Fostering Public Participation, Not Just Reception

It is a common misconception that the responsibility for the wellbeing of our community lies entirely on public health professionals. As part of the common public, we often demand improvements in healthcare policies, resources and information in the mindset of a recipient. It is this one-way, “receiving” mentality that often hinders maximum efficiency of public health campaigns. Often, the public health campaigns will need the general public to contribute toward the projects, examples of which include blood drives, demanding blood donors, and disease prevention, calling for the public’s change in practice. Not only that, there can be many regional and racial limitations imposed through certain ways of delivering the need for participation. Such limitations arise from the context in which the information is presented as well as the accessibility of the medium. In other words, it is crucial to implement the need for active participation and a culture that creates a “dialogue” in needs of public health throughout all the different subsets of the population in order to achieve maximum campaign efficiency.

By targeting the managers of public health campaigns, we strive to shift the atmosphere of public health from a one-way delivery of information for a small subset of the population toward a widespread dialogue between the people and the public health officials. We will ultimately address the fact that calling forth action from a larger population in a nondiscriminatory manner will maximize public health campaign efficacy.

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Current range of KUHF radio transmittance (https://www.houstonpublicmedia.org/news887/ways-to-listen/)

To do so, our project will evaluate the efficacy of Passing in Review’s instigation of public participation for MD Anderson’s newly opened Blood Bank. Aired on KPRC radio in Houston, 1946, Passing in Review can be taken as an example of an attempt to increase public participation in public health issues. In particular, we will be analyzing the broadcast on two levels: we will firstly dissect how the need for blood donors was presented and secondly investigate the accessibility of the broadcast by different racial, socioeconomic and gender groups. For example, Passing in Review presented blood donation as painless and easily do-able through interviews with experienced donors. It also specifically called for women participants, specifying the similarities and differences in male and female donors. Doing so expands the target audience of the campaign from just males to both males and females. However, the intrinsic nature of 1940’s radiobroadcast spoken in English limits the audience to Houston’s wealthy, English-speaking population that owned radios, and did not have work late on Friday nights. This is a possible critique for Passing in Review’s campaigning efficiency. As such, analyzing the positive and negative aspects of the broadcast in expanding the population for blood donors will ultimately help us to pinpoint out what needs to be improved in regards to widening the range of participants.

Our project, keeping in mind that our audience is public health campaign managers, will take the form of a formal presentation, proposing what needs to be improved in the delivery of campaigns. We will also have websites and pamphlets ready to give out to these officials to further enhance accessibility to our guidelines on how to increase public participation. To effectively do so, we will research how accessible the Passing in Review broadcast was towards the different ethnic and socioeconomic groups and its resulting change in blood donation participants. This information can possibly be found through other archival records on increase in blood donors. We will pay special attention to what groups of individuals decided to donate their blood (we predict the majority to be of upper-class, Caucasian males). We will also research the campaigning methods utilized by current blood drives to point out what aspect of it, specifically, can be ineffective in reaching a broader audience, and how it can be improved. Such information can be found through public health campaigns found in various forms themselves including websites, pamphlets and radio broadcasts.

Drugs: Then and Now

Our project is concerned with the Psychiatric Bulletin, a collection of informational magazines that address various aspects of psychiatry, from jealousy in children to prejudice as a disease. In the bulletin, many of the articles address issues that we today would not consider diseases and outlines the cause, prevention, and treatment of the “disease”. Since the Psychiatric Bulletin covers such a wide range of topics, we decided to focus on one topic that appeared frequently throughout the nine volumes we had access to, the concept of drugs and drug abuse. We are going to analyze how drug use and abuse were portrayed in the 1960s, the purpose that drugs served in different fields of medicine, and the rationale that some psychiatrists had to explain drug addiction. The articles place an emphasis on the social and cultural aspects of drug addiction aside from the biological reasoning behind it, and our project will be examining these aspects as well.

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Picture featured in an article we will be analyzing in the Psychiatric Bulletin. This is a visual depiction of drug-induced psychosis. 

