| Summary: | In this address Dr. Bodemer gives a history of surgery and medicine in the Pacific Northwest from early European exploration to the frontier days of the 19th century. He puts this in the context of ophthalmology, since he is addressing ophthalmologists, writing, "The early orientation of the Academy toward the professional improvement of ophthalmology coincided with the changes that were now becoming generally evident in American medicine." HISTORY OF SURGERY AND MEDICINE IN THE NORTHWEST Address given at the Annual Meeting of the Washington State Academy of Ophthalmology Seattle, Washington 19 April 1977 by Charles W. Bodemer Professor and Chairman Department of Biomedical History University of Washington School of Medicine Seattle, Washington HISTORY OF SURGERY AND MEDICINE IN THE NORTHWEST Address given at the Annual Meeting of the Washington State Academy of Ophthalmology 19 April 1977 by Charles W. Bodemer The northwestern edge of North America was the last temperate zone coastline to withhold its secrets from European explorers. Iberian mariners searching for the Northwest Passage believed to connect the Pacific and Atlantic Oceans played a principal role in eliminating that gap in geo graphical knowledge, and in the process carried Spain's empire to its great est expansion. The Spanish maritime expeditions dispatched to the Northwest coast during the 1540s reached no farther than the present southern boundary of Oregon, but their experience helped to establish the opinion that scurvy was most likely in the cold and wet higher latitudes. These and later Spanish expeditions rarely included medical personnel, a fact consistent with the fatalistic instructions provided explorers to the north by their leaders, who remained in the south, that, should the men become ill, "They must suffer." And suffer they did. Few Spanish expeditions reached northern California before the ships' crew was too reduced by scurvy to continue, and no expe dition returned from the Northwest v/aters with as much as a guarter of its crew fit for duty. This seemed proof that the northern climate was indeed dangerous, that scurvy v/as related to v/et and cold fog. And, demoralized by the effects of scurvy on its northern expeditions, Spain chose not to exploit its early advantage in the Pacific Northwest and turned its attention elsewhere. Scurvy thus profoundly affected the extent of Spanish exploration and settlement, and contributed to the eventual decline of Spain's influence in western North America. ******** 2. The Spanish were unusual in excluding medical personnel from their mari time expeditions. Ships of most European nationalities normally included a "ship's surgeon." Exploration, conquest and colonization were the objects of many European voyages to the New World* in which the practical skills of the surgeon were in far greater demand than were the more controversial, often doctrinaire, treatments of he who practiced Physick. He was called "Chirurgeon," as the French had termed the man who "did it with his hands." The ship's surgeon repaired wounds, stitched up lacerations, splinted broken bones or stopped hemorrage with a tourniquet. But his presence didn't necessarily protect an expedition from the ravages of scurvy. Witness the fate of the Great Northern Expedition of Russia. Under the command of Vitus Bering, this expedition departed the Kamchatka Peninsula in 1741 in an effort to determine the relation of the Bering strait to America. The medical chest of the ship's surgeon, George Steller, contained no remedies for scurvy. This might not have been disastrous had Steller's personality been different. Squabbling among explorers was not uncommon, but Bering's expedition suffered from more than its share of hardships, frustrations and abrasive personnel differences. Steller deserves much of the credit. Steller was a good scientist and a competent surgeon. He was also im patient, overbearing, pompous, egotistical, status conscious, pathologically hypersensitive, rudely arrogant, and supremely contemptuous of his fellows. He was scarcely more desirable as a travelling companion than a cholera bacillus. From the outset he quarreled with the government, scientific bodies and the expedition's officers. The cause of his anger was usually the same: colleagues 3. didn't show him enough respect, i.e., they didn't always follow his advice. Steller was not a reticent man, and he offered advice to everyone on every conceivable subject. The naval officers reacted to his manner by blocking his efforts, ridiculing his judgements and ignoring his advice. The effects of this attitude were apparent by mid-summer, at which time disease and ill ness had begun to debilitate the expedition. In August Steller joined a landing party collecting