and I was failing fast when the Dean came to the rescue and working together we made the grade with a rating of a hundred per cent.”
The school was new, up-and-coming, and Esther would later write: “I felt at home in it, and perhaps I could grow up with it.” She appreciated the school’s pioneer spirit, of working with raw material and making the best with whatever was to hand. She enjoyed her classes and excelled in them, but after her first term, she was obliged to return to work to earn enough money to continue her education. Working at Lipman Wolfe as a draper’s assistant, Esther would surreptitiously study medicine behind the counter. Despite this, she managed to maintain the best sales record in the department. Once, she was caught out by the floorwalker with a box of bones--scapula, clavicle, vertebrae. After this episode, she became even more determined to succeed in medicine.

Working for 18 months, she was finally able to save enough money, and in the fall of 1892, she returned to school.

Esther's medical education was standard for its day, and endeavored to prepare students for the types of illnesses they would encounter regularly once in practice. For example, typhoid had been endemic in Portland for years, and students were rigorously trained in diagnosis and treatment. But as Esther was getting ready to graduate from medical school, the situation changed. Esther later wrote:
“Typhoid fever was different. It didn’t have to break out. It was endemic and we were used to it. The typhoid wards of our hospitals were crowded in the fall of the year, and the death rate was high. Week after week we observed the cases, carefully watching the rise and fall of the temperature and other significant symptoms, until the patients recovered, or died. We were all qualified to treat typhoid fever, but just as we were hanging out our shingles, the Portland water system was changed. Infected water from the Willamette River was turned off, and pure water—Bull Run—from the mountains turned on, and typhoid fever, a seasonal blight on the community, and a regular source of income to the medical profession, practically disappeared from the city.
Here was a lesson in preventive medicine which none of us could forget.”
Esther graduated from medical school at last in 1894, receiving the Wall Prize for having achieved the “highest aggregate mark in anatomy, physiology, materia medica and chemistry.”

[Slide 3: Emil Pohl]
Shortly afterwards, she married her classmate Emil Pohl, who had graduated the year before.

After a few years in private practice and some additional postgraduate training in Chicago (Esther in OB/GYN, Emil in surgery), the couple were persuaded by Esther’s brothers to journey to the Alaskan gold fields, where doctors were in short supply. They soon found that doctors were not the only thing in short supply: Esther and Emil had to persuade a notorious gangster, Soapy Smith, to give them money to open a makeshift hospital where they could treat the victims of an outbreak of meningitis.

[Slide 4: in Alaska]
Esther and Emil spent about two years in Alaska, visiting patients by dog sled, but after her brother Frederick was murdered on the Dawson Trail in 1899, Esther chose to return to Portland. She and Emil divided their time between Portland and Alaska, and Esther gave birth to a son in 1901.

[Slide 5: Freddie Pohl]
But Esther again experienced the sadness of losing loved ones. On September 11, 1908, her son, Freddie, died as a result of septic peritonitis caused by tainted milk, and her husband Emil succumbed to spinal meningitis while in Fairbanks in 1911.

Despite these personal tragedies, Esther continued to practice medicine in Portland, becoming the director of the Portland Board of Health, the first woman to hold such a position in a city of that size.
[Slide 6: Health Dept. staff, 1907]
As Health Officer, Esther crafted Portland’s first milk ordinances, appointed the city’s first school nurse, campaigned for reforms in food handling, and began a campaign to rid the city of rats.

In addition to her public health work, Esther became a vocal proponent of women's rights, and was active in the successful suffrage campaign of 1912.

[Slide 7: AWH staff]
By 1917, Esther’s interests had turned from the local to the global, as war concerns were brought to the fore. She was, at that time, already a member of the Medical Women’s National Association, which had been formed in 1915 and was later called the American Medical Women’s Association. In June 1917, she attended the first meeting of the MWNA War Service Committee—soon renamed the American Women’s Hospitals. Esther volunteered to travel to Europe to ascertain whether the medical units the AWH proposed to send abroad should be for general medical services or for maternity services only. Once in France, she began work with the American Red Cross and continued to consult for the AWH until her return to the United States in 1918. She spent the next year writing a book about her experiences, The House of the Good Neighbor. She summed up her observations thus: "And this is war. Death to manhood, and worse than death to womanhood."

