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ACQUISITIONS POLICY

OF THE

NATIONAL MEDICAL LIBRARY
PROCEEDINGS OF A SYMPOSIUM
HELD 12 APRIL 1956
Cj>$   National Library of Medicine
           Washington,  D,  C.
                 1957 
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     On October 1, 1956, in accordance with
legislation enacted by the 8z*th Congress
and approved by the President on August 3, 1956,
the Armed Forces Medical Library became the
National Library of Medicine and was trans-
ferred from the Department of Defense to the
Public Health Service of the Department of
Health, Education and Welfare. 
CONTENTS
Foreword
Introduction and statement of the problem
     Frank B. Rogers
The problem from the viewpoint of library technology                    9
     Verner W. Glapp


The problem from the viewpoint of clinical medicine                     19
     Benjamin Manchester


The problem from the viewpoint of medical research                     23
     Homer W. Smith
The problem from the viewpoint of medical history                      33
     Richard H. Shryock


The problem from the viewpoint of strategic intelligence               39
     Frederick G. Kilgour


The problem from the viewpoint of general historiography               49
     Arthur E. Bestor


Discussion                                                             67


Summary                                                                73
     Keyes D. Metcalf


The Participants                                                       Si 
 
FOREWORD
     The present acquisitions policy of the National Library of
Medicine is based on the recommendation of the 1944- Survey Committee
that the then Army Medical Library should "acquire... all publications,
in all languages, directly relating to the science of medicine".  We
have followed this recommendation as faithfully and as diligently as
our resources have permitted„  During all these years a considerable
amount of staff time has been spent in discussion of the problems
involved in the practical implementation of this policy, especially
as we have become increasingly concerned by the mass of published
literature and the heavy costs of processing it.

     Late in 1955 it seemed the part of wisdom again to seek a view
of the problem from the outside.  A group of subject specialists
was therefore invited to discuss the adequacy of our policy and its
relevance to the ever-changing conditions under which the Library
must operate.  The papers which follow were delivered at the
Symposium on Acquisitions Policy of the National Medical Library,
held at the Library on April 12, 1956; the views presented in these
papers furnish new points of reference in the continuing reappraisal
of the acquisitions policy of the National Library of Medicine.
Samuel Lazerow
Assistant Librarian for Acquisitions
National Library of Medicine
March 1957 
 
INTRODUCTION AND STATEMENT OF THE PROBLEM

              FRANKS. ROGERS,  Lt. Col.,  M.C., U.S.A.
"... Most of the books  in a  large research
library are subjected to  an  extremely low,
almost negligible,  amount of use.  The use
of a large research library  is  clearly
concentrated at any one point in time over
a small percentage  of its total holdings."

             — Herman  Fussier

"An Army is maintained  for a thousand days
so that it may be used  on one particular
morning...  That is the luxury  and utility
of libraries of rare and  very rare items."

             — Hu  Shih2
     Acquisition is the first process,  in a sequence  of processes,
in which a library engages.  The acquiring of material is, therefore,
basic, in the fundamental sense that it precedes  other processes.
Books not acquired need not be cataloged, bound,  stored or serviced;
neither can they be used in the answering of reference queries.  The
problem of what books to try to acquire,  out of the vast number it is
possible to acquire, is a problem of very great importance to every
library, of whatever kind.  It is of the  very greatest importance
to the large research library.

     The large research library is established and operated to serve
the community of scholars.  The demands of scholarship are expansive,
and they place upon the research library  an exceedingly heavy require-
ment for extending its collecting policies in both breadth and depth.
Yet however large a library may be,  and however ambitious its program,
the time comes when every library must  face the question "How far?",
and strive to find useful and realistic policies  which will keep
collections manageable — which will make it possible to maintain
collections from which items of information are,  in fact, retrievable.
1 
2
FRANK 3. ROGERS
     This would seem to raise financial considerations  as  primary,  at the
very outset of our discussion.  This  is both true  and not  true.   We can
accept it as a fact of life that we can do almost  anything if we are pro-
vided with sufficient time and sufficient  funds  and  sufficient manpower.
In this sense, if we wanted to collect  everything, we could do so,   But
it is likely that food and shelter, guns and butter, will  be basic  pre-
occupations of mankind for a icng time  to  come,  and  that the building of
library collections, and other similar  activities, can  hope to claim only
their fair share of the remaining resources available„  For libraries this
means that something less than totality in collecting is all that can be
hoped for.  The question becomes what degree of  comprehensiveness in col-
lecting is reasonable, considering the  major purposes which must be served.
What policies can be set to explain exactly what this objective  of  reason-
able comprehensiveness consists in?  It is likely  that  this policy  goal
can best be determined and placed in  action by establishing some sort of
a priority system, some scale of values for assessing different  kinds of
materials.  With such a system we could cut our  cloth to fit more closely
the changing financial patterns obtaining  from time  to  time.  So I  hope
that, in the discussion which follows,  most of our panel members will pay
no special attention tc fiscal matters, but will merely tuck away in the
back of their minds the basic fact of the  primacy  of fiscal considerations.
We may safely leave matters of cost to  Mr, Clapp,  who will discuss  the
problem from the aspect of library technology.

     There are, however, two special  considerations  which  I hope all our
speakers will remember„  We are here  discussing  the  Acquisitions Policy
of the Armed Forces Medical Library,  This Library is a large research
library; it differs from many other large  research libraries in  that it
is also a national library, a library of record, a library which has a
special responsibility to the nation, beyond the responsibilities of all
other research libraries in its field.   For medicine, this Library must
serve as the ultimate recourse for all  other library facilities  in this
country.  This is a heavy obligation; we have always to remember it.

     The second special consideration must be recognition of the fact that
this Library does not stand alone in  having national responsibilities'„  Our
sister libraries — the Library of Congress and  the Library of the Depart-
ment of Agriculture — are as heavily committed  as we are, or more so.  We
must constantly bear in mind this division of responsibilities,  which by
reason of the fundamental organization  of the institutions involved,  is on
a subject basis.  In some areas — the  core areas  — this  division is re-
latively easy.  We do not collect medical fiction because the Library of
Congress covers all fiction.  We do not collect  extensively in the field
of veterinary medicine because the Library of the  Department of Agriculture
does so.  In other areas, this sort of division of responsibility is ex-
tremely difficult; as the periphery of any large subject area is approached,
fine distinctions are very hard to make. 
4
FRANK B.  ROGERS
The surveyors recommended that  "the Library should acquire on publication,
or as soon thereafter as possible, all publications, in all languages,
directly relating to the science  of medicine.  These would include books,
pamphlets, serials, government  publications, ephemeral material, prints,
pictures, etc.  Quack and crank publications should not be omitted.  Ac-
quisitions in this whole medical  field should be, as far as feasible,
inclusive rather than selective,  and the only material to be omitted would
be minor editions in which no changes in text occur, publications obviously
made simply to  sell, or those priced at entirely unreasonable figures when
the prospect for later acquisition at a much lower price would seem good."5

     The survey recommendation  was very broad and wide.  In an effort to
chart the course in more specific terms, the Library began to study the
problem intensively, issuing its  policy on scope and coverage of the
collections early in 1951.  This  policy statement went far toward ra-
tionalizing the Library's collecting policies, and its subsequent use
has served the  Library well.

     But in the decade which has  elapsed since the Survey, the Library's
yearly acquisitions have increased to the point where the Library is re-
ceiving materials at a rate in  excess of three times that of ten years ago*

     We have, in fact, long since reached the point where we begin to
wonder whether  our acquisitions are not now too inclusive, where once
they were not inclusive enough.

     We begin to look with a jaundiced eye at our definition of an exhaus-
tive collection, and we are collecting exhaustively in all the core areas
of medicine.  An exhaustive collection, says our policy, "is one which
includes everything written in  the field — books, pamphlets, periodicals,
abstracting and review Lag media,  government documents, loose-leaf systems,
congress reports, Festschriften,  dissertations, symposia, institutional
reports, school catalogs, leaflets, broadsides, notices, etc. — whether
printed, near-printed, typewritten, or in manuscript; in all languages;
of all time; in all editions, but not necessarily in translation or in
variant issues.  Ephemera such  as commercial promotional literature may
be kept permanently only in representative samples."

     In both instances — the Survey recommendation of 1944 and the policy
statement of 1951 — the use of the "etc." has perhaps served us ill.
And perhaps we  have not paid enough attention to the 1944- statement that
"publications obviously made simply to sell" need not be collected, or
to the 1951 exception for "ephemera such as commercial promotional
literature"; the qualification  such as may have been too frequently
overlooked. 
THE PROBLEM
3
      This,  it seems to me, is the point at which the two major facets  of
 an acquisition policy should be mentioned and defined.  These two facets
 may be named the facet of scope and the facet of coverage.  Scope may
 be defined  as range in breadth of a subject field; in considering matters
 of scope, only subject content is pertinent.  Coverage may be defined
 as depth of penetration into a subject field; in matters of coverage,
 language, physical format, imprint date, quality level — all these may
 be pertinent.

      Problems of scope can be very difficult.  In our discussion today,
 however, we are not primarily concerned with these problems.  Since,
 among them, the Library of Congress,  the Library of the Department of
 Agriculture and the Armed Forces Medical Library attempt to embrace
 the totality of knowledge, matters of scope may best be left to joint
 consideration by these libraries.  What we are mainly interested in
 here today  is the problem of coverage.

      Scope and coverage are inextricably linked,  as for any particular
 library the problem of coverage  arises  only for those subjects con-
 sidered to be in scope.   The Armed Forces Medical Library has made a
■detailed statement of its scope  policy,  and this  statement is in the
 hands of all participants in this discussion.   While our scope policy
 must undoubtedly be modified,  in discussion with  our sister libraries,
 we would like to have our panelists assume that the question of scope
 is solved,  and  is as outlined  in the  statements they have in hand.   We
 would like  to have them  consider our  problems  mainly from the viewpoint
 of coverage.

      The  Armed Forces Medical  Library has  long debated  this problem.
 In an address before the  Army Medical School on.8 February 1897 Robert
 Fletcher, the disciple, friend and protege of  Billings,  said that "it
 is of importance  in  forming a  great medical library to  avoid loading    ' ■
 its  shelves  with  books which, however valuable in themselves,  have  not
a  distinct relation  to the purpoe- of the  collection, and this view
has been  rigorously  adhered to [at the Surgeon General's Library]  from
both  policy  and economy."-^

 •  ,  Ifx,i!??!d there was  such a  Policy it  must have existed only in the
minds of Billings, Fletcher, and  their co-workers.   And whatever un-
written policy there was  inevitably was  diluted and deformed as  the
years passed.  To the extent that  there  was  a  policy, it could probably
be stated no more definitely than  "to collect  everything medical,"  and
this is practically the same as having no  policy  at all.

     When the Army Medical Library was surveyed in  1943--U  the surveyors
found that "the Library has followed  a somewhat wavering policy as  to
what constitutes a complete collection of  medical literature."^ 
THE PROBLEM
5
     It would  seem  that we must  ask  ourselves what, fundamentally, are
the purposes which  our collections are  to  serve.

     In a national  library of medicine  the collections have  several
outstanding objectives:

          (l)   They serve medical research.  They  provide new  ideas,
new data, new  techniques, new hypotheses,  which may be drawn upon and
incorporated into new studies, new experiments, and new hypotheses
which  advance  the frontiers  of science.  The use of the word "new"
here is relative; long periods of time  may elapse  before a datum or
a hypothesis is needed, or is recognized as relevant, for the  further
development of current work  in progress.

          (2)   They serve the workaday  practice of medicine.   For this
purpose, compendia  of the "best  that is known"  are needed.   Since "the
best"  is hard  to recognize and agree upon, more than one, but  certainly
less than all,  are  required.  In the highly developed nations  of the
West it is  probable that works in the national  language are  largely
sufficient  to  this  end.

          (3)   They serve as the basic  documents of intelligence studies,
at various  levels.

          (4.)   They serve as the basic  records  of  the history  of medicine,
the history of science, and  the  general history of civilization.  History
means  change;  obscure items may  reflect this change, or epitomize it,
as well as  or  better than more prominent items.  History is  also the
history of  man's stupidity and blindness;  it is necessary to know the
quack  as well  as the saint.  To  the  historian,  quantity may  reveal the
extent of penetration of an  idea or  prejudice,  or  the extent of transfer
of ideas across barriers of  space and custom.

          (5)   They serve important  auxiliary functions, such  as in fur-
nishing materials in legal disputes,  or as  guides  to the writers of
textbooks and  popular materials,  or  assistance  in  the conduct  of "Point
Four"  programs,  in  one form  or another.

     We must note that all these are facets of  one single corpus; break-
ing them down  is just a convenient analytical device.  All will fit
conveniently under  the headings  of medical research and practice, and
medical history.  And the practice of tomorrow will become the history
of yesterday, from  which another tomorrow must  draw its strength. 
6
FRANK B. ROGERS
     On the face of it, our analysis would make it appear that fix^aus.-
tivelv must really mean exhaustively.  And yet — and yet — is this
not presumptuous pride at its worst?  How can any collection,  even one
limited to a specific subject field, presume to be all-sufficient for
all purposes, even in that one field?  How measure the possible values
against the known cost?

     Looking around for help, we have found little outside opinion that
is pertinent to our predicament.  "Comprehensive" and "total record
are words that carry different levels of meaning to different people.
To most libraries, acquisition policy is largely a question of which
monographs, which journals, to procure.  Our problem is not large in
the area of books and journals; our problem lies in the tougher realms
of which mimeographed annual reports of which of thousands of provincial
hospitals we are to acquire; which popular pamphlets on tooth-brushing,
fly-killing, or toilet-training; which weekly sheet of morbidity statis-
tics from which obscure counties.  It is the same problem facing others,
but for us it is raised to an exponential pitch, thereby assuming a
different character.  We have to remember that even such a program as
the Farmington Plan carries limiting language such as "of research
value", and that the Library of Congress, in its third canon of selec-
tion, introduces limiting phrases such as "the ^"t^rial parts of the
record" and "representative records... of most immediate concern to the
people of the United States."

     We do not underestimate the inherent difficulties of this vexing
problem, and we are unwilling to settle for any illusory simple answer,
however attractive.  We realize we are playing a dangerous game.  We
have had some experience in pruning our old collection in accordance
with our newly developed scope policy, and we have had some examples
of what a nightmare this can occasionally be.  Harry Bauer tells a
story  which well illustrates this dilemma:

          "In his essay, 'A Mathematician's Apology1,the late Godfrey
     Harold Hardy tells of a terrible dream that tormented Bertrand
     Russell.  In the dream Russell found himself in the stacks of
     the Cambridge University Library about the year 2100 A.D.  He
     observed a library attendant sorting books which after examin-
     ation were either returned to the shelves or dumped into an
     enormous waste basket.  Eventually, the librarian reached the
     shelf where the only extant copy of Prinoipia Mathematica
     reposed.  He opened the first volume of this famous three-
     volume work by Whitehead and Russell, and skimmed through
     a few pages.  'Puzzled for a moment by the curious symbolism,
     the librarian shut the book, balanced it in his hand and hesi-
     tated...'  Presumably, that is all there is to the dream, since
     the Hardy essay does not reveal whether or not Russell was
     wakened by the dull thud of a heavy tome tumbling among the
     discards." 
THE PROBLEM
7
     Nevertheless, if it is dangerous to use discrimination, it is none-
theless necessary.  It is necessary if we are to discharge our Library
duties successfully, and it is necessary also if we merely wish to claim
the title of human beings in a world of human values„

     What we want to do is to develop a positive acquisitions policy,
with our eyes wide open, rather than backing into a safe, everything-
goes policy merely because we are fearful of what other fearful people
may say of us.  We have striven mightily to develop such a policy, but
our level of attainment in this area is far from satisfying.  Out of
our concern the organization of this symposium has arisen.  We turn to
our distinguished guests, and ask them to try to illuminate for us, from
the aspects of their several disciplines, and out of their experience,
their frustrations, and their longings, the multitude of factors which
bear on the acquisitions policy of the national medical library.  We ask
them to what depth our coverage ought to extend, how comprehensive a
comprehensive collection should be, how much is enough.  We ask for
guidance, for criteria of selection, however dimly they may be discerned.
In return, we offer our pledge that all that transpires here will be
given the most earnest consideration as we continue to seek out better
solutions to our problem.  And we hope and believe that all who partici-
pate in this symposium here today wil- have the satisfaction of knowing
that they have contributed to a vital program of this Library which
seeks to serve all those who work for the prevention of disease and the
alleviation of human suffering.
                              References

1.  College and Research Libraries, 14:365 (1953).

2.  Princeton University Library Chronicle. v. 15, no. 3, as quoted in
    a catalogue of Zeitlin and Verbrugge.

3.  MS. in Library collection.

4.  The National Medical Library; report of a survey... Chicago,
    American Library Association, 1944. P° 21.

5.  Ibid, p. 66

6.  in his Library Information, no. 71, 22 October 1953. 
 
THE PROBLEM FROM THE VIEWPOINT OF
LIBRARY TECHNOLOGY
VERNERW. CLAPP
     Colonel Rogers has just told ub that in the decade since the American
Library Association survey the rate of growth of the Armed Forces Medical
Library has increased to a point at which it is questionable whether  its
acquisitions are not too inclusive instead of not being inclusive enough;
and he asks this panel, in consequence, for its opinions as to the depth
to which the AFML's acquisition coverage should extend, how comprehensive
a comprehensive collection should be, and how much is enough.

     In response to these questions I am to muster what assistance can be
derived from library technology.  Now, library technology is the assembly
of techniques which are practiced in libraries and by librarians.  These
techniques, it may safely be said, are capable of taking care of any
library operation—at a price.  If Colonel Rogers will tell us how com-
prehensive he is willing and able to be, library technology will provide
the processes for doing it.

     But the question here is exactly this—to what degree of comprehen-
siveness should Colonel Rogers' willingness and ability extend?  Now
his willingness may be related to his ability in the sense that he may
be willing to acquire no more than he is able to handle; and his ability
to handle may in turn be related to library technology in the sense that
he could handle twice the amount of material for the same price if he
could find new techniques costing only half as much per unit as those in
current use.  But, even supposing that techniques could be devised so
inexpensive as to exact few qualms in applying them to material of very
dubious worth, there nevertheless comes a point at which willingness  to
acquire must be based neither upon ability nor upon techniques, but upon
a value-judgment as to the desirability of the material per se.  Here
technology, in the usual reference to technical processes, does not help.

     In a wider sense, however, library technology includes also the
procedures by which librarians assemble and apply considerations to the
making of value-judgments as to the desirability of potential acquisi-
tions.   And in a still more extended sense library technology may also
be considered to embrace the techniques by which librarians seek the
support which enables them to carry out their value-judgments.  In the
latter sense, library technology would include the organization of
Friends-of-the-Library groups, the cultivation of wealthy donors, the
education of trustees, and the holding of symposia on acquisition policy.
9 
10
VERNERW. CLAPP
     I shall, accordingly, attempt to touch, though necessarily briefly, on
 certain of each of these aspects—the techniques related to the making^ol
 value-judgments with respect to the acquisition cf material; the techniques
 for  carryirt?  out the decisions thus reached; and the techniques for securing
 the  supportVnerevlth to enable the execution.  It is obvious that each of
 these topics  lends itself to extended treatment,, and I may be excused if I
 touch only lightly on some salient considerationsr

     Let me commence with the last phase, that of securing support to enable
 the  execution of value-judgments previously made.,  Colonel Rogers started
 at this point, and I may follow his example.  He has told us that we can
 do almost anything if we have enough energy, time and money, and that if
 we wanted to  collect everything we could in this sense do so; but that
 since there are certain basic demands upon the community's resources, and
 since libraries can claim only a fair share of the remainder, something
 less than totality in collecting is all that can be hoped for.

     It seems to me that this statement of the problem either begs the
 question or involves a non-sequiturQ  It begs the question if the library's
 "fair share"  is defined as one which permits only something short of
 totality in acquisitions.  I do not think we should be prepared to accept
 this definition before making a value-judgment of totality and exploring
 its  cost0

     But if3  on the other hand, we do not thus define the "fair share",
 it does not then follow that totality is not to be hoped for, unless some
 additional proposition is inserted between Colonel Rogers' premise and
 his.conclusion.  One such proposition might be?  the cost of totality is
 so huge in 3caparison with its benefits that no money-granting body could
 ever be persuaded to appropriate the funds which would be required to make
 it possible.  From this it would then follow that something less than
 totality is all that can be hoped for„  But thus to state the matter is
 again to give the case away9 for if we have surrendered all hope of per-
 suading the money-granting body of the benefits of totality, it seems to
me very much  in question whether we are really convinced of them ourselves.

