WEBVTT 00:00.000 --> 00:02.226 [Gathering and spreading knowledge: publications 00:02.226 --> 00:05.301 and the Army Medical Library around World War 1; 2015] 00:07.268 --> 00:10.667 [Ken Koyle:] Good afternoon, ladies and gentlemen. Thank you for coming to this 00:10.667 --> 00:15.085 afternoon's History of Medicine lecture. I'm Ken Koyle. I'm the Deputy Chief of the 00:15.086 --> 00:19.175 History of Medicine Division here. And before I introduce today's speaker, 00:19.175 --> 00:23.800 I'd like to let everyone know that our next History of Medicine lecture will be January 28th, 00:23.800 --> 00:29.434 2016 when Doctor Eric Boyle from the National Museum of Health and Medicine. 00:29.435 --> 00:32.435 Will examine the history of complimentary and alternative medicine 00:32.435 --> 00:34.999 at the NIH. In a presentation co-sponsored by 00:34.999 --> 00:38.278 the National Center for Complimentary and Integrative Health 00:38.278 --> 00:44.501 and by the Office of NIH History. And I hope that you will all mark your calendars and join us on 00:44.501 --> 00:50.756 January 28th for that lecture. But on for today's lecture. Our speaker today is a friend and 00:50.756 --> 00:55.090 a longtime colleague of mine, Doctor Sanders Marble. Doctor Marble earned his undergraduate 00:55.090 --> 01:00.446 degree at the College of William and Mary. And his graduate degrees at King's College 01:00.446 --> 01:05.935 University of London. And he's worked for and written 01:05.935 --> 01:11.568 for ehistory.com, for the Smithsonian's National Museum of American History and 01:11.568 --> 01:17.401 for the Army Medical Department, both in the Office of Medical History and previously as the command 01:17.401 --> 01:22.968 historian for the Walter Reed Army Medical Center and the North Atlantic Regional Medical Command. 01:22.968 --> 01:27.519 Since 2010, he has held the post of Senior Historian with the Office of Medical 01:27.519 --> 01:32.721 History at Fort Sam Houston, Texas, a position that has included a tour in Afghanistan collecting 01:32.721 --> 01:36.900 the history of medical support to military operations in that region. 01:36.901 --> 01:40.468 Doctor Marble has written or edited about half a dozen books and numerous 01:40.468 --> 01:45.276 articles and chapters on artillery, military medicine, and military personnel, 01:45.276 --> 01:51.066 including Skilled and resolute History of the 12th Evacuation Hospital and the 212th MASH. 01:51.066 --> 01:57.168 From 1917 to 2006, which was published in 2013 and Rehabilitating the Wounded, 01:57.168 --> 02:04.502 Historical Perspectives on Army Policy, published in 2008. Doctor Marble is a volunteer with 02:04.502 --> 02:08.570 the US World War One Centennial Commission and is helping to organize 02:08.570 --> 02:12.346 an international conference on on the medical history of the Vietnam War, 02:12.346 --> 02:17.135 which will take place in Texas in March of 2016. And Doctor Marble is actively seeking 02:17.135 --> 02:22.335 proposals for that that program. You have to get them in soon, though I think the deadline 02:22.335 --> 02:26.701 has already passed. Doctor Marbles topic for today is Gathering and spreading knowledge 02:26.701 --> 02:32.068 publications and the Army Medical Library around World War One. There will be time for some 02:32.068 --> 02:35.416 questions and answers at the end. If you have questions for Doctor Marble, 02:35.416 --> 02:38.535 please use the the mics in front of you by pushing the button on the 02:38.535 --> 02:43.701 desk which will light up your mic so you'll know that it's active. Doctor Marble. 02:46.535 --> 02:50.284 [Dr. Marble:] Thanks for that very generous introduction and there's a sign 02:50.284 --> 02:53.856 over here saying please make an announcement if you didn't notice the three signs on the way in. 02:53.856 --> 02:55.535 There's no food or beverage in here. 02:58.868 --> 03:03.816 I work for the Department of Defense. I have to make a disclaimer that these views are are mine. 03:03.816 --> 03:07.067 They are not the official position of the Department of Defense, Department of the Army, 03:07.067 --> 03:12.211 or any other part of the US government. Don't worry about that. It's just pro forma. 03:12.211 --> 03:16.792 Today I'm going to talk about how the Army Medical Department gathered and distributed. 03:16.793 --> 03:21.266 I got to be careful with my gestures and not hit the mics knowledge around 03:21.266 --> 03:25.716 the time of World War One, before, certainly during and a little bit after. 03:25.716 --> 03:30.756 And I I want to focus on the Army Medical Library's role in that. 03:30.756 --> 03:34.556 And now the doors are closed and you're in here. 03:34.556 --> 03:37.596 The library was actually not the key node, 03:37.596 --> 03:40.235 so we'll have to see what the 03:40.235 --> 03:44.801 Army did to to replace that. I should thank various of my 03:44.801 --> 03:48.801 colleagues in San Antonio who helped me refine ideas 03:48.801 --> 03:53.206 and sat through a rough presentation of this. 03:53.206 --> 03:57.635 More than most history projects, this really actively engaged my librarian and archivist 03:57.635 --> 04:02.935 colleagues instead of just using the wonderful resources they have. 04:06.735 --> 04:12.538 I need you to think about an anachronistic term, but think about this and then 04:12.538 --> 04:16.196 not pay it too much attention. Before, during and after World War One, 04:16.196 --> 04:20.801 the Army Medical Department had to collect, categorize, and then distribute 04:20.801 --> 04:26.968 information. That is knowledge management. And while there were Hollerith cards 04:26.968 --> 04:33.267 and and other IT technologies of the day, I'm really not going to focus 04:33.267 --> 04:38.275 on information technology. So who here is a librarian? 04:38.276 --> 04:41.636 Yeah, quite a few historians? 04:41.636 --> 04:47.040 Yeah, okay, one loner. Physicians? Okay, 04:47.040 --> 04:53.076 I think you'll all have different perspectives on this knowledge management 04:53.076 --> 04:58.886 from your professional backgrounds. Now, the Surgeon General's library 04:58.886 --> 05:02.116 started in 1836. At first, I don't think it was very much of a library. 05:02.116 --> 05:07.236 It was a bookcase with books on it. 05:07.236 --> 05:11.168 Yeah, they collected material about medicine, especially military medicine, 05:11.168 --> 05:17.338 and it was a repository of information. You could use it if you visited. If you were an army doctor, 05:17.338 --> 05:22.796 you could write in and say, hey, I'd like some information about X or I'd like to borrow book Y. 05:22.796 --> 05:28.396 And they would do that. And they would also send information out. They would push out orders. 05:28.396 --> 05:34.101 They would send advice by letters around the Army. But of course, this is 1830s, 05:34.101 --> 05:40.000 1840s fifties. There's not a whole lot of good advice to send out. 05:40.000 --> 05:43.700 The Army starts producing some 05:43.701 --> 05:48.326 medical information, but there's no expectation of a quick turnaround. 05:48.326 --> 05:53.446 This circular is produced this sorry, this published four months of data, 05:53.446 --> 05:59.125 but it's two years into the war, so it's not, you know it not particularly useful. 05:59.125 --> 06:03.895 It's also descriptive data. Without prescriptions about what you should do. 06:03.896 --> 06:09.423 Individual doctors would look at this if they chose to, and then see how to best they 06:09.423 --> 06:14.400 thought to use it. Now it is part of William [Alexander] Hammond's efforts to gather information in the 06:14.401 --> 06:20.801 Surgeon General's library and the Army Medical Museum that he created. Now Hammond is expanding and 06:20.801 --> 06:25.668 establishing repositories for knowledge, but I don't think the mid 19th century 06:25.668 --> 06:32.676 circumstances are really great for pushing prescriptive information outwards. 06:32.676 --> 06:38.135 The Army sends out material for information. You know, again, you can decide what to 06:38.135 --> 06:45.716 do with the doctor and especially given how loosey-goosey medical diagnosis are, 06:45.716 --> 06:48.956 surgical surgery is different from medicine. Medicine is much more loosey-goosey 06:48.956 --> 06:54.968 in this time. The data would have had relatively little value you could interpret. 