Page 1


INTRODUCTION According to an old Latin proverb, “knowledge is power.” T hough of ten at tribu te d to Fran cis Bacon from his Meditationes Sacrae of 1597 or to his secretary, Thomas Hobbes, from his 1658 work De Homine, it is likely they borrowed the notion from the Old Testament, Book of Proverbs (24:5), “A wise man is strong, a man of knowledge increaseth in strength.” Such sources appear to support the notion that knowledge is a good thing, increases over time and includes a lasting legacy from those who added to our understanding of the universe. In the history of medicine, there are recognized giants – Hippocrates, Claudius Galen, Andreas Vesalius, William Harvey, Joseph Lister – whose contributions have added to our universe of knowledge and understanding. This legacy of knowledge through to our modern understanding of health and disease is the subject of the William P. Didusch Center’s 2014 histor y exhibit, Knowledge Unbound : Literature of Medicine.


a

ncient medical texts

MEDICAL SCROLLS IN ANCIENT EGYPT Medical papyri, documents much like our modern day medical textbooks, discuss medical conditions, diagnosis and treatment of disease in hieratic script of red and black ink. The medical papyri were copied from one scroll to another, enabling the information to be distributed and passed down through history. EBERS PAPYRUS Papyrus Paper Sample Please feel free to touch!

A river with clumped papyrus grass (Cyperus papyrus) and a rowing boat.

BOOKWORM FACT:

Lithograph, John Harrison Allan, 1843. Wellcome Library, London.

PAPYRUS As the ancient Egyptians evolved by developing a written language, they realized the need to write on something other than stone. They found their medium in the papyrus plant (Cyperus papyrus), a triangular reed that grew to about 10 feet. It was light, strong, thin, durable and easy to carry, and for thousands of years there was nothing better on which to write. To prepare the papyrus as a writing surface, outer fibers of the plant were peeled away, and the core of the stalk was sliced into thin, broad strips. These strips were soaked in water to remove the sugar content, pounded and drained, then placed side by side, overlapping slightly. More strips were placed at right angles to the first, again overlapping slightly. Next, the raw papyrus sheet was pounded once again and left under a heavy weight (usually a stone slab) for a few days to dry and seal. After drying, the surface of the sheet was then polished with ivory or a shell. Ancient Egyptians generally wrote on one side of the papyrus, with the fibers running horizontally, and they rarely included images. Although the papyrus was generally limited to 29-33 cm in length and 22 cm in width, pages were often joined to create a papyrus roll or scroll if longer documents were required.

Most knowledge of ancient Egyptian medicine has been gained through the study of medical papyri. To date, 10 medical papyri have been The ancient Egyptians had at least four words for knives used in discovered from ancient Egypt, surgery: “des,” “khepet,” “shas” and “hemem.” It is thought that and numerous urologic issues flint knives were used well into the Bronze Age and may have been used as a disposable surgical have been described in five instrument. A passage in the Ebers Papyrus also talks of using a reed of these documents. The “for making the knife-treatment.” Science Museum, London, Ebers Papyrus, discovered in Wellcome Images. a tomb at Thebes in 1862, is the longest of the medical texts. The discovered papyrus was written in 1550 BCE, but it is believed to have been copied from books that date back to 3400 BCE. The papyrus consists mainly of a compilation of recipes for the treatment of various diseases; treatment of urologic disorders makes up 6.8 percent of all the recipes found in the Ebers Papyrus. Urinary problems were treated with dates, grapes, gum, rush-nuts, wheat, celery, figs, carob, and yellow ochre. Impotence Two types of cauterization and priapism were treated with have been described in the medical papyri. The “hemem” carob, juniper, Hyoscyamus, is described in the Ebers Papyrus and is thought to be a metallic cautery or fire-heated oils, pine, salt, watermelon, and lancet. The “dja” (fire stick) is a drill that was rotated against flax. Honey, which has intrinsic wood to create enough friction to create sparks. The heat antibacterial properties, was produced on the tip of the drill could then be used to cauterize the ingredient prescribed most wounds. often in the Ebers Papyrus.

EDWIN SMITH PAPYRUS The medical papyri also indicate that the ancient Egyptians practiced medicine using a scientific method based on the clinical observation of disease, as exemplified by the Edwin Smith Papyrus shown in our display case. The Edwin Smith Papyrus is a surgical text that contains 48 cases of trauma. Each case is presented with a description of the history and physical examination, a diagnosis of the medical condition and the prognosis for the patient. This papyrus provides written evidence of the beginnings of deductive scientific reasoning in Ancient Egypt.

“Very often conditions are recorded as observable 'under thy fingers' ... Among such observations it is important to notice that the pulsations of the human heart are observed.”  JAMES HENRY BREASTED, THE EDWIN SMITH SURGICAL PAPYRUS: HIEROGLYPHIC TRANSLITERATION, TRANSLATION AND COMMENTARY, 1930


MEDICAL TEXT OF ANCIENT INDIA: SUSHRUTA SAMHITA, BOOK OF MEDICINE AND SURGERY The medical and surgical concepts narrated in the Sushruta Samhita prevailed in the early era of civilization in India. It spread later to China through the Buddhist pilgrims and also influenced the Arabic world through established trade routes. Sir William Hunter stated that Arabic medicine was founded on translations from Sanskrit treatises and, in turn, European medicine to the 7th century was based on the Latin versions of those Arabic translations of Indian medical texts.

Sushruta Samhita Sushruta Samhita was first translated from Sanskrit to Arabic as Kitab-I-Susrud by Abil Saibial in 8th century CE, then into Latin by Hesslar (1844), into German by J.A.Vullars (1846) and into English by Jones and Hoernle (1907). Shown here is Kunjalal Bhishagratna’s 1907 English translation, reprinted in 1963 in three elaborate volumes. Donated by Sakti Das, MD

Though there has been extensive discussion, most scholars of ancient Indology have placed Sushruta, author of the Sushruta Samhita, in the era between 600 and 800 BCE. Sushruta, Pen drawing. Wellcome Library, London

Sushruta Samhita is divided into five principal sections: Sutrasthana or primary principles Nidana or pathological concepts Sarirasthana – detailing anatomy Chikitsasthanam – dealing with medical and surgical treatment of various disease processes 5) Kalpasthana or toxicology 1) 2) 3) 4)

Sushruta Samhita provides critical details on preoperative and postoperative care, diet, indications, contraindications and surgical techniques. Surgical procedures are classified into eight categories – incision, excision, scarification, puncturing, probing, extraction, drainage and suturing. The Samhita contains details of manufacture and maintenance of at least 125 surgical instruments, including 28 types of catheters, sounds and syringes.

Among the urologic ailments detailed in the Samhita are several chapters on etiology and management of lower Sushruta Samhita, urinary tract infection, penile sores, Donated by Sakti Das, M.D. sexual hygiene and elaborate discussion on treatment of erectile dysfunction with Vaji Karana (aphrodisiacs). Urethral stricture disease (Niruddha Prakasa) was managed by gradual dilation with dilators

of gradually increasing caliber introduced every third day. In recalcitrant cases, the method of external urethrotomy surgery is discussed. Probably the most fascinating chapters on urologic disorders deal with urinary calculus diseases. Several varieties of calculi are mentioned with dietary indiscretions as the main etiology; initial medical measures with diet, fluids and alkalies are recommended. This is followed by exquisite details of the steps of the pioneering surgery of perineal vesicolithotomy starting with a description of the anatomy and concluding with postoperative care and potential complications.

BOOKWORM FACT:

Probably the highlight of surgical repertoire in Sushruta Samhita is the nasal reconstruction, or rhinoplasty. The technique was revived much later in Italy by Tagliacozzi and appeared in the Gentleman’s Magazine in 1794. Historian of medicine Erwin Ackernecht aptly observed that the plastic surgery in Europe that flourished first in medieval Italy is a direct descendant of classical Indian surgery. Even today, plastic surgeons refer to Sushruta’s pedicled forehead flap as the Indian flap.

[ ] “All in all, Sus h ruta must be

considered the greatest surgeon of the pre-medieval period.”

 WHIPPLE, A.O.: THE STORY OF WOUND HEALING AND WOUND REPAIR., 1963


F

Medieval Manuscripts to the Printing Revolution rom

After the fall of the Roman Empire, monasteries in Europe became centers of scholarship and medical practice since most had a physician and many an apothecary or other caregivers. Texts by classical authors were studied, copied and often beautifully illustrated by monks. Although many books had religious themes, philological works, natural history and medicine were also found in monasteries. Initially, only a few classical texts survived in Europe. Greek manuscripts were translated into Arabic by scholars in the Middle East, then from Arabic into Latin, and finally, when the knowledge of Greek had returned to Europe, authors like Hippocrates, Aristotle and Galen were translated directly from the originals. From the 10th to the 13th century, the first European medical schools were established with the first in Salerno, Southern Italy. Other influential medical schools were subsequently established in Montpellier, Southern France, where the medical school pre-dates the university, and Padua and Bologna in Northern Italy. During the Middle Ages, western medicine split sharply into two branches: internal medicine and surgery. The first followed the teachings of Hippocrates, Galen and eventually Ibn Sina (or Avicenna), while practice of the latter was forbidden to priests from the year 1215. This meant that lay surgeons and barbers, many of whom were not university educated, started to dominate this branch. The two main diagnostic tools for physicians were uroscopy (analysis of the color, smell and taste of the patient’s urine) and pulse diagnosis. The uroscopy flask became established as a symbol of physicians.

GUTENBERG PRINTING PRESS Books remained rare, handwritten objects until around 1453, when Johannes Gutenberg developed a printing press with movable, lead-cast type. Block printing had

WHAT AND WHEN WERE THE MIDDLE AGES? The Middle Ages is the time period between antiquity and the Renaissance (“re-birth”) of classical knowledge and culture. Start and end dates are not universally agreed upon, but many historians see the Sack of Rome in 410 CE or the closing of Plato’s academy in Athens in 529 CE as its starting point. The Middle Ages saw the spread of Christianity through Europe and of Islam through the Middle East and North Africa, as well as the foundations of the first universities. Its end point, too, is controversial. The fall of Constantinople in 1453 CE, the development of the printing press with movable type and the discovery of the Americas by Christopher Columbus in 1492 CE are often seen as its close.

existed in Europe before that time, and similar presses had been developed in Asia centuries earlier, but neither had a similar effect. The invention spread through Southern Germany and Northern Italy, and within just a few years, all of Europe. Early prints, called incunabula (“cradle prints”), such as the Printer’s shop around 1568 Meggs, Philip B., A History of Graphic Design. John Wiley & Sons, Inc. 1998. famous Gutenberg Bible, were still designed to look like manuscripts, many containing woodcut illustrations and the same kind of abbreviations used by scribes. By the year 1500, printers’ shops existed in about 200 European cities, supplying books to the church, the developing middle class and the more than 50 established universities. Printing made possible the rapid spread of information that led to the proliferation of new scientific, political and religious ideas.

