The Changing Character of Medical Literature, 1974 [II]
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speech for aspen colorado august 4 - 10 1974 given institute of pathobiology university of colorado summer conference

Page  2 the changing character of the medical literature martin m. cummings m.d. because american generated medical literature is vast and sophisticated we often forget that it was not always so important prior to 1776 american medicine was based almost exclusively on ideas and practices imported from europe colonial physicians relied on medical books imported from england american medical culture generated little scientific publication and meager communication other than that which transpired by word of mouth or letter according to toner there were less than 350 physicians with m.d. degrees in the colonies in 1775 but more than 3000 persons served as medical practitioners in a population of million there were few discoveries or inventions to be reported most public health matters were dealt with in the public press one merely needed to serve as an apprentice to gain sufficient experience or knowledge and assume medical practice only a few private libraries existed there was no formal training for research or clinical practice and scientific methodology was underdeveloped institutional libraries including medical works appeared in the 18th century particularly in the colleges of new england the first medical library was established at the pennsylvania hospital in 1763 although harvey boyle and other europeans made notable contributions to science previously the progress and growth of american medicine did not flourish until the 19th

Page  3 page 2 century when scientific reports appeared in the medical literature this is the period when koch pasteur vlrchow among others applied scientific methods into basic medical sciences still few american physicians were recognized as international contributors to science at the turn of the century a virtual explosion of medical literature became evident during the 20th century the remarkable increase in the size scope quality and diversity of medical literature became so large as to overwhelm the existing publications and library mechanisms set up to handle it the emergence of new disciplines in basic medical to accompany clinical practice was clearly reflected characteristics and the titles of new scientific journals as well as in books and monographs the emergence of american medical sciences was no longer totally dependent upon foreign science after the turn of the 20th century the american leadership in medical sciences was greatly amplified after world war ii when federal funds in large amounts were made available for support of medical research recognition of the high quality of american medicine in the 20th century was accompanied by a radical change in the flow and migration of physicians and scientists whereas prior to world war ii many americans traveled to europe and other countries for graduate and post-graduate medical education foreign physicians and scientists began to come to this country in enormous numbers for medical education and training at all levels

Page  4 page 3 before 1900 american physicians and scientists often submitted manuscripts for publication in foreign journals after the turn of the century most americans attempted to publish their scientific and clinical observations in the american literature this trend has been expanded to the point where many foreign physicians and scientists now seek an outlet for their ideas and observations through publication in the american literature from its modest beginning in 1836 when the national library of medicine had about 130 titles of which only 34 or so were american produced we now hold more than 29,000 serial titles with approximately 6000 having in the u.s. alone it should be pointed out that a third of these serial titles no longer exist as active publications each day two new scientific journals born while one dies data derived from the science citation index from the national science board in 1973 1 reveal that the states produced the largest share of literature in physics and geophysics moledular biology systematic biology economics mathematics and engineering the only analyzed in this report in which the u.s. did not rank among nations were chemistry and metallurgy if one separates 1 science indicators 1972 report of the national science board 1973 national science foundation

Page  5 page 4 these disciplines it is clear that the u.s. also produces more literature in chemistry than any other country in molecular biology the us produced almost half of the worlds literature with each of the next largest producers providing only 9 u.k. and france one important change is evident in scientific publications namely the emergence of english as the most frequently used language of science webb 2 reports that during the past 50 years the number of biochemical papers published in english has increased from 40% to 90% in medicine we would estimate a slower transition from approximately 40 to 90 during the same period the following analysis of the biomedical literature reveals some interesting data the national library of medicine has acquired more than 20000 serials published throughout the world approximately 73 of these originate from eight countries with 36 from the united states about 8000 are considered to contain substantially reports in medicine from these periodicals 2244 are selected by an advisory group of experts for inclusion in computer-based system medlars and 76% of those chosen are from the same eight countries but with a slightly different order of ranking these 2,244 serials included in index medicus come from 66 countries and are written in 36 languages sixty-two countries publish single-language journals and the 2 webb e.c. communications in biochemistry nature 1970 225 132-135