     Accordingly,  at this very preliminary state of the discussion we can
raise certain questionss

     10   What is the gap between present appropriations and the cost of
         totality in acquisitions?

     2.   Have we really made an effort to close this gap by persuading
         the money-granting body that totality is as important as many
         serious persons (including the members of the ALA Survey) have
         felt it to be? 
LIBRARY TECHNOLOGY
11
     3.  Should we  consider any departure from totality as the objective
         until either  (a) we have failed in an honest effort at persuasion,
         or  (b) looked closely at the totality principle and found it
         unconvincing  even to ourselves?

     Now I suppose  that the answer to the second question is that an all-
out effort has not  been made to convince the money-granting body of the
virtues of totality and that the reason for this is at least in part
a lack of complete  conviction within ourselves.  Consequently, We must
now start on the lowest rung of the ladder, and give the principle a
hard look.   And this,  I presume, is the real subject of the present
discussion.

     Should  this library—should any library—collect everything in its
field?  The  answer, I  think, will hardly ever be in the affirmative.
Yet it might conceivably be so for a very special library in a very
special field.  I can  conceive a field so narrow, one of which the
literature would be so small, so important and so unduplicative that a
library with a mission for comprehensiveness in the field should actually
collect everything  in  it.  Greek epigraphy, perhaps, or a species of
Echiuroids (ribbon  worms) of the Arctic Ocean bottom.  But, you have not
failed to remark that  I have smuggled several question-begging words
into my hypothetical field of acquisition, notably the words "important"
and "unduplicative".   Suppose for instance—and this has actually
happened—that even the Arctic Echiuroius should get into the news and
become the subject  of  press dispatches.  Should our imaginary library
acquire a copy of each newspaper in which these dispatches were repro-
duced?  Our  answer  would undoubtedly be in the negative unless it could
be demonstrated that the purpose of the library would require for its
fulfillment  the acquisition of all those issues.  It might be shown,
for example, to be  of  actual or potential importance for some purpose
to assemble  the exact  evidences of the manner in which information
regarding Arctic ribbon worms is disseminated to the public; and this
purpose might in turn  be shown to be among the objectives of this
particular library.  And if this demonstration were convincing in the
right quarter, money for the assemblage of all those issues of news-
papers would be forthcoming.

     We are driven, then, to the purpose of the library, and to the
relevance—i.e., the importance—of prospective acquisitions in the
light of the purpose.   No library can be expected to be permitted to
acquire at alii  much less comprehensively, unless it can justify both
the importance of its  purpose and the relevance of its acquisitions to
that purpose. 
12
VERNERW. CLAPP
      How is this  demonstration to be performed?. The answer is that there
 is no single answer.  And  it  is exactly this that constitutes the excitemen
 of building collections.   If  there were one answer, it would long ago have
 been reduced to an ALA  or  MLA code, would be taught in library schools and
 would in libraries be assigned to junior assistants to execute.  But the
 fact being otherwise, directors of research libraries still have to give
 time and attention to acquisitions—that is to say collection-building; and
 for this they should be very  grateful, for the library—that is to say the
 collection—has always  been and must always to a greater or less degree be
 a reflection of the wisdom and foresight and breadth of interest and per-
 suasiveness of the librarian.  There is no cause for regret in this, but
 for gratification.

      The persuasiveness that  enables the execution of value-judgments must
 then in the long  view rest on the value-judgments themselves.  There is
 perhaps little to distinguish this situation from that of every other
 institutional enterprise,  except the subject matter involved; and the
 problems pass over, in  consequence, from library technology in the narrow
 sense to the field of public  relations.  Now the public relations of
 libraries have received much  attention in recent years, and this is not
 the place to describe the  various techniques in detail.  One comment, how-
 ever,  may be fitting.   This is that institutional heads are so likely to
 be preoccupied with details of internal administration and with the
 substance of the  institutional purpose that they are likely to assign to
 only occasional or spasmodic  consideration the matter of public relations.
 But the studies of the  subject lead to the inescapable if obvious con-
 clusion that these relations, upon which in the last analysis rests the
 ability of the institution to secure not only a "fair share" but any
 share  at all with which to effect its purpose, must be continuous business.

      Let us  turn  then instead to those value-judgments which must precede
 any search for support.  In the case of a library these are all related to
 a user,  actual or potential.  As Colonel Rogers reminds us, the research
 library exists  to serve scholars.  It would seem then to be elementary
 that unless  the acquisition of material can be demonstrated to be likely
 to  serve  actual or potential users, its acquisition remains unjustified.

     Such a remark might seem to be supererogatory and even offensive,
were it not for the fact that libraries are only too likely to establish
a priori  statements of acquisition policy, and that from these statements
of  policy consequences can too easily flow which were not contemplated
at  the time the policy was framed and which are not justified by the real
purpose  of the library or by potential use.  Thus, in my hypothetical
illustration,  the library which had the a priori policy of collecting
everything on a species of Arctic ribbon worms would probably be betrayed
from its  genuine purpose if it allowed that statement of policy to draw
it  into a wild-goose-chase after multitudinous and duplicative newspaper
reproductions  of a syndicated article. 
LIBRARY TECHNOLOGY
13
     Consequently, though statements of acquisition policy are very
important it is equally important to test their application at each point
against real purpose, relevance of the material, and potential use; for
otherwise they may prove treacherous.

     Colonel Rogers has listed for us the purposes of the AFML under the
heading of its "outstanding objectives", and for the purposes of present
discussion we can assume the authority of his statement.  It seems to
me at this point, in consequence, that the problem which he has placed
before this panel is essentially a matter of submitting the question of
acquisition of various kinds of material to the test of compliance with
these purposes, plus the test of potential use.  At this point too, it
appears to me that the tests of purpose and use are entirely adequate,
and that if there has been difficulty in reaching a decision, that
difficulty probably derives from the fact that the statement of ac-
quisition policy was not itself accurately attuned to the statement of
purposes.  Of course, even in statements of purpose there may be un-
guarded (or was it considered?) proposals like "furnish materials in
legal disputes".  If one were to attempt to fulfill that purpose in
any comprehensive way, there would be absolutely nothing which might
not conceivably be of use.

     Now it is obvious that the usual techniques of book selection will
not settle questions of the kind which Colonel Rogers poses.  These
questions lie outside the charted areas where reference to book-reviews
or bibliographies or best-book-lists can help.  Even literature studies,
to ascertain what use has been made of this peripheral material in the
past, will yield few clues and no final answers.  About the only methods
left are to study the material itself in the light of the library's
purposes and potential use and to turn to informed persons for prognoses
from the points of view of their several interests.

     To be specific, let me take as an example one problem mentioned
by Colonel Rogers, that "of which mimeographed annual reports of which
of thousands of provincial hospitals the AFML is to acquire."  (There
are about 7,000 hospitals in the United States now; and if there were
an equal ratio of hospitals to population on a world-wide basis—as
possibly there may be some day—there might be something like 105,000
hospitals, all capable of issuing mimeographed annual reports.)  Now
I judge that these reports might potentially serve a number of the
purposes for which the AFML exists?  they provide data for research
and regarding practice; they provide material for history.  The ques-
tion is, to what degree is a comprehensive collection of them important
for these purposes?  Or, contrariwise, to what degree will some kind
of selection meet the requirement of purpose? 
u
VERNERW. CLAPP
      It  can be argued, I should suppose, that much of the information con-
 tained in  these reports which satisfies the purposes of the AFML is
 duplicated elsewhere, that the information bearing on research is largely
 represented in the journals, and the information regarding practice is
 summarized in the statistical compilations.  (Both of these suppositions
 of  course  require confirmation.)  Then, as sources of material for history
 of  individual local institutions, they may be presumed to be very inadequate
 and a comprehensive collection of them quite unsuitable, since for inquiries
 of  this  kind resort must be had to local archives and non-medical sources.
 Meanwhile, for history on a regional or national scale they are still un-
 suitable as being too voluminous; and a selection, or that part of the
 record which is reproduced in the statistical" compilations would be not
 only adequate but might perhaps serve even better for being already sifted
 and tabulated.  For these reasons (if confirmed by inquiry) it might be
 argued that a comprehensive collection could not be expected to serve any
 purposes which a selection would not serve, and in the exceptional case
 in  which the particular report of a particular institution, wanting in
 the national collection, were needed, it would be worth the gamble that
 it  might be found in local files or archives.  Thus might run the argument
 for selectivity.

      On  the other hand it might be argued that these reports contain
 important  data not reproduced in the journals or the statistical compila-
 tions, and that a comprehensive assemblage of this data is needed, perhaps
 for the  "intelligence" purposes which Colonel Rogers has mentioned or for
 use "in  legal disputes."  To enforce this argument upon a money-granting
 body would require, I should suppose, strong confirmation by represen-
 tatives  of the interests involved.

      Finally it might be argued that we are unable to forsee the research
 needs of the future| that though these reports appear to add little to
 our stock of knowledge, yet a need may some day arise which will justify
 the expense of assembling, organizing and storing a comprehensive
 collection of them.  This is a familiar argument, but it has a low degree
 of  persuasiveness.

      In  the last analysis, although the decision with respect to material
 of  this kind must rest on an exercise of judgment, yet  it is to be noted
that the more informed the judgment, the more persuasive it is likely to
be, and vice versa.

     But the librarian's conscience is not likely to be easily satisfied
in balancing arguments jgrfi bjoA contra? and it is never easy to know when
sufficient information is at hand to make a valid judgment, especially
if the judgment is of the kind that can never be reversed, like a death
sentence, and will cause the extinction, either by birth control or
euthanasia, of a unique collection.  The librarian's conscience is haunted 
LIBRARY TECHNOLOGY
15
by the recollection  of  important  collections  (like the Thomason Collec-
tion of British Civil War  pamphlets mentioned by Joseph Groesbeck in
his 1950 article  on  the acquisition policy of the AFML) which owe their
unique existence  to  the prescience of  some bookseller or collector at
a time when  librarians  one and  all were  failing of their responsibility;
and he wonders if history  may not be repeating itself.  When all other
values of  the mimeographed hospital reports fall short of  justifying
their comprehensive  acquisition,  he remembers their possible biographical
value.  We would  like to have,  if only for their biographical relevance,
the reports  of the T, H. Gallaudets and  the W. A. Whites of the future.
But, since we cannot identify these men  in advance, should we not collect
the reports  of all hospitals  so that we  may be sure of having those of
the great  hospital superintendents of  the future?  At this point library
technology may suggest  some expedients to save the day.

     This  is probably the  point at which to mention some of these ex-
pedients.  At the acquisition level they include such devices as
encouraging  other institutions  to accept responsibility for collecting
the material; or  of  encouraging a division of the responsibility among
several institutions; or of pooling resources with other institutions
to make a  common  collection.  It  may even be desirable to  develop a
reporting  service of some  kind  — a check list or union list — to
assure fulfillment of the  responsibility,,

     Or, if  these expedients  fail or are not justified, there is the
device of  making  an  arbitrary selection, based upon such factors as
size, geographical distribution,  etc., or even of making a random
sampling.  Or the selection may be deferred, on the principle of
"collect now, select later".

     At the  processing  level  there are various shortcuts,  both in
warehousing  the material and  in making the bibliographic record.  One
can microfilm in  order  to  reduce  bulk  and at the same time consolidate
the material, protect it from deterioration and save binding costs.
One can catalog it by short-cut methods, including brief cataloging
and group  cataloging.   One can  catalog it without shelf-classifying
it, or conversely one can  shelf-classify it (e.g., in pamphlet boxes
or vertical  files) without cataloging  it.  One can send it to a
storage warehouse, making  as  little record of it as possible.  Or,
finally, one can  pile it up and leave  it to one's successor, this
being the ultimate of the  "collect now,  select later" technique.

     It is apparent  that the  variables and imponderables involved
in the various formulas  of evaluation and treatment present the
librarian with considerations of  the greatest difficulty at the very
point at which the material is  of least  obvious worth.  This is the
basic dilemma which  faces  the comprehensive library.  It has already,
in a sense, exhausted itself  in its efforts to be comprehensive with 
16
VERNERW, CLAPP
respect to materials of unchallenged and generally conceded importance,
and finds itself facing the problems of the marginal material with
reduced energy.  It was in the light of some such consideration that
Robert C. Binkley, some years ago, urged the then Librarian of Congress
to cease attempting to secure so many important books, but, leaving their
acquisition to other libraries, to concentrate on the marginal material
which no other library would be acquiring.

     Consequently, even though Colonel Rogers has told us that with re-
spect to journals and monographs the problem of the AFML is not severe,
I should like to close these remarks by some comments upon the general
policy of totality in acquisition.

     The literature of any well-developed subject — and medicine is one
of the best developed, most international of all — manifests in the
very nature of things an enormous amount of duplication and repetitive-
ness.  A library which is concerned with research or teaching in the
subject can secure most of the relevant information for a fraction of
the cost which the comprehensive library must pay to close the gap
between "most" and "all".  The law of diminishing returns works greatly
to the disadvantage of the comprehensive library.

     In the case of the • atiooal library this additional cost for compre-
hensiveness is  justified on the grounds (a) that the library serves not
merely the spe ia± purposes of research and teaching which local inst-
tutions serve, but all possible purposes which the country as a whole
can properly demand of the literature of the subject; (b) that the
potential utility of the additional material, even if duplicative and
repetitive> is no Less in the light of nation-wide need than that of
the more selective local collection in the light of the local need which
it attempts to meet; (c) that the possession of the additional material
at a single national center relieves Local institutions of the obliga-
tion for acquiring for more than their immediate needs; and (d) that
the national library can make its co. orehensive collections the basis
for bibliographic services of great utility.

     The last item can be disposed of most easily.  For, granted the
utility and desirability of a comprehensive bibliographic record, it
is nevertheless well known that the retention of the material, once
the record has been made, is not always practiced and may not in
consequence be a sine aua nou0   Ihis consideration would tend to place
the retention if not the acquisition of duplicative and repetitive
material to a greater degree upon the merits of the material itself
than would be the case if it were insisted that it should be retained
merely because.it had been entered in a published bibliographic record. 
LIBRARY TECHNOLOGY
17
     Now with regard to  journals, the  problem  is more difficult than
with respect to monographs because  of  the fact that journals are
composite works wherein  a single important article once in ten years
may well justify the retention  of the  file for a whole decade.  (Indeed,
the retention of journals may be justified by  their content of medical
news and opinion quite apart  from their articles on medical research
and practice.)  But were articles to be published separately (as has
frequently been advocated and of which there are several harbingers),
would  there not be a problem  of selection regarding these articles
quite  as acute as with respect  to hospital reports?  However, until
separate publication becomes  a  reality, totality in acquisition of
journals has much to commend  it.

     But the situation that may arise  when journal articles are sep-
arately published may be suspected  to  exist now with respect to
monographs and especially textbooks and manuals, and the situation
will presumably intensify as  more and  more countries develop medical
publishing facilities and produce textbooks and other monographs in
their  own languages for  their own medical personnel.  For example,
in the five-year period  covered by  the recent  Armed Forces Medical
Library Catalog 1950-54. Subjects,  the AFML cataloged 73 works for
which  the primary subject entry was "Surgery—operative" (this being
just one of 49 headings  used  under  the subject "Surgery", exclusive
of cross-references).  Among  these  73  were 15  textbooks and manuals
at several levels, including  at least  one translation, as well as
other  monographs; and they represented 10 languages and 18 countries
of origin.  The acquisition and retention of all of these books can,
it seems to me, be justified  by potential use  only on very slender
grounds, many of which would  come under the objective of "intelligence".
And if the difficulty of justification of the  acquisition and retention
of this material is not  completely  apparent now, it will probably
become only too clear when the  increasing self-sufficiency of the
nations of the world increases  the  number of countries producing this
kind of material to a figure  in the order of 118, the number of lan-
guages to a figure in the order of  83  (these are the numbers of
countries and languages which appear to be most likely in the near
future to be producing this kind of literature) and the number of
publications in a five-year period  to  a proportionate total in the
order  of 500.

     For a closed subject the ideal of totality may still have
validity, but for a live subject the modes of  contemporary publication
make this ideal a will o8 the wisp  which is both practically impossible
and undesirable of complete realization.  And  once exceptions to the
complete realization of the ideal have been admitted, it requires the 
18
VERNERW. CLAPP
greatest of care to ascertain how far they should go.   If ™^e°Si?e and
reports of provincial hospitals, popular pamphlets on tooth-brusn  g
local morbidity statistics offer present problems of selection,
convinced that identical questions attach—or should attach--™
venerable and unchallenged forms of publications—the jou^1 ^
monograph.  If library technology teaches us anything, it is tnat
bibliographic record is more important than any centralized 0™er°frp>
and that library work is too vast for any one institution to De aoie
perform even perhaps a major segment of it alone. 
THE PROBLEM FROM THE VIEWPOINT OF
CLINICAL MEDICINE
BENJAMIN MANCHESTER,  M. D.
     I have been asked to present to you the clinician's point of view
 on what the Armed Forces Medical Library should collect.  I am afraid
 I accepted this flattering invitation too eagerly, because of many
 years of  interest in both libraries and the teaching of clinical medicine.
 At the outset, it should be stated that I do not pose either as an au-
 thority or a seer in any aspect of the problem, but merely as a repre-
 sentative of the physician-average-consumer of the wares of this Library.
 Perhaps from this vantage one can present a point of view to the Symposium
 that is different from those of the more scholarly and erudite members of
 the panel.

     For  the average clinician and medical teacher the collection already
 made by the Armed Forces Medical Library is more than adequate.  If the
 collection were continued along the lines that have already been estab-
 lished, the AFML would certainly provide the average physician with the
 material  he needs for his day-to-day work.  If, however, one were to ask
 what should be collected were the Library to start anew, I should have
 to start  by trying to define the term "clinical medicine".  Clinical
 medicine  can be viewed as the practical application of the theoretical
 portion of medicine, created by diligence and research.  The clinician
 is, therefore, the intermediary between the pure scientist and the patient.
 He is privileged to translate the advances of medical knowledge made by
 the research worker, whether in the laboratory or in the clinic, into
 practice  for the benefit of all society.  For that reason, clinical
 medicine  can only flourish if there is available knowledge of the sci-
 entific and technical advances as they are developed.  Without the
 medical literature to which the clinician has recourse he would be
 unaware and uninformed of current medicine in his special field.  As
 has been  said many times already, the progress of medicine today is so
 rapid that unless an attempt is made by the clinician to keep paoe he
 is certain to fall behind, and his work will reflect this lag by being
mediocre  or worse.  In addition, there are the legal obligations in the
 interests of society that require that the physician practice at the
 level of his colleagues.  For these reasons, if for no others, a prac-
 ticing physician is motivated to search the literature, no matter how
reluctant or how busy he may be.
19 
20
BENJAMIN MANCHESTER
     In addition to keeping abreast of current medical progress there is
another reason that the clinician has for searching the literature.  The
enigma of vexing medical disorders confront the physician daily.  The
formation of these puzzling problems of medical practice can only be un-
ravelled by a search of the medical literature.  Rare and unusual as well
as the common diseases with rare and unusual manifestations can be viewed
in a less exotic light when medical publications are adequately studied
and reviewed.  The protean nature of disease is revealed and made more
familiar by reading journals and by availing oneself of microfilm and
photoprint services.  A knowledge of the incidence, statistical analysis,
comparison of results and historical background for the treatment of
disease give perspective to a clinician's everyday work.

     Although the clinician may at times need to study extensively the
literature in his field of interest, more often he is concerned with only
the newer advances and with the synthesis of what has already been estab-
lished.  The average physician, overwhelmed by the routine problems on
his roster, with more calls on his time than he can devote comfortably
to a. problem, is perforce obliged to do less intensive investigation of
the literature than his research colleague who is able to devote his
entire time and attention to a particular problem.  For that reason, the
average physician reads only what is available in his native language,
and without concern for chronology or geography.  He may therefore read
the pharmaceutical company's publications as well as the standard journals
published in this or other countries.

     Reviews of the literature are particularly valuable, and therefore the
Bibliography of Medical Reviews,, which the Armed Forces Medical Library
expects to publish in May of this year, will be particularly valuable and
welcome.  Its use as a supplement to the Current Liat of Medical Literature
will be very great.  If one may parenthetically offer a criticism about the
Current List,, it is that the print is too small and the format difficult to
use.  If it were possible for the Bibliography of Medical Reviews to change
the format, it would help greatly.  It is my hope that extensive advertising
of the contents of this Bibliography of Medical Reviewq will be done, for I
am certain that a knowledge of its existence will be a boon to all physicians,
If this Review were available to all physicians, the use of the current
literature would increase.  One can hardly expect the general physician, who
is caught in the current of routine, to pause, to reflect, and to search the
voluminous literature of medicine.