MEDIEVAL MEDICAL TEXTS IBN SINA (CA. 980-1037), OR AVICENNA (IN THE WEST) Ibn Sina was born near the city of Bukhara in Central Asia (today Uzbekistan) into an educated family. Growing up speaking Persian, he learned Arabic at an early age and studied the Qur’an, Islamic jurisprudence and Greek philosophy.

Portrait of Avicenna Engraving early 17th cent. Wellcome Library, London

"What gunpowder did for war, the printing press has done for the mind."  WENDELL PHILLIPS, ABOLITIONIST, ORATOR, LAWYER


Medicina Antiqua William P. Didusch Center for Urologic History

The Medicina Antiqua is a book containing several distinct parts bound together. It was first compiled in late antiquity, i.e., the 4th or 5th century CE. More than 50 different manuscript copies (some of them incomplete or in poor condition) existed in the Middle Ages, and a 9th century manuscript from the Monte Cassino monastery became the model for the first printed edition in 1481. The text went through another eight editions the following century. Different manuscripts contain more or fewer chapters and illustrations. The facsimile copy on display here is the reproduction of a 13th century Italian manuscript, today owned by the Austrian National Library in Vienna. It is one of the most richly illustrated editions of the text, including not only color illustrations of animals, plants, physicians and medical practices, but also ink drawings, which were added about 50 years after the manuscript was completed and which further illustrate diseases and cures mentioned in the text.

The codex contains six parts, most of which were common genres of classical medical writing. The first is a text on the plant stachys, also known as heal-all or woundwort. The author describes 47 ailments that can be cured by use of the plant. Three chapters contain descriptions of animals and plants, including an excerpt of Dioscorides’ famous Materia Medica. The other chapters contain shorter texts of more varied nature, including a fictional letter of an Egyptian pharaoh to Roman Emperor Augustus praising the healing powers of pharmaceuticals produced from badgers and prayers to mother earth and to plants in general. The last two texts were censored by later Christian editors of the text. While some chapters provide the names of authors, in most cases, their identities cannot be firmly established. The facsimile of the Medicina Antiqua is one of the finest examples of an illustrated medieval medical manuscript containing excerpts of classical knowledge. Hans Zotter (ed) Medicina Antiqua. Codex Vindobonensis 93 der Österreichischen Zentralbibliothek. 2., unveränderte Auflage. Wissenschaftliche Buchgesellschaft Darmstadt, 2001.

Continued 

Ibn Sina turned to medicine at the age of 16 and was regarded a qualified physician at 18. As an adult, he sought the patronage of rulers, which allowed him to devote his time to scholarship, but which meant he had to move when he fell out of favor at court. Among his more than 300 works are books on medicine, natural philosophy, theology, logic, astronomy and astrology. His writings influenced styles of scholarly writing in Persian and Arabic. Today, he is best known as an interpreter of Aristotle and for his medical writings.

THE CANON OF MEDICINE (1025)

Top: Back cover binding board of manuscript of Avicenna's Canon of Medicine.

Chief among Ibn Sina’s medical writings is The Canon of Medicine, originally written in Arabic. The book is a compilation of Greek medical knowledge and its author’s practical experience. Ibn Sina’s physiology is deeply rooted in Hippocrates, Galen and Aristotle. He describes a balance of the four humours as the key to a healthy life. More than 700 simple and compound medications are described to restore this balance, and rules for the development and testing of pharmaceutics are presented. Two additional chapters describe diseases of single organs or parts of the body, from feet to head, and diseases of the whole body.

The Canon of Medicine was fi rst translated into Latin by Bottom: Arteries and Viscera (according to Avicenna) Gerard of Cremona, who 1632. Wellcome Library, London chaired a school of translation in Toledo in the 12th century. The Canon of Medicine soon spread throughout Europe and became the standard textbook of medicine. This brought its author the title “prince of physicians.” The Canon of Medicine 1632. Wellcome Library, London

was first printed in 1472, and within the next 30 years, 15 printed editions were published. It remained in use in medical education until the 17th century and has been called by William Osler, "the most famous medical textbook ever written."

GART DER GESUNDHEIT / ORTUS SANITATIS (GARDEN OF HEALTH) (1485) The Garden of Health had a number of people involved in its creation. The impetus came from Bernhard von Breidenbach, canon in Mainz. The text was compiled by the physician and botanist Johannes de Cuba, and many of the woodcut illustrations were created by Erhard Reuwich, an artist and friend of Breidenbach’s. The book was first printed in 1485 in Mainz by Peter Schöffer, an associate in Johannes Gutenberg’s original print shop.

Doctor examining urine, assistants comparing contents of urine flasks, patients bringing urine for examination. Woodcut. Wellcome Library, London

The book is remarkable in many ways. At its core, it is a collection of information on plants, their Latin, Greek and Arabic names, their natural histories and medical applications. In addition, the book contains information on smaller sets of animals and minerals, and a part Ortus sanitatis: on uroscopy. It contains everyday plants handcoloured woodcuts and text and animals like hares and wild clover, from section on minerals. but also exotic ones like elephants and Woodcut. Wellcome Library, London human-shaped mandrake roots. The book was the first of its kind to be printed, and was first published in German, which was unusual at a time when most learned books were still published in Latin. Editions in Latin and many other European vernacular languages followed a few years later. At the time, the woodcut illustrations, printed in black and white and hand-colored later, were of superb quality. This was due in part to the illustrator not just copying drawings from older manuscripts, but either creating them from real examples or copying them from a Venetian painter’s shop.

"Leeches should be kept a day before applying them. They should be squeezed to make them eject the contents of their stomachs."  AVICENNA, THE CANON, BK IV.


m

edical of the Texts Renaissance: TRANSLATING THE OPERA OMNIA OF HIPPOCRATES AND GALEN

In the Middle Ages, complete Hippocratic and Galenic writings were not available in Western Europe. Before the 10th and 11th centuries, only a few medical texts could be tracked down. At Salerno (11th/12th century), a wealth of manuscripts was translated from Arabic into Latin. Mainly based on Arabic translations of classical Greek medical writings, implemented by Hunain ibn Ishaq (808-873), a canonical anthology of medical texts arose called the Articella (“little art”). With its emphasis on works written by Galen, it served the medical students at the newly founded universities as a book of reference from about 1250 until 1700. Gradually, texts of the Corpus Hippocraticum were incorporated into the Articella.

HIPPOCRATES THE LIFE OF HIPPOCRATES

Portrait of Hippocrates Wellcome Library, London

Of Hippocrates (b. 460 BCE) little is known with any degree of certainty. He came from a family of physicians residing on the island of Cos. From 420 BCE onwards, after the death of his father, who was also his teacher, he practiced medicine as an itinerant physician travelling across most of the Greek world and its eastern neighbouring countries. He died in old age around 375 BCE at Larissa/Thessaly.

CORPUS HIPPOCRATICUM The writings ascribed to Hippocrates are summarized as “corpus hippocraticum” and encompass a collection of nearly 60 texts compiled in the library of Alexandria in the middle of the 3rd century BCE; its nucleus was probably the library of the medical school of Cos. The writings had a great number of authors and were written between 430-350 BCE, though a quarter of it st nd stems from 1 /2 century CE. It is not proven that any of these texts were composed by Hippocrates himself. The collection contains texts of different literary forms: elaborate teaching documents, speeches, notes, case histories, and philosophical treatises about a variety of topics without obvious structure or system, reflecting the state of Greek medicine between 450 and 350 BCE.

EARLY PUBLICATIONS OF THE COMPLETE WORKS OF HIPPOCRATES In earlier times, various works in Latin attributed to Hippocrates formed only part of the often republished and extended collection of the “Articella,” yet the first Latin edition of the complete Corpus Hippocraticum was to come out only in 1525/1526. It appeared in 1525 in Rome in the house of the printer and bookseller Franciscus Calvus. The publication of the complete Hippocratic collection in 1526 in Greek made it possible to compare the original texts with their Galenic version. For the moment, the dominance of the Galenic doctrine (Galenism) was not threatened by the increasing proliferation of the now available and complete Corpus Hippocraticum. Hippocrates as the leading medical figure and “father of medicine” remained more praised than read, though the Hippocratic methods in trauma and gynecology may have been considered superior because these specialities were somewhat neglected in the works of Galen. The situation changed during the 16th century when numerous errors in Galen’s anatomical and physiological doctrines were discovered by Paracelsus (1493-1541) with his “iatrochemistry,” Vesalius (1514-1564) with his autopsy of human bodies that improved the knowledge of anatomy, and eventually Harvey (1578-1657) with his experimentally founded physiology. All refrained from fundamental criticism against Hippocrates, whose work was regarded as the “canonical original.”

"Science is the father of knowledge, but opinion breeds ignorance."  HIPPOCRATES


BOOKWORM FACT:

At the age of 28, Galen was appointed as physician to the gladiators, where he acquired essential surgical and anatomical experience. Wellcome Library, London

GALEN THE LIFE OF GALEN In contrast to Hippocrates, we do have a thorough knowledge of Galen’s life, a consequence of his penchant for self-display and selfidealization. Galen was born around 129 in Pergamum, an intellectual center in the Roman province of Asia Minor. He was the only son of Nicon, a well-educated, affluent patrician Engraving: 'portrait' of Galen and architect, who ensured that his Wellcome Library, London son began medical studies at the age of 17. After the death of his father, the 19-year-old Galen visited medical centers, including Alexandria, the leading “medical school” at that time, where he learned the latest surgical techniques. With his reputation rising, Galen left Pergamum to move to Rome in 162. His therapeutic successes won him influential patients in the Roman upper class, and his public anatomical-physiological demonstrations, often on living animals, added to his prestige. These displays often took on the character of a spectacle, occasionally turning into “anatomical duels” to contradict the theories of opponents and rivals. Probably for these reasons and also for his self-assertive and provocative manners, he aroused the enmity of influential circles, prompting him to leave Rome in 166. At the end of the year 168, Emperor Marcus Aurelius called him back to Rome and appointed Galen as the personal physician of his son, Commodus, and Galen continued scientific and literary activities until his death at the old age of 87 or 88.

