Thursday, July 16, 2015

The Antebellum Medical World

From: the personal edited research notes of Dr. Michael Echols

Prior to the 1840s it was commonly held among medical educators in America that hands-on learning was not necessary, that medical students could learn anatomy and even clinical practice chiefly from books. The post-Vesalian, post-Harveian tradition of medicine was venerated. Physicians generally respected theoretical speculation alongside empirical science as a method of achieving medical knowledge. Books, the wisdom of the elders, were regarded on medical matters as an authority at least equal to, and perhaps greater than, clinical experience and direct observation. To be sure, the early nineteenth century produced some of the keenest observers of anatomical and pathological fact the world has ever known, but even the best of these observers would defer to the written record of generations past.

Thus the progress of medical knowledge was slow, even plodding, until the revolutionary implementations of anesthesia in the 1840s and antisepsis in the late 1860s. In the aftermath of these developments, as well as with the significant increase in surgical knowledge gained during the Civil War, the attitude grew among physicians that medical libraries were merely repositories of quaint curiosities and outdated information, that they had little clinical importance, and that current literature was disposable almost as soon as the next article or book appeared on the subject. This attitude stands in sharp contrast to that which prevailed for the first half of the nineteenth century, whereby physicians generally held medical libraries in great esteem. In that era, medical education was chiefly by lecture rather than demonstration, by reading rather than doing, by memorizing the wisdom of one's predecessors rather than direct clinical experience.

The nineteenth century was an era of widespread interest in curiosities for their own sake, not only those intended for popular exhibit by the likes of P.T. Barnum, but also those collected by physicians such as Isaac Parrish, Thomas Dent Mütter, Frank Hastings Hamilton, and Joseph Leidy for their own pleasure and that of their professional colleagues. Private "pathological cabinets" were quite common at the time. Yet these curiosities, from tumors in jars to bullet-shattered bones to Chang and Eng Bunker's conjoined liver to anthropodermic bookbindings, which may seem bizarre, irreverent, or even criminal to us nowadays, were not intended merely to entertain ghoulish physicians, but to instruct. As such, they were intended to be protected and preserved alongside the medical books and journals themselves. In antebellum America, medical libraries almost always existed in tandem with anatomical/pathological museums, and they were thought to go hand-in-hand as teaching tools.

Given the antebellum physicians' propensity toward "book-larnin," early in the nineteenth century it was not difficult for medical schools to secure large donations of both money and books for their libraries. For example, in 1820 a relatively obscure backwoods American medical school received a donation of $17,000 for the purchase of books. That amount would be approximately $180,000 in 1994 dollars. In 1839 the same library received a gift of another $11,000. These two gifts resulted in the purchase of over 10,000 books.

In the United States before the Civil War almost all medical libraries were in the private sector, owned by either hospitals, medical schools, pharmaceutical schools, medical societies, or individual physicians. The societies, hospitals, and educational institutions relied mainly upon donations for collection development and upon volunteers for labor. Cataloging was minimal. Books and journals would -- usually -- just be set in plain sight on shelves in a small, dark, uncomfortable room, uncatalogued but readily available to authorized persons; or -- at best -- they would be arranged in a gentleman's smoking room as a browsing collection, perhaps in alphabetical order or loosely grouped by subject, accession date, or size. Thus the overhead for the upkeep of antebellum institutional medical libraries was small. A librarian was not necessary, but only a clerk or a servant to record accessions in a ledger and to reshelve volumes. Since little effort was expended to facilitate access and retrievability, the books were in effect just "warehoused."

With the possible exception of the library of the College of Physicians of Philadelphia (whose collection was built mainly on donations), the greatest medical libraries in nineteenth century America (especially in the antebellum period) were owned by individuals. These great private medical libraries came into existence as physicians such as Hugh Lenox Hodge (1796-1873), Samuel D. Gross (1805-1884), Anson Colman (fl. 1836), Samuel Lewis (1813-1890), Stephen Smith (1823-1922), and William Osler (1849-1919) recognized the need to protect, preserve, and publicize the rich heritage of what, since the 1840s, had become a very rapidly changing field. Many such private libraries, when bequeathed, came to be either the foundations or significant components of major institutional medical libraries. Colman's went to Geneva Medical College and Smith's went to its successor, the Syracuse University College of Medicine (both now the SUNY Upstate Medical University); Lewis's and Gross's went to the College of Physicians of Philadelphia; Osler's to McGill University; and Hodge's to several locations through the agency of his son, Hugh Hodge, and George Milbry Gould. It is inconceivable that any of these libraries could have become substantial repositories of medical knowledge without the foresight and generosity of such collectors.

Yet for many such personal medical libraries, especially after the Civil War, the death of the owner entailed the dispersal or destruction of the collection at the hands of an ignorant or apathetic heir.

From: medical


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