We will be constructing an informational brochure accompanied with a short video illustrating how exactly the culture of drug abuse was like in the 1960s. We thought a brochure would be appropriate because it is similar to the form of the archive materials, and the video would enhance the teaching aspect of the project. Our project is meant to aid in professional research, and is targeted towards medical humanities researchers interested in how drug addiction was created and viewed in the past. Hopefully our project will provide them with new information about drug addiction in the past and a new perspective on modern forms of drug abuse treatment, to ultimately facilitate drug abuse treatment nowadays and to employ the use of drugs in an effective way when necessary for treatment of other diseases.

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Breakdown of several different types of barbiturates. We will be analyzing an article about barbiturates in the 1960s. Image

We are planning on also covering the differences between drug culture in the past and in the present day. To do this, we will need to conduct some outside research beyond the archive materials provided by the Woodson and search for articles similar to the format of the articles in the Psychiatric Bulletin, but that were published relatively recently. We are anticipating to find noteworthy differences between the treatment of drug abuse in the past and the present and are hoping to relay these differences in our project to provide new insight about this topic to medical humanities researchers and interested students. By understanding the treatment of drug addiction in the past, researchers and professionals in the healthcare industry will be able to further enhance treatment of drug addiction in the present day. The 1960s were a time of hard-scale drug usage, and substance abuse is still a very prevalent problem in today’s society, and hopefully we will be able to connect the two time periods to analyze the culture of drug abuse through history.

Artificial Heart: Balancing Ethics, Policy, and Medical Research

Our archive is a collection of newspaper and magazine photographs and articles describing the development and first transplant of the artificial heart by Dr. Denton Cooley. We hope to focus on the aspect of following institutional and governmental rules and regulations in regards to conducting clinical trials and performing experimental procedures.

We have chosen to target our project at students studying public health policy. For example, Rice has a program of studies dedicated to public health management, which can be found here. We believe our archive would benefit these students by providing information about the multifaceted nature of public health policy. We hope our archive can reveal different perspectives on how to balance ethics, policy, and research to provide the most supportive environment for producing advancements in medicine.

Intersection of medicine and law (cambridgemedicine.wordpress.com)

Our project is important because the government and medical institutions play a large role in deciding what types of medical research should be funded and what types of medical research should be discontinued or hindered. Dr. Denton Cooley was able to successfully perform the first artificial heart transplant by disregarding federal regulations and hiding his research from his colleagues at the Baylor College of Medicine. Did his success justify his disregard for protocol? Were his actions ethical from a philosophical perspective? How can the government make policy that ensures ethical practice but does not hinder important medical research that can be used to improve public health practices? These are questions that our archive provides perspective into and can hopefully inspire policy studies majors.

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Medical World News article about Dr. Cooley’s unauthorized transplant (Image taken at McGovern Historical Center)

We chose to present our archive in the form of an informative website because students will be able to have direct access to primary sources taking the form of videos, photographs, and articles. A website is the most accessible for students and allows students to reference the material easily during their studies.

We will need to conduct further research into the atmosphere of government regulation of medical research during the time that Dr. Cooley performed his transplant, by analyzing the material in our archive. We can also research how government regulation either protects public health or hinders medical research today by consulting with medical practitioners and professors and finding journal articles written about the topic. We can research how our archive can fit into the curriculum of policy studies majors by talking to current majors and professors.

 

Looking Back to Move Forward

People often regard the field of science to be a study heavily focused on innovation: developing a treatment method better than the previous, building a device more effective than the previous, and doing research more groundbreaking than the previous. Inevitably, researchers are always looking to pump out studies to publish—“new” and “revolutionary”. Perhaps this “innovative” aspect of science that pushes us to be ever more forward-thinking may, in other cases, hinder us from appreciating the work that we, as a community of scientists, have accomplished. Trying to build on the most recent model of “best method”, often the models from years to decades ago can get chucked away. The visit to the McGovern Historical Center was an invaluable experience in that not only were we able to see the medical journals of the 60’s and get a hands-on feel for surgical tools from decades ago, but, ultimately, it was also a reminder to cherish the steps we took to stand where we are in science and medicine today. As I found out, there was still so much to learn from these decade old archives.

