Your Correspondent on Streaming Radio

Occasionally, a surprise opportunity falls into our laps. This radio interview, broadcast on a streaming service called ReachMD, has me discussing my interest in the history of naval / maritime medicine, the society I co-founded (The Society for the History of Navy Medicine), the history of the Navy’s first hospital on the west coast (at Mare Island in the San Francisco Bay), and the contrast between Navy medicine in the 19th century and the 21st century. The audio clip is 11min29sec long. Learn and Enjoy!

https://www.reachmd.com/programs/clinicians-roundtable/the-history-american-naval-medicine-a-military-doctors-society-mission/9658/

(c)2017 Thomas L Snyder

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Navy Medicine in Araby – Then and Now (Episode 1)

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Historians, Doctors, and the History of Medicine

I assiduosly follow the listserv MEDMED-L (Medieval Medicine). The list manager is Monica Green, Professor of History at Arizona State University. Professor Green oversees a lively conversation that covers not only the history of medieval medicine, but also a general academic “take” on all matters medicohistorical. It gives me, a non-academic, insight into trends in historiography. She also posts occasional rants or pet peeves.

In her most recent of the latter, Professor Green cites a recent blogpost in which the British classicist Helen King describes “a particularly fine case of Bad History” in a newly published medical textbook. Professor Green takes the story and runs with it, observing that a relevant piece of historical scholarship never made its way into PubMed, a definitive bibliography for medical researchers. She concludes, “So, this is what we’re up against when we’re talking about the invisibility of humanistic work. We’ve talked about this on MEDMED-L multiple times, but even with Google and Google Scholar, it seems that people simply won’t step outside of certain boundaries when it comes to bibliography”. She means that mainstream medical authors don’t do a good job of researching and understanding historical aspects of their discipline.

This state of affairs is ironic because physicians themselves “discovered” medical history in the modern west. Early in the 20th century, men like William Osler, who was classically trained, and Fielding Garrison, a pioneer in the history of military medicine, cited their history direct from Greek and Latin. Two of the most renowned mid-century historians of medicine were physicians: Henry Sigerist mastered 14 languages – including Arabic, Sanskrit and Chinese – which he applied to his study. Unfortunately, he died of a stroke long before he had completed his work. More durable was Owsei Temkin, another physician giant in the history of medicine. Russian born and German trained, Dr Temkin held forth as Professor of History of Medicine at Johns Hopkins, publishing his last book just a year before he died at 99.

By around mid-twentieth century, PhD historians had also discovered medical history, and since that time, have come to dominate all aspects of the discipline, and justifiably so: they bring training in historical techniques, and, almost as importantly, the linguistic skills necessary to probe the ancients. That’s not to say physicians have left the field entirely. For instance, Howard Markel, MD., PhD, Professor of the History of Medicine at the University of Michigan is well known and well regarded, and has published more than 100 articles and reviews, and written or edited 10 books. Nevertheless, it’s pretty clear – despite protestations* to the contrary – that a PhD / MD divide exists in the production (and use?) of medical history. And, at least by the example cited here, MDs may not be doing such a good job of citing their own history, especially if that history is not found in the medical (vice historical) literature.

What to do? Professor Green says that relevant historical writing needs to find its way into standard medical research bibliographies. Surely, if the National Library of Medicine owns a volume, it should be listed in PubMed. In addition, I think that medical editors should, as a matter of policy, insist that works containing historical references be subjected to rigorous peer review – by historians. Professor Green closes, I’m not sure how relevantly, “Hence the value of blogs, which erase the scholarly / popular [shall I say ‘PhD / MD”] divide.”

The perspective physicians and other medical professionals bring to the medicohistorical enterprise  lends a vitality that dry historicism cannot. Even if we don’t have the skills or inclination to research and write medical history, our most human of professions calls on us to portray it with exemplary accuracy, and I might add, with extraordinary passion.  We need to make it part of our way of thinking.