water on an island southeast of the Alaska Peninsula. He objected when the seamen filled the v/ater casks from stagnant puddles. He objected even more when they ignored him. He was in a foul mood, then, when his imperious demand for help in gathering berries and anti-scorbutic herbs was refused. Steller thereupon abandoned his medical obligations to the expedition, recording in his diary: "When I saw my opinion concerning the water spurned and coarsely contradicted, and had to hear myself like a surgeon's apprentice ordered to gather herbs, I resolved that in the future I would only look after the preservation of my own self." Steller may be considered one of the reasons that in November, its rigging rotten and its deck strev/n with dead and dying men, the barely-manned St. Peter ran aground on what is now Bering Island in the western Bering Sea. Bering and some of Russia's imperial ambitions succumbed to scurvy on that island, but Steller survived to report on the natural life of the Bering Sea. He is remembered for his accomplishments as a naturalist; he is less praiseworthy, but noteworthy also as the first physician in the Northwest between California and the Arctic Circle. ********* As Spanish influence north of San Francisco weakened and a Russian pre sence became apparent in the North Pacific, England became more aggressive 4. in western North America. Eighteenth century Britain sought steady profits through peaceful trade, and it was calculated commercialism that brought Captain James Cook to the Northwest in 1778, when he stumbled into a market for Northwest furs. The accidental discovery that beaver skins purchased for trinkets sold for hundreds of dollars in China launched the Pacific North west into new prominence. One of the many subsequent expeditions in search of pelts and profits arrived at Nootka Sound in 1786, complete with a scorbutic crew and an Irish surgeon named John McKay. When the expedition departed three weeks later, both the disease and the surgeon were left behind. The captain had selected McKay to remain among the natives and convince them to save their pelts for his return. But the ship never returned, and the stranded McKay functioned as physician, colonist, trader, and anthropologist among the Indians of Vancouver Island for more than a year. This was hardly the fashionable Dublin practice McKay had envisaged as a medical student, and when a trading ship finally cast anchor in Nootka Sound, he was among the first to climb aboard. Emaciated, dirty, and dressed in greasy sea otter skins, McKay was indistinguishable from the natives, but his Gaelic charm had not rusted in the Northwest climate, and he wangled a position as ship's surgeon, departing Nootka and entering into history as the first resident practicing physician on the Pacific North west coast. ******** The Great Fur Rush had a determining influence upon the international balance of power, and it shaped the subsequent history of the Northwest. At the beginning of the nineteenth century the North Pacific lay open to the most aggressive power. By 1810 the Spanish American empire was in ruins, and as Madrid lost its hold on the western portion of the continent, American 5. leaders moved to prevent Russia, and especially Britain, from assuming control. The region that the Spanish had not appreciated enough to name more than "the coast to the North of California" now became "Oregon," and Britain and the United States competed for its coast and hinterland. In 1792 Captain Robert Gray, a New England trader in command of the Columbia, and Captain George Vancouver, commanding the British warship Discovery, sailed a few days apart along the Northwest coast. Vancouver was ostensibly on a voyage of exploration; Gray was in search of furs. Interesting ly, it was Gray, not Vancouver, who risked the bar and wall of breakers to enter the Columbia River. Gray's cool Yankee blood was not easily heated by exploration without profit, and he seems to have been more impressed by the number of furs he acquired through his daring seamanship than the discovery of the mightiest river west of the Mississippi. But he landed and, with characteristic New England clarity, resolved the ambiguous ownership of the territory by claiming the entire valley of the Columbia for the United States. His action was later exploited to provide the United States frontage on the Pacific Ocean and convert it into a transcontinental power. Gray's expedition had no surgeon, and when the Columbia arrived at Nootka Sound from Boston the crew was suffering grievously from scurvy. The sick were soon buried up to their necks in the soil of Vancouver Island in accordance with a popular quasi-magical treatment for scurvy. Vancouver's men, however, escaped this subterranean remedium, their