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<h1 class="entry-title">Selecting a Surgical Solution for Ulcers</h1>
<div class="entry-meta"><span class="meta-date"><svg class="icon icon-standard" aria-hidden="true" role="img"> <use xlink:href="https://circulatingnow.nlm.nih.gov/wp-content/themes/tortuga/assets/icons/genericons-neue.svg#standard"></use> </svg><a href="https://circulatingnow.nlm.nih.gov/2024/01/11/selecting-a-surgical-solution-for-ulcers/" title="11:00 AM" rel="bookmark"><time class="entry-date published updated" datetime="2024-01-11T11:00:42-05:00">January 11, 2024</time></a></span><span class="meta-author"> <svg class="icon icon-user" aria-hidden="true" role="img"> <use xlink:href="https://circulatingnow.nlm.nih.gov/wp-content/themes/tortuga/assets/icons/genericons-neue.svg#user"></use> </svg><span class="author vcard"><a class="url fn n" href="https://circulatingnow.nlm.nih.gov/author/bethmullen/" title="View all posts by Circulating Now" rel="author">Circulating Now</a></span></span><span class="meta-category"> <svg class="icon icon-category" aria-hidden="true" role="img"> <use xlink:href="https://circulatingnow.nlm.nih.gov/wp-content/themes/tortuga/assets/icons/genericons-neue.svg#category"></use> </svg><a href="https://circulatingnow.nlm.nih.gov/category/collections/archives-manuscripts/" rel="category tag">Archives &amp; Manuscripts</a>, <a href="https://circulatingnow.nlm.nih.gov/category/collections/" rel="category tag">Collections</a>, <a href="https://circulatingnow.nlm.nih.gov/category/guests/" rel="category tag">Guests</a></span><span class="meta-comments"> <svg class="icon icon-edit" aria-hidden="true" role="img"> <use xlink:href="https://circulatingnow.nlm.nih.gov/wp-content/themes/tortuga/assets/icons/genericons-neue.svg#edit"></use> </svg><a href="https://circulatingnow.nlm.nih.gov/2024/01/11/selecting-a-surgical-solution-for-ulcers/#respond">Leave a comment</a></span></div>
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<p><em>By Christopher Crenner ~</em></p>
<p>Can one surgical problem have more than one surgical solution? A version of this question vexed surgeons in the 1950s and 1960s. There had long been one basic way to remove an appendix. But for duodenal ulcers, it was a different story.  At midcentury, American surgeons were operating on the complications of duodenal <a href="https://medlineplus.gov/pepticulcer.html">ulcers</a> nearly as often as appendicitis. But for ulcers, no two surgeons were guaranteed to use the same operation in the same situation. Uncertainly reigned. In 1951, the writer <a href="https://catalog.nlm.nih.gov/permalink/01NLM_INST/1o1phhn/alma993368083406676">John Parr</a> riffed that his own ulcer was so bothersome that he might have to undergo an operation like a “high posterior Finsterer-Lake-Lahey modification of the Mikulicz-Krönlein-Hofmeister-Reichel-Polya improvement of the Billroth II gastrectomy.” Parr was kidding, but he had done his homework. Those were references to several different ulcer operations.</p>
<figure id="attachment_28222" aria-describedby="caption-attachment-28222" style="width: 242px" class="wp-caption alignleft"><a href="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?ssl=1"><img data-recalc-dims="1" decoding="async" data-attachment-id="28222" data-permalink="https://circulatingnow.nlm.nih.gov/2024/01/11/selecting-a-surgical-solution-for-ulcers/henry-harkins-1952_101417733/" data-orig-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?fit=966%2C1200&amp;ssl=1" data-orig-size="966,1200" data-comments-opened="1" data-image-meta="{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}" data-image-title="Henry-Harkins-1952_101417733" data-image-description="" data-image-caption="&lt;p&gt;Henry N. Harkins, 1952&lt;br /&gt;
National Library of Medicine #101417733&lt;/p&gt;
" data-medium-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?fit=242%2C300&amp;ssl=1" data-large-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?fit=824%2C1024&amp;ssl=1" class="size-medium wp-image-28222" src="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?resize=242%2C300&#038;ssl=1" alt="Black and white photograph of a white man in a tie and glasses." width="242" height="300" srcset="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?resize=242%2C300&amp;ssl=1 242w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?resize=824%2C1024&amp;ssl=1 824w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?resize=768%2C954&amp;ssl=1 768w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?resize=840%2C1043&amp;ssl=1 840w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Henry-Harkins-1952_101417733.jpg?w=966&amp;ssl=1 966w" sizes="(max-width: 242px) 100vw, 242px" /></a><figcaption id="caption-attachment-28222" class="wp-caption-text">Henry N. Harkins, 1952<br /><a href="http://resource.nlm.nih.gov/101417733"><em>National Library of Medicine #101417733</em></a></figcaption></figure>