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Camman’s Model Stethoscope, circa 1900, very similar to the one at McGovern (Image: http://melnickmedicalmuseum.com/2009/12/01/a-short-history-of-stethoscopes/)

Prior to the visit, the thought of an archive brought to my mind stacks of old books, lined by manuscripts chronicled merely by their placement in the seemingly endless row of shelves. When we arrived, I was most excited to see the old models of the stethoscope and forceps that we now call DeBakeys after Dr. Michael DeBakey from Baylor College of Medicine—legend of cardiovascular surgery. I was pleasantly surprised to see the old nursing gowns as well as amputation kits used on war grounds. In particular, I found it intriguing that Sandra Yates, our archivist, pointed out that having wooden handles for the amputation saws was probably not a good idea. As soon as I heard this, I was disgusted by a major possibility of the Marburg virus being transmitted (as we read in Preston’s The Hot Zone) while, simultaneously fascinated at the importance of selection of materials in engineering surgical tools. The recognition of viral transmissions and health risks associated with handles that soak up blood was probably a major step forward in health care during the time period that followed.

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Surgical Kit, circa 1850-1880 (Image taken at McGovern Historical Center)

The archived surgical kit from around 1850-1880 helps us to recognize this fact. Furthermore, because our multimedia project handles the Passing in Review radio program, we were able to see the original record that holds the recording. Archivist Sandra Yates noted that even she was surprised to receive the abnormally big record. She also pointed out that there no longer is technology to retrieve audio from such huge records and that it was a good thing the audio was already retrieved few years ago. In this I saw 1) the importance of timely management of archival materials in different kinds of media and 2) the modern technology involved in retrieving archival materials such as old records and floppy disks.

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Passing in Review Record (Photo taken at McGovern Historical Center)

As I looked around more and started reading the journals, I was particularly interested in Cooley’s Step-by-Step Transplant Film published in October 4, 1968 in the Medical World News magazine. Being the cardiovascular surgery nerd I am, Dr. Cooley had only been the legendary figure pioneering heart transplants. Seeing the photographs from the first successful artificial heart transplant was truly a humbling experience. I asked Sandra if they had more films of Dr. Cooley’s and Dr. DeBakey’s surgeries and she was glad to let me know how to access the films. In particular, the deep hypothermic circulatory arrest (DHCA) surgeries and patients’ post-surgery reports from the time period were especially intriguing to me as a major research currently in cardiovascular surgery concerns neuronal damage as a result of DHCA. These are the kinds of archival records that help to identify flaws in surgical procedures still in use today.

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Cooley’s Step-by-Step Transplant Film published 04/10/68 Medical World News Magazine (Photo taken at McGovern Historical Center)

 

In sum, the field trip to the McGovern Historical Center was truly a humbling experience—being able to handle decade old magazines and surgical tools. I now recognize the importance of knowing where we started to acknowledge the innovations of today. I was further enlightened by the fact that such archival materials help to point out flaws that, decades later in time, we still try to understand (as in the case of DHCA surgeries). I am excited to revisit the McGovern Historical Center to scavenge for more Texas Medical Center surgery and patient records if chance allows.

Finding Order in Disorder

Before I set foot in the McGovern Historical Center, I envisioned a museum with fancy exhibits outlining the history and development of medicine at the Texas Medical Center. While my expectations were partially fulfilled with displays of different medical devices and surgical instruments, what I found most interesting in the archive were different articles written regarding various medical issues of the past, and issues we as young students in the age of modern medicine would regard as foolish and primitive. I found the fact that surgical instrument handles pre-germ theory were made of wood intriguing. Consequently, blood was able to seep into the handle, which created a dangerous working environment for health professionals.

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Organ-specific surgical tool kit used by doctors in the 19th century. (photo taken at the McGovern Historical Center, Houston, TX)

I gravitated towards the two artworks entitled the “Re-evaluation of Lobotomy” and “Lost Cry,” simply because of the emotional intensities underlying the pieces. In both works, I felt an unsettling sensation that led me to inquire of what the artist is truly trying to delineate and express to me.