06:54.968 --> 07:00.006 You know whether whether patient has recurring fever or intermittent fever. 07:00.006 --> 07:03.766 Differently from another doctor. I'll give them credit for trying. 07:03.766 --> 07:08.050 But then this may have been more of a public relations public document 07:08.050 --> 07:12.368 and the Army Medical Department was under fire for the the rate of 07:12.368 --> 07:16.926 sickness and the the certainly the number of deaths from sickness. 07:16.926 --> 07:22.268 And they may have wanted to publish some statistics to make it look less bad. 07:22.268 --> 07:26.101 1863 sorry, 1865, this is one of the first books in the 07:26.101 --> 07:31.868 world to have surgical photographs. And again, the Army Medical Department 07:31.868 --> 07:37.076 is gathering and creating knowledge. You know that depends on your perspective 07:37.076 --> 07:41.668 and making it available and the museum is hugely important in this period. 07:41.668 --> 07:45.376 I think Shauna Devine has talked behind 07:45.376 --> 07:52.232 this very podium about that topic. And the in peacetime, 07:52.232 --> 07:58.026 you can just see the dates there that they continue publishing in peacetime. 07:58.026 --> 08:03.946 The Army is publishing this four years after a Lister publishes his article on antiseptic surgery, 08:03.946 --> 08:08.306 and if so, my point being this isn't a time when the Army is not doing a lot of surgery, 08:08.306 --> 08:13.768 so a few years is needed to get a robust data set. 08:13.768 --> 08:19.282 They continue gathering information and passing it around, but it's quite slow. 08:19.282 --> 08:25.135 Data collection for this publication began in the spring of 1868. 08:25.135 --> 08:29.686 And this information is finally being used for an argument. 08:29.686 --> 08:34.468 The main body of the report is descriptive, but the introduction by Doctor John Shaw Billings 08:34.468 --> 08:39.301 points out that better ventilation reduces respiratory diseases and that 08:39.301 --> 08:45.535 money spent on barracks reduces the Army's sick rate and thus keeps troops fit 08:45.535 --> 08:51.405 for duty and reduces medical expenses. He's trying to make an economic argument 08:51.405 --> 08:56.167 to Army leadership and to the Congress. That to get better facilities and he he 08:56.168 --> 09:01.336 reaches into the medical data for that. This report, also overseen by Billings, 09:01.336 --> 09:05.296 was rather quicker. This is all done in about 6 months. 09:05.296 --> 09:11.464 Data call went out in October of 74. It also covers a lot of things 09:11.464 --> 09:15.120 that we don't call hygiene today. The food of the Army, its quantity, 09:15.120 --> 09:19.268 quality and mode of preparation. Is the food of the men's inspected daily? 09:19.268 --> 09:23.275 Military punishments and their effect on the health and morale of the men. 09:23.275 --> 09:28.235 Personal cleanliness of the men. What are the post regulations, if any, with regard to bathing? 09:28.236 --> 09:32.916 What facilities are afforded? How often are the men's blankets washed? 09:32.916 --> 09:36.434 Again, the medical department is looking at making the Army healthier, 09:36.434 --> 09:42.115 looking for the best ways to do that, and literally airing the Army's dirty laundry. 09:42.116 --> 09:47.088 Both of these circulars were quite hefty, #4 was over 500 pages and 09:47.088 --> 09:51.635 this one is over 600 pages. Now these are being researched and 09:51.635 --> 09:54.934 published from the Army Medical Library. The librarian, 09:54.934 --> 09:58.006 Billings is converting it from a repository 09:58.006 --> 10:04.234 where information sits to a locus for the intellectually curious. There's of course a good 10:04.235 --> 10:10.176 literature on Billings. He could be probably has been the subject of a talk just by himself. 10:10.176 --> 10:14.309 And I'm not going to try and tease apart what portion of the the change in the 10:14.309 --> 10:19.456 late 19th century is due to Billings. What portion is due to 10:19.456 --> 10:25.501 surgeons general that come and go. My my point is that the AMED, the Army Medical Department used its 10:25.501 --> 10:31.268 library as an applied research tool. Now that may have been where the because the library was where 10:31.268 --> 10:35.641 underutilized hands were. You know the Surgeon General's 10:35.641 --> 10:42.296 office had only about six officers and 20 clerks and they were busy with routine administration. 10:42.296 --> 10:48.516 Billings had more time on his hands. That's not to take anything away from Billings. 10:48.516 --> 10:54.676 I have enormous respect for the variety of things he did. And the medical library was not alone. 10:54.676 --> 10:59.155 The medical surgical history was produced mostly from the museum. 10:59.155 --> 11:04.843 The six volumes are published over 1870 to 88. They are quite valuable, 11:04.844 --> 11:10.135 but there's clearly a long lag between the events and the publication. 11:10.135 --> 11:16.001 Now that's fine for history. That's probably important for history to get some perspective. 11:16.001 --> 11:20.568 But it's not a good way to pass around anything that's time sensitive. 11:20.568 --> 11:25.434 From 1880, Billings at the medical library was also producing the index catalog. 11:25.434 --> 11:30.067 I'm not going to belabor that for the audience here, but it not only organized knowledge 11:30.068 --> 11:37.006 by publishing that organized volume and soliciting more publications using doctor's vanity. 11:37.006 --> 11:41.179 I think doctor's vanity is the reason that the Army Medical Library became 11:41.179 --> 11:44.635 the world's largest medical library. The medical library brought together 11:44.635 --> 11:49.135 more and more knowledge and made itself more and more useful. And then it's also pushing, 11:49.135 --> 11:56.068 It's organizing this knowledge and pushing it back out. The catalog is not just available on site, 11:56.068 --> 12:03.136 but print runs are well over 1000 volumes. It's a print runs it by World War One, 12:03.136 --> 12:09.386 or about between 1000 and 1500 copies a year. Now the Index Medicus will be a worthy companion, 12:09.386 --> 12:13.230 the monthly review of publications rather than the much slower, much slower, 12:13.230 --> 12:19.285 but more comprehensive Index Cat. In 1893, 12:19.285 --> 12:24.585 the Army establishes a school. You can guess what it's called to train doctors. 12:24.586 --> 12:30.506 Some of it's in Army related topics like equitation. Dr. has to ride with his troops, 12:30.506 --> 12:36.628 some of it's in Army clinical matters like sanitation that a civilian Dr. 12:36.628 --> 12:39.875 wouldn't necessarily worry about, and some of it's in clinical things that are 12:39.875 --> 12:42.916 not necessarily common in medical school, like microscopy. 12:42.916 --> 12:48.886 The Army had a baseline standard for not just medical not just military topics, 12:48.886 --> 12:54.201 but medical topics that were not necessarily taught in schools. But the school is sized for 12:54.201 --> 13:00.401 the number of doctors that come into the Army any given year. There's no correspondence 13:00.401 --> 13:06.671 courses for anybody else. There is no follow up courses for guys 13:06.671 --> 13:13.129 10 or or so years into their career. This is, I think really the only place the Army 13:13.129 --> 13:16.976 pushes medical knowledge to doctors. They they will send out a circular letter 13:16.976 --> 13:21.301 occasionally. They can do that, but this is the formal place 13:21.301 --> 13:26.280 to make people smarter. Skipping and hopping ahead. 13:26.280 --> 13:30.738 Nothing to do with the medical library now, but this is a case of of the Army 13:30.738 --> 13:34.035 producing and disseminating knowledge. Reed, Vaughan and Shakespeare 13:34.035 --> 13:39.735 discover how typhoid is communicated, including the aha moment of well 13:39.735 --> 13:45.156 moments of the asymptomatic carrier and indeed the very idea of a carrier state. 13:45.156 --> 13:51.681 This is the 239 page preliminary report. Four years later they come out with 13:51.681 --> 13:55.866 the 1600 page doorstop report. 13:55.866 --> 14:01.546 I think this is a time when book type publishing met the information cycle. 