{"id":40962,"date":"2013-10-20T12:24:59","date_gmt":"2013-10-20T16:24:59","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=40962"},"modified":"2013-10-20T18:36:41","modified_gmt":"2013-10-20T22:36:41","slug":"in-the-museum","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/10\/20\/in-the-museum\/","title":{"rendered":"in the museum&#8230;"},"content":{"rendered":"<div align=\"justify\">Well, I&#8217;m on the road checking out some of those Civil War sites in the North I&#8217;ve never visited. Yesterday, we were in Frederick Maryland, a town that was turned into a hospital when the big battles in that War were fought nearby &#8211; Antietem [Sharpsburg] in particular, where 22,000+ died in a single day [America&#8217;s bloodiest day]. There&#8217;s a small museum, <a href=\"http:\/\/www.civilwarmed.org\/\" target=\"_blank\">The National Museum of Civil War Medicine<\/a> in Frederick filled with unknown facts. Here are a few:<\/div>\n<ul>\n<li>\n<div align=\"justify\">Of the 620,000 soldiers that died in our Civil War, only 1\/3 died from combat. The rest died from disease. Number one? Dysentery.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Before the Civil War, the were almost no hospitals in the US. There were created by necessity during the War.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Some of the innovations during the War were the concept of Triage, the use of Field Stations, the coming of Ambulances.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">95% of the amputations were done under anesthesia.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">The ubiquity of field amputations was because they&#8217;d learned that the miniball injuries lead to sure sepsis and death.<\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">The volunteer greeter at the museum was an aged bearded man [it wouldn&#8217;t have taken much to make you believe he actually fought in that War himself]. He rolled off his practiced spiel in the elevator. He said something like: &quot;<strong><font color=\"#200020\">This is a trip back to a time when it was the Art and Practice of Medicine that mattered. It was a time before Science came to Medicine.<\/font><\/strong>&quot; And the museum bore that out. With the exception of Opium and anesthetics, the few medications they used were toxic heavy metals and odd potions, none of which would have made it through the FDA [or even to the FDA]. Forget efficacy &#8211; they would&#8217;ve flunked Adverse Effects. Our guide went on to say, &quot;<strong><font color=\"#200020\">Forget about diseases &#8211; and treating diseases. This was a time for treating symptoms.<\/font><\/strong>&quot; My mind added &quot;<strong><font color=\"#200020\">badly<\/font><\/strong>.&quot;   <\/div>\n<p align=\"justify\">One little section of the museum was devoted to <a href=\"http:\/\/www.civilwarmed.org\/clara-bartons-missing-soldiers-office-museum\/about-clara-bartons-missing-soldiers-office\/\" target=\"_blank\">Clara Barton<\/a>, founder of the <a href=\"http:\/\/www.redcross.org\/about-us\/history\/clara-barton\" target=\"_blank\">American Red Cross<\/a>. She got her start delivering supplies to the hospitals [at Antietem, her supply wagons followed the cannon fire]. But she did more than that, offering personal support and personal attention to the wounded soldiers [on both sides]. After the War, she directed the Missing Soldiers Office, for example, identifying all but a few hundred of the thousands that died at Andersonville Prison &#8211; helping the grieving families come to closure. Her section of the museum was but a small testimonial to Clara Barton&#8217;s legacy &#8211; apparent today in every disaster. Her American Red Cross has become synonymous with the better side of the human enterprise.<\/p>\n<p align=\"justify\">The next stop was Harper&#8217;s Ferry, site of John Brown&#8217;s attempt to end slavery by capturing the US Armory and distributing the guns and ammo there to slaves for a violent uprising. He had 21 men and he held the Armory for just 36 hours. Even that&#8217;s an exaggeration. It was 36 hours before he was captured after being holed up in a small building. It may have been the spark that ignited the Civil War, but, to be honest, it was a mighty small spark seen in person. I&#8217;m thinking if something of value came from that ill-fated war, we&#8217;d put Clara Barton on the front page and John Brown in the footnotes. The real freeing of the slaves in the South took another century, and it wasn&#8217;t violence that made it happen. At least that&#8217;s how it looks to me.   <\/p>\n<div>So back to our greeter at the museum:<\/div>\n<blockquote>\n<div>&quot;<strong><font color=\"#200020\">This is a trip back to a time when it was the  Art and Practice of Medicine that mattered.<\/font><\/strong>&quot; <\/div>\n<div>&quot;<strong><font color=\"#200020\">It was a time before Science  came to Medicine.<\/font><\/strong>&quot;<\/div>\n<div>&quot;<strong><font color=\"#200020\">Forget about diseases &#8211; and treating diseases.<\/font><\/strong>&quot;<\/div>\n<div>&quot;<strong><font color=\"#200020\">This was a time for treating symptoms.