Document Sample
					 May, 1937                          WHITMAN CENTENNIAL-BEHNEMAN                                                           319

peridural anesthetic to a spinal anesthetic. For this reason
the importance of developing a careful technique during          THE URE OFMEDICAL HISTORYt
the injection cannot be overemphasized. For the first one
hundred cases injected by any individual, I think it would        THE WHITMAN CENTENNIAL: THE LATE
increase the factor of safety if the patients upon whom it
is used were limited to those that we would consider good               DR. MARCUS WHITMAN*
risks for spinal anesthesia.
   I would like to congratulate Doctor Heissig on the                         By H. M. F. BEHNEMAN, M.D.
excellent presentation of this subject, and urge her to con-                          San Francisco
tinue the use of peridural anesthesia until several of her
staff have become proficient with this form of injection.        ONE hundred years ago this month, what was
                                                                      probably the first American home on the
   PAUL M. WOOD, M.D. (131 Riverside Drive, New York             Pacific Coast was established. On the banks of
City).-Doctor Heissig has very thoroughly reviewed the           the Walla Walla River, in eastern Washington,
available literature on peridural anesthesia, and I agree        Dr. Marcus Whitman and his wife, Narcissa
with the findings concerning the relative safety of this         Prentiss Whitman, ended their long wedding jour-
regional form. In cases where the dura has been pene-            ney and began housekeeping in a crude log cabin.
trated, I have personally observed patients who apparently
did not have true spinal anesthesia as suggested by Doctor       The location of their home was known by the
Heissig and others of withdrawing the needle slightly.           Indians as Waiilatpu, or the "Place of Rye Grass,"
   However, I have also observed two cases where peri-           and it was the favorite resort of the Cayuse and
dural anesthesia was attempted, and where there was no           Walla Walla Indians.
question but that some spinal anesthesia was induced,
possibly by leakage into the subarachnoid space from                       THE CENTENNIAL MEMORIAL OF
sudden injection pressure into the peridural space.                                   JANUARY, 1936
   The greatest disadvantage in my practice is the length
of time required for securing this form of anesthesia.              In commemoration of the importance of this
A technical maneuver, which has aided me, is the use of          event, a public celebration, or centennial memorial,
a three-way stopcock between the needle and syringe.
The No. 10 or No. 20 syringe is filled with the fluid to         was held last August in Walla Walla, Wash-
be injected. A glass "filter adapter" (No. 21 Becton             ington. This was a three-day succession of events
Dickinson), which holds a little less than one-half cubic        depicting the life and work of these noble pioneers
centimeter of fluid, is placed in the upright position. The      of the Northwest. The first day was devoted to
stopcock is adjusted so that the fluid to be injected into
the peridural space is forced into the glass adapter. The        the interests of medicine, under the direction of
stopcock is then set, and with the entire apparatus bal-         the American Medical Association, when in the
anced in the hand the needle is advanced through the             beautiful open amphitheater on the campus of
tissues and ligaments. The moment the peridural space            Whitman College there were inspiring exercises.
is entered, the fluid quickly disappears from the little glass
adapter. Without any further manipulation the lever is           A large number of the residents of that part of
set in such a position that the fluid in the syringe may         our Northwest country are direct descendants of
be immediately injected. This has tended to eliminate            those who came in covered wagons, and with that
puncturing of the dura during the manipulation of attach-
ing the syringe.                                                 hereditary, inbred spirit of the pioneer, they
  I am convinced that this form of anesthesia has a defi-        opened their hearts and their homes to all who
nite place in the armamentarium of professional anesthesia,      came to do honor to the famous country doctor.
and provides efficient and relatively safe anesthesia in         Each day there was a huge parade, and each night
selected cases.