14:01.546 --> 14:05.735 Nothing could be published before the date is analyzed, so getting at a really good preliminary 14:05.735 --> 14:12.035 report in 18 months is very good, with other things going on in the background, 14:12.035 --> 14:17.301 Reed himself is busy with yellow fever. The Surgeon General's office is busy with political fallout 14:17.301 --> 14:24.001 from the Spanish American War. You're going to have a lag in publishing the full report. 14:24.001 --> 14:30.401 And I'm also not entirely sure what that full report gets you. More data to hit people over the head? 14:30.401 --> 14:37.412 Okay. The circulars on posts and hygiene 25 years in the past. 14:37.412 --> 14:42.835 But they're also correlative this and what we get around the turn of the century is that the the 14:42.835 --> 14:47.990 doctors have step by step science to back up what they're arguing and 14:47.990 --> 14:54.188 and what the army doctor is then. Saying to a unit commander, hey, you need to put the latrines 14:54.188 --> 14:59.135 downstream from the water supply because here's the science, not just because we have correlative 14:59.135 --> 15:05.701 data that that says it's smarter. 15:05.701 --> 15:11.126 Let's go 10 years forward. These bulletins started in January 1913 15:11.126 --> 15:17.356 under Surgeon General George H. Torney. I don't know that he had a personal impact on creating them. 15:17.356 --> 15:22.116 But he did build up the medical school at the time. He may well have been involved in this. 15:22.116 --> 15:25.780 There was some hope that these would be quarterly, but that never happened. 15:25.780 --> 15:30.901 They turned out to be enormously erratic. There are 10 / 36 months. 15:30.901 --> 15:36.735 Most of these would also be monographs. 45 pages, 133 pages, 97 pages. 15:36.735 --> 15:41.101 So they don't fit as an article, they don't fit as a book, 15:41.101 --> 15:46.401 and they can't get published any other way. But, it's a publishing route that 15:46.401 --> 15:52.568 is under the Surgeon General's control. And I have to apologize. I took some bad images along the way. 15:52.568 --> 15:56.809 Now the Army, not the, not the medical department, but the Army certainly had 15:56.809 --> 16:01.216 ways to push out information. There's a there is a book of Army regulations at this time. 16:01.216 --> 16:06.912 It is a book and it is enormously thick. Getting something changed around 16:06.912 --> 16:12.636 that applied across the Army. It meant that it had to be staffed through the whole army you had. 16:12.636 --> 16:19.260 You had to get everybody to agree that it didn't bother them. I meant, you know, 16:19.260 --> 16:25.476 the analog here would be getting HHS to approve everything that you have to do. 16:25.476 --> 16:32.356 So, but if it's something that only applies in your sphere, so in the medical department, 16:32.356 --> 16:35.516 something that applies there, you don't have to ask the rest of the army. 16:35.516 --> 16:41.135 Especially so for clinical things the the medical department can move much quicker. 16:41.135 --> 16:45.131 The circular letter, an arcane term, that, that's what they called it. Still, 16:45.131 --> 16:51.496 the circular letter was the main route. So that's background, probably too much background. 16:51.496 --> 16:58.335 So World War One, what does General Gorgas need? He knows his medical department is going to expand, 16:58.335 --> 17:04.301 but he doesn't know how big it's going to get. Ultimately, it's going to grow from 450 regular 17:04.301 --> 17:08.068 Army doctors to over 30,000 doctors, so. 17:08.068 --> 17:14.401 95% of of the guys are going to be new. Gorgas knows that, that he's going to have to push out 17:14.401 --> 17:19.452 information on all sorts of topics, but he doesn't know what those topics are 17:19.452 --> 17:25.756 yet or what the information is going to be. He does know that he needs it soon. 17:25.756 --> 17:29.401 So how's he going to get information out? So far I've talked about 17:29.401 --> 17:34.835 institutionalization and publications and that was a major route for the Army. 17:34.835 --> 17:39.201 But there were also person to person channels, which in the great Army way 17:39.201 --> 17:46.015 they institutionalized. Consultants was what they called it there another way the 17:46.015 --> 17:50.688 Army manages knowledge. For the first time the Army has to grapple with the 17:50.688 --> 17:56.886 many facets of medicine that have become more and more specialized even in the interval since 1898. 17:56.886 --> 18:00.726 And it and at the time, the Army has essentially no specialists. 18:00.726 --> 18:05.234 The Surgeon General's office, for instance, is still about eight officers. 18:05.234 --> 18:10.200 What they do is they quickly reach into civilian circles to get the technical experts. 18:10.201 --> 18:13.268 The lead actually comes from the American Expeditionary Force, 18:13.268 --> 18:20.301 the AEF over in France in the summer of 1917. They pick John Finney, 18:20.301 --> 18:25.768 JMT Finney out of Baltimore who was the 1st President of the American College of Surgeons as 18:25.768 --> 18:32.440 their Chief consultant in surgery. They reach grab Harvey Cushing and George Crile 18:32.440 --> 18:38.465 as another couple of consultants. The lead medical consultant was William Thayer, 18:38.465 --> 18:43.104 clinical professor out of Hopkins. They end up with 19 senior consultants. 18:43.105 --> 18:46.768 I'm not going to run all the names past you, but these are the most recognizable. 18:46.768 --> 18:52.268 Now, a consultant supervised and coordinated professional work, but they also were not an 18:52.268 --> 18:59.051 inspector in an Army sense. They might catch you out on doing something 18:59.051 --> 19:02.234 in that's clinically inappropriate but they're they're not there with a 19:02.234 --> 19:07.851 checklist of of how to do it just right. They're also and they're more interested 19:07.852 --> 19:11.435 in are you doing the right thing then are you doing it by the book. 19:11.435 --> 19:14.916 They also become personnel advisors. Who are the good neurosurgeons? 19:14.916 --> 19:20.316 Well I don't know let's ask Crile he knows. 19:20.316 --> 19:25.166 And they also I think it makes a big difference in the AEF 19:25.166 --> 19:30.486 that they are imminent practitioners because they and not inspectors 19:30.486 --> 19:36.646 because they can more easily, talk to the British and French to get their clinical developments 19:36.646 --> 19:41.246 than they could if their job was to inspect American facilities. 19:41.246 --> 19:46.006 In the US, consultants had similar duties. These brothers Mayo were the 19:46.006 --> 19:52.135 co-chief consultant in surgery. Each one of them ends up as a Brigadier General. 19:52.135 --> 19:57.768 So it takes a moment to look at some of the nontraditional knowledge in processes. In the past, 19:57.768 --> 20:02.201 the Army Medical Department had pulled information from its own doctors, those circular letters that 20:02.201 --> 20:08.101 tell us about your post. They've done literature searches the that the the library did. 20:08.101 --> 20:12.016 There are certainly friendly contacts between the military and civilian doctors, 20:12.016 --> 20:16.435 especially once the Medical Reserve Corps established in 1908. As an 20:16.435 --> 20:22.336 example when the medical department wanted validation that typhoid vaccination was the right thing. 20:22.336 --> 20:28.036 They assembled a board of reservists, including civilian luminaries like Victor Vaughan, biochemist, 20:28.036 --> 20:34.335 bacteriologist, and Dean of medicine at Michigan. William Thayer at Hopkins, Simon Flexner, 20:34.335 --> 20:38.536 a professor of experimental pathology at Penn and director of the Rockefeller Institute. 20:38.536 --> 20:42.936 Those guys are willing to serve in the Army as very junior officers, 20:42.936 --> 20:48.576 first lieutenants. But before US belligerence in World War One, 20:48.576 --> 20:53.734 so between 1914 and early 17. The Army had first permitted and 20:53.734 --> 21:00.900 then pushed medical observers to Europe to gather both clinical and administrative information. 21:00.901 --> 21:04.101 And also the army had pumped the civilian doctors that had gone over 21:04.101 --> 21:11.801 under Red Cross auspices to volunteer in mostly French civilian hospitals. 21:11.801 --> 21:15.701 Those doctors would also publish articles, and I'll touch on those later. 