An Address at the
Dedication of
The Clendening Medical
Library Building
by
Frank B. Rogers
Director, National Libraryof Medicine
This address by Colonel Rogers was de livered on the occasion of the dedication of a new library building for the University of Kan sas School of Medicine.
It is customary for the University to dedi cate its buildings to the memory of members of its faculty. When it came time to designate this library one name stood pre-eiminent. The library was named officially by action of the Kansas Board of Regents in memory of a mem ber of the medical faculty who was an engag ing teacher, an ardent bibliophile, a master historian, a scholar and litterateur-Logan Clendening.
With pride, the School of Medicine's library collections henceforth will be the Clendening Medical Library.
Dr. Ralph Major, Col. Rogers, Miss Opal Woodruff, and Mr. G. S. T. Cavanagh, with the Dedication Gifts in the Entrance Lounge, Clendening Medical Library.
MR. CHAIRMAN, OFFICERS OF THE UNIVERSITY, DISTINGUISHED GuEsTs, LADIES AND GENTLEMEN:
We are met today to dedicate a new facility to house the medical library of the University of Kansas. That of the making of books there is no end, we may all be cer tain; that more shelves will always be required is plainly inevitable. At this point and place in time when happily, if momentarily, the number of shelves is more than ade quate for the number of books, we pause to mark the felicity of the occasion, and to reflect on past and future fortunes.
"A common method in preparing an address for an occasion like this is to begin by saying that this new ad dition to your resources brings with it increased duties and responsibilities and then proceed to give a few thou sand words of advice."1 So spoke John Shaw Billings at the dedication of another library half a century ago. He did not follow through then, but I am not sure that I will be able to muster such forebearance now.
I begin with the multiplicity of books. This is a lament which has been heard in the land for a long time. In 1823 Dr. John Stearns, the first president of the New York Academy of Medicine, delivered an address entitled A
comparative view of the State of Medical Science amon,g the Ancients and Moderns; its revolutions in different periods of the world, and an enumeration of some of the errors which check its progress.2 "After tracing in a mas terly manner the general progress of medical science from
remote antiquity down to modern times," he discussed "some of the causes which have retarded its progression and in some instances have given it a retrograde course."3
He enumerated four main causes, and the first of these was "the multiplicity of books."
We may wonder why, at a time when the journal was in its early adolescence, Dr. Stearns was so exercised. We know that even by 1847, when at the first meeting of the American Medical Association a Committee on Medical Literature was appointed, consisting of Oliver Wendell Holmes, Daniel Drake, and Austin Flint ( among others), only 33 American medical journals were being pub lished.4 By 1880 there were 864 medical periodicals in the world, and of these 232 were of American origin.5 Today with over 5,000 medical periodicals being pub lished, of which about one third are American, we are in difficulties about fifty times as great as those faced by Dr. Stearns, even if we omit from consideration the mass of literature which has accumulated between his day and ours. Many have bemoaned this situation, and, like most other librarians, I have rent my garments from time to time concerning it. Great alarm at the constantly increas
ing torrent of medical publication was an obsession with Fielding H. Garrison, and he put it more pungently than most: "The notion that any Index has or ever can include even the commonplace and worthless in the literature of medicine, or the many repetitions and duplications, is, of course, a wild, chaotic dream, which would appal even the dreamers could they realize (in actual columns of
cold type) just what it means. It would swamp the good stuff in a diarrheal flux of verbiage or eventually petrify it, like flies in amber or fossils encased in a 'solid solu tion,' harder than reinforced concrete. The fault lies really with the editors of medical journals, and what we need is a Society for the Discouragement of Trivial or Superfluous Publications on Medicine."6
Membership in Garrison's Society would have its un doubted virtues, but it is just possible that the lesson of history here is not that we have arrived at the edge of catastrophe, but rather that the condition of man has at all times been precarious.
