A Brief History of the American Medical Literature: 1776-1976, 1974
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580-62-18 a brief history of the american medical literature 1776 - 1976 there is a dead medical literature and there is a live one the dead is not all ancient the live not all modern there is none modern or ancient which if it has no living value for the student will not teach him something by its autopsy - oliver wendell holmes medical writing dates back to the earliest recognized form of literature which appeared on clay tablets papyri and parchment slnce the printing press itself was invented 1450 before the creation of our nation american medical literature may be considered as a late contribution to the corpus of medical knowledge most civilized countries h.ad already published manuscripts books and journals before the first american attempted to write about medical events before the american revolution most publications dealing with health or medicine came from the pens of theologians and explorers spanish physicians had already begun to report on medical events in mexico and south america in the 16th century t thomas thacher ordained new england minister not only preached presented by martin m cummings m.d director national library of medicine to the alpha omega alpha university of oklahoma medical center oklahoma city oklahoma november 14 1974

Page  2 2 the gospel but also practiced medicine his brief rule to guide the common people of new england how to order themselves and theirs in the small pocks or measles which appeared in 1678 was the first medical publication written and printed in what is now the united states this was soon followed by the publications of rev. dr. cotton mather and his friend dr zabdiel boylston who first advocated and introduced the practice of inoculation against smallpox in america the first american medical journal medical repository was published in new york in 1797 more than a century after thacher's publication 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 3 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 to assume medical practice only a few private libraries existed there was no formal training for research or clinical

Page  3 3 practice and scientific methodology was undeveloped 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 as in europe where the first scientific journals were published by professional societies the american scientific literature was also an outgrowth of the emerging scientific societies the proceedings of learned societies soon dominated the field of scientific publications and have continued to do so despite the fact that many professional societies in recent years have been forced to sell their copyright to commercial publishers for economic reasons the american philosophical society founded in philadelphia in 1729 was the first organization to use a committee as an editorial review mechanism in the selection of manuscripts for publication subsequently other professional and scientific societies adopted similar procedures for handling communications sent to them this peer review mechanism has survived to the present and represents a great contribution to the quality of publications billings wrote at the commencement of the revolutionary war we had one medical book by an american author three reprints and about twenty pamphlets the war brought to the forefront three american physicians who became leaders of

Page  4 4 medical education and practice - john morgan 1735-1789 william shippen 1736-1803 and benjamin rush 1745-1813 all these came from philadelphia and all were to serve important roles in the revolutionary army morgan was appointed director general and physician-in-chief of the american army in 1775 he was replaced by action of politicians in 1777 and was succeeded by shippen as surgeon general morgan and shippen previously collaborated in organizing the medical department of the university of pennsylvania whereas morgan contributed an essay for improved medical education in this country shippen made no noteworthy contribution to the literature of medicine benjamin rush on the other hand became a vigorous contributor to our medical literature after succeeding morgan as professor of practice at pennsylvania although some of his therapeutic views and practices were arbitrary and incorrect he was recognized as the most sophisticated american clinician of his time and was applauded not only at home but abroad he contributed clear accounts of cholera dengue yellow fever and other infectious diseases which plagued our nation he produced the first systematic treatise on mental illness published in america hls ambitious program to combat yellow fever in philadelphia led to many difficulties with other physicians and politicians in addition he wrote an important thesis on hygiene in the troops 1777 which george washington apparently used as the sanitary rules for the revolutionary army

Page  5 5 the writings of thomas cadwalder also of philadelphia were also important since he was the first to describe lead poisoning leading to colic and palsy from habitual use of jamaican rum distilled through lead pipes his essay on the west india dry-gripes was printed by benjamin franklin 1706-1790 in 1745 franklin the universal man published several important papers and letters concerning treatment of paralysis with electricity observations on gout contagion and smallpox benjamin rush also ventured into broad philosophic and sociologic considerations of the times among the least noticed of his publications is a treatise on the spirit of the times in which he condemns the study of latin and greek languages as an obstacle to the perfection of english which he believed was essential to the propagation of the knowledge 3 and education in our country he wrote the rejection of the latin and greek languages from our schools would produce a revolution in science and in human affairs that nation which shall first shake off the fetters of those ancient languages will advance further in knowledge and in happiness in twenty years than any nation in europe has done in a hundred the course of subsequent history confirmed his judgment to a large degree among the most significant american medical publications of the 19th century were oliver wendell holmes 1809-1894 book

