Friday, May 01, 2009

Give 'em what they want. Which is...?

Apologies to you, gentle reader, if you are coming to this blog for thoughts on the history of the health sciences today. I'm feeling, as Laurence Sterne would say, a bit hobby-horsical about professional matters (and yes, there are more professions than just the one called medicine, although I suspect some physicians I know would argue that point with me. Bring it on! But after this.)

We have an intern in Historical Collections & Archives this week, and interns always provide stimulus for one to think more deeply about what one is doing, and why. Many regular readers will remember past posts (some here) deriding the universal utility of what archivists Greene and Meissner called MPLP ("more product, less process"), a worldview that espouses less physical processing and detailed inventorying of collections in an effort to make more materials available to the users.

We've discussed the burden shift that comes with minimal processing (from processing staff to reference staff and/or patron) and the physical damage that can result to collections that remain unprocessed. When chatting about it with our intern though, another thought struck me: the irony that libraries and archives are both altering their processes to "give users what they want," but while libraries are looking to add more information about already well-known items (tables of contents, book reviews, tags), some archives are advocating for recording less information about collections than ever before. It's almost as if libraries and archives are coming closer together in their institutional outlooks--and two worlds this much at odds (think toned-down querelle des femmes) might actually cross paths on their roads to (supposedly) mutual destinations.

Users want more, not less. I think we all agree on that. What "more" means and how to provide it, ah, well, there's the rub. The view from here seems to show a varied landscape, where some institutions and some collections of what we might call monoculture (flatlands of one type of record, or one subject focus) could implement an MPLP-style workflow, but other, more diverse institutions and collections (hills and valleys and pockets of materials, subjects, formats) would need a more locally-appropriate approach. HIPAA, for example, sets up nothing but gullies and sand dunes that need to be navigated in advance of any researcher request.

One possible modification of the MPLP approach for a polyculture repository might be a filter setting. Think of it as being akin to a spam filter. Trusted depositors could pass right through the MPLP filter, getting minimal processing, because staff would know that the depositor's record structure, file naming, and subject focus could be trusted. Depositors with less experience in arrangement and description of their materials would need to be stopped at the filter and dealt with then and there, before entering the repository and possibly wreaking havoc within. It's possible that with the rise of civilian archiving and the strengthening of personal collector networks on the web, we can expect to see more and more depositors that we can trust enough to pass the spam test.

As in all things, time will tell. Until then, I'll get back off the hobby horse and move on. Next week: NPLP (no posts on the library profession)!

Thursday, April 30, 2009

J.H.H. 1903-1904: Rare Hopkinsana at OHSU

Reading through a bookseller's catalog recently (PDF, see item #57), I came across an item which was immediately familiar: a photograph album from Johns Hopkins Hospital, titled "J.H.H., 1903-1904." The bookseller indicates the item's rarity by noting their own experience with two such albums, their further knowledge of one "in private hands", and fourteen at the Alan Mason Chesney Medical Archives at Hopkins. I guess ours brings the total to 18!

I had alluded to this scrapbook briefly in an earlier post about school yearbooks; at that time, I contacted the Hopkins archives to find out a little more about the history of these albums. There are two versions of the 1903-1904 album, one with 61 photos and one with 71. Ours is the 61-image version (a few of which are included here), with possibly some variation on the photo order and captions, as noted below.

The original owner of our book is not currently known, but there were several Hopkins men in Portland in the early part of the 20th century who might have been responsible for bringing this item to town. As always, if you have more information--or would like more information--about this piece, just give a holler.

OHSU's copy of "J.H.H., 1903-1904"

Typed label, front free endpaper: Photograph album on Osler's rounds at John [sic] Hopkins University
1. Johns Hopkins [Johns Hopkins Hospital, exterior view. Administration building]
2. Administration Building [different view]
3. Henry M. Hurd
4. Library
5. Osler's Rounds
6. The Chief
7. Rounds
8. William Osler, Rufus I. Cole
9. Osler
10. Osler-a characteristic pose
11. T. McRae-W. Osler, C. Howard
12. Osler and student
13. William S. Thayer "Sadie"
14. Thomas B. Futcher
15. Thomas McCrae
16. Rufus Cole
17. Charles P. Emerson
18. Campbell Howard
19. Thomas Boggs
20. Brush [possibly the photographer of the album images]
21. Resident's Library
22. Ward
23. Dedication of Halstead [sic] Surgury [sic]
24. Dedication of Halstead [sic] Surgury [sic] [different view]
25. William Stewart Halstead [sic]
26. Wm. Halstead [sic] with an X-ray
27. Wm. Halstead [sic] at dedication
28. Wm. Halstead [sic] at dedication [different view]
29. J.M.T. Finney - Smith
30. Hugh H. Young
31. Harvey Cushing
32. Richard Follis
33. William M. Sowers
34. Stephen H. Watts
35. [no caption; Camillus Bush?]
36. William S. Baer
37. Robert Miller
38. Joseph C. Bloodgood
39. William [sic] Baetjer
40. Women's Ward "B"
41. Gynecological Operating Room
42. Howard Kelly
43. Russell
44. William [sic] S. Cullen
45. Sampson
46. C. Burnham
47. Guy Hunter
48. Hutchins
49. “The Bridge”
50. Administration [different view]
51. William Welch "Popsy"
52. William McCallum [sic]
53. Charles Bunting
54. Back of wards
55. The Lawn
56. Whitridge Williams
57. Black and white [infants in ward]
58. Morris Slemmons [sic]
59. Little
60. [no caption; Dr. Francis C. Goldsborough?]
61. Back of Administration Building
Album maker's label: Housh Album 534 black leaves The Housh Co., Makers, Boston

Wednesday, April 29, 2009

If fame comes, can fortune be far behind?