     There is still another aspect to the problem.  It is the question of
physicians far removed from centers of medical education who cannot avail
themselves readily of the contents and services of large medical libraries.
By collecting the medical literature, the Armed Forces Medical Library ia
doing a great service for the advancement of medicine.  If, however9 ±^ 
CLINICAL MEDICINE
21
could establish a system whereby this literature is made more easily
available to the isolated physician, by greater use of inter-library
loans or photoduplication or by some other means, it would fulfill the
task for which the collection of the literature is only the fundamental
intent.

     In summary, the problem of the extent of coverage of medical litera-
ture necessary for the clinician may be viewed as the immediate and the
proximate objectives.  It is important that our National Medical Library
collect all the literature in all fields of medicine, in all languages
and in all times.  Such acquisition is essential for the researcher
concerned with the advances of medicine and for the synthesizer to com-
pile reviews and monographs, the secondary publications on the subject.
The clinician, -who is unable to read all the literature of all times
and languages, will then benefit by the synthesis, reviews and monographs
of medicine that are published as the result of examining this basic
literature.  Thus, even for the clinician, it is necessary that the Armed
Forces Medical Library collect extensively both in the basic medical
sciences and in paramedical fields.

     The National Medical Library has the responsibility of informing
physicians of its resources and facilities.  If in addition  a distri-
bution of medical literature could be made possible from the National
Medical Library through interlibrary loans and other means, clinioal
medicine (and therefore all of society) would be the beneficiary of the
vast resources held here.  Collections without use are exercises in
intellectuality, and a symposium on acquisitions must take the next
step and consider how its services can be improved.

     It is apparent that a library cannot be all things to all people;
it can hardly ever be the same thing to all people, but certainly it
can be many things to many people.  This is the goal that the National
Medical Library should attain. 
\ 
THE PROBLEM FROM THE VIEWPOINT OF
MEDICAL RESEARCH
HOMER W. SMITH,  Sc.D.
     Speaking as one occupied chiefly with medical research, I am not
moved to any great sorrow by the plight of the librarian because all
the librarian has to do is to collect publications, make out appro-
priate card indices, and then store his publications and indices some
place between the cellar and the roof.  Thereafter his task is over.
He can go home at 5?00 o'clock with the conviction that his job is
done and leave the investigator to read by the light of the midnight
oil.  Any good librarian can collect and catalog more books and
journals in a day than an investigator can read in a year.  No in-
vestigator can feel very sorry for a librarian,because he feels too
sorry for himself.

     Had some Euclid spelled out the self-evident axioms by which
scientific research is profitably to explore the unknown,the investi-
gator might also lay aside his labors at 5*00 o'clock, but unfortunately
no such geometer has yet appeared.  He who would venture into the unknown
with the hope of returning with new knowledge must frequently set out
with no weapons other than books that tell him where others have travel-
led, and what they found or failed to find.  And even if he knew all
the answers in all the books his chance of success, of translating some
bit of unknown into the corpus of verifiable knowledge which will stand
the test of, say, five decades, is probably not greater than one in ten.
Yet without books his ohances are practically nil.  The question is then,
how many books shall he read, and which ones?

     The number of different ways in which a library is used is approxi-
mately equal to the number of investigators.  Since we have no way of
assessing the productivity of various approaches we cannot assert that
one way is better than another; we must recognize all of them as valid.
At one extreme we have the man who completes his laboratory or clinical
investigation and only when it is time to write a paper is he moved to
consult the library, in order to preface his conclusions with a 'survey
of the pertinent literature'.  To this end he may search a half dozen
of his favorite journals and a couple of abstract organs, using at most
three or four key words to get him through the indices and thus missing
several important articles because the subject of his prime interest is
not mentioned in the title of these works.  Or he may even delegate this
part of his research to a 'bibliographic specialist'.  At the other
extreme we may imagine a man who, before ever putting his idea to the
23 
24
HOMER W. SMITH
test of experiment,  may make an 'exhaustive'  examination of every publi-
cation that could conceivably bear upon his notion.   I do not know what
fraction of papers currently published in the medical literature represent
the first approach,  but I think that the fraction representing the 'exhaus-
tive' method is the  order of magnitude of absolute zero for the simple and
sufficient reason that it is impossible.  Most investigators use a method
that lies somewhere  in between.

     If I may speak for myself, a few years ago I published a monograph on
the structure and function of the kidney, which contained 1049 pages and
2300 references by title, and weighed 4 pounds.  In only a trifling way
did this monograph deal with the history of my subject, the earliest
references dating from the early 1920"s.  Those papers cited by me were
selected from a much larger list.  Many factors entered into their selec-
tion, but every paper included or wittingly omitted had been read by me
at least once0  I was fully aware that the entire list fell substantially
short of an 'exhaustive' survey of the world's literature pertinent to my
subject, but my conscience did not keep me awake at nights.  Since January 1,
1950, when that bibliography was closed, over 3000 new papers having some
bearing on renal physiology have appeared.  My index is still far from
complete, nor has it ever been complete.  Nor can I ever hope that it will
be complete.  Do you expect me to feel sorry for a librarian?

     The material pertinent to normal and abnormal renal function is drawn
from almost every discipline of medicine.  How, then, do I keep track of it
(in an approximate manner of speaking)?  I read regularly a dozen-odd
journals which I find most important and, at intervals (sometimes quite long),
I systematically search the tables of contents of another hundred-odd journals,
most of them in the English language, examining all promising articles.  With
some attention to bibliographies I believe that by this approach I am able
to cover most of the world's literature (though just what the word 'most'
means in this connection I admit I will never know).

     Not every one,  however, has the time to examine a hundred or even fifty
journals systematically, and for many investigators who are capable of making
first class contributions to medical science—who are in fact making such
contributions—an abstract journal is an absolute necessity,  I do not read
abstract journals because to do so would almost double my load.  I would find
in them the papers which I have already seen, or papers that I will see in
the due course of time, and only occasionally (though perhaps more frequently
than I think) would I find a paper which I might otherwise miss entirely.
And what would I get out of the abstract?  The author's summary, which
generally does too much or too little justice to his work, and this only
after it has been filtered through the perhaps astigmatic interpretation of
an abstractor who may have deleted important material or added some interest-
ing implications of his own.  Moreover, highly important information is 
MEDICAL RESEARCH
25
 frequently contained in a paper which bears  no clue  to  this  fact  in the
 title or summary,  so in the end I would have to search  the original
 literature anyway.1  At its best an abstract journal cannot  be used as
 an ultimate source of information because  one can evaluate the conclusions
 of an investigator only in relation to the total context  and numerous
 details of his work.  Nevertheless, as I have emphasized, an adequate
 abstracting system is absolutely necessary,  and one  of  the functions of
 a national medical library might be to aid in the establishment of such
 a system,  functioning at an international  rather than at  a national level.

      It will now be evident to you why I have a rather  iconoclastic
 attitude with respect to what does and what  does not constitute scien-
 tific literature,  which I would define as  any document  that  adds with
 reasonable reliability to the sum total of scientific knowledge.

      To those who  think that a library should be all things  to all men,
 I can only say nonsense.  In size and scope  a library will exceed what
 any one man can achieve, but even after allowance for the multiplication
 of manpower and equipment,  its efficiency  still depends on the efficiency
 of one or the few  men who are responsible  for its operation.  You cannot
 turn a librarian into Superman by multiplying the number  of  his assistants,
 by multiplying his library's cubic footage or by reducing its contents to
 microcards.

      Opposed to these realities stands the terrifying fact that library
 literature has been growing by Malthusian  progression.  Rider^ was of
 course including many areas of literature  when he estimated  that by the
 year 2040  the Yale Library will possess 200,000,000  volumes  which will
 occupy 6,000 miles of shelves and require  a  staff of 6,000 persons to
 catalog its  new additions at the rate of 12,000,000  volumes  a year.  We
 can let Yale have  that headache while we take some prophylactic measures
 of our own against the all too familiar multiplication  of medical litera-
 ture. ^  Rider has  shown that it is the rule  for our  university libraries
 to double  their holdings every 16 years.   A  rough calculation indicates
 that  in this library the reproductive interval is  closer to  20 years,
 but no table of logarithms  is required for us to foresee that the efficient
 collection,  cataloging and,  above all,  the efficient  use of  primary
 material in  medicine will soon present a truly formidable problem.

      Perhaps  the combined catalog-microcard  will in  part solve the space
 problem, and  if it does  not  I can conceive that  the  6 l/4 X  7 l/2 cm.
microcard, holding on its back surface an  entire book, may someday be
 reduced to a  mere  pinpoint,  a dimensionless  book,  so  that many books can
be put  on each  microcard, but  will this  help the investigator?  Is the
librarian so  concerned with  the  problems of  acquisition, cataloging and
 storing that  he has  overlooked the  basic and only ultimate function of a 
26
HOMER W. SMITH
library, usefulness?  I will go so far as to suggest that someday someone may
develop an ELICADUS (Electronic Library Instantaneous Catalog and Deliver
Us Service) which will supply the answer to any question asked, but someone
unfortunately will still have to ask the questions, nor am I optimistic about
an electronic brain to read, learn and inwardly digest the answers when they
come.  Mere men and women must still do the job, and the process must be made
as simple as is possible.

     In respect to human population we may hope for something from birth
control, but in respect to the population of the library I see no solution
in the foreseeable future except to rely on the pruning shears of informed,
careful selection.

     We should start a discussion of the selective process by defining medicine
but this is difficult to do.  Webster's definition of medicine as 'the science
and art dealing with the prevention, cure and alleviation of disease' is lesB
a definition than a statement of one of its goals.  I cannot supply a better
definition unless it is to suggest that this goal is to be achieved by the
study of the normal and abnormal physiology of living organisms,^  In the
light of this definition I will venture to outline a working philosophy for
a national medical library, hoping that by its application the librarian can
resolve some of his problems and keep his institution within practical
physical limitations and at an efficient working level.

     My philosophy may startle you, and at this point I can only remind you
of the Quaker's remark that "all the world is queer 'cept thee and me, and
sometimes I think that even thee is a little queer 1"  This philosophy is,
in brief, that much of what the librarian in the past has been saving as
pertinent to medicine is not medicine, it is not scientific, it has no value
whatever, it is utter trash.  And in designing a library for the future I
would built a capacious incinerator close to the receiving desk, not so close
that its fires (which will have no interruption) will overheat the clerk but
close enough so that its open door can be hit by any amateur pitcher with
slight experience.

     Into this incinerator the mail clerk should throw all advertisements
and catalogs of drugs,  prosthetic devices, scientific apparatus, and all
so-called house-organs  published by medical supply houses for promotion
purposes, as soon as they are removed from the envelope.  (If anyone wishes
to argue about details  I will discuss them separately*)  Also all news
letters from medical societies, local or national, all medical school annuals
(e.g.   the Caduceus of  Switchit Medical College, Class 1956), all student and
alumni publications; all pamphlets addressed either to the physician or layman
on tooth-brushing, fly-killing, toilet-training, or the nutritional value of
canned pineapple.   Here goes your principle of an 'exhaustive' collection into 
MEDICAL RESEARCH                       27
 the  flames«   I  call such materials  'fugitive'  (from the latin, fugitivus,
 meaning to flee,  or derivatoly to fly) because they should fly from the
 receiving desk  into the  incinerator door; they qualify neither as scien-
 tific  publications  nor as  having potential  interest to the history of
 science.  They  are  a form  of cultural measles introduced by the invention
 of printing.  Also  fugitive, but for another reason—and here is a rich
 supply for the  polychromatic flames—are all reprints, separates, and
 republications  of contemporary scientific literature.  The amassing of
 large  reprint collections  is one of the most exaggerated perversions of
 the  oollecting  instinct  gone wild.  What the individual scientist does
 with reprints is  his personal,  private affair.5

     We now  come  to a second category, which I will call ephemera (from
 the  Greek eohemeron^ meaning to last but a  day, as in the case of the
 May  fly,  or  ephemerid) representing documents which may be admitted to
 the  library's vestibule  but  not to  the sacred shrine itself.  Such
 ephemera consist  of catalogs and advertisements of new textbooks and
 monographs,  periodic catalogs of second-hand books, and other tabula-
 tions  momentarily useful to  the bibliographer.  Also among the ephemera
 are  the announcements of symposia,  postgraduate assemblies, programs
 of future scientific meetingss   valuable before the event, these are
 almost worthless  afterwards. A more debatable category is represented
 by the catalogs of  schools of medicine, dentistry, pharmacy, nursing,
 the  annual reports  of hospitals, fund-raising programs, foundations,
 and  the like:   these I would also class as  ephemera but keep them for
 perhaps ten  years and reduce them to microcards before incineration.
 Such ephemera could be made  so  readily accessible by open entry that
 they need not be  catalogued  at  all."

     By the  enthusiastic use of the incinerator for fugitives and
 ephemera, we  approach the  hard  (or  it may be soft) core of scientific
 medical publications.  Here  we  encounter two obvious problems, the
 first  of which  is to distinguish the substance from the name.  How
 many pages per  1000 must a publication give to original reporting
 or critical assessment of  medical problems, as opposed to advertise-
 ments,  abstracts, announcements  before and after the event of medical
 meetings, letters to the editors, gossipy clinics, frequently inane
 question-and-answer hours, before it is to qualify as a scientific
 journal?  The physician  who  'once had a case' is no greater a plague
 on medical science  than  he who  'once wrote a paper' on that case.  I
 have my secret  list of what  I call  chit-chat journals, scientific
 gossip  Bheets,  archives  of stuff and nonsense, which carry only an
 occasional paper  of merit.   For  obvious reasons the list can be made
 public  only after my death,  and  then it will probably be ignored.
But for Borne time to  come  the librarian will just have to be blind
 in one  eye and  not  see too well  out of the other, and take the name
for substance. 
28
HOMER Wo SMITH
     A less difficult problem is that of distinguishing from amongst proper
scientific and technological vehicles those journals,, monographs,  etc.,
which are pertinent to medicine.  Returning to my definitional content of
medicine as normal and abnormal physiology, times change, thanks be, and
so does science, including physiology.  Sciences that once were the almost
exclusive prerogative of medicine have long since left home, married acme
brown-eyed technological lad and now are raising children of their own
with new chromosomes.  They have left home for good and they cannot ccoe
back into our library because there simply is no room.  There are dozens
of sciences and technological fields which exist of and for themselves,
and which also merit clear-cut definition; and, when defined, it will be
found that they have no direct bearing on normal or abnormal physiologyo
Few are the instances where ambiguity cannot be resolved by the touchstone
of this definitions  if noise abatement and therefore sound-proofing'
claim admission to our stacks, then so do traffic congestion, highway
engineering, train, automobile and airplane design, and architecture,
ventilation and illumination of the home.  The fact that a form of bursi-
tis is known as housemaid's knee is no warrant for our inclusion of home
economics and social security.

     In my view a national medical library should have an exhaustive col-
lection (and here only in a very qualified sense) of the primary, scientlfio
literature of the world dealing with the preclinical sciences, general
medicine and surgery, treatises on special systems, public health, the
medical and surgical specialties including gerontology and nursing,
dentistry, physical therapy and rehabilitation, medical technology, the
medical aspects of industrial technology including atomic radiation and
aviation medicine, and all medical aspects of military science.  By 'pri-
mary8 I mean original publications, plus review journals and monographs
in which critical integration rather than mere encapsulation is the aijn,
and such abstract journals and other devices as may aid the reader to find
his way through this literature.  One qualification implied above is that,
except in special instances, there is no need to acquire textbooks—i.e.
volumes intended for didactic purposes rather than critical evaluation and
integration—from foreign languages, nor is it necessary to procure copies
of every undergraduate textbook published.  Where a serious doubt can be
raised as to whether a document does or does not have the status of a
scientific medical contribution, burn it (or forbear to buy it).

     The problems presented by the ancillary sciences are generally less
difficult to resolve.  The library should have only a research collection
in normal and deviant psychology, veterinary medicine, dietetics, hospital
administration, chiropractic, osteopathy, and chiropody, and perhaps in
sanitary engineering especially as concerns the military establishments. 
MEDICAL RESEARCH                       29
     Only a reference collection is needed in anthropology, social sciences,
political science and law, education, general science, mathematics, physics,
chemistry, meteorology, biology, genetics (other than as applied to man),
comparative anatomy and embryology, and sports.

     On  the matter of the history of medicine I will say little because
Dr.  Shryock will deal with it.  However, I will confess that from time to
time I engage  in historical forays, and am now occupied with a history of
renal physiology.  I therefore speak from the heart rather than from the
head when I call this absorption with the past a true neurosis, one ap-
propriately to be considered by the student of deviant psychology or by
the  gerontologist.  But I am sure that I have yet to meet a librarian
who  did  not have a secret wish to possess a Rare Book Room, who would not
sell his soul  to the devil for a first edition of AverroSs1 Colliget in
Arabic which no one can read except a student who has specialized both
in medieval Arabic and in Averrofis.  The devil owns, I admit, some choice
souls who are  supremely happy with their lot, and every librarian must
be allowed a budget with which to buy the devil off, as every child must
have spending  money for self-selected sweets.  How big this budget should
be in a  national medical library will depend on long range policy, and
I  have no a yr%QT% answer.

     But of this I am confident?  textbooks, monographs, and the like are
not  the  stuff  of which the history of science will be made.  No historian
can  tell the librarian of what stuff the history of science will be made,
but  do not jump to the conclusion that for this reason you should save
everything—that way lies death while you are still alive.  You are not
called upon to save the history of scienoe, but to help make the history
of science by  aiding initiative, imagination and integration in a
generation of  scientists who have yet to cross your doors.  And if some
day  some curious soul requests a first edition of Howell's Textbook of
Physiology (now in its 51st year and 17th edition) just tell him in kind
words that when the useful life of textbooks and the like is over, such
works, like all spent human effort, are consigned to the flames where
their carbon will pass into the eternal cycle to become available for the
sustenance of  new trees and the manufacture of new paper.  Let the
librarian keep his library uncluttered, leaving plenty of room for
Journals not yet started, books undreamt of, trees ungrown.

     And now that the fires in my incinerator are burning brightly, and
in view  of the  substantial savings and enhanced efficiency accruing there-
from, I humbly  petition for a small personal favor.  What I want iB a
very little thing, it will not take up much room, or cost very much
money0  All I want is a tiny roam where on a table fully exposed to hand
and eye are a few books dealing with subjects as remote from medicine as
one can  imagine, such as the birth and death of the stars, the history
of the earth, the evolution of man and his society and law and mores.
Books wherein a man can learn whether the universe is or is not expanding,
the why and wherefore of winds and rains and droughts, the origin of the 
30                         HOMER W.  SMITH
 familyp  of  government and taxes? where he can make contact with living
 philosophy? man8 s neirw-s^Mg effort to understand himself, witt livinS
 jurisprudence, his. never-ending effort to live with himself, with history
 as a  critical effort to  Bstudy the day before yesterday, in order that  ^
 yesterday may not paralyze today, and today may not paralyze tomorrow oB**
 And perhaps a few books  that deal with the history of  ideas, with poetry
 or music or semantics, or books that just raise questions without answering
 them.

      This is not to be a Brare book room,0 nor, God help us* a room of the
 World's  Hundred Best Booksr but just an easy place to  drop into where a
 few good books will lie  always waiting to be picked up until they too go
 into  the flames»  Ephemera which will help the curious, the tired,  the
 discouraged, to learn what is going on in the great big world outside
'medicine,^  that the world, s&Z help medioinep as medicine has helped the
 world.