                                                                 a well-trained, spirited production, by three thou-
   JOHN G. DUNLOP, M.D. (111 North Normandie Avenue,
                                                                 sand actors, depicting the Northwest territory
Los Angeles).-The value of peridural anesthesia and its          from the arrival of Doctor Whitman to the
ultimate place in the repertoire of the anesthetist is yet       present. The citizenry turned out en masse in the
to be determined. The administration is more difficult,          costumes of the covered-wagon days, and each of
and requires a greater exactness than for a spinal anes-         the ten thousand visitors realized before he left
thesia; and as yet few anesthetists in America have had
sufficient experience with the method to warrant a just          that the preparation of this event had for two
evaluation of its merits. In certain clinics in Europe and       long years been entered into with shoulders to the
South America it has apparently proved satisfactory, and         wheel, as it was in the westward crossing. For
those persons in this country who are in a position to do        many months the State of Washington, through
so should be encouraged to perfect the technique and
determine for themselves its value.                              the newspapers, ran a popular contest, so that each
   Except for patients evidently suffering from hyperthy-        county in Washington was represented by a direct
roidism, adrenalin, I think, should not be omitted from the      descendant of a covered-wagon pioneer, chosen
anesthetic solution. By decreasing the rate of absorption,       through her popularity with the people of her
it decreases the toxicity, and also prolongs the anesthesia.
Because an occasional patient is apparently hypersensitive       county.
to the drug, however it is probably wise to limit the               On Medical Day, addresses were given by Dr.
amount used. For years, in our sacral anesthesias, which
are really low peridural anesthesias, we have been adding        Frederick C. Waite, Dean of Western Reserve
6 minims of 1-1000 adrenalin to 100 cubic centimeters of         University Medical School; Dr. S. B. Penrose,
one per cent novocain solution, with no severe untoward          President Emeritus of Whitman College; and by
reactions attributable to the adrenalin. A similar restric-      the presidents of the Washington and Oregon
tion would probably be wise with peridural anesthetic
   Fifty cubic centimeters of 2 per cent novocain solution         t A Twenty-Five Years Ago column, made up of excerpts
                                                                 from the offilcial Journal of the California Medical As-
contain 1,000 milligrams of novocain, and this amount            sociation of twenty-five years ago, is printed in each issue
injected into the highly vascular peridural space is capable     Of CALIFORNIA AND WESTERN MEDICINE. The column is one
of producing rather acute novocain intoxication. A slow          of the regular features of the Miscellany department, and
                                                                 Its page number will be found on the front cover.
administration, plus the judicious addition of adrenalin to         * Presented before the San Francisco County Medical
the anesthetic solution, is therefore indicated.                 Society, January 12, 1937.
.320                         CALIFORNIA AND WESTERN MEDICINE                                  VOl. 46, No. 5

State Medical Societies, as well as a trustee of         After practicing for a while in New York State
the American Medical Association; and the ad-         and Pennsylvania, he moved to Canada; but being
dress to the laity was entitled "A Century of         of an ambitious and searching nature, he wanted
Progress in Medicine."                                further formal education. Accordingly he re-
                                                      entered Fairfield Medical School in 1831. His
       PROFESSIONAL TRAINING OF MARCUS                new teacher of surgery was John Delamater, who
                  WHITMAN                             in forty years of teaching held nine professor-
   Marcus Whitman came to the Northwest as a          ships in as many different schools, and who, with
young man,    and met a tragic death a few years      Oliver Wendell Holmes, reestablished the de-
later, having been born in 1802 in a New York         cadent Dartmouth Medical School and took part
village now known as Rushville, named after           in founding the Cleveland Medical College, now
Dr. Benjamin Rush. In the veins of his parents        the Western Reserve University School of Medi-
was the blood of fearless, decisive, migrating pio-   cine. So on January 29, 1832, Marcus Whitman
neers. When Doctor Whitman was eight years            received the M. D. degree, a thoroughly educated
old, his father died and he was sent to live with     physician for his time, and soon after, as a coun-
his uncle in Comington, Massachusetts. When he        try doctor, began a residence of three years in
was thirteen, he moved to Plainfield and became       Steuben County, New York. There was no other
a pupil in the well-known private academy of          doctor within a radius of sixteen miles, so he had
Dr. Moses Hallock, from which emanated some           a varied experience.
of America's most noted men. When he was ready
to enter college at eighteen, he wanted to become         MEDICAL PRACTICE ONE HUNDRED YEARS
a clergyman; but lack of funds prevented this,                     AGO: FEES RECEIVED
so for a period of five years he worked in the           There were then no specialists, no consultations,
tannery and shoe shop of his stepfather and in        no office hours, and the young physician responded
the sawmills of his uncle. At that period, entrance   to calls regardless of weather, location, or time
to the ministry demanded four years of college        of day. The only transportation was on horse-
education and three years in a school of theology.    back, and the busy doctor needed more than one
The study of medicine, however, could be begun        such transport. In fact, a doctor's success was
in one's own home town, under the local doctor,       sometimes measured by the number of horses he
and from then on pursued jointly with other           maintained, and a new force was given to the old
duties.                                               expression, "one-horse," a deprecating term long
           FAIRFIELD MEDICAL SCHOOL                   applied in various ways. Naturally, he had to
   Fortunately for Marcus Whitman, the town's         furnish medicines to his patients, crude drugs
only physician, Dr. Ira Bryant, was a skillful        ground by himself, as there were no apothecaries.