CORPUS GALENICUM The writings of this vast collection, now incorporated under the title Corpus Galenicum, comprise approximately 170 works. Galen’s systematic thinking manifests itself in his concept of disease that draws on the Hippocratic doctrine of the four humours. Despite knowing the difference between arterial and venous blood and countless dissections of animals, Galen had no correct idea of the circulatory system. In therapeutics, Galen differentiates between preventive, causative and symptomatic treatments, attaching importance to Hippocratic principles promoting the

healing forces of nature and regulating all external influences. Galen further advocated drug therapy and the evacuation of noxious humours by way of bloodletting, leeches, purgatives (“purging”) and vomiting, and the use of diuretics. Surgical therapy was recommended by Galen only as the last resort and only in case of irrefutable need. He did not leave surgical texts, though his dissections/ vivisections of animals gave him a good insight in anatomy. Nevertheless, in his work De Methodo Medendi, he explains at length how to control bleeding, and treat wounds and abdominal injuries by means of sophisticated stitching techniques. Some Significant Contributions of Galen to Urology  Theory of uropoiesis: Urine resulting from the interaction of attractive, transformative and specific expelling faculties of the kidney  Classification of various kidney diseases (i.e., urolithiasis, renal abscess)  Verification and first report of vesicoureteral reflux through animal experiments  Differential diagnosis of voiding disorders  Anatomy and (patho-)physiology of male genital organs (e.g., priapism, spermatogenesis)

According to Galen, “the best physician was the one most capable of treating surgical conditions by means other than the knife and particularly by diet and drugs.” Nevertheless, he regarded surgery as a constituent part of the art of healing. The triumph of Galen’s anatomy planted the seeds of its gradual decline. Galen’s followers in anatomy took seriously his instruction to carry out dissections with their own hands and to “see with their own eyes” (the autopsy). In doing so, they found out that not all of his findings agreed with their own observations. The protagonist of this generation of anatomists was Andreas Vesalius (1514-1564), who realized that Galen’s anatomy was completely based on animal dissections. In his Fabrica of 1543, Vesalius had the boldness to point out Galenic errors and consequently incurred the wrath of orthodox Galenists. Not until at the end of the 16 century did Galen’s anatomy become completely outdated; his physiology died with the first description of blood circulation by Harvey in 1628. Paracelsus’ iatrochemistry further weakened the traditional doctrinal system. Nevertheless, Galen continued to be present at the universities until the 18th century, particularly in the fields of medical terminology, as well as in hygienics and general medicine. th

"Those who are enslaved to their sects are not merely devoid of all sound knowledge, but they will not even stop to learn!"  CLAUDIUS GALENUS


t

he Art Medicine: of

EARLY MEDICAL ILLUSTRATION

Mankind has long been fascinated with illustrations and artwork. The cave paintings in Southern France are truly works of art. In a rock painting from 6,000 BCE in Kakadu National Park, Australia, is an anatomical illustration that resembles an X-ray, while an early Mayan bust shows flesh on one side, and the skull on the opposite. Matching mysticism with medicine appears to be the earliest manifestations of these illustrations. Despite the rise of art, history, literature, philosophy and science, there are no extant Greek medical documents with illustrations. Even Galen of Pergamum had no illustrated works. In the Roman era, the work of Soranus of Ephesus, Gynaeica, from about 100 CE, supposedly had illustrations of female reproductive organs, "...the organs of the human body are divided according to the supercelestial but they have not survived. signs. When the moon is in the sign of the patient's organ, you should not Medicine had to wait for the treat that organ." Woodcut, Johannes de Ketham, Fasciculus medicinae, 15 century Dark Ages before illustrated Courtesy of Michael Moran, MD manuscripts appeared. The earliest medical illustrations are anatomical; anatomical art and medicine have been closely intertwined. Fourteenth century human anatomical dissections resulted in crude attempts to show students viscera. The English surgeon-anatomist John Ardene recognized the value of adding illustration to his 1412 work De Arte Physicali et de Cirugia. th

LEONARDO DA VINCI (1452–1519) Top: Portrait of Leonardo da Vinci National Library of Medicine

Bottom: Anatomical studies by Leonardo da Vinci Wellcome Library, London

Early medical illustration had its most profound influence from the Renaissance master Leonardo da Vinci. He went from the transcendence of oil painting to the gruesome sights and smells of the morgues in order to foster his desire to understand human anatomy. In his lifetime, Leonardo made approximately 30 dissections. He planned each topographical area of the body with at least four views and was the first to render cross-sectional anatomy, as well as longitudinal images. He developed cut-away views and partial morselment of viscera to illustrate them better. Leonardo’s anatomical work was bolstered by his reliance on experience, as he said, “If you find from your own experience that something is a fact and it contradicts what some authority has written down, then you must abandon the authority and base your reasoning on your own findings.” Though da Vinci worked just prior to the advent of printing and his remarkable anatomical illustrations were not published in his lifetime, he was widely heralded, and his anatomical work inspired others. Jacopono Berengaria de Carpi (1460-1530) followed in da Vinci’s footsteps, performing hundreds of dissections, and was the first to include figures to illustrate his text. Andreas Vesalius’ 1543 De humani corporis fabrica libri septum (On the fabric of the human body, or Fabrica) was a dramatic publication of illustrated anatomy that changed the landscape of medicine itself as it challenged the Galenic doctrine and stimulated illustration in anatomical and medical texts.

BOOKWORM FACT: Vesalius finished De Humani Corporis Fabrica in 1543 at age 29. Vesalius sent a copy to King Charles V with 200 amazing, hand-colored illustrations. The Emperor was so impressed that a few months later Vesalius was invited to be one of Charles' personal doctors. Image from De humani corporis fabrica libri septum, Courtesy of Rainer Engel, MD

"Learning never exhausts the mind."  LEONARDO DA VINCI


BOOKWORM FACT:

FOLLOWING THE FABRICA Medical illustration from the time of the Fabrica was now open to expansion and improvement. The Dutch masters of anatomy, as well as illustration, came from Leiden and Amsterdam. The anatomical works of the rivals Frederick Ruysch (1638-1731) and Govard Bidloo (1649-1713) exemplified this trend. Portrait of Govard Bidloo Wellcome Library, London Bidloo published his magnum opus Anatomia Humani Corporis in 1685 with magnificent illustrations, which were promptly pirated by the English anatomist William Cowper’s (1666-1709) Anatomy of Humane Bodies (1698). Cowper influenced his protégé Cheselden, who also produced great illustrated anatomical works.

Images from The Anatomy of the Human Body, 1806. William Cheselden William P. Didusch Center for Urologic History

THE PLAIN TRUTH: ANATOMIC ILLUSTRATIONS Dr. John Bell, surgeon, writer and older brother to the famous anatomist Charles Bell, noted that an anatomy without plates is “no better than a book of geography without maps;” artistically talented themselves, the brothers wrote and illustrated several anatomy The Anatomy and texts. John Bell criticized Physiology of the Human Body, 1817. anatomical illustrations bound John Bell Courtesy of John in huge volumes and featuring Herman, MD god-like corpses, pointing out that a smaller book is more suitable to teaching anatomy, and illustrations that faithfully represent a real body serve medical students better than images of “a statue anatomised.” At one end of this spectrum stands the 1747 images of Bernard Albinus and artist Jan Wandelaar (Man with Rhinoceros); at the other, Govard Bidloo’s images of bits and pieces of body parts pinned to the table and decorated with flies. In which representation, asked Dr. Bell, would the medical student have more confidence?

Image from Tabulae sceleti et musculorum corporis humani

Image from Anatomia Humani Corporis

Bernard Albinus Wellcome Library, London.

Govard Bidloo Wellcome Library, London.

This emphasis on plain images and words led Charles Bell to give up writing his texts in Latin; their books are small, bound in plain materials and printed on ordinary paper. Though not immediate (Irish surgeons Richard Quain and Joseph Maclise produced large anatomical volumes in the 1840s), the trend toward representing the unvarnished truth in medical texts continued through Gray’s Anatomy, published in 1858.

“… even in the first invention of our best anatomical plates, we see a continual struggle between the anatomist and the painter, the one striving for elegance of form, the other insisting on accuracy of representation.”  DR. JOHN BELL, ENGRAVINGS OF THE ANATOMY OF THE BONES, MUSCLES AND JOINTS, 1794.


t

he Art Medicine: of

MODERN MEDICAL ILLUSTRATION

The invention of lithography in the early 1800s brought a huge advance in medical illustration. Reproduced from tedious and expensive woodcuts or engravings, early medical illustration often lacked quality and accuracy. Through lithography, a process based on the repulsion of oil and water, many exquisitely illustrated anatomical, medical and surgical texts appeared in the 19th century. Notable examples included an elaborate series of anatomic plates published by Jones Quain in 1842 and the 1851 Surgical Anatomy Atlas of Joseph MacLise shown in our display case. The development of medical illustration corresponded with improvements in the reproduction process, including the invention of photoengraving in 1868, the halftone screen in 1880 and the four-color printing process in 1893. It became possible to reproduce pictures efficiently, accurately and economically by photomechanical means.

MAX BRÖDEL (1870-1941) The modern era of medical illustration arrived in the United States in 1894 with Max Brödel, who had been convinced by Hopkins physician Franklin Mall to leave Leipzig, Germany, for the new Johns Hopkins School of Medicine in Baltimore, Maryland. Brödel was quickly Max Brödel employed by Howard A. William P. Didusch Center for Urologic History Kelly, Chief of Gynecology, on illustrating his textbook Operative Gynecology, but as other physicians and surgeons realized the quality of Brödel’s images, they too wanted their research illustrated by Brödel. Early on, Max Brödel struggled to find a medium to represent wet, living tissue. Ink washes and watercolors require that highlights must be left unpainted so white paper shows through (tedious and inflexible) or opaque whites must be Carbon dust illustration added afterwards (hard and jarring Max Brödel, William P. Didusch Center for Urologic History against the watercolor). He found his medium with carbon dust on clay-coated paper. Carbon dust, created from sanded carbon pencils, could be added in stages to produce light or deep blacks, and erased or scratched from the paper to create subtle or brilliant highlights.

