THE NEED OF MORE MED¬ ICAL REFERENCE-LIBRA¬ RIES, AND THE WAY IN WHICH THEY CAN BE ESTABLISHED. BY REUBEN PETERSON, A.B., M.D. REPRINT FROM American Medico=Surgical Bulletin, September 15, 1895. TO CONTRIBUTORS. Contributions of Original Thought and Experiences, on Medical Surgical Topics, are desired by the AMERICAN MEDICO-SURGICAL BULLF on the following conditions: ^ 4 ,, 3 .—Authors of Scientific Papers or Clinical Reports accepted by us wi] receive— according to their own preference expressed with each communication a .-—A number of Reprints of their article in neat pamphlet form (pock« eize), ^^_ Ingtea( j 0 f above, an Equivalent value therefor in Cash. 2.—All contributions are received only on the express understanding: a: _That they have not been printed anywhere, nor communicated t any oth^Journal.th e y have been read an y W here to an audience,this fact! stated in full detail by a note on the manuscript. Contributors will serve their own interest by heeding the following suggestions Write Concisely and Clearly. What we desire to print, and what professional men like to read, is informatio not verbiage. An article will stand better chances of acceptance, and of being wide read and copied and discussed, the fewer its words are, in proportion to the facts ideas it embodies. Of course, a thought too thinly clad must suffer. Use, therefoi cheerfully, as many words as appear needed to convey your meaning,—but no more. Aim at Fact. Jt is not to be expected that every Medical or Surgical paper should be a me array of statistical data, hospital records, tabulated figures, or graphic summarie some room must be allowed to theory, or even conjecture, in its proper place; but tl true aim of theory should never be left out of sight,—which is, to lead to met; rule or result of practice.—And it should be likewise borne in mind that the R< will attach little weight to mere generalizing statements (such as, chat a certain rei ody procedure, or line of treatment has uniformly proved successful, etc.);—to convinced, he wants to see positive evidences recorded in clinical detail of cases: co ditions found, courses pursued, and results achieved* Do Not Fear, nowever, that a communication you may be inclined to make would be devoid oi val because you have but little time to spend on writing it! If your thought be a go one to yourself and for your patients’ benefit, it will be equally so to your coieagi and their practice, and will be worth communicating. It need not come in tne ga of an elaborate Scientific treatise; a simple “Letter to the Editor will often beji as acceptable. Some Rules of Order we should bke to have our esteemed Contribul comply with Do not write on both sides of the sheet. . Write as legibly as you conveniently can (names especially so). Leave a liberal margin on the sheet, or space between the lines. ( U writing is not conducive to correct typography: and what you save writing material has to be expended a thousand-iold by us in eyesig labor, and expense for printer’s corrections.) Address P O. Box, 2535 New York Citv. Editor Ameren Medico-Surgical Bulle c> ^ ^ vT rr* THE NEED OF MODE MEDICAL REFERENCE- LIBRARIES, AND THE WAY IN WHICH THEY-CAN BE ESTABLISHED.* By REUBEN PETERSON, A.B., M.D. r HIS paper has been undertaken with the idea to point out the need of more medical libraries, and to suggest some plan whereby they can be established. That there exists the need of writing such a paper, can be seen by any one who, undertaking the establish- a ment of a medical library, seeks to discover the published records of similar attempts - which have been made in the past. The natural desire of whoever sits down ■ > to write upon a medical subject is to have a ^ clear and distinct idea of what others have thought and written upon the same subject, a Whether he will be able to obtain the lit- <: erature necessary to the gratification of his desire will obviously depend upon the geo¬ graphical location of the writer. If he re¬ sides in one of our larger cities, he has: at his command the contents of the large medical libraries, and his study of the past and pres¬ ent literature of a given subject can be carried on with great completeness. But how different is the case, if by chance his lines have fallen in a smaller city or town! He may be, and probably is, possessed with *Read before the American Academy of Medi¬ cine, Baltimore, May 5, 1895. I p 15iu9 the same desire to get at the bottom of any subject he is interested in or upon which he is endeavoring to express his views, but he is continually thwarted by his inability to secure the books, pamphlets, and articles which have appeared upon the same topic from the pen of others. The resident of the smaller town is thus more or less handi¬ capped. The lack of adequate library fa¬ cilities removes the incentive to thorough and accurate work, and may prove a power¬ ful factor in preventing the highest intel¬ lectual development of the medical practi¬ tioner. Medical literature is unlike that of any other department in science, in that its most valuable contributions are scattered through