<p>The influential surgeon Henry Harkins, whose <a href="https://findingaids.nlm.nih.gov/repositories/ammp/resources/harkins">professional papers</a> I recently reviewed at the National Library of Medicine (NLM), suggested in 1959 that there were at least 8 basic approaches to <a href="https://openi.nlm.nih.gov/detailedresult?img=PMC2933631_1752-1947-4-272-1&amp;query=&amp;req=4">surgery on chronic duodenal ulcers</a>. He went on to suggest that “no one can foretell whether any one of these operative procedures will outstrip the others in preference.” This kind of uncertainty made ulcers a special challenge for midcentury academic surgeons like Harkins.</p>
<p>And ulcers were a high-profile problem. Ulcer disease was quite prevalent the U.S. during this period. According to a widely cited figure, as many as one in ten adults would suffer from duodenal ulcers. The disease also became a widely shared part of postwar popular culture. Your boss was typically either causing you an ulcer, or he was developing one. Yet, without powerful antacids or antibiotics, patients with ulcers went on to surgery with surprising frequency. Fortunately, operations for ulcers were achieving modest successes, producing low enough rates of operative mortality and complications to rival major abdominal operations for the gallbladder and appendix. Yet, as John Parr suggested, no one operation reigned, and sadly none was able to achieve reliable long-term cures. Ulcers tended to recur after surgery, even years later. This combination of a common problem, good short-term success, with too frequent late failures drove academic surgeons in urgent effort to find a better way.</p>
<figure id="attachment_28220" aria-describedby="caption-attachment-28220" style="width: 792px" class="wp-caption aligncenter"><a href="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?ssl=1"><img data-recalc-dims="1" decoding="async" data-attachment-id="28220" data-permalink="https://circulatingnow.nlm.nih.gov/2024/01/11/selecting-a-surgical-solution-for-ulcers/nlm_nlmuid-101597439-img/" data-orig-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?fit=1265%2C1636&amp;ssl=1" data-orig-size="1265,1636" data-comments-opened="1" data-image-meta="{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}" data-image-title="nlm_nlmuid-101597439-img" data-image-description="" data-image-caption="&lt;p&gt;Advertisement by graphic designer Lester Beall in Scope, vol. 1, no. 7, 1944&lt;br /&gt;
National Library of Medicine #101597439&lt;/p&gt;
" data-medium-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?fit=232%2C300&amp;ssl=1" data-large-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?fit=792%2C1024&amp;ssl=1" class="wp-image-28220 size-large" src="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?resize=792%2C1024&#038;ssl=1" alt="A full page color magazine advertisement illustrating heartburn with a man's silhouette overlaid on a wood grain background with flames." width="792" height="1024" srcset="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?resize=792%2C1024&amp;ssl=1 792w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?resize=232%2C300&amp;ssl=1 232w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?resize=768%2C993&amp;ssl=1 768w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?resize=1188%2C1536&amp;ssl=1 1188w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?resize=1200%2C1552&amp;ssl=1 1200w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?resize=840%2C1086&amp;ssl=1 840w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/nlm_nlmuid-101597439-img.jpg?w=1265&amp;ssl=1 1265w" sizes="(max-width: 792px) 100vw, 792px" /></a><figcaption id="caption-attachment-28220" class="wp-caption-text">Advertisement by graphic designer Lester Beall in <em>Scope</em>, vol. 1, no. 7, 1944<br /><a href="http://resource.nlm.nih.gov/101597439"><em>National Library of Medicine #101597439</em></a></figcaption></figure>