*The American Association for the History of Medicine, “a professional association of historians, physicians, nurses, archivists, curators, librarians, and others…” was founded in 1925 by a group of physicians. Some years ago, I attended the traditional Clinicians Historians’ Breakfast at an AAHM annual meeting. There, much bonhomie was generated around the importance of doctors to the medical historical enterprise. “After all, doctors create the history, and their presence provides verisimilitude to the undertaking”, people seemed to say. I’m not so sure the majority of attendees actually believed this, and I think that’s a good part of why a PhD / MD divide exists.

On the Scurvy

It’s been a long time since I’ve posted here, and I’m sorry for that. Blame it on a very busy life, which can’t be all bad! First, a new grandbaby, born on the Ides of March, to our younger son and his wife, both in the Foreign Service, who had to come home from their posting in Azerbaijan for the happy event. Needless to say, we visited them in Baku last year – a very interesting place worth a post (but in a different blog, for sure!). The past couple of years have also seen me as Commander of the San Francisco Commandery of the Naval Order of the United States, the oldest – and a preeminent – U.S. naval history society.  My command tenure will end in December, and I’m already looking forward to doing some more writing and blogging. Here’s the first salvo—

In January, quite by chance, I came across a New York Review advertisement for a then new book, Scurvy – the Disease of Discovery by Vanderbilt University humanities chair Jonathan Lamb (Princeton University Press, 2017). I quickly added it to my Kindle library, and there, by and large, it has sat. While Professor Lamb does give an up to date description of our current scientific understanding of the cause and pathophysiology of the affliction (well known now to be due to a dietary shortage of ascorbic acid, which by some genetic fluke, humans lost the ability to synthesize many millennia ago), the book has been a slow slog for me. That’s because, at least as far as I’ve gotten into it, it’s really a history of the (non-medical) literature about the disease, made up of descriptions of the horrors of scurvy (and, strangely the “wonders” of it, too) by sufferers and observers from the 15th century forward. The author also makes some interesting side trips into, say, the history of the philosophy of science as it relates to the (mis)understanding(s) of the disease in the centuries leading up to our only relatively recent scientific insights. So far, I’m really disappointed by the author’s treatment of the history of the development of that understanding. His research on this matter seems pretty much limited to the British literature (the Dutch, French and perhaps others DID write about the disease) by way of reruns of the venerable Keevil / Lloyd & Coulter multivolume history of medicine in the Royal Navy. So nothing new here.

I plan to write a more thorough review – if ever I can successfully grind my way all the way through – really: this book is hard work! In the nonce, if any reader wishes to put forward a review earlier than that (whenever it might happen), feel free to send it to me and I’ll happily – even eagerly – post it, with appropriate attribution of course.

Technical Glitch / Learning Opportunity

Yesterday I tried to post a 38 minute video of a talk I gave on the history of Naval Hospital Mare Island, California, the Navy’s first Hospital on the west coast. The video transfer didn’t “take”, however, so back to the drawing board.

The video does appear on a Facebook page of the same name: Of Ships and Surgeons. Go take a look if you can.

Our Shrinking Historical Patrimony

I’ve posted on this topic before, noting that the ravages of time and disasters (both natural and man made) seemingly inexorably erode the historical landscape. I argued that historians should lead (or at least actively support) efforts for the preservation of historical landmarks and other artifacts.

Just recently I learned of the possible imminent demolition of such an artifact – the 1920s Spanish-revival style former Oak Knoll Country Club and Officers’ Club for the Oakland (California) Naval Hospital. 

U.S. Naval Hospital Oakland – “Oak Knoll” to Bay Area locals – sprang into existence in 1942 as part of Navy Surgeon General Ross McIntire’s massive World War 2 expansion of Navy medical facilities.* Even before war broke out McIntire, realized that the Naval Hospital at Mare Island – the Navy’s first on the west coast – was too old, too small and vulnerable to collateral damage from any Japanese air strike on the huge shipyard nearby. He directed 12th Naval District officials to cast about for a replacement location, one that would be convenient to Alameda Island in the San Francisco Bay (where casualties from the war in the Pacific would be landed by ship and later plane), and capacious enough for a very large facility. McIntire’s agents hit upon the Oak Knoll Country Club, a luxurious facility that had gone bankrupt as a result of the Great Depression. Its facilities, including the lovely Club building, had lain fallow for several years. In April 1942, the government began the proceedings necessary to procure the property. The hospital received its first patients in August, and by the end of the war was caring for 3000 or more wounded and sick service personnel. The old Clubhouse was repurposed as the hospital Officers’ Club – a dining facility and watering hole for doctors, nurses and other officers serving in or visiting the facility and the Bay Area.