doctor and a man of high integrity, and in 1825,      All surgery was done in sick folks' homes; and
with two years of study under Doctor Bryant           as there was to be no anesthesia for another f our-
behind him, Whitman was ready to enter the study      teen years, speed was the index of surgical skill:
of medicine, there being at that time eight medical   a good surgeon amputated an arm in three min-
schools in New England, three in New York State,      utes and a leg in six! There was no antisepsis;
and only four more in all of the United States.       and instruments once used were wiped off and
Whitman entered in October as a student in the        ready for the next victim. It was to be fifty years
Fairfield Medical School, known also as the Col-      before bacteria were discovered. The doctor's fees
lege of Physicians and Surgeons of the Western        were of interest: a house visit within three miles
District of New York. The school then had five        was 25 cents, and for each mile thereafter an ad-
professors, one hundred and thirty students, and      ditional 6%4 cents was allowed. If the same patient
one hundred trustees !                                had a second call the same day, it was half the
   This medical college, however, had one dis-        fee of the first one! Thus the doctor could not
tinction. It was the only school in America where     be accused of running up a bill. Medicines were
human dissection could be carried on legally. The     extra and averaged 6%4 cents each. The office call
cost of this medical education is very interesting.   netted the doctor 12Y2 cents. The surgeon, too,
The session lasted four months, from October 1        was not on the road to wealth: Twelve and one-
to February 1. At that time the students paid         half cents was charged for tooth extraction; frac-
each individual professor; he "bought tickets" of     tures were rated from $2 to $5, and a charge of
them. In this year of 1825, the five tickets cost     $5 was made for lower-arm amputations, and $20
$54; the dormitory room cost 30 cents a week;         for the upper leg. Obstetrical deliveries were from
board was $1 a week; and firewood cost $1.25          $1.50 to $3, dependent upon the duration of labor.
 for the entire session. In addition, there was          The doctor in those days never spoke of his
expense for books, candles, and laundry, so that      "income"-it was what he "put on the books"; a
the total cost for the entire session was about       very successful country doctor averaged from $75
$100. That may seem small to us now, but it took      to $150 per month. His cash income was very
Marcus Whitman two years to save it. After just       little; he received a great deal in merchandise, and
one session at this school, Whitman was admitted      more in services of various kinds. (I have some
to his County Medical Society upon examination        account books to show you later where even the
and received his diploma on May 9, 1826.              bar claimed $12 used credit.)
May, 1937                   WHITMAN CENTENNIAL-BEHNEMAN                                                321

            CHOLERA EPIDEMIC OF 1832                  stops were those to kill an animal to furnish fat
   The year 1832 was a period of tortuous prac-       with which to grease the creaking, whining wheels.
tice for the American doctor, more than any year      The wagons were abandoned at Fort Laramie,
in the country's history. The terrifying cholera      now Wyoming, and their contents transferred to
spread over the Erie Canal and up the Mississippi     the backs of pack animals. From then on, as the
like a prairie fire. In this epidemic Whitman saw     strength of a chain in its weakest link, the speed
and learned much.                                     of the caravan was the pace of the slowest man
                                                      or animal.
