Saturday, March 21, 2020

Jonathan Letterman, MD

Everyone knows about the new enemy, Covid-19. This expression is meant to  suggest that we can learn from military experience. Given that the Army Corps of Engineers has stepped up to convert buildings in several cities into hospitals, we ought to look at that process and the players. The process involves meeting several requirements with respect to cleanliness and effectiveness. By way of comparison, this is a brief note about field hospitals which can be compared to the U.S. Navy's hospital ship that has been put into action.

In terms of context, we are talking the future where everyone is elated due to an initial flattening of the curve as they figure that we've won. Well, no. Down the pike will be recurrences. The current effort is to help handle those future cases. How permanent these need to be is unknown. Earlier this year, China put together a hospital in less than two weeks. These are consider temporary structures but met the requirement. What are the longer term necessities?

100 years ago, we had the Spanish flu. We have had a post or two about that (Ground zero). This coincided with the efforts at supporting Europe in WWI. So, there were lots of impacts from a reduction of the male population. England's ordeal has been covered quite well over the years. Now, we're seeing a resurgence of some type of threat that we ought not have lost sight of. Oh yes, inoculation? Cannot cover the basis. One contributing factor was technology and its child, globalization. So, there is nothing easy here.

Photo by Alexander Gardner
The interest of the TGS, Inc.? You bet. First, we will focus on Dr. Letterman. He is the namesake of the Army Hospital that was situated at the Presidio of San Francisco. So, lots of history. Too, Dr. Letterman is involved with the western movement. He was out in Kansas and other points west in the 1850s. This was before his real contribution. Which was? He is considered the 'Father of Battlefield Medicine' and is noted for his humane treatment of the wounded from both sides of the Civil War in the U.S. His introduction of improvements grew out of the experience of the Battle of Antietam. By Gettysburg, his contributions were seminal. There were heavy casualties. His methods saved a lot of people.

Dr. Letterman got his MD degree from the University of Washington and Jefferson in 1849. The U.S. Army offered him a commission. So, his career in the military and after will be of note. Hence expect several posts. He was later a coroner in San Francisco. This would have been after the wild times of the gold rush, however SF was a major port. Lots of tales there.

More information on Dr. Letterman.
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We have taken several themes in the context of the groupings by year. As D.A.R. is telling us, we have the 250th coming up in 2026. So, we have that as a focus. Before that, we had the 100th of the coming over. Guess what? People were too involved in survival to celebrate, however we will look to see if any researcher/writer mentioned this. That was just a few years post the Salem idiocy (Andover ordeal). On the other side, it was post the Revolution and Lewis/Clark that we saw the major moves west. Some of this was by water; however, we need to look at those special situations related to moving by land (trails, et al). Dr. Letterman was further west (New Mexico). We can add efforts of the U.S. Army to our look at the western movement.

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When I first got to editing on Wikipedia, I added information to Dr. Letterman's profile. We think of hospitals as permanent structures, but there are many times when a temporary structure is required. Say, post a tornado. I have seen many rise and function for a year or two while the rebuilding took place. The naval hospital ship has gone to many a port over the past decade or so.

Provisions have to be there, though, for future use which means warehousing. And, those things warehoused must be managed for replacement due to time, fatigue, or just orneriness by nature.

Personally, I remember that after Korea that the U.S. Army worked to improve the field hospital (think MASH). My role was in the operating room (surgical specialist) which consisted of a GP medium and small. The joy of it? Going out into the fields and mountains in blackout conditions (vehicles and flashlights were limited light; tents had entry way with flaps to conceal ins and outs) and setting up the operating room overnight in all types of weather. And, that whole set of material fit into a 2 1/2-ton truck with a trailer. The overall hospital had several wards.

Oh yes, what tent went up first? The mess, what else? You have to take care of the workers.

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We see that Virginia hospital is setting up a field hospital in a parking garage. Good thinking.

Remarks: Modified: 04/04/2020

03/29/2020 -- Today, I listened to a MD (Respiratory specialist) talk about his experiences with Covid-19, on a daily basis for a while now, in an environment with hundreds of beds in a highly stressful place (U.S.). His message dealt with contagion and other aspects that will be answered eventually. Right now, there is a lot of mania/hype on the internet and other media (TV). So, it was good to hear an expert speak. And, the result of listening to the guy? A calming effect. I'll forgo the details, but, for the most part, there are clear rules that will assist mitigation of the spread. Hopefully, those will become more clear and accepted. And, on the next go-around, we'll do better. Any chance that?

04/04/2020 -- With regard to this Spanish Flu, this video provides a very good overview of the times and the situations. The MD mentioned as identifying the problem early was Dr. Loring Miner.

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