OUR MEDICAL LITERATURE. 
By JOHN S. BILLINGS, M.D., 
Surgeon U.S. Army, 
When I was surprised by tlie honour] of an invitation to address this Congress, 
my first thought was that it must be declined, for the simple, but sufficient 
reason that I had nothing to say that would be worth occupying the time of such 
an assemblage as it was evident this would be. But while thinking over the 
matter, and looking absent-mindedly at a shelf of catalogues and a pile of new 
books and journals awaiting examination, it occurred to me that perhaps some 
facts connected with our medical literature, past and present, from the point of 
view of the reader, librarian, and bibliographer, rather than from that of the 
writer or practitioner, might be of sufficient interest to you to warrant an attempt 
to present them; and, the wish being probably father to the thought, I decided to 
make the trial. 
When I say “ Our Medical Literature,” it is not with reference to that of any 
particular country or nation, but to that which is the common property of the 
educated physicians of the world as represented here to-day—the literature which ' 
forms the intra- and international bond of the medical profession of all civilized 
countries ; and by virtue of which we, who have come herefrom the far West and 
the farther Last, do not now meet, for the first time, as strangers, but as friends, 
having common interests, and though of many nations, a common language, and 
whose thoughts are perhaps better known to each other than to some of our 
nearest neighbours. 
It is usual to estimate that about one-tlxirtieth part of the whole mass of the 
world’s literature belongs to medicine and its allied sciences. This corresponds 
very well to the results obtained from an examination of bibliographies, and cata- 
logues of the principal medical libraries. It appears from this that our medical 
literature now forms a little over 120,000 volumes properly so called, and about 
twice that number of pamphlets, and that this accumulation is now increasing at 
the rate of about 1,500 volumes and 2,500 pamphlets yearly. 
Let us consider the character of this annual growth somewhat in detail, first 
giving some figures as the numbers of those who are producing it. 
There are at the present time scattered over the earth about 180,000 medical 
men, who, by a liberal construction of the phrase, may be said to be educated; 
that is, who have some kind of a diploma; and for whose edification this current 
medical literature is produced. Of this number about 11,600 are producers of, or 
contributors to, this literature, being divided as follows: United States, 2,800; 
France and her Colonies, 2,600; the German Empire and Austro-Hungary, 2,300; 
Great Britain and her Colonies, 2,000; Italy, 600: Spain, 300: all others, 1,000. 
These figures should be considered in connection with the number of physicians ' 2 
in each country; but this I can only give approximately, as follows: United States 
65,000; Great Britain and her Colonies, 35,000: Germany and Austro-Hungary, 
32,000; France and her Colonies, 26,000; Italy, 10,000; Spain, 5,000; all others, 
17,000. 
It will be seen from these figures that the number of Physicians who are 
writers, is proportionately greatest in France and least in the United States. As 
regards France, this is largely due to the requirement of a printed thesis for 
graduation, which of itself adds between six and seven hundred annually to the 
number of writers. 
Excluding popular medicine, pathies, pharmacy and dentistry, all of which 
were included in the figures for the annual product just given, we find that the 
contributions to medicine, properly so called, form a little over 1000 volumes and 
1600 pamphlets yearly. 
For 1879, Piupprecht’s Bibliotheca gives as the total number of new medical 
books, excluding pamphlets, periodicals and transactions, 419; divided as follows, 
viz.: France, 187; Germany, 110; England, 43 ; Italy, 32 ; United States, 21; 
all others, 26. These figures are, however, too small, and especially so as regai'ds 
Great Britain and the United States. The Index Medicus for the same year 
shows by analysis that the total number of medical books and pamphlets, 
excluding periodicals and transactions was 1643; divided as follows : France, 541; 
Germany, 364; United States, 310; Great Britain, 182; all others, 246. This 
does not include the inaugural theses, of which 693 were published in France 
alone. 