21:15.701 --> 21:21.316 Most of the observers are senior men, so they're have credibility in the army. 21:21.316 --> 21:26.701 The guy in London, for instance, is a full Colonel who would become the first 21:26.701 --> 21:30.768 surgeon of the American Expeditionary Force. So the Army Medical Department 21:30.768 --> 21:36.568 is preemptively trying to get information and which is good, it now has to organize it 21:36.568 --> 21:41.635 and send that back out. I'm not going to underplay getting information from its own doctors 21:41.635 --> 21:46.568 in World War One. There were certainly inspection tours by those consultants that both 21:46.568 --> 21:51.968 gathered and disseminated knowledge. There are also medical liaison officers that come to 21:51.968 --> 21:56.568 the AEF from the British and French. British and French also push medical 21:56.568 --> 22:02.468 officers over to Washington to work at the Surgeon General's office. 22:04.582 --> 22:07.230 Gorgas had the medical library which 22:07.230 --> 22:12.640 does a wonderful job of publishing the Index cat and the the people working nights and weekends and 22:12.640 --> 22:17.261 get out the index medicus as well, but that is not his main route to 22:17.261 --> 22:24.066 push information during the war. Part of that was staffing during the the border flap with Mexico, 22:24.066 --> 22:28.821 which in those days it was Poncho Villa coming from the the South. Nowadays, of course, 22:28.821 --> 22:33.619 it's Donald Trump going from the north. The surgeon General's office had pulled 22:33.619 --> 22:38.785 the most active library clerks to work on other projects since that was in night. 22:38.786 --> 22:45.066 You know, we had troops in Mexico into 1916, by 1917, those guys, and they're mostly guys, 22:45.066 --> 22:48.961 still haven't returned to the library. The library is increasingly left 22:48.961 --> 22:53.921 with the old grumpy, infirm clerks. One was nearly blind, which was a 22:53.921 --> 22:59.396 great qualification for library work. They do get to hire more, but there's serious morale 22:59.396 --> 23:05.115 problems in the library. The librarian has to write a note to all staff saying knock it off. 23:05.115 --> 23:11.156 I'm sure things have changed tremendously. They do. They do get to hire some more during the war, 23:11.156 --> 23:16.412 but they're simply not able to work fast enough. Administratively, the library and museum are 23:16.412 --> 23:22.526 lumped together under one guy, but the museum's wartime responsibilities start to dominate his time. 23:22.526 --> 23:27.317 Champ McCulloch spends more time finding histopathology technicians 23:27.317 --> 23:32.428 than working on the index catalog. He possibly spends more time going 23:32.428 --> 23:37.445 over to France in in his mind, in support of his responsibilities, 23:37.445 --> 23:43.854 than either than actually working on the the library. 23:43.855 --> 23:49.695 A few people were given desks in the library, but they're not working on library projects. 23:49.695 --> 23:55.383 There's a publications branch that gets started and there's some. So there's some people that 23:55.384 --> 24:01.361 that work in the library, that don't work for the library, but with more doctors and also the 24:01.361 --> 24:04.455 specialists, those consultants sitting in the surgeon general's office, 24:04.455 --> 24:09.757 those are the ones that are tapped to select and organize the important literature, the librarians. 24:09.758 --> 24:15.096 Are just the the the view of them changes to. They're just clerks that 24:15.096 --> 24:19.346 that catalog the books. These doctors who have the specialty 24:19.346 --> 24:26.176 knowledge are the ones that we look to for that specialty knowledge. In the A EF there is no library. 24:26.176 --> 24:30.986 We did, we didn't duplicate everything and send it to France. So the chief surgeons staff 24:30.986 --> 24:37.088 and the consultants select and organize the information. So I'm going to spend a lot of time 24:37.088 --> 24:43.096 on how they get that information out. The peacetime dissemination routes were inadequate. 24:43.096 --> 24:47.688 I don't think an index of the, sorry, an issue of the index catalog is 24:47.688 --> 24:51.556 really going to be much used to a doctor in the trenches who's dealing 24:51.556 --> 24:56.656 with trench foot or shell shock. It's just the wrong sort of 24:56.656 --> 25:02.968 source of sorted information. 25:02.968 --> 25:08.276 Now regulations had to be coordinated around the Army, so that's slow. 25:08.276 --> 25:11.375 Manuals were apparently more technical 25:11.375 --> 25:18.036 and decentralized how to pieces. They could be very basic. What is the right way to pick up a litter? 25:18.036 --> 25:22.115 They told you what the right way was. It could be a manual of laboratory methods. 25:22.115 --> 25:26.676 This is how we do lab to dark field smears. 25:26.676 --> 25:32.195 If that's an actual thing. A circular letter could be issued across lines of command. 25:32.195 --> 25:37.017 These would be technical guidance on how to do things, I think. 25:37.018 --> 25:43.036 A good analogy would be when the Library of Congress changes cataloging methods. 25:43.036 --> 25:47.715 They published that and they don't tell you how to do it, but they tell you what their standard is, 25:47.715 --> 25:53.206 and you get to choose whether to adopt it or not. They could also, 25:53.207 --> 25:58.835 because they cut across command lines, that's important. In the Army, they could, 25:58.835 --> 26:02.701 so they can spread information laterally instead of just from the 26:02.701 --> 26:06.360 Surgeon General's office to anything that's directly under his control. 26:06.360 --> 26:10.535 You can also use them for information, so they publish more morbidity 26:10.535 --> 26:17.116 and mortality data that way. So that the bulletins are apparently unchanged from before the war. 26:17.116 --> 26:21.636 It's a publication that the Surgeon General controls. They were very erratic before the war, 26:21.636 --> 26:28.636 though. They will be what really changes. And knowing the small capacity 26:28.636 --> 26:33.201 of the medical school, the Army had been starting some 26:33.201 --> 26:39.136 correspondence courses before the war, but timings wrong. They start them in 1914. 26:39.136 --> 26:45.335 Nobody has graduated by the time of the war and they get absorbed. So some of the unofficial routes. 26:45.335 --> 26:48.301 Messrs. Lea and Febiger published eight of 26:48.301 --> 26:54.068 these medical war manuals in 1917 and 18. I don't know what they charged for it. 26:54.068 --> 26:59.401 I think the Army ended up buying a bunch of these as textbooks. I don't know how they handled 26:59.401 --> 27:03.512 royalties for doctors who, you know, government employees who published 27:03.512 --> 27:09.101 this and then have the Army buy it. These are the topics. Again, I think these fall into the 27:09.101 --> 27:16.035 textbook category. They're not critically quick or topical, but they're good for things 27:16.035 --> 27:19.835 that don't change very quickly. You know, ophthalmology is not going to change 27:19.835 --> 27:24.735 enormously over the course of a year. Some of these are purchased by the 27:24.735 --> 27:30.001 army and issued as textbooks at the medical officer training camp. 27:30.001 --> 27:33.490 And the Army organized special schools 27:33.490 --> 27:39.566 on some of these topics, and that's where these were especially important manuals. #2 is actually 27:39.566 --> 27:43.166 written by a British officer, one of the liaison officers in Washington. 27:43.166 --> 27:48.635 I think he was probably asked to give us a quick manual on everything we need to know. 27:48.635 --> 27:52.101 Independent committees are also doing things that help the war effort. 27:52.101 --> 27:57.068 I don't know if the Army asked the National Committee for Mental Hygiene 27:57.068 --> 28:03.366 to publish this, or if Salmon asked them to? Salmon was a member. I don't know if he said, hey, 28:03.366 --> 28:08.646 here's an important thing, can you guys publish this more widely? 28:08.646 --> 28:14.886 The government had sent him over to Britain and France to observe shell shock. 28:14.886 --> 28:19.442 He'd gone over from Britain to France to see up close to the front. 28:19.442 --> 28:24.786 So this is essentially a government report, but it's published at no cost to the government. 