Early American Medicine

If we lived one or two hundred years ago, many of us would have died long before we reached our current age. Medical knowledge has exploded, and we are the happy beneficiaries. But studying the past still holds clues for the future. 

This summer my family and I explored Fort Ligonier, an eighteenth century British fort in Western Pennsylvania, and the Bushy Run Battlefield, a historic site of the Seven Years War (1756-1763). My children opined about what it must have been like to live in those days. As we looked at the hospital buildings, however, my daughter said “the thing that I would miss the most is 21st century medicine. “

She is not alone. Some people attend Renaissance Fairs and pretend to live in Medieval Europe. Others reenact the Civil War or other major conflicts. No one that I have ever spoken to, however, wants to give up modern medicine. Not that modern medicine is perfect. Too often it is impersonal, profit driven, complicated and expensive. However, compared to much of existed before, it is miraculous. We would do well to remember that, and be thankful for it.

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The Year in Science, Technology, Engineering and Mathematics History

7 Jan – The first trans-Atlantic telephone service, from New York to London, was established (1927).

7 Jan – Japan launched the Sakigake, the first non-US and non-Soviet deep space probe and interplanetary spacecraft (1985).

16 Jan – The Space Shuttle Columbia takes off for mission STS-107 which would be its final one. Columbia disintegrated 16 days later on re-entry (2003).

21 Jan – The first nuclear powered submarine, the USS Nautilus (SSN 571), was launched at Groton, CT (1954).

19 Feb – Thomas Edison patented the phonograph, US Patent 200,521 (1878).

21 Feb – The first steam locomotive self-propelled in Wales at the Pen-y-Darren Ironworks (1804).

4 Mar – The Forth Bridge crossing the Firth of Forth, the longest (until 1917) cantilever bridge in the world (spanning 8,296 feet) opened in Scotland (1890).

8 Mar – The Philips Company first publicly demonstrated the Compact Disc (1979).

10 Mar – The American John Stone patented the pile driver (1792).

10 Mar – The American inventor Alexander Graham Bell made the first telephone call, saying “Mr. Watson, come here. I want to see you (1876).”

16 Mar – Gemini VIII completed the first successful docking of two spacecraft while in orbit (1966).

25 Mar – Dutch mathematician, scientist and astronomer Christiaan Huygens discovered Saturn’s largest moon, Titan (1655).

25 Mar – The Oystermouth Railway, now called the Swansea and Mumbles Railway, became the first passenger carrying railway in the world (1807).

25 Mar – The first successful tornado forecast predicted that a tornado would strike Tinker Air Force Base, Oklahoma (1948).

26 Mar – In Auburn, Massachussets, Robert Goddard launched the first successful liquid fueled rocket (1926).

12 Apr – The Soviet Comonaut Yuri Alekseyevich Gagarin (1934-1968) became the first human in space and the first to orbit the earth aboard Vostok 3KA-3 (1961).

12 Apr – First launch (STS-1) of the first US Space Shuttle, Columbia, from Cape Canaveral (1981). John W. Young was Mission Commander and Robert L. Crippen was the pilot.

19 Apr – In Springfield, MA, Charles Duryea claimed to the first American to drive a car (1892).

24 Apr – Sigmund Freud published his famous paper, Das Ich und das Es, outlining his concept of the Id, the Ego, and the Super-Ego (1923).

1 May – Swedish Botanist Carl Linnaeus published Plant Taxonomy, thus birthing the field of plant taxonomy (1753).

2 May – The first jet airliner in history, the De Haviland Comet 1, made its maiden voyage from London to Johannesburg (1952).

5 May – Having discovered a better way to weave straw with silk and thread, Mary Kies became the first woman to be awarded a US patent (1809).

21 Aug – William Seward Burroughs patented the first practical adding machine in the United States (1888).

30 Aug – The maiden voyage of the Space Shuttle Discovery (STS 41D) began (1984).

31 Aug – The radio station 8MK in Detroit, MI, broadcast the first radio news program (1920).

4 Sep – The first commercial electric power plant in history began operations in New York City, inaugurating the electrical age (1882).

13 Sep – Henry Bliss was the first person in the US killed in an automobile accident (1899).

1 Oct – The Ford Motor Company launched the Model T for $825, making cars available to the middle class and revolutionizing transportation in American (1908).

24 Oct – The first Transcontinental Telegraph was completed with lines from St Louis and Carson City meeting in Salt Lake City and making the Pony Express obsolete (1861).