health reflecting the Royal Navy's adoption of kind's anti-scorbutic regimen and the skill of the ship's surgeon, Archibald Menzies. During Vancouver's four-year expedition Menzies allowed no crew member to succumb to disease and, in addition, he carried out extensive studies of Northwest flora. His name is associated with many Northwest plants, and he is renowned as a naturalist. He was also the last medical man on the 6. Northwest coast between 1792 and the second decade of the nineteenth century. Gray's voyages established the Yankee trade triangle, which sent ships from Boston to the Northwest, where Massachusetts gimcracks were exchanged for furs later traded in Whampoa for silks, porcelains and tea for transport to Boston. Americans flooded into the China trade, operating against a backdrop of an international contest of exploration, colonization and diplo macy in the Northwest. Americans now saw their destiny on the Pacific Ocean, and Jefferson spoke of developing a continent occupied by "a people speaking the same language, governed in similar forms, and by similar laws." Indeed, events seemed to be moving quickly in that direction. The Louisiana Purchase, the Lewis and Clark expedition, and the establishment of Astoria, John Jacob Astor's fur enterprise at the mouth of the Columbia, all broadened the American claim to the Columbia Valley. But the British soon regained control of the Northwest country as a result of the overland fur trade. The overland fur traders entered the Oregon country from the East in search of beaver skins. Toward this goal independent British traders, organized as the North West Company, established trading posts in the upper Columbia country. The Astorians competed with the Nor' Westers briefly, but American fur enterprises were destroyed by the War of 1812. The North West Company expanded in all directions, and when it later merged with Hudson's Bay Company, British dominance of the territory was complete. This merger brought about the entrance of Dr. John McLoughlin into the Northwest. Chief Factor for the Hudson's Bay Company territories west of the Rockies, McLoughlin, like the Company itself, dominated the history of the Pacific Northwest during the period 1824-1840. McLoughlin entered into a medical apprenticeship at the age of thirteen, but he longed for the adventure and romance of a fur trader's life. He 7. associated himself v/ith the North West Company, and, practicing his profession as little as possible, demonstrated those non-medical skills leading to his appointment as head of the Columbia Department. It was not, then, a Marcus Wei by who brought medicine into the Pacific Northwest in 1824, but a reluctant healer whose Magnificent Obsession was the fur trade. McLoughlin established the Company's.main post at a site designated Fort Vancouver on the north side of the Columbia. Fort Vancouver developed into an establishment of about 700 residents. McLoughlin served as administrator and the only physician. His medical duties were minor at first, but in 1829 the first of a series of epidemics spread along the Columbia and its tribu taries, and McLoughlin was kept busy attending to the sick. A clerk wrote that "the fever and ague was very prevalent at Vancouver, and Dr. McLoughlin had to officiate [as physician], although he greatly disliked it." A dis gruntled McLoughlin, his administrator's eyes on the account books, complained that "for a time, it put an entire stop to our business." It's difficult to identify the diseases McLoughlin and others at Fort Vancouver dealt with during these epidemics, but the evidence suggests typhus and malaria. It's not likely McLoughlin cared much about the nosological niceties; he treated all fevers with quinine or a dogwood bark decoction. His real concern was getting relief from medical practice, and when the company sent Drs. Tolmie and Gairdner from London in 1833, he put away his quinine vials and had no further contact with medicine. It is uncharitable to assume a causal relationship, but after McLoughlin stopped practicing medicine, epidemic disease in the Vancouver region declined. By 1841 the Willamette Valley was considered quite healthy; it was also quite deserted, for the epidemics had depopulated large areas, leaving them open for settlement. ******** 8. Christian missionaries had seldom heard the Macedonian Call more clearly than early in the nineteenth century, and the vast, unsettled Oregon country became an arena where men of the cloth struggled for the souls of the Far Western Indians, and, while they were about it, undertook to relieve them of the responsibilities of real estate management. Action was catalyzed initially by a visit of some Indians to the Saint Louis .home of William Clark. A religious journal described