Jefferson Medical College - Clinic Yearbook (Philadelphia, PA)

Page 26 text:

he nation was at war. lt was barely two months after Pearl Harbor. Wives and sweethearts feared for their loved ones. No one knew but everyone feared what lay ahead . . . death . . . destruction . . . pain and- most of all-horrible maiming injuries. During these dark days, Time, the weekly news magazine, reassured its readers that American soldiers would go into battle with the benefit of an elaborate medical evacuation system to remove the wounded from the battlefield and provide necessary care immediately. The magazine chose to illustrate the article with an idealized drawing of Maj. jonathan Letterman riding in a Civil War ambulance. It was the major-a career medical officer -who masterminded an effective evac- uation system during the Civil War. In modified form, the system re- mains in effect even today, and is still saving lives in Vietnam. Maj. Cen. Paul Pr. Hawley, Cen. Eisenhower's chief surgeon for the European The- ater, has said: There was not a day during VVorld War ll that 1 did not thank Cod for jonathan Letterman. Time reassured its anxious readers in February 1942: The lives and suffer- ing saved by this brilliant and humane he lives and suffering saved by this brilliant and humane U.S. Army medical man can never be measured U.S. Army medical man can never be measured. Yet, despite the importance of his contribution, few Cls ever heard of Letterman. Those who did probably were treated at the Army's Letterman General Hospital in San Francisco. Modern medical officers have come to expect-and take for granted- prompt, efiicient evacuation of casual- ties. lt's almost unthinkable that wars were not always fought in this manner. But barely 100 years ago, wounded lay on the battlefield for a week or more. This was the situation during the Cri- mean War in Europe, which preceded the American Civil War by a few years. Early Civil War battles followed the same script. Letterman saw the problem and submitted a plan for an ambulance corps to the War Depart- ment, it was rejected. Letterman then submitted the plan to Cen Ceorge B. McClellan-whose father founded jef- ferson-and it was approved. - This was only the beginning, how- ever, Letterman got his ambulances, but line oflicers often preempted them for other uses. He had to fight military politics continually to recruit and train litter bearers and ambulance attendants -the forerunners of the modem medic The ambulance corps was bloodied at Antietam in September of 1862, and acquitted itself superbly. Antietam ranks among the bloodiest battles of our history, but the field was cleared of casualties within 24 hours. The famous photo by Matthew Brady of Lincoln at McC1el1an's headquarters after the battle shows the President with a smile. Since Dr. Letterman is in the group, it may be assumed that the humane President was doubly pleased with his military victory and medical triumph. Letterman kept improving his sys- tem throughout the war and set up a network of hospitals where wounded taken from the battlefield by ambu- lance could get treatment. According to Cen. Hawley, it is the same system as is in use today, with some slight modifications, perhaps, to adjust to the airplane and to take advantage of the great advances in surgery since the Civil War. - The brilliant success of Letter- man's system sparked the interest of the many European military observers sent to evaluate new tactics developed during the Civil War. Military men eventually saw the value of salvaging wounded men-many of whom would return to fight another day. Letterman's principles were applied in the develop- ment of similar services for the world's armies. Marion Sims, another jeffer- son immortal, used the system in direct- ing an ambulance corps for France in the War of 1870. It was probably the first use of the Letterman system by a foreign army. The system reached far beyond the battlefield. It was the inspiration for what is claimed to be the nation's first city ambulance service-that of Bellevue Hospital in New York. Dr. Edward B. Dalton, who developed the service, served in the Army Of the Potomac under Letterman. The Armyis first permanent gen- eral hospital was erected in San Pran- cisco in 1911. Fittingly, it was named for Letterman, who had died in that city in 1872-a mere 10 years after his plan was tested in battle. A new com- plex was dedicated last year. The plaque contains this observation: Maj. Lettermanis principles Of organization stand today, influencing the medical evacuation service of every modern army. ,. ,111 .5 ij f any ol Weir l paramounl and succel men in ar C0mplaintf force of hi WSIS H1011 Iliff heart Vltlion th, Hlliltl Wag Miithellg HSPCCK of h lies him 3 pslycliliilrig hlU1SClf 3 Ernest Ea flassifies 6 . 0552? P . UW In PSYClii: Prom his Wi, hi aimed hi lifetime . 1 . can SlIlQe rrsil genius!!! E f0Ilte 38 mP0r

Page 25 text:

