Giving Thanks Where Thanks is Due

One of the great joys of being the Director of the National Library of Medicine is the many opportunities for me to express gratitude. In the past, I have given thanks to NLM staff who are veterans (2021), for progress during my tenure (2020), and to our amazing NLM staff members (2019). This year, I am pausing to give thanks for the outstanding products and services developed and stewarded by our NLM staff, made available every day of the year to anyone with an internet connection—and even to some without!

First, I am thankful for our information collections in their many forms. The NLM Board of Regents oversees our Collection and Preservation Policy, which guides NLM as it meets its mission to acquire, organize, preserve, and disseminate biomedical knowledge from around the world. Our collection spans ten centuries from the 11th to the 21st, and ranges from the third oldest Arabic medical manuscript in existence to the “Rosetta Stone” of modern science, Marshall Nirenberg’s genetic chart, from genomic sequences essential for current and future research to information for mothers taking care of sick children.

Organizing the collections and making them findable and accessible builds on the knowledge of library and information science. This foundational knowledge means we can tag objects—real or virtual—with codes and terms that help with organization and retrieval. It also means we use our knowledge of library and information science to guide efforts to annotate and curate molecular data, literature citations, and images so they are accessible to the public. So I am grateful not only for the 66 miles of shelving that hold our precious objects, books, and journals here in Bethesda, but for the ever-powerful computer clouds that preserve our high-value research databases and 34 million bibliographic citations in PubMed. Libraries do more than house books; they use sophisticated knowledge to organize materials and make them readily available.

I am thankful for the ways that staff at NLM’s National Center for Biotechnology Information (NCBI) manages the submission, curation, and dissemination of our enormous genomic and molecular databases. From ClinVar (our collection of genomic sequences linked to clinical annotation) to the Sequence Read Archive (the world’s largest scientific data repository), our staff makes sure that depositors can effectively deposit data, scientific curators can conduct quality checks, and web and interface designers allow access to the data. A few years ago, the NCBI team led a cloud migration process to make available data from the entire 15-petabyte SRA resource on two commercial cloud providers. This bold step democratized sequence-based scientific inquiry and harnessed the computational power of cloud platforms, which contributed to industrial innovations and shortened the pathway for scientific discovery from days and months to minutes and hours. I am thankful for the role NLM plays in accelerating scientific advances and leveraging research resources for public health benefit.

NLM offers more than 1,000 easy-to-read health topic articles through our online consumer health information resource known as MedlinePlus. MedlinePlus is available in both English and Spanish, thereby assuring information access to speakers of two of the world’s most common languages. Through MedlinePlus Connect, our technical team also provides direct, tailored access to MedlinePlus resources automatically through electronic health records, patient portals, and other health information technology systems to deliver information from MedlinePlus to patients and providers at the point of care. I am thankful for the efforts of the MedlinePlus teams that bring timely and trusted information to the lives of everyone, everywhere.

I hinted earlier that there are two main pathways to access NLM products and services. Electronic access, supporting both human- and machine-readable forms, is by far the most common pathway to NLM. We also support the Network of the National Library of Medicine (NNLM) and its more than 8,000 members around the country in public, hospital, and academic medical center libraries to bring the power of NLM and its resources to the public. I am grateful for everyone who works as part of NNLM for their ability to bring NLM’s products and services to communities everywhere as well as how the needs and practices of those communities bring awareness of NLM.

As you pause this year in thanksgiving for the many public services that support you in everyday life, please remember to give thanks for NLM’s products and services. We think they are world class, and we are grateful for our ability to serve you.

From Our Community to Yours, Happy Healthful Halloween!

Guest post by Jeffrey S. Reznick, PhD, Chief of the History of Medicine Division (HMD) at the National Library of Medicine (NLM).

I have always associated Halloween with community and health.

My family and I appreciate the holiday for the way it brings together our neighborhood of individuals and families with diverse backgrounds, creativity, and interests, all celebrating the occasion safely and meaningfully. Some of our neighbors don’t observe the holiday, and we certainly respect their choice by interacting with them in other ways that bring us together as neighbors. But for me, Halloween is very much about community, family, and friends, and the benefits of gathering supportively.

When I was growing up in Rochester, New York, I participated in the trick-or-treat program for the United Nations Children’s Fund, learning how the coins I collected from my neighbors could help vulnerable children. After I arrived home, I tallied the money before placing it in a special mailing envelope. I also sorted my candy while my parents simultaneously—and paradoxically—reminded me not to eat too much and asked me to set aside some for them to enjoy.