their visit in fervent, sentimentalized terms, suggesting that the natives of the Far West were desperate for spiritual salvation. The Methodists thus sent Jason Lee and a small group to found the first Protestant mission in the Willamette Valley in 1834. This mission became the nucleus of American colonization and the center of attraction for future settlers. Lee, who believed devoutly in God's design, was convinced that God favored thumping majorities, and he worked toward advancement of the settlement in the East, promoting the wonders of the Oregon country and the need for Christian settlers. Soon Americans were crossing the plains to establish white Christian civiliza tion in the Willamette Valley, where it is rumored to exist even today. The Reverend Samuel Parker, like Lee, subscribed to the principle that civilization follows Christianity. Amost persuasive man, Parker not only recruited Marcus Whitman from a thriving medical practice in upstate New York and persuaded the American Board of Commissioners for Foreign Missions to reverse their earlier rejection of Whitman, but, because the Board appointed only married missionaries, so skilfully orchestrated the evangelical zeal of Narcissa Prentiss that she agreed to marry Whitman even before they were intro duced. In 1836 Vlhitman established a station among the Cayuse at Waiilatpu, near Walla Walla. He practiced much medicine, surgery, and dentistry at his mission. Withal, Whitman's influence was greatest in terms of advancing migration into 9. the Pacific Northwest. Waiilatpu became an important rest stop for the immi grants, especially after 1843, when Whitman brought about a thousand people from Missouri to Oregon, opening the Oregon Trail. The nineteenth century was the time of Manifest Destiny. The availability of land and official encouragement to settle the wilderness provided philosoph ical justification for the massive migration and occupation of the West as completing a universal design of providence. To the Indians near Waiilatpu Manifest Destiny meant a flood of white immigrants, and the anger this aroused contributed to their attack upon the Waiilatpu station, during which the Whitmans were killed. The Whitman Massacre ended the missionary period in Northwest history. It also prompted Congress to create the Oregon Territory in 1848 and usher a new order into the Pacific Northwest. In 1844 George Bush and Colonel Simmons crossed the Columbia River to settle in Tumwater and begin settlement of Washington State. At first it was rather lonely there, but in 1849 people hurried northward to capitalize on the California market for lumber and food, and the 1850 census showed over a thousand white inhabitants north of the Columbia River. A physician urged them on. In 1848 Richard Landsdale departed the midwest for California and Gold. Medical men generally used their skills to underwrite the expenses of the transcontinental trip. But to Landsdale professional fees were little more than "seed money" for financial dealings on a more grand scale. His were the perceptions of the urban planner and the instincts of the real estate developer, and he bought land, platted towns, and sold lots to people ready to settle along the route to the Pacific. In 1850 he crossed the Columbia, bought 160 acres and platted the town of Vancouver, selling the lots and 10. opening an office for medical practice. He subsequently helped to organize several counties and held various public offices, maintaining also a general practice. In 1857, while on government business in New York, he attended lectures at the City College and received an M.D., an item he had lacked during his thirty years of medical practice. Finally in possession of the appropriate credentials, Landsdale promptly retired from medicine to manage his real estate holdings, a good example of the medical entrepeneur who gave spirit to the immigration patterns and early organization of the Far West. Once v/estward migration began the Praire Schooner became the primary shaping element of the Pacific Northwest. Dr. Elijah White was waqonmaster of a wagon train to Oregon in 1842, but few trains included physicians, and most emigrants relied upon books, assorted medical kits, and somebody's sovereign remedy for all ailments. Vlagonmasters like Sol Tetherow were famous for their medical abilities. Sol's advice on dosage was, "Always git all you can, but use what you can git," and when a child's cough disturbed the quiet of the night, Sol spooned in his mixture of boiled licorice root, syrup of skunk cabbage root, tincture of lobelia and Balm of Gilead, a truly V'Vondrous amalgam of expectorant, diaphoretic, antispasmodic and sedative properties, confident that the little patient, dosed to the eyeballs, would quiet dov/n and