7/21/2019 October 2015 Sombrero http://slidepdf.com/reader/full/october-2015-sombrero 1/24 S OMBRERO Pima County Medical Society Home Medical Society of the 17th United States Surgeon-General OCTOBER 2015 Tumamoc Hill: To your health! Paramedicine: Coming on strong in Rio Rico The old Presidio: Spanish garrison medicine
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SOMBRERO (ISSN 0279-909X) is published monthlyexcept bimonthly June/July and August/September by thePima County Medical Society, 5199 E. Farness, Tucson,
Ariz. 85712. Annual subscription price is $30. Periodicalspaid at Tucson, AZ. POSTMASTER: Send address
Rosh Hashana, Sept. 13-15, newyear 5776 on the Hebrewcalendar, marks the the HighHoly Days for Jews around theworld. The New Year is a me totake stock, to atone, and tothink about what’s important.This is also somewhat of a newstart for your medical society.
Last Friday, Sept. 11, I signedthe papers to sell the PCMS building. While this was not my ideaor project, if I were simply a board member, I would have votedfor it. Good or bad, it will likely become my legacy as PCMSpresident. Only me will tell us if it was the right move. It gives a
needed infusion of cash into our coers. It removesfrom us an encumbrance that I consider a growingliability. I hope it will make us more exible andbeer able to meet the needs of our members.
Many of you have read the me-line in last month’s
Sombrero about the sale of the PCMS building. If so,I am sorry to be repeve, but I think a fewhighlights bear repeang. At our March 2014 boardmeeng, Dr. Jim Klein and a few others presentedideas about ways to save money and renovate thebuilding. The board, and our execuve director,looked into those. In October 2014, Dr. TimothyMarshall wrote his editorial in Sombrero about the
health of the PCMS building. In that discussion henoted that members had received a survey asking ifthey would be willing to contribute to therenovaon, and asking members to vote.Approximately 12 percent of members answeredthat survey, and it was two-to-one against.
My rst Sombrero column talked about relevance.The Execuve Commiee and the Board ofDirectors struggle with that. How do we increasethe society’s relevance? I am sll searching for thatanswer, but one of the ways is to have the funds forlobbying the legislature, or the local city council,about the needs of physicians and our paents.Aer all, I think that despite our dierences, that iswhat we want. We want to take care of ourpaents, and be able to take care of our families.
We invite members to give us ideas, to share in civildiscourse, and to engage in conversaon intendedto enhance understanding. Your board wants toknow what the needs of the members are, andwhat PCMS can do for them.
In the past few weeks I have received some rather
vitriolic leers, based on misinformaon regarding
the sale of the building. I have taken the me to
answer most of them. As your president, I felt that
was my responsibility. It is now me to move forward.
I’ll paraphrase a story my Rabbi recently told. Bob Baert is thetrainer of American Pharaoh, the horse that won the Triple Crownof thoroughbred racing this year, the rst to do so in 37 years.Baert is also from Southern Arizona. What I did not realize isthat Baert came within a nose of a Triple Crown in 1998 with ahorse named Real Quiet . As the photo-nish showed, Victory
Gallop came out of nowhere and won by a nose. As Bob Baertrealized he had lost the race—the Triple Crown and a $5 millionprize—his four-year-old daughter Savannah said, “Daddy, you sllhave me.”
Rabbi Tom implored those present to take stock of what isimportant. I implore you to do the same. The medical societybuilding was not the Washington Monument, and the medicalsociety is not the building. We sll have what is important. Wehave a good sta who work hard for us, we have good peoplewho volunteer their me to serve—and we have our members.
L’Shana Tova Tikatavu. May you all be inscribed for a goodyear. n
2015 End-of-LifeCommunity ConferenceIntegrative Approaches to End-of-Life Care
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Leers
Medicare unsustainableTo the Editor:
Thanks for Dr. Levine’s interesng history of Medicare, Parts 1 and 2 [May and August-
September Sombrero]. They read rather like the history of the PCMS building. People tried
and tried unl they got it. And now it is a nancial “disaster waing to happen.”
The opmisc predicons about PCMS didn’t happen. The gloomy predicons about
Medicare made by the Associaon of American Physicians and Surgeons, did.