<p>The crisis over ulcers exposed fundamental questions about the relationship between surgical knowledge and practice. An ever-changing spectrum of new, revised, and competing operations heightened tension between efforts to innovate and the stable habits of practice. Such challenges drew new attention to the methods for analyzing and confirming good results. Some of the earliest attempts at systematic, long-term follow up of operative outcomes and the initially controversial use of randomized, controlled trials of surgical operations took place in ulcer research.</p>
<figure id="attachment_28223" aria-describedby="caption-attachment-28223" style="width: 233px" class="wp-caption alignright"><a href="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?ssl=1"><img data-recalc-dims="1" loading="lazy" decoding="async" data-attachment-id="28223" data-permalink="https://circulatingnow.nlm.nih.gov/2024/01/11/selecting-a-surgical-solution-for-ulcers/raymond-postlethwait-1949_101439758/" data-orig-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?fit=930%2C1200&amp;ssl=1" data-orig-size="930,1200" data-comments-opened="1" data-image-meta="{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}" data-image-title="Raymond-Postlethwait-1949_101439758" data-image-description="" data-image-caption="&lt;p&gt;Raymond Postlethwait, 1949&lt;br /&gt;
National Library of Medicine #101439758&lt;/p&gt;
" data-medium-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?fit=233%2C300&amp;ssl=1" data-large-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?fit=794%2C1024&amp;ssl=1" class="size-medium wp-image-28223" src="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?resize=233%2C300&#038;ssl=1" alt="Black and white photograph of a white man in a jacket and tie, signed Ray Postlethwait in ink." width="233" height="300" srcset="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?resize=233%2C300&amp;ssl=1 233w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?resize=794%2C1024&amp;ssl=1 794w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?resize=768%2C991&amp;ssl=1 768w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?resize=840%2C1084&amp;ssl=1 840w, https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/Raymond-Postlethwait-1949_101439758.jpg?w=930&amp;ssl=1 930w" sizes="auto, (max-width: 233px) 100vw, 233px" /></a><figcaption id="caption-attachment-28223" class="wp-caption-text">Raymond Postlethwait, 1949<br /><a href="http://resource.nlm.nih.gov/101439758"><em>National Library of Medicine #101439758</em></a></figcaption></figure>
<p>Henry Harkins was in the thick of these developments. He was the first chair at a new, growing academic surgical program–mirroring others around the country that would embrace ulcer disease as a key area for experimentation and innovation. New infusions of postwar funding backed the development of surgical laboratories and experimental clinical trials. One of Harkins’ correspondents, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=Postlethwait+RW&amp;cauthor_id=4578736">Raymond Postlethwait</a>, mounted a massive, multicenter clinical trial, randomizing over 1300 ulcer patient to compare four different ulcer operations across twelve hospitals in the system of the Department of Veterans Affairs. The project folded under its weight, but made clear certain challenges of how randomization would function in surgical science.  <a href="https://findingaids.nlm.nih.gov/repositories/ammp/resources/harkins">The Harkins Papers</a> and related collections at the NLM help in exploring ulcer surgery as an early testing ground for the fit of experimental surgery in the burgeoning academic training programs of the time. The manifold choices facing ulcer surgeons also made ulcer research an early site for the deployment of randomized trials in surgery—exposing many surgeons for the first time to their power as an experimental tool and the special challenges they posed in applying them to the scientific craftwork of surgical care.</p>