In the weeks following Halloween, certain pieces of my saved candy would disappear; my memory of this fact is tied to understanding now that whoever helped themselves was still enjoying the holiday well into Thanksgiving. Candy is still a big part of Halloween, but now parents have better access to information about candy labels and food safety tips to consider before they and their children indulge. It should come as no surprise that I now simultaneously—and paradoxically—remind my daughters not to eat too much and ask them to save pieces of candy for me to enjoy, right up to and sometimes even beyond Thanksgiving.

Every Halloween, I also looked forward to the annual television broadcast of It’s the Great Pumpkin, Charlie Brown, based on the Peanuts comics by Charles M. Schulz. With its humor, interesting cast of young characters, melodious music, and vibrant colors, the whole special gave meaning to the day. It also made me think about parts of the story involving Snoopy dressing himself in a World War I flying ace costume and imagining scenes behind the Western Front. Something bigger was going on here. That something—Schulz channeling his experiences as a combat soldier as well as his pride as a World War II veteran—partly inspired my interest to study and publish on wartime humanitarianism and experiences of soldiers wounded in World War I.  

I’ll confess that I still enjoy It’s the Great Pumpkin, Charlie Brown. I watch it every year with my younger daughter who has come to enjoy it also. It makes the holiday special for both of us. I hope our time together today around the program will be transcendent and inform her future memories of the holiday, indeed time well spent laughing, appreciating the humor, wondering about Snoopy’s interest in dressing up like a World War I flying ace, and how precisely he sat comfortably atop his doghouse-turned-Sopwith Camel airplane.

Like Snoopy and the gang, and as my talented NLM colleagues have shared through their expertise of our collections, many people enjoy occasions like Halloween when they can don creative costumes and masks, think about the lore around black cats and skeletons, and regale each other with stories of ghosts and other frightful subjects. The timeless vulnerability and mystery of the human body form the basis for many of these observations and stories. Apropos, therefore, is the NLM’s newly redesigned online exhibition Dream Anatomy, which draws on collections of our library, along with work of 20th- and 21st-century artists, to explore how what lies beneath our skin has scared, amazed, entertained, fascinated, and inspired us.  Ultimately, Dream Anatomy demonstrates how art and the artistic imagination have always been an essential part of the science of anatomy and the fun of Halloween.

I join with my NLM colleagues to wish you and your family a truly healthful Halloween, one complete with experiences of togetherness in your community, treasured memories of past holidays and the creation of new memories to treasure in the future, and inspired learning through NLM’s globally appreciated collections, trusted health information resources, and the exciting and updated Dream Anatomy online exhibition.

Dr. Reznick leads all aspects of HMD and has over two decades of leadership experience in federal, nonprofit, and academic spaces. As a cultural historian, he also maintains a diverse, interdisciplinary, and highly collaborative historical research portfolio supported by the library and based on its diverse collections and associated programs. Dr. Reznick is the author of three books and numerous book chapters and journal articles, including as co-author with Ken Koyle of History matters: in the past, present & future of the NLM, published in 2021 by the Journal of the Medical Library Association

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.

Bring on the New Year!

Marking the turning of the years is a way to make peace with what is and prepare for what will be. There’s a beautiful night passage that I’ve been drawn to reflect on this week:

It is night after a long day.

What has been done has been done;
what has not been done has not been done;
let it be.

These words urge us to accept where we are without judgement as we look forward to the new year.

So, what will 2022 look like for me, my family, and NLM? I am looking forward with hopes of more togetherness – at work, with friends, and with society. I am renovating a 110-year-old home in Easton, Maryland to use as a weekend getaway and vacation home. I am looking forward to meeting neighbors and reinvigorating this beautiful, old structure. My family is looking forward to weddings, graduations, retirements, and other milestones across my nine siblings and 37 nieces and nephews. My 92-year-old mom will move to an independent living facility—bringing treasured possessions from the home she shared with my dad along with the anticipation of making new friends.

NLM has big plans for 2022 as well! We anticipate a gradual return to the physical workspace. However, we won’t be returning to work as we knew it almost 2 years ago; we’ve learned a lot about working remotely, and many staff have found joy and satisfaction with this new way of working. We expect that staff will find a balance between working on campus and working elsewhere.