Page  6 6 puerperal fever as a private pestilence published in boston in 1855 james marion sims 1813-1883 reports on the treatment of vesico-vaginal fistula published in the american journal of medical sciences and william beaumont's 1785-1853 book experiments and observations on the gastric juice and the physiology of digestion published in 1833 beaumont's first report of his studies on alexis st martin who had been wounded by an accidental rifle discharge leaving a gastric fistula was published in 1825 in the medical recorder by joseph lovell who was the surgeon general to whom beaumont had sent his complete observations pioneer research reports on the early use of anesthesia by crawford w long 1815-1878 and wllliam t g morton 1819-1868 have been summarized by thomas e keys '" on the occasion of the centenary of surgical anesthesia silas weir mitchell 1829-1914 pioneer american neurologist was probably the most stylistic writer of scientific and clinical reports many of his publications were translated into french german and spanish in addition to his medical writing he was a creative author of poems and novels which are still recognized as important works daniel drake 1785-1852 founder of several american medical schools and peripatetic professor of materia medica wrote several important books including natural and

Page  7 7 statistical view or picture of cincinnati 1815 and a two-volume work a systematic treatise historical etiological and practical on the principal diseases of the interior valley of north america as they appear in the caucasian african indian and esquimaux varieties of its population 1350-1855 this remains a classic of early western american writing the two americans who wrote most productively and brilliantly at the turn of the century were close friends john shaw billings 1838-1913 and sir william osler 1849-1919 billings was undoubtedly our country's greatest bibliographer and librarian while osler the canadian transplant became our most notable medical teacher and clinician blllings creation of the index catalogue and index medicus remains america's greatest contribution to medicine while osler's essays and principles and practice of medicine was the first and best systematic textbook on the subject during this period billings and osler were the most influencial physicians in establishing the role of the medical library in support of patient care and continuing medical education 8 osler discussing the importance of the medical library in the continuing education of the physician wrote for the general practitioner a well-used library is one of the few correctives of the premature senility which is so apt to overtake him self~centered self-taught he leads a solitary life and unless his everyday experience is controlled by

Page  8 8 careful reading or by the attrition of a medical society it soon ceases to be of the slightest value and becomes a mere accretion of isolated facts without correlation it is astonishing with how little reading a doctor can practice medicine but it is not astonishing how badly he may do it today the medical profession is threatened by compulsory peer review recertification and relicensure requirements this will force the practitioner to seek new means of refurbishment of his knowledge base for decision making a wide array of information sources are available to him if only he will seek them out books journals and audiovisual materials are so portable as to be easily available to the physician in his office clinic hospital and even his home the use of these resources associated with attendance at selected informative medical meetings personal contacts with other physicians especially those who teach should be more than an adequate base for sustained continued education this system of communication is useful however only to those who take the time to study medicine as it continues to evolve those who willingly deny themselves of new knowledge also deprive their patients of benefits to be gained from such knowledge physicians unwilling to make such an effort probably are not worthy of the profession they have joined thus they may be expelled or dissociated from practice until they show evidence that they are prepared to offer the best care available from the medical science

Page  9 9 american physicians are fortunate because english has becomunate because english has become the predominant language of science we no longer need to learn latin german and french to keep abreast of advances in medicineunate because english has become the predominant language of science we no longer need to learn latin german and french to keep abreast of advances in medicine - although a knowledge of these languages has other virtues we have recently analyzed the world's biomedical literature the sources of origin and the languages in which it appears is most revealing the national library of medicine acquires annually 19000 serials published throughout the world approximately 73 of this number originate from eight countries with 36 from the united states from this body of 19000 periodicals 11.8 or 2244 serials are selected by an advisory group of experts for inclusion in our computer-based system and 76 of these chosen serials again come from the same eight countries but with slightly different order of ranking this leads to a consideration of the languages represented by the index medicus serials this total of 2244 serials come from 66 countries and 36 languages sixty-two countries publish single-language journals and the number of languages represented in this category is 26 1172 52 are published in english only and are produced in 39 countries in addition there are 300 polyglot journals 178 or 59 have english as the primary language thus one cannot assume that the language of a publication is necessarily that of the country of origin

Page  10 10 furthermore it is essential to examine the articles before one can generalize on what constitutes the language s of the biomedical literature 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 accounted essentially for all the english language articles in 1879 today this literature now emanates 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% these findings reveal that it is no longer difficult to

Page  11 11 learn what is going on in medicine if only we would take the time to do so no one of course can be expected to read everything relevant to medicine however with the aid of published and computer based indexes and catalogs one can readily find access to the wealth of new knowledge when it is required although medicine has evolved rapidly and with a reasonable pattern of directed growth the most significant new advances often have resulted from unexpected observations or practices in many different places no physician should practice medicine without a regard for the safety and welfare of his patients unfortunately this does not occur when the physician is disinclined to learn of new discoveries which time and attention can bring to light in recent years there has been a change in the format as well as the character of the medical literature