 *     But I  can  see the powers-that-be shake their heads.  I can hear the
 answer coming?  ^Dr. Smith,.** I will be told, % great  national medical
 library-is  concerned with medicine period.  If it needs to buy books on
 the prowess of  the medicine man in the Trobriand Islands, or the sex
 mores of adolescents in  Kamchatka, goodo  But astronomy* paleontology,
 archeology? anthropology, jurisprudence, philosophy—why. Dr. Smith,-  -
 it is thee  who  are queer?  Remember, sir, we are spending the taxpayer's
 money and this  is a library dedicated to the healing of the sick and the
 preservation of health and sanity.  What you propose is not medicine for
 anyone,  but only a supplement to the physician^s general education  which
 was presumably  completed in a library arts college before he ever entered
 medical  school.  If ha wants to keep abreagt of what is going on in the
 world outside let him read the newspapers and popailar  magazines, or listen
 to the radio or TV.  He  will probably get around to reading Bcsae of those
 books some  day  anyhow, if and when he hears of them and has the time0
 Moreover, some  of the topics you memtion represent fallible human opinions
 and hence are controversial subjects.  No, Dr. Smith,  not in a national
 medical  library! ^

      Please, just one hundred books to last for five years, after which
 you can  burn them?  Say, not more all together than $750?  Please•
 Mr. Director of the Budget? 
MEDICAL RESEARCH
31
Notes
 1.   I regularly read the Proceedings  of  the  Federation of American
 Biological Societies, etc.,  and make  card references thereto, but I have
 almost decided that I will make no further bibliographic references to
 such preliminary notes,  for  reasons too  numerous to mention here.  I
 would put in a word of commendation for  the  Office of Naval Research's
 recently initiated 'European Scientific  Notes', which are marked "This
 document is issued for information purposes.   It is requested that it
 not be considered part of the scientific literature and not be cited,
 abstracted or reprinted as Buch.ff

 2.   'But, if the Yale Library does continue  to grow, and to grow at a
 rate no whit greater than it has been steadily growing through its more
 than two centuries of past existence,  if it  continues to grow at a rate
 no  greater than the most conservative rate at  which all our other
 .American colleges and universities have  grown  ever since they started,
 and are now growing, then, by a series of further successive doublings,
 the Yale Library will, in 2040, have  approximately 200,000,000 volumes,
 which will occupy over 6,000 miles of shelves.  Its card catalog files—
 if  it then has a card catalog-—will consist  of nearly three-quarters of
 a million catalog drawers, which will of themselves occupy not less
 than eight acres of floor spaceo   New material will be coming in to it
 at  the rate of 12,000,000 volumes  a year; and  the cataloging of this
 new material will require a  cataloging staff of over six thousand
 persons.'  Fremont Rider,  fthe Scholar  and the  Future of the Research
 Library.  New York,  Hadham Press, 1944, pp» 11-12.

 3.   Billings (Literature and institutions.   In B.H. Clarke, A century
 of  American medicine.  1776-1876. Philadelphia, Henry C. Lea, 1876,
 pp.  291-366),  reviewing  our  medical literature and institutions at
 the end of our first century aB a  nation, noted that 195 strictly
 medical journals had been started  in  this country between 1776 and
 1876,  but of these only  58 survived in 1875  (p. 294)»  Nevertheless,
 he  says that it is  a common  complaint  that there are too many.  At
 that time the world literature comprised about 280 regular medical
 journals,  of which 46  were published  in  the United States (p. 343)•
 In  1876 Garland (see New England Journal of Medioine. 190i865,1924)
 wrote  that 'It is  as useless  to advise a man not to start a new
 journal as it  is  to advise him not to  commit suicide.1  As of 1900
 the  world list of  journals had increased to about 800, and the
 estimated figure for  true  periodicals  (exclusive of occasional
 pamphlets,  government  publications, etc.) for  1950 is about 4,000„
 (Miss  Janet Doe, personal  communication).  In  1876, acoording to
Billings,  the  National Medical Library contained 40,000 volumes
 and  about  the  same  number  of  pamphletBj  the 1955 report enumerates
961,631 volumes, pamphlets, microfilms and other items, of which
nearly half (462,474)  are  monographs or  bound  serials. 
32
HOMER W. SMITH
     In 1876, the number of books including new editions and translations
made available to the American physician did not exceed 35 per year.  As
between 1914 and 1955 the Armed Forces Medical Library acquired 110,952
monographs, a figure only slightly greater than the total number dated
between 1801 and 1913.  (Data from AFML Annual Report for the calendar
year 1955).  As of 1952 the number of such books appearing annually is
estimated as between 6,000 and 7,000.  (Miss Janet Doe, personal com-
munication.)

4.  Even here the words 'normal' and 'abnormal' are superfluous unless
we distinguish the abnormal as that which carries the threat of pain,
disability or death, or otherwise diminishes human happiness.

5.  Personally, I keep such reprints as are of interest to me and are
sent to me by the author(s), and for these I am grateful, but I would
never think of inflicting them on a library.  In any case, I suspect
that the day of the reprint is drawing to its end because we are coming
to the point where we are publishing reprints rather than scientific
journals.

6.  If it is argued that the catalog of Harvard Medical School for 1895
is an historically valuable document, then I must reply that so may be
the 1956 catalog of Switchit Medical School, and if we multiply Harvard
and Switchit by all the medical schools in the world and all the years
gone by and yet to come, you will have sickened our potentially useful
library by catalog constipation.  When the dated, momentarily useful
ephemera have served their purposes, to the flames I

7.  Joseph Groesbeck.  Some Problems of Scope and Coverage.  Bulletin
of the Medical Library Association, 39?97-101,1951.

8.  B.N. Cardozo.  The Nature of the Judicial Process.  Yale University
Press, New Haven, 1921, p.54°  Quoted from Maitland.

9.  We have such a small room at New York University-Bellevue Medical
Center which is in general concerned with anything of enduring human
interest.  We call it our Man's Place in Nature Library, indirectly
honoring a great nineteenth century biologist whose perspectives en-
compassed almost the whole of science and philosophy of his time, and
who sought to translate this into a better way of living.  Not that we
know very much about either man or nature, but Thomas Henry Huxley's
vision that man had a place in nature gives our library meaning and
integration. 
THE PROBLEM FROM THE VIEWPOINT OF
MEDICAL HISTORY
RICHARD H.  SHRYOCK,  Ph.D.
      I have been  impressed, as no doubt  we all have, by the continuing
 critical analysis which  the staff of the Armed Forces Medical Library
 have  given to  problems of  scope and coverage in the course of deter-
 mining an acquisitions policy.  Caught between what Colonel Rogers calls
 "two  great polar  forces" — between the  alternatives of acquiring too
 much  or too little — they are remaining upright "somewhere in the field
 of  force which is generated between them."  In maintaining this difficult
 balancing act,  they have requested the suggestions of those concerned
 with  special aspects or  values in a great medical library and it is my
 lot to discuss  acquisitions as these relate to medical history.

      This Library has long possessed the greatest collections in medical
 history, in terms of both  scope aAd coverage, which are available in the
 United States.  In consequence, its Index Catalogue serves as the basic
 bibliographic  tool of all  serious medical historians.  The services
 provided by the Library  to medical history constitute one of its major
 traditions and  I  have no doubt that this tradition will be maintained.
 Let me add that in serving medical history, the Library has also provided
 materials for  social history, but I must not poach upon Professor Bestor's
 discussion of  this latter  theme.

      Colonel Rogers has  indicated that he primarily desires to discuss
 coverage, though  it is difficult for one concerned with a particular
 field to avoid  comments  on scope as well.  Certainly, in regard to medical
 history, the scope of the  collections In most respects has been all that
 could be desired.  I take  it for granted that nearly all books and pam-
 phlets in all languages  which relate primarily to the history of medicine
 (as that term is  defined in the December statement on policy) will continue
 to  be acquired.   Incidentally, I assume  that the definition of "medicine"
 here  employed includes personal and public hygiene as well as "dental
 hygiene," though  I do not  recall that it is so stated.

      The phrase "nearly  all" Is an inevitable qualification here as else-
where, since some discretion must always be exercised in excluding trivia.
 This will not often be a problem in relation to books on medical history,
and even old pamphlets on  the subject would usually seem desirable.
Collections should include even so-called '"house organs," such as Ciba
SyjggLE2fiiyffij> when these contain considerable material pertinent to medical
history.
33 
34
RICHARD H,  SHRYOCK
     In like manner,  ones hopes that nearly all journals in all languages
devoted primarily to  medical history will be secured.   But I can think of
one current, foreign  journal, ostensibly devoted to the field,  which is
hardly worth ordering.

     With regard to books and journals relating to the history of science
in general, or to that  of sciences closely related to  medicine, I think the
rules already suggested are acceptable.  The criteria  here are the extent
to which materials on medical history appear or the degree of pertinence to
medical history which may be exhibited.

     One special question which arises in this area, however, is that con-
cerning medical biographies.  Should the Library acquire all such works?
Here I am inclined to say yes in general, though I hasten to qualify.  I
would not limit works of this nature to those about "prominent" physicians
or other workers in the designated fields, but I would limit them to those
which really pertain to medical activities.  There is  no need for biographies
of John Keats because he happened to have had medical  training.  Nor do I
think that we need the biographies of scientists whose work touched on
medicine in only minor degree.

     Since most books about medical history do not antedate the eighteenth
century, there will not be many problems in this area  concerning depth of
coverage.  I am mot much concerned here about first editions as such, about
the inclusions of all editions just for the sake of completeness, or about
typographical variants.  In short, I do not share all  the enthusiasms of
bibliographers.  Where two editions vary in content, both of course should
be secured.

     With regard to translations, the Library states that it secures those
made into English or from an unfamiliar to a familiar  language.  I would
suggest that it might also secure those translated from English, at least
in the case of American publications, as a measure of  the influence of our
medical writings abroad.

     So much for works about medical history — what historians ordinarily
call secondary writings.  The sources for medical history are a more complex
matter.  These include manuscripts as well as publications in the ordinary
sense.  In general, one can divide this area between (l) sources for the
past history, and (2) sources for the future history of medicine.

     The sources for the past history include manuscripts antedating the
invention of printing,  subsequent printings of such manuscripts, later
manuscripts, so-called "source books," and, last but not least, the whole
corpus of medical publications which has appeared since the later fifteenth
century. 
MEDICAL HISTORY
35
     In regard to manuscripts antedating the  invention of printing, I
suppose the Library tries to secure any of these which pertain primarily
to medicine and which happen to  come within reach.  Manuscript treatises
prepared after the invention of  printing should be viewed with the
cautiousness  suggested by Dr. William  J. Wilson in his 1951 article in
the Library Quarterly.   I also agree with the latter that all European
books  in this field published prior to 1501,  and practically ail those
published before 1601, should be purchased as far as is feasible.  The
term %11" here covers different eaitions, including translations.

     Such a policy, it is true,  will result in the acquisition of items
whose  value derives — like that of gems ~ largely from their rarity.
And one therefore may be accused here  of expressing the enthusiasm of
collectors rather than the needs of historians.  Who will ever use
these  works,  to say nothing of their various  editions?  On the other
hand,  they certainly should be preserved somewhere, and where better
than in a national medical library?  Meantime, if one scholar in each
generation has such specialized  interests as  to desire a given book,
he will certainly wish to see it in all its forms.

     When one advances into the  seventeenth and later centuries, all-
inclusive policies are neither feasible nor desirable.  As far as
manuscripts are concerned, both  general treatises and monographs
become rare and are usually ones whose authors failed to find a pub-
lisher.  Only occasionally are these desirable, but the exceptions
may be important.  An American example is Cotton Mather's "Angel of
Bethesda."  Although this is apparently the first general treatise
on medicine prepared in  this country,  its author and his son were
never  able to get it into print.

     In the later centuries, however,  other types of manuscripts
become more common and,  at times, troublesome.  There are, for example,
the lecture notes of professors  and of their  students.  Here the rule
of prominence can be applied.  One would like to secure all such notes
by the outstanding medical men and a sampling of those by their students.
Otherwise, one can be content with a few examples which reflect a
particular place or time.

     More significant than lecture notes, in  many cases, is the corres-
pondence of those active in medical and related fields.  Medical
historians, until recently, seemed to  assume  that printed sources were
all that were needed for the modern period, and tended to everlook the
insights provided in off-the-record correspondence.  But such neglect
of letters may have resulted also from the simple fact that these were
rarely available.  Families were more  likely  to preserve the papers of
politicians or generals  than those of  physicians.  Hence it would be
especially valuable to historians of modern medicine  if the private
papers of physicians could be secured.  This  applies both to prominent
men and also  to those who may be viewed as typical of certain periods
or places. 
36
RICHARD H.  SHRYOCK
      Subsequent printings of earlier manuscripts, particularly critical
 editions  of classics, are usually considered "musts." Librarians desire
 all  editions,  including translations, of such standard items as Hippo-
 crates, Galen, and of other notable classical and medieval figures.  The
 same holds true for critical editions of early modern leaders, such as
 Paracelsus, even though their works may have appeared originally in
 printed form.

      Publications of source collections are not numerous, but I assume
 that the  Library secures those which do appear in the field; for example,
 such works as  those by Major and by Clendening, or Kelly's series of
 Medical Classics.

      A word might be added here about sources other than the written or
 printed word.  In the first place, what about pictures?  Most medical
 libraries "go  in for" portraits of medical men and some provide catalogues
 of these  items.  Since many prize portraits highly and they are obviously
 needed in biographies, I have no objection to this; but, frankly, I do
 not  think that such pictures ~ except in the case of photographs — have
 much value to  the serious historian.  More useful to him are pictures of
 old  scenes, especially those which illustrate typical settings or activi-
 ties.  Even illustrations by contemporary artists are of value, and actual
 photographs more so.  Yet these are harder to come by than are portraits,
 and  I hope that the Library will seek and organize collections of this
 tiort.  No doubt it has done so in one degree or another — I simply wish
 to emphasize the matter.

     Other types of illustrative material are objects, such as pathological
 specimens and scientific instruments.  Collections of such objects can
 probably  be allocated to specialized institutions, such as the Army Medical
Museum; though it would be logical enough to house a museum of medical
 technology in the Library itself.

     Returning to the matter of photography, one need not labor the values
 of reproduction on film or microcard.  Except for convenience, medical
sources reproduced in this manner are usually as valuable to the historian
as are the originals.  The interests of book collectors and of bibliophiles
are another matter; but the historian should acknowledge his debt to these
gentlemen for having located and preserved originals so that they can,  in
this later day, be duplicated.

     It is when one comes to the general corpus of medical literature  in
the modern centuries  that problems of coverage become acute.  I agree
at once that there are many ephemera which the Library should ignore,
keep temporarily, or preserve only in the form of typical examples —■
for  instance, school catalogues, promotional literature, and the like. 
MEDICAL HISTORY
37
     One presumably desires all general texts on medicine from the
eighteenth century onwards, but only in the case of the most famous
would it seem necessary to secure more than one or two editions —
preferably the first and last.  In the case of a few outstanding texts
— such as Osier's — successive editions in sequence are desirable in
order to illumine changing concepts and knowledge over a limited span
of years.

     All publications on specialized medical themes, whether in books
or journals, are potential grist to the historian's mill.  Hence the
value of the Library's broad coverage of earlier books and journals.
As is often pointed out, a book may lie ignored for a century and then
suddenly be much desired by an individual scholar.  Here again, however,
I think that — except in the case of famous items which are not likely
to be ignored — the single edition is usually adequate.

     When one comes to the collection of sources for the future history
of medicine, the acquisition of the usual current publications is
obviously the major need.  These are the raw materials for future his-
torical study.  I would like to emphasize, however, the pertinence for
this theme of certain remarks already made in relation to older materials.
The Library already may be securing, or planning to secure, much of the
visual material which is now becoming so plentiful in the medical area;
for example, still and moving pictures of medical procedures or person-
alities.  When the papers of prominent physicians are assembled, these
are usually presented to local institutions, but I trust that the
Library would accept such as came its way and even seek them in certain
cases.

     A special category here is that of the papers of professional
organizations, as distinct from those of individuals.  Professional
bodies, voluntary health societies, and the like, sometimes do not know
what to do with accumulated records; yet these throw light upon pro-
fessional and sometimes on technical history.  Major societies might
well give their collections to a Library which is certainly national
in character and will be shortly, we hope, national in name as well.
I realize that such materials are difficult to organize but some
processing might be required in return for acceptance.

     A special procedure aimed at collecting  current data for future
historical studies is that of interviewing elder statesmen for auto-
biographical information.  This procedure has been developed on a
considerable scale by Allan Nevlns and other scholars at Columbia
University, and seems calculated to preserve much that otherwise
would be lost.  One can hardly expect this Library to embark on a
similar program for medical men alone.  But it might be worth while
to keep in touch with the Columbia group, in reference to such medical
records as they may be persuaded to assemble. 
38
RICHARD H,  SHRYOCK
     I trust that what has been said here avoids both the counsels of
perfection and those of indifference to serious scholarship.   What the
medical historian desires is what can be really used.  The scope and
coverage of such collections is broad enough,  without burdening the
librarians with endless requirements — however decorative these may be.

     The term librarians is used advisedly here.  Most historians, as
professors, are accustomed to university libraries in which they do most
of the ordering.  In national and public libraries,  on the other hand,
the ordering is entirely directed by librarians.  In the case of national
libraries, staff members are themselves specialized scholars  and this
has certain advantages.  All that historians can do here is to offer such
disinterested advice as they can.  In the long run,  future opportunities
in medical history will turn on the acquisition decisions made by the
staffs of this and of the other great medical  libraries. 
THE PROBLEM FROM THE VIEWPOINT OF
STRATEGIC INTELLIGENCE
FREDERICKS  KILGOUR
      Intelligence is  information.   In  its broadest sense, intelligence
 is  information that constitutes  part of a basis for action such as the
 determination of a foreign policy,  a commercial policy of a private
 enterprise,  or even a course  of  investigation  in biological research.
 In  its  narrower sense,  Intelligence, often  secret, is one of the in-
 gredients  of both domestic and foreign national policies.

      This  paper will  discuss  foreign medical publications in the light
 of  their  intelligence values  for the national  welfare and security.
 In  general,  the use of scientific and  technical intelligence differs
 from that  of most other intelligence because the national government
 does not have exclusive action in science,  technology, and medicine.
 By  and  large, it is private individuals who produce the scientific
 and medical  developments that contribute most  greatly to national
 welfare and  security.   It was in recognition of this fact that the
 Alien Property Custodian arranged for  the republication of enemy
 scientific and technical publications  during the Second World War
 so  that information on recent advances mace in enemy areas would be
 available  in libraries,  laboratories,  and industries throughout the
 country.

      A  bit of history will point up the difference between the use of
 foreign medical  and foreign political  intelligence.  In 1798, Dr. George
 Logan of Pennsylvania,  later  a United  States Senator, went to France on
 his  own private  initiative in an attempt to prevent the war threatening
 at  the  time,  and indeed,  Logan's efforts probably contributed in some
 degree  to  preserving  the peace.  His mission generated much hostile
 criticism, however, and  on January  30, 1799, the Congress passed the
 "Logan  Act"  which is  still on the statute books.  The Logan Act makes
 it a high misdemeanor for a private American citizen to correspond
 without official sanction with a foreign government about a dispute
 or controversy between  it and the United States.  In effect, the
 Logan Act assigns  the right of foreign political negotiations to the
 United  States  Government  alone,  and, therefore, foreign political
 intelligence  is  only  of value to the government.  Interestingly enough,
 Logan was also a  physician, and  neither in  1798 nor  today would there
 occur a furor  if  an American  physician  corresponded with a foreign
 physician, be he  a  government official or otherwise, concerning a dis-
 pute  over —  let us say — a  treatment of choice.  In other words, to
 the  extent ■—> and  it  is a very great extent — that health contributes
 to the national welfare and security, all those associated with the
fields  of medicine have a national responsibility.
39 
40
FREDERICK G.  KILGOUR
     Conversely, a national medical library is responsible for making
foreign medical information available to the medical professions at large.

     The fundamental significance of national health is so great that it
needs continuous re-emphasis.   Health contributes more than any other factor
to a national potential for welfare and security.  A nation with a disease-
ridden populace is a crippled  state no matter how much wealth it may have
in other resources.

     Medical advances to improve our national health are not all made in
the United States, however. Foreign discoveries are vital to us.  An
analysis of Nobel Prizes awarded in medicine and physiology indicates the
extent of American dependence  on foreign discoveries.  Figure 1 is such
an analysis that compares by decades the percentages of Prizes awarded for
American discoveries with those for foreign.  The dates of the Prize awards
do not, of course, correspond  with the dates when the discoveries were made
but a chronological charting of the discoveries yields essentially the same
pattern.  It is clear from Figure 1 that there has been a significant in-
crease in Prizes awarded for work done in the United States, but it is
equally clear that the results of foreign investigations must be available
if progress is to continue.

     In the following discussion of the value of foreign medical publications
as sources of foreign intelligence, the type of intelligence to be emphasized
will be that which bears on the formulation and execution of national poli-
cies — so-called "strategic Intelligence"; in other, words,counter-intelligence,
counter-espionage, and intelligence associated with law enforcement will not
be included.  For instance, the possible use of medical publications in
connection with eliminating illegal traffic in narcotics will be excluded
although such intelligence is  obviously of considerable consequence.