Brödel teaching a class at Johns Hopkins, Department of Art as Applied to Medicine. Also pictured, student William P. Didusch (back row, far left). William P. Didusch Center for Urologic History

In 1911, when Dr. Kelly retired, Dr. Thomas Cullen conceived of a department where Brödel could train students in the necessary knowledge and skills to become medical illustrators. Henry Walters, a Baltimore philanthropist and art collector, provided an endowment that created the Department of Art as Applied to Medicine at Johns Hopkins. It opened in 1911, with Max Brödel serving as both Professor and Director for almost 30 years.

WILLIAM P. DIDUSCH (1895-1981) The Department of Art as Applied to Medicine flourished, and among the early graduates were two brothers, James and William Didusch. Around Christmas of 1915, Brödel gave Bill Didusch the opportunity to become the staff artist for the newly created Johns Hopkins Brady Urological Institute, under the direction of Dr. Hugh Hampton Young. Didusch decided to take the job, which evolved into a lifelong dedication to urology. Didusch’s skills as an artist and visual teacher were quickly recognized as he produced a prolific number of drawings for the Hopkins urologists, illustrating 18 major medical texts and countless journal articles.

“In Max’s view, teaching had always been a central function of his role at Hopkins.”  RANICE CROSBY, MAX BRÖDEL: THE MAN WHO PUT ART INTO MEDICINE, 1991


A Collection of Urogenital Drawings William P. Didusch William P. Didusch Center for Urologic History

Bill Didusch with his dogs William P. Didusch Center for Urologic History

In 1949, Bill Didusch was appointed an instructor in the Department of Urology at the Brady Institute, and in 1953, became the executive secretary of the American Urological Association (AUA), a position he held until 1968. That same year, 1968, Didusch proposed the creation of a urologic museum based upon his collection: “I had in mind the preservation of this vast amount of graphic material depicting the surgical techniques of the ‘Greats’ in urology that covered a period of many years.” In response to this proposal, in 1971 significant funds were raised at a surprise dinner in his honor held by the AUA; and in 1972, Didusch became the new museum’s first curator. The William P. Didusch Center for Urological History, housed at the AUA headquarters in Linthicum, Maryland, has grown into a wonderful tribute to urologists around the world.

FRANK H. NETTER, MD (1906-1991) Much of this text on medical illustration has been taken from an article by surgeon/medical illustrator Frank Netter. Frank Netter has been likened to da Vinci in his preparation of each painted work, with a thorough understanding of the task of the illustrator. Illustration of the ear.

Frank Netter Netter was born in Manhattan in National Library of Medicine 1906 and showed aptitude for art at an early age, drawing portraits and cartoons for his high school yearbook. But he had promised his mother he would go to medical school, and enrolled at New York University Medical College in 1927.

But even in medical school, Netter took notes in pictures, saying later, "Mine was a graphic viewpoint. My notebooks were crammed with illustrations. It was the only way I could remember things." Soon Netter began to pay for part of his medical education by illustrating lectures and textbooks; and as a young doctor in the Depression, Dr. Netter found that the demand for his illustrations grew faster than the demand for surgery. He gave up his practice entirely.

Illustration of bladder cancer William P. Didusch Center for Urologic History

In 1948, the CIBA Pharmaceutical Company published a book of Dr. Netter's meticulous, lifelike renderings that was followed by the series of volumes – The Netter Collection of Medical Illustrations. Even after his death, Dr. Netter is still considered a master of medical illustration; his anatomical drawings are the gold standard of medical art.

“As I delved a little into the history of medical illustration I came to realize that pictures have played a vital role not only in teaching but in the actual development of surgery to its present high levels.”  FRANK NETTER, MEDICAL ILLUSTRATION, 1956


m

edical Training: TEXTBOOKS

WILLIAM OSLER’S PRINCIPLES AND PRACTICE OF MEDICINE Principles and Practices of Medicine William Osler William P. Didusch Center for Urologic History

BOOKWORM FACTS:

 Osler’s textbook, the Principles and Practice of Medicine, was the standard teaching text in both North America and England for more than 50 years  Osler became a worldwide leader of medicine and medical education from this work

WILLIAM OSLER (1849-1919) Born in rural Ontario in 1849, young William Osler had a penchant for pranks and jokes (one of which kept him in jail overnight), but went on to become known as one of the most influential physicians in modern medicine. The Father of Modern Medicine, Osler is not known for any major medical Sir William Osler (1849-1919) Canadian physician, aged 63. discovery, no breakthroughs in Wellcome Images, London. knowledge nor legendary papers, but rather for a variety of accomplishments, including his textbook Principles and Practice of Medicine, which not only became a best-seller, but developed Osler into the towering medical figure of his era. Much has been written on Osler and his textbook. In fact, his Pulitzer Prize-winning biographer Harvey Cushing stated, “Someone, some day, could well write a volume devoted to a study of the successive editions of this famous work, which continues to exert an enormous influence on students of medicine.” Osler had recently become the Professor of Medicine at the fledgling Johns Hopkins Hospital, which allowed him the precious time for the culmination of his “inkpot career.” He wrote the Principles and Practice of Medicine: “one of the great accomplishments of his life and one of the great books in the history of medical education and publishing,” according to medical historian Michael Bliss. The book became an instant best-seller; the first edition sold 23,500 copies. He legendarily gave the first copy to Grace Revere Gross; they were married in May 1892. The second edition was issued in 1895 and sold 17,500 copies; the third through seventh editions occurred approximately every five years. The sixth edition came th out in 1905, and the 100,000 copy was given by the publisher (Appleton) to Osler’s son Revere. The seventh edition, Osler’s last sole-author edition, is considered the zenith of his works because he so ably encompassed all of the most recent scientific advances in medicine since his 1892 beginnings. His textbooks were translated all around the globe in French, German, Spanish, Portuguese, Russian, Chinese and Japanese.

 Osler believed that the best teachers are those who are perpetual students themselves, and he frequently put himself in the place of students during his classes. This philosophy would leave an indelible mark on the medical world.

OSLER’S TEXT CHANGES MEDICAL EDUCATION Osler’s textbook had far-ranging consequences. It was read widely even by laypersons. In July 1897, Frederick T. Gates, advisor to John D. Rockefeller, read Osler’s textbook during his summer holiday and reported back to his boss the need to fund medical education and medical scientific research. Osler's style, which included bedside Gates later wrote, “Filled teaching, discussing diagnostic errors and spending time with patients, with these thoughts and was considered radical. Until Osler, medical education consisted of textbook-reading, lectures and enthusiasms, I returned from studying illustrations; there was no contact with patients. my vacation … and … dictated Wellcome Images, London. for Mr. Rockefeller’s eye a memorandum in which I aimed to show to him the actual condition of medicine in the United States and the world as disclosed by Dr. Osler’s book.” The Harvard Medical School first benefited from Rockefeller’s largesse with an endowment of $1 million from the Institute in 1902. Then Johns Hopkins Hospital received a donation of $1.5 million to establish a fulltime staff system in 1913. The Rockefeller Foundation established the Rockefeller Institute of Medical Research in 1914, funded the Johns Hopkins School of Hygiene and Public Health in 1918, the Institute of the History of Medicine and the Wilmer Institute in 1929 – quite a legacy for Osler’s textbook. “Osler’s textbook was a marvel of precision, clarity, and up-to-date information based on a solid foundation of pathology.” – Jeremiah Barondess, American Osler Society meeting

“As great a lover of books as he [Osler] was of men, his great library of 7,600 volumes was collected and catalogued, not as a series of treasures by reason of their rarity, but as instruments for the advancement of knowledge, and with this end in view the collection was bequeathed to McGill University.”  WILLIAM STUART WELCH


HUGH YOUNG’S PRACTICE OF UROLOGY Young's Practice of Urology William P. Didusch Center for Urologic History

Young's Boomerang Needle Donated by Patrick Walsh, MD

HUGH HAMPTON YOUNG (1870-1945)

YOUNG'S FIRST TEXTBOOK

Hugh Hampton Young was born the only son of a Confederate Army general in Austin, Texas, in 1870 shortly after the Civil War between the South and the North ended. Though he wanted to become “a military man” like his grandfather, whom he adored, the Civil War had Hugh Hampton Young been too recent; and his family could William P. Didusch Center for Urologic History not tolerate him being trained in the “Yankee” stronghold of West Point. So Young went to medical school in Virginia, where he obtained a BA, MA and MD degree within four years, completed his training in 1894, and then moved to the Johns Hopkins Hospital to begin a career in general surgery. When James Brown, the Chief of the Genitourinary Division at Hopkins, suddenly died, Hugh Young was asked to assume that position. Shortly thereafter, he was struck by an episode of jaundice. During his recuperation on a farm in Maryland, he read urological texts to familiarize himself with his future profession. He took over the division in late November 1897 and soon was propelled into the forefront of urology. His surgical imagination, mechanical ingenuity and outstanding qualities as a teacher all compounded to an illustrious career in the field.

In the preface to his 1926 two-volume Young’s Practice of Urology, Based on a Study of 12,500 Cases, Young himself asks the question:

Why another “Urology”? Have we not the recent great treatises by Legueu, Marion, in France, Thompson-Walker in England, Watson and Cunningham, Guiteras, Chetwood, Keyes, and Cabot in America. Certainly a veritable embarras de richesse. Citing the many milestone books (Sir Henry Thompson’s Lithotomy, Sir Astley Cooper’s Diseases of the Testis, Jean Civiale’s Lithotritie, etc.) that inspired Young and his coauthor David M. Davis, Young noted that those books remain valuable because of “their individual character and their detailed description of personal experiences and inventions.” So Young and Davis assembled a clinical study of their own experiences in the practice of urology, listing the procedures, devices and research initiated at the Brady Urological Institute, with great thanks offered to “that keen man of affairs and remarkable sportsman who presented us with two-thirds of a million to build to his memory the James Buchanan Brady Urological Institute.” The volumes include over 1,000 original illustrations – “the result of years of patient work and enthusiasm for artistic ideals on the part of Mr. William P. Didusch.” This text book, along with Hugh Cabot's 1918 Modern Urology, enjoyed wide sales, as they represented the earliest efforts to provide comprehensive coverage of the field of urology.

