Gold-Headed Cane as a Symbol of Continued Medical Education, 1972
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the gold-headed cane as a symbol of continued medical education martin m cummings m.d i am pleased and honored to have been invited to give the gold-headed cane address on the occasion of this honors convocation the gold-headed cane symbolizes different things to many persons for myself it symbolizes a quality of professional excellence related to continued medical education the cane made its first appearance in 1639 it was carried 3y the leading physicians of england as it passed through the hands of radcliffe mead askew pltcairn and baillie until 1825 when it finally came to rest in the library of the royal college of physicians in london the gold-headed cane became a universal symbol of high quality medicine after dr wllliam i'lacmichael's publication in 1327 1j slides 1 and 2 hls book v.'as cleverly written as though the cane itself was giving an account of the lives of the physicians who had carried it in fact no good physician of the 18tk century would be seen in public without such an adornment the hollow head of the cake held aromatic disinfectants thought to prevent infection complete or incomplete biographies of the aforementioned physicians have appeared from time to time there is little 1 can add about their character or performance however there is one element of history associated with these men which i do not director national library of medicine addressing the hj c o n v o c a t i o n the university of texas medical center branch school icdicine june7,1972

Page  2 page 2 believe has been systematically or carefully examined which deserves attention each of these distinguished physicians was interested in libraries and books radcliffe accumulated a fortune and used it to establish a great library which still bears his name in oxford mead was well known for his great personal library 10,000 volumes and for his written contributions to medicine he more than anyone else with the possible exception of baillie left significant original publications on a wide variety of subjects importantly he produced a mechanical account o poisons in 1702 and a short discourse concerning pestilential contagion in 1720 the latter treatise revealed fairly significv insights into infectious and contagious diseases and was subsequently followed by a series of papers dealing with selected medical problems including plague askew like mead acquired a significant private library vi unfortunately was dispersed at auction after his death he was particularly interested in greek and roman literature 0|\'ly pltcairn contributed nothing to the medical literature but he introduced a freer use of opium in the treatment of fevers for which he was honored flatthew baillie was the last to carry the gold-headed cane and is best remembered for his work with william hunter it was hunter and baillie who built the great collection of anatomic and pathologic specimens that led to

Page  3 page 3 baillie's publication the morbid anatomy of some of the most important parts of the human body that important treatise ccnta ,¦•::::: the first comprehensive descriptions of peptic ulcer and cirrhosis of the liver the work was first published when baillie was 32 years of age but it was dr william tiacmichael author of the gold-headed cane physician extraordinary to king gegrge iv and physician in ordinary to king william iv who interests me most for it was he who succeeded dr robert gcoch as librarian to the klng if one examines macmichael's book he will observe descriptions of several libraries - mead's and askew's of course but also the royal college of physicians and sir hans sloane's particularly he described libraries as meeting places between the literary and the scientific scholars of the time where the gold-headed cane eavesdropped on the conversations as related by macmi chael . i have attempted to learn something of tiacmichael's responsibilities as the klng's librarian but i was not able to uncover a great deal however in macmichael's lives of british physicians published in 1830 k macmichael described the life of his immediate predecessor gooch and wrote in april 1825 he was appointed librarian to the klng a situation which added much to his comfort by insuring him a moderate annuity for life in case which then appeared too pr03a3le ill health should oblige him to relinquish his profession entirely for this he was indebted to the kindness of his friend sir w ill i am knightom i suspect that this position was largely a sinecure and fiacm i ch ael''s

Page  4 page l appointment was made for similar reasons as a result of ialfadr''c ji\ij o influence fialford was physician to ln6 george iii the so called mad king whose mental illness has recently been attribute to acute porphyria by the clever retrospective studies of hacalpine and hunter halford's clinical notes and careful description of the king's urine made this diagnosis possible king george iii d 1820 built a very distinguished library but his successor george iv during whose reign macmichael was appointed sold the collection to raise money although the sale was euphemistically described as turning the library over to the british nation after his death on june 25 1350 his successor king william iv found himself the only sovereign in europe not possessed of a library he proceeded to rebuild the royal library we can only assume that dr william acmichael played an important role in this process kls passion for which anonymity makes it most difficult to give him the credit which probably was his due but why should anyone talk to young medical school graduates about libraries i believe there is good reason to do so because the library is not only the storehouse of man's past accomplishments but also the repository of contemporary ikfci^atio men like osler billings gushing welch bean and wangenstee among others acknowledged that medical libraries were their major source of information inspiration and relaxation the

Page  5 rauc j knowledge of how to use a library properly often makes the difference between a man's ability to carry on continual self education or his dependence upon other medical specialists this medical center has developed a great medical collect ic i\c now has one of the nation's most outstanding library buildings therefore these analogies seem particularly appropriate a great physician once said 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 wit his time at the beck and call of everybody a man needs a gcco deal of reserve and determination to maintain it ^ slr william osler wrote this in i9c9 in discussing the role of thi medical library in post-graduate education he was of course exhorting students of medicine and young physicians to acquit the habit of reading and study at an age when it serves as t.iz beginning of sustained continued education osler suggested that a great part of post-graduate re;\d;;s must take place in a man's home since the physician has little time during his practice for such study fluch of his pgst-gt education will come from participation in meetings confer^ci and other scheduled events slnce most of you will not 2e a to escape meetings i shall comment briefly on the impgrtai-.cji ..:¦. disciplined sustained reading the regular reading of 8-10 journals each week is usually

