Above: Semiologie des Affections du Systeme Nerveux by J. Degerine, 1914 (colour litho).
Perhaps the most famous of these fielddefining books is Gray’s Anatomy, first published in the middle of the 19th century. Originally written by the British anatomist Henry Gray, it is currently in its 40th edition. It has become more than simply a textbook: it’s part of popular culture, its name borrowed for a long-running US television drama. In Ian McEwan’s Atonement, the correct draft of a fateful letter lies unsent across an opened Gray’s, while the wrong draft is delivered, setting in motion a terrible chain of events. By the middle of the 19th century, journals had largely taken over from books – both textbooks and research monographs – for the communication of new knowledge. “There were still important exceptions,” points out Hopwood. “For example, around 1870, the periodic table in chemistry began as a device in a textbook. You could still find that kind of innovation. But generally speaking, journals presented new claims, while textbooks kept a big role in recognising them as discoveries.” So what part does the textbook play today, in an age when a new discovery, idea or study can be flashed around the world in seconds? The internet has revolutionised the whole business of disseminating and sharing research, says Stephen Gillam. “They have much more online, and they advance-publish material online, which goes through a quickfire review process. The whole process of review and publication has been potentially speeded up. And there’s much more open access to published papers and the data on which they are based.” Journals may be where new ideas can be found. But as their numbers continue to proliferate, the medical professional faces a new problem of information overload. Which studies and ideas are truly relevant? Who has the time to go searching among thousands and thousands of online sources? Perhaps that’s now where the textbook’s true function lies – as a trusted source that vets and validates ideas. “Textbook authors have always had a gatekeeping function in deciding what to include and what to accept,” points out Hopwood. “So a new idea may not have to be accepted before it’s included in a textbook. It may rather be the act of inclusion that makes it accepted.” Speed is good, says Gillam, and so is patient empowerment. But the challenge will be getting the information to doctors as it is needed. “The next frontier is making that information available to the practitioner on their desktop,” he says. “This process is well on the way. The future is here now. Because it’s one thing talking about research but it’s another getting it to the practitioner who wants to see the research there and then, when they see the patient. Patients are what matter, first and foremost.” Just as Hippocrates first wrote, thousands of years ago.
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