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The history of America, by and for doctors
The unfamiliar landscape of America's medical past is marked by bizarre incidents, forgotten breakthroughs and selfless sacrifice.
- We all know Columbus, but who remembers Diego Alvarez Chanca, his doctor?
- This map does – and it lists centuries of medical figures, events, and achievements.
- It provides an unusual perspective on North American history… with one exception.
A familiar canvas
The map illuminates the topography of America with simplified, symbolic representations of the persons, institutions and events that have shaped medical history.
Credit: Boston Rare Maps
The map of America is a familiar canvas for a multitude of stories – soil types and weather fronts, road trips and election results. But sometimes geographical acquaintance intersects with narrative quaintness, especially when the topic is very specific. As in this beautifully detailed map of "Medical Events in North America," as bizarre as it is instructive.
In the manner of a medieval miniature, it illuminates the topography of America with simplified, symbolic representations of the persons, institutions and events that have shaped medical history. That makes for some interesting discoveries.
For example, whatever our feelings about Columbus, we are familiar with him via his signature achievement. However, few will have heard of Dr. Diego Alvarez Chanca of Seville, physician to the king and queen of Spain, and here seen accompanying the intrepid and/or invidious Genovese on his second voyage to America (on the ship painted in the bottom right corner).
Dr. Philip Syng, holding up a jar with gallstones he removed from the bladder of Chief-Justice John Marshall, who contentedly observes from the operating table.
Credit: Boston Rare Maps
While on Hispaniola in 1493, Chanca cured Columbus from an attack of malaria – quite probably the first application of western medicine in the western hemisphere.
For a good while, Spain remains the motor of medical progress in North America, with the publication in Mexico of "Opera Medicinalia," the first medical book printed in the Americas (1570), and just 10 years later, the establishment of the first university chair of medicine in the New World, also in Mexico.
Circa 1760, Junipero Serra prevented and controlled an outbreak of scurvy in California with the use of citrus juice – doing so 34 years before the British Navy struck upon the same idea. The Spanish padre is shown holding up oversized slices of oranges, dripping with healing sap.
Soon thereafter, the initiative–medical and otherwise–is seized by the Anglos on the East Coast.
Remembering the pioneers
Dr. Samuel Gross, carting in cadavers for anatomical study.
Credit: Boston Rare Maps
Many of the achievements detailed on this map were truly revolutionary, helping to elevate the state of medical science to the heights it has reached today. But, as the legend of the map says, "(t)he names of the prime-movers of science disappear gradually in a general fusion, and the more a science advances, the more impersonal and detached it becomes."
So it's nice to see remembered here, among other pioneers:
- Dr. Howard Taylor Ricketts (1871-1910), from near Missoula, who demonstrated the tick-transmission of Rocky Mountain spotted fever and died of Mexican typhus during the investigation and demonstration of the disease.
- Dr. J.C. Otto (1774-1844), from Philadelphia, who established haemophilia as a clinical entity.
- Sir Frederick Banting, working at Toronto University Medical School, who assisted by Charles Best managed to isolate insulin and succeeded in manufacturing it in 1922. Together with J.R.R. MacLeod, he received the Nobel Prize in 1923.
Quarantine Enforcement Act
First called "Letheon"', ether was discovered by dentist W.T.G. Morton, and first surgically used at Massachusetts General Hospital.
Credit: Boston Rare Maps
Several institutions are singled out as beacons of medical progress, notably
- hospitals like Massachusetts General Hospital, Johns Hopkins Hospital, the Mayo Clinic;
- educational centers of excellence such as Harvard Medical School, the Transylvania University Medical School and Jefferson Medical College; and
- associations such as the State Boards of Health (first one established in 1869 in Massachusetts) and the American Medical Association (founded in Chicago).
Among the achievements mentioned on the map with resonance for our own pandemic times are the Quarantine Enforcement Act, passed by Congress as early as 1799, and the stamping out, in 1905 in New Orleans of an "epidemic of yellow fever (…) by U.S. Public Health Service."Produced in 1950 and reflecting on earlier times, the map is dominated by white males.The exceptions proving the rule are
- Dr. Hideyo Noguchi (1876-1928), who was associated with the Rockefeller Institute for Medical Research and who in 1911 discovered the agent of syphilis as the cause of progressive paralytic disease;
- Dr. Elizabeth Blackwell (1821-1910), the first woman in America to receive the degree of doctor in medicine, who together with Marie Zakrzewska established the first training school for nurses in America; and
- a procession of slaves owned by Washington and Jefferson, standing in line to get inoculated for smallpox.