The special characteristics of the literature of the present day are lai’gely 
due to journals and transactions, and this is particularly true in medicine. Our 
periodicals contain the most recent observations, the most original matter, and 
are the truest representations of the living thought of the day, and of the tastes 
and wants of the great mass of the medical profession, a large part of whom, 
in fact, read very little else. They form about one-half of the current medical 
literature, and in the year 1879 amounted to 655 volumes, of which the United 
States produced 156 ; Germany, 129; France, 122; Great Britain, 54; Italy, 65 ; 
and Spain, 24. This is exclusive of journals of pharmacy, dentistry, &c., and 
of journals devoted to medical sects and isms. These are given in an appended 
table from which it appears that the total number of volumes of medical journals 
and transactions of all kinds was for the year 1879,—850 and for 1880,—864. The 
figures for 1880 are too small, but the real increase is slight. During the year 
1879, the total number of original articles in medical journals and transactions 
which were thought worth noting for the Index Medicus was a little over 20,000. 
Of these there appeared in American periodicals 4781, in French, 4608 ; in 
German, 4027 ; in English, 3592 ; in Italian, 1210; in Spanish, 703 ; in all others, 
1248. The figures for 1880 are about the same. It will be seen that at present 
more of this class of literature appears in the English language than in any 
other, and that the number of journal contributions is greatest in the United 
States. The actual bulk of periodical literature is, however, greatest in Germany, 
owing to the greater average length of the articles. With regard to the mode of 
publication, I will only say that in all countries except Spain, the greater number 
of medical periodicals are monthly, while in Spain they are semi-monthly. It is 
this periodical literature which, more than anything else, makes medicines cosmo- 
politan, and although as regards new discoveries or methods of treatment, it is 
still somewhat farther from London or Berlin or Paris to New York, than it is from New York to either of these places, the discrepancy is gradually becoming 
less. 
Many of the medical journals are very short lived, but the total number is 
increasing. In 1879, 23 such journals ceased, but 60 new ones appeared, and in 
18S0 there were 24 deaths and 78 births in this department of literature. Over 
one-third of this fluctuation occurs in the United States alone, France being 
next in the scale, Spain third and Italy fourth, while Great Britain is the most 
stable of all. 
This merely quantitative classification gives of course no idea as to the character, 
and very little as to the value of the product. Let us now consider it by subjects. 
During 1879 there were published 167 books and pamphlets and 1543 articles 
relating to anatomy, physiology and pathology—that* is, to the biological or 
scientific side of medicine. Dividing this again by nations, we find that Germany 
produced a majority of the whole, France being second. The proportionate 
production by nations of this class of literature is perhaps better shown by an 
analysis of the bibliography of physiological literature for the year 1879, as pub- 
lished by the Journal of Physiology. This shows 59 treatises and 500 articles in 
German, 17 treatises and 227 articles in French, 5 treatises and 77 articles from 
Great Britain, 8 treatises and 41 articles from Italy, and 2 treatises and 24 articles 
from the United States. The number of authors for this product was, German, 
393, French, 119, English, 59, Italian, 39, United States, 19, all others, 41. For 
the year 1880 the same journal reports 62 treatises and 452 articles from Germany 
23 treatises and 216 articles from France, 12 treatises and 76 articles from Great 
Britain, 4 treatises and 51 articles from Italy, 6 treatises and 25 articles from the 
United States, and 10 treatises and 31 articles from all other countries.* 
When we turn to the literature of the art, or practical side of the profession 
the figures are decidedly different. We find over 1200 treatises and 18,000 journal 
articles which come under this head, and the order of precedence of countries as to 
quantity is : France, United States, Germany, Great Britain, Italy and Spain. 
The appended tables give still further subdivisions, showing by nations the 
number of works and journal articles upon the practice of medicine, surgery, 
obstetrics, hygiene, etc., for the years 1879 and 1880, and some of the figures will 
be found interesting. A marked increase has occurred in the literature of 
hygiene during the last two years, and this especially in England, France, 
Germany and the United States. The literature of diseases of the nervous system 
of ophthalmology, otology, dermatology, and gynaecology, is also increasing more 
rapidly than that of the more general branches. 