The 2015 Trustees Report on Medicare is full of hopeful speculaons. It uses the word“insolvency” only once, but acknowledges that (1) the number of beneciaries is increasing
faster than the number of workers; (2) Part A expenditures have exceeded income every
year since 2008; and (3) the Trustees’ minimum standards expressed as short-term nancial
adequacy and long-term actuarial balance have not been met for more than a decade.
The trustees also acknowledge that “if [Trust Fund] assets were depleted, Medicare couldpay health plans and providers of Part A services only to the extent allowed by ongoing tax
revenues—and these revenues would be inadequate to fully cover costs. Beneciary access
to health care services would rapidly be curtailed.”
They assume that Congress will somehow “nd” the money [in the future hopes andopportunies of the younger generaon], but as AAPS’s journal editor Dr. LawrenceHuntoon points out, “There is no way to ‘manage’ a wealth transfer Ponzi scheme to make
it nancially sustainable.” He concludes that Medicare at 50 is “terminally ill.” (see hp://
www.jpands.org/vol20no3/huntoon.pdf).Sincerely,
Jane M. Orient, M.D.
Tucson
Dr. Orient is AAPS execuve director and a PCMS past-president.
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and wrinkles were among the topics. In May, he spoke at the
UofA Dermatology Grand Rounds with his presentaon, “Lasers:
A 30-Year Experience.”
This fall Dr. Goldberg introduces Pima Dermatology’s 17th laser
modality, the Sciton Halo. “The world’s rst hybrid fraconal laser
delivers both ablave and non-ablave wavelengths to the same
or dierent microscopic treatment zones to provide ablave
results, with non-ablave downme,” Dr. Goldberg said. “Pima
Dermatology is the only dermatology physician pracce in Tucson
to oer this new and sophiscated laser.”
Rounding out a year of advancements, Dr. Goldberg and his
associates welcome Sarah E. Schram, M.D. to their team. Board-
cered by the American Board of Dermatology, Dr. Schram
specializes in Mohs skin cancer surgery with a special interest in
cutaneous oncology and cosmec dermatology. She is thoroughly
skilled in surgical dermatology, cosmec dermatology, and lasers.
Dr. Schram earned her M.D. at University of Minnesota Medical
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School. She achieved
academic honors with the
Glasgow-Rubin Citaon for
Academic Achievement, and
was elected to the presgious
Alpha Omega Alpha Honor
Medical Society. She completed
her dermatology residency at
University of Minnesota
Medical School in 2011, andreceived extensive training in
Mohs and laser surgery during
a Procedural Dermatology
Fellowship at the University of
Minnesota in 2012.
Prior to joining Pima Dermatology, Dr. Schram was a dermatologic
surgeon and assistant professor at University of Minnesota
Medical School. Dr. Schram began seeing paents on Sept. 1.
Dr. Goldberg is a Clinical Professor of Dermatology at the
University of Arizona where he has been on faculty since 1984
instrucng medical students and residents. He is a preceptor for
dermatology residents for the American Society of DermatologicSurgery (ASDS) as well as the ASLMS. He also lectures throughout
the year at Canyon Ranch, educang guests from all over the
world about the latest trends in dermatology, including an-aging
treatments and products.
Dr. Wong joins Rena CentersRena Centers reports that Ryan K. Wong,
M.D. has joined the pracce, which
includes PCMS members George S. Novalis,
M.D. andMartn A. Worrall, M.D.
Tucson nave Dr. Wong is a vitreorenal
surgeon. He earned his bachelor’s degreein biology with a minor in chemistry at the
University of Pennsylvania, Philadelphia. He
earned his M.D. at Weill Cornell MedicalCollege of Cornell University, New York.
He did his internship at the Hospital of St.
Raphael and his ophthalmology residency
at Yale-New Haven Hospital/Yale University,
both in New Haven, Conn. Dr. Wong thencompleted a two-year vitreorenal
fellowship at the Jules Stein Eye Instute,
University of California at Los Angeles.
