Monthly Archives: August 2014

Whither the History of Medicine (Again…)

Last month, in an article entitled Offline: The moribund body of medical history, Lancet Editor-in-Chief Richard Horton opined that, since the 1980s, medical historians have lost the bubble on “important issues of the past as they might relate to the present.”  He declaims that the academics dominating the field have somehow forgotten that  the esteemed Owsei Temkin (a father of the study of medical history in the west) related the history of medicine to the social, cultural, political and economic milieu in which the art and science are practiced. Temkin, he says, felt that historians, more than mere toters-up of medical events, should interpret the ebbs and flows of this most human of human endeavors. Citing what he sees as a dearth of current relevant historical inquiry, Horton’s damning peroration is: “So where are the historians of today to illuminate the past as we struggle with the aggressive commercialisation of medicine, failures of professional leadership, notions of free will and death, misuse of medicines, paralysis in public health policy, or catastrophic failures of care? They appear to have evaporated, leaving a residue of dead and inert dust.”

University of Manchester medical historian Carsten Timmerman, replying in the Guardian blog The H Word, begged to differ. He lists several recent works that offer the kind of inquiry Horton despairs of seeing ever again, and points to his own bookshelf as proof. But here, Timmerman admits, may lie the problem. The books on his shelf are probably on the shelves of other medical historians, and that’s about all. He allows that there are so many historians of medicine now that they mostly content themselves by discussing the high topics of the day – with each other. So what Horton sees as a coffin may simply be an historical echo chamber!

Timmerman offers an answer to this problem of communication, and it’s one that will be familiar to readers of this blog: make your historical work relevant by talking to doctors and other health care givers. To this I would add, talk to the general populace by participating in the debate about social and medical policy through op-ed articles, letters to the editor, media interviews, and talks at your local Rotary club.

©2014 Thomas L Snyder, MD

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A View of the People’s Liberation Army Navy (PLAN) Hospital Ship ”Peace Ark”

I’ve written about hospital ships before. Since then, I have privately wondered if there was a combat-casualty role for them in the modern world of sophisticated forward combat care hospitals and air transport to evacuate the most severe combat casualties to the highest levels of care. Moreover, big gray ships are increasingly being fitted out with sophisticated medical capabilities. In my posting on hospital ships, I mentioned the German Berlin-class Fleet Support Ship as an example. US amphibious ships, intended to provide support for Marine Corps operations, are all fitted out for surgery; the new USS America (LHA 6) will have expanded medical spaces in view with her capability to take on casualties by helicopter evacuation.(1) With this apparent move away from big white ships with big red crosses, whither hospital ships?

Peoples' Liberation Army Navy Hospital Ship "Peace Ark". Xinhoa Photo

People’s Liberation Army Navy Hospital Ship “Peace Ark”. (Xinhua Photo; Source: USNI News)

Enter the PLAN’s Peace Ark. This bwswbrc, the only Type 920 Hospital Ship in the Chinese inventory, possibly the only active PLAN hospital ship of any class, made a dramatic appearance at the recently concluded RIMPAC 2014 exercises. The Naval Institute news blog carried a nice article on the ship on 23 July.(2) Featured was Senior Captain Sun Tao, identified as the officer in charge of the ship’s medical detachment. Captain Sun told his interviewers that, when not under way, the ship carries a crew of 113 and a 20 person medical detachment. When at sea, the crew would increase to 300+ and the medical detachment to around 100.

While capable of receiving war casualties by helicopter, boat or high line, it appears that the ship has been used mainly for humanitarian / public affairs visits since it was first deployed beyond Chinese waters in 2010. Her most recent overseas activity was a humanitarian mission to the Philippines after super typhoon Haiyan.

The ship is fitted out with 8 operating rooms, 20 intensive care beds and 300 general care beds. Apparently, much of her medical gear is manufactured by the Dutch firm Phillips. She is equipped with an ultrasound suite, and CT and x-ray

Senior Captain Sun Demonstrates an Operating Room in PLAN Hospital Ship "Peace Ark" (Source: USNI News)

Senior Captain Sun Demonstrates an Operating Room in PLAN Hospital Ship “Peace Ark” (Source: USNI News)

capabilities. Interestingly, even her life boats are equipped to handle up to 18 stretchers or 24 ambulatory patients. Captain Sun showed off a gynecological examining room; this was a space, he said, that was particularly useful during humanitarian missions.

Given that navies of the world are apparently building ever more med-surg capability into big gray ships that are capable of protecting themselves against terrorist attacks, one is left wondering if hospital ships have any military utility at all. On the other hand, the dramatic good-will advertising power of a big white ship with big red crosses showing up in times of humanitarian need, makes the civilian utility of such vessels pretty obvious.