It would of course be extremely unscientific to use these figures as if they 
represented positively ascertained and comparable facts, the accuracy of which, as 
well as of the classification, could be verified. They represent merely the opinions 
of an individual—first as to whether each treatise or pamphlet included in these 
statistics was worth noting, and second as how it should be classed. Had every- 
thing been indexed the figures, for journal articles at least, might have been 
nearly doubled; while if the selection had been made by a more severe critic they 
might have been reduced one-half. 
* The difference between these figures and those of the Index Medicus, is due, on 
the one hand, to the fact that the Journal of Physiology includes articles which are placed 
under other headings in the Index Medicus, and on the other hand, to the fact that the 
Journal has a different standard of excellence from that of the Index, rejecting many articles 
which the latter must accept as original. 4 
f I had to do the work again I should not obtain the same results. The 
prevailing error is that, as regards journal articles, the figures are too large, for 
some of those included are of so little value or interest that they are, I fear, 
never read by more than two persons. 
Be that as it may, I think we can take them as indicating certain differences 
in the direction of work of the medical authors of the great civilized nations of 
the earth ; but they must be considered as approximations only; and the statistical 
axiom must be remembered that the results obtained from a large number of facts 
are applicable to an aggregate of similar facts but not to single cases. There will 
be a certain number of medical books and papers printed next year, just as there 
will be a certain number of children born ;—and as we can within certain limits 
predict the number of births and the proportion of the sexes, or even of 
monsters;—so we can within certain limits predict the amount and character of 
literature that is yet to come, the ideas that are yet unborn. The differences are 
due to race, political organization, and density of population. As Dr. Chadwick 
has pointed out, in speaking of the statistics of obstetric literature, one of the chief 
causes of the multiplication of medical societies is geographical. “ In England it 
is possible for those who are specially interested in gynaecology and obstetrics to 
attend the meetings of the Obstetrical Society of London, whereas in America the 
distances are so great that this is impossible.” Speaking broadly we may say 
that at present Germany leads in scientific medicine both in quantity and quality 
of product, and that the rising generation of physicians are learning German 
physiology. But the seed has gone abroad and scientific work is receiving more 
and more appreciation everywhere. 
Seven years ago Professor Huxley declared that if a student in his own branch 
showed power and originality he dared not advise him to adopt a scientific career, 
for he could not give him the assurance that any amount of proficiency in the 
biological sciences would be convertible into the most modest bread and cheese. 
To-day I think he might be bolder, for such a fear would hardly be justifiable ; at 
all events, in America; where such a man as is referred to could almost certainly 
find a place, bearing in mind the Professor’s remark that it is no impediment to 
an original investigator to have to devote a moderate portion of his time to giving 
instruction either in the laboratory or in the lecture room. 
Within the last ten years the literature of France, Germany, Great Britain, and 
the United States has contained much with regard to medical education and the 
means for its improvement. In all these countries there is more or less dissatis- 
faction with the existing condition of things, although there is no general agree- 
ment as to the remedy. Solomon’s question, “ Wherefore is there a price in the 
hands of a fool to get wisdom, seeing lie' hath no heart to it V’ is now easily 
answered, for even a fool knows that he must have the semblance of wisdom, and 
a diploma to imply it, if he is to succeed in the practice of medicine; but to ensure 
the value of a diploma as a proof of education is the difficulty. 
This evidence of discontent and tendency to change is a good sign. In these 
matters stillness means sleep or death—and the fact that a stream is continually 
changing its bed shows that its course lies through fertile alluvium and not 
through sterile lava or granite. 