Slaves of Washington and Jefferson, getting inoculated for smallpox.
Credit: Boston Rare Maps
Few of the events and achievement mentioned on this map have made it into general public knowledge, with two possible exceptions.
One is "the American Crowbar Case", an 'extraordinary medical incident' mentioned in a note stuck to the East Coast: "In 1848, an explosion propelled a 3 ½ ft. crowbar through the head of Phineas T. Gage and up into the air. The patient recovered completely except for loss of sight in one eye…"
The other, the curious case contained within Dr. William Beaumont's book, "Experiments & Observations of Gastric Juices." On June 6, 1822, a man named Alexis St. Martin was accidentally wounded by gunshot at Fort Mackinac. The wound healed, leaving a gastric fistula, through which Dr. Beaumont was able to make observations. But Mr. St. Martin "is a difficult subject (and) runs away repeatedly."
Commissioned as sergeant
Dr. Beaumont's book on gastric juices, with pages illustrating the story of his unwilling subject, Alexis St. Martin.
Credit: Boston Rare Maps
Really? Who doesn't want a doctor poking into their stomach through a hole in their belly? But eventually the situation is resolved to the satisfaction of both parties: "Beaumont gets (Mr. St. Martin) commissioned as sergeant to keep him during experiments."
One of the more familiar names on the map is that of Dr. Walter Reed, but mainly because he is now synonymous for the Army Medical Center named after him. The map reveals why he became famous enough for that honor:
In Cuba, Dr. Walter Reed (1851-1902) proved, together with Dr. Jesse W. Lazear, Dr. James Carroll and Dr. Aristide Agramonte, that mosquitoes were the carrier of yellow fever. Dr. Lazear & Dr. Carroll allowed themselves to be bitten by infected mosquitoes. Lazear died of the fever, Carroll's health was permanently impaired.
Walter Reed in Cuba
Dr. Walter Reed (in white), in between Dr. Carlos Finlay (who first theorised that mosquitoes carried yellow fever) and Drs. Lazar and Carroll, who put that theory to the test.
Credit: Boston Rare Maps
Although they are scant remembered today, their selfless sacrifice has doubtlessly saved the lives of many in the 120 years since.
Strange Maps #1059
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Dr. Theobald Smith established that tick bits caused Texas Fever in cattle, thus proving that insects can carry diseases.
Credit: Boston Rare Maps
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Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>
Making machine-learning tools openly accessible<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
Scientists used CT scanning and 3D-printing technology to re-create the voice of Nesyamun, an ancient Egyptian priest.
- Scientists printed a 3D replica of the vocal tract of Nesyamun, an Egyptian priest whose mummified corpse has been on display in the UK for two centuries.
- With the help of an electronic device, the reproduced voice is able to "speak" a vowel noise.
- The team behind the "Voices of the Past" project suggest reproducing ancient voices could make museum experiences more dynamic.
Howard et al.<p style="margin-left: 20px;">"While this approach has wide implications for heritage management/museum display, its relevance conforms exactly to the ancient Egyptians' fundamental belief that 'to speak the name of the dead is to make them live again'," they wrote in a <a href="https://www.nature.com/articles/s41598-019-56316-y#Fig3" target="_blank">paper</a> published in Nature Scientific Reports. "Given Nesyamun's stated desire to have his voice heard in the afterlife in order to live forever, the fulfilment of his beliefs through the synthesis of his vocal function allows us to make direct contact with ancient Egypt by listening to a sound from a vocal tract that has not been heard for over 3000 years, preserved through mummification and now restored through this new technique."</p>
Connecting modern people with history<p>It's not the first time scientists have "re-created" an ancient human's voice. In 2016, for example, Italian researchers used software to <a href="https://www.smithsonianmag.com/smart-news/hear-recreated-voice-otzi-iceman-180960570/" target="_blank">reconstruct the voice of Ötzi,</a> an iceman who was discovered in 1991 and is thought to have died more than 5,000 years ago. But the "Voices of the Past" project is different, the researchers note, because Nesyamun's mummified corpse is especially well preserved.</p><p style="margin-left: 20px;">"It was particularly suited, given its age and preservation [of its soft tissues], which is unusual," Howard told <em><a href="https://www.livescience.com/amp/ancient-egypt-mummy-voice-reconstructed.html" target="_blank">Live Science</a>.</em></p><p>As to whether Nesyamun's reconstructed voice will ever be able to speak complete sentences, Howard told <em><a href="https://abcnews.go.com/Weird/wireStory/ancient-voice-scientists-recreate-sound-egyptian-mummy-68482015" target="_blank">The Associated Press</a>, </em>that it's "something that is being worked on, so it will be possible one day."</p><p>John Schofield, an archaeologist at the University of York, said that reproducing voices from history can make museum experiences "more multidimensional."</p><p style="margin-left: 20px;">"There is nothing more personal than someone's voice," he told <em>The Associated Press.</em> "So we think that hearing a voice from so long ago will be an unforgettable experience, making heritage places like Karnak, Nesyamun's temple, come alive."</p>
A new study proposes mysterious axions may be found in X-rays coming from a cluster of neutron stars.