let the rest of the wagon train get some sleep. Medical men, like others who took the trails West, did so for various reasons. Some looked for adventure; some traveled v/est for their health; others were after gold or land. Some looked for quick profit. Jesse Cunninoham, for example, drove four thousand sheep across the Oregon Trail to sell them for a forty thousand dollar profit. Some searched for a New Start. Such was David Swinton Maynard. With a new M.D. and an equally new bride, Maynard left Vermont in 1828 to n. establish a practice in the small town of Cleveland, Ohio. Highly susceptible to grand profit schemes, Maynard quickly became involved in numerous financial enterprises, including establishment of a medical school. Intelligent and energetic, Maynard was also impulsively generous and careless of the morrow. He was reluctant to bill his patients, but curiously receptive to co-signing their promissory notes. It's not surprising, then, that following the crash of 1837, he found himself fifty thousand dollars in debt. For years he struggled to meet his obligations, then, in April, 1850, his wanderlust fortified by what he deemed his wife's increasingly shrewish behavior, Maynard gathered his surgical instruments and a few books, bought a mule and a buffalo robe, and headed West, recording in his diary a single entry: "Left home for California." It took courage to travel by wagon from Missouri to the Pacific Coast, for the transcontinental .journey was accompanied by suffering, dirt, and disease. A physician who made the trip said, "The prevailing diseases were bilious fever, which often assumed a typhoid character, pleurisy, pneumonia, and scurvy." The scourge of the wagon trains, however, was cholera. In 1850 it accounted for approximately three thousand deaths on the Oregon Trail alone, and there were several stretches of about sixty miles where the markers of cholera graves lined the Trail like a picket fence. Few physicians suspected the water supply; the prevailing assumption was that the disease resulted from contagious miasmata in the atmosphere. Whatever the presumed etiology, treatment was crude. The emigrants usually relied upon brandy and cayenne pepper, physicians used whiskey or Perry Davis Pain Killer with the cayenne, some mixing this nostrum with calomel. Maynard provides some idea of the efficacy of these treatments in his diary notation that when he contracted cholera on the Trail he dosed him self with calomel, adding with the realism born of practice that he recovered because nobody meddled with him. 12. Maynard left Ohio for the California gold fields and ended up at the southern tip of Puget Sound. He was admittedly no Magellan, but in this case the navigational dislocation was deliberate. Maynard was busy attending to cholera cases soon after his train left St. Joseph, and the disease entered very directly into his life on the plains of Nebraska. One afternoon he attended a cholera-stricken family in another wagon train, but before morning 0 the husband and family of Mrs. Israel Broshears were dead. Maynard's diary notes that the beautiful widow was "ill both in body and mind and badly in need of doctoring." His next entry reads, "I made arrangements to shift my duds into the widow's wagon in the morning." Maynard clearly intended to pro vide a variety of medical care which is perhaps best termed comprehensive. The physician accompanied the Widow Broshears to Tumwater to join her brother, the same Colonel Simmons we followed across the Columbia in 1844. Maynard showed little interest in leaving the Simmons farm, and, so far as the Colonel was concerned, far too much interest in his sister. He therefore suggested, at least once from the butt-end of a shotgun, that Maynard remember he was a married man and seek his fortunes elsewhere. Considering this an offer he couldn't refuse, Maynard canoed north to prospect for gold, but he succeeded only in losing a skillet. Back in Olympia, he spent his last money on an axe, cut four hundred cords of wood, and promoted transportation for it and himself to San Francisco. After selling the wood, Maynard visited the California gold fields with the thought of profit through practice and prospecting. But the mining camps were scarcely the El Dorado he had envisaged in Ohio. Their character is revealed in the statistic that between 1849 and 1856 the California Mother Lode gave up six hundred million dollars in gold, and during that period miners spent six million dollars on Bov/ie knives and pistols. During the first five 13, years of the Gold Rush there were forty-two hundred murders and fourteen hundred suicides in California mining camps alone. The mining camp surgeon was a busy man, and he lived close to trouble. One surgeon, bunked next to a hotel