Celebrating Independence Day: Fortitude in Philadelphia, 1776

Guest post by Susan L. Speaker, PhD, Elizabeth A. Mullen, and Erika Mills, History of Medicine Division, Library Operations, National Library of Medicine, National Institutes of Health.

Stories of the momentous political events of the American revolution can often leave out the broader context in which they happened, and the concurrent day-to-day challenges Americans faced, particularly to their health. In honor of this year’s Independence Day celebrations, let’s pull back the curtain and peer into Philadelphia in 1776.

In the spring and summer of 1776, the Second Continental Congress gathered in Philadelphia to debate declaring independence from King George III and the British Parliament. Accounts from that time clearly convey the delegates’ fears about the possible consequences of fighting for independence: the American army, vastly outnumbered by British forces, could lose the war; their leaders could be executed as traitors; supporters could have their property confiscated; and the occupying British army could wreak havoc on towns and cities. But British rule wasn’t the only threat to life and liberty during this time. Disease posed yet another significant threat.

A portrait of Dr. Benjamin Rush
Dr. Benjamin Rush, a prominent Philadelphia physician and signer of the Declaration of Independence, split from many of his medical peers over the suspected origins and best treatment of yellow fever. In his book, An Account of the Bilious Remitting Yellow Fever, as It Appeared in the City of Philadelphia, in the Year 1793, Rush chronicled his approach to the disease and experience treating yellow fever patients.

The Continental Congress included many well-educated delegates, and Philadelphia itself (then America’s largest city with about 30,000 residents) was a center for science, commerce, and medicine. Philadelphia was home to America’s first medical college (at the University of Pennsylvania, 1765), first general hospital (Pennsylvania Hospital, 1752), and the American Philosophical Society (1743). Five of the Declaration signers were physicians, including Benjamin Rush. While medical, scientific, and public health knowledge was steadily advancing in the late eighteenth century, it was often inadequate when illness struck. Most of our modern understanding of the physiological, biochemical, and microbial causes of disease wouldn’t develop for another century.

Philadelphia, like most cities of the era, was crowded, and by current standards, filthy.  Sewage and other waste flowed in open gutters and ditches; animal manure was everywhere. Washing and drinking water often came from the rivers. Diseases such as typhoid and dysentery were common as was malaria (transmitted by mosquitoes breeding in standing water). Occasionally, yellow fever (another mosquito-borne disease) invaded the city, taking a terrible toll. When such epidemics arrived, the well-to-do often left town, while poorer folk, including slaves and servants, stayed, caring for the ill, burying the dead, and risking their own health.

A letter written by Dr. Rush to his sister.
In this letter to his sister, written during the yellow fever epidemic, Dr. Rush described the “deep and universal distress” in Philadelphia. He mentioned “190 fresh graves” in the churchyard and “nearly deserted” streets.

The health of the Continental Army, led by George Washington, was also a constant worry. Army camps were much like small cities where crowding and poor sanitation provided ideal conditions for disease transmission. The lack of proper food and shelter made soldiers more susceptible to illness. Many military leaders knew, even before disease microbes were discovered, that cleanliness, proper waste disposal, adequate diet and clothing, and other measures were keys to keeping troops fit for battle. One of Washington’s first general orders, in 1775, addressed measures for maintaining soldiers’ health; such orders would be frequently repeated throughout the War of Independence, as camp commanders didn’t always comply.

A sketch of a nurse tending to a solider in the revolutionary war period.
Sketch of a nurse tending to a solider. Washington began to inoculate and quarantine troops to control and minimize the impact of the smallpox. His decision was bold and dangerous, as inoculation brought risk of death, although far less frequently than if contracting smallpox naturally.

Washington’s health-related orders also addressed inoculation against smallpox, a dangerous and highly contagious disease. Inoculation was risky as it used material from an infected person (rather than vaccination using cowpox material, which was developed later) to produce (one hoped) a mild infection and consequent immunity. Civilians also took a chance with the procedure; an outbreak in Boston in 1776 spurred Abigail Adams (wife of John Adams) to get herself and her children inoculated against it, though it took several of them weeks to recover.

An illustration of the Cinchona tree.
The bark of the Cinchona tree, a source of Quinine, was the bark in the “bark and wine” cure.  Madeira wine was the wine portion of the cure.  Secretary of the Treasury and leading Federalist Alexander Hamilton favored the “bark and wine” treatment for yellow fever.