Oakland Naval Hospital, around 1945. Officers’ Club ? in lower right corner. Naval Hospital San Leandro , purpose-built to care for psychiatric casualties, is in the background.

The hospital flourished, especially after the Mare Island hospital closed in 1957. Its staff of doctors, nurses and corpsmen and corps waves cared for casualties of the Korean and Vietnam wars, and for legions of military family members and retirees. The “temporary” ward buildings you see in the image above were finally replaced with a new “Moderne”-style tower structure in 1968. Your correspondent drilled as a Reservist in one of those “temporary” buildings, in the 1980s. – Ed. The hospital closed in 1996 as part of the “BRAC”^ process that shuttered military bases and facilities all across the country.

Today, all that remains on the 160+ acre site is the Country Club / Officers’ Club. Developers had cleared the land by the early 2000s for a large housing area. At the time they expressed the intent of preserving the structure for use as a community center. This project came to a halt in 2008, a victim of the Great Recession. Now, developers are proceeding, but this time they express the intent to demolish the Club.

Naval Hospital Oakland Officers’ Club building, neglected. Next: demolition?

Facing the possibility that this lovely and historical structure may go away, a group of Oakland residents – Oakland Heritage Alliance – are mobilizing the forces to lobby Oakland city officials for its preservation, restoration and adaptive reuse. A piece of our historical patrimony hangs in the balance. Hearings are scheduled for some time this spring.

*U.S. Naval Hospitals numbered 19 at the outset of World War 2. One, at Cañacao in the Philippines, was lost early to the Japanese invasion. By the end of the war, the Navy was operating 99 hospitals. This number included country clubs, hotels, college dormitories “taken up from trade” or purchased outright (this is another story), and large, semi-permanent base, mobile and fleet hospitals located typically in “exotic” locations like Tutuila, American Samoa (e.g., Mobile Hospital No 3) or Hollandia, New Guinea (e.g., Base Hospital No 17).

^BRAC – [Defense] Base Realignment And Closure – the most recent in a long string of United States military base closures that began shortly after World War II. In all, something like 350 bases and installations went out of business in the five rounds (1988, 1991, 1993, 1995, 2005) of the BRAC process.

(C)2016 Thomas L Snyder, MD

History of Medical Corps Ranks – a Guest Post

by André Sobocinski*

Medical titles for the U.S. Navy were established by the Act of 24 May 1828 for the “Better Organization of the Medical Department of the Navy.”   After 1828, a Navy medical officer could serve as a Surgeon, Passed Assistant Surgeon, and Assistant Surgeon. You also see the term “Acting Assistant Surgeon” which usually denoted temporary service (a la contract) or a physician who was serving aboard a ship but has not yet received a commission or been approved by a Board of Naval Surgeons. It should be understood that Naval medical officers were called “surgeons”, but were qualified nominally to practice both medicine and surgery.

The 1828 Act provided that all candidates for appointment needed to be examined by  a Board of Naval Surgeons (AKA Board of Examiners). Upon
successful completion of the exam, the newly appointed physician would be given the title of “Assistant Surgeon.”   In order to be promoted to
Surgeon, the Assistant Surgeon needed to serve at sea for at least two years and be examined again by the Board of Naval Surgeons.  Successfully passing the board did not mean that he was automatically promoted to Surgeon.  Until vacancies occurred the Assistant Surgeon would be known as a “Passed Assistant Surgeon.”   Medical Officers could serve for years as a Passed Assistant Surgeon. We even have cases of physicians retiring from service as a Passed Assistant Surgeon.