the different journals devoted to medicine. The number of these,.journals has assumed such large proportions that it is impossible for one single person to sub¬ scribe for those even of real value. He must content himself, therefore, with some of the standard journals, and possibly one or more of the minor periodicals for the sake of the local matter they may contain. Even should his subscription list comprise some dozen or more journals, he is but poorly equipped for exact literary work. Except in occasional instances, it is impossible for him to complete the files of the journals that come regularly to his office. Even should he be of a systematic turn, of mind, and file away the different numbers as fast as they have been looked over, he will find that he is an exception to the general rule in this regard if he seeks to obtain the references to the journals not on his list from those in the possession of his professional friends. The majority of physicians do not preserve their journals, but cast them aside when through with them. They are thrown into a closet, and there remain until the accumulation is either burned or sold for old paper. Again, the best physicians of ia town will be found to be subscribers to nearly the same journals. The local State or county medical journals will be among the number, and then will appear the standard American journals, with an occasional British or for¬ eign periodical, for outside the large cities and towns there will be found but very few foreign journals. Hence, if all the medical literature within a certain district could be collected, while the total amount would as¬ sume large proportions, the variety would be meager. But let us suppose that there does exist a town where the different jour¬ nals are never lost, but are carefully pre¬ served in volumes, and that the seeker after knowledge is possessed of the perseverance to ask for and obtain the privilege of con¬ sulting his neighbor's files, where will he obtain access to the various large indices to medical literature? Very few are the pri¬ vate individuals who possess files of the “In¬ dex Catalogue" and “Index Medicus,” and without these it is almost impossible to com¬ plete the bibliography of any subject. I think that possibly those who enjoy the benefits of a large library sometimes fail to appreciate their advantages, and do not realize the annoyances to which their less fortunately situated brethren are subjected. I feel certain that the latter will readily agree with the previous statements, and will eagerly adopt any plan which will provide 3 them with greater facilities for pursuing their literary and scientific researches. But first let us consider the advantages which will be derived from the establish¬ ment of a medical reference-library. i. A large number of medical works can be collected under one roof, and by being accessible and well indexed, will be the means of saving to the busy practitioner both time and labor. 2. More volumes can be obta ned through the means of a library than by the most strenuous efforts of private individuals. The physicians’ residing in the immediate vicinity of the library will readily respond to requests for books and medical journals, and will turn them into the common fund. In this way large numbers of duplicates will be collected, which can be used in exchange with other libraries to complete the files of the journals. 3. A large list of the current periodicals can be secured. In this way the physician can have access to one hundred or more in¬ stead of six or eight journals. This will prove a great saving of the hard-earned dol¬ lars of the members of the profession, for a great many of the journals are taken merely for reference. Two of these journals will suffice for one's general reading, if there be at hand others which can be glanced through or consulted for special topics. I am convinced that the average physician in good practice takes more journals than he can read. I have seen more than one of¬ fice where the table was covered with jour¬ nals whose wrappers had not been removed. 4 This is a sad waste of money, which might be expended to far better advantage. . 4. When the library is once organized it will be found that 75 per cent, of the ma¬ terial, which is continually accumulating, comes from donations. These will be made to a library organized upon the right prin¬ ciples, when they would be refused, or not even considered, were the request made by a private individual. This is a great gain to the physicians having access to the gifts, while only a small tax upon the means of each donator. 