Dr. Wong is cered by the American Boardof Ophthalmology. He is a member of theAmerican Society of Rena Specialists,
American Academy of Ophthalmology, the
Associaon for Research in Vision and
Ophthalmology, and AMA. As a naveTucsonan, Dr. Wong says he is excited to
return and serve the community in which
he grew up.
Dr. Wong has extensive training andexperience in management of medical and
surgical diseases of the rena and vitreous,
including severe diabec eye
disease, trauma, and
proliferave vitreorenopathy.
He has also been acve inacademic medicine and
research, having given
numerous oral and posterpresentaons at naonal and
internaonal meengs.
Addionally, he has wrien
book chapters and severalpapers in peer-reviewed
journals.
Rena Centers Northwest,
East, and Southwest say they
are “fully equipped with state-
of-the-art technology for diagnosis and outpaent treatment of
renal disorders. The highly trained sta strives for excellence in
care, and parcipates in providing consultave, diagnosc, and
treatment services within one oce visit when needed, an
important me saver for working and out-of-town paents.
Treatment of renal tears and detachments, as well as diabec
renopathy and age-related macular degeneraon, constute a
major part of the pracce.”
Dr. Wong accepts Medicare Assignment, and is a parcipang
provider for all area health plans, including AHCCCS and TRICARE.
Central Appointments: 520.742.7444 or 800. 535-2484. n
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PCMS News
Judge rules AHCCCSexpansion constuonalMaricopa County Superior Court Judge Douglas Gerlach ruledrecently that the simple majority vote that expanded AHCCCS in2013 was constuonal, ArMA’s Medicine This Week reported in
September.
Last December, the weekly reported, the Arizona Supreme Courtruled to allow a lawsuit challenging Gov. Jan Brewer’s AHCCCS(Arizona’s Medicaid program, the Arizona Health Care CostControl System) expansion plan to move forward. The high courtagreed that 36 Republican legislators could sue Gov. Brewer overthe legality of a hospital assessment that funds the expansionplan, which was passed by a bare majority in the legislature.
The Goldwater Instute, suing on behalf of the legislators, arguedthat the assessment meets the criteria of a tax, and thereforerequires a two-thirds majority in the legislature. State aorneyscountered that the assessment was not a tax because it iscollected from hospitals rather than the broad populaon.
Without the assessment, Arizona would not have the matchingfunds needed to pay its share of the expansion that is nowcovering about 255,000 low-income Arizonans.
In his ruling, Judge Gerlach stated that since hospitals directlybenet from the assessment, it is actually a fee rather than a tax.As the judge himself pointed out during the court hearing, hisruling meant lile at that point because appeals would be ledregardless of his decision. The case will ulmately be decided bythe Arizona Supreme Court.
The Arizona Medical Associaon fully endorsed and acvely
supported Gov. Brewer’s work to expand the AHCCCS program,and said it will connue to closely monitor the lawsuit’s progress.
Are you feeling narrower?The majority of Arizona medical marketplace plans arecompromised of narrow networks, reports a new study by theUniversity of Pennsylvania’s Leonard Davis Instute of HealthEconomics, noted by ArMA’s Medicine This Week .
The study found that the prevalence of narrow physician networksin the federally dened Health Insurance Marketplaces varieswidely by state. It considers networks narrow if 25 percent orfewer physicians in a rang area parcipate. According to thestudy, 73 percent of qualied health plans oered on theMarketplace in Arizona in 2014 were comprised of these narrow
networks, making Arizona the h highest state in terms of narrownetwork prevalence. (Source: AzHHA Connecon, Aug. 28, 2015)
Doc compensaon surveyedThe American Medical Associaon recently released results of areport on its 2014 Physician Pracce Survey detailing how
physicians outside of solo pracce are paid. The survey, completedby 3,500 physicians around the country, idened six trends:
• Slightly more than half of physicians (51 percent) reportedbeing paid by mulple methods.
• Salary and producvity-based payment were the mostcommon payment methods.
• On average, half of physicians’ total compensaon wasearned from salary.
• Being employed didn’t necessarily mean a salary. • Outside of group pracce, salary was more oen a key facto
than inside group pracce. • Physician payment methods vary widely across speciales.