<p><em><a href="https://www.kumc.edu/ccrenner.html"><img data-recalc-dims="1" loading="lazy" decoding="async" data-attachment-id="28227" data-permalink="https://circulatingnow.nlm.nih.gov/2024/01/11/selecting-a-surgical-solution-for-ulcers/crenner-christopher/" data-orig-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/crenner-christopher.jpg?fit=163%2C225&amp;ssl=1" data-orig-size="163,225" data-comments-opened="1" data-image-meta="{&quot;aperture&quot;:&quot;13&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;NIKON D2X&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;1380672907&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;70&quot;,&quot;iso&quot;:&quot;125&quot;,&quot;shutter_speed&quot;:&quot;0.008&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;1&quot;}" data-image-title="crenner-christopher" data-image-description="" data-image-caption="" data-medium-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/crenner-christopher.jpg?fit=163%2C225&amp;ssl=1" data-large-file="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/crenner-christopher.jpg?fit=163%2C225&amp;ssl=1" class="alignleft wp-image-28227" title="Christopher Crenner" src="https://i0.wp.com/circulatingnow.nlm.nih.gov/wp-content/uploads/2024/01/crenner-christopher.jpg?resize=100%2C138&#038;ssl=1" alt="Formal photograph of a white man in a shirt and tie." width="100" height="138" /></a>Christopher Crenner, MD, PhD, is a Professor and the Chair of the department of History and Philosophy of Medicine at the University of Kansas Medical Center and a 2020 <a href="https://www.nlm.nih.gov/hmd/get-involved/debakey-fellowship.html">NLM Michael E. DeBakey Fellow in the History of Medicine</a>. </em></p>
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<a href="https://circulatingnow.nlm.nih.gov/tag/animals/" class="tag-cloud-link tag-link-490 tag-link-position-11" style="font-size: 10.613333333333pt;" aria-label="animals (29 items)">animals</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/anniversaries/" class="tag-cloud-link tag-link-678875953 tag-link-position-12" style="font-size: 11.173333333333pt;" aria-label="anniversaries (31 items)">anniversaries</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/archives/" class="tag-cloud-link tag-link-12080 tag-link-position-13" style="font-size: 14.533333333333pt;" aria-label="archives (48 items)">archives</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/art/" class="tag-cloud-link tag-link-177 tag-link-position-14" style="font-size: 18.64pt;" aria-label="art (80 items)">art</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/book-illustration/" class="tag-cloud-link tag-link-1480675 tag-link-position-15" style="font-size: 16.4pt;" aria-label="book illustration (61 items)">book illustration</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/children/" class="tag-cloud-link tag-link-1343 tag-link-position-16" style="font-size: 8pt;" aria-label="children (21 items)">children</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/covid-19/" class="tag-cloud-link tag-link-678875829 tag-link-position-17" style="font-size: 10.613333333333pt;" aria-label="COVID-19 (29 items)">COVID-19</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/data/" class="tag-cloud-link tag-link-22379 tag-link-position-18" style="font-size: 16.586666666667pt;" aria-label="data (62 items)">data</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/digital-humanities/" class="tag-cloud-link tag-link-541876 tag-link-position-19" style="font-size: 12.106666666667pt;" aria-label="digital humanities (35 items)">digital humanities</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/digitization/" class="tag-cloud-link tag-link-106484 tag-link-position-20" style="font-size: 13.04pt;" aria-label="digitization (40 items)">digitization</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/drugs/" class="tag-cloud-link tag-link-6200 tag-link-position-21" style="font-size: 9.12pt;" aria-label="drugs (24 items)">drugs</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/education/" class="tag-cloud-link tag-link-1342 tag-link-position-22" style="font-size: 13.04pt;" aria-label="education (40 items)">education</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/epidemic/" class="tag-cloud-link tag-link-136219 tag-link-position-23" style="font-size: 15.84pt;" aria-label="epidemic (56 items)">epidemic</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/film/" class="tag-cloud-link tag-link-524 tag-link-position-24" style="font-size: 17.52pt;" aria-label="film (70 items)">film</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/food/" class="tag-cloud-link tag-link-586 tag-link-position-25" style="font-size: 11.546666666667pt;" aria-label="food (33 items)">food</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/france/" class="tag-cloud-link tag-link-4704 tag-link-position-26" style="font-size: 10.613333333333pt;" aria-label="France (29 items)">France</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/germany/" class="tag-cloud-link tag-link-3550 tag-link-position-27" style="font-size: 