These medical titles did not have an associated rank until 31 August 1846, when new regulations provided for “relative” ranks. Surgeons with more than 12 years of experience held “relative rank” equivalent to Navy line Commanders.  Surgeons with less than 12 years of experience held “relative rank” of Lieutenant Commanders, Passed Assistant Surgeons, as Lieutenants, and Assistant Surgeons were considered roughtly equivalent to Lieutenants (junior grade).

On 3 March 1871, the title structure was again altered.   The Navy Medical Department now had the additional titles of Surgeon General, Medical Director, Medical Inspector, Surgeon, Passed Assistant Surgeon, and Assistant Surgeon.  Each of these conferred additional relative rank (Surgeon General=Commodore (one star), Medical Director=Captain, Medical Inspector=Commander, Surgeon=Lieutenant Commander, Passed Assistant Surgeon=Lieutenant, Assistant Surgeon=Lieutenant (junior grade) or Ensign). In 1899, the Surgeon General/Chief of the Bureau of Medicine and Surgery (“BUMED”) was given relative rank of Rear Admiral (two star).

On 15 August 1918, the concept of relative rank was abolished by General Order 418. Medical Officers were finally accepted in the Naval hierarchy and
looked upon as Naval Officers (the exception to this in 1918 was the Nurse Corps). With this said, the titles Medical Director, Passed Assistant
Surgeon etc continued to be used through 1947, but after WWI were less commonly used.  A Medical Director would typically be called Captain, Passed Assistant Surgeon a Lieutenant Commander, etc.

As for Navy’s medicine’s most senior officers, from 1842-1871, the Chief of BUMED was a Surgeon,  equivalent to Commander; 1871-1899 the Surgeon General/Chief of BUMED was equivalent  to a Commodore (one star); 1899-1918 the Surgeon General/Chief of BUMED had the relative rank of Rear Admiral (two stars); from 1918 to 1965 the Surgeon General/Chief of BUMED had the rank of Rear Admiral. The only exception to this was Ross McIntire who, while serving simultaneously as FDR’s White House physician and Navy Surgeon General, held the three star rank of Vice Admiral. From 1965 to present the Surgeon General/Chief of BUMED holds the rank of Vice Admiral.

The Navy very wisely established Boards of Examiners in a day when medical education in the U.S. was unregulated and quite irregular. To assure a certain level of competence, each candidate for appointment as Assistant Surgeon had to pass a rigorous examination of his knowledge of medicine, surgery, anatomy, obstetrics and gynecology, pharmacy, legal medicine and more. For the convenience of the candidates, the Examining Boards sat at the Naval Asylum at Grays Ferry (Philadelphia), Brooklyn (Naval Hospital/School of Instruction), and later Washington, DC (Naval Museum of Hygiene/Naval Medical School).  In the mid to late 19th century examinations were also conducted  at Norfolk, VA, New Orleans, LA, and at Mare Island Navy Yard, CA.

Image: http://s277.photobucket.com/user/Sheriff__001/media/USNavyOffier.png.html, accessed 27 May 2015. The modern rank of Rear Admiral (lower half) was known as Commodore in earlier years. The Coast Guard retains the rank of Commodore for its one star flag officers.

*André Sobocinski is the Historian in the Communication Directorate at the U.S. Navy Bureau of Medicine and Surgery in Washington DC (his physical location is in Falls Church, VA). André wrote this article in response to a question about medical officer relative ranks put to the Executive Director of the Society for the History of Navy Medicine, Professor Annette Finley-Croswhite.

©2015 André Sobocinski

Paeon to Corpsmen

Recently, I came across this praise of medics. It’s from the 3rd Armored Division newsletter. It was written by a journalist who served in the 3rd AD during World War II. The story he tells could be repeated today in Afganistan and elsewhere. It’s a powerful and poignant tribute to selfless and brave folks:

© Leslie Woolner Bardsley  Woolner Index      NEXT

PILL ROLLERS
by
Frank Woolner
Journalist, Headquarters, 3rd Armored Division

Published in 3AD Association Newsletter – December, 1974

Every time I read about some gutless dim-bulb who advocates surrender rather than serving his country in a time of need I am reminded of our pill rollers. There is little doubt that many of the gentlemen who served as medics in WWII were conscientious objectors, but they didn’t run and they were major contributors to our ultimate victory.