Page  12 12 a relatively new type of medical literature emerged after world war ii when medical newsletters and controlled circulation medical magazines were introduced supported largely by advertising or by the pharmaceutical industry this form of publication began to compete with medical periodicals for the time and attention of the busy practitioner much of the information appeared in lay language in abstract form making it easy for the non-scholarly non-scientific health professional to scan quickly the highlights of medical advances for those who later sought and studied the full medical reports this form of writing served a useful alerting purpose however for those who depended completely on this type of information it soon became apparent that the quality of the information was not adequate for high-level continuing education or health care delivery the future of such publications remains in doubt as more government surveillance of advertising claims is beginning to take place medical textbooks have also changed in character it is rare that a single author attempts to write a comprehensive textbook in any field or discipline slnce 1950 most textbooks have been written by joint authors or by a large number of contributors who prepare chapters for inclusion in large texts compiled and edited by one or more experts in the field this reflects the complexity of modern medicine and has served to make texts more authoritative and timely

Page  13 13 the critical review which has served as a means of providing analytical as well as synthetic information has not flourished during this century although most physicians and scientists seek information in this form they are apparently unwilling or unable to provide carefully documented objective reviews themselves this is a serious shortcoming of modern science and in my view greater efforts are needed to support and subsidize such writing by recognized leaders of american medicine 9 sir theodore fox former long-term editor of lancet described the present inadequate methods of transmitting medical information as a crisis in communications he described the roles of medical journals in terms which suggest that they have outlived their usefulness in large part because of editorial deficiencies and lack of organization i agree that we are approaching the period when the conventional journal will be replaced by more efficient timely and less costly mechanisms for information transfer i believe a medical press to record significant medical events and observations will continue but it will be associated with more dynamic audiovisual and other electronic means of communication physicians and scientists will have several options available for dissemination of their findings and will no longer be solely depending upon the written word for

Page  14 14 priority or prestige kronick 10 in a most interesting study of the history of early scientific journals questions whether the development of new communications technology adversely affects scholarship i believe that it does however it also makes the dissemination of new knowledge much easier and thus has more social utility it is important therefore that a new bibliographic apparatus evolve concurrently with the proliferation of new communications media if this is done the integrity of the literature can be maintained even though it appears in radically new and different formats just as books are difficult to use without a table of contents or an index so are other information forms the national library of medicine has recognized this and continually struggles to maintain an efficient bibliographic system to meet these needs libraries are changing from passive repositories of printed matter to active centers of biomedical information the national library of medicine now employs computers photographic methods television and satellites for dissemination of bibliographic data and more complete informational messages this will be

Page  15 15. expanded to include information in organized blocks which should be more significant in the service of mankind the literature will be expanded to include information in many forms and formats and importantly will be delivered rapidly to those who wish it or need it personal communications will be continued through meetings letters and telephone but it will no longer be haphazard and available to an exclusive society of the rich reforms and improvements in communications will come rapidly when the present control of the medical press by the commercial publisher is returned to its rightful owners the authors and the professional societies with which they are affiliated i have no doubt that within the next several decades that it will be possible for all medical information to be transmitted with great speed and accuracy to any physician located anywhere on this earth and perhaps to other planets as well the major problem which will remain will be the selection of the most appropriate information for the problem at hand to deal with this medical educators must find the means to teach students where to get the information they need

Page  16 16 rather than attempting to force them to memorize the information itself man's brain remarkable and versatile as it is simply will not be capable of acquiring and retaining the vast amount of new knowledge generated by the biomedical sciences

Page  17 references 1 billings john s literature and institutions in a century of american medicine 1776-1876 by edward h clarke et al philadelphia lea 1876 p 293 2 rush benjamin medical inquiries and observations philadelphia prichard & hall 1789 3 rush benjamin an enquiry into the utility of a knowledge of the latin and greek languages as a branch of liberal education in the spirit of the times edo by simon search london h gardner strand 1791 p 213 4 holmes oliver w puerperal fever as a private pestilence boston tlcknor and fields 1855 60 p reprinted in med classics 1:211-68 1936-7 5 sims james m on the treatment of vesico-vaginal fistula philadelphia blanchard & lea 1853 28p reprinted from the amer j med sci n s 23: i.e 69-92 jan 1852 6 myer jesse s life and letters of dr william beaumont including hitherto unpublished data concerning the case of alexis st martin with an introduction by sir william osler st louis c v mosby 1912 7 keys thomas e the history of surgical anesthesia with an introductory essay by c d leake and a concluding chapter the future of anesthesia by n a gillespie new york schuman's 1945 8 osler sir william aequanimitas philadelphia blakiston's son & co 1932 chapt 12 books and men p 211 9 fox theodore crisis in communication the functions and future of medical journals london athlone press 1965 10 kronick david a studies of the early scientific journal: 1 the basic source lists texas rep biol med 32:61-74 1974