8pt;" aria-label="Germany (21 items)">Germany</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/hidden-treasure/" class="tag-cloud-link tag-link-1487506 tag-link-position-28" style="font-size: 13.226666666667pt;" aria-label="Hidden Treasure (41 items)">Hidden Treasure</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/hospitals/" class="tag-cloud-link tag-link-38746 tag-link-position-29" style="font-size: 13.04pt;" aria-label="hospitals (40 items)">hospitals</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/interview/" class="tag-cloud-link tag-link-11788 tag-link-position-30" style="font-size: 22pt;" aria-label="interview (121 items)">interview</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/legislation/" class="tag-cloud-link tag-link-5563 tag-link-position-31" style="font-size: 12.853333333333pt;" aria-label="legislation (39 items)">legislation</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/letter/" class="tag-cloud-link tag-link-50991 tag-link-position-32" style="font-size: 9.68pt;" aria-label="letter (26 items)">letter</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/librarians/" class="tag-cloud-link tag-link-15380 tag-link-position-33" style="font-size: 9.68pt;" aria-label="librarians (26 items)">librarians</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/libraries/" class="tag-cloud-link tag-link-12499 tag-link-position-34" style="font-size: 10.613333333333pt;" aria-label="libraries (29 items)">libraries</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/manuscript/" class="tag-cloud-link tag-link-517998 tag-link-position-35" style="font-size: 16.4pt;" aria-label="manuscript (60 items)">manuscript</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/medicine-on-screen/" class="tag-cloud-link tag-link-671616459 tag-link-position-36" style="font-size: 12.106666666667pt;" aria-label="Medicine on Screen (35 items)">Medicine on Screen</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/mental-health/" class="tag-cloud-link tag-link-5004 tag-link-position-37" style="font-size: 10.8pt;" aria-label="mental health (30 items)">mental health</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/michael-e-debakey/" class="tag-cloud-link tag-link-1753209 tag-link-position-38" style="font-size: 8.7466666666667pt;" aria-label="Michael E. DeBakey (23 items)">Michael E. DeBakey</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/military/" class="tag-cloud-link tag-link-488 tag-link-position-39" style="font-size: 18.266666666667pt;" aria-label="military (76 items)">military</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/nih/" class="tag-cloud-link tag-link-631875 tag-link-position-40" style="font-size: 8.3733333333333pt;" aria-label="NIH (22 items)">NIH</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/fellowship/" class="tag-cloud-link tag-link-58980 tag-link-position-41" style="font-size: 12.853333333333pt;" aria-label="NLM DeBakey Fellowship (39 items)">NLM DeBakey Fellowship</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/nlmhisttalk/" class="tag-cloud-link tag-link-5711 tag-link-position-42" style="font-size: 19.013333333333pt;" aria-label="NLM History Talks (85 items)">NLM History Talks</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/nursing/" class="tag-cloud-link tag-link-7193 tag-link-position-43" style="font-size: 11.36pt;" aria-label="nursing (32 items)">nursing</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/photograph/" class="tag-cloud-link tag-link-12074 tag-link-position-44" style="font-size: 12.293333333333pt;" aria-label="photograph (36 items)">photograph</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/physician/" class="tag-cloud-link tag-link-541893 tag-link-position-45" style="font-size: 10.613333333333pt;" aria-label="physician (29 items)">physician</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/plants/" class="tag-cloud-link tag-link-15734 tag-link-position-46" style="font-size: 9.12pt;" aria-label="plants (24 items)">plants</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/posters/" class="tag-cloud-link tag-link-7195 tag-link-position-47" style="font-size: 12.106666666667pt;" aria-label="posters (35 items)">posters</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/profiles-in-science/" class="tag-cloud-link tag-link-5535849 tag-link-position-48" style="font-size: 9.68pt;" aria-label="Profiles in Science (26 items)">Profiles in Science</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/public-health/" class="tag-cloud-link