     In an admirable clarification of intelligence terminology, Sherman Kent
has called the three main forms of the strategic intelligence product "the
basic-d,escriptive form, the current-reportorial form, and the speculative-
evaluatiye fprm."1  Basic-descriptive intelligence is an encyclopedic and
detailed account of a country  including its geography, government, people,
economy, military establishment, etc.  Current-reportorial intelligence
deals with current changes taking place in a country, and speculative-
evaluative intelligence predicts events which will probably occur in the
future.

     Most sources of data employed today in constructing these forms of
intelligence are "open," despite the popular tradition that intelligence
constitutes secret and undercover information obtained in exotic if not
erotic circumstances.  Historically, intelligence activities began under
the best possible sponsorship, in the Judaic-Greco-Christian tradition at
least, for the Bible (Num. 13) records that it was the Lord who said to Mos
es 
0%L
1901-10      1911-20
941-50     1951-55
Foreign  Discoveries
American Discoveries
Figure 1:   Percentages of Nobel Prizes in medicine and physiology
           awarded for discoveries made in the United States and
           for those made elsewhere. 
&                        FREDERICK G.  KILGOUR
"Send men to spy out the land of Canaan."  Moses selected an individual
from each of the twelve tribes of Israel, and the group spied out the land
for 40 days.  One aspect of the intelligence tradition originated on thifl
mission: ten of the men gave evil reports of the land and subsequently
"died by the plague before the Lord."  One who did not give an evil report
was Joshua, later to be Moses' minister and eventually his successor.
Joshua also had occasion to use spies and R. V. Jones has described the
incidents  "You may remember that when Joshua attacked Jericho he sent
two spies to the town to obtain information.  These men subsequently took
part in the first "pick-up," or rather "let-down" operation, when they
were lowered over the side of the wall in a basket.  Unfortunately for the
tradition of secret services, where did they stay in Jericho bu/t at the
house of Rahab the harlot?  It is a tradition that dies hard."

     Millenniums after the time of Joshua, Jericho was the scene of a classic
example of the use of published material for intelligence purposes.  The
publication was the Bible; the information was not medical but combat intelli-
gence.  Vivian Gilbert has recorded^ that on 14 February 1918 General Allenby
ordered the British 60th Division to attack Jericho and drive the Turks aoroBB
the River Jordon.  It was necessary to take the village of Michmash on a high
rocky hill before the main attack could begin, and a brigade waB detached from
the 60th to take Michmash by frontal assault.  When the raid was first being
planned, the brigade major had the feeling that he had heard of Michmash,
and while reading his Bible by candle in his bivouac the night before the
attack, he located a reference to it in Samuel I, chapters 13 and 14.  The
passage described how Jonathon, son of Saul who commanded a force opposing
the PhilistineB encamped at Michmash, had gone up to Michmash one night
through a pass in the rocky headland, accompanied only by his armor-bearer
to whom he said, "nothing can hinder the Lord from saving by many or by few."
The surprise appearance of the two Israelites produced panic amongst the
Philistines, and Saul attacked them with success.

     On reading about this pass up to Michmash, the major woke his brigadier
who sent out scouts to see if the pass was still there.  The scouts located
the pass and reported it weakly held by the Turks.  The brigadier immediately
changed the plan of attack and dispatched a single infantry company to make,
as Jonathon had done, a surprise attack up through the pass.  The raid was
completely successful and every Turk in Michmash that night was either killed
or captured.

     Probably the greatest intelligence value of medical publications is for
basic-descriptive intelligence.  Here, accurate information on the health statufl
of a nation is of primary importance.  A knowledge of the morbidity and vitality
of a people is a fundamental prerequisite for an intelligence estimate of their 
STRATEGIC INTELLIGENCE
43
political, economic, and military  potential.  Public health reports from
some countries  go  far  in supplying   such  information, but it is necessary
to use  other medical data  in  the case of other countries.  In addition,
it is important to know the health agencies of a country, both public and
private,  including public  health organizations, medical schools, medical
societies, research institutes, clinics, hospitals, and pharmaceutical
establishments. The quality  of medical services, both preventive and
curative, should be known.  Information on the numbers of health workers
and, in the case of physicians, directory  biographical information should
be at hand.

     As far as  preventive  and curative medicine is concerned, it is doubt-
ful that medical publications have much to contribute to current-
reportorial intelligence.  Important  events in this area are apt to be
available sooner in the popular press.  In the case of scientific dis-
coveries with important applications  in medicine, it may well be that
information about  them would  be available  first in strictly medical and
scientific publications.

     To select  but one example in  the area of speculative-evaluative
intelligence, it is manifest  that  every strategic intelligence organiza-
tion in the world  must be  concerned with population growth and with
making  estimates of the effect of  population growth on the potentials
of the  various  countries.  The principal factor in the tremendous
population increase in the twentieth  century is the application of
scientific medicine, particularly  in  therapy.  Whereas preventive med-
icine has had less effect  in  Asian countries than in the West, modern
curative medicine  has  initiated a  dramatic lengthening of life span
in the  East.  For  instance, life expectancy at birth in India has shot
up spectacularly in the last  three decades — from 20 to 32 years.

     Population growth can improve or worsen national potentials for
prosperity and  security depending  on  other factors such as the avail-
ability of natural resources,  power,  housing, food, communications,
and the like.   Nevertheless,  the decisive  factor in this complex is
population increase, and to predict the amount of population in the
future  it is necessary to do  more  than extrapolate a curve of past
growth.  If, for example, in  a given  country the present rates of
increase of medical knowledge, medical education, modern hospitals,
availability of modern drugs,  and  numbers  of physicians and other
health  workers  are higher than the rates of the immediate past,
these factors will accelerate the  rate of  population growth in the
immediate future.  All other  factors  being equal, the total population
in a decade or  two would be higher than that estimated from an ex-
trapolated curve of past growth.   Information in medical publications
has much to contribute to such estimates,  and the type of data required
is probably more readily available from these publications than from
other sources. 
u
FREDERICK G.  KILGOUR
     In time of war the value of medical information of the types described
in the previous paragraphs is enhanced because of the imperative need for
accurate and timely strategic intelligence on the military potential of
enemy and enemy-occupied areas.   Such information takes on an additional
value insofar as it can also contribute to tactical intelligence, including,
of course, intelligence on health conditions in friendly areas where one's
own armed forces may be stationed.  Commanders and medical officers must
have continuous and accurate intelligence on indigenous health hazards in
foreign areas to preserve the health of their forces; similarly, up-to-date
knowledge of the treatment of indigenous diseases must be at hand.  A
disease-ridden military force is a liability, not an asset.

     Information in medical publications has many possible incidental in-
telligence uses in connection with military operations.  According to the
rules of war,hospitals, as well as some other types of buildings, should be
distinctively marked and all necessary steps should be taken to spare them
from attack and bombardment.  Because of the character of modern strategic
aerial bombardment and because the use of aircraft in war is for practical
purposes unregulated, little can be done to spare hospitals from aerial
bombs or guided missiles. Tactical artillery bombardment is another matter,
however, and hospital buildings can be spared destruction providing that
they can be accurately identified and providing they have not been converted
into military objectives by the enemy.  Topographic information giving the
location of hospitals is available from maps, but more detailed descriptions
can be obtained from medical publications and guide books.

     Examples of incidental intelligence information could be multiplied
ad infinitum and, in the case of "black" psychological warfare, ad nauseum.
In time of war, secret agents often have to penetrate areas where health
conditions are such that individuals must carry an inoculation record to
move about, and the regulations concerning these records change with
disease incidence.  A properly equipped agent has such documents, and
official health publications often supply the information necessary for
preparing them.

     Medical publications also yield incidental data of value to economic
intelligence; an example is information about pharmaceutical firms, which
in some countries form a significant segment of the financial structure.
According to Harry M. Berner, American hospitals constitute the fifth
largest "industry" in the United States.3  To the extent that hospitals
occupy a like position in other countries, information about their valuation,
operating costs, etc. is of use for economic intelligence. 
STRATEGIC INTELLIGENCE
45
     Although the preceding description of the intelligence uses of
medical publications has been very brief, it is adequate to suggest in
a general way the scope and coverage of an acquisition program — an
intelligence acquisition program perhaps — of a national medical library.
It is assumed that because of the security problem involved intelligence
agencies cannot give specific collection directives to the library; such
directives would reveal the agency's interests which are, of course,
confidential.  The acquisition  of foreign medical publications for the
purposes outlined above must be highly selective.  There is little to
be gained and much to be lost by having the acquisitions department go
through the sea of the world's  published materials pulling out all the
medical publications like a whalebone whale going through the ocean
straining out plankton.

     A national medical library must acquire all foreign monographs con-
taining new information, foreign periodicals consistently reporting new
information, and current abstracting and indexing journals to fulfill
its function of making new advances available.  Such publications are
in the minority, there being a  vast duplication of previously published
information.  It is, of course, well known that some medical journals
contain much more new and useful information than others, and two recent
studies have indicated the relative value and usage of journals quite
sharply.  In a study of the use of journals published in the previous
five year's, the Yale Medical Library found that, out of approximately
1,150 titles currently received (300 as gifts), it was only 40 titles
that supplied nearly half the use of such current periodicals.^

     In an unpublished study,   the Armed Forces Medical Library analyzed
the periodical titles from which 12,726 articles were photocopied on
request during two months of 1955°  The total number of journals was
1,887 of which 125 supplied 51  per cent of the requests; 34 of these
125 titles were foreign periodicals.  Some of the requests, of course.,
were for articles in periodicals no longer being published but at the
time of the study, the Library  was receiving about 5,000 titles.  This
Btudy strongly suggests that the Armed Forces Medical Library is now
receiving more than an adequate number of journals ■— but not necessarily
the right individual titles —  to fulfill the function of making foreign
medical advances available which, it is recognized, is not its only
function.  Moreover, the quality and number of journals is continuously
changing, and the acquisitions  program should keep abreast of these changes.

     For governmental intelligence purposes the library will, of course
use the monographs, periodicals, and abstracting and indexing journals
suggested above, but from most  areas it will also need dictionaries,
directories of institutions, societies, and physicians, loose-leaf
systems, government documents particularly in public health, one or two 
46
FREDERICK G. KILGOUR
current texts in each subject, and institutional and school reports con-
taining substantive and not just administrative information.  This
collection of materials should be viewed as an up-to-date reference col-
lection; materials containing older information could be safely discarded
when superseded by more recent information as far as intelligence require-
ments are concerned, but it will probably be desirable to retain them for
other purposes, particularly as historical documents.  It must be emphasized
that the timeliness of these materials is of the essence, and the library
should acquire them immediately upon publication.

     A national medical library should continue to receive the recommended
materials in time of war, and it is of the utmost importance to obtain them
from enemy and enemy-controlled areas.  War does not ordinarily come so
swiftly that it is a complete surprise, and during any period of a possi-
bility of war the library should lay specific plans for developing and
maintaining channels through which publications can continue to be acquired.
In any period of probability of war, as opposed to possibility, such
channels should be actively developed so that they will be well established
before an outbreak of war.

     This paper has presented only a very few specific examples of the in-
telligence values of foreign medical publications.  Many others could have
been included also in specific detail, but they would not have added
anything commensurate with the space taken up.  But there are some in-
telligence problems about which it seems probable that the library could
only know about or guess about in a most general way; intelligence concern-
ing biological warfare is a representative specimen from this vague area,
and there are others.  Any plans of another government for prosecuting
biological warfare will surely not appear in medical publications, but
counter measures to such action will in part depend on the availability
of a good collection of information in the biological sciences.  Here
as in other areas, it will be necessary to depend on a solid base of
scientific knowledge without knowing what knowledge is going to be needed.

     It must be realized that a national medical library will be unable
occasionally to fulfill requests for intelligence information because the
information does not exist — in medical publications or elsewhere.  It
must also be realized that occasional failure to supply data to intelligence
requests will neither jeopardize the peace nor lose a war.

     In conclusion it should be pointed out that this paper is based largely
on wartime experience which is now much out of date as far as details are
concerned.  Intelligence activities are highly dynamic, and it will be
necessary to revise continuously the details and perhaps the underlying
principles of the acquisition of foreign medical publications for intelli-
gence purposes as the information requirements change. 
STRATEGIC INTELLIGENCE
47
                            References


1.  Kent, Shermans  Strategic Intelligence for American World  Policy,
    Princeton, N.J., Princeton University Press,  1951,  p.8.

2.  Jones, R. V.s  Scientific Intelligence, Journal of  the Royal United
    Service Institution.  $2%  352-369 (August) 1947. p.358.

3.  Gilbert, Vivians  The Romance of the Last Crusade,  New York,
    W. B. Feakins, 1923, pp. 183-186.

4.  Hospitals rated America's fifth largest industry, Hospital Management,
    73?  108 (April) 1952.

5.  Yale University, School of Medicine, Yale Medical Library, Annual
    Report, 1952/53, p.5.

6.  Personal communication from Lt.  Col. Frank B. Rogers, Director,
    Armed Forces Medical Library. 
 
THE PROBLEM FROM THE VIEWPOINT OF
GENERAL HISTORIOGRAPHY
ARTHUR BESTOR, Ph. D.
     The historian is, of necessity, a parasite on other men's  activi-
ties .  He does not, qua historian, govern nations; he finds  out how
other men have governed them.  He does not write poetry or dissect
cadavers or till the soil; he analyzes the work of those who have
done so.  Hence he cannot gather his materials in the laboratory or
the field, he can only use the records that other men have made or the
documents they have accumulated—  for their own purposes, not  his.
He goes to the library not to prepare for his research, but  to  carry
it out.

     Though a parasite, the historian 1b a rather spectral one. He
doeB not interfere in the everyday lives of men.  If he affeots them
at all, he does so by haunting them.  Like Dickens' Ghost of Christmas
Yet To Come, the historian suddenly appears out of the void, uttering
sepulchral warnings about the opinions of posterity.  The apparition
is particularly frightening to librarians and archivists, who,  having
done their jobs well, do not relish being remembered only for the
records they may have inadvertently allowed to perish.  When meeting
in an ancient edifice like this, we are doubtless wise in attempting,
bb part of our proceedings, to exorcise whatever spooks may  be  wander-
ing about the garrets—inoluding the Bpook of General Historiography.
I am here to offer my services as exorcist.

     The question put to me I take to be this:  After all the materials
needed for current medical research have been provided by the national
medical library, after even the needs of medical history have been met,
is there something else which the future historian of things in general
will expect the library to have preserved that it might, without his
warning, have been tempted to discard?  This is a fair question to aBk
of the historian.  And it is fair also to remind him that he, in common
with the rest of mankind, has no right to aBk for the moon.

     The question is not one the historian is accustomed to  think about.
He is obliged to use remains and records as he finds them.  It  is almost
as strange for him to think of having a hand in determining  how the
deposits shall be laid down as it would be for a geologist to imagine
himself controlling for Mb own convenience the forces that  produoe  and
uncover the strata he studies.  The situation, it is true, is ohanging.
49 
50
ARTHUR BESTOR
In archival work, particularly, historians have been given an opportunity
to engage in a certain amount of planned parenthood.  Moreover, the enormous
growth in bulk of contemporary documentation has forced historians—to the
laceration of their deepest instincts—to face the awesome responsibility of
sanctioning the destruction of superfluous and peripheral records.

     Even so, the experience of historians with the selective preservation
of records is so new that little has actually been written on the general
issues involved.  Manuals of historical method deal principally with the
problem of extracting the last droplet of meaning from a scanty array of
documents.  The great tragedies of historiography revolve about the destruc-
tion of records.  The historian's occupational hazard is normally the
paucity of sources; only occasionally is he confronted with material so
richly voluminous that he must apply sampling methods borrowed from workers
in other fields of research.  In general, the historian's first impulse is
to says  Collect everything and preserve everything.  If he were asked to
nominate a sacred bird to perch upon the lintel of a library, he would
probably choose not the owl but the magpie.

     In point of fact, however, the historian is not really as interested
in the indiscriminate preservation of materials as he is apt to imagine
himself to be.  To discuss intelligently the questions raised by the present
symposium, it is desirable to look at the actual facts about how the his-
torian normally gathers his material.

     The first fact I would emphasize is that the historian does not in
actuality work with isolated documents, he works with collections and with
series.  Every historian can remember coming unexpectedly upon some isolated
document—a single letter that cleared up an important point, or an obscure
pamphlet or newspaper that had hitherto eluded discovery.  The excitement
of such a find often leads him to exaggerate its importance in the total
pattern of historical investigation.  Research is actually more prosaic
and more planned.

     In embarking upon a new topic the historian engages in a series of acts
of imaginative historical re-creation.  He tries to imagine what records
would have been produced in the course of the events he wishes to study
And he asks himself where these records are most likely to have been pre-
served.  He is apt to make a number of lists, on paper or in his heads
lists of persons who were participants in the events he plans to discuss,
of agencies of government or private organizations that were involved  of
localities in which important activities took place, of organs of news and
opinion that were likely to have been used by or to have taken notice 0f
the movement in question.  Lists like these tell him where it will be worth
his while to look for source materials.  Accordingly he compiles bibli0"
raphies of writings by and about the persons on his list, and he attempts 
GENERAL HISTORIOGRAPHY                  51
to locate their private papers.  He searches for reports, proceedings,
and other publications of the agencies or institutions that were con-
temporaneously interested in the matters under investigation, and he
takes note of the archival repositories in which their records might
have been preserved.  He gives close attention to the geographical
locality where the events occurred, examining regional collections of
manuscripts and printed materials, noting newspapers published there,
and weighing the possible value of the legal records on file in county
courthouses.  Finally, he looks into the contemporary periodicals that
were especially concerned with the matters at issue, and the metropolitan
newspapers that might be expected to give them attention.  It is in
obvious and predictable places like these that the historian must, in
general, expect to obtain the overwhelming bulk of his documentary evi-
dence.

     To verify what  I have just said, I have found it instructive to
analyze the documentation of one of my own monographs.  In the footnotes
of two selected chapters I counted a total of 581 direct references to
original sources.   Approximately half the citations (276, or 48 per
cent) were to works  generally available in large libraries or (in the
case of metropolitan newspapers) easily located through published union
lists.  The remaining 305 references were to sources of a more esoteric
character, which had to be sought in specialized repositories.  Some
158 citations (or 27 per cent of the whole) were to books, pamphlets,
and periodicals directly connected with the movement about which I
was writing, and these could be found (in anything other than scattered
samples) only in certain specialized collections in the field.  Another
105 citations (or 18 per cent of the whole) were to local newspapers
and archives, to manuscripts preserved in the locality where the events
took place, and to the private papers of the leader of the movement
(a collection preserved intact, though at some distance from the scene).
The remaining 42 citations (only 7 per cent of the whole) included all
instances of documents that were located through persistent search of
less likely locations and through occasional happy discoveries—some
29 references to local manuscripts scattered in other than local re-
positories, ten references to manuscripts that were found among the
papers of persons connected in no special way with the movement or
that stood in complete isolation, and three references to rare pam-
phlets that actually turned up in general collections.  I am not
concerned at this time with the difficulty of utilizing many of these
materials, nor with the disproportionate pleasure that some of the
discoveries gave me, nor even with the qualitative value of the various
kinds of sources.  I am simply offering a slight piece of quantitative
evidence to buttress my statement that the historian usually knows—
indeed, must know—where, in general he is likely to find the bulk of
his evidence, if any evidence still exists.  And I am illustrating the
point that relatively little material does in fact turn up in places
other than those where the historian would logically expect to find it. 
52
ARTHUR BESTOR
     The moral of all this,  for the present symposium,  can be simply put.
The historian turns to any repository—library,  manuscript collection, or
archive—because of what he knows to have been its main interest and its
main activity.  He does not go to it—or very rarely does he do so—in
the hope of discovering something that was quite unconnected with this
main activity but that might, by some odd chance, happen to have been
preserved there.  By and large the historian cannot afford to work a vein
of ore unless it has a high enough assay to promise at least some margin
of profit.  To be specific, the general historian is not likely to use
the Armed Forces Medical Library unless his subject is in some way
connected with medicine—either because physicians were involved in the
events he is examining, or because some general idea in which he is
interested had (or might have had) some impact on medical thinking, or
because some other element in his problem would suggest that an out-
standing medical library would be the logical place to look for substan-
tial bodies of relevant evidence.

     By and large, any library in a technical field is doing its full
duty to general historiography by simply continuing to be a great, open-
minded, imaginative library in its own field.