<\/font><\/strong>&quot;<\/div>\n<\/blockquote>\n<div align=\"justify\">My thoughts were predictable. After a pretty hearty romp on the side of treating diseases, I gravitated to what I considered the more humanitarian side of things and became a psychotherapist. I was at my best in the years I taught medical students, where I leaned the Behavioral Science course into a course about the psychological consequences of &quot;being sick,&quot; something I&#8217;d learned about in an Internal Medicine practice formalized some by psychiatric training. I was more suited for the Clara Barton side of Medicine than as a Field Surgeon, though I enjoyed both. The Civil War surgeons are still seen as &quot;butchers&quot; because there were so many amputations, but they were following science &#8211; and they were right. There was no treatment for infection. The germ theory of diseases was still &quot;germinating&quot; in the mind of Louis Pasteur across the pond at the time of our Civil War. Those surgeons saved lives by desperate measures, but it was solid science for that day. Clara Barton saved something else, something equally important.<\/div>\n<p align=\"justify\">I wanted to say to our greeter, &quot;<strong><font color=\"#200020\">You know, there&#8217;s nothing wrong with treating symptoms. After all, it&#8217;s what people want first and foremost anyway. But those chemicals in those ancient vials in your museum aren&#8217;t very good for that &#8211; too toxic. Mercury doesn&#8217;t do much for people that&#8217;s good for them. We have this rule &#8211; Do No Harm.<\/font><\/strong>&quot; But what I thought about later was that this whole business of Clinical Trials in psychopharmacology that I write about is right in the center of this 150 year ago discussion. These are symptomatic medications we&#8217;re talking about. As much as many try to turn this into a discussion of treating disease [as listed in the DSM-5], it&#8217;s the symptoms of psychosis, depression, mania, anxiety, inattentiveness that are measured in a clinical trial &#8211; not diseases. I suppose that&#8217;s a point Dr. Szasz might make, though I&#8217;m not sure that he would be altogether justified in his claim that there are no diseases proper in psychiatry, but in terms of treatment, we might agree. We&#8217;re primarily treating symptoms. Again, there&#8217;s nothing wrong with that, if we do it right.<\/p>\n<div align=\"justify\">There are two rules in the symptomatic treatment of disease:<\/div>\n<ul>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">Don&#8217;t mask underlying disease.<\/font><\/strong> Don&#8217;t give someone with acute right lower quadrant abdominal pain a shot of Morphine. The diagnosis of Appendicitis is made by the course of the symptoms. Once you give a pain shot, you end up having to operate and will do a lot of unnecessary operating on people who have a virus or an inconsequential painful ovulation.<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><strong><font color=\"#200020\">Do no harm.<\/font><\/strong> Don&#8217;t treat symptoms if the consequence is disastrous like putting someone with rheumatoid arthritis on maintenance steroids and giving them another long-term illnesses unnecessarily.<\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">I suppose there&#8217;s a third rule<\/div>\n<div align=\"justify\">\n<ul>\n<li><strong><font color=\"#200020\">Don&#8217;t lie about the Efficacy or Adverse Effects of medications<\/font><\/strong> &#8211; like happened with the psychopharmacological agents in the era from 1987 to the present. There&#8217;s nothing wrong with the drugs. They are what they are. But they&#8217;ve been used as if they&#8217;re what we want them to be [and they aren&#8217;t].<\/li>\n<\/ul>\n<\/div>\n<div align=\"justify\">So my comrades in travel are off hiking at Gettysburg this morning. I&#8217;m joining them for a bus tour of the Battlefield this afternoon. Two spinal fusions and 71 years have put an end to my hiking days. The surgeries were a big help, but hardly a cure. Some symptomatic medications helped and I&#8217;m glad for the help, but adapting to infirmity and learning to live with that adaptation has been the key to success [along with one on those handicapped stickers that gets me closer to the doors of the bus]. Other symptomatic medications, more powerful, might help even more with the symptoms, but they carry a very loud &quot;uh-oh.&quot; In psychiatry, the very loud &quot;uh-oh&quot; of our drugs was suppressed far too long, and we&#8217;ve been ignoring the Clara Barton side of things. That&#8217;s what I thought about at the <strong><font color=\"#200020\">The National Museum of Civil War Medicine<\/font><\/strong>&#8230; <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Well, I&#8217;m on the road checking out some of those Civil War sites in the North I&#8217;ve never visited. Yesterday, we were in Frederick Maryland, a town that was turned into a hospital when the big battles in that War were fought nearby &#8211; Antietem [Sharpsburg] in particular, where 22,000+ died in a single day [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-40962","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40962","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=40962"}],"version-history":[{"count":11,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40962\/revisions"}],"predecessor-version":[{"id":40973,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/40962\/revisions\/40973"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=40962"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=40962"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=40962"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}