Surgeon General's Office Research Articles

The 1964 US Surgeon General's report on smoking and health.

The 1964 report of the US Surgeon General on smoking and health made an authoritative case that tobacco smoking was a cause of premature deaths from lung cancer and chronic bronchitis. It justified the practice of drawing causal inferences from epidemiological studies, specified influential criteria for doing so, and made use of an early form of meta-analysis.

Pneumococcal pneumonia on the job: Uncovering the past story of occupational exposure to metal fumes and dust.

The objectives of this study are to elucidate the early history of risk for pneumococcal pneumonia from occupational exposure to metal fumes and dusts, and to demonstrate the importance of searching older literature when performing reviews. We performed manual searching for articles in the Library of the Surgeon General's Office (the precursor to Index Medicus), in the Hathi Trust database, in PubMed, andby screening reference lists in literature appearing before the introduction of PubMed. An early body of literature, from the 1890s onward, recognized that pneumonia was linked to “Thomas slag,” a steel industry byproduct containing iron, manganese, and lime. Researchers, mainly in Germany, showed that workers in metal‐dust‐exposed occupations, especially using manganese, manifested an increased incidence of pneumococcal pneumonia. An outbreak of pneumococcal pneumonia in the 1930s implicated manganese fume in its etiology. In the immediate post‐World War II period, there was a brief flurry of interest in pneumonia from exposure to potassium permanganate that was soon dismissed as a chemical pneumonitis. After a hiatus of two decades, epidemiologic investigations drew attention to the pneumonia risks of welding and related metal fume exposure, bringing renewed interest to the forgotten role of pneumococcal pneumonia as an occupational disease. Occupational or environmental inhalation of manganese, iron, or irritants may be causally related to increased pneumococcal pneumonia risk. In particular, the risk associated with manganese seems to be overlooked in recent literature. An important conclusion is the importance of obtaining additional evidence through a deeper assessment of the literature in a broad historical context.

Implementing the national suicide prevention strategy: Time for action to flatten the curve

Since 1999, the Office of the United States Surgeon General has identified suicide prevention as a national public health priority. The National Strategy on Suicide Prevention, coordinated by the public-private Action Alliance, was most recently updated in 2012. In early 2021, the Surgeon General's office released a Call to Action to fully implement the national strategy. Six core types of actions to prevent suicide include adopting a broad public health approach, addressing upstream factors including social determinants of health, reducing access to multiple forms of lethal means, adopting evidence-based care for persons at risk, enhancing crisis care and care transitions, and improving the quality and use of suicide-related data. From 1999 through 2018, suicide rates in the U.S. increased by approximately one-third, and suicide had become the tenth leading cause of death. While most recent national data indicate a small reduction in the suicide rate, decreases were not seen across all demographic groups. Population groups which may require special emphasis or outreach efforts include adolescents, working age adults, military veterans, and American Indians/Alaskan Natives. Increases in social isolation, mental distress, and economic hardship during the COVID-19 pandemic indicate clear needs to address the full spectrum of suicidal behavior. This will require a multisector and whole of government approach, using contemporary evidence-informed approaches and best practices as well as innovative methods including those based on predictive analytics.

Historical Origins of the Tuskegee Experiment: The Dilemma of Public Health in the United States.

