The Medical Library in Postgraduate Work (Osler's Views Reexamined), 1969
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trent lecture - 1969 the medical library in postgraduate work osier's views reexamined

trent lecture - 1969 the medical library in postgraduate work osier's views reexamined martin m cummings m d i responded to the invitation to give this talk with temerity mixed witty pleasure to face one's classmates and teachers after a quarter of a century is not an easy task under most circumstances to do so after i have wandered through many facets of medicine teaching research and science administration only to appear before you now as an amateur medical historian-librarian compounds my presumptions the pleasure of course comes from the warmth and pride which is associated with a return to alma mater and especially to see her growth in beauty and stature as contrasted to my own evidences of physical deterioration and disability the pleasure is derived also from the opportunity to add my exptession of respect for dr josiah c trent who gave so much of his time energy and resources to establish a significant medical historical collection within the duke medical library i have chosen to present my evaluation of osier's views on the role of medical libraries in postgraduate work for several reasons first i do so frankly because i have only recently completed this analysis for inclusion in the monograph which will commemorate the 50th anniversary of tiis death this year and secondly because i believe the subject is 0sller william the medical library in postgraduate work proc med lib asfeoc vol i pt ii 1909 reprinted from the brit med j v 2 pp 925-928 1909

Page  2 2 timely and appropriate in these times when american medicine is seeking for new ways to improve medical education at all levels but especially as it relates to continued medical education half a century the time since osier's death is but a small flicker in the history of civilization yet it represents a considerable segment of the history of life sciences and medicine in particular thus the views of men at the turn of this century no matter how learned or prophetic cannot be expected to be totally appropriate for today's society lester king reviewing osier's textbook revisited reprint of selected sections with commentaries wisely commented that to fully appreciate osier we should understand his relationship to his own contemporaries whereas i agree with this viewpoint i must add that his greatness strikes me more when we view his lasting judgments with the exception of areas as clinical therapeutics which change rapidly his philosophic and educational views are strengthened rather than weakened by the passage of time osier's remarks on the medical library in postgraduate work delivered at the inaugural meeting of the medical library association in belfast 1909 reflect a perspective on medicine as seen from his most mature period of clinical medicine and scholarship the article itself however begins in a somewhat parochial vein praising the british for the king l.s osier revisited vol 200 no 2 jama april 10 1967

Page  3 3 development of a large number of local libraries as well as recognizing the contributions to medicine from the several large libraries of great britain such as the british museum and the bodleian the pith of osler's philosophy relating the medical library to post graduate education emerges mid-point in his essay when he virtually explodes with aphorisms and maxims mainly directed at literature libraries and self-education i have selected a few which i believe had profound meaning for his audience at the turn of the century and some which have equal applicability today the oslerian quotations which i have selected for analysis fall into two general categories those concerned with self education or continuing education and those relating to books journals and libraries through out his paper osier calls for early development of good study habits the development of good personal and local medical libraries and a system for discrimination in the selection of reading materials to keep abreast of the changes and advances in medicine i shall deal first with only those few statements which i do not consider completely appropriate today but how can a busy man read driven early and late tired out and worried he cannot it is useless to try unless he has got into the habit when he was not so busy then it comes easy enough and the hardest-worked man in the land may read his journals every week even if he has to do it in his carriage

Page  4 4 it is not so much a question of when but of what and of how what sort of reading will best help a man in his education will help him to keep up with the times and develop into a thinking reasoning practitioner let him get rid of the notion that much has to be read one or two journals a good weekly-the lancet or the british medical journal a good monthly-the practitioner or the american journal of the medical sciences- suffice but let them be read thoroughly with half an hour's reading in bed every night as a steady practice the busiest man can get a fair education before the plasma sets in the periganglionic spaces of his grey cortex in the context of medical practice at the turn of the century one might be expected to be well read by keeping up with only a few leading british and american medical journals through bedtime reading perhaps the most significant change which has taken place since osler's death has been the explosive growth of the medical literature itself the number of serial titles has increased from 864 in 1880 billings to approximately 6000 in 1960 since he recommended a half hour's reading each night at bedtime in the present world of specialization and multidisciplined medical science osler's advice seems no longer appropriate with respect to numbers of journals to be read or the amount of time required to read them with more than 300000 medical articles published annually it seems more necessary to sample the writings in a large number of journals rather than read thoroughly only a few to sample this vast