The study found that while the structure of physician payments
has changed lile since 2012, the use of producvity-based payand bonuses both increased by about three percent. For moreinformaon, and to access the AMA survey report, read AMAWire for Aug. 25, 2015. [This story noted by ArMA’s MedicineThis Week.] n
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ATTENTION CARDIOLOGISTS – Very busy central Tucsoncardiology office is seeking an experienced cardiologist to join itspractice. Interested candidates contact Denise at [email protected] resume or any questions about the position.
Downtown street vendors are open at 4:30 p.m. The Tumble-
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Rio Rico paramedicine projectindications strongBy Steve Nash
Paramedicine
Y ou have never seen a Paramedicine department inSombrero
because this is the rst one.
Aer years of preliminary work, the rst Southern Arizona
“community healthcare paramedicine program,” begun in
January 2014, now has lessons learned from its rst 15 months.
“This is called the Rio Rico Fire and Medical District Community
Integrated Paramedicine Program,” Rio Rico Fire and Medical
Chief Les Caid said. “The term comes from ‘Community
Paramedic,’ which is trademarked, so when I rst became
interested in this concept in 2010, I wanted to use a term that
was close enough, but did not infringe on the trademark.“Since then the concept has gained tracon throughout Arizona.
In 2014 Arizona Department of Health Services put together a
steering group under the term Community Integrated
Paramedicine (CIP). This is a term I support, because this program
truly must be integrated into the overall healthcare resources of
each community if it is to be successful.”
Five condions qualify paents to enter the program: congesve
heart failure, heart aack, pneumonia, diabetes, and chronic
obstrucve pulmonary disease (COPD). The Rio Rico CIP provides
in-home healthcare services to residents with these chronic
illnesses.
The inial project focuses on helping parcipants manage their
medical condions so that they don’t have to return to the
hospital or call 911 so oen. They idened 911 high-use paents
from their system, “specically individuals who suer from
chronic disease,” Caid said. “Once idened, we scheduled
appointments in an aempt to help them manage their disease.
It is cheaper for us to send two reghter/paramedics at 2 p.m.
than four to six reghters for an emergency 911 call at 2 a.m.
“Our CIP teams consist of a reghter, an emergency paramedic,
and a reghter EMT,” Caid said. “While at the home, the CIP
team gets a baseline set of vitals and conducts a health survey.
Working with the Arizona Poison and Drug Informaon Center,
we do a medicaon reconciliaon, to ensure they are taking their
meds properly, that they are not duplicang medicaon, or have
medicaons that are counteracng each other. We also conduct a
home environmental and safety survey to idenfy and migate
trip-fall hazards, mold, or other environmental issues that can
adversely impact health. If we suspect mold, for example, we can
work with community resources to make the home safe.”
Caid says these services are to help engage and guide parcipants
in understanding their health and disease processes. “We also
want to try to idenfy the core reason that drives the need for
frequent 911 calls, and help the individual idenfy other
Rio Rico Fire and Medical Chief Les Caid says, ‘I truly believethat working pro-actively in the health of our communities, toimprove outcomes, is the logical evolution of the re service(Photo courtesy Les Caid).
healthcare resources that exist, but which they may not have
known about, or known how to access.”
Caid brings a wealth of experience to the job. He began his re
service career in 1979, and served 25 years with the Tucson Fire
Department. While with TFD he worked in all areas of the
department, including many years as a paramedic and EMS
supervisor, baalion chief of technical rescue; hazmat; and
support services. He rered as the deputy chief of emergency
management. While with Tucson Fire, Caid was recognized at the
naonal level for his work in building the Tucson Metropolitan
Medical Response System (MMRS). He worked four years with
Rural Metro Fire as regional re chief, running operaons inArizona and Oregon.
Caid has an A.A. in re science, a bachelor’s degree in public
administraon, and an MS in execuve leadership. He is
president of the Medical Reserve Corps of Southern Arizona. He
sits on the IAFC Exercise and Response Subcommiee, is EMS
Representave for the Arizona Fire Chiefs Associaon, and is a
long-standing member of the AFCA Mutual Aid Commiee. He is
currently co-chairman of the USEPA Border 20/20 Emergency
Preparedness Task Force, chairs the Santa Cruz County LEPC, and
chairs the Pima Community College—FSC-EMT Advisory Board.