The Tuskegee Study of Untreated Syphilis in the Negro Male was an observational study on African-American males in Tuskegee, Alabama between 1932 and 1972. The U. S. Public Health Service ran this study on more than 300 people without notifying the participants about their disease nor treating them even after the introduction of penicillin. The study included recording the progress of disease and performing an autopsy on the deaths. This paper explores historical backgrounds enabled this infamous study, and discusses three driving forces behind the Tuskegee Study. First, it is important to understand that the Public Health Service was established in the U. S. Surgeon General's office and was operated as a military organization. Amidst the development of an imperial agenda of the U.S. in the late 19th and early 20th centuries, the PHS was responsible for protecting hygiene and the superiority of "the American race" against infectious foreign elements from the borders. The U.S. Army's experience of medical experiments in colonies and abroad was imported back to the country and formed a crucial part of the attitude and philosophy on public health. Secondly, the growing influence of eugenics and racial pathology at the time reinforced discriminative views on minorities. Progressivism was realized in the form of domestic reform and imperial pursuit at the same time. Major medical journals argued that blacks were inclined to have certain defects, especially sexually transmitted diseases like syphilis, because of their prodigal behavior and lack of hygiene. This kind of racial ideas were shared by the PHS officials who were in charge of the Tuskegee Study. Lastly, the PHS officials believed in continuing the experiment regardless of various social changes. They considered that black participants were not only poor but also ignorant of and even unwilling to undergo the treatment. When the exposure of the experiment led to the Senate investigation in 1973, the participating doctors of the PHS maintained that their study offered valuable contribution to the medical research. This paper argues that the combination of the efficiency of military medicine, progressive and imperial racial ideology, and discrimination on African-Americans resulted in the Tuskegee Syphilis Experiment.

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

Borrowing from tobacco control to curtail the overweight and obesity epidemic: Leveraging the U.S. Surgeon General's Report

There is broad agreement that more needs to be done to curtail the U.S. overweight and obesity epidemic. Fifty years of regular Surgeon General's Reports on the health consequences of smoking appear to have been a highly effective contributor to the notable successes that have been made in reducing smoking prevalence. Comparing the rate of Surgeon General's Reports on smoking and obesity reveals striking differences, with more than a five-fold lower rate of reporting on the latter. Developing practices that more effectively leverage the power of the U.S. Surgeon General's Office in efforts to reduce obesity is a relatively straightforward but potentially powerful additional step that warrants consideration.

Learning from the Wounded: The Civil War and the Rise of American Medical Science, by Shauna Devine

Learning from Wounded: The War and Rise of American Medical Science, by Shauna Devine. Chapel Hill, University of North Carolina Press, 2014. x, 372 pp. $39.95 US (cloth). Shauna Devine proposes to relocate roots of modern medical science in America from commonly ascribed influences of late nineteenth-century Germany to traumatic years of 1861-1865, American War. Civil War author explains, especially northern physicians, transformed American medical science. The War created context for most significant medical experience of nineteenth century in United States and in process set American on new course (p. 2). Devine addresses this theme through leitmotif of shared experience memorialized in projects established principally by innovative Surgeon General William A. Hammond. The first of his projects was Army Medical Museum, initiated with Circular No. 2 on May 21, 1862. Through able leadership of men like Joseph Janvier Woodward, John Brinton, and later John Shaw Billings, chaos of deadly camp diseases and devastating combat injuries became what Woodward called, museum of curiosities, but rather a collection that teaches (p. 50). Devine offers convincing testimonials and clear examples of how museum became important institutional foundation for development of investigative medicine (p. 92). If Army Medical Museum made material object pedagogical resource, Devine shows that The Medical and Surgical History of War of Rebellion was its print counterpart. The brainchild of Hammond, it was Joseph K. Bames who would see it through to publication from 1870 to 1888. This massive six-volume compilation of field case studies and reports on everything from regimental illness and injury to hospital management and purveyors' stores caught even attention of Europe. Other medical accounts of wartime had been written before, but never anything on this scale. In December of 1864 young, battletested John Shaw Billings was called to tamer service in Surgeon General's Office. There he soon metamorphosed into de facto librarian that for next thirty years would transform old Surgeon General's Library into truly National Library of Medicine, specialized collection envy of world. Billings reflected passionate desire of younger medical men to recast war's devastation into redemption of meaningful scientific endeavor that could reap permanent benefits. The goal of both museum and library was to create kind of laboratory of object specimens and books that could be used for continuing medical education. It was progressive and ambitious plan that worked. Devine offers some other evidence for role played in developing medical specialization and, more interestingly, in ways in which soldiers-turned-veterans contributed to the medicalization of state (p. 254). War pensions to disabled veterans were mediated through physicians, helping to improve their professional status in civilian community, and for first time, place within federal government an official fiduciary responsibility to those who so valiantly defended it. Despite diligent work of medical elites on gathering, preserving and mounting museum specimens, on collecting books and journals, on requiring and compiling systematic reporting of case studies, and on acquiring tools of trade, there was discernible underbelly of not made clear in Devine's work. Famed surgeon William Keen, for example, doubted if there were half dozen thermometers and hypodermic needles in whole Army of Potomac in war (Medical Research and Human Welfare. Boston, Houghton Mifflin, 1917, p. 18). In another example, court martial of William A. Hammond in summer of 1864 removed one of best Surgeon Generals ever to grace uniform. …