5. Such a library as we have been consid¬ ering will prove a powerful factor in edu¬ cating the members of the medical profes¬ sion. It will act as an incentive and stimu¬ lus to accurate and exhaustive literary re¬ searches. As the library is more and more used, we shall see less frequently in the columns of the medical journals the ac¬ counts of original discoveries; but half an hour spent among the volumes in the li¬ brary would have shown the author of the article that his so-called discovery had been well known to the medical profession for at least twenty-five years. There would be fewer worthless articles inflicted upon the unprotected public. I think that I cannot, in the time at my disposal, better illustrate the plan upon which a medical library may be established than by giving a brief history of a medical- library association which has recently been organized in Grand Rapids, Mich. I do this all the more willingly, because I know from the letters I have received as sec¬ retary of the association that the need of better library facilities is felt by many phy¬ sicians outside of the large cities, and that they need only the proof of the practica¬ bility of some plan, to take immediate steps toward its adoption. The plan about to be described may have to be changed some¬ what to meet the repuirements of the in¬ dividual case, but I believe it will be found to be fundamentally sound and worthy of consideration. Grand Rapids is the second largest city in Michigan, having a population of about 85,000, and about 150 physicians. All of the so-called schools of medicine are rep¬ resented, and one of the first questions to arise was whether a medical library should be supported by, and its readers confined to, the members of the regular profession, or whether it should be established upon the principle that it was to be a storehouse of knowledge and should be free to all who should contribute to its support. This is an important question to be settled, and the future success of any library will depend largely, I feel sure, upon the wisdom that is manifested in dealing with this problem. Whatever may be a man’s opinion in regard to the ethical question of consulting with the adherents of systems of medicine, I can¬ not see why any objection should be raised to the association of men who, while they may think differently upon medical matters, still desire to pool issues for the establish¬ ment of a library, which will be a means toward the better education and advance¬ ment of all. But inasmuch as the library should be for the greatest good to the great¬ est number, if the feeling among the phy- 6 sicians of the community be so strong against admitting those who are not regular, that the adoption of any such plan would lead to lack of support from a considerable number, then it would be best, perhaps, to limit its membership to the members of the regular profession. If this course be taken, however, there will be great danger of fail¬ ing to obtain the support of the public. The people have looked on at the struggle to crush out homeopathy for many years now, and, according to my experience, their judgment to-day is that it is a doctor’s quar¬ rel, and their sympathies, if they have any, are always with the adherents of sectarian¬ ism. They could not be brought to see why any respectable person, who so desires, and will contribute to its support, should not have access to the library. The plan upon which the Grand Rapids Medical-Library Association was founded is that membership is open to all persons of respectability who comply with the condi¬ tions. The constitution provides that there shall be active, life, honorary, non-resident, and associate members. Active members comprise those who re¬ side in the city, and who belong to either of the professions of medicine, dentistry, or pharmacy. The annual dues are ten dol¬ lars. Life members are those who pay into the treasury one hundred dollars or more at one time. Non-resident physicians who desire to avail themselves of the privileges of the li¬ brary, can become members on the payment of five dollars per year. 7 Associate members also pay five dollars per year. They make no use of the library, as a rule, but have enrolled themselves be¬ cause of their desire to help a worthy in r stitution. The public must be made to understand that it is for their interest, and not solely for the advantage of the profession, that a medical library should be established. They should be expected to render substantial- aid to such an institution just as they are ex¬ pected to contribute toward the support of other scientific undertakings. Physicians as a class are poor, and have a hard struggle for existence. Only in the large cities, as a rule, do we find men of sufficient means to give more than their pro rata to¬ ward the support of the library. Donations may be looked for from various sources, however, when the purposes of the library are set forth plainly before the public. The library association whose history we are now considering was organized in October, 1894. A paper containing a state¬ ment of the plan of organization was circu¬ lated among the physicians, dentists, and pharmacists, and was signed by enough to show the desire for such an institution. A meeting was then called, and the organiza¬ tion of the association perfected. Arrange¬ ments were made by which the regular city medical society subleased the library rooms for their regular semi-monthly meetings, and the local dental society were to use the rooms once a month. The rent is thus re¬ duced to a minimum. For the convenience