appropriately called The Slaughter Pen, erected a bullet-proof screen of boards and sand to protect himself from the stray bullets that constantly perforated the walls around his bed. When Maynard visited a camp which had been described as having "in the space of twenty-four days, murders, fearful accidents, bloody deaths, a mob, whippings, a hanging, an attempt at suicide, and a duel," his Vermount soul was shaken. And, when in his first two days of practice he treated four gunshot wounds, he left the Mother Lode to others. In San Francisco Maynard bought hardware goods with the proceeds from the sale of his wood, returned to Tumv/ater, and opened a store. Maynard's concept of business was unusual, even by frontier standards, and he had long subscribed to the injunction, "Drink no longer water, but use a little wine for thy stomach's sake." This often resulted in the exotic business practice of giving away his goods toward the end of the day. Understandably, the com peting merchants of Tumwater shed no tears when Maynard left in 1852 to help found the village of Seattle. The first building in Seattle v/as Maynard's log cabin, named the Seattle Exchange, from which he practiced boosterism, capitalism, and medicine. Ever-alert to an economic opportunity, Maynard undertook that first year to supply San Francisco with Puget Sound salmon, packing and shipping a hundred barrels of fish to that city. They were, however, badly spoiled when they reached California, and Maynard's vision of himself as the Salmon King came to an odoriferous end. But not without historical distinction: with this venture Maynard became the first business failure in the northern Puget Sound. 14. When the Territory of Washington was created, Maynard, who was a delegate at the Convention, was named Auditor and Notary Public of King County, and his Seattle claim was designated the county seat. Duly invested with new offices and by virtue of a dubious Territorial divorce bill duly divested of his Cleve land wife, Maynard married the Widow of the Wagon and occupied himself with various administrative matters, marriages, prosecutions and trials, supervising the school district, managing a store, practicing medicine, operating a hospital, and manning a blacksmith shop. It's not surprising, then, that Seattle origi nally developed on Maynard's claim. Despite his vigor and various activities, Maynard was a child of sorrow, and his fortunes fluctuated between calamity and cataclysm. He had a tendency to give away his land, especially when he was viewing the world through booze-colored glasses. On one occasion, Maynard, whose total agricultural experience was acquired on the Oregon Trail viewing the eastern ends of oxen pulling a wagon west, sold most of his Seattle land and attempted to farm three hundred acres near Alki Point. As a farmer, Maynard was a good blacksmith, and he al most starved to death. He had to sell the land at great loss and return to Seattle to operate his hospital, practice medicine, and a few doors down the street, practice law. Still he didn't fare well, and he became increasingly dedicated to the bottle. His sobriety was hardly advanced when his Cleveland wife arrived one day to contest the validity of the "no-questions-asked" Terri torial divorce and moved in with him and the second Mrs. Maynard. For some months he survived this menage si trois with some humor, but his claim to owner ship of the little land in his name didn't survive the litigation associated with his marital status. When he died in 1873, appropriately enough from liver disease, he was a poor man. Nonetheless, it was recognized even then that Maynard was an important force in the development of the Washington Territory, the Puget Sound region, and Seattle. ******** 15 With the time of Maynard's death we arrive at the modern beginnings of medicine in the Pacific Northwest. The modern beginnings of medicine doesn't, of course, mean the beginning of medicine in its modern form, for in the second half of the nineteenth century medicine, although it was called heroic, was hardly triumphant, especially on the western frontier. Faced with a medical problem, the physician, depending upon his training or lack thereof, would administer the drugs or perform the operations he believed were required. Generally, the therapeutic regimen was based in the traditional weapons of western medicine, emetics, cupping, purges, and blood-letting. In its nine teenth century form treatment might be a solution of tartar emetic to produce vomiting and perspiration. It might be the local administration of "Spanish fly" to produce a blister or counter-irritant. It might be a massive dose of calomel, mercurous chloride, the favorite, liberally employed cathartic of the era. Or the treatment might be