In the “Re-evaluation of Lobotomy,” I was able to recognize the birth of biochemistry as a means of treatment for psychological and neurological disorders. In this piece, demons, animals, and creatures seem to come out of the brain of a skull, which illustrates past notions of psychological diseases. There seems to a hole in the skull, which shows how psychosurgery is able to solve these illnesses by “releasing” the entities that control the mind. However, after the success of drugs in treating personality disorders, psychosurgery was re-evaluated, and even considered the last resort for patients suffering mental illnesses, since psychosurgery’s effects on personality were drastic.

Another piece related to neurological and mental disorders was “Lost Cry” from the Psychiatric Bulletin. The piece depicts a greenish, monstrous figure with an intense fear in his eyes. His eyes are open wide in a full scream, and the artist’s use of chiaroscuro and contrast in light created an uncomfortable atmosphere for me. Although the piece was obviously silent, I was easily able to hear the loud and cacophonous cry of the patient in anguish. I believe this to be a picture of his inner subconscious turmoil, and the artwork does a tremendous job in expressing the patient’s real feelings, which would be impossible to utter in speech.

All in all, my eye-opening visit to the archive forced me to reconsider my perceptions of the past, in regards to both its medical technologies and its depiction of patients with mental health disorders. I have come to realize how medicine, or any topic, can be viewed through artistic lenses that are often able to reveal another layer of emotions than through words of mouth.

 

 

 

My First Hands-on Interaction With Medicinal History

As someone who had never been to an archive before, I thought that an archive would be an extremely formal, museum-like place full of old materials. Because of my preconceived notion of what I thought an archive would be, I merely expected an informational tour around the archives with not much interaction with the works that were being stored there. However, through our guide, archivist Sandra Yates, I learned that an archive is a place that stores and preserves unpublished works that can be easily accessed and interacted with. Even though there still is a formal attitude that must be maintained in order to respect the works in the archives, the atmosphere of the archives was a little more informal in the sense that the works there could be touched.

During my visit to the archives, I was most surprised at the fact that the items at the archives could be touched. This interesting characteristic of the McGovern Historical Center gave me my first opportunity to touch real surgical instruments, even if they were outdated. At the archives, we were able to pick up and observe each instrument in a surgical kit that was used from 1850-1880 before the germ theory of disease existed. Instead of stainless steel or any kind of metal for the handles, the surgical instruments’ handles in this kit were made out of wood. As a result, blood often seeped into the handles of the instruments, creating a home for infection and unsanitary buildup. Another work that caught my eye was the article from the Medical World News that was published on October 4, 1968. The article’s elaboration on Cooley’s step-by-step transplant film was enthralling because I was able to see pictures and read about the procedure in such detail. Also, after asking Sandra more about the transplant surgery, I learned that the McGovern Historical Center has the actual footage of the surgery itself, which was an even bigger surprise.

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Surgical Kit used from 1850-1880 (photo taken at the McGovern Historical Center)

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Article from Medical World News about Cooley’s step-by-step heart transplant (photo taken at the McGovern Historical Center)

Being able to see works from centuries ago all the way up to modern day confined into one big space was fascinating. Through our class visit to the McGovern Historical Center, I was able to see how medicine and its history have changed over the years due to improving technology and constant research by scientists- an example being the surgical kit. Now, I know that archives are more than just a library full of information that can only be accessed from afar. Instead, I know that archives serve as an interactive exhibit for observers to be able to learn more as they interact with the different works that are stored in the archives.

A Flash to the Past

Although I had never been to an archive before, I had some general ideas of what it would be like before the trip. Basically, I just thought that it would be similar to a library. I wasn’t expecting it to have so many different types of unpublished primary sources—from VCR tapes that had been converted into a video easily shared by USB to books written in Latin from 1778, from framed artwork and maps to a surgical kit used in 1850. The antiquity of these sources really intrigued me and I was fascinated at how we were able to interact and touch the same materials that our predecessors created hundreds of years ago.