   And then came into his daily routine an event         But after many narrow escapes from Battles
which changed not only his life, but the lives of     with roving Indians, the caravan reached the sum-
countless to come, as well as the geography of the    mit of the Continental Divide, and on August 10,
United States. Whitman, in his heart, never lost      1835, Marcus Whitman gazed westward, the first
the desire he had cherished to become a minister.     graduate of an American medical school to stand
Out of a clear sky in 1835, the famous clergyman,     on the western side of the Rockies, the pioneer of
Rev. Samuel Parker, persuaded him to be his           all the thousands of us who have administered to
companion in a missionary exploration to the          the millions residing in this great empire in the
Northwest. Here Whitman saw his opportunity           past century.
to combine the two greatest fields of service to         Two days later another historic event took place.
humanity, the ministry and medicine.                  The caravan came to the crossing of the Green
   So, in March, 1835, he bade farewell to the sad    River, where about two thousand Indians and two
people of his district, for he was not just their     hundred white trappers were gathered. Among
doctor; he was their friend and counselor. Pick-      them was James Bridger, noted American guide
ing his best horse, with eyes toward the unknown      and scout. He was suffering and annoyed at the
western wilderness, he started alone for St. Louis,   presence of a large iron arrowhead he had carried
seven hundred miles away, which he reached early      for over three years just under one scapula. Whit-
in April. There the Rev. Parker met him, and          man removed it for him and also one from an-
from there they went by boat on the Missouri          other trapper. Can you for a moment visualize
River to Liberty, Missouri, the starting point of     the historic setting-was there ever any amphi-
many caravans to the West and Southwest. And          theater' containing over two thousand Indians and
so, in the middle of May, these two brave hearts      whites wherein one physician's future standing
with sixty men, comprising the caravan of the         with his fellow man was more at stake-? The grati-
American Fur Company, pushed westward. I              tude of the two men was unlimited, and the
need not comment upon the ruggedness of these         astonishment of the Indians beyond our compre-
sixty travelers. Unfortunately, the Rev. Mr.          hension. Thus resulted a lasting friendship with
Parker was a bit inconvenienced by the hardships      Jim Bridger and a firm reputation as a surgeon
of travel and was poor at concealing it. He soon      in the entire Northwest empire. The Indian chiefs
became an object of contempt and the target of        sent runners clear to the Columbia River to tell
rotten eggs. Moreover, the whole outfit felt like     of the coming of the great white medicine man.
birds of a color traveling together, and thus Whit-
man was as mistakenly labeled as Parker. This                     THE MISSIONARY PROJECT
animosity grew until there was much talk of              And now another important episode took place.
murdering the pair. Fortune, however, decreed         After a long conference it was decided that the
otherwise and saved them in the form of dreaded       Reverend Parker should continue West and Whit-
cholera. Where the Platte River joins the Mis-        man should turn back and go East for more
souri, one of the caravans succumbed to the dis-      missionaries. It took him until November to reach
ease. They were two hundred miles from any            St. Louis, and in the opposite direction Parker
town; they had three choices-desertion, death, or     had reached the Columbia River in August. Whit-
the despised doctor.                                  man had great difficulty in finding recruits, but
   Fontanelle, the brave caravan leader, sent for     in February, 1836, he persuaded the Rev. Henry
Whitman and reported three cases of cholera.          H. Spalding to join with him. Before starting,
Must they turn back? Must they all die? Then          however, he made the trip back East to claim
they learned to know Marcus Whitman. He had           Narcissa Prentiss as his bride-a lovely, cultured,
seen cholera; he had the drugs with him that          educated young woman, courageous beyond words,
would stop early cases; so, as a result, only three   zealous to carry the word of God to the Indians,
members of the caravan died. Overnight the            and deeply in love with Marcus Whitman.
doctor was the' leader among men; his place was          So the Whitmans and Spaldings joined the
'so high that his friend the minister basked safely   caravan of 1836. These two women were the first
in Whitman's shadow, ignored and harmless.            white women to cross the Rocky Mountains, and
   So the eleven-day stop ended, and the caravan      the party arrived in the Columbia River valley
headed once again into the wilderness of the land     late in September. There Dr. and Mrs. Whitman
of the setting sun. For fifty fatiguing days under    established a station on the banks of the Walla
the burning rays of summer sun, they plodded on,      Walla River, while the Spaldings went one hun-
across eight hundred miles of roadless, treeless      dred and twenty miles farther on to the Snake
plain and prairie. The only unscheduled daytime       River valley, now in Idaho.