28:24.786 --> 28:29.586 I think, but I also think that the the committee here and Lea and Febiger shows 28:29.586 --> 28:32.146 that there is a market for these things. 28:32.146 --> 28:38.101 This is cutting edge information and this is something that is 28:38.101 --> 28:42.901 actually brand new during World War One and doctors want it. 28:42.901 --> 28:48.386 30,000 doctors end up in the army. Some of them are, you know, are going to be seeing shell shock. 28:48.386 --> 28:53.001 They're going to want to buy it. Civilians may well want it as well. 28:53.001 --> 28:58.635 Here's the Army writing something in the AMA publishing it for them. According to the Army, 28:58.635 --> 29:02.655 this was popular with civilian practitioners and it's taken over by 29:02.655 --> 29:06.886 the Public Health Service after the war. So the knowledge is organized by the Army, 29:06.886 --> 29:13.526 published by the AM A, and then could perpetuated by elsewhere in the government. 29:13.526 --> 29:18.606 I think this is a completely independent product, but it's a medical library creating, 29:18.606 --> 29:23.886 you know, organizing the knowledge, creating bibliography, and then pushing it out. 29:23.886 --> 29:27.486 This was sent to military bases so their hospitals could have a reference guide. 29:27.486 --> 29:32.726 I don't think the AML did that. The Crerar are was willing to 29:32.726 --> 29:37.263 interlibrary loan the the books that they had and they would also make 29:37.263 --> 29:44.046 photocopies of journal articles at cost, which is pretty big of them. Here's a nice effort to help. 29:44.046 --> 29:47.926 It's, you know, unlike the National Committee for Mental Hygiene this is not a one off. 29:47.926 --> 29:54.306 This is a supplement, obviously. October 1918 is not going to 29:54.306 --> 29:59.616 be enormously useful with the war ending the next month, but you know their information 29:59.616 --> 30:05.516 technology was just not as quick as up to date or the databases we have now. 30:05.516 --> 30:12.476 This went through additions and publication or and reprints in 1917 and 18. 30:12.476 --> 30:16.326 Again there's a market for this sort of thing probably helps 30:16.326 --> 30:20.756 that Keene was really well known. 30:20.756 --> 30:27.041 This is a special neurosurgery volume. The contents come from those those big 30:27.041 --> 30:32.466 brains in the certain general's office. But this is a 360 page literature 30:32.466 --> 30:38.543 review and you can imagine how frequently this would be useful. I know you have to be a 30:38.543 --> 30:42.076 neurosurgeon to actually use this, so maybe they could get one to everybody, 30:42.076 --> 30:48.598 but you can't really update it. And preparing something officially 30:48.598 --> 30:52.346 doesn't necessarily mean that it actually gets published officially. Again, 30:52.346 --> 30:57.501 they publish this gets published privately. There's different editions of this 30:57.501 --> 31:03.566 506 pages about how to shoot X-rays. $4.00 for some editions, 31:03.566 --> 31:09.386 $5 for others at the time. So I think you know a lot of civilians, physicians 31:09.386 --> 31:13.926 I've never worked with X-rays before. A GP really wouldn't. 31:13.926 --> 31:19.576 So there's an interest in the American medicine. Now, 31:19.576 --> 31:22.456 Gorgas had excellent relations with the medical profession, 31:22.456 --> 31:27.006 and the AMA quickly began to help the Army. For instance, 31:27.006 --> 31:32.934 they sent 69,000 letters to doctors, not one guy getting 69,069 thousand-- 31:32.934 --> 31:37.126 69,069 thousand doctors getting a letter each. And it would tell them, Dear Doctor Jones, 31:37.126 --> 31:43.696 this is how you volunteer for the Army. Wouldn't you like to do that in our time of national need? 31:43.696 --> 31:49.091 JAMA begins to publish this column. The very first issue after the US 31:49.091 --> 31:52.967 declaration of war and the Army liked this. The Army really appreciated it. 31:52.967 --> 31:56.234 The propaganda published in the Journal of the American Medical Medical 31:56.234 --> 31:59.567 Association and the printing done for the medical department by that journal 31:59.567 --> 32:04.829 were of great importance and value. Credit is also due to other medical journals and the American 32:04.829 --> 32:10.034 Medical Editors Association for the use of space and editorials in placing the needs of the medical 32:10.034 --> 32:14.027 department before the profession. Practically all the leading medical 32:14.027 --> 32:18.096 societies of the country rendered assistance in this connection. 32:18.096 --> 32:24.096 But Gorgas doesn't control the AMA or JAMA. It's also not a perfect route to doctors. 32:24.096 --> 32:29.295 Not every doctor is a member. They're still not. And getting JAMA through the through 32:29.295 --> 32:33.656 the mail is going to be a trick. Getting it over to France is going to be a trick. 32:33.656 --> 32:38.980 And also JAMA had never paid 32:38.980 --> 32:44.864 much attention to the military. In 1916, from 1916 to 32:44.864 --> 32:50.888 in, in all of 1916, it published 32:50.888 --> 32:56.301 eight articles on wartime medicine. None of those was a particularly quick turnaround from the events 32:56.301 --> 33:02.586 it was describing to a publication. By the fourth quarter of 1917, US had been at war for six months, 33:02.586 --> 33:07.626 and JAMA is publishing 11 articles in that quarter. 33:07.626 --> 33:12.101 But that's only 5.5% of their articles. 33:12.101 --> 33:16.634 Now the AMED had excellent relations with the Association of Military Surgeons. 33:16.634 --> 33:21.334 AMSIS had started in 1893 mostly for National Guard doctors, 33:21.334 --> 33:26.867 but it had expanded to the to include the Regular Army and the Medical Reserve Corps. 33:26.867 --> 33:31.934 The journal was run by a retired Army doctor and articles were on military medicine. 33:31.934 --> 33:38.516 There's also multiple columns of administrative news, administrative changes, how to get things done. 33:38.516 --> 33:42.567 Moreover, at the time, they were so flush financially that they had recently expanded the number of 33:42.567 --> 33:48.396 pages and size of pages so they could. They doubled the space available for articles. 33:48.396 --> 33:53.996 They even sent free copies to every Army hospital. There's actually a reference in the official, 33:53.996 --> 33:59.134 the Army's official history saying this was an official publication. 33:59.134 --> 34:03.688 And they're also people that are so useful to the Army their their desks are 34:03.688 --> 34:07.136 in the Army Medical Library building. But this is a monthly. 34:07.136 --> 34:12.424 This is not an "as I need it" to be published, and the Army could 34:12.424 --> 34:17.534 not require doctors to join a private organization to get the information they needed. 34:17.534 --> 34:24.219 And if you know this also goes out through the mails. AMSIS had had problems for all the 34:24.219 --> 34:28.308 reservists that have been mobilized to go down to the Mexican border in 1915 and 16. 34:28.308 --> 34:33.408 Those guys were not necessarily getting their copies of this in the mail and then they knew that 34:33.408 --> 34:38.986 that was going to be a problem. In the US, when the army moves you from point A to point B, 34:38.986 --> 34:44.506 and certainly a problem if you go overseas. Now, they do pay more attention to war medicine. 34:44.506 --> 34:51.426 They had brought people more up to date. 1916 they published 28 articles on World War One, 34:51.426 --> 34:57.186 which was about 1/4 of their total articles. But these journals have to be independent. 34:57.186 --> 35:03.766 They cannot be let themselves be taken over by the Army and then try and come back out later. 35:03.766 --> 35:09.409 So, I hope you can see where this is led. The Army needs a publication and 35:09.410 --> 35:14.096 need a way to push out information. They have to do it themselves. 