The trip consisted of a brief introduction to the archive in the reading room, also known as the face of the archive—what people first see when they enter, followed by a visit to the media room where tapes are converted from one file type to another since many video players are not being produced anymore. We finished the trip by visiting the “stacks”. They are literally stacks of books and other mediums organized by subject dating all the way back to the 18th century (or even older). The archivist had laid out some resources pertaining to the topics of our research projects, mainly focused on the artificial heart and Psychiatric Bulletin, the latter being my project! What I found the most interesting was the surgical kit from the 1850s (pictured below). The archivist explained how blood seeped

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Surgical Kit from 1850-1880

into the cracks of the wooden handles of the instruments and was impossible to clean out completely, creating unsanitary tools to perform each surgery. We were even able to handle these instruments, which was amazing considering their age and the consequences of mishandling them.

When we were allowed to explore the archive on our own, I gravitated towards the Psychiatric Bulletins because they are the focus of my project. Below is a cover of one of the magazines published in 1952, depicting a man in agony, screaming. The title of the painting is Lost Cry, and probably refers to how mentally ill patients are suffering, but people refuse to acknowledge their pain, just how we as viewers cannot audibly hear his cry for help. The Psychiatric Bulletins covered a wide variety of mental illnesses but also

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“Lost Cry” front cover artwork; Fall 1952

included other topics pertaining to psychology. One bulletin I noticed was fixated on the topic of alcohol, with almost all articles relating to alcohol abuse and indicated how alcoholism was an illness that could be healed with psychology. The text of the articles was all very engaging to read, enhanced with expressive pictures like this one, and I wished that I could take the bulletins back to read them closely because a lot has changed regarding mental health and stigmas surrounding it since the 1950s.

The archive was an incredible opportunity to have because we are rarely exposed to so many primary sources. These unpublished materials could provide new perspectives on widely held beliefs and allow researchers and us students to explore topics in more depth. Without an archive, these important photographs, magazines, manuscripts, maps, books, tapes—all would be inaccessible and lost forever.

 

 

Visiting the Backstage of Medical History

When I heard that we would be visiting an archive, I honestly didn’t know what to expect. I didn’t understand the relevance of an archive, because I imagined that any information a researcher needed could be accessed in a library or on the Internet.

However, after touring the McGovern Historical Center and listening to Ms. Yates describe the archive’s purpose, I realized that I had been very narrow-minded. Walking down the aisles filled with books, photographs, film reels, and other odd artifacts, I realized that all the resources we have access to online are only available after an archivist has sorted, cataloged, and photographed those documents.

I was fascinated when Ms. Yates pointed out surgical tools from the late 1800s and explained how you could tell that the instruments were designed prior to the discovery of the germ theory of disease: the wooden handle of the blade easily absorbed blood that dripped down the blade, providing a breeding ground for bacteria and viruses. Her example made clear the opportunities that an archive can provide to researchers.

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Surgical kit circa 1850-1880 (photo taken at the McGovern Historical Center)

I was surprised when we were allowed to touch the archival material. It fascinated me to imagine a surgeon holding the same instrument and operating on patients over 100 years ago. It’s primary sources like these that cannot be digitized but can only be experienced and analyzed at an archive.

I also learned that an archive’s main role is to organize and preserve unpublished work. This reminded me of an assignment I did in high school where I analyzed poetry by Sylvia Plath. During my research, I had found photographs of Plath’s notes and prior drafts, which had given me further insight into Plath’s ideas. It was only after our visit to the archive that I realized that I was able to access those photographs because of the existence of archives.

At the archive, it was interesting to see the kinds of unpublished work that a medical archive stored, including physician notes, film reels of surgeries, and original magazine artwork. I particularly enjoyed looking at the original contact sheets and negatives for an article in the Medical World News; we could identify which photos the magazine decided to publish over others.

Archives give us a behind-the-scenes perspective of published work that we sometimes take for granted. Through archives, we are able to see the authentic and original ideas and content that may have been lost in the publishing process. This backstage perspective of an archive gives us vital raw information to help us analyze and understand history with more insight.

Archives: Mission (Initially) Unknown

While driving to the McGovern Historical Center, my thoughts were both wild and restrained. I wondered about the layout, age, and purpose of an archive as I tried to recall fragments of information that I had learned over the years. Still, my musing remained grounded in the notion that an archive was a mix of a library and museum. Even after entering the mundane building and observing the lounge area, I still could not discern what made archives unique. Fortunately, our guide, Sandra Yates, allowed us to enter the storage room where the stacks were kept.