Page  6 page 5 number of languages represented in this category is 26 1,72 52% are published in english only and are produced in 39 countries in addition there are 300 polyglot journals 178 or 59% use english as the primary language a comparison of those articles published in the first issue of index medicus in 1879 with those in the index medicus of 1972 is revealing the number of articles has increased ten-fold there is a significant shift toward the english language from 42% to 64.5% with a decline in french german spanish and italian russian japanese and some slavic languages have gained in prominence furthermore whereas the united states and great britain accounts essentially for all the english language articles in 1879 today english language articles emanate from 52 countries also a significant percentage of these foreign language articles now carry english abstracts russian 59% italian 54% german 49% spanish 39% japanese 32% french 32% all other foreign 52% this is a wholesome and useful development in the trasfer and understanding of scientific information on a global basis in any examination of american medicine one musi distinguish between the large amount of uncritical and

Page  7 page 5 anecdotal writing which characterized the 18th and 19th centuries from the more scientific and technical writing which has appeared in the 20th century although the former gives an image of medicine as a reflection of the civilization of the time the latter more clearly portrays the evolution of scientific ideas concepts and inventions when it became generally accepted that research was incomplete until published there was a further rise in the number of manuscripts and reports dealing with scientific and social aspects of human health and disease tlie published literature expanded at such a rate that it was necessary to increase greatly the number of abstract journals which gave informative summaries of much of the work much had been published in more comprehensive form the great expansion of scientific writing in the 19th century led to the development of index catalogue and medicus prepared by dr john shaw billings first director of the national library of medicine at the turn of the century dr. william h. welch at johns hopkins and later the royal society of medicine identified these awesome products as america's greatest contribution to medicine the 20th century brought forth multi-disciplinary and inter-disciplinary research which generated the need for new types of journals this led to another surge of new journals with broad scope and coverage of subject material however

Page  8 page 7 as the base for medical science continued to broaden many highly specialized journals were started and now greatly outnumber those of a multi disciplinary nature as biomedical science became more fragmented new titles appeared to give more specialized accounts of research in very narrow fields this is dramatically exemplified by hie recent creation of a journal which deals with one series of chemical compounds alone the prostaglandins in the ten years since the isolation and chemical identification of prostaglandins in sweden more than a thousand papers dealing with these compounds have been published one may properly ask why the scientific journal may survived three centuries when the costs for such publications have risen to almost unacceptable levels and its growth has been so rapid as to make the reading of these materials almost impossible the purpose of the scientific journal as described by ziman is to bring into the public domain an explicit account of some new scientific development or discovery the whole activity of science is dependent on the publication of such documents and their subsequent criticism re-evaluation and eventual acceptance or rejection as part of the consensus of public knowledge he also stated that the literature of a subject is quite as important as the research work that it embodies these views of a 3 ziman j.m. public knowledge an essay concerning social dimension of science cambridge university press 1968

Page  9 page 8 distinguished british theoretical physicist need reinforcement in this period of history when research is expensive and our tolerance for redundancy of effort must be more limited as the funds for support of science become more difficult to acquire few scientists can make original scientific contributions without an awareness of the previous work of others science grows sequentially as research leads to new knowledge background information can be acquired from many sources but reading still ranks high as a means of learning what has been developed in the past engler writing about the relative value and of learning about scientific developments at meltings versus reading the literature said the man who reads providing he is intelligent will always learn more whether this generalization is true for all is an open question nevertheless it is clear that most scientists prefer to describe their original research in publication form and many certainly acquire new knowledge by reading the real problem is that there is inadequate time for both discussing and reading science new mechanisms for contributing and retrieving relevant information need to be developed conferences such as these serve this purpose well but only a small number of persons are privileged to be included 4 engler h. the way of science hafner publishin new york 1970

Page  10 page 9 written syntheses or critical reviews of highly specialized subjects are more useful in the long run than a series of small unrelated accounts of the same observations and conclusions in addition to serving as an information source for highly specific scientific events the medical literature also serves to reveal the changing trends and growth of medical thought sometimes it has innocently or deliberately ignored the true origin of a new idea but most often through careful historiography one can trace the convergence of previous bits of information into the building of new hypothesis or into the development of a new practice procedure nevertheless there are always some problem of historical interpretation and evaluation which remain for future historians to analyze and explain information in written form is available for study evaluation or debate whereas informal information although speedy may not be as reliable or defensible is much easier to retract or deny what one has said what one has written and i take some comfort in this now