Let us return to the times of Dr. Stearns. When he was a boy, Hippocrates and Celsus were still read and referred to as authorities of only yesterday. Medical libraries and medical bibliography were inherently and inescapably built for the long retrospective view. Times change. "The emergence of medicine from the confusion of the eight eenth century into the relatively clear and critical atmos phere of modern science was the achievement of no single time or place."' But one of the results of the emergence was, I believe, an over-reaction to the methods of medical scholasticism. We have the testimony of Billings, sur veying the American scene in 1876, that "almost all at tempts to establish medical libraries in connection with medical schools have been failures. Commenced with enthusiasm, they soon become antiquated, are rarely con sulted, except by one or two species of beetles, are never properly cataloged or cared for, and dust and mold
reign in them supreme."8 Obviously, study at the bedside and at the laboratory bench are powerful tools. Just as obviously, books did not suddenly lose their powers to instruct and challenge. What happens, I think, is that as the scientific development of medicine becomes dominant over the old ars practica, the literature of medicine neces sarily takes on the characteristics of the literature of sci ence. And one of the most salient features of the literature of science is its cumulative nature, as Crane Brinton has theorized.9
We may divide knowledge into two classes: non cumulative and cumulative. Non-cumulative knowledge is represented, for example, by knowledge in the area of the humanities; it is clear that if one's subject is the imagery of Chaucer, or Milton, or Swinburne, the opin ions of Milton on Chaucer, Swinburne on Milton, or Pater on Swinburne are quite as important as the opin ions expressed at last week's meeting of the local English Literature Society.
But the situation is different in the sciences, and in medicine, and the difference has become particularly prominent in this century, with the explosive acceleration of scientific advance. There is a sense in which it is true to say that while the literature of the humanities is non cumulative, the literature of the natural sciences is cum ulative. That is to say to some extent, in science, each new work supersedes its predecessor. This is a very broad generalization, and I do not wish to push it too far; it is obvious that on occasion long periods of time may, and
do, elapse before a datum or an hypothesis is needed, or is recognized as relevant, for the further development of current work in progress. But it is an illuminating idea for the dimension of the problem which here concerns us. It is perhaps-it is almost certainly-what Billings was thinking of when he made repeated statements to the effect that only the recent literature was of practical value to the physician. Thus he says, "Much the larger part of our literature which has any practical value be longs to the present century, and indeed will be found in the publications of the last 20 years."5 And again, "Nine tenths ... at least [ of the medical literature] be comes worthless and of no interest within ten years after the date of publication, and much of it is so when it first appears."10 In our day repeated surveys have confirmed that the use of scientific literature is overwhelmingly that of the literature of the past few years.
You have here a library of over 50,000 volumes, gath ered over a period of 50 years. Despite the relative youth of this school, the holdings of your library are, numeri cally, slightly above the average of all medical schools in the United States. With a little money and time it would be possible to double or treble your collection in the next five years, out of current publishing only; then another building, and another dedication ceremony would be re quired. May I greatly urge you not to pursue this course?
There has always been "too much" literature, and there always will be. But if much of it is repetitious, most of it is cumulative. The wise course for the Clendening
Medical Library to take will be to build its collection not passively but purposefully. I state my conviction that the mere fact that a library finds a particular work lacking is not sufficient reason for trying to acquire it. The libra rian should not be dismayed if an eminent surgeon com plains that the library lacks a work on dinosaurs, or if eminent faculty dinosaurs complain of the lack of an ancient text on surgery. For in the one case, you have a well-coordinated University library system on which to rely, and which can no doubt produce several books on dinosaurs; in the other case, we may understand that no university library system, however great, needs to rely solely on its own collections, but recognizing its kinship with its sister universities, will contribute to, and share in, the combined resources of the group.
So I would recommend the adoption of a critical at titude in collecting; it would be wise to look all gift horses in the mouth, and to adopt the attitude that all is not gold among the items offered on exchange and "free of charge" from other libraries. I go further; you have recognized that you have an able and effective librarian, and just as you have given him every opportunity to de velop the kind of well-organized library building that only a librarian can foresee, so I would recommend that you allow, indeed urge, him to do a little judicious prun ing of the collection from time to time. A medical library is like a wedge; let us be clear about which is the back side and which is the edge, and let us keep the edge sharp.
All of this is, of course, a most dangerous game. If half the material in our libraries is "superlatively middling, the quintessential extract of mediocrity," the rub may be that only God knows which half is which. Nevertheless, I counsel living dangerously. You may have an insurance policy by continuing to support your National Library of Medicine in Washington, on which you may rely for occasional needs of the more obscure and exotic items.