     I hope these words of mine will lay the ghost that flitted through
my opening remarks.

                                    II

     The  ephemeral material that comes into a great research library—
publications  related  to the subject-matter of the library but of small
use for current  scientific research—poses certain problems which an
historian may properly be asked to help solve, for he is the most likely
potential user of  the material.  To this problem I should like to address
myself  for a  few minutes.

     Acquisitions  policy, of course, is the subject of this symposium.
So far  as ephemera are concerned, however, the question of acquisition
cannot  be separated from the question of classification and cataloguing
and from  the  question of the form of ultimate preservation.  The mere
acquisition  of ephemeral publications involves relatively little expense;
the heavy costs  arise in processing and preserving them.  These costs can
be so  large  as to  be  prohibitive.  On the  other hand, ephemera  if not
collected as  they appear are almost impossible to acquire later.  For
these reasons, policy with respect to the  acquisition of ephemeral
material  is  necessarily a  function of policy with respect to classification,
cataloguing,  and preservation.

      To begin with,  let me remind you that the  elaborate bibliographical
procedures  of a modern library-—minute  classification,  preparation  0f
subject-entries, indexing of periodicals,  and the  like—are  designed  to
give  control of the collection for  the  purposes  of current research. 
GENERAL HISTORIOGRAPHY
53
The historian makes  full use  of the  resulting reference tools when he
wishes  to  locate works  about  history.   In  his quest for source materials,
however, this great  apparatus is of  very much less direct use to him.
As I  have  said  in  an earlier  paragraph,  the  historian commences his
real  research,  not by consulting a subject-entry as one would normally
do in a piece of scientific  investigation, but by mapping out the whole
terrain of possible  sources.   He thinks  in terms of types of material,
and he  expects  to  page  through each  body of  relevant documents looking
for scattered clues, which he must recognize for himself with only
very  occasional aid  from  indexes.

      Though the historian  is  grateful  for  every finding-aid that exists,
he recognizes,  as  the very condition of his  professional work, that no
comprehensive and  detailed bibliographical control of the source mate-
rials of history is  even conceivable.   For one thing, his potential
sources do not  constitute  a  limited  class  of materials; they are, in
theory, coextensive  with all  man-made  recordss  printed publications,
manuscripts, inscriptions, even artifacts.   For another thing, each
topic of investigation  is  sui generis.   In historical research a truly
original contribution arises  from the  discovery of new implications
in material that may or may not have been  consulted before.  The his-
torian, in other words, is frequently  looking for precisely the things
that  an indexer (if  he  worked on the materials at all) would not have
been  alerted to record.

      As a  consequence,  materials preserved primarily as sources for
historical investigation require quite  different—that is to say,
much  simpler—handling  than publications collected in aid of current
research.   The  difference  is  reflected  in  the procedures employed
by the  custodians  of material whose  almost exclusive use is historical—
namely, manuscript collections and archives.  Let us note the salient
differences.

      In a  library  the unit is the book  or, at the largest, the serial.
In a  manuscript repository or an archive,  the unit is the collection,
that  is, the papers  of  so-and-so, or the records of such-and-such a
governmental agency.

      In a  library  it is assumed that each  book or serial can be classi-
fied  by subject (even though  the subject,  in some instances, must be a
very  inclusive  one).  In repositories of manuscript materials, subject-
classification  is  virtually impossible and hence virtually unknown.
Archival order  follows  the table of  organization of the government or
institution that produced the records.   If this amounts to an ordering
of materials by subject, it is  simply and  solely because particular
agencies and offices  happen to have  been responsible for particular
matters or subjects.  In a manuscript repository, the collections,
which are the units,  assume an alphabetical  order in most guides, and 
54
ARTHUR BESTOR
their subjects are brought to attention, if at all, only in the descrip-
tions (necessarily impressionistic) that may be given of individual
collections.

     If a collection of books is compared with a collection of manuscripts,
striking differences in the method of internal arrangement are obvious.
A collection of books is ordered according to the logic of the subject
with which it deals, and chronology plays very little part in the arrange-
ment.  In manuscript collections (other than archives) chronology is the
be-all and end-all of classification.  Even in archives, once^one reaches
down to the level of a particular agency, chronology is likewise the
controlling factor in arrangement.

     The methods of handling manuscripts and archives are perhaps too well
known to have required restatement here.  These particular contrasts,
however, need to be borne clearly in mind, because out of a consideration
of  them can come, I believe, a possible solution to the problem of dealing
with ephemera.  May I repeat my earlier definition of the latter terms
 "publications relating to the subject-matter of the library but of small
use for current scientific research.**  Since these materials are to be
 preserved  primarily as historical sources, why should they not be handled
 as  much as  possible like manuscripts and archives, which are likewise
 preserved mainly for historical purposes?

     Allow me to describe a procedure that would appear to me both satis-
 factory and feasible.  As current materials reach the library, a decision
 ought  immediately to be made which would separate out those materials
 that are  of small use for current scientific research but are yet clearly
 related to the subject-matter of the library.  Some of these might be
 bound  volumes, but most would be pamphlets, broadsides, and mimeographed
 documents—the materials suggested by Colonel Rogers' phrasing of the
 problem  in the opening paper todays  "which mimeographed annual reports
 of which  of thousands of provincial hospitals...; which popular pamphlets
 on tooth-brushing,  fly-killing, or toilet-training; which weekly sheet
 of morbidity  statistics from which obscure counties."

     Once these materials have been separated out, all thought of apply-
 ing to them even  a  simplified form of cataloguing ought to be abandoned.
 They are  thenceforth to be handled according to the procedures appropriate
 to manuscripts, where even an author list is ordinarily impracticable.
 They should,  it seems to me, be sorted roughly by subject, employing,
 perhaps,  the  grand  divisions of the library's classification scheme-
 that is,  the  divisions  indicated simply by the two-letter element at
 the beginning of  the class-mark.  During the year, the materials in  each
 broad  class would accumulate in boxes, to be consulted  in their unarranged
 state  by  readers who might need to do so, but who would have to be pre-
 pared  to  search  out for themselves the  particular  items they desired. 
GENERAL HISTORIOGRAPHY
55
     At the end of the year, the accumulated material in each classi-
fication would be put in proper order.  Misfilings would be corrected,
duplicates and obviously worthless materials discarded, and a few
important items withdrawn for regular cataloguing.  The balance would
then be sorted into three or four groups.  Pamphlets published with
the author's name would form one group, the items to be arranged in
alphabetical order.  Reports and other publications of institutions
and minor governmental agencies would form a second group, to be
given a geographical arrangement.  Anonymous materials, forming the
third group, would be arranged alphabetically by title.  Certain
special types of ephemera, such as commercial promotional literature,
might constitute a fourth group, to be preserved only in a represen-
tative sample—say, the material received during one calendar month.

     A standard form would be filled out for each collection so
arranged, giving the classification name and number and the year,
describing the quadripartite arrangement of the material, and if
possible listing the names of the authors (but not the titles) of
the publications included in the first of the four groups.

     The whole collection would next be microfilmed, with the des-
criptive form at the beginning.  The original materials could there-
after be discarded.  Entries would be made, for the collection taken
as a whole, in the dictionary catalogue (under appropriate subjects)
and in the shelf-list.  The descriptive forms would be placed in
loose-leaf books, for eventual binding, to serve the convenience
of persons consulting the microfilms.  The job would then be done.

     Under such a system, be it noted, the decision that a given
document possesses little value for current research is not an
irrevocable decision, for the text has not been lost.  If need be,
positive prints can always be made from the film and any given
document, in photographic form, put through regular and complete
cataloguing procedures.  In the meantime neither the shelves nor
the card catalogues are being cluttered up with masses of material
of marginal value.  As experience is gained, moreover, the library
may discover that it is feasible and safe to treat an increasing
number of minor publications in the way suggested.

     The savings of expense in processing and of space in storage
are so obvious that I need not dwell upon them.  The fundamental
question is whether such a handling of ephemeral materials can
satisfy the legitimate demands of scholars.  I believe that it can. 
56
ARTHUR BESTOR
     If a scientist engaged in current research has need of any of the
materials preserved in this way he will, of course, lack the guidanoe of
the normal apparatus of catalogue-entries, indexes, and abstracts.  But
he will find the material in excellent order, classified by large divisions
of the subject, and arranged in such a way that authors and geographical
areas can be quickly located.  He will encounter no difficulties except
those that must always be expected when one ventures among materials
admittedly peripheral.

     The historian, moreover, will find the materials in fully as usable
a state as those he normally encounters in manuscript and archival collec-
tions.  His sense of chronology is fully satisfied, since each film
represents a single year.  The inclusive classifications employed are
more useful to him than detailed ones would be.  If his approach is
biographical, the checklist of authors provides the needed key.  If he
is interested in a geographical region, he can quickly turn to the offi-
cial and quasi-official sources emanating therefrom.  If he wishes to
use a sampling technique, he has the whole to choose from.  And if he
must run down an isolated publication, he has a far better chance of
succeeding because of the systematic way in which the material has been
assembled and preserved.

                                     Ill

     The third question which I wish to discuss is policy with respect
to the acquisition of older publications in the field, materials primarily
if not exclusively for the use of historians.

     Here again it is impossible to separate acquisitions policy from
policy with respect to classification and cataloguing.  The reasons,
however, are not those of expense, which arose in connection with ephemera.
There are two deeper reasons why the policies of acquisition and of classi-
fication are inseparable in connection with older books.  In the first
place, unless it is perfectly clear how historic materials are to be
arranged and used, it is impossible to state any criteria, short of abso-
lute completeness, for deciding how extensive the collection in itB
various parts ought to be.  In the second place, an inadequate scheme
for classifying older works will put on the shelves, alongside and
mingled with the works needed for current research, a vast quantity of
books that are obsolete for the purpose.  To the active scientist such
acquisitions will appear nothing but a costly nuisance.  Even the historian
will be needlessly hampered in locating works of the period in which he is
interested.   In both instances, support for a thoughtful acquisitions
policy will be lacking.

     A somewhat extended discussion of the problem of classification is
therefore necessary,  distant though it may seem from the announced subject
of the present symposium. 
GENERAL HISTORIOGRAPHY
57
     Library classification and cataloguing crystallized in modern form
some seventy-five  years  ago, at the very time that modern research
scholarship  wsb  developing its present institutional character and be-
ginning  its  enormous  expansion.  The opening of the Johns Hopkins University
in 1876,  a landmark in the history of organized research, coincided with
the first edition  of  Melvil Dewey's work on decimal classification and
followed by  a year Charles A. Cutter's Rules for a Printed Dictionary
Catalogue.

     The impressive thing, to that generation, was the cataclysmic change
that was taking  place in the nature of scholarly and scientific research.
The older work in  every  field was being rapidly outmoded, not so much by
the normal attrition  of  time as by the revolution in method, which was
making research  professional and highly specialized.  The ambitious
"general" works  of the past—  wide-ranging and diffuse, presenting
brilliant insightB on some matters and covering otherb in woefully un-
critical fashion— stood in sharpest contrast with the new kind of
monographs,  which  aimed  to be precise and never to go beyond the limits
of its explicit  documentation.  The gulf that separated the old and the
new seemed so great that most schemes of classification made "Early
works" a distinct  category.  The implication was that, though the pro-
ducts  of the new scholarship might eventually grow out of date, they
would  differ,  even in their obsolescence, from the works of all earlier
generations.   As a consequence, classification schemes made no real
provision for the  gradual outdating of modern works, except through
wholesale reclassification at some future time.

     It  is no reflection on the founders of library scienoe that they
failed to foresee how  much more rapid than before would be the processes
of obsolescence.  Experience has shown us (though we have hardly mastered
the lesson)  that "Early  works" do not constitute a fixed classification
but one  that hungrily devours the books in every class in the schedule.
It is  amusing to note, for example, that in the 1910 edition of the Li-
brary  of Congress  classification for medicine, the class-mark RD30
denoted  early workB in surgery 1& 1800.  In the 1952 revision, the same
olaBB-mark covered general works in surgery i£ 1900.  The 1951 classi-
fication schedule  of  the Army Medical Library, pushed "Nineteenth
Century  Titles"  on to include publications through 1913.  And the Armed
ForceB Medical Library Catalog at present limits subject entries (with
certain  exceptions) to titles published since 1224«   These are not
Btrictly comparable instances, of course, but they all point the same
morals   Time marches  on.

     Speaking  as an historian, I would say that libraries have never
really reokoned  with  the significance of time in planning the classifi-
cation of libraries.   Books do not become out of date because of some 
58
ARTHUR BESTOR
great cataclysm of scholarship; they grow old, as all things grow old,
gradually, naturally, and in many instances gracefully.  They cease from
active striving with the oncoming generation of books, and retire to the
companionships of history.

     In less metaphorical language, books in every separate class in the
library are being pushed aside, for the purposes of current research, by
newer books.  Eventually all the books we now possess will be of interest
primarily, indeed exclusively, to the historian.  Can we not find a way
of embodying this inevitable fact in the very framework of our systems of
classification, so that it can be dealt with in an orderly fashion?  I
believe that we can, and I should like to offer, with the diffidence proper
to one who is not a librarian, a few observations on the matter.

     The call-number of any book, according to present practice, consists
of two parts s  a class-mark that groups together the books dealing primarily
with the same subject, and a book-number that determines the actual shelving
of the various books belonging to a given class.  The latter is usually an
author-number, that is, a number which automatically arranges the books
within a class alphabetically according to authorship.  To distinguish
between editions of the same work, the date is frequently given as a third
element of the call-number.  In certain libraries, notably the Armed Forces
Medical Library, the date is an integral part of the call-number of every
book, following the author number.  The number of libraries that follow
this practice uniformly is, however, exceedingly small.

     The effect of the existing system, as I have described it, is, of
course, to arrange the books on the shelves by classes, and within the
classes to arrange them in strictly alphabetical order, regardless of date.
The result, I maintain, is satisfactory neither to the research worker
interested in the current literature of the subject, nor to the historian,
nor even to the librarian.  No matter where one looks—on the shelves them-
selves, or in the classified catalogue (that is, the shelf-list), or under
a given subject-heading in the dictionary or subject catalogue—one encoun-
ters the same indiscriminate mixture of new and old books.  Whether one is
looking for the most recent works or for those belonging to a given period
of time, one must follow the same laborious procedure of examining every
title in the group, from A to Z.  The only way obsolete books can be
separated from current ones is by reclassifying them, that is, transferring
them to an entirely different class consisting of 88Early works."

     To grasp what is wrong with this system, we must go back to first prin-
ciples.  Let us consider primarily the scientist or scholar who is advancing
current knowledge, and who is therefore interested in the latest results  in
the various fields that can be expected to contribute to or impinge upon  his
own investigation.  The research library ought to serve him in both a positive
and negative way.  It ought to put him in immediate touch with the latest
publications on his particular topic and on related topics.  On the other hand
it ought to save him, as much as possible, from the labor of examining j^ 
GENERAL HISTORIOGRAPHY
59
 of  irrelevant material.   Classification is  supposed to perform both
 functions,  but  the present  system does  so imperfectly.  As material
 accumulates in  a  given class,  the latter must  ordinarly be subdivided.
 This  increases  both the difficulties  of cross-reference and the risk
 that  the  research worker will  overlook  important  publications related
 to  his work but included in a  different classification.  Moreover, the
 saying of the research worker's  time  is largely  illusory.  If he con-
 scientiously examines  all the  new subclasses,  he  goes through just
 as  much material  as if no subdivision had taken place.

      The  fact of  the matter is that the scientist or scholar engaged
 in  current research is swamped,  not by  the  material that is slightly
 off his subject,  but by the mass of material that is obsolete for his
 purposes.   And  the minute subdivision of classes  does nothing to help
 him in this respect.

      The  solution is not continuous reclassification of older material
 into  separate categories labelled "Early works."  The cost alone would
 be  prohibitive.   Moreover,  the decisions that  would have to be made
 (except,  perhaps,  with regard  to really ancient works) are ones that
 the librarian is  not in a position to make  and ought not to undertake.
 Only  the  actual investigator,  after all, is capable of deciding, in
 any instance, how far  back  in  time he ought to carry his examination
 or  work previously done.  In some investigations, the two or three
 preceding years may embrace all  that  is relevant.  In other research,
 the work  of a century  ago may  provide essential clues.  No librarian
 can possibly make this decision  for the scholar,  nor should any rule
 of  library classification be based on the assumption that he can or
 should do  so even approximately.

      The answer,  as  I  see it,  is  not  to be  found  in a further elabor-
 ation of subject  classification,  but  in a full and frank recognition
 of  time as  an independent factor  in classification itself.  Classi-
 fication,  in other words, must be conceived of as a function of two
 variabless   subject and  date.

      This  can actually be done by a relatively simple alteration of
 current practice.  The call-number need simply be thought of as
 comprising  three  distinct and  equally important elements, instead
 of  two.  First would be  the  class-mark;  second would be the date;
 third would be the author-number.   The date,  in  other words,
would not be a mere subordinate modification of the author-number,
but an independent classificatory element,  universally employed, and
taking precedence  over the author-number.^  Finally, dates should be
handled,  both in filing and  shelving, in reverse  chronological order. 
60
ARTHUR BESTOR
     The automatic result of such a system would be this:   Within each
class the latest books would be placed first on the shelves and would
appear first in the classified catalogue or shelf-list.   After them would
come books of various degrees of obsolescence.   And at the end of each
class one would reach the very beginnings of the subject,  where the books
would be of interest only to historians.  The research worker could examine
the literature back as far as seemed relevant to the problem in hand with-
out finding himself burdened with earlier titles.  The historian could
define his period and find together on the shelves the works appropriate
to his investigationo

     One other step should be taken to round out the plan.  Subject-entries
in the card-catalogue should also be arranged in reverse chronological
order.  If the date of publication were to be typed as the final element in
the subject-heading of each subject-card and reverse-chronological filing
prescribed, this desired result would automatically follow.  A person
consulting the subject-catalogue would then be confronted first with the
latest works, instead of being required to thumb through what sometimes
amounts to a trayful of cards.  And the historical investigator could
quickly turn to the works of the period with which he happens to be con-
cerned.

     Time is a continuity, and the proposal I have made treats it as such.
Use  of a category like "Early works" means dealing with time, unrealisti-
cally, as a succession of discontinuitieso  Actually the category "Early
works" is an anomaly in any logical scheme of classification by subject.
Chronological divisions are logical when one is dealing with books about
a  given period, for then the period ig, a subject.  An early book on
anatomy, however, is not a work on the history of medicine°} it is, always
and  forever, a work on anatomy, even though It may be of interest only to
an historian of medicine.  Bocks about a specific subject do not logically
belong to different classes simply because they were published at different
times.  As a practical matter, moreover, if one treats the classification
of a book as something that automatically changes with age, one inevitably
implies that all  the older books in a library must be periodically re-
classified—  a portentous prospect.

     The proposed system could be introduced at any time, without disturb-
ing  the existing  collection.  One need only adopt the simple rule that
books with a tripartite call-number (that is, a call-number including the
date as its second  element) should be arranged, in each class, ahead of
those with bipartite call-numbers,  Immediately the latest books would
appear at the beginning of each class.  With the passage of time, and
without any renumbering of earlier acquisitions, the current literature
would all become  accessible according to the new plan.  The renumbering
of the  older books  would be relatively simple, for it would normally in.
volve only the  insertion of the date between the two elements  of the
existing  call-number.  And such renumbering might be postponed without
causing the historian a whit more difficulty than he actually  encounters
at present. 
GENERAL HISTORIOGRAPHY
61
     The physical accessibility of the books might well be improved by a
system like this.  There would be nothing unfeasible about shelving all
books since a certain date  (varying, of course, with the class) in the
most convenient  part of the library (perhaps even on open shelves).
This would bring current books in all classes much closer together,
making consultation and cross-reference far easier.  The older works
could then occupy a predominantly historical section of the stacks, being
brought there merely by periodic reshelving without reclassification.
In general libraries (as distinguished from research collections), more-
over, the withdrawal of obsolete books would be a much easier task than
at present.

     The matter  of bringing the historical parts of the collection together
in a special part of the stacks deserves a word or two of elaboration.
Such stacks might adjoin a  special historical reading room, where works
on the history of medicine  (a genuine subject-class) could occupy open
shelves.  At regular intervals, books before a certain date (recognizable
from the call-number alone)  would be moved from the stacks assigned to
current and recent materials to the shelves of the historical stacks,
without the necessity of calling upon professional cataloguers for addi-
tional services.  Within the historical stacks, divisions could, if
desired, be set  up according to centuries, and the books would go to
their proper places On the  basis of the call-number alone.  Within each
century, moreover, the books would preserve their articulation into
subject-classes.