Are Axions Dark Matter?<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="5e35ce24a5b17102bfce5ae6aecc7c14"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/e7yXqF32Yvw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
New research suggests you can't fake your emotional state to improve your work life — you have to feel it.
What is deep acting?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTQ1NDk2OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTY5MzA0Nn0._s7aP25Es1CInq51pbzGrUj3GtOIRWBHZxCBFnbyXY8/img.jpg?width=1245&coordinates=333%2C-1%2C333%2C-1&height=700" id="ddf09" class="rm-shortcode" data-rm-shortcode-id="9dc42c4d6a8e372ad7b72907b46ecd3f" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
Arlie Russell Hochschild (pictured) laid out the concept of emotional labor in her 1983 book, "The Managed Heart."
Credit: Wikimedia Commons<p>Deep and surface acting are the principal components of emotional labor, a buzz phrase you have likely seen flitting about the Twittersphere. Today, "<a href="https://www.bbc.co.uk/bbcthree/article/5ea9f140-f722-4214-bb57-8b84f9418a7e" target="_blank">emotional labor</a>" has been adopted by groups as diverse as family counselors, academic feminists, and corporate CEOs, and each has redefined it with a patented spin. But while the phrase has splintered into a smorgasbord of pop-psychological arguments, its initial usage was more specific.</p><p>First coined by sociologist Arlie Russell Hochschild in her 1983 book, "<a href="https://www.ucpress.edu/book/9780520272941/the-managed-heart" target="_blank">The Managed Heart</a>," emotional labor describes the work we do to regulate our emotions on the job. Hochschild's go-to example is the flight attendant, who is tasked with being "nicer than natural" to enhance the customer experience. While at work, flight attendants are expected to smile and be exceedingly helpful even if they are wrestling with personal issues, the passengers are rude, and that one kid just upchucked down the center aisle. Hochschild's counterpart to the flight attendant is the bill collector, who must instead be "nastier than natural."</p><p>Such personas may serve an organization's mission or commercial interests, but if they cause emotional dissonance, they can potentially lead to high emotional costs for the employee—bringing us back to deep and surface acting.</p><p>Deep acting is the process by which people modify their emotions to match their expected role. Deep actors still encounter the negative emotions, but they devise ways to <a href="http://www.selfinjury.bctr.cornell.edu/perch/resources/what-is-emotion-regulationsinfo-brief.pdf" target="_blank">regulate those emotions</a> and return to the desired state. Flight attendants may modify their internal state by talking through harsh emotions (say, with a coworker), focusing on life's benefits (next stop Paris!), physically expressing their desired emotion (smiling and deep breaths), or recontextualizing an inauspicious situation (not the kid's fault he got sick).</p><p>Conversely, surface acting occurs when employees display ersatz emotions to match those expected by their role. These actors are the waiters who smile despite being crushed by the stress of a dinner rush. They are the CEOs who wear a confident swagger despite feelings of inauthenticity. And they are the bouncers who must maintain a steely edge despite humming show tunes in their heart of hearts.</p><p>As we'll see in the research, surface acting can degrade our mental well-being. This deterioration can be especially true of people who must contend with negative emotions or situations inside while displaying an elated mood outside. Hochschild argues such emotional labor can lead to exhaustion and self-estrangement—that is, surface actors erect a bulwark against anger, fear, and stress, but that disconnect estranges them from the emotions that allow them to connect with others and live fulfilling lives.</p>
Don't fake it till you make it<p>Most studies on emotional labor have focused on customer service for the obvious reason that such jobs prescribe emotional states—service with a smile or, if you're in the bouncing business, a scowl. But <a href="https://eller.arizona.edu/people/allison-s-gabriel" target="_blank">Allison Gabriel</a>, associate professor of management and organizations at the University of Arizona's Eller College of Management, wanted to explore how employees used emotional labor strategies in their intra-office interactions and which strategies proved most beneficial.</p><p>"What we wanted to know is whether people choose to engage in emotion regulation when interacting with their co-workers, why they choose to regulate their emotions if there is no formal rule requiring them to do so, and what benefits, if any, they get out of this effort," Gabriel said in <a href="https://www.sciencedaily.com/releases/2020/01/200117162703.htm" target="_blank">a press release</a>.