35:14.096 --> 35:18.634 This review of war surgery and medicine is a fortnightly push of 35:18.634 --> 35:25.467 abstracts and special articles. And they can choose. The Army can choose what goes into 35:25.467 --> 35:31.495 this for for topicality keeps the doctors abreast of what the army thinks they need. 35:31.495 --> 35:35.455 And it can also travel in supply channels. Though it's not considered mail, 35:35.455 --> 35:40.295 it's considered an official publication. That's not to say it's necessarily prompt, 35:40.295 --> 35:44.804 but it stands a better chance. And ahead articles on things that civilian 35:44.805 --> 35:49.975 doctors would simply never have seen. It would never, civilian doctors don't see trench foot, 35:49.975 --> 35:56.636 so they they publish a 10 page article on trench foot in March of 1918. If they also make it available 35:56.636 --> 36:02.346 later to civilian medical libraries, only $0.10 an issue cheap at the price. 36:02.346 --> 36:07.946 It ran for about 18 months through volume 2 #6 in June of 1919. 36:07.946 --> 36:12.466 It slows down from fortnightly to monthly, but it's, you know, 36:12.466 --> 36:17.434 it is the Army Medical Department's own and owned publications channel. 36:20.167 --> 36:26.111 Again, I'm sorry this isn't more legible. It's abstracts, translations and reviews 36:26.111 --> 36:31.475 of literature, reconstruction and reeducation of the disabled soldier. 36:31.475 --> 36:38.167 So the Army was facing new questions about rehabilitation of the severely 36:38.167 --> 36:43.238 wounded and also guys who've gotten sick. So they both they first established 36:43.238 --> 36:49.589 policy spearheaded by a former AMA president and then it starts a rehabilitation bulletin. 36:49.589 --> 36:54.396 This and it again, it has abstracts, translations, reviews, 36:54.396 --> 36:59.906 articles on various facets of reconstruction that their their catchall term. 36:59.906 --> 37:05.705 Including vocational training. This is a publication headed not for publication, 37:05.705 --> 37:10.167 and that's something I thought only the Air Force could do. 37:10.167 --> 37:16.132 Now I'm going to talk about what this guy, Major General Merritte Ireland wanted to do. He's surgeon, 37:16.132 --> 37:21.866 the chief surgeon over in France for the American Expeditionary Force for the key part of the war. 37:21.866 --> 37:24.946 There's a guy before him, but General Bradley doesn't have, 37:24.946 --> 37:29.404 is in poor health and doesn't get much done. Ireland has liaison officers 37:29.404 --> 37:35.995 out to the British and French. They have liaison officers in. He also writes to officers 37:35.995 --> 37:40.916 saying keep your eyes open, talk to people, listen to people. 37:40.916 --> 37:46.516 Sent back reports to my office. He had different ways to push information out. 37:46.516 --> 37:50.916 He used circular letters, for instance. Some of these are administrative, 37:50.916 --> 37:55.556 some of them are very clinical, he tells hospitals. If you have a pneumonia patient, 37:55.556 --> 38:02.076 don't evacuate them back to the next hospital up out of the chain of evacuation that kills them. 38:02.076 --> 38:07.534 He also used the Red Cross to print at 38:07.534 --> 38:12.636 least one manual and a journal for him. He also published a weekly bulletin. 38:12.636 --> 38:16.167 I don't know if any copies of this have survived. It would be great if you guys 38:16.167 --> 38:21.930 could find some. It was 5 inches. It was a 5 by 8 sheet. 38:21.930 --> 38:24.957 6 to 12 pages included not only data 38:24.957 --> 38:30.065 on epidemics in the over in France, but the causes and treatment of wounds, 38:30.065 --> 38:36.025 notes on health conditions back in the states, references and extracts from medical literature, 38:36.026 --> 38:39.786 charts and drawings. They even said that they wrote it to be interesting. 38:39.786 --> 38:45.091 I don't know how it was received, but they tried to make it readable. As I mentioned, 38:45.091 --> 38:48.705 they have consultants staying abreast, professional developments and advising, 38:48.705 --> 38:53.467 you know, so those guys are the ones who are really managing the the knowledge in there. 38:53.467 --> 38:59.567 Ireland also sets up a school called the Army Sanitary School. Only a very small percentage 38:59.567 --> 39:04.716 of doctors would go through, but he did use it to spread information to they sent the 39:04.716 --> 39:10.315 classes up to the front lines, not literally in the front trenches, but up close. 39:10.315 --> 39:14.333 They brought in British and French lecturers to the school, so they're using that as a 39:14.334 --> 39:21.516 means for knowledge exchange. This is published by the published by the Red Cross. 39:21.516 --> 39:25.291 They, the Red Cross also publishes a second thing, a medical bulletin, 39:25.291 --> 39:31.667 which was focused on research. Now there's an unusual category of 39:31.667 --> 39:36.301 information we don't see anymore. Army general hospitals. These are the referral centers, 39:36.301 --> 39:43.315 not the community hospitals. And because they are seeing the more complex longterm patients, 39:43.315 --> 39:48.410 they're going to be, the patients are going to be there for months. These hospitals are 39:48.411 --> 39:51.401 encouraged to have newspapers. These are a mix of humor, 39:51.401 --> 39:57.636 local news, you know, sports teams, administrative information. 39:57.636 --> 40:02.840 So for instance, how the Army has changed its discharge policy lately and something 40:02.840 --> 40:07.201 that would apply to to patients and encouragement for patients. 40:07.201 --> 40:12.076 TB patients were a particular concern. [dramatic voice] It was planned to control the thought, 40:12.076 --> 40:18.000 attitude and conversation of patients so far as possible, by means of personal talks and pamphlets, 40:18.000 --> 40:23.101 and by building up in them some cheerful philosophy of life. Hospital newspapers were active 40:23.101 --> 40:27.801 morale agents, considerable thought being devoted to suggestive titles as "Ward 40:27.801 --> 40:34.156 Healer, The Comeback" and "Carry On", and to contents that would be encouraging, 40:34.156 --> 40:39.266 stimulating and attractive. I think Jeff Resnick would cheerfully 40:39.266 --> 40:43.532 throttle me if I didn't highlight "Carry On." It was the longest lasting hospital 40:43.533 --> 40:50.383 newspaper and probably by by virtue of being printed in DC, had articles ghosted for 40:50.384 --> 40:55.684 the great and the good. You'll even notice that that this official 40:55.684 --> 41:01.233 publication is paid for by the Red Cross. These are are definitely 41:01.233 --> 41:05.099 government communication routes. The Army sent out notes to the editors 41:05.100 --> 41:11.733 saying do not contradict official policy. [dramatic voice] For the information of the patients, 41:11.733 --> 41:16.108 their relatives and friends. The hospital newspaper should contain some authoritative statements 41:16.109 --> 41:21.133 furnished by the Bureau of War Risk Insurance and by the Federal Board of Vocational Education, 41:21.133 --> 41:26.222 which embrace the benefits provided by the government of convincible disabled soldiers and 41:26.223 --> 41:32.000 sailors after their discharge. --And while I'm looking at 41:32.000 --> 41:38.018 patient directed literature, health advice is another category. Enlistment data. 41:38.018 --> 41:43.942 You know, medical screening of recruits had showed how wide STD's were. 41:43.942 --> 41:49.766 And the progressives were progressive. They wanted to make things better. This is a short booklet on 41:49.766 --> 41:56.966 how to lead a clean life, part of a multiformat campaign that was unleashed on soldiers. 41:56.966 --> 42:00.299 You can also see how the various agencies are involved. 42:00.300 --> 42:05.100 The War Department had set up the CTCA, the Commission on Training Camp Activities. 42:05.100 --> 42:09.933 They were a bunch of no funs. They didn't like red light districts, 42:09.933 --> 42:12.895 which is, you know, from the Army's perspective to keep soldiers healthy. 42:12.896 --> 42:19.886 So okay, so the Army sets up the CTCA. The CTCA then publishes this-- 42:19.886 --> 42:25.786 Once the war is over, the Public Health Service are going to be the guys who are 42:25.786 --> 42:31.266 keeping the effort going, but while you know, but if you're directing information 42:31.266 --> 42:37.946 as people in the Army, soldiers, then the Army is probably the best means to get this job done. 42:37.946 --> 42:44.545 So the Army actually sends this out. Here's another part of that propaganda information campaign. 