Admittedly, back in the states (where every rookie is a self-appointed hero) those of us who were silly enough to think war a glorious adventure made bad jokes about the moral fiber of aid-men. We should have had our mouths washed out with yellow, GI soap!

Much later, in combat, our definition of bravery underwent some startling changes. It turned out that 90 per cent of us were scared blue; we performed our duties, but it was no piece of cake. I’m sure the medics were scared too, but I never saw better soldiers.

Indeed, if comparisons are necessary, then I held these crusaders of the red cross on an absolute par with the crazy, wonderful gladiators of The Big Red One, the Ninth, the Screaming Eagles – and the best of our own superb Spearhead warriors. Today I’ll buy drinks for any aging character who admits that he was a medic in the big leagues.

Whether they were company aid-men or battalion, we got to know our pill rollers in combat. They were gentle men. Few of them wanted to kill, yet they lacked no intestinal fortitude. They were as beat-up and dirty as any of us, but they were angels of mercy toting plasma and sulphanil-amide and bandages – and hope.

Ever stop to think that the medics are directly responsible for the fact that many Spearhead veterans are getting old? One of Woolner’s sage maxims is an observation that aging is an alternative; otherwise one dies young.

A certain company aid-man I knew rather intimately, due to mutual suffering in basic training and later operations in assorted beer joints, may have been typical. Maybe I should name him, but I won’t – other than to say his first name was John and he originated away back East. This guy was well-read and cultured, really officer material, yet he shook his head at the thought of killing other human beings. John went AWOL out of Camp Hood, Texas, eluded all of the MP’s, thumbed his way back East and married “that girl” in his life. Then he returned to face the music.

They gave him a month of hard labor, and he took it in stride, never complaining.

Hard labor wasn’t much fun. On several occasions I had to be watch-dog and, once, having fouled-up a given task, I had a day of it myself. You dug latrines, broke rocks and raked sand. It was dawn to dusk under armed guard. The hard labor boys were temporary second-class citizens, and you’d better believe it.

John felt that his “crime” was worth the punishment. Laughing it off, he served his sentence and went back to company duty, a buck private with no immediate dream of advancement. That man served with distinction when the guns began to pound; he was a hell of a great soldier.

Spearhead brats must realize that a red cross on arm and helmet was no armor, yet these characters scurried out under the heaviest of fire to rescue the wounded. Lots of them were killed in action, daring too much. Some were slaughtered by the spiteful SS, but more caught it because machinegun fire and artillery is indiscriminate. The rank and file of the German Army respected aid-men. Often, in surrounded pockets. Kraut and GI medics worked together to save the lives of soldiers of both sides.

There may have been medics who dogged it, but I never saw one. To those of us up front they were all heroes, and I might add that our standards were pretty high. How else do you rate a man who darts out of cover during a tremendous bombardment to succor the wounded? While brave infantrymen were crouching in foxholes and tank commanders tried to get hull-down and inconspicuous, these wonderful bastards answered every call for help.

In the Third Armored Division, as in every true lighting formation, we swiftly reached a point where “pill-roller” was uttered only if, like Owen Wister’s Virginian, “you smile when you say that!”

Commanders reap most of the glory and combat troops harvest a lion’s share of medals, but talk to “old soldiers, broke in the wars,” and you’ll find their greatest praise reserved for the unarmed medics who didn’t want to kill anybody, but who had the guts to conquer fear, to dive into a furnace and save the lives of comrades. No braver men ever served America.