©2014 Thomas L Snyder, MD

(1) Defense Media Network Article “USS America (LHA 6) – a different kind of gator”, accessed 2014August06

(2) USNI News Article “Peace Ark: Onboard China’s Hospital Ship”, accessed 2014July24

On Reaching Age 70

In a 1905 speech marking his departure from the Johns Hopkins medical faculty, the revered William Osler offered that he had “two fixed ideas” about age. The first of these “is the comparative uselessness of men above forty years of age”, evidence for which, as he saw it, was the paucity “of human achievement in action, in science, in art, in literature -” arising from men above that age. He went on, “[t]he effective, moving, vitalizing work of the world is done between ages twenty-five and forty – these fifteen golden years of plenty, the anabolic or constructive period, in which there is always a balance in the mental bank and the credit is still good.”

Osler’s second fixed idea “is the uselessness of men above sixty years of age, and the incalculable benefit it would be in commercial, political, and in professional life if, as a matter of course, men stopped work at this age.” Osler quotes Donne stating that in ancient Rome, men at age sixty and beyond were denied the vote and were referred to as Depontani “because the way to the senate was per pontem [by way of the bridge], and they were not permitted to come thither.” He then cited – tongue firmly in cheek, I believe – Anthony Trollope’s novel “The Fixed Period” where that author advocates for “the admirable scheme of a college into which at sixty men retired for a year of contemplation before a peaceful departure by chloroform[!]“.

I retired – at Osler’s prescribed age 60 – from a very busy practice of urology. Part of my motivation was that the specialty was undergoing a sea change in surgical technique – to a much more laparoscope-based approach. I expected this would take me a good 3 or 4 years to master, just about in time to retire anyway. Better to make room for younger people brought up in the new surgical environment.

"The Astronomer" by Vermeer  (Credit: http://vermeer0708.wordpress.com/about/)
“The Astronomer” by Vermeer
(Credit: http://vermeer0708.wordpress.com/about/)

But no chloroform exit for me! In fact, enjoying a “comfortable” retirement has given me a sense of what it must have been like in 17th and 18th century Europe when men of means, who did not have to work for the next meal, could spend their mental energy immersed in artistic, literary or scientific endeavors. And thus it’s been for me in the intervening 10 years: I’ve researched and written some history and some commentary, In 2003, I founded the Society for the History of Navy Medicine to serve as a scholarly home for people interested in research, study and publication in the history of maritime medicine. For the last 2 years, I wrote a nearly weekly blog on various medical history topics (I just “retired” from these last two endeavors, on my 70th birthday). And then, there is “Community Involvement”: a Rotary club presidency, reorganizing the Fleet Admiral Nimitz Chapter of the Association of the United States Navy after decades of unconscionable silence; leadership in historical organizations both local and national; and recently, chairing a committee to establish a Poet Laureate program for my city.

One of the saddest things I observed in my practice were men whose lives essentially ended with retirement. With no “purpose” in life, these men descended into sometimes dreadful depressions. But for no reason! I believe that, in any community, all one has to do is let it be known that one is retired, and the phone will ring off the hook with offers of opportunity for community service. This is often joyful work, done alongside other people of good will who are doing it simply because they want to!

So, at age 70, at the beginning of the “third half” of my life, my calendar is “booked” right up through my 75th year. If I were to die tomorrow, I’d do so satisfied with a life well lived – but really pissed because there’s so much more I want to do!

This article was originally posted to my blog “Of Surgeons and the Sea” on 30 April 2013

©2013, 2014 Thomas L Snyder, MD

 

Of Ships and Surgeons Going “Private”

I started this blog when I was the Executive Director (Founding) of the Society for the History of Navy Medicine. I intended the blog to be the public voice of the Society, and so it was during my directorship of six years. When the Society’s next Director, Jim Dolbow took the helm, he created a blog specifically (and appropriately) for Society news and events. I suspect that the Society’s third Executive Director, Professor Annette Finley-Croswhite will expand the use of that site to get the Society’s word out. Given the firm establishment of the Society’s blog, I believe now’s a good time to take this blog, which is really my personal “historical” statement, “private”. Henceforth, the blog will be my personal means of communicating maritime medical history and commentary to the world.

After posting an article (typically of 400 – 600 words, and usually a researched historical piece) a week here for nearly two and a half years, my brain was pretty much sucked dry – I REALLY respect professional writers who must work to a weekly deadline for a whole career! – and the muse left me. But now, after a year’s sabbatical, I think it’s time to tiptoe back into the arena. Accordingly, I will post such occasional piece here, either history or commentary, as I am moved to produce. I hope you gain some benefit from these scriblings

The Blogger-in-Chief

(c) 2014 Thomas L Snyder, MD