The 1964 Surgeon General's report and Americans' beliefs about smoking.

Half a century ago, on January 11, 1964, the U.S. Surgeon General's office released a landmark report on the health consequences of smoking. That report received massive media attention and triggered a steadily growing number of federal, state, and local restrictions on the advertising, sale, and use of cigarettes. Little is known about the report's impact on American public opinion because all the timely public opinion polls that measured the report's impact were privately commissioned by the tobacco industry and were not made publicly available. A review of these polls shows that the 1964 Surgeon General's report had a large and immediate effect on Americans' beliefs that cigarettes were a cause of lung cancer and of heart disease. However, the report had less impact on public preferences for government action or on smoking rates.

The 50th Anniversary of the US Surgeon General's Report on Tobacco: What We've Accomplished and Where We Go From Here

January 11, 2014, marks the 50th anniversary of a significant milestone in our nation's public health. It was on this date in 1964 that US Surgeon General, Dr. Luther Terry, courageously released the first Surgeon General's Report on Smoking and Health.[1][1] This landmark report transformed the way

DSM-5: Changes and Controversies: Table 1

A Brief History of DSMThe American Psychiatric Association's (APA) 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 2013a) represents the latest iteration of a document which has been shaped by social and scientific forces. DSMI (APA, 1952) represented APA's attempt improve on the diagnostic system of mental disorders contained in the World Health Organization's (WHO) International Classification of Diseases (ICD; see World Health Organization, 1948) which was, at that time, in its 6th revision (Grob, 1991). Based largely on War Department Technical Bulletin Medical 203, a classification system developed by the Surgeon General's Office under the leadership of William C. Menninger, DSMI reflected a psychodynamic orientation which asserted that the development and maintenance of mental disorders was explained by a person's biological, psychological, and environmental stressors (Clegg, 2012).Changes DSM-II (1968) were minimal and characterized by an increase in the number of disorders which some attributed the inclusion of milder forms of more serious mental conditions (Kawa & Giordano, 2012). Another change involved the slow movement away from a psychodynamic orientation (although most consider the DSM-II be largely grounded in that tradition), characterized by the removal of the term reaction from the definition of mental disorders (Clegg, 2012; Houts, 2000). Bigger changes, however, were on the horizon.DSM-III (1980), under the guidance of Dr. Robert Spitzer, contained 500 pages (an increase from 132 pages in DSM-II) and embodied significant changes in classifications and scientific notions about the etiology of mental disorders (Fischer, 20121). First, the manual's authors developed a criteria-based, classificatory approach diagnosis whereby one could determine the relative presence or absence of a set of specific psychiatric symptoms (Mayes & Horwitz, 2005). While some accused the new system of relying too heavily on a positivistic, research-based method of diagnosis for case formulation (McWilliams, 2013), others acknowledge the revision for its improvement in diagnostic clarity and reliability (Wilson, 1993). This move also represented a theoretical paradigm shiftfor DSM: from a predominantly psychodynamic a largely atheoretical approach. No longer relying on the presence of unobserved phenomena for the codification of mental disorders, the empirically-based system allowed an increasing number of practitioners whose training reflected an array of theoretical orientations use the manual (Neimeyer, 2013). This changed the focus of DSM from a manual of etiology (causes) a manual for diagnosis (Wilson, 1993).Another notable addition DSM-III was the introduction of the multi-axial system allowing the user compile a diagnostic profile based on: (Axis I) Diagnoses of clinical attention; (Axis II) Disorders of personality or intellectual ability; (Axis III) Medical and physical disorders; (Axis IV) Psychosocial and environmental problems; and (Axis V) A rating of highest adaptive functioning. According APA, this five-axis system was introduced to ensure that certain information that may be of value in planning and treatment and predicting outcomes for each individual is recorded (APA, 1980, p. 9).Subsequent revisions focused predominantly on refining the operationalization of disorders, updating statistical prevalence and incidence of disorders, and introducing and deleting new diagnoses based on prevailing clinical evidence. DSM-III-R (1987) was 594 pages in length and saw the removal of egodystonic homosexuality, the last remnant of a homosexualityrelated mental health disorder (Fischer, 2012). A notable addition DSM-IV (under the leadership of Dr. Allen Frances in 1994) involved the inclusion of a clinical significance standard many diagnostic criteria sets (i.e., the disorder must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning) (APA, 1994). …