11 Nov – Searching for a way to find the area under the curve Y=f(x), Gottfried Liebnitz introduced integral calculus (1675).

24 Nov – Charles Darwin published On the Origin of Species, the book that ushered in the Theory of Evolution and gave a biological basis to modern naturalism (1859).

1 Dec – Henry Ford’s Ford Motor Company introduced the moving assembly line, cutting time and costs in producing cars (1913).

13 Dec – Apollo 17 astronauts Harrison Schmitt and Eugene Cernan performed the third and final moon walk of the program. As of 2014 they were still the last humans to walk on the moon (1972).

27 Dec – Japan commissioned the first purpose built aircraft carrier in the world, Hōshō (1922).

The Year in Medical History

1 Jan – German scientist William Rontgen announced his discovery of x-rays (1896).

1 Jan – All cigarette packages sold in the US were required to include the US Surgeon General’s warning “Caution: Cigarette smoking may be hazardous to your health (1966)

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How to Improve your Health and Health Care

Most people get lost in the maze of health care, and suffer as a result. Some strategies help…

Throughout Central Asia, the Middle East, and much of the developing world, people have told me that they cannot get good medical care. In some cases good care is too expensive, in other cases medical care is affordable but poor quality, and in still other cases medical care, good or bad, does not exist. Some friends with significant health care problems labor in austere conditions never knowing when a medical emergency will strike, and if they will be able to get help when and where they need.

Some people have similar problems in the developed world, even including the United States. America has been swept by debates about health care, especially about how to make quality health care available to all Americans. Medicare is a government single payer program for the elderly and Medicaid is the same for the poor, but these programs pay providers too little and yet are unsustainably expensive for the nation. The Affordable Care Act (ACA) was the most recent Federal attempt to improve Americans’ health, but the results have been mixed. Fundamentally the ACA was health insurance reform, not health care reform, and providing someone with an insurance card is not the same as providing them with health care. Hence we have millions who lost their insurance, millions who got new insurance, and millions waving their new insurance cards in the air who cannot get care because it doesn’t exist in their area, wait times are too long, or the system pays so little that providers cannot afford to take these patients.

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Useful Quotations on Aviation and Space

Pithy Prose for Politicians, Preachers, Professors, Pundits, and Public Speakers.

“There’s a historical milestone in the fact that our Apollo 11 landing on the moon took place a mere 66 years after the Wright Brothers’ first flight.” Buzz Aldrin

“The moment you doubt whether you can fly, you cease for ever to be able to do it.” J.M. Barrie, Peter Pan

“A superior pilot uses his superior judgment to avoid situations which require the use of his superior skills.” Frank Borman – Apollo 8

“I’m going to fly this thing, then I’m going to set it afire and never have another thing to do with aeroplanes.” Clyde Cessna, after an unsuccessful 1911 attempt at flight

“The reason angels can fly is because they take themselves lightly.” G.K. Chesterton, Orthodoxy

“Once you have tasted flight, you will forever walk the earth with your eyes turned skyward, for there you have been, and there you will always long to return.” Leonardo da Vinci

“If you’re faced with a forced landing, fly the thing as far into the crash as possible” Bob Hoover, former test pilot and airshow performer

“Always keep an ‘out’ in your hip pocket.” Beverly “Bevo” Howard, aerobatic pilot and entrepreneur.

“Keep thy airspeed up, lest the earth come from below and smite thee.” William Kershner, test pilot, flight instructor and author.

“Flight by machines heavier than air is unpractical and insignificant, if not utterly impossible.” Simon Newcomb (March 12, 1835 – July 11, 1909), Canadian-American astronomer and mathematician.

“Aviation is proof that given, the will, we have the capacity to achieve the impossible.” Eddie Rickenbacker

“A single lifetime, even though entirely devoted to the sky, would not be enough for the study of so vast a subject. A time will come when our descendants will be amazed that we did not know things that are so plain to them.” Seneca, Roman philosopher, 1st century AD

“Man must rise above the Earth—to the top of the atmosphere and beyond—for only thus will he fully understand the world in which he lives”. Socrates

“Thank God men cannot fly, and lay waste the sky as well as the earth.” Henry David Thoreau

Understanding Problems

Ever feel like your problems are so big that you can’t even understand them, much less deal with them? Ever feel impotent to grasp others’ problems, much less help them with them? Approaching the topic first from a medical and then from a larger perspective, the attached article may provide some insight.