     Such a system as the one here proposed might also lighten the burden
of preparing, revising, and using the classification schedules themselves.
Obviously new subjects of investigation must be recognized by continuous
interpolations in existing  schedules.  On the other hand, minute sub-
division is often a response simply to the problem of quantity rather
than to the necessities of  logic.  Materials accumulate to unmanageable
proportions in certain inclusive classes, and subdivision of the latter
seems the only answer.  Actually minute subdivision has serious drawbacks,
for it arbitrarily separates materials that are closely related to one
another and thus hinders the cross-fertilization of ideas.  If quantity
could be kept manageable, most research workers, I believe, would prefer
more inclusive classifications to narrower ones.  A chronological arrange-
ment within each class would keep quantity manageable, for it would
automatically enable a research worker to eliminate from consideration a
vast quantity of obsolescent material and thus to cope with current
materials extending over a  considerably broader field.  Broad and inclusive
classifications could thus be maintained in a research library, and the
fragmentation of knowledge that results from minute subdivision could be
healthfully checked. 
62
ARTHUR BESTOR
     How should old books newly acquired be classifieds  The existing practice
of the Armed Forcefl Medical Library points the way.  All books published
between 1801 and 1913 are now classified according to subject, but the classi-
fication scheme is simplified.  In the complete schedules for current books,
the class-mark consists of two letters followed by numerals. . In the. simplified
soheme for nineteenth century publications, only the letters are uBed (with
certain exceptions and modifications).^  The highly commendable result is
that the same general outline of classification is used for both current books
and older ones, but subclassifioation is dispensed with for the latter, as
befitB a period when specialization was less intense and publications less
numerous.  In my judgment the system should be pushed back to earlier centuries,
with increasing simplification of schedules, instead of placing all books he-
fore 1800 in the classes WZ220, WZ230, etc., which consist of "Early printed  ,
books," arranged by oenturieB, forming subclasses under "History of Medicine.^

     The question of the date to be used in classification would require some
formulation in rules.  Works published in modern times in the United States
should undoubtedly be classified by oopyright date, which is, of course,
altered for eaoh new edition.  This would bring the latest revised edition to
the forefront.  For other countries, imprint date would have to be employed.
For books before 1800 it might be desirable to use, not the date of the Imprint,
but the date of first publication of the work in question.  This would bring
the various editions of the work together, and would enable the student to
find at least one edition under the date of the edltio princess.  For books
written before the beginning of printing, the date (or perhaps merely the
century) of composition would obviously be more appropriate than the date of
publication.  The fact that the system would separate the successive editions
of a given work, and a. fortiori the different books on the same subject by
the same author is, to my mind, a very minor disadvantage in all scientific
fields— perhaps in all fields except literature itself.  One must remember
that the author oatalogue of the library already provides fundamental bibliog-
raphical oontrol of the collection as a whole, and that all the works of a
given author (inoluding editions and translations) are grouped together there.

     Needless to Bay, serial publications (inoluding journals, proceedings of
societies, and the like) would not inolude the element of date in their oall-
numbers, for continuous publication precludes the idea of assigning a single
date (even the date of founding) to the series as a whole.  Alphabetical or
geographical arrangement is obviously called for in olasses oomposed of serials.

     I apologize for this long excursion into classification, in a paper that
was supposed to discuss acquisition.  In justification I would say only this.
Books are acquired so that they may be used.  One oan hardly have a sound
polioy for acquiring them, without having also a sound plan for UBing, and
henoe for arranging, them.  So long as time is treated as discontinuous, so
long as "Early works" are relegated to a oIbbb by themselves, the acquisition
of historic materials is bound to appear a kind of aberration.  Acquisitions 
GENERAL HISTORIOGRAPHY
63
policy can amount to little more than an attempt to answer the questions
How far can we afford to indulge ourselves in the luxury of antiquarianism?

     If, however, we look upon time as continuous, if we think of the body
of current knowledge as slowly receding into the past but preserving its
own inherent structure, then we will think of historic materials not as
scattered relics, but as parts of a living, articulated collection.  Ac-
quisitions policy then becomes something different from a mere policy
toward rare books.  Its criteria with respect to older works become
essentially the same as for current publications.  The ideal of the
library will be to build up, for each period of time, a well-rounded
collection, presenting the state of knowledge of the time.  Because even
the earliest books are being regularly classified by subject, gaps in the
collection will be spotted, not in terms of rarities that are missing,
but in terms of subjects that are poorly represented.  The librarian
should find it possible to work out, for past periods as well as for the
present, definitions of "scope" and of "levels or degrees of coverage,"7
and should be able to apply them to the various classes within the his-
torical sections of the library.

     The historian, after all, has no more use for disjecta membra than
any other scholar.  When, by mental effort, he translates himself into
the past, he is not looking for curiosities and rarities, he is trying
to comprehend the organized world in which the men of the period lived.
He is interested in their knowledge as organized knowledge, their ideas
as articulated ideas.  A library which can provide him with a well-
balanced collection of books of the period, chosen so as to be repre-
sentative in range, and classified according to a logical scheme (even
if not precisely the scheme that contemporaries would have used), is
offering the historian everything he can properly wish for.  If a li-
brary, in its historical acquisitions policy, is guided by such a
concept of its purpose, then the requirements of general historiography
can hardly fail to be met in abundant measure.
                                   Notes


     1.  Arthur Bestor, Backwoods Utopias (Philadelphia, 1950), chapters
5 and 7.  The 581 references included 120 to manuscripts, 219 to articles
in contemporary newspapers and magazines, and 242 to books and pamphlets.

     2.  Compare Library of Congress, Subject Cataloging Division, Classi-
fication R, Medicine (Washington, 1910), p. 65? idem (3rd ed., Washington,
1952), p. 89$ Army Medical Library, Classification. Medicine (Washington,
1951), pp. 9, 12; Armed Forces Medical Library, Catalog. 1953 (Washington,
1954), Po Hi. 
64
ARTHUR BESTOR
     30  In an institution like the Armed Forces Medical Library, where the
date is already an integral part of every call-number, the effect intended
could be brought about, of course, by establishing the rule that in shelving
and filing, the date is to take precedence over the author-number.  The risk
of accidental misshelving would be considerable, but if newly acquired books
were to be regularly marked in the new way, the staff would habitually look
for the date as a second element in shelving, and mistakes with older books
would probably become few.

     4.  The principle is precisely the same as that embodied in the book-
numbers devised by Andrew Keogh for the Yale University Library, and used
since 1908 for certain classes for books there.  "The Keogh number is ...
composed of the last three digits of the date of publication of the book
plus (usually) the initial letter of the author's surname.  A typical call
number  is Ukul5 / 918B (in two lines).  With this notation it is at once
indicated that the book was published in 1918 and that the author's name
begins  with  'B.' ...  If it is desirable to keep editions, translations,
and related material together—  and this is the accepted practice in the
social  sciences and humanities—  then the imprint date of the first edition
is used as the basic number and supplementary letters are added to the
author's surname initial, as  'b' for second edition or 'h' for French
translation.  If a strict publication-date arrangement is more desirable —
as  in  the sciences and technology <— then the book number incorporates the
imprint date  of the particular book, irrespective of edition or translation.
(Jennette E.  Hitchcock, "The Yale Library Classification," Yale University
Library Gazette, vol. 27, pp. 103-104; Jan. 1953.)  This admirable system
was in part a response to "an ever-present desire for a chronological
arrangement"  (ibid.P p. 99) expressed by many members of the faculty.  This
desire  (as I  am trying to make clear in the present paper) is a natural and
logical one for research scholars to feel.

         For  another system of book-numbers based on date, see the descrip-
tion of Biscoe time-numbers in Melvil Dewey,  Decimal Classification and
Relativ Index (13th ed., Lake Placid Club, N0Y0, 1932), II, 1643.

     5.  Armed Forces Medical Library, Army Medical Library Classification
... Additions and Chpnppa. List No. 3,Sept. 1953 (mimeographed): "Special
Scheme  for Nineteenth Century Publications."  The modifications are that a
third  letter  is sometimes added, to subclassify works, but on a less ela-
borate  scale  than is done by the numbers of the complete schedule.  The
exceptions are the continued use of a few subclass if icat ions denoted by
both letters  and numbers, especially for such types of materials as direc-
tories, periodicals, etc., which should obviously be kept together.  This
scheme  represents a simplification of that of 1951, which prescribed that
certain numbers only of the full schedule were to be applied to nineteenth
century titles. 
GENERAL HISTORIOGRAPHY
65
Under this previous plan, for example,  current  books about the "Ear"
were to be subclassified in considerable detail,  but only the two
classes "General Works" (WV200) and "Deafness"  (WV270) were to be
used for works published between 1801 and 1913.  Army Medical Library,
Classification. Medicine (Washington, 1951),  pp.  9, 12, 183-184.

     6.  Army Medical Library, Classification.  Medicine (1951), pp. 12,
202.

     7.  See Armed Forces Medical Library, Library Manual B-5. Scope
and Coverage of Collections (mimeographed, Washington, 20 December
1955), p.l, where levels or degrees of coverage are defined for
"skeletal," "reference," "research," and "exhaustive" collections. 
 
DISCUSSION
Dr, Saul Jarcho.  Dr. Homer Smith has proposed, albeit facetiously,  a
policy of what might be called limited incendiarism for library collec-
tions.  Even as a jest or fantasy this suggestion is horrible to
contemplate.  We live in a century which more than once has witnessed
the burning of books.  Such methods, once introduced, could prove un-
controllable, and I fear that the idea is not merely iconoclastic but
potentially anthropoclastic.  Therefore I wish to record 100 percent
disagreement with it.

     Dr. Smith has moreover asserted that the practice of historical
study is a neurosis.  I do not know whether this diagnosis is correct
but I would be willing to be neurotic in the company of Polybius,
Gibbon, and Ranke.

     My discussion this afternoon will deal with the question of what
the clinician wants of the medical library and will be a vote for a
policy of intensive coverage in the clinical field.  The following
comments are generalized impressions based on prolonged casual
observation and not on systematic survey.

     The general practitioner's ordinary medical reading consists of
the J.A.M.A. and the drug companies' advertising squibs.  The latter
go on the Virgilian principle of TAM FICTI PRAVIQUE TENAX QUAM NUNTIUS
VERI.

     His non-medical reading in general consists of the Reader's Digest
(and magazines of equivalent veracity and luminosity); of the newspapers
or newspaper headlines; of detective stories and occasional random
samples of biographies or novels.  I need not mention the precedent of
Western adventure stories read by persons in high office.

     The specialist reads the J.A.M.A. and the Archives of this or that
specialty.  In the best-developed specialties the clinical journals
include much information derived from basic sciences.  In less advanced
specialties the basic scientific materials are apt to be much less
abundant.

     We may hope that the specialist's non-medical reading is wider and
deeper than that of the general practitioner, since his daily routine
is apt to be less strenuous and his prestige and income are greater,
but his informal conversation gives little evidence of wide reading
or wide intellectual interest, although he is apt to utter conventional
words of admiration about respectable classics.
67 
68
DISCUSSION
     This is a generalized description; there are of course occasional
exceptions.  The consideration of non-medical reading is relevant because
it illustrates the fact that the practicing physician tends not to be a
reader, just as he is not a scholar or a historian.

     Of works in foreign languages— modern, ancient, or medieval, medical
or non-medical— both the general practitioner and the specialist read less
and less.  Among  today's interns, the flower of a somewhat infertile
educational system, even the ability to read French is nowadays becoming
uncommon (about as rare as gout is said to be in women).

     Homes and offices are small and there is less space than there used
to be  for books and for back numbers of periodicals.  The television appara-
tus has crowded out Galen and Trousseau and Graves.

     This being the case, what do the practicing physician and practicing
specialist want from a major medical library?

     Their  preponderant demand is for material which bears on current cases.
The  commonest situation takes the following form.  Dr. X. notices that Mrs. Y.
has  pain over the xiphoid cartilage, plus a series of symptoms which are
coincidental  and hence possibly related thereto.  The doctor wants reports of
other  cases  of pain  in the xiphoid cartilage.  If he has never seen this
condition before, he infers that it is uncommon or perhaps unreported.  He
wants  reports of other cases, if such exist, and he needs these reports
immediately.   If he  thinks the condition is rare he may want to report it.
He may then want all published reports on the subject, as far back as Imhotep,
Any  report,  however ancient, may prove useful in the care of the patient and
 in the analysis of the problem.  The older reports are desired not because of
their  age but despite their age.  There is no question here of constructing a
historical sequence and examining it for intelligible patterns.

     The physician may be able to disinter the necessary references himself
but  he is likely to  expect the librarian to provide the references, to locate
and  borrow the less  accessible books for him, and perhaps provide photostats
or microfilm or translations.

     An analogous condition obtains if the physician's starting point  is not
merely one case but  a series of cases or an entire disease.  The doctor who
is interested in myasthenia gravis may need to know whether the disease  occurs
in children and, if  so, whether cases occurring in children are in  any way
different from cases occurring in adults.  To the librarian his needs  are  the
same as those of the physician whose patient has a sore xiphoid.

     In summary, the physician engaged in practice needss

           (a)  reports of cases,  or series of cases, as far back as  the
literature extends.
          (b)  he needs not only case reports but the references by which
such reports can be found. 
DISCUSSION
69
            (c)  he may need  a wealth of basic scientific material bearing
 on his problem.

 «...        (d>  he needs supplementary services such as photostats, micro-
 rilm, translations, and abstracts.

            (®)  he needs facilities which can transmit these materials to
 him and transmit them promptly and inexpensively.

            (f)  he needs not only these material things but also the
 services of intelligent, skilled, and devoted people who can plan, devise,
 and administer the mechanisms which will satisfy his needs.

      All of this is entirely within the realm of the possible and it is
 a matter of observation that these extensive resources and great talents
 are daily  placed at the physician's disposal in innumerable libraries
 throughout the United States.


 Dr.  Morris Saffron.  I am  Dr. Saffron of  New Jersey,  While I agree that
 there are many doctors who do not have the  inclination or leisure for
 scholarly pursuits in libraries, still generalizations are  always dangerous,
 and I believe  that the medical profession may well be on the verge of a
 revival of  interest  in literary and historical work.

     I have been greatly stimulated by the  excellent discussion here today.
 The problem as I see it is whether we are to continue to collect in Collier
 brothers fashion all printed material relating to medicine, regardless of
 merit; or whether we ought to discard some  of the apparently useless items
 already accumulated and use  greater discrimination in the matter of future
 selections.  This is a universal problem confronting large  repository
 libraries.

     While  stationed in Washington during the last World War, I had ample
 opportunity to become familiar with the resources of this wonderful library.
 It was during  the same period that I persuaded our kindly panelist Mr. Clapp
 to place my name on the list of those who receive the annual report of the
 Library of  Congress.  This publication I read each year with lively interest
 and amazement, having successfully resisted periodic attempts at my oopy
made under  the guise of economy.  There they are simply inundated by tidal
waves of print pouring in from all over the globe, and in their capacity
 of national repository they  are obligated to retain everything.  The pro-
blem here is, of course, minute in comparison, and I feel that our basic
philosophy  should also be different.  My term as library chairman of the
Academy of Medicine of New Jersey made me realize that all medical li-
braries of  stature, national or otherwise,  must keep two essential objec-
tives in view.  The first is to acquire within budgetary limitations all
available current publications which have the slightest pretense to 
70
DISCUSSION
originality, and without regard to their ultimate usefulness.  The second^
and more important from an historical viewpoint is to preserve for posterity
the worth-while publications of the past.  I emphasize the expression worth-
while for we all know that the annual output of textbooks often produces
little that is of enduring value.  Many so-called revised editions contain
minor changes which hardly justify their addition to the collection.  I have
been reviewing books on dermatology for many years, and I must confess that
it is often difficult to discover the one or two original thoughts which
distinguish an author from his predecessors.

     I am convinced that what this library needs is not merely a definite
policy of acquisition, but one of"de-acquisition" as well.  Periodic and
orderly reappraisal of the holdings should lead to the elimination from the
shelves of  ephemera, trivia, and above all outmoded textbooks.  By such
procedure,  carefully controlled, we can avoid the Scylla of a chimerical
all-inclusiveness and the Charybdis of Dr. Smith's fiery furnace.  The return
to the director and his associates of discretionary powers would remove them
from the class of mechanical accumulators.

     If we  were still in the age of the cuneiform tablet our space requirement
would be ten  times as large as now.  We can derive some consolation from the
fact that we  are today in the age of the printed word, and can anticipate
relief  in the prospect which lies before us.  Mechanical processes or re-
production, including microfilm, and advances in the use of the "electronic
brain"  should eventually make possible the preservation of enormous quantities
of printed  records in some reasonable space.  Although I am told that micro-
filming is  too costly a procedure to solve our problem at the present time,
it seems reasonable to expect that human ingenuity will soon turn up an in-
expensive method of preserving the contents of obsolescent works.

     Finally  I should like to offer a suggestion concerning the voluminous
hospital reports mentioned by one of the earlier speakers.  This would
involve a cooperative effort on a national or even international basis.
To shelve the annual reports of thousands of hospitals requires considerable
space.  On  the other hand if these reports could be stripped down to essen-
tials and consolidated each year by the American Hospital Association the
resulting volume, massive though it might be, would prove a tremendous
space-saver as well as a boon to the research worker.  Another national
organization  could perform a similar task in the matter of state and muni-
cipal health  reports.

     In closing I wish to thank the speakers for their admirable presentations,
and  this audience for listening with patience to my unprepared remarks. 
DISCUSSION
71
Mr.  Kllgour.   Continuing part of the  last  speakers  thought, I would
like to suggest to you that  in thinking about problems of coverage in
acquisition that you might also include the point of view of how little
do you need,not just how much.  I think this approach can be an additional
and profitable basis on which  to  think about some of these problems, but
I want to speak more specifically about one section of Dr. Bestor's
Buperb paper.

     Shortly after the turn  of the century some genius whom I haven't
been able to identify started  to  put books in the scientlfio classifi-
cations in the Yale University Library on the shelf arranged by date in
precisely the manner that you  suggested.  And fortunately, this is the
case in the Yale Medical Library.  Of  course, many medical libraries have
a very large percentage of their  volumes arranged by date anyway because
the periodicals are automatically arranged that way, but everything you
said about the advantages of the  date  arrangement of books is true and
very muoh more la true too.  I am not  going to go into those details,
but  I am going  to suggest that if any  of you are  interested in this'
type of arrangement, you  can see  it aotually working at the Yale Medical
Library, and you can see  many  of  the advantages that Dr. Bestor described.

Dr. Shryock.  My colleague  here  set the precedent for a speaker taking
 a little more time,  so I just want to add a postscript to Dr.  BeBtor's
 emphasis upon time as  a factor in the whole picture.  This is  not in
 relation to cataloging or assembling but again in relation to  scope,
 because the time factor gradually transforms  the  areas or fields  which
 are considered medical.   We may therefore,  with reference to one  era,
 indicate the necessity of acquiring volumes in a  certain  subject;  and
 yet we would not purchase in that subject for another  period.  For
 example,  we recall that anatomy and physiology played  a relatively
 small role in medical education or medioal thought down to about  the
modern period.   Certainly, these disciplines  played a  small role  in
 the medieval era.   Conversely, we think of anatomy and physiology as
 essential medioal soienoes when the modern period is reached.

      There also was  a  time, prior to about 1800,  when  botany was  an
 essential part of medicine.  Presumably,  we would wish to buy  botanical
treatises  chiefly for  that earlier period.  In the 17th and 18th  cen-
turies  chemistry was very muoh a medical soienoe.  And in some
questioning of Dr.  Smith's generalization,  I  think we  are now  approach-
ing an  age when social science also will enter into our medioal tradition.
To  the  extent  that  it  does, the Library will  have to keep its  eyes open
in  this area  in the  future.   This will involve more than  collecting a
few basic  texts.  There would  then have to  be a systematic collection
of  social  science materials pertinent  to medicine,  just as we  assume
that we should  secure  all the  materials  in  anatomy or  physiology  which
are basic  to medioine. 
 