Brigadier General James Stevens Simmons (1890–1954), Medical Corps, United States Army: a career in preventive medicine

James Simmons began his career in the US Army as a laboratory officer and his assignments progressed into tropical medicine research. His interests and work evolved into preventive medicine (PM, as the Army termed public health), and he took both a PhD and a Doctorate in Public Health. As the Army's leading PM officer he was appointed head of PM in 1940 and guided the Army's PM effort through World War II. His responsibility ran from gas masks through healthy nutrition and occupational health to an enormous variety of diseases; by the war's end, the breadth and importance of PM was reflected in the Preventive Medicine Division, having fully one-sixth of all military personnel at the Surgeon General's Office. Simmons used his strong professional credentials to tap into civilian medicine for expertise the Army lacked and he established organizations that survive to this day. After retirement, he sought to expand the field of public health and raise another generation of public health physicians.

Charles G. Gross. A Hole in the Head: More Tales in the History of Neuroscience. Cambridge, MA: The MIT Press, 2009. 336 pp. $35.00 (cloth). ISBN‐13: 978‐0‐262‐01338‐3

Journal of the History of the Behavioral SciencesVolume 47, Issue 1 p. 115-116 Book Review Charles G. Gross. A Hole in the Head: More Tales in the History of Neuroscience. Cambridge, MA: The MIT Press, 2009. 336 pp. $35.00 (cloth). ISBN-13: 978-0-262-01338-3 Douglas B. Gibson Ph.D., Douglas B. Gibson Ph.D. U.S. Air Force Surgeon General's Office, AFMSA/SGR, Falls Church, VASearch for more papers by this author Douglas B. Gibson Ph.D., Douglas B. Gibson Ph.D. U.S. Air Force Surgeon General's Office, AFMSA/SGR, Falls Church, VASearch for more papers by this author First published: 04 January 2011 https://doi.org/10.1002/jhbs.20479Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume47, Issue1Winter 2011Pages 115-116 RelatedInformation