But he had no t the procedure. edical school lec- .md accordingllk 1 her liI1695 and probe her pelvis ddenly, 5115 was was more SUI' ' P pwfeioutl 1l'0rem0Ved hls .may he dorm was an fm' I Sims realllfd expllkion of an . g the pfmel it WHS amos' .d restored the Placer He f aPPlican0n 0 uld be usedto . ' al Cam 5 vaglgi to the hr it 511nmU0n'aed sith fhe.dI?geC IU 51 to im. aeallr' began plan an operation to cure the girl- and the others he had seen. He never considered the possibility of failure. His career, to this point-except for an early setback when he attempted to establish a medical practice in his native Lancaster, S.C. - had been marked by repeated success. He gained confidence after mov- ing to Alabama and had begun to tackle some very complicated cases. His first contribution to the literature was a description of the surgical repair of a cleft lip and the cleft palate in an adult woman. Others included a revo- lutionary procedure for removing osteo- sarcoma of the jaw that did not require disfiguring incision of the face. Clearly, when Sims began to plan his vaginal operation he was riding the crest of a successful medical practice, based mostly on his achievements in surgery for which he was gaining reknown throughout the South. - His first requirement was the de- sign of the necessary instruments. On his way home to reexamine the slave girl he stopped to purchase a pewter spoon, which he was able to bend into varying configurations. His improvised instrument became the basis of the famous duck-billed CSimsD speculum. It brought the fistulous tract clearly into View and confirmed Sims' decision to operate. He faced four years of frustration, doubt, loss of confidence by his colleagues and financial sacrifice before he would see success. He oper- ated on one of the slave girls 30 times -leading to charges by his critics in Montgomery that he was conducting human experimentation. However, de- spite the fact that anesthesia had not been adopted generally in surgery in the 1840's, Sims' patients never com- plained. This was due in part, no doubt, to the docility bred by years of slavery, but was in no small measure due to their confidence in Sims, plus the knowledge his operation was their only hope of being restored to a normal life. Sims became obsessed with the operation. He built an addition to the small hospital behand his home and assumed the obligation of feeding and clothing his patients while he worked to perfect his procedure. It was not until 1849-five years after his first unsuccessful attempt-that he effected a cure. The ingredients of success were five: the Sims position and Sims speculum, of course, a catheter to keep the bladder empty while the fistula healed, silver wire sutures and a new method for drawing them together. The last two were the most important, for without them success eluded the surgeon for years, with them he suc- ceeded in his first attempt. - After this, Sims turned much of his attention to the field he originally disdained-diseases of women. He was described even in his day as the father of gynecology, though he continued to be a gifted general surgeon. Sims be- gan to build a national and later a worldwide reputation after he moved from the South to New York, where he was able to find relief from chronic debilitating diarrhea. He left Alabama in 1853 and two years later was the primary force behind establishment of the Womanis Hospital of the State of New York. Here he collaborated with Thomas Addis Emmet, also a Jefferson graduate, and other gynecological pio- neers. With the approach of the Civil War, Sims' expression of Southern sympathies made New York increas- ingly inhospitable. So he Went to Europe, where he was called on to demonstrate his operation before lead- ing surgeons. He remained abroad longer than he had anticipated and engaged in private practice in both France and England. A biographer notes that his acceptance by European aristocracy allowed him to transform the tradi- tional role of the American physician abroad from that of humble student to that of honored teacher. His reputa- tion assured him an extensive practice in whatever country he chose to visit. While he commanded large fees from those who could afford them, Sims al- ways had an active charity practice. Biographers agree he practiced medi- cine for the sheer satisfaction of it- not financial reward. While in England in 1866 he published a textbook, Clinical Notes of Uterine Surgery, which stirred up a great deal of controversy because of its frank consideration of what were con- sidered indelicate topics at that time. His discussion of the treatment of sterility aroused the most criticism, es- pecially his advocation of postcoital microscopic examination of sperm. His proposal that artificial insemination could be an answer to sterility brought this retort from the Medical Times and Gazette of London: Better let ancient families become extinct than keep up the succession by such means. Soon, however, many of Sims' in- novations began to be widely accepted and on his return to New York in 1858 he was acknowledged as the world's foremost gynecologist. He returned to Woman's Hospital as senior consulting surgeon and accepted a position on the board of governors. Six years later, however, when his worldwide reputa- tion was at its peak, he became embroiled in a dispute with the super- visors of the hospital and resigned. So, as 1875 dawned, the foremost Ameri- can gynecologist was barred from the institution he was responsible for founding and forced to practice in a small ofiice in his home. As always, he continued to see charity patients, even on Sundays. His prestige outside of New York did not suffer, and the year he left the Woman's Hospital he was elected president of the American Med- ical Association. A year later he was a charter member of the American Cy- necological Society, which elected him president in 1880 Cthe year Woman's Hospital reinstated him as consulting surgeonl -The final task to which Sims turned his attention was an autobiog- raphy, Story of My Life, which he never completed. lt was published in unrefined form after his death in 1883 and has provided much of the source material for subsequent biographers. Seale Harris' version, W0man's Sur- geon, published 1950, includes this assessment of the man: Marion Sims was one of a few out- standing 19th century pioneers who added more to the basic knowledge of medicine and surgery in three or four decades than had been accumu- lated in all the thousands of years preceding. Chiefly, however, he was the physician who brought new hope and new life to women. Today at Jefferson, where he re- ceived his medical degree in 1835, a society bearing his name and founded in his honor, serves as the nidus for young men who hope to practice the specialty he developed. They, as he, may be aided by good fortune. But they will have to supplement it with keen minds and hard work.