“I was struck by the fact that had the entire prostate gland been removed with its capsule, it would have been possible to cure both these patients.”  HUGH HAMPTON YOUNG, HUGH YOUNG: A SURGEON’S AUTOBIOGRAPHY


p

ediatric urology texts

Just as urology developed as a specialty when medical techniques, procedures and knowledge advanced, pediatric urology developed into a subspecialty with certain techniques (infant endoscopy and microsurgery) and a focus on the embryological and developing organ system.

Diseases of the Urinary Tract in Children, 1930 Edwin Beer and Abraham Hyman William P. Didusch Center for Urologic History

The first material devoted to pediatric urology, published in 1898, was titled The Affections of the Urinary Apparatus in Children, by John H. Morgan, a surgeon at the Charing Cross Hospital in London, and described pediatric urology prior to cystoscopy or radiographic imaging.

In 1937, Young produced another noteworthy text, Genital Abnormalities, Hermaphroditism and Related Adrenal Disease. Well referenced and indexed, this book included 534 Didusch drawings. It is interesting that Young chose this topic, largely a pediatric one, as his last major piece of work.

HUGH HAMPTON YOUNG (1870-1945)

EDWIN BEER (1876-1938)

In 1919, Dr. Young published a landmark paper, Congenital Obstruction of the Posterior Urethra, on the successful surgical management of posterior urethral valves using his pediatric punch instrument. Then, in 1926, Hugh Young and David Davis produced a two-volume text, Young’s Hugh Hampton Young William P. Didusch Center Practice of Urology, that included a 12for Urologic History page pediatric section titled Urology in Infancy and Childhood, and began, “Increasing interest has recently been aroused in urologic problems of infancy and childhood by a number of important articles, and it seems wise to devote a special chapter to this subject.” Dr. Young had a significant interest in the care and surgical management of children with complex urological conditions, and turned much of his clinical efforts to the management of children at the Harriet Lane Home, the pediatric department of the Johns Hopkins Hospital.

In 1911, pioneer of pediatric urology Dr. Edwin Beer described the use of cystoscopy and urethral catheterization in children using the first practical pediatric cystoscope that he designed. His 1930 text, Diseases of the Urinary Tract in Children, by Edwin Beer and Abraham Hyman, was the first pediatric urology textbook, although its influence is questionable as few copies are currently found, and references to it were rare.

Edwin Beer William P. Didusch Center for Urologic History

“Increasing interest has recently been aroused in urologic problems of infancy and childhood by a number of important articles, and it seems wise to devote a special chapter to this subject.”  HUGH HAMPTON YOUNG, PRACTICE OF UROLOGY, 1926


BOOKWORM FACT:

Doctors Harry Spence and Frank Bicknell first envisioned a pediatric urology group in a cab in 1948. In 1951, at their first meeting, the Society for Pediatric Urology was born. Frank Hinman, American Pediatric Urology

Atlas of Pediatric Urologic Surgery Frank Hinman, Jr., 1994 Donated by Douglas Canning, MD and Peggy Duckett

This first edition was owned by pediatric urologist John Duckett

MEREDITH CAMPBELL (1894-1969) Known as the “Father of Pediatric Urology,” Meredith Campbell published his two-volume Pediatric Urology in 1937, authoring 11 of the 12 chapters of the over 500-page text. It was extensively referenced and had more than 1,300 illustrations. This text also Meredith Campbell included a chapter written by a William P. Didusch Center for Urologic History nephrologist because Campbell stated, “The urologists should be as conversant with medical as with surgical diseases of the kidney.” In the preface he stated that the book took 10 years to prepare. In 1951, he published Clinical Pediatric Urology, a text of more than 1,000 pages in 14 chapters, 13 of which were written by Campbell. Extensively referenced, it became the standard pediatric urology reference, and included chapters on physical examination and diagnosis, embryology, infections, tumors, trauma, enuresis, neuropathy and surgical techniques. Meredith Campbell was the first president of the Society for Pediatric Urology, the secretary and president of the New York Section of the American Urological Association, and vice president of the American Association of Genitourinary Surgeons. A member of numerous additional societies, he was the recipient of innumerable honors. In 1964, the Society for Pediatric Urology established the annual Meredith Campbell Lecture in his honor.

FRANK HINMAN, SR. (1880-1961), AND FRANK HINMAN, JR. (1915-2011)

Top: Frank Hinman, Sr

Frank Hinman, Sr.’s Principles and Practices of Urology of 1935 was a scholarly volume that contained numerous sections on the urogenital anomalies of development. In 1994, his son, Frank Hinman, Jr. (one of the founders of Society of Pediatric Urology in 1951), published the Atlas of Pediatric Urologic Surgery, of which a more recent edition was published in 2008. Prior to his Atlas, in 1991 Dr. Hinman, Jr. published an interesting text on the history of pediatric urology, American Pediatric Urology, detailing the history of the specialty and the supporting pediatric societies.

William P. Didusch Center for Urologic History

Bottom: Frank Hinman, Jr William P. Didusch Center for Urologic History

This book served as a standard reference for pediatric urology for the next 20 years.

“About half of all children suffer some form of urologic disturbance before they reach puberty.”  MEREDITH CAMPBELL, FOREWORD, PEDIATRIC UROLOGY, 1937


m

edical journals

Left:

The Lancet August 5, 1911

Center:

Proceedings of the Royal Society of Medicine, Section of Urology January, 1932

Right:

The Journal of the American Medical Association January 18, 1936 William P. Didusch Center for Urologic History

The history of medical publications, for practical purposes, can be said to have started with the growth of experimental science during the later Renaissance. Journals and periodicals began to take over from books in the world of science and medicine in the late 17th and early 18th century. Communication between scientists took a leap in the early 1500s when the printing press became more available. For the first time, exact copies of scientific works could be obtained easily and comparatively cheaply by all who wished. One of the first scientific journals was the Philosophical Transactions of the Royal Society of London, which included observations on mathematics, physics, chemistry and the developing biological sciences. Not until the 18th century did medical journals begin to appear. As discoveries in experimental science became more frequent, the periodical came into its own. It provided a more rapid and exact publication, essential in a field where knowledge is cumulative, and it offered the advantage of the automatic subscription distribution method.

periodicals, which, by the end of the 19th century, had made it nearly impossible for any person to own all the medical periodical literature he or she needed for research and/or practice. Prior to the 19th century, American medical literature consisted of reprints, translations and imitations of European counterparts. With the development of the new nation and the lessening of European influences, American medical societies began to emerge. This, combined with the need for better communication between American physicians, produced the first truly American medical periodical literature. In 1797, the first issue of The Medical Repository was published. This was the earliest American source of medical news and information, and set the example for other Map demonstrates the contiguity of periodicals to follow. By the yellow fever cases near the befouled slips of the New York waterfront during the year 1850, more than 200 autumn of 1797. An enquiry into the cause of the prevalence of the yellow fever in New-York, Medical Repository titles were in circulation, Wellcome Library, London. and every settled area in the United States was represented by a medical periodical publication. By 1900, one thousand more had been published. Sketch, Girl with Blue stage of the spasmodic Cholera, 1831. The Lancet Wellcome Library, London.

Probably no other factor has so powerfully acted for the establishment of medical libraries and the training of medical librarians as the proliferation of medical

“Since the year 1800 medical journalism has become the principal means of recording and communicating the observations and ideas of those engaged in the practice of medicine…”  JOHN SHAW BILLINGS, LITERATURE AND INSTITUTIONS, 1876


To identify and characterize the most frequently cited articles published in journals dedicated to urology over the last 50 years, a search was performed of all Pubmed articles published in the 13 most cited urological journals between 1955 and 2009. Articles with more than 100 citations were identified as "classic" and were analyzed further. Of 97,554 articles published during this time, the most common topic was prostate cancer and prostate-specific antigen, followed by bladder cancer and benign prostatic hyperplasia.

The Journal of Urology British Journal of Urology European Urology William P. Didusch Center for Urologic History

JOURNALS OF UROLOGY The history of journals dedicated to only urology is much younger. The first scientific articles of the newly establishing specialty appeared in surgical or general medicine journals such as The Lancet or JAMA. The journals of the early period were regional publications, containing a diversity of topics: husbandry, natural history and biographical information, as well as medical news. These early journals also traced the development of American medical societies; the demand for definitive ethics in practice; and the reorganization, expansion and adjustment of medical education. Founded in 1823, The Lancet had the prestigious heritage as one of the world's leading medical journals. It was, and remains, independent, without affiliation to a medical or scientific organization. Established in 1883, the Journal of the American Medical Association is a weekly, peer-reviewed medical journal published by the American Medical Association. Its acronym, JAMA, was not added until 1960.

Above: Annales des maladies des organes génito-urinaires, 1898. Right: Image from Annales des maladies des organes génito-urinaires University of Michigan Library, digitized by Google.

It was in France in the year 1883 that the first urology-only journal Annales des maladies des organs genito-urinaires was published under the supervision of Felix Guyon (1831-1920) and Joaquin Albarran (1860-1912). The British Journal of Urology was established in 1929. One of the first scientific articles, Drainage Of The Bladder Through The Perineum After Supra-Pubic Prostatectomy, was published by Andrew Fullerton. In Germany, there were two journals at first: the Internationales Centralblatt für die Physiologie und Pathologie (Krankheiten) der Harn- und Sexualorgane (Journal of the Physiology and Pathology of the Genitourinary Tract), established in 1889/1890 by Wilhelm Zuelzer (1834-1893), and a second journal devoted to urology alone, the Monatsberichte für Urologie, edited by Hugo Lohnstein (1864-1918). These two journals merged with the foundation of the German Urologic Society after the death of Max Nitze in 1906 and became Zeitschrift für Urologie (Journal for Urology), edited by the Georg Thieme publishing house in Leipzig. This Journal lasted to the end of the former German Democratic Republic (GDR) in 1989 and was then included in Aktuelle Urologie. From 1964 (Volume 57) to 1989, und Nephrologie (and Nephrology) was added, and the Journal was published under the auspices of the Urologic Association of the former GDR. After the foundation of the European Association of Urology (EAU) in 1973, the journal European Urology became the official scientific journal of the EAU in 1975. Today it belongs with The Journal of Urology as one with the highest impact factor in the field of urology.