tag-link-28006 tag-link-position-49" style="font-size: 19.946666666667pt;" aria-label="public health (95 items)">public health</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/race/" class="tag-cloud-link tag-link-678875950 tag-link-position-50" style="font-size: 11.733333333333pt;" aria-label="race (34 items)">race</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/rare-books/" class="tag-cloud-link tag-link-393736 tag-link-position-51" style="font-size: 9.68pt;" aria-label="Rare Books (26 items)">Rare Books</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/recent-acquisitions/" class="tag-cloud-link tag-link-2971278 tag-link-position-52" style="font-size: 15.093333333333pt;" aria-label="Recent Acquisitions (51 items)">Recent Acquisitions</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/research/" class="tag-cloud-link tag-link-668 tag-link-position-53" style="font-size: 20.693333333333pt;" aria-label="research (104 items)">research</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/surgeon-general/" class="tag-cloud-link tag-link-385674 tag-link-position-54" style="font-size: 9.12pt;" aria-label="Surgeon General (24 items)">Surgeon General</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/surgery/" class="tag-cloud-link tag-link-57544 tag-link-position-55" style="font-size: 8pt;" aria-label="surgery (21 items)">surgery</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/traveling-exhibitions/" class="tag-cloud-link tag-link-6044794 tag-link-position-56" style="font-size: 9.68pt;" aria-label="traveling exhibitions (26 items)">traveling exhibitions</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/web-collecting/" class="tag-cloud-link tag-link-238214791 tag-link-position-57" style="font-size: 8pt;" aria-label="web collecting (21 items)">web collecting</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/womens-history/" class="tag-cloud-link tag-link-97077 tag-link-position-58" style="font-size: 17.146666666667pt;" aria-label="Women&#039;s History (66 items)">Women&#039;s History</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/world-war-i/" class="tag-cloud-link tag-link-110820 tag-link-position-59" style="font-size: 14.906666666667pt;" aria-label="World War I (50 items)">World War I</a>
<a href="https://circulatingnow.nlm.nih.gov/tag/world-war-ii/" class="tag-cloud-link tag-link-62291 tag-link-position-60" style="font-size: 13.6pt;" aria-label="World War II (43 items)">World War II</a></div>
</aside></div><div class="widget-wrap"><aside id="archives-5" class="widget widget_archive clearfix"><div class="widget-header"><h3 class="widget-title">Archives</h3></div> <label class="screen-reader-text" for="archives-dropdown-5">Archives</label>
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<option value='https://circulatingnow.nlm.nih.gov/2025/01/'> January 2025 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2017/12/'> December 2017 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2017/09/'> September 2017 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2017/03/'> March 2017 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2016/10/'> October 2016 </option>
<option value='https://circulatingnow.nlm.nih.gov/2016/09/'> September 2016 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2015/12/'> December 2015 </option>
<option value='https://circulatingnow.nlm.nih.gov/2015/11/'> November 2015 </option>
<option value='https://circulatingnow.nlm.nih.gov/2015/10/'> October 2015 </option>
<option value='https://circulatingnow.nlm.nih.gov/2015/09/'> September 2015 </option>
<option value='https://circulatingnow.nlm.nih.gov/2015/08/'> August 2015 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2014/12/'> December 2014 </option>
<option value='https://circulatingnow.nlm.nih.gov/2014/11/'> November 2014 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2014/09/'> September 2014 </option>
<option value='https://circulatingnow.nlm.nih.gov/2014/08/'> August 2014 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2014/03/'> March 2014 </option>
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<option value='https://circulatingnow.nlm.nih.gov/2013/12/'> December 2013 </option>
<option value='https://circulatingnow.nlm.nih.gov/2013/11/'> November 2013 </option>
<option value='https://circulatingnow.nlm.nih.gov/2013/10/'> October 2013 </option>
<option value='https://circulatingnow.nlm.nih.gov/2013/09/'> September 2013 </option>
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