Hotline Proves Valuable Tool in Preventing Vets' Suicides

Back to table of contents Previous article Next article Government NewsFull AccessHotline Proves Valuable Tool in Preventing Vets' SuicidesAaron LevinAaron LevinSearch for more papers by this authorPublished Online:17 Oct 2008https://doi.org/10.1176/pn.43.20.0013It's tough enough being a military veteran with memories of war still racing around inside your head, but it can get bleaker when the current conflict charges into your living room through the television set.When Thomas Berger, Ph.D., senior analyst of veterans' benefits and mental health issues for the Vietnam Veterans of America, heard that a documentary about an emergency room in Iraq was scheduled to appear, he called Janet Kemp, R.N., Ph.D., national suicide-prevention coordinator for the U.S. Department of Veterans Affairs. Kemp made sure that the VA Suicide Prevention Hotline had extra staff on hand on the nights the program was aired.In its first 13 months of operation, through August, the Suicide Prevention Hotline fielded more than 69,000 calls, of which more than 32,000 identified themselves as veterans, their family members, or friends, Kemp told members of the House Veterans Affairs Subcommittee on Health in September. Another 789 calls came from active-duty military personnel who were eventually referred to Department of Defense sources of care. The other calls came from non-veterans or persons who did not disclose their status.The two biggest groups of callers who stated their era of military service were veterans of the current conflicts or the Vietnam War.The system referred 5,980 calls to suicide-prevention coordinators at VA medical facilities around the country. The call system led to 1,628“ rescues,” events in which a caller is in imminent crisis, and police or ambulance services are sent to the caller's address.The hotline is based in upstate New York, near the Canandaigua Center of Excellence for Suicide Prevention. The VA call-in system uses the federal Substance Abuse and Mental Health Services Administration's National Suicide Prevention Lifeline at (800) 273-TALK, but prompts veterans to“ press 1” to reach one of six phone lines staffed around the clock by nurses, social workers, or psychologists who have been specially trained as responders, she said.The VA is taking steps to increase awareness of the hotline, Kemp said in response to a question from subcommittee Chair Michael Michaud (D-Maine).In June, VA Secretary James Peake over-turned a ban on paid advertising to support the hotline, but the VA is still developing a request for proposal for advertising services and measurements.A pilot program in the Washington, D.C., area used advertisements in buses, subway stations, and subway cars to inform veterans about help available through the VA's suicide hotline.The campaign led to doubling the number of calls from the region, and radio announcements have been effective in rural areas, Kent said. “But it will take a lot of different methods to reach a lot of different segments of the population.”Call-center personnel in Canandaigua ask the callers for permission to look at their VA medical records and see if the caller is enrolled in the VA, she said.Once or twice a day, all the lines are in use, so the call center can switch additional incoming calls to overflow call centers with staff trained to handle calls from veterans.An average of 18 veterans commit suicide every day, noted Kemp. The Department of Veterans Affairs convened a panel on suicide prevention during the summer. Among other points, the panel recommended that the VA design a study to identify suicide risk among veterans, improve suicidality screening for veterans with depression or posttraumatic stress disorder, apply evidence-based research to the choice of treatments, and increase research about suicide prevention.In his testimony to the subcommittee, Berger praised the VA's hotline—especially “in the absence of any yet implemented VA national suicide surveillance plan or program”—but said that the hotline could do more to track the daily number of calls, collect clinical information (such as prior suicide attempts) and combat status during the call, and employ a tracking system to follow up with callers.In related news, the U.S. Army announced that 62 soldiers had committed suicide through August. The service was investigating 31 deaths as possible suicides. There were a total of 115 suicides in 2007 and 102 in 2006, according to data previously released by the Army.Concerned about the rising numbers, the Army Surgeon General's office announced expansion of its suicide prevention programs, moving from education and awareness efforts to training soldiers and their families to“ actively intervene” when signs of suicide appear.More information on the hotline is posted at<www.suicidepreventionlifeline.org/Veterans/Default.aspx>.▪ ISSUES NewArchived