SUMMARY
KEYES D. METCALF
     Colonel Rogers  has  indicated  in his  too  generous introduction
at least  one of the  reasons  why I  am glad to  be here todays the
survey  of the Army Medical Library for which  I had some responsibility
thirteen  years  ago made  me very much interested in the problem that
we have been discussing.   In addition I have  always been interested
in acquisition  programs  because I  believe that in the long run they
are the most important task  faced  by librarians and in most cases
are the task that  librarians have  done least  well.  I am also glad
to be here because it is  evident from what has been said that the
proposal  for an acquisition  program made  by the survey committee
thirteen  years  ago did not work out entirely  satisfactorily and being
at least  partly responsible, I  am  anxious to  see that situation improved.

     There can  be  no question of the importance of a good acquisition
policy.   Theoretically at least, it is simpler to prepare one for a
library in a special field,  such as medicine, and particularly for a
library that expects to  collect comprehensively, because less selection
is required and part of  the  problem would seem to be solved automatical-
ly.  Those of you  who heard  Colonel Rogers in his introductory paper
soon realized that it was not as simple as that and to come closer to
home it is not  as  simple  as  I thought it  was  thirteen years ago when I
had something to do  with writing the directive that he quoted.  Colonel
Rogers  stated the  problem and did  it superbly.  He did more than that,
he persuaded six specialists from  six different fields to prepare first
class papers tackling the problem  from different points of view.  It
might be  worthwhile  to reread Colonel Rogers' paper at this point; it
might even make a  good place to stop.  I  shall content myself, however,
by quoting certain paragraphs which I think need emphasis.

     Colonel Rogers, after stating briefly the effect of acquisition
on the  rest of  library problems, admitted the important part that
finances  play in an  acquisition program.   But he suggested that as
far as  possible, finances be left  out of  consideration today, and
except  for Verner  Clapp's statement that  library technology can do
almost  anything in a library if money is  provided, and his question
as to whether everything  possible  had been done to provide the money
required  to do  almost everything,  the papers  followed Colonel Rogers'
admonition.  Colonel Rogers  then went on  and  asked us to remember that
the Armed  Forces Medical  Library is also  a national library, which has
a special  responsibility  to  the nation beyond the responsibilities of
all other  libraries  in its field.
73 
74
KEYES D. METCALF
     He said that there were two major facets in an acquisition policy—
scope and coverage—and that we were today interested chiefly in the
problem of coverage.  He quoted the survey recommendation that the Library
should acquire all publications in all languages directly relating to the
science of medicine.  He then added, rather sorrowfully,  that in the decade
which has elapsed since the survey, the Library's yearly acquisitions have
increased to the point where he had begun to wonder whether acquisitions
are not now too inclusive where once they were not inclusive enough.

     He went on to say that the acquisition objectives were theses  To serve
medical research and the work-a-day practice of medicine; to serve also as
basic documents of intelligence studies, and as the basic records of the
history of medicine, the history of science and the general history of
civilization.  He commented on the fact that he had found little outside
opinion that was pertinent to the predicament in which the Library had found
itself.  He then said that even the "Farmington Plan" carries limiting language,
such as "of research value" and that the Library of Congress in its third canon
of selection introduces limiting phrases, such as "the material parts of the
record".  He then turned to the speakers and asked for guidance.

     Verner Clapp of the Library of Congress came first and spoke from the
point of view of Library Technology.  (As a librarian I can say no better
choice could have been made for a library representative.)  Mr. Clapp raised
questions dealing with the financial situation and made the cogent remarks
Should this Library, should any library, collect everything in its field?
He thought that the answer should hardly ever be in the affirmative.  No
library, he said, should be permitted to acquire at all,  much less compre-
hensively, unless it can justify both the importance of its purpose and the
relevance of its acquisitions to that purpose.  A research library exists
to serve scholars; unless the acquisition of material can be demonstrated
to be likely to serve actual or potential users, its acquisition remains
unjustified.

     He brought up the question of marginal material, but admitted that we
are unable to foresee the research needs of the future.  He added that the
decision with respect to material of this kind must rest on an exercise of
judgment,  and that the more informed the judgment, the more persuasive it
is likely to be.  He spoke of the possibility of arbitrary selection, of
random sampling, and of deferred selection on the principle of collect
now and select later; and added that imponderables present the librarian
with considerations of the greatest difficulty at the very point at which
the material is of the least obvious worth.

     Mr. Clapp suggested that there were possible short cuts on the pro-
cessing level, and mentioned the enormous amount of duplication in medical
literature.  A library which is concerned only with research or teaching
the subject can secure most of the relevant information for a fraction of
the cost which the comprehensive library must pay to close the gap between 
SUMMARY
75
most and all.  The law of diminishing returns works to the disadvantage
of the National Medical Library but the additional cost of comprehensive-
ness is justified because the Library serves all possible purposes which
the country as a whole can properly demand of the literature of the
subject.  In addition its possession of the material relieves local
institutions of the obligation for acquiring more than their immediate
needs.  He concluded by saying that the bibliographic record is more
important than any centralized ownership.

     The next paper was by Dr. Manchester, who spoke from the standpoint
of the clinician.  He said that it was impossible for physicians to
practice without the aid of publications that record advances and ex-
periences in medical and related sciences.  He suggested that a bibliog-
raphy of medical reviews would help the clinician greatly.  He believed
that the Library's coverage should be exhaustive in the medical sciences
and related fields, and in all languages.  He emphasized the desirability
of abstracting and translating material in foreign languages.  And he
closed by saying that the best of medicine cannot be made available to
society without the literature.  He believed that the National Medical
Library is an incalculable public health asset; it can be many things
to many people.  Dr. Manchester made it clear that a first class national
medical library was necessary for the practicing physician as well as the
researoher in the medical field.

     Next came Dr. Smith.  He began by saying, facetiously, something
that I wish were true, that any good librarian can collect and catalogue
more books and journals in a day than an investigator can read in a
year.  He made a statement frightening to the librarian that the number
of ways in which a library is used  is approximately equal to the number
of investigators.  He went on to say "nonsense" to those who think that
the library should be all things to all men.  He stated that you cannot
turn a librarian into Superman  by multiplying the number of his
assistants, and you cannot improve the quality of a library simply by
multiplying its cubic footage.

     Dr. Smith believed that much of what the librarian has been saving
as pertinent to medicine is not medicine, that it is not scientific,
that it has no value and is utter trash.  And he proposed a capacious
incinerator for much of the fugitive and ephemeral material that is
received.  Dr. Smith admitted that to distinguish the substance from
the name and to discover what is pertinent to medicine  is a problem.
He said  a national medical library should have an exhaustive collec-
tion of the primary literature, dealing with the pre-clinical sciences,
general medicine and surgery, but he proposed that in the ancillary
sciences, a research or reference collection only was needed. 
76
KEYES D. METCALF
He was confident that textbooks, monographs and the like are not the stuff
of which the history of science will be made, and proposed that the librarian
keep his library uncluttered,leaving room for journals not yet started, and
books undreamed of.  Since I have worked in libraries for fifty-one years,
and have yet to find an uncluttered one, I hope Dr. Smith will find one and
tell me about it.

     And then Dr. Smith closed by asking for a tiny room where on a table
fully exposed to hand and eye  were a few books dealing with subjects as
remote to medicine as one can imagine.  And he said, please, just a hundred
books, to last for five years, after which you can burn them.  Personally
I sympathize with Dr. Smith, but he failed to state that the books that he
wants will be the same ones that each of his colleagues will want.  If the
librarians will take Dr. Smith's paper with the grains of salt with which
I am sure it was intended, and not too literally, it should go a long way
toward simplifying their problems and making their life more bearable, and
incidentally, more interesting.  When Dr. Jarcho in the discussion period
condemned the limited incendiarism proposed by Dr. Smith, on the basis
that it might get out of hand, he made an appeal for more rather than less
extensive coverage and also for more general non-medical reading by the
medical man, thereby agreeing with Dr. Smith's final suggestion.

     Dr. Shryock, speaking from the point of view of medical history,
began by saying that the scope of the collections has been in most respects
all that could be desired.  But he called attention to the difficulty of
reaching agreement on the definition of such phrases as "nearly all", and
other qualifying phrases used in the directives for acquisition.  He
mentioned that medical biographies should be acquired with some exceptions,
and said he was interested in translations,including those from an unfamiliar
to a familiar language and also those translated from English.  He of course
wanted works about medical history, books that historians ordinarily called
secondary writings,as well as sources.  He spoke of lecture notes, and
recommended the correspondence of those active in medical and related fields.
He mentioned the usefulness of portraits and photographs, particularly
pictures of old scenes that illustrate typical settings and activities.

     I admit that I was pleased to note that Dr. Shryock said that there
were many ephemera he thought the library could ignore, or keep temporarily,
or preserve only in the form of typical examples.  But,he added, all pub-
lications on specialized medical themes whether in books or journals are
potential grist to the historian's mill.  He spoke of the papers of pro-
fessional organizations, as distinct from those of individuals; and
concluded by stating that both the counsels of perfection and those of
indifference to serious scholarship could be avoided.  Dr. Shryock,as has
been the case with the others, sympathized with the Library in its struggle
to keep its head above the waters, and if he and his colleagues will forgive
the librarians when from time to time they fall down on their assignments
they can look forward to the future with only a reasonable amount of trepidation. 
SUMMARY
77
     Mr. Kilgour  then talked on the  intelligence values  of foreign medical
publications.   He discussed them in  the  light  of the national welfare
and  security.   He said that the National Library is responsible for
making  foreign medical information available to the medical profession
at large.   He  reminded us  that  medical advances are not  all made in the
United  States,  and he reported, to the surprise of many  of us, that while
secret  agents  do  produce useful information, the bulk of intelligence
information and probably the most valuable  is  freely available from open
sources.   He described the types of  information that are important as
intelligence.   He said that as  far as medicine is concerned, it is
doubtful that  medical publications have  much to contribute to current
reportorial intelligence.   He added  that commanders and  medical officers
must have  continuous  and accurate intelligence on local  health hazards
in order to preserve  the health of their forces.

     Mr. Kilgour  told us that medical publications yield incidental data
of value to economic  intelligence.  He said that the acquisition of
foreign medical publications can and should be selective, and that while
a national medical library should acquire all  foreign monographs and
periodicals consistently reporting new information, such publications
are  in  the minority.   A national medical library, he said, should continue
to receive these  materials in time of war,  and it is of  the utmost im-
portance to obtain them from enemy and enemy-controlled  areas.  It is
evident to this listener at least that his  knowledge of  what is important
in intelligence has been almost negligible.

     Dr. Bestor presented  the final  paper.  He began by  saying that the
historian  is a parasite on other men's activities.  He uses the records
that other men have made or accumulated  for their own purposes, not his.
The  question,  he  said,  is  thiss   After all  the materials  needed for
current medical research have been provided, after the needs of medical
history have been met,  is  there something else which the future historian
of things  in general  will  expect the Library to have preserved?  He said
that this  question was  not one  that  the  historian was accustomed to think
about;  that he  is obliged  ordinarily to  use records as he finds them.
And  he  added that the historian is not really  as interested in indis-
criminate  preservation of  materials  as he is apt to imagine himself
to be.  He said that  relatively little material turns up in places other
than those where  the  historian  would logically expect to find it, and that
by and  large the  historian cannot afford to work a vein  of ore unless it
has  a high enough assay to promise at least some margin  of profit; the
general historian is  not likely to use the  Armed Forces Medical Library
unless  his  subject is  in some way connected with medicine.

     Speaking of  the  ephemeral material  that comes into  a great research
library, Dr. Bestor thought  that while it may  be of small use for current
scientific research,  it  may  be  very  valuable for historical research,
and poses  certain problems which an  historian  may properly be asked to
help solve,  for he is  its most  likely potential user.  Dr. Bestor then 
78
KEYES D. METCALF
proposed that this material should not receive regular library classification
and cataloguing but should be treated as archival material which would cost
a great deal less than adding it to the library in the regular fashion.  He
also suggested  that the classification for older publications should be
primarily a chronological one; that libraries have never really reckoned
with the significance of time in planning their classifications.  Let me
unofficially in the name of the library profession  thank Dr. Bestor for
his two suggestions dealing with library technology and assure him that
they will not be forgotten.  But I should add that various attempts have
been made along these lines, sometimes with fair success and sometimes
with lack of it.  The third proposal that he made, that for filing a card
for the latest books first, followed by those for the earlier ones, was
proposed at Harvard recently and rejected.

     In the discussion that followed the papers, Dr. Jarcho brought out the
need of reports of cases, of scientific reports, of the availability of
photoduplication, and of good general library services.  Dr. Saffron spoke
of the problem of the elimination of some of the redundancy of material.
He said that we should learn to use discrimination in selection, so as to
preserve the worthwhile without being overwhelmed with the bulk of useless
material.  Acquisition and de-acquisition, he said, was required, and he pro-
posed the use of microfilm and the destruction of the original and later
perhaps the destruction of the microfilm.  I am not sure that he realizes
that up to this time at least  the cost of microfilming is greater than
the cost of keeping the original.  That may not continue to be the case.
The cost of discarding is not as great as keeping the original.  Dr. Saffron
also suggested that the American Hospital Association should summarize
hospital reports so as to make unnecessary their preservation.

     Mr. Kilgour spoke of the desirability of considering not only how much
should the Library acquire, but how little it could get by with.  Dr. Shryock
said that changes in what is considered medical science at different times
are bound to have effect on collecting policies.

     I had expected simply to try to summarize the papers.  This I have done
very inadequately.  Colonel Rogers has asked me however to say something on
my own.                                                   t

     As for scope, a subject in which we were not supposed to become in-
volved today, let me say that since I feel that so much of the salvation
of our libraries depends on cooperation I don't much care about the scope
of the National Library of Medicine; I shall not worry about the marginal
or peripheral material so long as one of the three national libraries collects
it.  Whether veterinary medicine comes here, or goes to the Department of
Agriculture, and whether medical fiction comes here or to the Library of
Congress doesn't make much difference so long as one of the libraries includes
it persistently.

     And now let me take advantage of my position as the last speaker by telling
three stories which seem to me to be pertinent to our Symposium. 
SUMMARY
79
      In 1897 the New York Public Library received  by gift  the Gordon
 Lester Ford collection of material relating  to  this  country.  It was
 one  of the greatest collections ever gathered together.  The task of
 going through the tremendous collection of pamphlets included in it
 was  given to Harry Miller Lydenberg, who later  became the  Director
 of the Library and the greatest all-around librarian that  this country
 has  produced.   He selected the items that he thought worthy of cat-
 aloguing and arranged to have the remainder  stored in great bundles
 in the basement.  Twenty-five years later as a  young librarian I
 went through these pamphlets and found a considerable number that
 by that time seemed valuable enough to add to the  Library  and part
 of them went to the Rare Book Division.   Some were discarded and
 the  remainder were again stored in the basement until twenty-five
 years later when another young librarian, E.G.  Freehafer,  who by
 the  way is now the Director of the New York  Public Library, examined
 the  collection and once more turned up considerable  material worthy
 of inclusion in the Rare Book Room to say nothing  of more  for the
 regular collections.   He also stored some of the left-overs in the
 basement and some of us here may live long enough  to see those
 remainders worked over by some brash young librarian with  profitable
 results for the fourth time.   This story might  be  summed up by saying
 that time as well as other things affects values.

      Also illuminating is this story.   In my duties  at the New York
 Public Library I had the task for fifteen years of selecting, from
 the  150,000 gifts received by that institution  annually, those worthy
 of being added to the Library.   With chagrin I  have  to admit that
 after fifteen  years I found myself less  confident  about what should
 be kept and what discarded than was the  case when  I  began  2,000,000
 decisions earlier.

      And finally let  me tell the story that  I found  current at Harvard
 when I went there in 1937.   A group of senior faculty members discuss-
 ing  the overgrowth of the University Library agreed  that perhaps half
 of its  millions  of volumes  were useless  and  should be discarded.  Then
 Alfred  North Whitehead is said to have spoken up somewhat  as follows s
 Of course,  gentlemen,  much of the contents of the  Library  is not worth
 keeping.   I suggest that  we arrange to have  the whole collection examined
 by experts  and divided into two approximately equal  parts, one for dis-
 card  and  one to  be  kept.   I shall then suggest  that  the half selected
 for discard  should  be  kept  as  the more valuable part, as much of it will
 represent the only  copies available in any library and will be more
 valuable to future  scholarship than the  half selected for  retention,
which will be made  up  of  volumes  that  can readily be  found elsewhere. 
do
KEYES D. METCALF
     With these stories in mind, I suggc-cJ: that when it corner to coverage
I am inclined to report, judging from my experience during fifty-one years
as a librarian, that no completely satisfactory directive will ever be
written.  This should not deter us from trying to write one.  But it's
an art, not an exact science, and works of art never satisfy everyone.
I can think of no brief description better than the one proposed for the
Farmington Plan?  "Everything conceivably of research importance should
be acquired."  But that statement has to be interpreted, and no two persons,
at least no two librarians, will interpret it in the same way.  But as time
goes on we should find some more definitions on which we can agree.  We shall,
I am confident, be able to move forward.

     One final warning if we are to make mistakes, as we are bound to do.
Let us try to make them, in the case of most libraries, by not getting enough,
because the law of diminishing returns will come to our aid.  But, and this
is a large but, let us make the mistake on the side of getting too much in
the National Libraries.  The total coat to the library world of this method
will be less, and nationally only a drop in the bucket.

     And now to summarize the summary.  As was to be expected, each speaker
wanted something at least a little different from each of the others.  All
made good points; the Library ...'bviousJy cannot follow ail, all the way
through.  But the National Medical library should do what it can within the
limits of the funds chat it can obtain; and all of us should pitch in and
help the Library to obtain the funds it requires.

     I do not consider this Symposium a failure because we have failed to
reach definite conclusions,  I am sure that we have helped the Library to
help itself, and we con count on its continuing to struggle and to make
progress.  When I c-jmpare the present situation with that which prevailed
thirteen years ago, I am optimistic.  At the same time, I am holding my
breath until Congress decides what to do with Senator Hill's bill for a
National Medical Library, 
THE PARTICIPANTS
     LT. COL. FRANK B, ROGERS has been Director of the National
Library of Medicine since 1949.  He holds the degree of Doctor of
Medicine from Ohio State University and the professional degree in
library science from Columbia University.

     MR. VERNER W. CLAPP came to the Library of Congress in 1922,
and served that Library in progressively more responsible positions
until his retirement in October 1956 as Chief Assistant Librarian.
He is the author of many papers in the field of librarianship,
several of them relating to the problem of scope and coverage of
library collections.  Mr. Clapp is now President of the Council on
Library Resources, Washington, D. C, established in 1956 through
a grant from the Ford Foundation.

     DR. BENJAMIN MANCHESTER practices cardiology in Washington, D.C.,
and has written extensively in his specialty.  He is Assistant
Clinical Professor of Medicine at the George Washington University
School of Medicine,

     DR. HOMER W. SMITH is Professor of Physiology and Chairman
of the Physiology Department at New York University-Bellevue
Medical Center,  He is the author of numerous works on renal
physiology.  Dr. Smith has long been interested in the problems
of medical libraries, and for many years has been Chairman of
the Library Committee of the Medical Center.

     DR, RICHARD H. SHRYOCK is Director of the Institute of
the History of Medicine of the Johns Hopkins University.
Previously he was Professor of History at Duke University and
Professor of American History at the University of Pennsylvania.
Dr. Shryock is the author of several well-known treatises in
the history of science and medicine.

     MR. FREDERICK G. KILGOUR is Librarian of the Yale Medical
Library and Lecturer in the History of Science at Yale University.
During World War II, as Deputy Director of the Office of Intelligence
Collection and Dissemination, he played an important role in the
intelligence operations of the United States Government.
81 
82
PARTICIPANTS
     DR. ARTHUR E. BESTOR is Professor of History at the University
of Illinois; during the current academic year he is serving as
Harmsworth Professor of American History at Oxford University.
Dr, Bestor's special interests lie in the fields of education and
general historiography.  He is the author of the widely-heralded
The Restoration of Learning s  A Program for Redeeming the Unfulfilled
Promise of American Education, published in 1955°

     MR. KEYES D. METCALF retired in 1955 as Director of the Harvard
University Libranies, Librarian of Harvard College and Professor of
Bibliography.  Before that time he served the New York Public Library
as chief of three divisions, as Executive Assistant and finally from
1928 to 1937 as Chief of the Reference Department.   Mr.  Metcalf has
been a leading figure in many professional associations and was active
in the organization of the Farmington Plan,  the  objective of which is
to make sure that at least one copy of every new foreign work of research
value is acquired by an American library.   Since his retirement from
Harvard University, Men Metcalf has been Professor of Library Science
at the Graduate Library School of Rutgers University.
24 49