[Slide 8: Smyrna, 1922]
The AWH concentrated from the outset on work with civilians and refugees, especially orphaned children. In June 1919, Esther assumed the chairmanship of the AWH. Her witnessing of the forced evacuation of Turkish-born Christians from Smyrna to Greece in 1922 was a pivotal event in her life and galvanized her resolve to provide medical care to civilian victims of warfare. A later account of the event noted that “When the Turks burned the port of Smyrna, which they’d just wrested from the Greeks, Dr. Lovejoy was the only American woman on the scene. Mistaken for a Greek she was beaten with a rifle by a Turkish soldier. Several times, armed only with a terrible look of anger, she stared down Turkish soldiers about to abduct young girls. She rescued others by strapping them down on stretchers.” Esther herself would later write, in her book Certain Samaritans: "How did the American women in our service happen to be in the immediate field at the time of this epochal call? How did I happen to be on the railroad pier in Smyrna when the Christian population of that old city left the land of their fathers to take refuge in the only country which would receive them? The answer to these questions might involve the history of the feminist movement since Eve moved out of Eden, or it might be covered by the universal answer to difficult questions, employed in France between 1914 and 1918, to wit, "C'est la guerre."" In a 1981 article for Women & Health, Ann Mitchell wrote: “It was emergencies such as this which refined Dr. Lovejoy’s techniques for identifying and investigating a problem, going home to raise money for it (from the early 1920s she did this virtually single-handed), then returning abroad to supervise the spending.”

[Slide 9: MWIA meeting, London, 1958]
Esther led the AWH for over 45 years, from 1919 to 1965, and under her direction the organization expanded into thirty countries, providing public health services to civilian victims and refugees from war-torn areas. In 1919, she helped found the Medical Women's International Association, serving as the first president of what has become one of the oldest international professional organizations.

Throughout her life, Esther applied the lessons she had learned early on in Portland: that the actions of individuals can make a difference, that organized groups of concerned citizens can effect powerful change, that public health measures save lives.

Over the course of her long career, Esther was awarded numerous medals and honors, including the French Legion of Honor, the Order of St. Sava from Serbia, the Gold Cross of the Holy Sepulchre from Jerusalem, the Cross of the Redeemer and the Order of the Redeemer from Greece, and the Elizabeth Blackwell Centennial Award from Hobart and William Smith Colleges. A mural with Esther's portrait was displayed in a hall bearing her name in the Philippine Medical Women’s Association building in Manila. And two years after her death, a bust of Esther was erected in the town square of Nikea, Greece.

Despite this international acclaim, Esther continued to think of Oregon as her home.
Writing to her old friend and fellow “draper’s assistant” Paul Kelty (then editor of the Oregonian) in 1935, Esther wrote: “I shall be coming home myself, one of these days, if I live long enough. I have carefully avoided becoming a legal resident of New York. I should hate to die here—lest Tammany get my bones. I would rather leave them to the Medical Dept. of the University of Oregon.”

On March 25, 1944, the 50th anniversary of her graduation, the faculty and alumni of the UOMS paid tribute to her career at a University Club banquet. Esther had maintained a lifelong interest in the school, and in 1951 wrote to Dean Richard Dillehunt: “I am an old woman, over 80, and practically everything worth having that has come to me during a long life has stemmed from the Oregon Medical School.”

[Slide 10: 1957 Alumni mtg]
And here is Esther, back for the Alumni meeting in 1957, not as pleased with what she was hearing.

[Slide 11: flying for Liberty Loan]
Interviewed in 1963 at the age of 94, Esther still exhibited the impatience that had characterized her actions throughout her life. She would still walk up six flights of stairs rather than waste time waiting for the elevator. Esther once wrote: “There is sickness here – famine there – war and hatred all around – ignorance and malice affecting thousands. Life is short at its longest – with all there is to do, let’s get busy.” As fitting a call today as it was a half century ago.

Monday, May 05, 2008

History of Medicine Society Lecture TODAY!

For readers in the Portland area, a reminder that the final lecture in the 2007-08 season of OHSU History of Medicine Society Lecture Series will take place today at noon--please join us! The full announcement follows:

The OHSU History of Medicine Society is proud to announce the next presentation in the OHSU History of Medicine Society Lecture Series:

"William Stewart Halsted: Our Surgical Heritage"
Guest speaker, John L. Cameron, M.D., Alfred Blalock Distinguished Service Professor of Surgery, Johns Hopkins University School of Medicine

Monday May 5, 2008
Public lecture: 12:15 p.m.
Refreshments served at noon
Location: Old Library Auditorium

Dr. Cameron, the Alfred Blalock Professor of Surgery, Distinguished Service Professor, and the first William Stewart Halsted Professor of Surgery at Johns Hopkins, stepped down in 2003 as surgeon-in-chief and chairman of the Department of Surgery. He has made many contributions to the understanding of the pathophysiology and management of benign and malignant pancreatic diseases. Most often associated with the Whipple procedure, a complex operation used to treat a variety of pancreatic diseases including pancreatic cancer, he has performed more of these operations than any other surgeon in the world. Except for two years at the Walter Reed Army Institute of Research, Dr. Cameron has spent his entire medical career at Johns Hopkins. He has published over 300 articles, over 90 book chapters, and is the editor of nine books. He is on the editorial board of several journals, is co-editor of the Journal of Gastrointestinal Surgery and is editor of Advances in Surgery. Dr. Cameron remains active as a clinical surgeon, as a teacher, and an investigator.