He has served on numerous boards, including the Board of
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Directors of the American Red Cross, Greater Tucson Leadership,
the Arizona School Counselors Associaon, and World Care.
Caid calls the CIP program ideal for follow-up home visits of post-
hospital-discharge paents, “which I know will prove to be very
benecial in reducing re-admissions,” he said. “ With the PPACA
there are penales for hospitals that have paents re-admied
within 30 days. Working with a re-based CIP team can help the
boom-line nancials of hospitals. If we do this right, we can help
the paent and the hospital, and that is a win-win that you have
to love!”
The concept of using cered emergency paramedics (CEPs) for
prevenve healthcare is not new, and has been around for maybe
20 years, but the concept started internaonally and slowly
gained tracon in the U.S., Caid said. “Last October, I spoke in
Reno at the 10th Annual Internaonal Roundtable on Community
Paramedics. The project we started in Rio Rico is the rst in
Arizona, and from my understanding, at the me it was one of
only a handful of re-based programs—that is, care provided by a
re department or re district.”
Caid said he became involved because he knew that pung out
res is far from the only thing such department do, and that the
public may not realize that. “Most people do not know what the
U.S. Fire Service is all about,” he said. “They see the term ‘re’and think that is all we do. We must always be trained and know
how to put out res, but in actuality, re is only a small
percentage of what we do. If you look at the stascs, Emergency
Medical Services (EMS) is really the bulk of
what our jobs entail. In addion, ‘community
risk reducon’ is a term we have used in the
re service for years. We have been involved
for decades in re prevenon, drowning
prevenon, and in advocang seatbelt use
and bike safety.
“Aer almost 35 years in the re service,
I can aest that you can teach an old doga new trick. I had a FF/CEP Captain Alex
Green come to me and talk about the CIP
program. Aer some badgering by Capt.
Green, and a lile research, I became
convinced that this was an opportunity for
for re-based EMS here.
“Rio Rico is a beauful place to live and
work. It is, however, considered a rural
seng and we are under-resourced as far as
healthcare is concerned. We we lack public
transportaon. We have no buses, or
services to help our aging populaon get todoctors’ appointments. I truly believe that
working pro-acvely in the health of our
communies to improve outcomes is the
logical evoluon of the re service. To me,
since we are the gateway into the U.S.
healthcare system, we should embrace that,
and work to make others aware of the
potenal to improve paent outcomes by
forming partnerships to coordinate care.”
Caid said his department is sll looking at
surveys and total data for 2014, but even
now he can tell from some indicaons “We
have one parcipant who, in the rst six
months of 2014, reduced her 911 calls and
visits to the ED by 50 percent. We had
another for whom we found local PT
resources aer she was told in Tucson that
she could only drive back to Tucson for PT.
This saved her hours of driving me,
reducing her stress and risk of driving
accidents. We had one parcipant whom,
we found out during our medicaon
reconciliaon, had ve dierent physicians
who had prescribed her an-depressants.
Dr. Clavenna was born in Texas butspent most of his childhood in
Baton Rouge, Louisiana. Heattended Trinity University in SanAntonio for his undergraduate work,receiving a B.S. in Biochemistry. Dr.Clavenna’s desire to personallyhelp those with ailments, led himinto the field of medicine. He earned his medical degree fromLouisiana State University Medical School in Shreveport in 2009,where he was elected into Alpha Omega Alpha Honor Society.While in medical school, he was introduced to Otolaryngology(ear, nose, & throat), a wonderful field of complex anatomy,requiring surgical and medical expertise to treat those withproblems of the head and neck. Dr. Clavenna completed a generalsurgery internship and otolaryngology surgical residency atLouisiana State University Health in Shreveport.
Following residency, Dr. Clavenna completed a Fellowship in sinus,
allergy, and anterior skull base surgery at Vanderbilt University inNashville, Tennessee. There he trained under internationallyknown surgeons, Drs. Rick Chandra, Paul Russell, and JustinTurner. During fellowship he focused on advanced sinus surgeries,including management of frontal sinus disease, nasal and skullbase tumors, pituitary surgery approaches, ophthalmologicalrelated procedures and treatment of allergies. Many of thesecases were performed in conjunction with neurosurgeons andophthalmologists. One of his most fond memories from fellowshipinvolved treating a patient emergently transferred to Vanderbiltfor severe sinus disease encroaching on the vision of his right eye.Using his recently learned endoscopic sinus surgery techniqueswith the aid of image guidance, he was able to successfully treatand drain the infection and preserve the patient’s vision.