42:44.545 --> 42:49.589 They made a movie. It would be great if a copy survived, but apparently none did. 42:49.590 --> 42:55.214 It was it would have been really, really interesting. Now I mentioned Index Medicus. Index Cat 42:55.214 --> 43:00.866 Series 2 ran from 1916 and then Series 3 picks up in 1918 and 43:00.866 --> 43:06.724 I think that reflects some of the the big issues that the medical library is having at the time. 43:06.725 --> 43:11.974 The medical library certainly contributes to this 260 page summary of 43:11.974 --> 43:18.174 international literature on military hygiene, medicine, surgery, ophthalmology, ear, nose, ear, 43:18.174 --> 43:22.633 nose, throat, naval medicine and surgery and related matters. It includes psych that's 43:22.633 --> 43:30.045 categorized under military medicine, but this is published sometime after one July 1918. 43:30.045 --> 43:34.365 All I could find out that it was published was in. It was published in fiscal 1918, 43:34.366 --> 43:40.565 so sometime after the the middle of the year. So it's a a nice thing to do, 43:40.565 --> 43:46.605 but it's not particularly timely. Those semi official publications continued after the war. 43:46.606 --> 43:51.770 I think this came out after the war because that's when the AMED had shifted 43:51.770 --> 43:58.200 focus on keeping them healthy, keeping them alive to reconstructing them. 43:58.200 --> 44:01.801 Now it's a good thing that lunch is over, because I don't think you really 44:01.801 --> 44:07.044 want to flip through the 256 figures. But this was 442 pages, 44:07.044 --> 44:11.364 so it's a it's quite a compendium. Military journals were not the only 44:11.364 --> 44:15.033 route for knowledge to move around. They certainly used civilian journals. 44:15.033 --> 44:21.199 Military officers were encouraged to prepare articles for publication 44:21.200 --> 44:24.833 so it they would inform the the profession, 44:24.833 --> 44:30.599 not just those in the military, and the Army would then abstract these 44:30.600 --> 44:36.700 articles to get another feedback loop. This was a supplement to the Army's bulletin 44:36.700 --> 44:41.800 that stopped in June 1919. This starts in December 1919 44:41.800 --> 44:46.666 continues into 21. 44:46.666 --> 44:52.166 I think it was sent to organizations, not to individual doctors. 44:52.166 --> 44:57.066 Later on, it is supposed to be sent out to every doctor in the regular Army, 44:57.066 --> 45:01.699 the Guard and the Reserve, and a few civilian libraries and 45:01.700 --> 45:07.433 individuals and a few journal offices were put on the distribution list. 45:07.433 --> 45:13.533 It's published not by the library. But by the laboratories and infectious disease division and 45:13.533 --> 45:21.075 it includes article abstracts, notes on investigations that are going on clinical investigations, 45:21.076 --> 45:25.236 not anything else and all statistics. 45:25.236 --> 45:31.596 Hospital capacity, how many beds are full, how communicable diseases were going at that time. 45:31.596 --> 45:35.924 I think that's why it's coming out of the, the infectious disease division. 45:35.924 --> 45:40.200 So this is largely clinical. The Army Medical Bulletin starts up 45:40.200 --> 45:47.786 after the war instead of the review. Initially it's not a regular publication, but as needed, 45:47.786 --> 45:53.282 just like the prewar bulletin. And it ditches the fortnightly disease and hospital stuff 45:53.282 --> 45:56.946 because not every doctor needs it, and also if you're coming out irregularly, 45:56.946 --> 46:03.106 then having that data isn't really, really useful. Later, the Bulletin would become regular 46:03.106 --> 46:09.210 as the Interwar Army refines its intellectual infrastructure. The consultants cling by 46:09.210 --> 46:14.266 their toenails after the war, and by 1921 the Army Medical Department had lonely, 46:14.266 --> 46:19.442 had gone back to generalized hospitals, not really general hospitals. 46:19.442 --> 46:23.962 There are a couple general hospitals, but only really two. 46:23.962 --> 46:30.556 They only one or two officers in the Surgeon General's Office are overseeing the specialized 46:30.556 --> 46:36.295 wards that hospitals have. So in both facilities and personnel, 46:36.295 --> 46:41.947 the Army Medical Department is really back to its prewar condition. And actually handling those 46:41.948 --> 46:45.776 specialists is mostly just a personnel matter as far as they see it. 46:45.776 --> 46:52.224 There's a restructuring of Army regulations after the war from one big book to a lot, 46:52.224 --> 46:57.200 a lot, a lot of small books. The Army Medical Department had its own 46:57.200 --> 47:02.133 index to all the regulations that covered it. 47:02.133 --> 47:08.345 These are. These are an important way to get information out, although I'm not sure they 47:08.346 --> 47:14.233 were necessarily a timely one. The time to revise these could be quite long. And I'll close with 47:14.233 --> 47:20.099 a long term knowledge project, the Official History. This was remarkably completed in 1929. 47:20.100 --> 47:24.700 The original plans for the history were laid by the surgeon, the librarian, 47:24.700 --> 47:29.920 Colonel Champe McCulloch, and the bulk of the editing work was done 47:29.920 --> 47:33.732 by somebody sitting in the medical library. Contract surgeon Loy McAfee, 47:33.732 --> 47:38.133 who I think is one of the profiles in medicine somewhere on your website. 47:38.133 --> 47:43.282 With my knowledge theme. The post war reorganization split the 47:43.283 --> 47:48.356 medical museum in the Medical library. They've been together since the 1860s. 47:48.356 --> 47:54.356 Now the library is paired off with the historians while the museum is put in with the laboratory, 47:54.356 --> 47:58.133 which was appropriate for an organization that was leaving medical 47:58.133 --> 48:04.447 curiosities and becoming a pathology collection and Pathology Organization. 48:04.448 --> 48:09.781 And I'll conclude, The Army Medical Department diversified its ways to gather, organize, 48:09.781 --> 48:13.866 and disseminate knowledge around World War One. It paid far more attention to 48:13.866 --> 48:19.216 what other countries were doing, trying to learn from example rather than learn from experience. 48:19.216 --> 48:23.333 Lacking good existing routes, Gorgas also used a large number of 48:23.333 --> 48:28.099 unofficial routes to spread knowledge. He created some official routes because 48:28.100 --> 48:33.433 the unofficial ones were not sufficient. New routes were pioneered and 48:33.433 --> 48:35.666 new audiences were targeted. 48:35.666 --> 48:40.099 The medical library played little role in this until after the war. 48:40.100 --> 48:45.033 I think it's prewar specialization in producing a long cycle publication. 48:45.033 --> 48:49.266 The index catalog meant that it was simply not flexible enough to handle 48:49.266 --> 48:54.329 the volume of work or the deadlines. And library clerks also were not 48:54.330 --> 48:59.033 probably the right people to stay up with the current clinical literature. 48:59.033 --> 49:01.453 Thanks very much and I look forward to questions. 49:01.453 --> 49:05.432 [applause] 49:07.994 --> 49:10.332 Use the light please. Sure. 49:10.333 --> 49:16.533 [Ken Koyle:] Thank you. So, thank you Doctor Marble I really appreciate your your talk and 49:16.533 --> 49:22.566 this analysis of the the publications really from the end of the Civil War 49:22.566 --> 49:26.666 all the way up through World War One. So my question is about what the 49:26.666 --> 49:33.499 publication that you closed with the the histories of the the Great War. 49:33.500 --> 49:39.133 How did since this was a a publication primarily of the library, 49:39.133 --> 49:42.869 how did they gather the the content 49:42.870 --> 49:48.166 for it they you know how did they get doctors to write the the essays that 49:48.166 --> 49:51.399 became these remarkable histories? 49:51.400 --> 49:56.933 [Dr. Marble:] A lot of what they did was pull the 49:56.933 --> 50:02.760 monthly reports that had been filed during the the war and they actually 50:02.761 --> 50:08.266 enforced filing monthly reports. During the war, people got in trouble for not doing monthly reports. 