Page  6 page 5 sufficient to keep abreast of most of the current advances li'i medicine with these and several dozen current reference v;o;::ks readily available a well-trained physician can usually locate most of the information he needs selective use of audiovisual information packages may enrich or elaborate information in specialized fields every physician should begin to build a personal library early in his career the book still represents a most compact and durable and tested form of information retrieval unlike the computer one may use it without fear of electrical or mechanical failure it is portable and can be read in the bedroom as well as the classroom it may be used repetitively for one needs only a bookmark to pick up the program sequence vf any convenient time wlth a good index it is ideally suited rcw random access its major limitation is its built-in obsgl£sce;:c resulting from its long process of preparation 1'ihen a i-iys:c;w personal library cannot provide the information he seeks the library of the community hospital should be the next pcrt-oi call if it fails to have the information the request should ¦¦-,.: transferred to the nearest regional f'iedical library tj-ie national library of medicine serves as the court of last fogay medicine is the only discipline blessed with a journal lihrary network it will serve your information needs if only you w,u take the time to use it just as man does not live by bread alone neither will his education be nourished by books alone osler recognized this

Page  7 page 7 when we wrote 3 while getting his medical education and making his calling and election sure 3y hard work the young doctor should look about early for a avocation a pastime that i1 ill take him away from patients pills and potions in a society beset by poverty prejudice and war time se aside for amusement and recreation provides essential guardians of physical and mental health the young physician in the spring of his career can more easily make such choices and commitments than the tired old work horse who knows only the route from his office clinic or hospital and then back home one such avocation which attracts too few physicians in th:s century is the study of the history of medicine i\'o profession has a richer heritage which is full of good ore to be mined by young and old alike i\ot only does historical study enrich the mind broadly it sometimes leads to rediscovery of information which may have practical contemporary value above all historical studies and knowledge add perspective and understanding not only to scientific problems and questioi in medical practice and research but to the many ethical ecc-/\l and economic problems facing the medical profession today importantly it enlightens cur citizens and legislators in considering questions of social policy such as the ethics of organ transplantation the appropriate level for support or research and education and a host of related problems 1 tbinx all of us here would agree that it is important for americans

Page  8 page 8 to know about our history and the traditions that have f-'ade cl nation great al_so i believe physicians should have thc same respect for their history and traditions they will ee 3ette physicians for it unfortunately education in the history of medicine is sadl lacking in more than half of our f'ation's medical schools john bowers president of the macy foundation quoted from a letter from a nobel laureate as follows history is the study of recorded knowledge the library is the repository of this knowledge the two should work together hi story extends from the present moment all the way back as far as records go all this is self-evident but neither students nor faculty now have the concept of history as pervading all thought both retrospective amd prospective a vast amount of present day research simply represents work already done and done well faculty and students should be more alert and more learned oliver wendell holmes said it even more succinctly wz knowledge of today finds a soil in the forgotten facts of yesterday he went on to point cut that a youth had kamy advantages as he entered the practice of medicine ike ycjiki man's senses are quicker than those of his older rival i-iis education in all the accessory branches is more recent and therefore nearer the existing conditions of knowledge lils most powerful statement in support of youth is simply expressed

Page  9 page 9 new ideas build their nests in young men's brains granting all these advantages to today's graduates in their green years they must remember that they must continue to study for the rest of their lives the health professional must realize early that much of today's accepted practice may 3e tomorrow's malpractice thus like the gold-headed came if you spend a portion of your time in a good medical library you will continue to learn from the pioneers of the past as well ts in young men's brains granting all these advantages to today's graduates in thets in young men's brains granting all these advantages to today's graduates in their green years they must remember that they must continue to study for the rest of their lives the health professional must realize early that much of today's accepted practice may 3e tomorrow's malpractice thus like the gold-headed came if you spend a portion of your time in a good medical library you will continue to learn from the pioneers of the past as well ts in young men's brains granting all these advantages to today's graduates in their green years they must remember that they must continue to study for the rest of their lives the health professional must realize early that much of today's accepted practice may 3e tomorrow's malpractice thus like the gold-headed came if you spend a portion of your time in a good medical library you will continue to learn from the pioneers of the past as well as those of the present the humanistic side of medicine also must be cultivated continuously humanism may be stimulated amd fostered in tl-il-i home the church or the school but most often it comes from personal associations dr william 3 3jean in a convocation address to medical students discussed the importance of having good friends as well as good morals and excellent manners iu dealing with colleagues and patients in medicine in the selection and cultivation of your friendships remember that subtle qualities rather than superficial ones are of importance to a surprising degree your friends influence you and mold your habits amd character in your associates be content with nothing less than the best avoid the flashy the vicious and the shallow bood company elevates whether it be in the people you associate with or in the books you read indifferent company is retarding and dulling bad company weakens and ultimately cripples

Page  10 page 10 finally i end with the hope that there will be some amoks you who like members of this faculty will become interested and skilled in teaching research and practice for only thos:7 who participate in all of these activities can know the real joys amd satisfaction which come from generating new knowledge sharing it with others and applying it to help your sick and disabled fellow citizens those of you who accomplish this successfully carry the gold-headed cane of this generation while preparing the next to receive it i offer my congratulations to those new graduates who are being honored today .

Page  11 director national library of medicine addressing the honors convocation the university of texas medical branch school of medicine june 7 1972 1 macmichael william the gold-headed cane a facsimile of the author's 1827 copy illustrated and interleaved with his own amendations and additions london the royal college of physicians 1968 original publication london john murray 1827 2 macmichael william lives of british physicians london john murray 1830 3 osier william remarks on the medical library in post-graduate work brit med j 2:925-928 1909 4 blake john b , ed education in the history of medicine report of a macy conference sponsored by the josiah macy jr foundation in cooperation with the national library of medicine new york hafner publishing co 1968 5 bean wm . b caritos medici the pharos feb 1.954