bleeding, up to 12 ounces at a time. The country was on the verge of total exsanguination. One river-boat surgeon said he had "dispensed enough calomel to load a paddle steamer and cupped enough blood to float it." The more incautious blood-letter could easily duplicate the case recorded in the diary of Benjamin Rogers: "1 April, Ordered William Allen bled for the pleurisy; 2 April. Ordered him bled again; 3 April. He was bled again, 10 ounces being taken away as before, 4 April, He died." The frontier surgeon did what he could. Amputations, with or without anaesthetic, were extremely common, partly because of the battlefield training of many of the physicians in the Civil War and partly because they didn't know any other way to save a patient from more disastrous effects. The toes and fingers of frost-bite victims were quick to go; hands and feet weren't spared if the surgeon believed that mortification had occurred. An 1889 issue of the Mew Northwest reported on the removal of two frozen toes by a local surgeon. 16 "This," the paper said, "makes twenty-two toes Dr, Mee has amputated within three months." The Northwest frontier would appear to have been the domain of the doomed digits. Tumors which could be seen or felt were sometimes operated for, but other internal disorders were often baffling to the surgeon, who had neither experi ence nor equipment to accomplish a proper diagnosis. Appendicitis was frequent ly termed "knotted bowels," and surgery was not performed. When the operation was attempted, more often than not it occurred in-an unusual setting. Surgeons wielded scalpels under trees, in carpenter shops, on wagon beds, in saloons, and on kitchen and billiard tables. One military surgeon carried a collapsible table with him, and when day's work was done, he rinsed it off and used it for elegant dining in the wilderness. Sometimes the surgeon had boiling water available, sometimes not. He seldom had qualified help. Inexperienced members of the patient's family often assisted, holding lamps, chasing flies, and administering chloroform with a wadded cloth. It was not unusual for these volunteers to faint at critical moments, and one pioneer surgeon completed his first appendectomy -- he'd never seen one before -- at night in a farm kitchen by the light of a fire on the floor where his quaking helper had' dropped a kerosene lantern. Whatever the operation's deficiencies, one may assume it was performed quickly. ******** In the 1860s Joseph Lister introduced the use of carbolic acid to combat bacterial decay, and in time established antiseptic principles in surgery. Listerism, as it was called, was accepted slowly in the United States. In 1876, Samuel Gross, who performed, operations as a model of sartorial splendor, clad In a black frockcoat with velvet lapels, large pearl buttons and a gold watch chain, wrote that "little if any faith is placed by any enlightened 17. surgeon on this side of the Atlantic in Lister's treatment." Lister's methods were gradually adopted, but acceptance was rarely effective, scholarly, or understanding. Thus one Northwest surgeon, operating for hernia in 1870, used turpentine as an antiseptic. Most didn't use anything, and a good many surgeons washed their hand after, not before, operating. By 1900, however, the concept of asepsis was established, and major operations could be performed without fear of infection. Clean primary healing of incised wounds was now expected. The painlessness of surgery engendered decades before by the demonstration of ether anesthesia could now be accompanied by an appropriate increase in safety. The new surgery arose to replace the old to the strains of the popular Dance on the Operating Floor: "Wash your hands and get them dry. Keep them clean and keep them high. When you're sure that you are able. Promenade up to the table. And get that appendix and lay it bare. We're doing the McBurney Square." Another late nineteenth century force that changed the nature of American surgery was the founding of Johns Hopkins medical School and its professor of surgery, William Halsted. Halsted showed that by research based on anatomical and physiological principles, it was possible to develop new operative proce- • dures, and he demonstrated a clear sequence from the laboratories of surgery, anatomy and pathology to the operating room. A comparable respect for the importance of anatomical study in the development of surgical skills and tech- . niques motivated Seattle's Anatomical Club, an organization founded for the primary purpose of "anatomizing" cadavers supplied by the coroner. Dr. Tate Mason. This activity may have produced some marital discord in Seattle, since the bodies were kept in the member's basements. But as William Shippen said, "all ages have agreed as to the danger of innovations." 