These health burdens on the population, in Philadelphia and elsewhere in the colonies, were ubiquitous but insufficient to sway the colonies in their determination to be free of British rule. In spite of their administrative concerns and personal health complaints, the delegates to the Second Continental Congress made history on July 4, 1776.

After the revolution, Rush wrote an essay: “An account of the influence of the military and political events of the American revolution upon the human body” and another: “The result of observations made upon the diseases which occurred in the military hospitals of the United States, during the late war” an early usage of the nation’s new name.

You can find Rush’s essays in NLM Digital Collections and learn more about the health and politics of the early years of the United States NLM’s exhibition Yellow Fever in Alexander Hamilton’s America.

Dr. Speaker has been Historian for the Digital Manuscripts Program in NLM’s History of Medicine Division since 2002. She conducts research, selects documents, and writes in-depth contextual narratives for the Profiles in Science project, and she carries out other historical work including articles, blog posts, presentations, and oral histories on a variety of topics. She is also the historical consultant for the NLM Web Collecting and Archiving Working Group.

Elizabeth Mullen is Manager of Web Development and Social Media in NLM’s History of Medicine Division.  As managing editor of Circulating Now, she is privileged to work closely with many creative and dedicated NLM staff members and a wide range of historians, artists, curators, students, educators, and members of the public who have found meaning in the collections and shared their enthusiasm for the history of medicine.

Erika Mills is an exhibit specialist for the Exhibition Program in NLM’s History of Medicine Division. She has co-curated exhibitions on a collection of images from the World Health Organization and the first history of the NLM as presented in the institution’s first exhibition. Ms. Mills has worked at NLM since 2005, starting out as the community outreach coordinator for the Exhibition Program.

A New Frontier: The Impact of a 1959 Board Meeting

Guest blog by Ken Koyle, MA, Deputy Chief of the History of Medicine Division (HMD) at the NIH National Library of Medicine. This post celebrates the important work performed by our archival professionals and the archival collections held by the library, from which the source material was drawn, as NLM celebrates International Archives Week #IAW2022.

In November 1959, when construction of NLM’s current building at NIH was still underway and digital computing was in its infancy, the NLM Board of Regents convened on the third floor of the Old Red Brick building for a demonstration of the indexing process. When Board Chairman Michael E. DeBakey, MD, asked if computer technology could be used in indexing, NLM Director Col. Frank B. Rogers, MD, was ready with an answer. Dr. Rogers, clearly interested in the emerging technology of automated data processing (ADP), described an article by Robert S. Ledley, DDS, in that month’s issue of Science and noted that Dr. Ledley was already contracted with NLM to report on using computers in indexing.

Black-and-white photo of Dr. Rogers leaning on a stack of books with bookshelves in background.
Dr. Frank Rogers at NLM, 1962.

Dr. Rogers was instrumental in NLM’s first explorations of automated processes and had a clear vision of the potential of electronic computing, including how it could improve efficiency at NLM, but his optimism was tempered by prescient realism. Dr. Rogers recognized—and conveyed to the Board—that the potential benefits of ADP would require a commensurate investment of staff time and labor. “We should not forget that ‘automatically’ means ‘because we told it to do so beforehand,’ and this in itself may turn out to be quite a trick.” Dr. Rogers made it clear that the computer age would bring a change in work, but not necessarily a reduction in work. “Remarkable as the capacity of the computer may be for sustaining a long sequence of operations, it is nevertheless ultimately only the end-phase of that still longer sequence which must include as a first phase the human labor of input.”

Acknowledging the upfront labor investment in ADP was only part of Dr. Rogers’ insight. He also explained that the human work was not only substantial and necessary, but also incredibly complex: “The instructions [for a computer] are a thousand times more detailed, for the simplest task, than those required to be given to the . . . clerk.” Unleashing computers’ potential would require staff to think in new ways, conceive new methods of organizing data, and embark on a new journey of continuous learning and professional development.

Black-and-white photo of members of the NLM Board of Regents posing for a photo. Four members sit behind a table stacked with papers. 13 members stand in the background. Dr. Rogers is featured on the far right.
Dr. Frank Rogers (far right) with the NLM Board of Regents meeting in the “Old Red Brick,” 1957.