Page  5 5 literature selectively requires surveillance of the indexing and abstracting services which relate to medicine only the index medicus was available in the english language for this purpose during osler's period most other foreign languages indexes were used for retrospective searches as was the index catalogue today there exists a myriad of other alerting services which may be useful to the health practitioner and biomedical scientist his plea for systematic postgraduate study is most appropriate for contemporary medicine and few would argue against his call for looking at everything with an inquiring spirit post-graduate study is a habit of mind only to be acquired as are other habits in the slow repetition of the practice of looking at everything with an inquiring spirit he neatly distinguishes between owning books and reading them many know of the existence of beautiful collections of books which seem to have been acquired for their decorative or prestige value rather than for their substance or content it is much simpler to buy books than to read them and easier to read them than to absorb their contents too many men slip early out of the habit of studious reading and yet this is essential to a man if he is to get an education to be worth anything it must be associated with concentration - with that mental application which means real effort

Page  6 6 osler lived and worked during the renaissance of life sciences the latter third of the 19th century thus he was exposed to and participated in the conversion of the profession of medicine to an art more soundly based on science he perceived this transition earlier than most physicians of his times but conditions have changed and medicine is now a rapidly progressive science as well as an exceedingly com plicated art of which at qualification a man has only laid the foundation and if he is to develop his intelligence that is get an education--it must be by systematic post graduate study out of leading strings he must himself be at once teacher and pupil and make and keep certain self made laws whether he will get this education whether indeed he will be able to keep what he has will depend in part upon the sort of training he has received and in part upon the type of mind with which he has been endowed unless as a student he has got that relish of knowledge of which locke speaks unless he has got far enough to have his senses well trained to make accurate observations unless he has been taught how to use his intelligence so as to form a good judgement the teacher will have more or less of a fool for a pupil and between them make a sad mess of an education

Page  7 7 he witnessed the development of professionalism in science and he was wise enough to understand and cultivate the acquisition of knowledge in depth as well as generalized information the physicians who stopped learning after graduation in the 19th century did not become obsolescent as quickly as the physician of today surrounded by new medical discoveries which overwhelm him by their number and complexity thus common sense alone would carry a man farther in osier's time than it does today osler's impressive influence on canadian american and english medicine resulted primarily from his clinical abilities and his prowess as a teacher his most profound contributions stem from his willingness and skill in transmitting ideas observations and provocations through thoughtful stylish and informative writing he not only was a prolific and analytic user of the medical literature but was perhaps the most significant contributor to this literature during his active career he put to practical use his knowledge of medical history better than most of his contemporaries recognizing its value it is easy to under stand why he exhorted students of medicine to learn early the habit of reading and study he considered the exordium or preface to learning as a student to be the key to sustained or continuing education more than once i have referred to the three essentials in the house of the general practitioner--the library the laboratory and the nursery--and of these the first is much the easiest to get as he starts with a nucleus in his

Page  8 8 students textbooks effort and system gradually train a man's capacity to read intelligently and profitably but only while the green years are on his head is the habit to be acquired and in a desultory life without fixed hours and with his time at the beck and call of everybody a man needs a good deal of reserve and determination to maintain it like his friend john shaw billings osier became a bibliophile early in his medical career he was the second president of the medical library association and gave a major address to the association the day before a meeting of the american medical association he did this to attract physicians to a small library meeting and literally packed the 9 audience by bringing young physicians from baltimore to the meeting his call for building a personal library reflects his scholarly in terests over a fifty year period using his home as the tranquil base for thinking and writing it is therefore easy to appreciate and understand the following statements so far as the library is a factor the greater part of a man's post-graduate education must be at home in this country no man practices very far from a country town in which there is a medical society or a general hospital with a library attached 2 cushing h the life of sir william osler new york oxford university press 1940 p 580