Dr. Clavenna moves to Tucson with the desire of helping those inthe community with their ear, nose and throat related problems.He is the first fellowship trained sinus and anterior skull basesurgeon to join a private practice group in Tucson. Though he hasa passion for nasal, sinus, and allergy related disorders, he alsoenjoys treating the full gamut of ENT related issues, from neckmasses to ear surgery.
Dr. Clavenna in his free time enjoys spending time with his wife,the outdoors, and looks forward to taking advantage of thewonderful surroundings Tucson and Arizona have to offer.
Dr. Matthew Clavenna,
MD
www.CarlsonENT.com
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This is the kind of thing that would never have been caught
without someone actually going into the home and being the
eyes and ears of the primary care provider to ensure that the
reconciliaon was done.”
Another gap paramedicine can ll is called “stove piping,” Caid
said. “I rst heard the term years ago when I was doing some
work with the CDC in Washington. D.C. ‘Stove piping’ was used
inside the capital beltway to refer to agencies not familiar with
anything outside their own sphere of inuence. I guess you can
say healthcare, with its lack of shared informaon and/orresources, is stove piped. This lack creates barriers to good health
outcomes. If you don’t know about a resource, it is not really a
resource. So when we see individuals who need help while we
are on a CIP visit, the team has to be the
connecon to healthcare resources.”
So far, the EMTs and reghters have seen
posive outcomes. “They have established
good solid relaonships with these individuals
in our program,” Caid said. “It is so much
easier for everyone involved to interact
because this is a scheduled visit, which is a
calm seng, way outside the normal stress ofan emergency call.”
In the early evaluaon stage, Caid said, they
idened that they would spend 10 hours per
week on the CIP. “We want to collect good
solid data to validate our premise that this
produces beer outcomes. Aer seeing the
posive eects and outcomes, we will
connue this program unl we nd funding,
but there will be no cost to the parcipants. I
guess you can say this is the eld-of-dreams
model: build it and they will come.” The Rio
Rico Fire & Medical District has applied forseveral grants to help fund the program.
CEPs have a strong training foundaon in
acute care, Caid emphasized. “Their inial
courses are between 1,200 to 1,800 hours of
lectures, hands-on skills training, and clinical
me. Once working in the eld every day, FF/
CEP’s are seeing people in emergencies.
However, we have to have our FF/CEP learn to
focus on a 30-day healthcare picture as
opposed to a 30-minute focus and short-term
emphasis. With the help of our supporng
partners, we have brought classes that focus
on care of chronic diseases such as diabetes,
MI, asthma and COPD. We have been very
fortunate to have great partners like Southeast
Arizona Area Health Educaon Center
(SEAHEC), the University of Arizona, and the
Arizona Poison and Drug Informaon Center
who have helped idenfy and provide
training.”
Caid said he does not see it as necessary to
change the CEP “scope of pracce.” “We have
found that you do not have to change the
scope of pracce for CIP; we just need to change the role of the
CEP. We have to work within the current scope of pracce and if
we do, we can have posive outcomes right away, and we have
proven that.
“First and foremost CIP has to prove it will provide beer
outcomes for the individuals and can reduce healthcare costs.
Once the data are in, we have to look for payers like the insurance
companies and hospitals to share in the savings that are gained
from this. We don’t need to make money providing this extra
service, but we must cover our costs of providing it.”
Steve Nash is execuve director of Tucson Osteopathic Medical
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An 18th-century military barber-surgeon’s instruments went onthe job in his canvas haversack. A bone saw has not changedmuch, though this one was made for the smaller hands ofsmaller practitioners. Two sizes of brass bleeding bowls werealways included.
populace alike. Indeed, some military doctors
moonlighted on o-duty hours seng up
outside pracces to treat local residents as a
supplement to their rather meager army pay.”