322                           CALIFORNIA AND WESTERN MEDICINE                                  vol. 46, No. s

         THE POST AT FORT WALA WALLA,                  1843 he led to Oregon the first of never-ending
                  WASHINGTON                           caravans, a body of eight hundred people. By
   Here at Fort Walla Walla, which became a            1847 the whites in the new Oregon Territory had
very  important post, Whitman and his good wife        increased to over three thousand. His mission
fulfilled all the strenuous duties of missionary,      was surrounded by settlers and the ever-present
doctor, agriculturist, and historian, for eleven       Cayuse and Walla Walla Indians. But, unknow-
years. Their lives were of hardship, particularly      ingly, the end was near. Distrust and unrest
for a gentlewoman of the sheltered eastern home        among the Indian tribes increased with the tide
life she had known; but she was equal to it.           of white settlers in the middle forties. The Indians
While Whitman performed his medicine and sur-          referred to Whitman as the good doctor and re-
gery, teaching of agriculture and many other pur-      garded Mrs. Whitman as an angel of mercy, but
suits, Mrs. Whitman taught the Indian women to         felt more and more terrified at the thought of
cook, to sew, and to speak our language; before        being driven from the home of their fathers. One
long she had a large school of Indian women and        Indian was the leader in this movement, by name
children, eager to learn the things she had to teach   of Tam-a-has, and his wily associate, Joe Lewis,
them. Both of the Whitmans worked arduously            kept firing the furnace of hatred. They told their
to convert the Indians to the white man's religion.    tribes Whitman was the man who brought the
   In 1838 the second missionary party arrived,        whites to steal their land. Then, at a crucial
containing nine white people, including the Rev.       moment Fate was most unkind, for the first epi-
Cushing Eells. The mission and trading post grew       demic of measles broke out at the mission and
far beyond their expectations. Meanwhile great         spread rapidly among the Indians and whites.
happiness had come for the Whitmans in the form        Naturally, Whitman was unable to control it, al-
of a baby daughter, born March 14, 1837, perhaps       though he worked day and night to save those he
the first white child born west of the Rockies.        could. The many deaths left but one path to follow
Blonde like her mother, she was worshiped by           in the mind of the Indian-revenge upon the
the Indians.                                           medicine man.
                                                                         THE MASSACRE
   We come near the end of the tale now, and
fortune appears to desert the Whitmans, finally            The befriended reds soon reverted to the centu-
giving place to bloodshed and tragedy. The first       ries of barbarism in their veins. On a cold No-
blow to the faithful pair came late in 1839? With      vember night in 1847, there was a knock on the
her father busy in the fields and her mother teach-    mission door. Whitman was weak from fatigue
ing school, the little two and one-half year old       and worry, and asleep. Narcissa Whitman opened
child wandered alone to the forbidden banks of         the shutter; two familiar faces, Lewis and Tam-a-
the Walla Walla River and tumbled in. Her body         has, dourly looked at her, demanding to see the
 was found by the heartbroken Indians and re-          doctor for medicine for their squaws. With fear
turned to the grief-stricken parents. The shadow       in her heart she locked the door and called her
 of trouble grew larger. In a few months, Whit-        husband. He, too, was suspicious of trouble, but
 man heard the mission board in the East was           did not feel it was so close at hand. She begged
 about to abandon this mission. Also, now at its       him not to see them, but he pointed out they
 height was public discussion as to whether the        were far outnumbered and it would be better to
 United States or Great Britain should buy Oregon      be friendly, saying: "God's will shall soon be
 Territory. It was then under the administration       known."
 of both countries.                                        He arose and locked the door behind him into
                                                       the inner part of the house, went to the outer
                                                       entrance and welcomed the two Indians. They
                                                       demanded medicine for their squaws and that was
   So, once again, early in 1842, Whitman made         all. Whitman talked a few moments to them, re-
the long trek to the East. There, through his elo-     lieved that they did not want him to go to their
quence and sincerity of purpose, he convinced the      tents. The two pairs, of treacherous eyes followed
Board the mission should remain. Achieving this,       him. As the young martyr bent over his bag, the
he then went to Washington. A leader among             swift, sure stroke of a tomahawk deep into his
men with the blood of migrators coursing in his        skull ended a noble life.
veins, he appeared before President Tyler and              Pandemonium broke loose as the house was
part of his cabinet in an historic session. He         being surrounded while the two Indians were talk-
urged Secretary of State Daniel Webster, mem-          ing to Whitman. A shot through the open window
bers of Congress, and the President, to purchase,      brought down Mrs. Whitman with a bullet under
without further hesitation, this Northwest empire.     her arm and in her cheek; she lived for some
They listened and were impressed with his tales        hours. One by one, fourteen white lives were taken
of wealth in very useful land, with a large river       during the remainder of the night. Fifty loyal
running to the Pacific Ocean-the mighty Co-             Indians and whites were wounded in an effort to
lumbia. As we know, Congress did not hesitate           stop the massacre. All the remaining whites were
very long.                                             held hostages for a month, and then sold at a high
                 OREGON TERRITORY
                                                        price to Governor Ogden in Umatilla. Thus ended
    The rest of that year Whitman spent in zealous      Waiilatpu Mission, but thus began monuments to
 enlistmnent of settlers for the new land, and in       its memory.