“Besides his duties to his patients, the physician is under certain obligations to contribute, by way of interest, his quota to the common stock of medical knowledge from which he has drawn so freely.”  JOHN SHAW BILLINGS, LITERATURE AND INSTITUTIONS, 1876


b

ooks changed medicine that

De mortu cordis et sanguinus in anamalibus Reprint, 1978 William Harvey Donated by Rainer Engel, MD

William Harvey Courtesy of Rainer Engel, MD

The centerpiece of historical knowledge has always centered upon “the ideas that changed medicine.” These represent the crown jewels of medical knowledge. Many people underappreciate this knowledge and its legacy because the knowledge translates into ideas that subsequent generations take for granted.

WILLIAM HARVEY: THE FATHER OF PHYSIOLOGY William Harvey was born to yeoman farmer Thomas Harvey on April 1, 1578. He went up to study at Gonville and Caius College in Cambridge at age 16. In 1600, Harvey traveled to Padua to complete his medical education. His professor of anatomy was Girolamo Fabrizio (Hieronymus Fabricius ab Aquapendente), who had just described the valves in veins. Harvey worked tirelessly on his own experiments upon returning to England. He began to lecture and demonstrate anatomy at the Royal College of Physicians. In 1628 he finally published his physiologic experimental observations confirming the circulation of blood: the actions of the heart as a pump. This overturned the ancient notions of the Greek masters and began the open assault in all areas of medicine to a new method of investigation. In 1628 William Harvey published his landmark text, De mortu cordis et sanguinus in anamalibus, in Frankfurt, Germany. Of course a firestorm of controversy arose regarding much of the precepts, but the floodgates were open; and observation and investigation rapidly confirmed the truth of Harvey’s observations. This book is rightly ascribed to a monumental leap in knowledge as it established a landmark in both science and medicine.

EDWARD JENNER: FATHER OF IMMUNOLOGY Born in 1749 and orphaned by the age of 5, Edward Jenner was sent by his brothers and sisters to a small boarding school in which a terrible smallpox epidemic broke out. As was customary at the time, those preparing to undergo variolation (inoculation with smallpox Top: Image of smallpox from Jenner's An Inquiry into the Cause virus in order to minimize and Effects of Variolae Vaccinae William P. Didusch Center for Urologic disease severity and induce History immunity) were first Bottom: Caricature of Edward Jenner inoculating patients in the subjected to a medical ritual Smallpox and Inoculation Hospital at St. Pancras. Lettering: The cowof six weeks of bleeding, pock - or - the wonderful effects of the new inoculation! - Vide, the publications of ye anti-vaccine fasting and purging. The society. Js. Gillray James Gillray, colored etching, 1802. horrifi c experience left Wellcome Library, London. young Jenner plagued by insomnia, anxiety and hallucinations, and perhaps began his lifelong quest to eradicate smallpox. Never a stellar student, Jenner did qualify for training as a surgeon and so enrolled as a student at St. George’s Hospital in London. There, he boarded and took classes with Chief of Surgery John Hunter; they became best of friends. Jenner learned from Hunter the importance of testing a hypothesis by performing well-conceived experiments, and incorporated this scientific method on his belief that inoculation with cowpox would prevent smallpox. On May 14, 1796, Jenner took fluid from Sarah Nelmes’ cowpox lesions and inserted it into two half-inch incisions on the arm of 8-year-old James Phipps, whose father worked for Jenner. Eight days later, James developed cowpox pustules and a slight fever, but when Jenner variolated James in July – which SHOULD have given the boy a slight attack of smallpox – the boy showed no sign of the disease.

“ … it is absolutely necessary to conclude that the blood is in a state of ceaseless motion; that this is the act or function which the heart performs by means of its pulse; and that is the sole and only end of the motion and contraction of the heart.”  WILLIAM HARVEY, DE MORTU CORDIS ET SANGUINUS IN ANAMALIBUS, 1628


Jenner continued to inoculate children with cowpox; many were the children of laborers or workhouse inmates, but he both inoculated AND variolated his own son Robert. Jenner wrote his now-famous book, An Inquiry into the Cause and Effects of Variolae Vaccinae, and paid for the printing himself. Though the first copies were sold for a shilling, a copy today would cost thousands of dollars, not only because it is rare but because it heralded the birth of the only method yet devised by medicine to prevent the onset of an infectious disease. Jenner’s work literally altered the course of a major disease – smallpox – estimated to have killed over 7 million people worldwide, and set the stage for the eradication in 1977 of the first major disease in modern times.

JOSEPH LISTER: THE FATHER OF MODERN MEDICINE The founder of antiseptic surgery, Baron Joseph Lister (1827-1912) was born on April 5, 1827, to a Quaker family; his father was the famous Joseph Jackson Lister, who invented the compound microscope and achromatic lenses. Young Lister attended the University of London, graduated with honors as Bachelor of Medicine, and entered the Royal College of Surgeons at age 26. He moved to the University of Edinburgh to work with James Syme and eventually married Syme’s eldest daughter Agnes, who became his chief research assistant. He moved to the University of Glasgow as professor of surgery.

the widespread belief that being in an institution was associated with bad outcomes. He had read Louis Pasteur’s work on microbes and investigated the use of carbolic acid to reduce the infection rates of wounds. In August 1865, Lister applied carbolic acid-soaked dressings to a compound fracture on an 11-year-old boy who survived and whose leg healed without an amputation. But when it had been shown by the researches of Pasteur that the septic property of the atmosphere depended, not on the oxygen or any gaseous constituent, but on minute organisms suspended in it, which owed their energy to their vitality, it occurred to me that decomposition in the injured part might be avoided without excluding the air, by applying as a dressing some material capable of destroying the life of the floating particle.

Lister treated 11 patients with compound fractures during this period, and nine recovered. He began to treat all of his postoperative wounds with antiseptics. In August 1867 at the Dublin meeting of the British Medical Association, he announced that during the last nine months: his wards – previously amongst the unhealthiest in the whole surgical division of the Glasgow Royal Infirmary – had been entirely free from hospital sepsis. Uniting Louis Pasteur’s germ theory to practical application in surgery, Lister rightly assumed a place in the pantheon of medical heroes.

As a young surgeon, Lister was distressed by his high rate of postoperative infections and resulting death. The term “hospitalism” had been coined to describe

Back:

The Collected Papers of Joseph Lister, 1979 Donated by Rainer Engel, MD

Front: Lister's carbolic sprayer William P. Didusch Center for Urologic History

“The men I speak of [bibliomaniacs] keep alive in us an interest in the great men of the past, and not alone in their works, which they cherish, but in their lives, which they emulate.”  WILLIAM OSLER, BOOKS AND MEN, 1901


a

history urology histories of

Left:

The History of Urology Leonard J.T. Murphy, 1972 William P. Didusch Center for Urologic History

Right:

Urology: A View Through the Retrospectroscope John R. Herman, 1973 William P. Didusch Center for Urologic History

THE HISTORY OF UROLOGY The History of Urology by Leonard J.T. Murphy was one of the first complete history of urology texts. Published in 1972, the text is divided into two parts, with Part I incorporating an edited translation of Ernest Desnos’ L’Histoire De L’Urologie covering “The History of Urology to the Latter Half of the Nineteenth Century.” Ernest Desnos was a French urologist; he and Alfred Pousson from the Necker Hospital in Paris convinced their professor, Felix Guyon, of the need to unite urologists from around the world. He thus became one of the 1907 founders of the Société Internationale d’Urologie (SIU). Desnos’ text covers topics from urology in ancient times in the Orient, urology in Greece and Rome, Arabian medicine, urology in the Renaissance, Images from Leonard J.T. Murphy's lithotomy and lithotomists, and The History of Urology William P. Didusch Center for Urologic uroscopy up to 19th century History advances in urology. At a time when medical historians were writing more on the history of medicine and there was less of a contribution by physicians, Murphy would write, “I was encouraged to bring Desnos’ work up to date by Douglas Guthrie’s opinion that the history of recent medicine is best written by a specialist in the subject under review rather than by a medical historian.” He found “many important urological conditions had not been included in Desnos’ text, and thus necessitated going back over the field covered by him.”

replacement, the bladder, the prostate, the urethra and miscellanea. Murphy bridges the advances in urology from the period when anesthesia and asepsis opened the field of surgery up to the 1970s, including the works of many early master-surgeons (Trendelenburg, Nitze, Gustav Simon, George Goodfellow, H.H Young and Bigelow). Many of his chapters are filled with original illustrations of early operative techniques and instruments, as well as his own simple illustrations to depict anatomy and techniques. Upon completing his text, Murphy ended the preface to his book “Feci quod potui: faciant meliora potentes.” [“I have done what I could: let those who could do more.”]

UROLOGY: A VIEW THROUGH THE RETROSPECTROSCOPE Urology: A View Through the Retrospectroscope © by John R. Herman 1973. Dr. Herman, a clinical professor of urology at Albert Einstein College of Medicine, Bronx, New York, would write, “A study of history need not be painful. Here then is offered a short description of the development of urology, to be read with ease and (hopefully) to be enjoyed.” As an introduction to the history of urology, chapters included: the beginnings of urology (urology in ancient times up to Columbus’ voyage to the new world), lithotomy, catheters, the development of the cystoscope, the development of x-ray studies, gonorrhea and syphilis,

Dr. John Herman (right) visiting the Museum on Charles Street with Dr. Rainer Engel (left) in 2001. William P. Didusch Center for Urologic History

Part II of Murphy’s text, titled “The Development of Modern Urology,” is divided into chapters organized by organ system: the kidney, the ureter, ureteric repair and

“The penis is a sexy sewer and as such it has long been of interest to mankind.”  JOHN HERMAN, UROLOGY: A VIEW THROUGH THE RETROSPECTROSCOPE. 1973


surgical approaches to the prostate, the development of transurethral resection instruments, aphrodisiacs, bladder tumors and urinalysis. Herman’s short text (only 181 pages) was meant to be an introduction to the history of urology, not an allencompassing tome. He states as his goal: “If this work comes into the hands of medical students and residents and inculcates a sense of enjoyment of medical history, it will have served its purpose.”

