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 solutions. 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. WHITMAN S MISSIONARY EXPLORATION ON THE CONTINENTAL DIVIDE 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 WHITMAN S CONFERENCE WITH PRESIDENT entrance and welcomed the two Indians. They TYLER 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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