50:08.266 --> 50:13.745 And it's a whether it's a hospital in the USA, hospital in France, 50:13.745 --> 50:16.745 a regimental surgeon with, you know, 50:16.745 --> 50:22.433 the 123rd Infantry Regiment in the whatever it was division. They were all supposed to file 50:22.433 --> 50:28.733 reports and and then and they did. Those were enormously useful. 50:28.733 --> 50:32.266 They also bring in people that oversaw 50:32.266 --> 50:39.199 that particular function during the war. The guy overseeing it would 50:39.200 --> 50:41.300 probably be a regular who was still 50:41.300 --> 50:49.079 in the army in 19/23/25 and and he would know the things to highlight 50:49.079 --> 50:54.100 and the things to that that were certainly present in the reports 50:54.100 --> 51:00.585 but less important. McAfee I think actually writes it the you know I don't. 51:00.585 --> 51:05.265 I think Lynch and Reed and and all the other senior officers have plenty 51:05.266 --> 51:08.399 to do as senior officers and they 51:08.400 --> 51:14.633 work with her to put it together and then she figures out what you 51:14.633 --> 51:21.865 know what sentence to quote from a report and there's a lot of of-- unquoted quotes. 51:21.866 --> 51:27.366 So they they take chunks out of reports. 51:27.366 --> 51:34.166 But they they use the existing reports. They bring in the officers that had overseen something, 51:34.166 --> 51:39.432 including some of the clinicians who had gone back into civilian practice. 51:39.433 --> 51:43.305 So Salmon is involved in the Neuropsychiatry Volume, 51:43.306 --> 51:50.266 Crile is writing parts of the Neurosurgery Volume. 51:50.266 --> 51:56.705 But then McAfee does most of the writing. I think they're more content 51:56.706 --> 52:01.928 with her because she is an MD. They wouldn't hire a historian to do it, but they would hire a Doctor 52:01.928 --> 52:04.650 who was willing to write. 52:04.650 --> 52:07.372 [Audience:] Thank you for a really interesting 52:07.372 --> 52:12.786 talk with lots to think about. So the for me at the moment, 52:12.786 --> 52:18.258 the most interesting question was your point about the 52:18.258 --> 52:24.814 distribution of information during the Civil War being mostly here's the information, you, the doc, 52:24.814 --> 52:29.926 should make your judgment based on it, but you it's your judgment that's in charge. 52:29.926 --> 52:34.133 And then it seems by the end of of the Great War, there's much more of a 52:34.133 --> 52:40.085 standardized approach to things. What I can't tell because I think I'm just ignorant, 52:40.086 --> 52:45.250 is whether there were certain turning points in just an emerging consensus 52:45.250 --> 52:51.462 which then the Army built upon, or whether part of it is a top down kind of thing because they 52:51.462 --> 52:56.814 had to run a system of hospitals or whether there's an interplay, that's a huge question 52:56.814 --> 53:00.120 but I think you have at least the start of an answer? 53:00.120 --> 53:03.426 [Dr. Marble:] Yeah, I'll give some answer and I will 53:03.426 --> 53:07.946 also say that I it is a big thing and I don't know all of it. 53:07.946 --> 53:13.654 I think you have the beginnings of medicine becoming a science in that period 53:13.654 --> 53:19.126 and there is a clear answer on what is the best thing to do. 53:19.126 --> 53:23.166 You also have a lot more specialization in medicine, 53:23.166 --> 53:26.967 so not anything like what we've got 53:26.967 --> 53:32.726 today with boards and fellowships and people that only do such and such, 53:32.726 --> 53:38.046 either because it's more lucrative or because that's what they've specialized in. 53:38.046 --> 53:43.806 But you know, there is a board of Ophthalmology, there is this that is the only board established. 53:43.806 --> 53:49.540 It's established in 1914. But there are guys that have said I do eyes, 53:49.540 --> 53:56.056 I don't do medicine, I do eyes. There are people that say, you know, 53:56.056 --> 54:01.656 they're not organizers aboard yet, but there are neurosurgeons and you know, I don't do medicine, 54:01.656 --> 54:06.376 I don't do surgery, I do neurosurgery. But in the bigger picture, 54:06.376 --> 54:12.044 going back out to things like sanitation, we've gone from something 54:12.044 --> 54:17.396 that that Von Shtoyben knew. In the Revolutionary War, which is if you, 54:17.396 --> 54:23.516 you will have less disease in your troops if you pay that more attention to hygiene. 54:23.516 --> 54:29.596 He knew this. He didn't know why. After 1898, you've got a lot of science 54:29.596 --> 54:35.836 as to why don't poop where you drink. You're going to get dysentery, you're going to get typhoid, 54:35.836 --> 54:40.734 and a lot of your people are going to die. And I think they're also haunted 54:40.734 --> 54:44.874 by that the the medical department as an organization is haunted by 54:44.874 --> 54:49.390 its professional failings in 1898, for which they get hammered in the 54:49.390 --> 54:55.846 press and they are desperate to avoid another hammering in the press. 54:55.846 --> 55:01.444 They also, you know, even in something they get hammered in the press for in in World 55:01.444 --> 55:06.536 War One is childhood diseases. It's a much more rural population. 55:06.536 --> 55:11.716 In the US in 1917 and you bring together 55:11.716 --> 55:16.936 millions of young men a lot of them haven't been exposed to scarlet fever. 55:16.936 --> 55:20.840 There is a big measles and scarlet and another scarlet fever epidemic 55:20.840 --> 55:25.068 in the army and hundreds of deaths. Hundreds as opposed to millions of 55:25.068 --> 55:30.220 men in the army but hundreds is bad enough and they they take the army 55:30.220 --> 55:36.346 takes heat for that they but they have some science to to go on saying. 55:36.346 --> 55:42.664 I told you the surgeon general testifies to Congress saying, I told the the the army we needed to 55:42.664 --> 55:47.986 have more square footage per man in the barracks and better ventilation, 55:47.986 --> 55:53.346 or we would have epidemics of communicable disease. 55:53.346 --> 55:58.188 And they said we need to win the war. This does not win the surgeon General 55:58.188 --> 56:02.216 friends for testifying in front of Congress that his bosses had overruled him. 56:02.216 --> 56:07.536 But he has science to go on and and 56:07.536 --> 56:13.692 exactly which piece of science or which piece of this whole topic, there's, you know, 56:13.692 --> 56:19.336 there's a lot of different answers to that, but they, they had a lot more science to go on from, 56:19.336 --> 56:25.536 you know, the antiseptic surgery from 67. 56:25.536 --> 56:31.044 They had a lot of hygiene data to go on. And they've also got doctors that 56:31.044 --> 56:35.896 are much more specialized and know what to what the right answer is. But they are also, yes, 56:35.896 --> 56:41.336 they are more prescriptive. And I think it comes back to if I know what the right answer is, 56:41.336 --> 56:44.586 I'm going to tell you what it is. [Audience:] That's what's interesting about the 56:44.586 --> 56:48.675 way you framed the question though is that it's in both an in and and out flow. 56:48.675 --> 56:53.056 And so they're gathering the information which makes the science, 56:53.056 --> 56:58.712 maybe not in the sense of scientific law, but also partly about 56:58.712 --> 57:02.766 local conditions in this war, but at the same time they have to run 57:02.766 --> 57:08.575 a system and so it's very interesting to see it move in the direction of 57:08.576 --> 57:13.176 you know here you go make your own decision to this is the proper way to. 57:13.176 --> 57:19.151 [Dr. Marble:] And I think there may also have been a changed expectation in the 57:19.151 --> 57:24.536 public and if I'm a family, you know if if I have lent the 57:24.536 --> 57:30.933 the government my son in 1862, I want them to take the best 57:30.933 --> 57:35.799 possible care for of him, but I don't know what that is. And I know that nobody is 57:35.800 --> 57:43.133 certain what that is. In 1917 there's a whole lot more certainty about what the right care is, 57:43.133 --> 57:48.215 and if the Army doesn't do that, then that great big hammer of public opinion is going 57:48.216 --> 57:51.333 to come down on their head. 57:51.333 --> 57:52.499 --Thank you. 57:54.566 --> 58:01.132 I scared everybody else off? 58:01.133 --> 58:03.333 Well, thanks very much. 58:03.333 --> 58:07.499 [applause] 58:11.326 --> 58:14.466 [graphic and program end]