18. Ophthalmology shared with general surgery the benefits of asepsis and general anesthesia. The discipline had begun to emerge as a distinct branch of medicine during the second half of the nineteenth century. It arose from the foundations established by Bowman's studies on the anatomy and surgery of the eye, the investigations of the physiology and optics of the eye and the application of this knowledge to the correction of errors of refraction by Bonder, the work of von Graefe on glaucoma, cataract and strabismus, and the development of the ophthalmoscope by Helmholtz. By 1880 the ophthalmologist has at his disposal trial lenses for refraction, prisms and the ophthalmometer, the perimeter for studies of the visual fields, the condensing lens and magnifying loup for study of the ocular media and fundus, and various instruments designed for ocular surgery. His armamentarium included atropine and scopolamine for mydriasis, which he used for iritis, eserine and pilocarpine for miotics in the treatment of glaucoma, and, after Roller's work in 1884, cocaine as a local anesthetic. Much of the knowledge and many of the tools of ophthalmology were in existence in 1888, then, when Alfred Kibbe settled in Seattle as the first physician to specialize in diseases of the eye and ear. Kibbe's obituary notes that he "had his faults, but over his shortcomings we can easily throw the mantle of charity, and remember that v/hich is good." Certainly we can assume that it is not necessary to throw the mantle of charity over either Or Kibbe or ophthalmology to obscure the fact that within weeks after they arrived in Seattle the city v/as destroyed by a great fire. But it is interesting to note a certain fiery tendency of ophthalmology to disturb the existing order. The ecological balance of Seattle's medical population was changed by the influx of oculists and aurists into the rebuilt Seattle, and by the time of Kibbe's death in 1904 there were approximately tv/enty ophthalmologists in Seattle and the Puget Sound Academy of Oohthalmology 19. and Otolaryngology was less than a year from formation in the Alaska Building office of David DeBeck, its first president. In this regard the Academy adumbrated a national development in which ophthalmology took the lead. Thus eleven years after formation of the Puget Sound Academy the American Board of Ophthalmology was established as the first specialty board in the United States, an event that had profound influence in determining the subsequent development of postgraduate education and the nature and shape of the American medical profession. The early orientation of the Academy toward the professional improvement of ophthalmology coincided with the changes that were now becoming generally evident in American medicine. "Somewhere between 1910 and 1912 in this country," Lawrence Henderson wrote, "a random patient, with a random disease, consulting a doctor chosen at random, had, for the first time in the history of mankind, a better than fifty-fifty chance of profitting from the encounter." Indeed, medicine was improved: Moliere's remark to Louis XIV that he listened to his physician's advice and then ignored it so he v/ould get well, no longer had the sting of truth. The progress of medicine since then has been truly remarkable. Medicine, surgery, and Seattle, too, have been transformed since Or Maynard spilled a half-filled bottle of black pills in an area thick with rabbits and, after collecting them from the ground, dispensed pills and pellets randomnly from a magically full bottle, since Drs Spinning and Smith acquired the names of "canoe doctors," and since Or Churchill affixed a compass to his instrument bag so he wouldn't spend yet another dark night paddling about Lake Washington in a vain search for Mercer Island. Ophthalmology has changed also from the time when Or Kibbe brought the first x-ray machine to the Pacific Northwest and, dissatisfied with its performance, constructed a new coil himself, consuming more than five miles of wire in its fabrication. Yet, the recent formation of the Washington State Academy of Ophthalmology from the original 20 Puget Sound Academy of Ophthalmology and Otolaryngology demonstrates clearly that contemporary ophthalmology in the Pacific Northv/est is, in the tradition of its predecessor and early twentieth century American ophthalmology, sensi tive to changing needs and demands and appreciates v/ell the significance of Percival Pott's comment that "many and great are the improvements which the chirurgic art has received v/ithin these last fifty years, but when vie reflect how much still remains to be done, it should rather excite our industry than inflame our vanity."
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