Suicide Among Soldiers Still Rising as Stress Piles Up

Back to table of contents Next article Professional NewsFull AccessSuicide Among Soldiers Still Rising as Stress Piles UpAaron LevinAaron LevinSearch for more papers by this authorPublished Online:20 Jun 2008https://doi.org/10.1176/pn.43.12.0001Suicides among active U.S. Army soldiers increased for the second straight year, as 117 soldiers killed themselves in 2007, according to a report released on May 29.There were 934 nonfatal suicide attempts. The numbers of suicides and attempts were the highest in recent years. In 2006, 102 soldiers took their own lives.Of those who died by suicide in 2007, 29 killed themselves during service in Iraq and four while in Afghanistan.The increase comes at a time when the Army is recruiting more mental health professionals, conducting Army-wide training programs to fight the stigma surrounding mental health issues, and beginning to integrate screening and treatment for posttraumatic stress disorder (PTSD) and depression into primary care settings.“I am saddened and frustrated that the number of suicides hasn't declined,” said psychiatrist Col. Elspeth Cameron Ritchie, M.C., director of behavioral health in the Army Surgeon General's office, in an interview with Psychiatric News. But many of the Army's interventions were too recent to show any effect on the 2007 figures, she said.Similar demographic factors characterized suicidal behavior in both 2006 and 2007, according to the Army Suicide Event Report. The Army requires a formal report on any suicidal behavior that results in a soldier's hospitalization, evacuation, or death.Demographically, soldiers who completed or attempted suicide were most likely to be young, Caucasian, and in the lower enlisted ranks. About 95 percent of those completing suicide were men, while 27 percent of those attempting suicide were women—about twice their proportion in the Army overall.Use of firearms, military or nonmilitary, accounted for 63 percent of deaths, while overdoses (60 percent) and cutting (19 percent) were the prime methods for those attempting suicide. Most attempts and completed suicides occurred at the soldier's personal residence.Suicide rates (19.5 per 100,000) adjusted for gender and age are roughly comparable to civilian rates, but both protective and risk factors are different enough that comparisons are not useful, said Ritchie.“They are both more resilient and more vulnerable,” Ritchie noted. “Soldiers are prescreened and get all their health care free, but also have access to lethal weapons and face the stresses of war.”A recently failed intimate or spousal relationship was again the most common association with completed or attempted suicide, according to the report. However, being married was slightly protective for completed suicides but less so for attempts while in the two war zones.About 44 percent of those who completed suicides and 55 percent of those who attempted suicide also had a history of at least one diagnosed mental disorder, mainly mood or anxiety disorders, or substance abuse.Soldiers who had served at least once in Iraq or Afghanistan accounted for 61 percent of completions (n=66) and 33 percent of attempts (n=304). Only eight soldiers who completed suicide and 64 who made attempts were reported to have histories of multiple deployments to the two war zones. The report did not compare suicides with a history of combat injury, said Ritchie.Many factors commonly associated with deployment could not be associated with the suicides assessed in this study. PTSD was diagnosed in only seven completed cases, and direct combat experience in 26—although this latter information was unavailable in over one-third of cases.A recent study by Army researchers found that rates of mental health problems six months after soldiers returned from war was higher among Reserve or National Guard troops than among regular active-duty soldiers. However, the 2007 Army suicide report found that members of the Reserve or National Guard were less likely to commit suicide than their regular Army peers.The Army's Battlemind program, which prepares troops for the psychological stresses of deployment, combat, and return home, and prepares their families for separation, proved protective against those stresses, according to last fall's Mental Health Advisory Report-V (Psychiatric News, April 4). While Battlemind is not specifically an antisuicide program, the Army had no data on whether soldiers who had taken the training (usually on a unit basis) were less likely to commit suicide.The Army's various interventions may eventually bear fruit in terms of reducing suicidal behavior, but there is no panacea that will prevent suicide in the service, said Ritchie.“We don't know what the numbers would be without these programs,” she pointed out. “But the current high level of operations tempo will persist, and there is no guarantee that the suicide rate will go down.”The Army Suicide Event Report for 2007 is posted at<http://media.mcclatchydc.com/smedia/2008/05/29/19/Army-Suicide.source.prod_affiliate.91.pdf>.▪ ISSUES NewArchived

Two Confederate Hospitals and Their Patients, Atlanta to Opelika (review)