Page  9 9 to the man who is ambitious to use his opportunities in a town or city a well selected library is essential and whether he be surgeon physician or specialist he needs as a rule more than his own shelves supply often indeed a good deal more than the library can offer he called for library exchanges to share literature resources freely although interlibrary loans and exchanges can be traced back three cen turies osier was among the first to recommend this for economic as well as for intellectual reasons by means to use his opportunities in a town or city a well selected library is to use his opportunities in a town or city a well selected library is essential and whether he be surgeon physician or specialist he needs as a rule more than his own shelves supply often indeed a good deal more than the library can offer he called for library exchanges to share literature resources freely although interlibrary loans and exchanges can be traced back three cen turies osier was among the first to recommend this for economic as well as for intellectual reasons by means to use his opportunities in a town or city a well selected library is essential and whether he be surgeon physician or specialist he needs as a rule more than his own shelves supply often indeed a good deal more than the library can offer he called for library exchanges to share literature resources freely although interlibrary loans and exchanges can be traced back three cen turies osier was among the first to recommend this for economic as well as for intellectual reasons by means of an exchange this association can render great assistance while in the thickly populated districts a system of exchanges between libraries would cut in half the cost of the more expensive journals in this matter too a central library like that of the british medical association may be most helpful finally his scope and wisdom emerge when he reflects in the biblical vein that man does not live by bread alone it may also be said that man does not live by books alone thus his call for diversion and avocation that was surely sound advice in the early 1900 s is even more appropriate today but there is another side of the question of books and libraries--man does not live by bread alone and while getting

Page  10 10 his medical education and making his calling and election sure by hard work the young doctor should look about early for an avocation a pastime that will take him away from patients pills and potions for some the hobby may be fishing sailing or a garden osler recommends books and one senses that for him if it must be fishing then the curse on even this can be removed by collecting books of piscatology i have mentioned that at some points i cannot agree with osler one of them is his implied attitude toward fishing i must also disagree with osler when he implies that one can acquire five or six books only the masterpieces on auscultation and percussion for a very small expenditure of money prices for the recognized master pieces have expanded like the literature in geometrical ratio and we may look back on the prices of his day with the same thrill of regret that he experienced upon contemplating the sale catalog of richard mead's collection one can still collect however without being wealthy he need not collect masterpieces and indeed can often get more pleasure from working a less well tilled field knowing that the intellectual value of what he gathers as well as its pecuniary value will depend on his own knowledge and sense of discrimination rather than on a book dealer's or garrison-morton's osler speaks of collecting from the point of view of the individual collector and what this hobby can do for him we may go further and

Page  11 11 come full circle at the beginning of his address osler notes the important role collectors have played in laying the foundations of great historical libraries in this country we need refer only to the cushing klebs fulton collection at yale the clendening at kansas or more recently the reynolds at alabama which has just been described in a catalogue that would have delighted osler's heart one of the most important such libraries of course is osler's own at mcgill in this way the collector's hobby in the long run can also further the purposes of general-not just personal—education as his library becomes a new foundation for graduate and postgraduate education study and inspiration in the history and heritage of medicine i could not close my remarks tonight without reminding this audience particularly of the unusual relationship which duke's three deans have had to the national library of medicine dr davison was president of the association of honorary consultants to the army medical library the predecessor of the national library of medicine in this capacity he was responsible for getting the library moved from its leaky fire susceptible quarters to the elegiant new building we now enjoy in bethesda our second dean dr barnes woodhall was appointed to the nlm board of regents by the late president john f kennedy in 1964 and was elected board chairman in 1967 during his tenure he helped plan for the develop ment of the lister hill national center for biomedical communications as well as giving general advice and guidance on overall library policies

Page  12 12 last year president johnson appointed your third dean dr william anlyan to the board of regents and he has already begun to shape and influence the library's role in support of medical education throughout the nation i offer the suggestion that our medical school whose deans have done so much for the national library of medicine should now turn its attention to its own medical library needs if you examine the duke library you will find it essentially unchanged since we studied or slept in its chairs although the collection has been enlarged and enriched the physical plant remains inadequate for present and future needs of its students and faculty what would be more fitting than having the classes of 1944 make the first gesture towards building a new medical library by asking that our class contributions be set aside for this purpose with the opportunity to match private funds with federal and foundation dollars i believe we can see this accomplished in the very near future i close by presenting to the duke medical library a small gift from the national library of medicine which is given under the authority of the national library of medicine act of 1956 it is entitled an oration on the improvement of medicine by amosa dingley published in new york in 1794 i hope you will accept this book as our way of modestly saying thanks for what you have done for us in the past your history and ours have been intertwined and i hope it will remain so in the future