A fellow student from the public health program at Johns Hopkins came to me with a research idea many years ago. Performing publishable research is a requirement of the program, and we were struggling with the most fundamental issue; thoroughly understanding the problem that you wish to address. Our team wrestled with the possibilities, explored lots of dead ends, and sought guidance from more experienced researchers. Eventually a reasonable, although not groundbreaking, plan took shape.

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Slaves to the Numbers

We are humans, not robots. We have brains and hearts, not computers. Why then do we enslave ourselves to robotic, computer-numerical evaluation of what we do, how our days have gone, and everything else in our lives?

The topic of our study in the young married adult class at church yesterday was “Leaving a Legacy”. For the first time in years, I did not have to teach and so had the rare privilege of just listening. The teacher was describing the importance of being intentional and taking time to build a legacy with your family. “Life” he said, “is more than just taking your kids from one sports event to another every Saturday.” A woman in the class replied “Yes, but Washington is a competitive place, and I was talking to some friends last week about our coming weekend schedules. Theirs were packed, and ours was lighter. Over the course of the conversation I almost felt guilty that we weren’t doing as much. I hope that we can get support in the church to live our lives with our lighter schedule.”

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Checklist for Evaluating Articles in the Medical Literature

Clinicians face mountains of medical literature, and no one can keep up. Much of it is trash. Doctors and other health care professionals must know how to evaluate medical literature to provide the best possible care to their patients; but few know how. Here is some help:

Title and General

1.    Is the title appropriate?

2.    Are the authors appropriately identified?

3.    Does information on conflict of interest or other disclaimers appear in the article?

Abstract

1.    Does the abstract entice the reader to read the article?

2.    Does the abstract correctly summarize the study and its findings?

Objective

1.    Objective(s)

2.    Study type – observational (cross sectional, case control, cohort) or experimental (randomized controlled trial, vaccine trial)

3.    Are the objectives reasonable and worthwhile?

4.    Strengths and limitations of the objective and study type

5.    How could these affect the results or conclusions (biased, generalizable)?

Methods

Study design

1.    Study design –

2.    How conducted?

3.    Who conducted?

4.    Methods appropriate for objective?

5.    Strengths and limitations

6.    How could these affect the results or conclusions (internal and external validity)?

Study population

1.    Who are the study subjects?

2.    How selected?

3.    Who selected?

4.    Strengths and limitations –

5.    How could these affect the results or conclusions (biased, generalizable)?

Study maneuver

1.    What treatments/interventions planned?

2.    How administered?

3.    Who will provide the maneuvers (where and when)?

4.    Are these appropriate for the study objectives?

5.    Strengths and limitations of planned maneuver –

6.    How could these affect the results or conclusions (biased, generalizable)?

Study observations/measures and data to be collected

1.    What observations/data collection is planned (On whom, where and when; are they consistent)?

2.    How will they be made or collected (by what method, are they standardized, are observers blinded)?

3.    Who will make the observations and collect the data, where and when?

4.    Are these appropriate for the study objectives?

5.    What are the strengths and limitations of the planned observations (exclusion, masked or unmasked, sources of bias, likely to be reliable, valid)?

6.    How could these affect the results or conclusions (biased, generalizable)?

Analysis

1.    What is the planned data analysis (what methods will be used, how will the data be grouped, what tests will be used for each analysis planned, what will be considered statistically significant)?  Are assumptions based on prior studies?

2.    How will the data be analyzed?

3.    Who will conduct the analysis?

4.    Is the planned analysis appropriate for the study objective and the type and level of data collected (parametric or non-parametric tests, one-sided vs. two-sided tests of significance, stratification when appropriate)?

5.    What are the strengths and limitations of the planned analysis (what is the power of the planned data collection/analysis)?

6.    How could these affect the results or conclusions (failure to detect a true difference)?

Results

1.    What results/observations are presented/not presented (are all the findings presented for all subjects)?

2.    How were the results obtained (what analysis was used, was the planned analysis completed)?

3.    How were the results which are presented/excluded determined and why (data insufficient, poor response, not significant)?

4.    Are the results appropriate for study objectives, planned observations and analysis?  Are they correctly performed and interpreted, internally consistent and valid (arithmetic errors, what is considered statistically significant, appropriate comparisons)?

5.    What are the strengths and limitations of the analysis results (statistical vs. biologic/clinical significance, statistical power)?