I have said that as regards scientific medicine we are at present going to school 
to Germany. This, however, is not the case with regard to therapeutics either 
external or internal,—in regard to which I presume that the physicians of each 
nation are satisfied as to their own pre-eminence. At all events it is true that, 5 
for tlie treatment of the common diseases, a physician can obtain his most valuable 
instruction in his own country ; among those whom he is to treat. I Just as each 
individual is in some respects peculiar and unique, so that even the arrangement 
of the minute ridges and furrows at the end of his forefinger differs from that of. 
all other forefingers, and is sufficient to identify him; and as the members of 
certain families require special care to guard against haemorrhage, or insanity, or 
phthisis; so it is with nations and races. The experienced military surgeon 
knows this well, and in the United States, which is now the great mixing ground, 
illustrations of race peculiarities are familiar to every practitioner. 
Neither the tendency nor the true value of this current medical literature 
can be properly estimated by attending to it alone. It is a part of the thought 
of the age—of that wonderful kaleidoscopic pattern which is unrolling before 
us, and must be judged in connection with it. From several sources of high 
authority there have come of late years warnings and laments that science is 
becoming too utilitarian. For example, Prof. Du Bois-Reymond in his address 
upon civilization and science, says that that side of science which is connected 
with the useful arts is steadily becoming more prominent, each generation being 
more and more bent on material interests. “ Amid the unrest which possesses 
the civilized world men’s minds live as it were from hand to mouth. * * * 
And if industry receives its impulse from science it also has a tendency to destroy 
science. In short, idealism is succumbing in the struggle with realism and the 
kingdom of material interests is coming.” Having laid down this rather 
pessimistic platform, he goes on to state that this is especially the casein America 
which is the principal home of utilitarianism, and that it has become the custom 
to characterize as “ Americanization” the dreaded permeation of European 
civilization by realism. If this characterization be correct it would seem that 
Europe is pretty thoroughly Americanized as regards attention to material 
interests and appreciation of practical results. But the truth of the picture seems 
to me doubtful. Science is becoming popular, even fashionable, and some of its 
would be votaries rival the devotees of modern Aestheticism in their dislike and 
fear of the sunlight of comprehensibility and common sense. The languid 
scientific swell who thinks it bad style to be practical, who takes no interest in 
any thing but pure science, and makes it a point to refrain from any investigations 
which might lead to useful results lest he might be confounded with mere 
“practical men” or “inventors,” exists and has his admirers. We have such in 
medicine, and their number will increase. 
The separation of biological study from practical medicine, which has of late 
years become quite marked in the literature of the subject, has its advantages 
and disadvantages. Thus far the former have far outweighed the latter, and 
both the science and the art of medicine have been promoted thereby. But are 
not the physiologists, or as I believe they prefer to be called, the biologists, sepa- 
rating themselves too completely from medicine for the best interests of their 
own "science, in that they are negelecting human pathology 1 In our hospital 
wards and among our patients, nature is continually performing experiments 
which the most dexterous operator cannot copy in the laboratory—she is, as 
Professor Foster says, “ a relentless and untrammelled vivisector, and there is no 
secret of the living frame which she has not, or will not, at some time or place? 
lay bare in misery and pain.” _ 
Now while it is true that Professor Foster, in his address before the British 
Medical Association last year, (which address is the clearest exposition of the 6 
aims of the physiology of the present day that I have seen) insists upon the fact 
that all distinctions between physiology and pathology are fictitious, and declares 
that attempts to divide them are like attempts to divide meteorology into a 
science of good and a science of bad weather, his conclusion that the pathologist 
should be trained in methods of physiological investigation seems to me to be 
only a part of the truth. The tacit assumption is that all, or at least the most 
important, phenomena of human disease may be reproduced in the physiological 
laboratory. If this were only true, what a tremendous stride would have been 
taken towards making medicine a science. Unfortunately it is not so. Many of 
the most interesting of these phenomena—the most interesting because as yet the 
most unexplainable—can only be observed in the sick man himself. Nor have 
the physiologists as yet made much use of that field which ought to be specially 
inviting to them—namely: comparative pathology; although the literature of 
the present time already indicates that a change has begun in this respect. 
