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

Revealing and Preserving Data for Today and Tomorrow

Guest post by Jeffrey S. Reznick, PhD, Chief of the History of Medicine Division (HMD) at the National Library of Medicine (NLM); Kenneth M. Koyle, MA, Deputy Chief of HMD; and Christie Moffatt, MLIS, Program Manager of the HMD Digital Manuscripts Program.

On this International Day for Universal Access to Information, we proudly showcase the globally appreciated role of NLM as a long-standing steward of vast collections of data even as it is now a recognized home of data science at the National Institutes of Health and beyond. A key part of the NLM mission is to provide access to that data and all the biomedical information we hold in our collections, which span ten centuries and originate from nearly every part of our world.

During the past several years, talented staff of the library have recognized this enduring and dedicated stewardship as part of our institution’s data-driven present and future by curating Revealing Data, an ongoing series of posts on the division’s popular blog Circulating Now. This series explores what data-minded researchers from a variety of disciplines are learning from centuries of data preserved in the collections of the NLM and associated with a variety of topics: from 17th-century bills of mortality to tuberculosis in the 19th-century to the 1918 influenza pandemic and more recent 20th- and 21st-century public health issues. Circulating Now also explores data-driven conservation research on some of our most treasured collections, research methods and tools for analysis in the study of digitized images and texts, and the origins, purpose, and development of highly regarded NLM resources like GenBank and the Index-Catalogue of the library of the Surgeon General’s Office.

A fundamental role of the NLM binds these data-driven explorations: its Congressionally mandated mission to collect, preserve, and provide access to past and present medical and scientific information in its multiplicity of formats, and, by extension, the vast amounts of data which reside in them. Generations of dedicated civil servants, including archivists, data scientists, historians, librarians, and many others, contributed their expertise to the NLM preserving the data-rich collections studied by a diverse field of researchers today. Without this commitment and these efforts, so much of this research would not be possible.

The NLM’s work of preservation continues today not only because it is mandated but also because the institution owes such work to future generations so they will be able to undertake their research, reveal new stories about the human condition, and make new discoveries. Today’s preservation work is evolving in tandem with changes to the collections themselves. NLM staff are developing new processes to collect and preserve web content, born-digital records, and digital ephemera while continuing to preserve vast quantities of data stored in paper, parchment, and vellum, some of it centuries old.

Viewed nearly 18,000 times since it was launched in 2017, Revealing Data reveals much more than valued data. It connects us to the very essence of NLM’s mission, its history, and the enduring importance of our institution’s initiative to preserve this data and the contexts in which it was originally created for today and tomorrow.

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 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.

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

Ms. Moffatt leads content development for NLM’s Profiles in Science website, which provides access to 20th century manuscripts in science, medicine, and public health. As Chair of the Library’s Web Collecting and Archiving Working Group, she supports web archiving on topics and events related to NLM collecting interests, including Global Health Events (Ebola, COVID-19, Monkeypox), HIV/AIDS, and the opioid epidemic, among others.

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.

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