Reviewed by: Two Confederate Hospitals and Their Patients, Atlanta to Opelika Gert H. Brieger Jack D. Welsh . Two Confederate Hospitals and Their Patients, Atlanta to Opelika. Macon, Ga.: Mercer University Press, 2005. viii + 183 pp. Maps, tables. Appendix on CD-ROM. $35.00 (ISBN-10: 0-86554-971-0; ISBN-13: 978-0-86554-971-5). The medical history of the American Civil War has, in the last few years, become popular again. Statistics of the northern side of the war, of the sick, the wounded, [End Page 205] the dead, have been available since the publication of The Medical and Surgical History of the War of the Rebellion in the later decades of the nineteenth century. Because so many of the records of the Confederacy went up in the flames of Richmond in April 1865, the Confederate medical story has had more gaps. Yet there are some good caches of records, and one of them supplies the data for this book. The medical director of the Army of Tennessee, Dr. Samuel H. Stout (1822–1903), carefully preserved 1,500 pounds of hospital records in the hope of producing for the South what the Surgeon General's office of the Union Army produced for the North. Before his death Stout wrote some articles, but he never obtained the necessary funding to allow him to write a more complete history. For a time after his death his daughters preserved the records, but then slowly dispersed them; the bulk is now at the University of Texas in Austin and at Emory University in Atlanta. It is the extensive records of two of the many hospitals that Stout supervised that form the basis of this book. Founded as a single hospital on the Atlanta fairgrounds in 1862, they were divided into Fairground No. 1 and No. 2 early in the next year. They received many of the wounded at the battle of Chickamauga in 1863. As Sherman approached Atlanta in 1864, Stout ordered the hospitals moved to other Georgia towns, and eventually to Mississippi and Alabama. It is the records of 18,905 patients in these two hospitals that Jack Welsh has analyzed in print and on an enclosed CD-ROM. The result is full of medical information, but it is not a narrative of the medical care received in the two hospitals and is therefore not easy reading. For the narrative history of Stout's work, Glenna Schroeder-Lein's Confederate Hospitals on the Move (1994) is still the place to go. Welsh's focus is on the nearly nineteen thousand admissions, 16,269 of whom received specific diagnoses, with a total of 213 different diagnostic designations. He has also traced the final disposition of 17,120 patients. As one would expect, intestinal disease and pulmonary problems predominated. Surprisingly, there were only 675 deaths recorded. Unfortunately there is virtually no mention of surgery, although 4,380 were listed as wounded or injured. It is true, as Welsh points out in a very good concluding chapter on comparisons with other hospitals (both North and South), that many of the seriously wounded were treated near the battlefields or died of their injuries before they could be shipped to hospitals in the rear. It seems fair to say that Dr. Welsh excels in compiling information, as witnessed by two previous books about the medical histories of Union and Confederate generals. In this one, too, he has included brief biographical sketches of fifty-three of the surgeons who served in one of the Fairground Hospitals. Although the military doctors were referred to as "surgeon," many of them spent most or all of their time taking care of the sick or the wounded who so frequently developed infections. This book provides an interesting sample of patients, and Welsh's description and analysis give us a richer and more precise understanding of the work of the doctors and the suffering of their patients. Gert H. Brieger Johns Hopkins University (emeritus) Copyright © 2008 The Johns Hopkins University Press

Quinine Substitutes in the Confederate Army

During the Civil War, the unreliable supply and high cost of quinine forced the Confederate Army to use alternative treatments for malaria. Many quinine substitutes were mentioned in the literature of the time, but relatively few were advocated by Confederate officials and even fewer are described in surviving records. Medical supply officers often issued substitute remedies when quinine was requisitioned. Most alternative treatments were made from indigenous plants such as dogwood, willow (a constituent of which gave rise to aspirin), and tulip tree. High hopes were held for Georgia bark, which was thought to be closely related to cinchona, from which quinine was derived. Documentation of the effectiveness of quinine substitutes is scanty but is most plentiful for the external application of turpentine. The quinine substitutes were generally considered useful but not as effective as quinine. The Confederate Surgeon General's Office was active in seeking out and supplying troops with quinine substitutes.

Assisting Hurricane Evacuees in Houston and Louisiana

Skip Skivington, MBA, Editor Fall 2006 - Volume 10 Number 3 On Saturday, September 10, 2005, the California Emergency Medical Services Authority called. The US Surgeon General's Office had requested that the state provide medical support in the Houst