Along with the challenges of training staff to work with ADP equipment came the interminable problem of cost. Much as today’s public institutions are grappling with the costs of cloud computing, digitization, and increasing storage requirements, Dr. Rogers had to balance the potential benefits with the considerable costs of computer equipment. The type of computer necessary to realize Dr. Rogers’ vision would cost about $1.5 million in 1960—98% of NLM’s total budget of $1,566,000.

Undeterred, Dr. Rogers found an answer to the funding problem by collaborating with another agency that would benefit from the increased processing speed of scientific literature that the envisioned system could provide: the National Heart Institute. They provided the initial funding, NLM did the legwork, and in 1963, the new MEDLARS computer went into service. Dr. Rogers had realized his vision of bringing automated indexing to NLM. As Surgeon General Luther Terry said at the Board meeting in April 1961, “If any institution ever stood on the borderland of a new frontier it is the National Library of Medicine.”

Computer operators working with the Honeywell 800 mainframe computer, originally acquired by NLM in the 1960s.

Dr. Rogers was very clear about the issues of cost, labor, and expectations in his 1960 presentation to the Board, including his overarching concern about balancing NLM’s core mission with these potential new directions:

[The] purpose of the Library is not to operate a particular machine system, however great an acrobatic achievement that might be in itself. It is not to publish and distribute a particular index in a particular way, however ingenious and successful that operation may be deemed to be. It is not even just to be a good library, however great and distinguished that library may be. It is rather, by virtue of being a library, to use every available bibliothecal means to promote awareness of and access to the subject content of recorded medical knowledge, to the end that the science of medicine will advance and prosper.

More than 60 years later, NLM still holds fast to that purpose. As stated in our statutory mission and reiterated in our current strategic plan, we are here “to assist the advancement of medical and related sciences and to aid in the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health.” Our continued pioneering work in data science is just one way we accomplish that mission.

Mr. Koyle joined HMD in the NLM Division of Library Operations in 2012. Before joining NLM, Ken served as a medical evacuation helicopter pilot and a historian in the U.S. Army. He is the co-editor with Jeffrey Reznick of Images of America: U.S. National Library of Medicine, a collaborative work with HMD staff.

Please Join Us in Honoring Milton Corn, MD

This blog post is based on remarks given at the May 17 Milton Corn Memorial Concert.

Yesterday, I was honored to join in a beautiful celebration for the life of Dr. Milton Corn, an amazing man who I regarded as my adviser, colleague, and—most importantly—my friend. I would like to thank his wife Gilan and all of Milt’s friends and family for creating that wonderful moment of togetherness. Many of us knew Milt when he was Dean of the School of Medicine at Georgetown University or in his role with the National Library of Medicine, and I suspect that some even knew him as a bon vivant around town!

While I’m sure many of you can remember the moment you met Milt, I actually can’t—in my mind, it seems like he was an ever-present professional of the big data and scientific technology community! As a newly minted PhD in the late 1980s/early 1990s, I remember Milt as eminent in our field… and that was 30 years ago! I got to know Milt as part of the medical informatics community that was just emerging as a research powerhouse. Milt was a mentor to me; he reached into the visions I had for—and breathed life into—the ways technology could support patient engagement. He was always supportive, but he was also a hard questioner who wanted to know the value of the community’s investment.

Milt brought so many gifts to the field of biomedical informatics. He brought his wisdom as a physician executive to a fledgling field, applying his gentle but direct guidance to inspire research in the domain. Milt also funded my research; I remember a phone call one August afternoon over 20 years ago when Milt said, “Do you still need money for this project? Because we have some end-of-year money for you, and it’s available if you want to use it,” which of course let us advance our original ComputerLink project.

Interestingly enough, I actually know very little about Milt’s role at NLM, although I know a lot about his contributions! He joined our beloved NLM in 1990 during the first decade of applying computer technology to health care, in support of Don Lindberg’s visionary leadership. Milt served as NLM’s ambassador to the broader academic and research community as both their instigator and a supporter of many novel research ideas. Milt was in love with ideas, but he never let that love cloud his judgment or interfere with his expectation that emerging fields needed good science. He was as enchanted with a novel approach to genetic analysis as he was with securing proposals to write important books that detailed the history of medicine.