May, 1937                              CLINICAL NOTES-CASE REPORTS                                         323

                     WHITMAN COLLEGE
   Indian wars continued for twelve years, and
then in 1859 the Rev. Cushing Eells returned
to the scene of the massacre. He resolved to
devote the rest of his life to honoring Dr. and
Mrs. Whitman, and the monument he erected was
Whitman College, for seventy-five years a worthy
tribute to the Whitman's, a coeducational college
of high character and large enrollment, in Walla
Walla, Washington.
   In the pictures frequently shown, you may see
the grave of Marcus Whitman, a marble shaft
pointing high into the sky, arising on a peaceful
hillside in the rolling green hills of eastern Wash-
ington. There are tablets to his memory in the
three places where he practiced in New York, and
the State of Washington has a county named
after him.
                      IN CONCLUSION
   All these commemorate a capable physician, a
true pioneer, a fearless American of sterling in-
tegrity. But, as I look back and realize the multi-
tude of grateful people who came from four states
to honor Whitman on medical day, it appears to
be more than just a tribute to Whitman. It was
also a tribute to the ideals of American medicine,
for they gathered to hear all about what we are
doing and hope to do in the practice of medi-
cine. In the amphitheater in the shadow of the
Whitman Memorial Building, it was heartening
to know that these people left the routine of
busy lives, some of them for a week, to travel
many miles to honor and revere a noble charac-                   Fig. 1.-Front view of brace not in use.
ter in American medicine. It brought to mind
words spoken two thousand years ago by Cicero:           efficient, as it was apparent through one's clothes.
"Memory is the treasury . . . of all things. The         The perineal straps were uncomfortable. It did
life of the dead is placed in the memorv of the          not give proper support, and one had the general
living."                                                 feeling of being the support instead of being sup-
  384 Post Street.                                       ported. If you have never worn one of these
                                                         contrivances you will not appreciate what I am
  CLINICAL NOTES AND CASE                                saying; besides, there is a multiplicity of straps
                                                         and buckles, and the breast straps are worthless.
          REPORTS                                        It is uncomfortable, particularly when one is sit-
                                                         ting down, and in spite of the perineal straps, it
            AN EFFICIENT BACK BRACE                      hikes upward in this position.
              By HUBERT R. ARNOLD, M.D.
                                                            Then I was fitted with a crutch brace. The
                       San Francisco                     lower part of this brace was made identical to the
                                                         brace which I have devised and shall describe in
                                                         detail below. The crutch was a constant annoy-
TNECESSITY frequently compels not otherwise
   ways and means which would
                               one to devise
                                                         ance and discomfort under the arms and, besides.
materialize.                                             the brace did not give the proper support to my
   Several years ago I was unfortunate enough to         upper back. I was in constant fear, also, of a
develop a destructive lesion of my fifth dorsal          crutch paralysis from the pressure in the axillae.
vertebra, with extension into the fourth and sixth       This brace, indeed, did not give the proper free-
vertebral bodies. After a prolonged period of bed        dom of the arms, and it was impossible to let one's
rest, x-ray and other appropriate therapy, I be-         arms hang down by the sides of the body; the
came ambulatory and was confronted with the              arms were always out at an angle and the shoul-
problem of immobilizing my upper dorsal spine.           ders somewhat pushed up. A friend remarked to
Since my general health was otherwise excellent,         me one day that I looked tough. After a busy day
I was, naturally, anxious to be fitted with an ap-       I frequently felt that I was.
pliance which would give the proper degree of               A light plaster jacket would give good support,
fixation, but at the same time afford sufficient free-   but this is not practical for permanent wear and,
dom of motion so I could get back to practice.           besides, it would not give the desired freedom for
The Taylor brace soon proved awkward and in-             one who is actively engaged in work.

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