6.    How could these affect the results or conclusions?

Discussion and Conclusions

1.    What are the conclusions?

2.    How or on what basis were they made (are they justified by the results and analysis, is that analysis sufficient to determine whether significant differences may be due to incomparability of groups or methodological considerations)?

3.    Are the above limitations under all other sections adequately addressed in this section?

4.    How do they affect the conclusions?  Is this adequately assessed?

5.    What are the strengths and limitations of the conclusions?

6.    What recommendations do the authors have for future study?

 

Seven Secrets of Health #3 – Maximal Musculoskeletal

Our minister of music was having a lot of pain in his shoulders, legs and back during a mission trip. I told him that exercise can reduce pain, improve range of motion, and increase musculoskeletal function. Then I told him how. 

A man in his 70s came to the Nirschl Sports Medicine Center in Virginia. His chief complaint was mild weakness in his golf swing for several months, but no pain or other functional limitation. His exam was unremarkable except for asymmetric weakness in the right shoulder. We ordered a magnetic resonance imaging (MRI) scan to evaluate possible surgical options.

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Seven Secrets of Health #2 – Keep Life in Balance

A life in balance is the healthiest life, but what does balance mean, and how can you attain it?

In the movie Karate Kid, the martial arts master Mr. Miyagi tells his student Daniel “Got to learn balance. Balance is key. Balance good, karate good. Everything good.”  It cannot be denied that in athletics and in all of health and fitness, balance is a fundamental goal. Webster’s New World Dictionary defines balance as “a state of equilibrium or equipoise; equality in amount, weight, value, or importance, as between two things or the parts of a thing: mental, emotional, or bodily stability.”

I have many patients who want to hear directly from their doctor on health and fitness topics, and so I dedicate these articles to you. Thank you for letting me partner in taking care of you. In this article we will focus on balance as it relates to health and fitness.

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Jonathan Potts – American Revolutionary Physician

Military physicians, just like all soldiers and military officers, should read military history. We will be better if we do.

Napoleon suggested “Read over and over again the campaigns of Alexander, Hannibal, Caesar, Gustavus, Turenne, Eugene and Frederic. … This is the only way to become a great general and master the secrets of the art of war. …” As true as this maxim is for line officers, it is also true for leaders in the Army medical department. By studying the struggles, victories and defeats of our forebears we can better surmount the obstacles we face today.

Dr. Jonathan Potts is a medical officer worth studying. He was born in Popodickon, Pennsylvania in 1747 and, with Dr. Benjamin Rush, attended the famous medical school in Edinburgh, Scotland. He returned to the colonies on learning of the illness of his fiancé, Miss Grace Richardson. Potts married her in May 1767 and completed his Doctor of Medicine at the College of Philadelphia, the first institution to grant medical degrees in America, in 1771. He began a private practice in Reading, PA, but responded to the call of independence, seeking assignment with the Continental Hospital Department, comprised of Northern, Middle and Eastern Departments.

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Seven Secrets of Health #1 – The Core is the Key

Physically, no one can do much without a strong core. This article describes why you should work on it, and how.

Have you ever tried to throw a ball while treading water in a swimming pool? Water polo players notwithstanding, there is little to push against, so no one can throw far. That’s because of Newton’s third Law of motion – for every action there’s an equal and opposite reaction. If we throw something forward, our body absorbs the same force in a backward motion. If the forward force is greater than our body’s ability to absorb and if we are not braced against something solid, we will move backward. The principle is that we can only generate force in one direction when doing so against solid resistance, either within our body or from some external fixed point, in the opposite direction.

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Healing the Health Care Cost Conundrum

A prescription for making US health care better quality, more accessible, and less expensive for all of us. 

The military health care system is different in many ways from the civilian system, but a primary difference is the income incentive. Simply put, health care providers and other medical professionals are not paid based on the number of patients that they see or the number of procedures that they do. Instead they receive a fixed salary with few if any bonuses for productivity or quality. The budgets for military health care institutions, and many others in the Federal government, are based on Congressional appropriations, not on productivity. This has been changing in the past decade but remains largely true today.

Civilian medicine is not so. They are paid for what they did, patients seen and procedures done, and everyone on staff is usually highly motivated to do more. Some have described such fee-for-service reimbursement arrangements as “you eat what you kill.” In some practices, that can equate to more visits and more procedures, even if some are not medically required.

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