The Medical Library in Postgraduate Work, 1969
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tht medical library in postgraduate a review by martin m cummings m d half a century the time since osler s death is but a small flicker in the history of civilisation yet it represents a considerable segment of the history of life sciences and medicine in particular thus the views of me a 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 bevislted reprint of selected sections with commentaries wisely consented that to fully appreciate osier we should understand his relationship to his own contemporaries whereas i gree with this viewpoint i must add that osier s greatness strikes me more when we view his lasting judgements wtih 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 osler 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 during his most osler william the medical library in postgraduate work proc med lib assoc vol i pt ii 1909 reprinted from the brit med j v 2 pp 925 928 1909 2 king l s osler revisited vol 200 no 2 jama april 10 1967

Page  2 2 mature period of clinical medicine and scholarship the article itself however begins in a somewhat parochial vein praising the british for the development of a large number of local libraries as well as recognising the contributions to medlcine 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 throughout his paper osler 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

Page  3 3 then it comet easy enough and the hardest worked men in the land nay read his journals every week even if he has to do it in his carriage i do not believe that a physician exhausted from the rigors of his practice of medicine today can read and absorb the content of journals while driving to and from work more likely he might listen to audio tapes which present extracted or synthesized information which is provided by a few professional societies 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 natch 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 ot medical practice at the turn of the century one night be expected t be well read by keeping up with only a few leading british and american medical journals through bedtime reading even osler

Page  4 4 himself seemed to have reserved his bedtime reading for non medical literature ogden a first year medical student at mcgill described osler's reaction to finding him in bed reading physiology as follows he broke out at once in praise of the habit of reading in bed but heartily disapproved the physiology only literature never medicine 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 osier reconmeaded a half hour s reading each night at bedtime in the present world of specialization and multidisciplined medical science osier 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 store necessary to sample the writings in a large number of journals rather than read thoroughly only a few to sample this vast 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 osier 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 nay be useful to the health practitioner and biomedical scientist 3 cushing h the life of sir william osler vol 1 oxford clarendon press 1925 p 176

Page  5 5 how i should like to discuss briefly some of osler s views which i strongly support 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 seen 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 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

Page  6 6 but conditions have changed and medicine is now a rapidly progressive science as well as an exceedingly complicated 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 locks 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 judgeaent the teacher will have more or less of a fool for a pupil and between them make a sad mess of an education he witnessed the development of professional ism in science and he was wise enough to understand and cultivate the acquisition of knowledge in depth a well as generalised information the physicians who stopped learning after graduation in the 19th century did not become obsolescent

Page  7 7 as quickly at 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 osler s time than it does today osler s impressive influence on canadian american and english nediclne resulted primarily from his phenomenal industry as well as his clinical abilities and his prowess as a teacher his oost 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 writing the principles and practice of medicine was perhaps the most significant contribution to this literature during his active career be put to practical use his knowledge of medical history better than moat 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 learning as a student the exordium or preface to sustained or continuing education here 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 students textbooks effort and system gradually train a

Page  8 8 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 like his friend john shaw billings osler 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 audience by bringing young physicians from baltimore to the meeting his call for building a personal library reflects his scholarly interests over a fifty year period using his hone as the tranquil base for thinking and writing it is therefore easy to appreciate and under stand 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 county town in which there is a medical society or a general hospital with a library attached op cit 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 1 p15 he called for library exchanges to share literature resources freely although interlibrary loans and exchanges can be traced back three centuries osler was anong 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 say be most helpful 1 p 15 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 1900s 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 his medical education and making his calling and

Page  10 10 election sure by hard work the young doctor should look about early for an avocation a pastime that will take him away fro patients pill and potions 1 p 17 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 the young doctor should look about early for an avocation a pastime that will take him away fro patients pillthe young doctor should look about early for an avocation a pastime that will take him away fro patients pill and potions 1 p 17 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 the young doctor should look about early for an avocation a pastime that will take him away fro patients pill and potions 1 p 17 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 osier 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 recognised masterpieces have expanded like the literature in geometricai 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 froa 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 dealers or garrison mortons

Page  11 11 osler speaks of collecting from the point of view of the individual collector and what this hobby can do for him we say go further and 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 oslers 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