Medline in the UK: pioneering the past, present and future

This article provides a brief history of the development of the MEDLINE database and its huge impact within the UK, from its inception to the present time. The origins of MEDLINE can be traced back to a collection of books in the US Surgeon General's Office during the American Civil War and John Shaw Billings' decision, during 1867, to make this Library as complete as possible. From these beginnings, Index Medicus was developed in the early years of the 20th century, and electronic versions of the database began with the computerized on-demand search service MEDLARS in 1964 and then via CD-ROM and Internet Grateful Med to the web-based and free-to-all service, PubMed, in 1997. The response to PubMed was immediate and startling with usage increasing from 7 million searches per annum in 1996 to 400 million searches per annum in 2001 and the service continues to improve. MEDLINE providers are now offering mapping of natural language queries to the sophisticated indexing vocabulary (Medical Subject Headings, MeSH) and the provision of specific filters for different types of publication to improve searching efficiency, as well as links to full-text versions of the papers where available. The next steps are likely to involve an increased blurring of database and full-text boundaries, incorporating seamless access to the best available evidence within MEDLINE and a wide range of other information resources within a single search and to an increasing amount of full-text via various open-archive initiatives. As ever, the US National Library of Medicine is in the vanguard of research and further applications of its MEDLINE database for users within the UK will be awaited with great interest.

Human exposure to 2450 MHz CW energy at levels outside the IEEE C95.1 standard does not increase core temperature.

Permission was received from the Brooks AFB Institutional Review Board and the AF Surgeon General's Office to exceed the peak power density (PD = 35 mW/cm(2)) we had previously studied during partial body exposure of human volunteers at 2450 MHz. Two additional peak PD were tested (50 and 70 mW/cm(2)). The higher of these PD (normalized peak local SAR = 15.4 W/kg) is well outside the IEEE C95.1 guidelines for partial body exposure, as is the estimated whole body SAR approximately 1.0 W/kg. Seven volunteers (four males, three females) were tested at each PD in three ambient temperatures (T(a) = 24, 28, and 31 degrees C) under our standard protocol (30 min baseline, 45 min RF exposure, 10 min baseline). The thermophysiological data (esophageal and six skin temperatures, metabolic heat production, local sweat rate, and local skin blood flow) were combined with comparable data at PD = 0, 27, and 35 mW/cm(2) from our 1999 study to generate response functions across PD. No change in esophageal temperature or metabolic heat production was recorded at any PD in any T(a). At PD = 70 mW/cm(2), skin temperature on the upper back (irradiated directly) increased 4.0 degrees C in T(a) = 24 degrees C, 2.6 degrees C in T(a) = 28 degrees C, and 1.8 degrees C in T(a) = 31 degrees C. These differences were primarily due to the increase in local sweat rate, which was greatest in T(a) = 31 degrees C. Also at PD = 70 mW/cm(2), local skin blood flow on the back increased 65% over baseline levels in T(a) = 31 degrees C, but only 40% in T(a) = 24 degrees C. Although T(a) becomes an important variable when RF exposure exceeds the C95.1 partial body exposure limits, vigorous heat loss responses of blood flow and sweating maintain thermal homeostasis efficiently. It is also clear that strong sensations of heat and thermal discomfort will motivate a timely retreat from a strong RF field, long before these physiological responses are exhausted. Published 2001 Wiley-Liss, Inc.

Prescription of resistance training for health and disease.

When prescribed appropriately, resistance training is effective for developing fitness, health, and for the prevention and rehabilitation of orthopedic injuries. Because resistance training is an integral component in the comprehensive health program promoted by the major health organizations (e.g., American College of Sports Medicine, American Heart Association, American Association of Cardiovascular and Cardiopulmonary Rehabilitation, Surgeon General's Office), population-specific guidelines have recently been published. The current research indicates that, for healthy persons of all ages and many patients with chronic diseases, single set programs of up to 15 repetitions performed a minimum of 2 d x wk(-1) are recommended. Each workout session should consist of 8-10 different exercises that train the major muscle groups. Single set programs are less time consuming and more cost efficient, which generally translates into improved program compliance. Further, single set programs are recommended for the above-mentioned populations because they produce most of the health and fitness benefits of multiple set programs. The goal of this type of program is to develop and maintain a significant amount of muscle mass, endurance, and strength to contribute to overall fitness and health. Patients with chronic diseases (e.g., arthritis) may have to limit range of motion for some exercises and use lighter weights with more repetitions.