Toot, toot! Yes, that would be the sound of my own horn, featured in this bonus second post of the day. After initial disbelief and surprise, and a week of convincing myself that the first announcement was probably a typo, we cannot deny that we have been named co-winners of Best Institutional Blog in the Best Archives on the Web Awards.

The realization that we were nominated was exciting enough; the award is truly humbling. The fact that we share the award with Peeling Back the Bark, which is a blog I really admire, was an added bonus. Our heartfelt thanks to the committee: Kate Theimer, Geof Huth, Jeanne Kramer-Smyth, Claude Zachary, and Tanya Zanish-Belcher.

And now, back to our regularly scheduled programming...

Hotelital? Hospitel? Luxurious living for the ill

Ah, swine flu. Some pundits are waxing nostalgic for mandatory quarantines and confinement of the sick. Sounds terrible to anyone who's been in a modern hospital room, all white and sterile and soulless. But what if you could stay at the equivalent of a hotel for the ill? Hospitals used to compete for patients (and physicians) by advertising their amenities, as in these two print ads from the pink pages of the 1905 Register and directory of physicians and surgeons in the state of California, to which is added a directory of physicians and surgeons of Oregon and Washington and a directory of California State Nurses' Association (and some other stuff too, like maps and legislation, but they couldn't squeeze all of that onto the title page and still have room for the logo of the Medical Society of the State of California...)

The North Pacific Sanatorium notes that it is "situated in the most select residence portion of the City of Portland" (hospitals make great neighbors!), while the Portland Sanitarium implies that it is located in the mountains (although I hardly think Mt. Tabor qualifies).

What do you think? Would you be less afraid of getting sick if you had a relaxing locale such as these to which you could retire to get well?

Tuesday, April 28, 2009

Cover the Uninsured Week. Decade. Century.

This week is national Cover the Uninsured Week (CTUW), and the students of OHSU have put together an incredible slate of public activities and events that highlight current realities and ongoing controversies about health care for the uninsured and the underinsured.

Just in time for this year's commemoration, our weekly donor Dr. Charles Grossman has brought us a reminder of the enduring nature of this conundrum. Along with manuscript letters from Jonas Salk and Earl Robinson, this week's packet of materials for the Grossman Papers includes the text of a talk Grossman delivered on October 28, 1974, titled "National Health Insurance and the Poor." He begins:
My role is to tell you what these insurance plans will do for the poor. I was offered twenty minutes in which to explain this. After much reading and soul-searching I can only say in all honesty that what I have to say is so close to zero that perhaps I should stop here and sit down!
While he, obviously, did not sit down at that point, Grossman did use this opportunity to remind the group that "Because the voluntary health insurance industry has really failed to offer coverage to most Americans, we are now facing the problem that should have been faced many years ago, namely that insurance coverage for all is a necessity."

One of the studies cited by Grossman in this speech was published by Mitch Greenlick et alii in Medical Care in 1972, "Comparing the use of medical care services by a medically indigent and a general membership population in a comprehensive prepaid group practice program" (1972 May-Jun; 10(3): 187-200). This study confirmed Grossman's own anecdotal evidence that people who don't have to worry about paying for a doctor's visit are much more likely to seek treatment early; the uninsured and the underinsured tend to delay seeking care until a condition is more advanced, and therefore, often more difficult to treat.

What Grossman's 1974 talk shows us, most of all, is that the issue of universal healthcare is not new, that the problems it seeks to solve are real and persistent, and that the solutions require a great deal of planning, forethought, and compromise. This week's events will hopefully shed more light on how we can get there from here.

Monday, April 27, 2009

Dental bling

About a year and a half ago, we shared Dean Lou Terkla's version of the story about business manager Gene Bauer allegedly speculating in gold futures down at the School of Dentistry. While that particular incident, occurring during the presidency of Lewis Bluemle, M.D. (1974-77), came at a time of rising gold prices, the market was nowhere near today's values.

A recently received document, the Schedule of Fees from the University of Oregon Dental School, as of October 1, 1963, helps put Dean Terkla's story into some context. Even before the era of "dental bling", the Dental School had no fewer than thirteen types of procedures that might include gold, from foil and inlays to cast gold space maintainers ($25.00).

The fee schedule provides a snapshot of dental services in transition: House Calls are still listed as an option ($5.00), while lab tests done for "Patients for Research Purposes" are given gratis. Patients could be referred to Nutritional Guidance (primarily for caries control) for a fee of $3.00.

The single most expensive item on the list is an obturator, which would set the patient (or his insurance company) back $150.00. Just in case the five-page schedule missed some potential service, a note at the end indicates that "Fees for the less common types of operations will be arranged by the head of the department concerned with the treatment." If you could dream it, they could do it... So who knows? Maybe in the post-Shaft years, Gene Bauer really was speculating--on the future popularity of grillz.

(Beautiful shot from Rob! on Flickr)