NLM leadership is working with all supervisors and staff to make sure the return to the physical workspace is a safe, positive, and meaningful experience for everyone. We are tasked with discerning what type of work is best done when one is onsite at NLM and what is best accomplished when working remotely. What we don’t want is to bring our valuable workforce back to the physical NLM location only to have them sit in virtual meetings all day!

With less restrictions on travel, I expect to see our staff attending professional meetings and providing informative talks at conferences once again. This will be particularly valuable for our trainees as it helps socialize them into the professional societies that will form their lifelong career support network. I’ve empaneled a “Future of Work” council, not to plan for 2022, but to look into the distant future to envision what work might be like and how NLM can best organize itself to meet the challenges of the future.

In 2022, NLM will continue to work with the rest of NIH to rectify the impact of structural racism on science and the scientific workforce. Under the UNITE Initiative, hundreds of people across NIH are envisioning ways to create a workplace that is free of harassment, inclusive and welcoming to all, and achieves the highest level of scientific impact by engaging a diverse workforce addressing the challenges needed to eliminate health disparities.

We anticipate that the renovation of our building will continue at full speed. All of us will be challenged to call on our sense of flexibility as we move toward a stronger infrastructure that will take us into our third century.

NLM will continue to acquire, preserve, and disseminate scientific literature to make it easier for scientists, clinicians, patients, and the public to acquire information about clinical trials and health concerns, and make our genomic databases more accessible and more useful for society. Our investigators will leverage the new collaborations they forged during the COVID-19 pandemic to augment their longstanding investments in computational biology and clinical health informatics research. We will bring new scientists into our workforce and strengthen our technical and administrative services.

We’ve got a big year ahead – what would you like to see us accomplish? And, more importantly, I’d love to hear your hopes for the coming year!

[1] The Anglican Church in Aotearoa, New Zealand and Polynesia. (1988). A New Zealand Prayer Book. The Office of the General Synod.

Happy Holiday Season!

It’s the holiday season and a time for celebration, reflection, and catching up with family and friends. This year, I am struck by two themes: the celebration of light and darkness, and the time-honored traditions found in special foods and decorations.

For me, a winter aficionado with strong Irish roots, my holidays began with Samhain (pronounced “SAH-win”). Samhain is a Celtic festival that marks the “wintering of the world” – that necessary time of slowing down, becoming quiet, and resting. As I write this blog, millions of people across the globe are celebrating the festival of Diwali. Diwali is a five-day celebration marking the triumph of light over darkness, good over evil, and knowledge over ignorance. Families gather over Diwali in households decorated with vibrant flowers and candles, enjoying sweets in acknowledgement of the year’s bountiful harvest.

This year, Hanukkah began at sundown on November 28 and ended December 6. This eight-day Jewish holiday commemorates the rededication of the temple in Jerusalem as a festival of lights remembering the miracle of the oil lamp that burned for eight days. For those who celebrate Christmas, this is both a secular as well as a religious festival including special prayers and church services, household decorations, sparkling trees, and sweet treats. In many places you might find luminarias, small paper sacks filled with sand that support candles creating beautiful lights along streets and up pathways in many neighborhoods inspired by traditions arising from Central and South America. Kwanzaa celebrates African heritage and identity, beginning the day after Christmas lasting for several days. During Kwanzaa people light candles, eat special foods recognizing the “first fruits” of the harvest, and place special symbols around their homes.

Light plays a leading role in many winter celebrations. During this time of year, at least in the northern hemisphere, light is a cherished resource dispelling the darker days and cold weather inspiring vision and hope. Light serves as a symbol of many things to many people, but to me, light symbolizes goodness and knowledge and has special meaning to the National Library of Medicine. NLM brings knowledge to the world 24/7, and I personally take this time to remember the “light” that NLM brings to the world.

NLM has a bit less to do with food and decorations, but we are filled with books, articles, and artifacts about nutrition and symbolism. We can extend the celebration of food and decorations to NLM. In 2016, NLM’s History of Medicine division launched a special exhibition, “Fire and Freedom: Food & Enslavement in Early America.” This exhibit illustrated the important connection between meals and power dynamics – you can visit the online exhibition here. NLM’s digital collection includes pictures of holiday events across time and around the world – you can look here for a poster urging Americans to Buy Christmas Seals, Fight Tuberculosis and here for a September 1917 list of suggestions from the American Red Cross for Christmas packets for our military personnel at home and abroad.

As you experience the lights and marvel at the foods and decorations of this holiday season, in whatever way you celebrate, please take with you the good wishes of the National Library of Medicine!

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