</p><p>Across three studies, she and her colleagues surveyed more than 2,500 full-time employees on their emotional regulation with coworkers. The survey asked participants to agree or disagree with statements such as "I try to experience the emotions that I show to my coworkers" or "I fake a good mood when interacting with my coworkers." Other statements gauged the outcomes of such strategies—for example, "I feel emotionally drained at work." Participants were drawn from industries as varied as education, engineering, and financial services.</p><p>The results, <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fapl0000473" target="_blank" rel="noopener noreferrer">published in the Journal of Applied Psychology</a>, revealed four different emotional strategies. "Deep actors" engaged in high levels of deep acting; "low actors" leaned more heavily on surface acting. Meanwhile, "non-actors" engaged in negligible amounts of emotional labor, while "regulators" switched between both. The survey also revealed two drivers for such strategies: prosocial and impression management motives. The former aimed to cultivate positive relationships, the latter to present a positive front.</p><p>The researchers found deep actors were driven by prosocial motives and enjoyed advantages from their strategy of choice. These actors reported lower levels of fatigue, fewer feelings of inauthenticity, improved coworker trust, and advanced progress toward career goals. </p><p>As Gabriel told <a href="https://www.psypost.org/2021/01/new-psychology-research-suggests-deep-acting-can-reduce-fatigue-and-improve-your-work-life-59081" target="_blank" rel="noopener noreferrer">PsyPost in an interview</a>: "So, it's a win-win-win in terms of feeling good, performing well, and having positive coworker interactions."</p><p>Non-actors did not report the emotional exhaustion of their low-actor peers, but they also didn't enjoy the social gains of the deep actors. Finally, the regulators showed that the flip-flopping between surface and deep acting drained emotional reserves and strained office relationships.</p><p>"I think the 'fake it until you make it' idea suggests a survival tactic at work," Gabriel noted. "Maybe plastering on a smile to simply get out of an interaction is easier in the short run, but long term, it will undermine efforts to improve your health and the relationships you have at work. </p><p>"It all boils down to, 'Let's be nice to each other.' Not only will people feel better, but people's performance and social relationships can also improve."</p>
You'll be glad ya' decided to smile<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="88a0a6a8d1c1abfcf7b1aca8e71247c6"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/QOSgpq9EGSw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>But as with any research that relies on self-reported data, there are confounders here to untangle. Even during anonymous studies, participants may select socially acceptable answers over honest ones. They may further interpret their goal progress and coworker interactions more favorably than is accurate. And certain work conditions may not produce the same effects, such as toxic work environments or those that require employees to project negative emotions.</p><p>There also remains the question of the causal mechanism. If surface acting—or switching between surface and deep acting—is more mentally taxing than genuinely feeling an emotion, then what physiological process causes this fatigue? <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2019.00151/full" target="_blank">One study published in the <em>Frontiers in Human Neuroscience</em></a><em> </em>measured hemoglobin density in participants' brains using an fNIRS while they expressed emotions facially. The researchers found no significant difference in energy consumed in the prefrontal cortex by those asked to deep act or surface act (though, this study too is limited by a lack of real-life task).<br></p><p>With that said, Gabriel's studies reinforce much of the current research on emotional labor. <a href="https://journals.sagepub.com/doi/abs/10.1177/2041386611417746" target="_blank">A 2011 meta-analysis</a> found that "discordant emotional labor states" (read: surface acting) were associated with harmful effects on well-being and performance. The analysis found no such consequences for deep acting. <a href="https://doi.apa.org/doiLanding?doi=10.1037%2Fa0022876" target="_blank" rel="noopener noreferrer">Another meta-analysis</a> found an association between surface acting and impaired well-being, job attitudes, and performance outcomes. Conversely, deep acting was associated with improved emotional performance.</p><p>So, although there's still much to learn on the emotional labor front, it seems Van Dyke's advice to a Leigh was half correct. We should put on a happy face, but it will <a href="https://bigthink.com/design-for-good/everything-you-should-know-about-happiness-in-one-infographic" target="_self">only help if we can feel it</a>.</p>
Archaeologists discover a cave painting of a wild pig that is now the world's oldest dated work of representational art.