Such counsel may seem somewhat shocking, especially when given here at Kansas, where you are privileged to have one of the outstanding medical historical collections of this country. Would I really recommend discarding Sydenham and Pare, because they were published prior to the day before yesterday, and in any case can give us no useful information whatsoever on dosage schedules for prednisolone and tetracycline, or the technique of mitral valvulotomy? In this tercentenary year of the death of Harvey, would it be reasonable to discard the book he published in Frankfurt in 1628, because it is replete with errors and because even our most backward sophomore has a grasp of much more, and more accurate, information, and forget that it was Harvey's emphasis on quantitative methods of investigation which has been the wellspring from which a great part of progress in our knowledge of the functioning of the human body has derived? Would I deny the fructifying power of the his tory of medicine to illumine our present efforts, to dis close direction, and to refresh the spirit? That would indeed be a paradox. How curious if "of all professions
the one could become estranged from its own history which daily in taking 'case histories' pays its tribute to the enormous clarifying value that a knowledge of the past holds for the present and future."11
If we return to Billings, in the very essays in which he stated his feelings concerning the usefulness of the recent literature, we will also find that he had some feel ing for history. "Do I seem to depreciate," he says, "the value of the thoughts which our masters have left us, and which have furnished the foundations on which we build? If so I have said what I did not mean to say .... There are a few books written prior to 1800 which every well-educated medical man should-I will not say read but-dip into, such as some of the works of Hippocrates and Galen, of Harvey and Hunter, of Morgagni and Sydenham-but this is done to learn their methods and style rather than their facts or theories .... In our great medical libraries each of the folios or quaint little black letter pamphlets which mark the first two centuries of printing, or of the cheap and dirty volumes of more mod ern days with their scrofulous paper and abominable typography, represents to a great extent the life of our profession."5 Elsewhere he says, "I like to see on the doctor's shelves a little group of books such as Sprengel's or Daremberg's or Haeser's Histories of Medicine, the letters of Guy Patin, the Medical Portrait Gallery of Pet tigrew, the works of John Brown of Edinburgh, or a col lection of pamphlets relating to local medical history; and it certainly does not cause a lower estimate of his
ability as a practical physician and surgeon to know that he reads something else besides manuals and text books."12 Nor does he fear for history; "There is not," he says, "and has not been any lack of men who have the taste and time to search the records of the past."5
What he is saying here, I take it, is that while every phys ician need not be his own medical historian, every phys ician worthy of the name must be aware of medical his tory, and all his actions should be informed thereby.
There was a time-perhaps there was a time-when this simple idea did not require iteration, and explicit statement. But in this day when we have an overweening tendency to remain sleepwalkers in an eternal present, we need to remind ourselves, over and again, of our need to know more about all the human sources and contin gencies of the development of medicine in the past. "Our resistance to history is no doubt ultimately to be ac counted for," a contemporary critic tells us, "by nothing less than the whole nature of our life today. Our cold ness to historical thought may in part be explained by our feeling that it is precisely the past that has caused all our troubles. With all the passion of a desire kept secret even from ourselves, we yearn to elect a way of life which shall be satisfactory once and for all, time with out end, and we do not want to be reminded by the past that our present is but perpetuating mistakes and failures and instituting new troubles. And yet, when we come to think about it, the chances are all in favor of our having to go on making our choices and so of making our
mis-takes. History, in its meaning of a continuum of events, is really not likely to come to an end. The historical sense is to be understood as the critical sense, as the sense which life uses to test itself. And since there never was a time when the instinct for [discrimination] was so much needed, our growing estrangement from history must be understood as the sign of our desperation."13
A contemporary philosopher of science tells us that the historian's "role is to put in order in its historical setting what we experience piecemeal from day to day; so that in place of sporadic experience, the continuity of events becomes available. An age which has lost its con sciousness of the things that shape its life will know neither where it stands nor, even less, at what it aims. A civilization that has lost its memory and stumbles from day to day, from happening to happening, lives more irresponsibly than the cattle, who at least have their in stincts to fall back upon."14
This also I believe, and so my second recommendation is that you build on strength, that you continue to de velop the historical collection so magnificently begun by Clendening, Major, and others. By all means let it grow in number of both primary and secondary materials. Burden it with no arbitrary chronological limitations, except as these may appear useful for shelving and dis play purposes. May your historical collection flourish; long may it reveal its open secrets to the men who receive their training here, and to the men who conduct that training.