Abraham Ruddell Byrd III, M.D. of Sonora Family
Pracce, a.k.a. Dr. Rudy Byrd, PCMS member
since 1983, has in his 72 years gone—if there is
such a declension—from history fan, to bu, to
expert. Part of the Presidio historic trust, Dr.
Byrd plays a Presidio soldier and member of the
Spanish garrison, and in this instance the
barber-surgeon. He has oen spoken on “Blood
and Guts Medicine in the 18th Century.”
It’s the nature of science that those called
physicians in the exhibit’s me-frame would not
even merit the name today. Yet there were sll
benecial things they did, and they saved many
baleeld lives, even if they knew lile or
nothing about infecons that would kill the
paent anyway.
Essenally “you’re bleeding people all the
me,” Dr. Byrd said, “because that’s [thought to
be] good for everything. If bleeding doesn’t
work at rst, try bleeding again. Dr. Benjamin Rush, a friend of
Washington, Adams, and Jeerson believed you could remove
three-fourths of the blood in the human body—though he
thought we had an extra quart.”
Usually bleeding was from an arm, but was considered so
essenal that it was done from any vein, even underneath the Dr. Rudy Byrd and his historical bullet-puller. Merely jam it painfully into the wound, pressin farther to ensure a hard bone backup, thenscrew the auger into the soft-lead bullet tograb and extract. Anesthetic? Bite another bullet.
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tongue, or from the penis. “Inially, it was believed that bleeding
needed to be done as close as possible to the source of the
problem,” Dr. Byrd said, “and some areas did not lend themselves
to use of the tourniquet.”
They also used many catharcs and emecs, Dr. Byrd said, all
based on the Hippocrac “four humors” theory of achieving
balance of the four disnct uids in the body, so as to directly
inuence temperament and health. According to this theory,
which was prevalent in Europe and which the Spanish brought
when conquering Mexico, it was believed that each paent hadhis own humoral composion of black bile, yellow bile, phlegm,
and blood, and that each corresponded to one of the tradional
four temperaments. This sounds crazy today, but it existed for
centuries unl the advent of medical research in the 19th century.
The barber-surgeon bled the paent from the arm using a
tourniquet, Dr. Byrd said. Even bleeding injuries were treated
with more bleeding. For amputaons, they used an “extreme”
tourniquet to cut o arterial circulaon, then sliced around
through the skin and into the so ssues using a large curved
knife such as seen on the le in our haversack photo. Then the
“sawbones” was ready to saw bone. Again, “anesthec” was to
bite the bullet, or take on a good amount of alcohol, usuallybrandy or rum. “They had opiates,” Dr. Byrd said, “but they did
not know they could be used for pain.”
They did not know germ theory but they knew a wound had to be
clean, Dr. Byrd noted, so they dressed it up, and “they would look
for pus as a sign that the body was throwing o the foreign debris
and material. It was always a good sign when they got what they
called ‘laudable pus.’”
The Tucson Presidio Trust for Historic Preservaon operates the
Presidio San Agusn del Tucson Museum, a re-creaon of the
original Spanish fort from which metropolitan Tucson sprang. The
museum funcons as a monument to Hispanic history in Tucson
and the region.
The Presidio’s goal is to educate the public about the many layers
of Tucson history, including an archaic pit house, the northeastcorner of the Presidio, a Territorial Pao, and in the future, exhibit
space to honor the Mexican-American veteran and a visitor
center for the Juan Bausta de Anza Naonal Historic Trail.
The humanies content of the Trust’s mission is history,
anthropology, and archeology, providing the general public and
students with an appreciaon of the mixture of cultures that
made up early Tucson and their success in building a culture of
cooperaon that sll permeates the lives of the residents of
region.
The all-volunteer sta includes two PCMS members, the afore-
menoned Dr. Rudy Byrd, and Robert Hunter, D.O. The Trust has
designed and constructed rotang exhibits and related programsthat honor those cultures and aspects of life that make Tucson
unique. The Trust also conducts Living History Days, and a hands-
on school program known as Friday at the Fort. The hands-on
acvies promote crical thinking, study of history, and further
exploraon of this period and its cultural diversity. n
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