Milt became a colleague, a trusted advisor, and someone I could talk with about biomedical informatics. We could laugh about the field while enjoying its growth. Later, Milt became my friend. We shared family stories, our love for our children, and the challenges we faced with them. I loved his humor—he had the best sardonic laugh in the world. And then, surprise of all surprises, Milt became my employee, which had nothing to do with his actions, but with my actions! I remember being very mindful of Milt during my first NIH interview, where one of the committee members asked what it was going to be like for me, and I said I’m now going to be the boss of someone who I felt that I have learned from my whole career… it’s going to be fabulous!

Not that it wasn’t daunting; for 25 years, my career success depended on Milt! And he was wise: on my first day on the job, Milt stopped by with a little gift—a bag of peanut M&Ms! What a way to level the playing field. Sometime during those first few weeks, Milt came to my office and said, “Anytime you need my desk for someone else, you just let me know, and I’ll go home.” Every year he would say that sentence, and every year I thought not yet, I need you here. I couldn’t be without Milt, the magic maker.

After working more closely with Milt, I realized his judgment, discernment, and incredibly keen sense of what was a good investment—and, more importantly, what wasn’t—were critical to how NLM functioned. Later in our time at NLM, we needed a single scientific director to unify our intramural programs, and Milt took this responsibility on. Adding the title of Acting Scientific Director to his already stretched ambit, Milt aligned our two very strong intramural research groups: one addressing computational biology, and the other, clinical health informatics. He guided these two very disparate groups of investigators into a single structure… not totally unified, but respectful of each other and clearly willing to meet halfway across the bridge.

I turned to Milt many times as counselor to my position. Navigating the federal waters as director of a venerable institute like the NIH National Library of Medicine was a challenge—even for someone who thought herself quite sophisticated in dealing with complex organizations. Periodically, I’d walk over to Milt’s office, settle into one of his nice leather chairs, and lay out whatever issue I was confronting or a personality that perplexed me. Through a question or a brief comment, he led me to solutions, insights, and confidence, but none more so than the day he said, “Your job is important, and you deserve to have fun—so make sure that you do that!” I am brimming with tears as I remember how his strength made me strong!

In October of 2020, Milt told me that the pandemic was good for him. What an odd statement, I thought. However, he revealed that our maximum telework posture, with everyone working from home, eliminated the need for him to make the long commute from Virginia to Bethesda. Working from home made it possible for him to continue to engage. And engage he did! He remained a mentor all the way up until his very last weeks at the National Library of Medicine. I remember the night he called me and said, “I don’t think I can come back to work anymore,” but he reminded me, “You can call me if you need me.” I took his generous offer to heart and took it up as often as I could.

Above all, Milt was important to me, to the National Library of Medicine, and to the entire scientific and clinical world. Thank you.

Nursing in the Headlines

Every year, we celebrate National Nurses Week between May 6, which is National Nurses Day, and May 12, which happens to be Florence Nightingale’s birthday. If you haven’t picked up a specialty journal or public newspaper in the past few months, you may not know that nursing has made it to the headlines:


Some of us might argue that any press is better than none, and others might say it’s about time that the real story about nurses and nursing become better known. While I believe a little in both perspectives, the real reason I’m glad to see them today is that they depict a much richer, more valid, and more robust story about who and what nurses are and how they serve society.

A recent article in The New York Times stated, “A Shrinking Band of Southern Nurses, Neck Deep in Another Covid Wave.” This news story brings into national view the importance of small, nonprofit safety-net hospitals and the experience of the nurses who work there. Told without romanticizing nurses’ dedication or pointing out their long-suffering compassionate nature, this article tells of the real challenges faced by nurses who want to do good for their communities but are faced with persistent shortages, significant illnesses that could have been avoided, and politically motivated, bureaucratic financial decisions. However, it also tells of the creative problem solving demonstrated by these nurses as they try to meet patient needs and the compassion they provide to their colleagues as they continue, yet another day, to address the needs of many with fewer and fewer resources.

Look at the first three headlines: together, these depict a professional field dedicated to meeting the conditions of its social contract—to provide high-quality patient care—and awash with opportunities for outstanding career growth, and at the same time at risk of losing some of its critical workforce due to unrelenting stress in the workplace. What does this say about nursing? Never has there been such opportunity, but never has the opportunity promised so little.