This second recommendation, on the cultivation of history, may seem to conflict with my first recommenda tion, relating to critically selective acquisition and weed ing policies. If we are to understand history, and if we are to have perceptive histories which will instruct us as clinicians and as researchers and as administrators, then we must have historiography, and historians who must turn to primary works, and where but to the University should we look for provision for bringing the historian and his materials together? We know that "the histori an's occupational hazard is normally the paucity of sources." How then can he be satisfied with less than the total record; how can we contemplate giving him less? The answer is that, after all, when the historian projects himself into the past, "he is not looking for curiosities and rarities; he is trying to comprehend the organized world in which the men of the period lived. He is inter ested in their knowledge as organized knowledge, their ideas as articulated ideas. The library which can provide him with a well-balanced collection of books of the pe riod, chosen so as to be representative in range ... is offer ing the historian every thing he can properly wish for."15
Or, as the philosopher Martin Buber might explain it, there is always a duality of things. Men have a "two-fold relationship to their experience and environment-orien tation and realization. Orientation is the 'objective' atti tude that orders the environment for knowledge and use; realization is the a pp roach that brings out the inner meaning of life in intensified perception and existence."16
Orientation and realization; soence and art; today and all the yesterdays of history.
Harvey Cushing said that "Some doctors have the conception that a medical library is a place where some one can be found who will prepare a list of references with which to embellish their compositions."17 I can
only hope that this breed is in the minority at the Uni versity of Kansas.
Cushing also said that "It is someone's business in every medical school to teach laboratory methods to the students, but it is no one's particular business to teach them how to use medical literature, which to the majority in the long run will be infinitely more useful than an experience with smoked paper and Ludwig's drum."17 I am glad to know that at the University of Kansas this defect has long since been remedied.
Billings, speaking at the dedication of the Boston Medical Library in 1901, said that "the medical prospect has changed somewhat within the last ... years; there is a new literature, a new pathology, a new surgery, and new names for some very old things ... , but the old records have not lost all interest; and the special value of the library is that it contains both the old and the new."18 As the Clendening Medical Library of the Uni versity of Kansas is here dedicated, I would wish for you and your successors the continued development of this collection along the tough lines of a policy of what is first-rate; some things old, some things new; not all of either, but the best of both.
References
1. Billings, ). S. Address given at the opening of the new li brary building at Radcliffe College, Cambridge, April 27, 1908. Radcliffe Magazine 10:107-11 (1908).
2. Philadelphia fournal of Medical and Physical Sciences 7: 211-26 (1823).
3. Purple, Samuel Smith. Biographical sketch of the life of Dr. John Stearns. MS. in New York Academy of Medicine Library.
4. Transactions of the American Medical Association 1 :249-88
(1848).
5. Billings, J. S. Our medical literature. Transactions Inter national Medical Congress (7th), London, 1881. pp. 54-71.
6. Garrison, F. H. [Letter to Dr. Morris Fishbein, December 4, 1929] in Kagan, Solomon R. Life and letters of Fielding H. Garrison. Boston, The Medico-Historical Press, 1938. p. 203.
7. Shryock, Richard H. The development of modern medicine. New York, Knopf, 1947. p. 151.
8. Billings, J. S. Literature and institutions. In A century of American medicine, 1776-1876. Philadelphia, Lea, 1876. p. 351.
9. Brinton, Crane. Ideas and men. New York, Prentice Hall, 1950.
10. Billings, J. S. Methods of research in medical literature.
Boston Medical and Surgical Journal 116:597-600 (1887).
11. Ackerknecht, E. H. The role of medical history in medical education. Bulletin of the History of Medicine 21:135-45 (1947).
12. Billings, J. S. Medical bibliography. Transactions of the
Medical and Chirurgical Faculty of the State of Maryland, Balti
13. Trilling, Lionel. The sense of the past. In his The liberal imagination. New York, Doubleday Anchor Books, 1953. [In the original the quoted passage is interspersed by phrase and sentence among other phrases and sentences, but the words, their order, and the sense of the passage have not been altered.]
14. Giedion, Siegfried. Mechanization takes command; a con tribution to anonymous history. New York, Oxford University Press, 1948.
15. Bestor, A. E. General historiography. In Acquisitions pol icy of the National Medical Library. Washington, National Li brary of Medicine, 1957.
16. The writings of Martin Buber. New York, Meridian Books, 1956. [ Quotation from the Introduction by Will Herberg, p. 12.]
17. Cushing, Harvey. The doctor and his books. In his Con secratio medici and other papers. Boston, Little Brown, 1928.
18. Billings, J. S. [Remarks] In Dedication of the new build ing of the Boston Medical Library. Boston, S. J. Parkhill, 1901.