Page 27 text:

:C COIPS W siffptember the blperblil t the Hlooditst :hin 24eld Was yatth h0Llrs. T ew Brady titan- sCtlI61'n-lan feSldQm is in umed that th doubly pleases ll and medical :roving his Sys- r and set up, here W0U11ded 'eld bl' Hmbu- ent. According he SHH16 system th some slight V0 adjust to the lvantage of the gery since the :ess of Letter- the interest of litary observers ctics developed Military men ue of salvaging if whom would ay. Lettermans in the develop- for the worlds another leller- .vstem in direct- s for France in as p1'0lJalJlY the tan system bla ted far beimd the inspiratwtl be the nationS that Ol View York. Df- , devel0Pfd the AITUY 0 -emacs- E the lan- n ermaflellf gen Fran- - s dlfl annamed d died in iff 3 -ears after his 1 3 A new com' C. . it was 7 e last Year' ll 'our s Pflnclpleiing ay, infuffgvery 56IVlfeO f any of the accomplishments of S. Weir Mitchell can be considered paramount, it is that he understood- and successfully treated-neurotic wo- men in an age contemptuous of their complaints. He did so by the sheer force of his personality and will, which were more than equal to the task. At the heart of his method was the con- viction that the best way to heal the mind was to provide it a healthy body. Mitchell's work in this field-only one aspect of his multifaceted career-quali- fies him as one of the early American psychiatrists, though he considered himself a neurologist and physiologist. Ernest Earnest, a critical biographer, classifies Mitchell as probably the leading psychiatrist in America for one or two decades. While his success in psychiatry earned him adulation from his patients and a great deal of money, his contributions in other fields earned him consideration during his lifetime as the most versatile Amer- ican since Franklin. Silas Weir Mitchell was almost a genius, Earnest wrote in 1950. His contemporaries believed that he was Iways eager to seek out a new truth or accept a new challenge one, an opinion Mitchell came to share. The reasons for this belief were impressivef' Mitchell contributed clas- sic works in the Held of neurology, conducted research on brain function and snake venom, wrote novels that won critical acclaim, numbered many of the luminaries of his age among his friends and served in a host of civic, institutional and charitable positions- all in addition to his large medical practice. Earnest notes that others made more important contributions to psy- chiatry but are less well remembered than Mitchell. The reason: If he did nothing else he took psy- chiatry out of the madhouse and brought it into everyday life. It became respectable to be treated for mental illness. He might have added that not only is it respectable but in 20th century America it is considered fashionable in many circles. Une of the ways Mitchell helped in this regard was in using his influence to overcome opposition to Charles K. Mills when he attempted to start a department for nervous dis- orders at Blockley-predecessor of Phil- adelphia General Hospital. Mitchell hoped proper administration of the de- partment would allow Philadelphia to become the American center for neu- rology and psychiatry, but political opposition eventually thwarted the ef- fort. Mitchell's psychiatric methods are now outdated, but shortly after his rest cure for nervous disorders was introduced it was adopted in clinics throughout America and Europe. Fat and Blood, his famous little book out- lining the new method went through eight editions in America and was translated into French. German, Span- ish, italian and Russian. Though it was written for doctors, its style was so straightforward it was easily under- stood by laymen. Unencumbered writ- ing was a Mitchell hallmark. He avoided jargon and frowned on its use by others. COnce after receiving a lengthy, complicated report from an ophthalmologist, he replied, 'iThanks, but what I really wanted to know was if this patient needs glasses.,'D Con- sequently, Fat and Blood has none of the elaborate terminology used by Freud, but is noteworthy for its prag- matism and realism. Mitchell's descrip- tion of a Victorian-era neurotic is classic: Everything wearies her-to sew, to write, to read, to walk-and by and by the sofa or the bed is her only comfort. Every effort is paid for dearly, and she describes herself as aching and sore, as sleeping ill, as needing constant stimulus and end- less tonics. Mitchell ordered such women to bed for a month or six weeks and then began their rehabilitation. His success was no doubt due to his ability to get his patients to follow his instructions. Sometimes, however, he had to resort to extreme measures. The most famous anecdote concerning his handling of patients involved a woman who re- fused to get out of bed following her month of rest. When he found the usual methods of persuasion were not working, Mitchell said, lf you are not out of bed in five minutes Iill get into it with youf' The patient was unmoved as he began removing his clothing but when his pants started to drop she bolted to her feet. It was this force of