Ms. Yates explained that an archive was a collection of many different types of materials, including anything from books to architectural designs, cassettes, and even actual surgical equipment. I learned that archives are for specific topics. For example, the McGovern Historical Center handles materials related to health and medicine. Moreover, the material is unpublished work that is donated by individuals or organizations, which means that every archive is unique.

As our group concluded the tour, we were allowed to view and engage with specific materials on the table. Because my group’s project wasn’t available, I gravitated towards something similar: a 17th century anatomy book. The book was written in German; sifting through the centuries-old pages, I saw many diagrams and illustrations that depicted body parts. Truthfully, I would not have known that it was an anatomy book except for the label because the illustrations hardly seemed to represent an actual body. I came to a conclusion at that point. An archive’s primary function wasn’t to provide factual knowledge like museums do. Instead, researchers use archives to analyze the trends, changes, or transformations of human knowledge.

 

 

 

Take the surgical tool pictured above. It is a 16th century device, and the McGovern Center had a similar one except that the handle was made of wood. Right beside this tool was a book with pictures of improved tools. The archivists even allowed us to hold and touch the surgical tools, which is an experience that one looking at pictures simply can’t attain. As our guide explained, the problem with the wooden handle was that blood became easily trapped inside, making it hard to clean the equipment. Only being able to observe either the tool or the equipment pictures would be interesting, but it would not be useful. By viewing both, researchers can extrapolate how attitudes toward hygiene and sanitation changed and manifested themselves in equipment. The detailed and varied materials of the archive allow researchers to amplify the knowledge gained from the two sources alone.

Exiting the building, I walked away with much more appreciation and understanding of the purpose of an archive. The careful preservation and sheer amount of detailed information may never be fully analyzed, but the fact that it is available and accessible ensures that one looking for such materials can find them. The specificity, historical value, and accessibility of archival materials can be matched neither by a library nor a museum.

 

Sources:

WikiMedia Commons, https://commons.wikimedia.org/wiki/File:Large_amputation_saw,_16th_century._Wellcome_L0011386.jpg#file. Accessed September 2016.

 

A Walk Through Health History

Before visiting the archive, I had envisioned it as a something nearly identical to a library, but with a more quaint atmosphere. Having never visited an archive before, I assumed one would walk in and be greeted by rows of shelves of medical journals, encyclopedias, and manuals and be able to pick out whatever book suited one’s research or interest. After visiting the archive, I could clearly see how my preconceived notions of McGovern Historical Center were incorrect. The archive stands as a place of passion and progress. No one is meandering through the warehouse-like shelves. Rather, people are there to research to better contribute to the field of public health.

The kinds of people who would regularly frequent the archive never crossed my mind before the visit, but it became fairly obvious as in walked a group of college freshman (mostly). To the employees of the archive, we were an odd sight be been seen walking through the door, our presence being worthy of photo documentation throughout our visit. Rather than the usual visitors, researcher, professors, historians, etc., I imagine that our visit presented a new insight into the future of academic interest in the medical field, a future which is faced with the challenges such as global warming and upcoming infectious diseases of the newest global health era.

Despite all of this, our interactions with the materials themselves were the most impactful part of our visit. Flipping freely through materials whose lives spanned decades, we given the opportunity to have a unique glimpse into our relationship with the history of public health how it has impacted modern medicine. Personally, this glimpse was most compelling as I gravitated toward the wood-handled surgical equipment. It is easy to imagine technological progress as an abstract concept, but the unsterile wooden handles of the tools provided a concrete example of how public health has evolved.

 

Overall, I am reminded of our first assignment: defining public health. The archive encompasses what we all realized as we shared our own personal perspective on the definition of public health, each different from the next. The archive was no different. Every book, journal, and manual has a unique grasp on the evolving and vast field of public health. All of the encounters and experience of this trip combined, it is easy to see the bigger picture of the McGovern Historical Center: To provide those of us with a passion for health, literature, and history an avenue to explore that passion.