A beautiful story in March in The New York Times, “Confronting Grief, With Margaret Atwood, in ‘The Nurse Antigone,’” which talks about regular nurses participating with Margaret Atwood in the reading of the play Antigone, provides me with hope and vision. In this rendition, Atwood will play the blind prophet Theophanes and the nurses will be part of the Greek chorus. This story of Antigone’s determination to bury her brother, who died in battle, despite a law forbidding the burial of traitors mirrors the challenges nurses face by attending to those in need despite enormous challenges in acquiring resources needed to provide care, including sufficient time. An ethicist quoted in the article remarks that Antigone’s triumph over Creon’s prohibitions provides an apt mirror of the moral injury with which nurses cope, neither romanticizing their decision nor despairing at their deplorable conditions.

The final headline in the middle of the pack heralds nurses’ awakening to their economic power. The COVID-19 pandemic didn’t create the traveling nurse sector of our profession, but it certainly accelerated its growth across the country. Individual remuneration soared, leaving many nurses with the dilemma to remain as a loyal worker in a long-served institution or move on for financial gain. Hospitals too faced the challenge of differential staff compensation, with highly paid traveling nurse staff working next to more modestly paid existing staff. Fortunately, the perversity of this economic structure has led to hospitals and clinics improving staff nurse compensation, attending to their work conditions, and stabilizing the staffing complement.

As we celebrate National Nurses Week this year, please join me in recognizing the vibrant, rich picture of our profession. We are not unbuffered by these challenging times, and as a profession, we are responding in a way that serves our patients while preserving our profession. Accepting new models of care, innovative career trajectories, and an expanded understanding of how to create compassionate workplaces promises a future in which all nurses can work to the top of their licenses. Let us know how we can help you do this, too!

MLA ’22: NLM as an Engine for Innovation and Discovery

Guest post by Amanda J. Wilson, Chief of the NLM Office of Engagement and Training (OET), and Dianne Babski, Associate Director for Library Operations.

NLM is excited to participate in the annual Medical Library Association (MLA) conference MLA ’22: Reconnect, Renew, Reflect, held virtually from April 27 to May 2 and on-site in New Orleans from May 3 to 6.

Information on how NLM products, services, and programs support innovation and discovery is available at NLM @ MLA’22. We encourage to you visit the NLM Technical Showcases on May 5 for a PubMed update with Amanda Sawyer, an introduction to NIH Data Management and Sharing Policy from Dr. Lisa Federer, and a PubMed Central update and information about NIH preprints with Katie Funk. The NLM Update on May 6 with Dianne Babski, Amanda Wilson, and Network of the National Library of Medicine (NNLM) Project Director Martha Meacham will include the latest activities and be followed by an interactive Q&A.

If you missed the April 28 session, check out the NNLM Day @ MLA: National Update page to hear about NNLM members’ work and accomplishments over the past year and to learn how the regions took advantage of their new configuration, partnerships, upcoming activities, and available opportunities. For example, the NNLM Center for Data Services hosted a session to help professionals implement the NIH Data Management and Sharing Policy, with concurrent sessions from the NNLM Training Office and NNLM Public Health Coordination Office. NNLM Day will reconvene in November 2022, so be sure to let us know your topics of interest.

MLA, which comprises more than 400 institutions and 3,000 professionals, is one of NLM’s key stakeholder groups that inform our products, initiatives, and services. MLA’s annual meeting offers NLM the opportunity to introduce new products and initiatives, get feedback on our services, and explore ways to better support the medical library community. As an NIH institute and a national library, NLM continually adapts to changes in the research ecosystem, including data standards, scientific developments, technological advancements, and the evolving norms of how we operate together.

As a catalyst for innovation and discovery, NLM is committed to equipping health science information professionals and the public at large with tools, platforms, and the ability to conduct today’s data-intensive research and community outreach. Please visit NLM @ MLA’22 to learn how you can become part of this partnership as we develop health information solutions and joint programs to support the future of health information.

Ms. Wilson coordinates engagement, training, and outreach staff from across NLM to elevate NLM’s presence across the United States and internationally. OET is also home to the Environmental Health Information Partnership for NLM and coordinates the Network of the National Library of Medicine.

Ms. Babski is responsible for the management of one of NLM’s largest divisions, with more than 450 staff, who provide health information services to a global audience of health care professionals, researchers, administrators, students, historians, patients, and the public.

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