 

Erosion of the Historical Landscape

“Fires Continue to Plague Historic Forts” is the headline in the most recent number (318) of Headquarters Heliogram, the Council on America’s Military Past newsletter. The article then details damage to structures at Fort Wayne (Indiana), Fort Niagara (upstate New York), and Fort Mifflin (near Philadelphia) over the past year. In my own backyard, the 6.0 American Canyon earthquake in August damaged several historic buildings – including the Museum and the main hospital structure – in the Mare Island Navy Yard historical area of northern California.  The Heliogram article closes: “Fires and vandalism [I’d add “nature and neglect”] seem to be a constant threat to historic sites. While some have around-the-clock security or alarm systems, many do not due to technical or financial challenges. Making repairs also costs money and many sites don’t have adequate insurance or reserves to cover the cost of [repairs of] damage.” City and other governmental agencies are often as dangerous to our history as “fires and vandalism”. My own city of Vallejo saw the wholesale destruction of historical structures – including a lovely and iconic Carnegie library – in its haste for urban renewal in the late 1960s.

Carnegie Exterior

Carnegie Library Vallejo CA. Opened 1904. Demolished 1969. Photo Courtesy Vallejo Naval and Historical Museum via http://www.carnegie-libraries.org/california/vallejo.html

Carnegie interior

Carnegie Library Vallejo CA. Interior. Image Courtesy Vallejo Naval and Historical Museum via http://www.carnegie-libraries.org/california/vallejo.html. Opened in 1904, it was demolished in an ill-advised flurry of downtown urban renewal in 1969.

 

And so we see that the inevitable result of the insults of time, nature, people and events – plus the lack of resources or interest to restore, preserve and protect them –  is the gradual degradation and disappearance of the most compelling records of our history – the physical evidence as represented by structures and landscapes.

So, what should historians – professional, academic and amateur – do?

First, of course, is to do what historians have always done: research and collect the information, write about it, analyze it, and make sure the historical structure, event, person, is made part of the historical record. While material published by traditional means – be it on stone, clay or paper – is pretty durable, especially if published in periodicals and books published by the hundreds or thousands, electronic publishing is problematic. Will the electronic format change? Will electronic storage “tanks” fall into disuse and neglect as time and technology move on? (The whole issue of archival storage is a topic for another day.)

Second, historians need to “sell” history to a public very interested in their past. Lectures given at libraries and museums are a natural. Lectures given to local service clubs like Rotary or Soroptimists deliver a message to community business and professional leaders, people with influence and money, people for whom “getting things done” is a way of life. Want to raise money or workers to restore a local icon? Get the Rotarians involved! Another way to deliver history to the public is by being a docent at a museum, park or historic site. Docents make history come alive by their enthusiastic and knowledgable story telling and explanations. My personal favorite is giving walking tours of historic sites; there’s something compelling about walking in the steps of the people who were part of the history you’re telling.

Third, historians need to become involved in the “politics” of restoration/reservation/protection. This may take the form of serving on the Commission that’s responsible for overseeing a community’s heritage or landmarks. Historians who give testimony or who advocate for preservation bring powerful and respected voices to any discussion about preserving our past. I know a local historian who quite literally single-handedly faced down developers and sympathetic local legislators to preserve a significant historic resource that was just weeks from being demolished for a construction project. (She gives credit to the historical society, but the reality is, she was one person – tenacious to be sure – who saved an important historical resource.) Public advocacy works!

Finally, historians can learn how to establish tax-exempt foundations to support preservation efforts of important resources. It’s easy to do – Nolo Press publish a handy go-by that really works. I know because I’ve set up three 501(c)(3) non-profits using their publication. Of course the non-profit corporation is just the first step. After that, you have to go out and beat the bushes for money. See steps two and three above. And recruit friends, colleagues and relatives to help out!

There you have it. Historians working to preserve our past by researching and publishing it, by selling it to a public hungry to know more, by advocating for restoration/preservation/protection at a local governmental level, and by raising funds for those efforts. No small order, but committed action does get results.

Tell us what you have done in your community. Give us your best ideas and best practices for restoring/preserving/protecting our past. Post your comments and I’ll make sure our readers see them.

©2014 Thomas L Snyder, MD

 

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