of those who desire to consult this article for the purpose of gathering information 8 whereby other medical libraries may be established, I shall append a statement of the essential details, and I shall only state in a general way what has been accom¬ plished during the first six months of the library's existence. The membership list comprises fifty-five active, six non-resident, and fifteen associate members. Starting without a book or journal, the library pos¬ sesses some 2000 books and bound jour¬ nals. These have been acquired in various ways—from contributions from the private libraries of members and others interested in the library, and by donations from pub¬ lishing-houses and national and State so¬ cieties. Journals have literally poured into the library, and the files of the standard periodicals are rapidly being completed through exchanges with and contributions from other libraries. Through a generous donation of money for the purpose, com¬ plete sets of the “Index Medicus” and “In¬ dex Catalogue" have been obtained. Vol¬ umes from private libraries have been do¬ nated conditional to their being properly indexed and cared for. This provision was found to be necessary for the reason that members hesitated to part with their books unless the library was to be a permanent organization. In other words, they are willing to make donations if the proper use were made of the gifts. The list of current periodicals comprises over ioo journals and transactions. There are but very few foreign journals outside of those printed in the English language. In making up the subscription list care must be exercised to meet the needs of the libra- 9 ry association. At the same time, as far as possible, the money should be expended for journals of real merit, which are not so liable to be met with in the physician’s of¬ fice. Yet, where but a few members read French or German, it is obviously unfair to subscribe for many journals in either of these languages, however valuable they may be for reference. It would seem best to subscribe, at first, for as many American and British journals as the funds of the li¬ brary will allow, and to subscribe later fo ~ the foreign journals, as the standard of educa¬ tion of the. users of the library be raised. Each community will present peculiar con¬ ditions which must be carefully considered, and the success of the library will largely depend upon the good judgment displayed in settling the various problems which may arise. The greatest stumbling-block will be found to be the lack of funds, but that this can be overcome by persistent and energetic work, will be seen by glancing over the ap¬ pended report of one institution. The dif¬ ference between a medical library and other libraries is that, as before stated, fully 75 per cent, of its possessions can be obtained free of charge by courteously worded re¬ quests. And upon this fact must the li¬ brary rely for the first few years of its ex¬ istence, for nearly its entire income will have to be used in meeting the running expenses. Not one dollar has been expended in the direct purchase of a book, yet the Grand Rapids library has now 2000 bound vol¬ umes, and all acquired since October last. The reason for the failure of quite a ntim- 10 ber of similar undertakings has lain in the fact, it would seem to me, that no provision has been made to secure the services of a librarian who should give up his or her whole time to the work. Some one must do the work, and what is every one’s duty is no one’s, and the; result is that witli 3 Ut a librarian the books are lost, and the dust accumulates on those that remain. In or¬ der that the library may be a success, it must be so arranged that it will be of use to the members. You cannot make a stu¬ dent of every one, but the fact that a few men are making use of the library will act as an example and incentive to others. Reading-clubs can be organized in con¬ nection with it, and ambition be kindled in the minds of the younger men at least. Opposition will be met with. It will be claimed that the library is maintained for the use of a few; that its officers are reaping the benefits; that it is of very little value, and its shelves are mostly filled with worth¬ less volumes, but such utterances are not alone used against medical libraries. They are characteristic, I am sorry to say, of some of the members of our profession, who not only fail to progress, but bitterly oppose any signs of progression in others. This class may have considerable influence for a time, and their opposition may be a cause of much annoyance, but they must be dealt with tactfully, and in time will be made to see that they have been in the wrong. The unanswerable argument to all this criticism is that the privileges of the library are at the disposal of all who seek to avail themselves of them. If a man will not, then he will not, and no one is to blame but him¬ self. It may be well to state that, adopting the plan of the Boston Medical-Library Asso¬ ciation, a Directory for Nurses has been established in connection with the library. This has proved a