The AUA History Committee’s Annual award for the best history forum presentation and paper, originally named the “Rusty Cystoscope Award,” was renamed the AUA Earl Nation Retrospectroscope Award in 2006 in honor of Earl Nation and in recognition of John Herman’s book.

PERSPECTIVES IN UROLOGY Perspectives in Urology The Official American Urological Association History of Urology, Volume 1 © 1976. Editors: Ralph R Landes, MD; Ronnie B Bush, PhD; and Adrian W Zorgniotti, MD. Dr. Landes was head of urology at Danville, Virginia, and served as the AUA Historian from 1965 to 1979. Dr. Zorgniotti, a urologist from New York, was known for his innovation in the field of erectile dysfunction when he combined papaverine and phentolamine as an intracavernous injection for the treatment of erectile dysfunction. He succeeded Dr. Landes to serve as the AUA Historian from 1980 to 1988. The editors would comment since the AUA published its first History of Urology in 1933, “new pioneers in urology have emerged with as much impact as Guiteras, Bigelow, Young, Albarran, Nitze.” The influence of World War II was also evident. “While research was often hampered by wartime conditions, wounded and injured men provided urologists with the opportunity to develop new surgical approaches.” Volume 1 included 12 chapters on various topics: endoscopy; nephrectomy; pyelonephritis; endoscopic manipulation of ureteral stones; vesicoureteral reflux; catheters and sounds; suprapubic prostatectomy; venereal diseases; noncalculous obstruction at the ureteropelvic junction; urologic x-ray cinematography; the influence of Dr. John MacIntyre; and hemodialysis and peritoneal dialysis.

The text includes a section titled “A Visit to the AUA William P. Didusch Museum.” The museum was officially opened on January 12, 1972, and included the unveiling William Didusch portrait of a portrait of William P. Ann Didusch Schuler William P. Didusch Center for Urologic Didusch painted by his niece, History Ann Didusch Schuler. This photograph, included in the book, shows Mr. Didusch next to his portrait, along with Bertha Trott, secretary to Drs. Young, Colston and Jewett, and known for her many years of service to the AUA and The Journal of Urology. The section includes numerous illustrations by Mr. Didusch, as well as photographs of instruments and artifacts from the museum at the time. Despite the fact a second volume was never published, the text remains a valuable source of urological history.

THE AMERICAN UROLOGICAL ASSOCIATION CENTENNIAL HISTORY: 1902-2002 The American Urological Association Centennial History: 1902-2002 Editors: Lawrence W Jones, MD; © Paul C Peters, MD; Wendy Cowles Husser, 2002. The two-volume work was begun in 1991 in anticipation of the AUA’s 2002 Centennial. Ever since Bransford Lewis edited and wrote the first chapter on the History of Urology in 1933, there had been several unsuccessful attempts to produce a history of Image of the original the AUA, from Dr. Wirt Dakin, first AUA headquarters from The American Urological official historian of the AUA, to Association Centennial History: 1902-2002 subsequent historians Drs. Landes William P. Didusch Center for Urologic History and Zorgniotti. The two-volume set is an all-inclusive history of the AUA. Filled with photographs of the “giants in the field” and many of the founding fathers of urology, it tracked the development of each of the Sections of the AUA and the history of The Journal of Urology, as well as the growth of the William P. Didusch Museum. Comprehensive and chronologically oriented, it included notes in the margin corresponding to other national and international historical events during the time.

“It all began in Toronto’s L’Hotel, June 5, 1991. Earl Nation was elected to chair a committee to write the chapter of the narrative history of the AUA for the 2002 centennial history…”  LAWRENCE JONES, THE AMERICAN UROLOGICAL ASSOCIATION CENTENNIAL HISTORY, 1902-2002, 2002


MICHAEL E. MORAN, MD

Curator, William P. Didusch Center for Urologic History According to an old Latin proverb, “knowledge is power.” Though often attributed to Francis Bacon from his Meditationes Sacrae of 1597 or to his secretary, Thomas Hobbes, from his 1658 work De Homine, it is likely they borrowed the notion from the Old Testament, Book of Proverbs (24:5), “A wise man is strong, a man of knowledge increaseth in strength.” Such sources appear to support the notion that knowledge is a good thing, increases over time and includes a lasting legacy from those who added to our understanding of the universe. In the history of medicine, there are recognized giants – Hippocrates, Claudius Galen, Andreas Vesalius, William Harvey, Joseph Lister – whose contributions have added to our universe of knowledge and understanding. This legacy of knowledge through to our modern understanding of health and disease is the subject of the William P. Didusch Center’s 2014 history exhibit, Knowledge Unbound: Literature of Medicine. Our journey through time begins with the very foundations of script and first written medical treatises, which were documented on clay tablets from the Fertile Crescent. Papyri followed, becoming the written repository for the early Egyptian dynasties. Writing was extremely important to the Egyptian empires. Rulers often mandated that every book brought into the country be copied for the library, and scribes were educated individuals who came from elite families. The evolution of Egyptian hieroglyphics is a contentious fragment of historical research, but most believe it evolved synchronously with Sumerian script. From these scripts, libraries evolved – most notably the Library of Alexandria, which held an estimated 400,000 manuscripts or papyri. Despite the rise of art, history, literature, philosophy and science, there were no extant Greek medical documents with illustrations. Medicine had to wait for the Dark Ages before illustrated manuscripts appeared. The printing press revolutionized literature, making dissemination of knowledge, including medical instruction, possible. Johannes Gutenberg (1400 – 1468) is credited for being the first to develop this movable type printing; though in reality, the Chinese had performed the feat sometime earlier for governmental printings. Gutenberg’s printing method was rapidly copied, and the growth of the printing industry was phenomenal. In 1480, only 1,000 books were published; however, by 1501, between 8 and 24 million books had been printed. Jacopono Berengaria de Carpi (1460 – 1530) was the first to include figures to illustrate his text, but it was Andreas Vesalius’ 1543 dramatic publication of illustrated anatomy, De humani corporis fabrica libri septum (On the fabric of the human body, or Fabrica), that changed the landscape of medicine itself by allowing physicians to explore all areas of medicine. This textbook derailed almost 1,500 years of Galenic-dominated medicine, anatomy and philosophy, and began the events that would lead to William Harvey’s monumental De motu cordis et sanguinus in animalibus. Now anatomy and physiology were available for curious physicians to open the locked secrets of health and disease. As time progressed, Louis Pasteur rediscovered the germ theory of disease and Robert Koch developed the science of microbiology; but it was the struggling young surgeon Joseph Lister who applied this knowledge clinically and began to save literally millions of lives by antisepsis. These remarkable findings are now shared for all to read. Today’s physician has at his or her fingertips information on every topic imaginable. A veritable tidal wave of data is now available with a simple click of a computer key, and it seems unimaginable the answers to the greatest secrets of medicine are not yet available to us.

Where would we as urologists be today if not for the knowledge we share so freely around the world? Learn more about the rise of the written word, and join us in giving tribute to the physicians, educators and illustrators who have supported the growth of medical knowledge throughout time.


“I like to think of my books in an alcove of a fire-proof library in some institution that I love; at the back of an alcove an open fireplace and a few easy chairs, and on the mantel piece an urn with my ashes, through which my astral self could peek at the books I have loved, and enjoy the delight which kindred souls still in the flesh would handle them.�  SIR WILLIAM OSLER


HISTORY OF THE

National of Library Medicine THE EARLY YEARS, 1836-1862 This astounding medical library began as a few books in the office of the Surgeon General of the Army. As historian, Wyndham D. Miles noted in his history of the National Library of Medicine (NLM), “The entire collection [as listed in the 1840 catalog] could have been held by a four-shelf bookcase, shoulder high and 7 or 8 feet wide.”

BILLINGS COMES ABOARD, 1862-1866 In 1862, the Surgeon General’s library was moved to the Riggs Bank Building in Washington, DC, and held approximately 2,100 volumes. One year later, with the closing of temporary Civil War hospitals and the consolidation of their libraries, the Surgeon General’s office got a windfall of medical books and journals.

John Shaw Billings William P. Didusch Center for Urologic History

In January 1865, the Army summoned 27-year-old surgeon—and book lover—Lieutenant John Shaw Billings to take charge of the collection; within six years, the library had 13,000 volumes, and by 1873 the collection included 25,000 books and 15,000 pamphlets. By 1880, the number of books had doubled to 50,000 and the number of pamphlets had quadrupled to 60,000.

An enthusiastic book collector, Billings wrote physicians, librarians and editors to request donations of books, and even accosted State Department officials, asking them to bring back foreign medical works from their trips abroad. Before resigning from the Army in 1895, Billings had transformed the collection into the world’s greatest medical library, covering the medical literature of virtually all eras and nations. Its holdings in 1895 included 116,847 books and 191,598 pamphlets. John Shaw Billings helped chart the course for today’s National Library of Medicine in many ways. By the end of his tenure and with his encouragement, books and journals were regularly going out on loan to physicians, and thousands of reference inquiries were being answered annually. John Billings in Library Hall (between 1887 and 1894) National Library of Medicine


GROWTH AND DEVELOPMENT, 1866-1887 After President Lincoln was assassinated at Ford’s Theatre, the government purchased the building to house the Army’s medical records, museum and library. In the years that the library’s collections were kept at Ford’s, the first eight volumes of the Index Catalogue appeared. Launched in 1880, this work was a combined author-and-subject catalog of the library’s growing collection of monographs and periodicals. Ford’s Theater, 1865 National Library of Medicine

Surgeon General Joseph K. Barnes National Library of Medicine

This was a time of real growth for the library. In 1871, Surgeon General Joseph K. Barnes and Billings started laying plans to develop the collection into the “National Medical Library.” To Barnes, this meant that the library would contain “every medical book published in this country and every work relating to public health and state medicine;” and Billings set out to inform the American medical profession that the library existed and would be developed for the use of all physicians.

ARMY MEDICAL MUSEUM AND LIBRARY, 1887-1962 Army Medical Library Signage, ca. 1940 National Library of Medicine

Army Medical Library Staff, ca. 1910 National Library of Medicine

Called the Army Medical Library in 1922 and located with the Army Medical Museum in a three-story, red brick building designed by Billings, the library began offering services to meet the information needs of health professionals. By the 1880s, books and journals were regularly going out on loan to physicians across the country and, as technology improved, microfilming and photocopying of literature for patrons followed. The library also took its first steps into the computer age, launching a mechanized system for producing its publications in 1958. A 1956 act of Congress transferred the library to the Public Health Service and named it the National Library of Medicine (NLM). In 1962, NLM opened its doors on the campus of the National Institutes of Health in Bethesda, Maryland.

