“Those who cannot remember the past are condemned to repeat it”. Thus, statesman / philosopher Edmund Burke. Or statesmen / historian Winston Churchill. Or philosopher George Santayana. We are familiar with this argument about the benefit of the study of history. We know we neglect our past at our peril. Think Hitler in Russia. Think our Navy having to rediscover the use of convoys in World War II, but only after we had sustained huge shipping losses to U boat attacks. In medicine, the Chicago Tribune reports that today young doctors are forgetting (or are never taught) diseases common in an earlier era – diseases that are now reappearing and are being misdiagnosed.
Beyond the avoidance of errors of historical ignorance, Santayana (1) hit upon another value of history. He wrote “Progress, far from consisting in change, depends on retentiveness. When change is absolute there remains no being to improve and no direction is set for possible improvement: and when experience is not retained, as among savages, infancy is perpetual. Those who cannot remember the past are condemned to repeat it.” That is, if we continually have to re-invent the wheel, we’ll never conceive the wing. Santayana seems to be telling us that our history is a base upon which we can build improvement. I would add: looked upon properly, our history can be a motivator for the “progress” Santayana imagined.
A brief history of The [Kaiser] Permanente Medical Group was part of my initiation into partnership. The lesson covered salient points of Kaiser Health Care Program history from its origins at Desert General Hospital during the Great Depression, through its growth during World War II, to the trials it faced after the war, and its responses – generally but not always successful- to the stresses facing medicine in the modern world. Through that history lesson, I better understood how the values of the organization developed. That historical lesson and those values informed how I played my role in helping improve the organization – and added to its history – through both my medical practice and my administrative work.
The Marines use their history to very good effect. They teach the history of valor under combat. But also they teach, by examples from their history, such “values” as, “no Marine is ever left behind”, a sure and powerful morale tool that helps maintain combat power when the going gets tough. But in addition, the teaching of high moral values, again by examples from Marine Corps history, makes the common Marine reaction to the recent controversy over desecration of Muslim bodies to be one of universal condemnation – by other Marines. This condemnation itself becomes part of Marine history – an additional layer of Santayanan “retentiveness” that is the foundation of progress and improvement.
What “retentiveness” does the history of maritime medicine have to offer us? William Osler – looked upon as the father of modern medicine in the US – in highlighting what he saw as advantages of practicing medicine in the military, cited the historical advances in medicine produced by men like William Beaumont working , isolated, in posts remote from the Big City. (2) The Navy has the example of research pioneers like Ashton Graybiel, who, in a 40+ year career at the Naval Aerospace Medicine Research Center / it predecessors, laid a foundation of discoveries upon which researchers build even today. Similar examples no doubt can be found in the annals of Tropical and Hyperbaric / Submarine Medicine. Certainly the history of the Navy Medical Department in World War II offers us lessons even today on how an organization can respond effectively to extraordinary demands.
The National Archives building at 700 Pennsylvania Avenue in Washington DC bears the motto “What is Past is Prologue” (see inside the yellow rectangle in the image above). Retained and properly studied, that Past, our history, can inform how we build an “improved” – a better – future.
(1) Santayana, George. The Life of Reason, or the Phases of Human Progress, originally published by Charles Scribner’s Sons in 1905, now available on line from The Project Gutenberg, http://www.gutenberg.org/files/15000/15000-h/vol1.html#CHAPTER_I_THE_BIRTH_OF_REASON, accessed 26 Jan 2012, Volume I “Reason in Common Sense”, section “Continuity Necessary to Progress”.
(2) Beaumont, an Army surgeon, elucidated the physiology of gastric digestion in a series of observations made at a series of posts on the Canadian frontier in the early 19th century. Osler mentions other isolated workers as well as Beaumont in his 1896 speech “The Army Surgeon”, given at the graduation of the first class from the then new Army Medical School in Washington DC. http://mcgovern.library.tmc.edu/data/www/html/people/osler/PA1/P25001.htm, accessed 27 January 2012.
©2012 Thomas L Snyder