highly successful under¬ taking, and is of value to the public, the profession, and the nurses. While it has not been a source of income to the library, it has from the start been self-supporting, and there is every reason to believe that in time it may be more than this. In order that the aims, purposes, and needs of the association might be made known to the profession and to the public, certain distinguished men have been invited to read papers at its regular monthly meet¬ ings. Invitations to these meetings were sent not only to members of the association, but to all respectable physicians within the city and in the neighboring towns. The meetings have been largely attended, and have been highly interesting and instruc¬ tive. In conclusion, I will say that in the time assigned to each reader, it is impossible to do justice to all the important matters con¬ nected with this subject. In my opinion the subject of medical libraries is one of great importance, and one worthy of the most careful consideration by members of the Academy. If these institutions can be established throughout the country, they will prove to be powerful instruments in the settlement of the very questions with which this society is grappling. The members of the medical profession must be educated, 12 not merely in the medical schools, but in after-life as well. The establishment of medical libraries may not be the only way, but it is one of the ways. I wish to take this opportunity of saying that the as¬ sociation of which I have spoken is under deep obligations to Dr. Bayard Holmes for his many practical suggestions as to the best plan upon which a medical library should be established. Appendix. Receipts from Oct. 1, 1894, to Oct. 1, 1895. Annual dues, 55 active members, at $10.$550.00 Annual dues, 6 non-resident members, at $5. 80.00 Annual dues, 15 associate members, at $5 70.00 Prom private donation. 200.00 Prom rent of rooms to societies for one year.125.00 $980.00 Expenditures. Rent of library rooms for one year.$200.00 Furniture. 80.00 Librarian’s salary, 52 weeks, at $4 per week. 208.00 Subscriptions to current journals.162.00 Purchase of “Index Catalogue” and “In¬ dex Medicus”.. 100.00 Card-catalogue outfit. 85.00 Shelving. 85.00 Expressage and stamps. 80.00 Insurance. 20.00 Lighting. 20.00 Incidentals . 80.00 $980.00 The above will give an approximate idea of the receipts and expenditures for the cur¬ rent year, and will form a basis for calcula¬ tion. It may be urged that the donation of $2oo cannot be expected every year, but, on 13 the other hand, it will be seen that some of the expenditures were incidental to the library’s first year, such as furniture, pur¬ chase of “Index Medicus” and “Index Cata¬ logue/' card catalogue, etc. The above is not given as an example to be blindly followed, but simply with the view to form a basis from which a plan can be formulated to suit the exigencies of the case. It will, moreover, demonstrate the practicability of maintaining a library by the methods employed. Grand Rapids, Mich. 14 SUBSCRIPTION ORDER. 3>cUe- of &zdax, __ 189 IGHTH YEAR. American 53 00 Der year Medico=Surgical Bulletin SEMI-MONTHLY JOURNAL OF PRACTICE AND SCIENCE. Issued on the ist and 15 th of each month. HE BULLETIN PUBLISHING COMPANY, 73 William Street, N.Y. The BULLETIN is the only journal that publishes regularly complete reports of Ithe meetings of the New York Academy of Medicine and its ten Special Sections, e BULLETIN is also the Official Organ of the Sections on Orthopedic Surgery, d on Laryngology and Rhinology. Editorial Staff. LLIAM HENRY PORTER, M.D., Chief Editor. WILLIAM C. GLTH, M.D., Pathology and General Medicine. If SAMUEL LLOYD, M.D., Surgery. H ADOLPH ZEH, M.D., Pathology and General Medicine. FREDERICK PETERSON, M.D., Associate Editor. T.S. SOUTH WORTH, M.D., Obstetrics, Gynecology, Pediatrics. WILLIAM FANKHAUSER, M.D., Materia Medica and Therapeutics. LEWIS A. CONNER, M.D., Neurology. :ORGE G. VAN SCHAICK, M.D., ALBERT WARREN FERRIS, M.D., Pathology and Clinical Medicine W. TRAVIS GIBB, M.D., Gynecology. LLIAM OLIVER MOORE, M.D. ^Ophthalmology and Otology. ADOLPH BARON, M.D., Diseases of Children. WILLIAM VISSMAN, M.D., Pathology and Bacteriology. T. HALSTED MYERS. M.D., Orthopedic Surgery. )RGE THOMAS TACKSON, M.D Dermatology, WILLIAM B. COLEY, M.D., ; General Surgery. JAMES E. NEWCOMB, M.D., Laryngology. EORGE K. SWINBURNE. M.D., Genito-Urinary Surgery. HENRY T. BROOKS, M.D., Bacteriology. N WINTERS BRANNAN, M.D, Neurology and Psychiatry. IRA VAN GIESON. M.D., Pathology of Nervous System. Neurology. PEARCE BAILEY, M.D., Neurology. • MORTON R. PECK, M.D., Neurology. LOUIS HEITZMANN, M.D., General Medicine and Pathology. DANIEL B. HARDENBERGH, M.D., Obstetrics and Gynecology. OTTO H. SCHULTZE, M.D., Obstetrics and Gynecology. , JOHN HOCH, M.D., General Medicine. HOWELL T. PERSHING, M.D., Neurology. THOMAS PECK PROUT, M.D., Psychiatry, B. FARQUHAR CURTIS, M.D., Surgery. CHARLES HENRY WALKER, M.D., General Medicine. ALBERT H. ELY, M.D., Gynecology. GEORGE G. WARD, M.D., Obstetrics. WALTER A. DUNCKEL, M.D., Diseases of Children.