NLM ENTERS THE COMPUTER AGE, 1962-PRESENT Designed to protect the collection from possible Cold War threats, the current building features foot-thick limestone walls, over 50 miles of subterranean bookshelves, and a collapsible roof. The computer era blossomed here, with the establishment of the Lister Hill National Center for Biomedical Communications in 1968; the creation of MEDLINE in the 1970s; the establishment of the National Center for Biotechnology Information in 1988; the introduction of free MEDLINE in 1997; the creation of consumer-friendly MedlinePlus in 1998; and the introduction of ClinicalTrials.gov in 2000, among other developments. Meanwhile, the collection has grown dramatically, and with it the number of interlibrary loan requests that are filled. NLM now partners with over 20 nations, and has expanded its outreach efforts to consumers and health professionals around the globe. “A Brief History of NLM.” U.S National Library of Medicine. U.S. National Library of Medicine, 05 Nov. 2013. Web. 17 Jan. 2014.

BOOKWORM FACT:

In 1949, the Army Medical Library’s sister organization, the Army Medical Museum (AMM), became the Armed Forces Institute of Pathology (AFIP). The AUA gave its original collection of old urologic instruments to AFIP in the 1950s, 20 years before Bill Didusch opened the AUA Museum.


Index Medicus: MAKING DATA USEFUL AND AVAILABLE The medical profession eventually needed to organize the vast and dispersed knowledge in journals. This again is largely the history of one physician in the right place at the right time: John Shaw Billings.

JOHN SHAW BILLINGS (1838-1913)

John Shaw Billings William P. Didusch Center for Urologic History

John Shaw Billings was a physician, soldier, hospital planner, bibliophile, librarian, archivist, census statistician and medical knowledge indexer. He sought to create an index of all journal articles by subject, and organize the periodic medical literature by author and title. He began this task with his own struggle to compile a complete bibliography for his thesis on the surgical treatment of epilepsy. After preparing a partial catalogue of the “National Medical Library” with which to beg Congress for funding, Billings received both funding and an assistant, Dr. Robert Fletcher (1823-1912), who remained at the library until he finally retired in 1911 at age 88.

CATALOGUING THE LIBRARY Cataloguing the library was a gargantuan task when the only available technologies were informed people, reading, ink and index cards. It took Billings and Fletcher 15 years (1880-1895) to produce the primary bibliographic output: the Index Catalogue. This first series, consisting of 16 volumes, was completed in 1895, the same year Billings retired and moved on to become Director of the New York Public Library. With the classic bibliographer’s caveat, Billings wrote of the Catalogue:

… permit me to call attention to the fact that this is not a complete medical bibliography, and that any one who relies upon it as such will commit a serious error. It is a Catalogue of what is to be found in a single collection—a collection so large and of such a character, that there are few subjects in medicine with regard to which something may not be found in it, but which is by no means complete.

William Welch (1850-1934), professor of pathology and first dean of the Johns Hopkins Medical School, pronounced the Index Catalogue “America’s greatest contribution to 19th century medicine.” Index Catalog Division, 1948. National Library of Medicine

Robert Fletcher National Library of Medicine


THE INDEX MEDICUS Since the Index Catalogue could not keep up with new medical information as it was published, Drs. Billings and Fletcher worked with publisher Frederick Leypoldt to establish the monthly Index Medicus in 1879 as a monthly index of medical literature. The very first task was to develop a guideline outline of medical topics, a complex task in its own right. Fortunately for Billings, an acceptable system had been conceived by a British physician, Frederic John Farre. This would evolve into the MeSH headings of our current electronic databases of PubMed. Initially priced at $3 a year, the Index Medicus proved to be a powerful tool for the library in the organization and documentation of medical progress. Billings wrote the introduction to the first volume of the Index Medicus: It has often been suggested that it is highly desirable that [the Index Catalogue] should be supplemented by some current publication, which should show all recent works, together with articles and periodicals, arranged by subjects, but until quite lately no proper means have been available for such an undertaking. Now, however, Mr. F. Leypoldt, of New York City, proposes to undertake the publication of such a current medical bibliographical serial. The Index Medicus was originally published by Leypoldt, but several publishers followed with contracts from the U.S. government. In 1926, the last Index Medicus was published in its original format; thereafter it fused with the American Medical Association’s (AMA) Quarterly Cumulative Index to Current Literature and became the Quarterly Cumulative Index Medicus.

Left: Index Medicus, 1879 Right: Index Medicus, 1906 National Library of Medicine


Electronic Medicine: THE FUTURE In 2012, it was estimated that 1 million medical articles were archived in the Index Medicus. There are about 10,000 diseases and syndromes, about 3,000 medications and approximately 1,100 laboratory tests to add to medical complexity. Even a specialist, such as a urologist, must struggle just to remain current; it has been estimated that if one read for 21 hours a day, he/she might just barely keep up with this maelstrom of knowledge. One such specialist, Henry Noyes (an ophthalmologist), lamented, “medical men strive manfully to keep up their knowledge of how the world of medicine moves on, but too often they are the first to accuse themselves of being unable to meet the duties of their daily calling.” He said this in 1865!

COMPUTERS IN MEDICAL KNOWLEDGE The exponential rise in medical knowledge led directly to electronic methods of computerized searching and data storage. The Medical Literature Analysis and Retrieval System (MEDLARS) began in 1964, based upon Frank Bradway Rogers’ computer-based technologies at the National Library of Medicine. The Library’s first digital archives were produced and available on CD-ROMs using the Medical Subject Headings (MeSH) familiar to medical librarians from the Index Medicus. The MeSH list originally combined 4,500 headings and 67 topical subheadings to organize the biomedical database. MEDLINE developed into the electronic database at the National Library of Medicine, and Grateful Med was launched in 1986 to search the rapidly expanding electronic database. The first free MEDLINE search was initiated by Vice President Al Gore on June 26, 1997. The Entrez system was released in 1995. BSD MEDLINE computer, 1974 The rise of Internet use for this free, Web-based database National Library of Medicine rose from 7 million MEDLINE searches in 1996 to 255 million in 1999, to 400 million in 2001.

Watson demoed by IBM employees Raysonho, Wikimedia Commons

In 1997, a computer algorithm beat all the physicians in diagnosing meningitis in children; that same year, Deep Blue (an IBM computer) beat Garry Kasparov in a game of chess, which shook the world. In 2011, an IBM computer program called Watson competed on a game show called Jeopardy! and won against the two leading human players. The program learned all of Wikipedia and other encyclopedias: about 4 trillion bytes of language. This system is more than capable of encompassing all of the data on biomedical knowledge.

“Housing the world’s largest biomedical collection (over 17 million items in more than 150 languages), the Library is about more than just books, journals, artworks and other items, dating back to the 11th century. Everyday, via the Internet, NLM delivers trillions of bytes of health data crucial to the lives of millions of people around the globe.”  DONALD A.B. LINDBERG, MD, CURRENT DIRECTOR OF THE NATIONAL LIBRARY OF MEDICINE


“‘History of the book’ might even be called the social and cultural history of communication by print, if that were not such a mouthful, because its purpose is to understand how ideas were transmitted through print and how exposure to the printed word affected the thought and behavior of mankind during the last five hundred years.”  ROBERT DARNTON, 1982


POSTSCRIPT We are currently in a revolution of information that some have called the Information Age when even forgotten works are rapidly and easily available. Even the 10th edition of Campbell’s textbook of urology can be searched electronically. This exhibit is about the power of books and printed materials that have brought medicine to its current position in the history of humanity. The accumulation of mankind’s wisdom, knowledge, leisure and enjoyment has both a sense of grandeur as well as a mournful sense of loss. It has been estimated that the bulk of ancient ideas and writings have been forever lost. In every major area of academic achievement, there are classic authors whose works were lost forever, along with the ancient Library of Alexandria. This year’s historical focus is a tribute to the efforts of our predecessors in medicine, paying homage to the written artifacts and ideas that remain. There is also what has been called the “paradox of print” – glorifying the overthrow of past beliefs. Discovery and recollection of the past is intimately tied to the progress and development of science and medicine. These two streams, the past and the future, are tied together in a classic Gordian knot. The future is clearly linked to advancements in electronics – storage, recall, transmission and smaller personal devices. In 2011, IBM’s Watson program competed and destroyed two of the best Jeopardy! champions of all time in IBM’s quest to explore replacing physicians as diagnosticians. Our National Library of Medicine (NLM) in Bethesda and our Library of Congress (LOC) in Washington are closest to a universal depository of mankind’s knowledge; the NLM has an estimated 17 million items in its collection, and the LOC has an unimaginable 119 million items available. Even the attempts of the struggling government of Egypt to reinstitute the fabled Library of Alexandria (at the urging of Richard Nixon) have so far not come close, though a Bibliotheca Alexandria and an “online” version are trying to get scholarly contributions.

“...Show me the books he loves and I shall know the man far better than through his mortal friends...”  S. WEIR MITCHELL, MD


CONTRIBUTORS David Bloom, MD Sakti Das, MD Peggy Duckett Rainer Engel, MD, AUA Historian Jennifer Gordetsky, MD Matthis Krischel, PhD Franz J. Marx, MD Friedrich Moll, MD, Curator, DGU Michael E. Moran, MD, Curator, AUA Sutchin R. Patel, MD Ronald Rabinowitz, MD Erwin Rugendorff, MD National Library of Medicine Wellcome Trust Special thanks to GES: Smiley Carrasco, Clay Lovelace, Rob Noble, and Robert Redfern’s Orlando Team! Supported by

2014 History Exhibit Panels – "Knowledge Unbound: Literature of Medicine"  

William P. Didusch Center for Urologic History's 2014 Exhibit, "Knowledge Unbound: Literature of Medicine"

2014 History Exhibit Panels – "Knowledge Unbound: Literature of Medicine"  

William P. Didusch Center for Urologic History's 2014 Exhibit, "Knowledge Unbound: Literature of Medicine"