While it is true that to the graduate of thirty years ago much of the physio- 
logical literature of the present day is in an unknown tongue, it is also true that 
the physiologist of the present, who confines himself to laboratory work, will find 
himself distanced by the man who keeps his clinical and pathological studies and 
his experimental work well abreast. 
The lincrease in both the amount and value of the literature of the several 
specialities in medicine is readily seen by a comparison of recent catalogues and 
bibliographies with those of twenty or thirty years ago, and this increase still 
continues at a greater rate than prevails in the more general branches. There 
are great differences of opinion as to the relative value of this increase and as to 
its future effect upon the profession, but there can be no doubt as to the fact. 
There must be specialities and specialists in medicine, and the results will be both 
good and evil; but the evils fall largely upon those specialists who have an 
insufficient general education,—who attempt to construct the pyramid of their 
knowledge with the small end as a foundation. It has been said by Dr. Hodgen 
that “ in medicine a specialist should be a skilled physician and something more, 
but that he is often something else—and something less.” There is truth in this : 
truth which the young man will do well to consider with care before he begins to 
specialize his studies; but on the other hand it is also true that the great majority 
of men must limit their field of work very much and very clearly if they hope to 
achieve success. The tool must have an edge if it is to cut. It is by the labour 
of specialists that many of the new channels for thought and research have been 
opened, and if the flood has sometimes seemed to spread too far, and to lose itself 
in shallow and sandy places, it has nevertheless tended to fertilize them in the 
end. 
The specialists are not only making the principal advances in science but they 
are furnishing both strong incentives and valuable assistance towards the collec- 
tion rand preservation of medical literature and the formation of large public 
libraries. 
Burton declares that a great library cannot be improvised, not even if one had 
the national debt to do it with—thinks that 20,000 volumes is about the limit of 
what a miscellaneous collection can bring together, and refers especially to the 
difficulty in creating large public libraries in America. My experience would 
show that these statements do not apply to medical books. Of these the folios 
Riid quartos of three and four hundred years ago seem to have had great capacity 
for resistance to ordinary destructive forces. Perhaps much of this is due to the 7 
fact that they are not usually injured by too much handling or perusal. True," 
they are gradually becoming rarer, but at the same time by means of properly 
organized libraries they are becoming more accessible to all who wish to really use 
them, and not merely to collect and hide them away. They drift about like the' 
sea weed, but the survivors are gradually finding secure aud permanent resting- 
places in the score of great collections of such literature which the world now 
possesses. At present the currents of trade are carrying them in relatively large 
numbers to the United States, where medical collectors and specialists are among 
the best customers of the antiquarian booksellers of Europe. I could name a 
dozen American physicians who have given to European agents almost unlimited 
orders for books relating to their several specialities, and upon their shelves may 
be found books of the 15th and 16th centuries, which may be properly marked as 
“rarissime.” 
Not that the rarest books are by any means the oldest. The collector who 
seeks to ornament his shelves with the “Roseof John of Gaddesden,” or the “ Lily 
of Bernard de Gordon,” the first folios of “ Avicenna” or “ Celsus,” or almost any 
of the eight hundred medical incunabulae described by Hain, will probably 
succeed in his quest quite as soon as the one who has set his heart on the first 
editions of Harvey or Jenner, the American tracts on inoculation for small-pox, or 
complete sets of many of the journals and transactions of the present century. 
Whatever may be the chosen line of the book collector, he is the special helper 
of the public library, and this whether he intend it or not. In most cases his 
treasures pass through the auction room, and sooner or later the librarian, who 
can afford to wait, will secure them from further travel. Thanks to the labours 
of such collectors, I think it is safe to say,—what certainly would not have been 
true twenty years ago,—that if the entire medical literature of the world with the 
exception of that which is collected in the United States, were to be now destroyed, 
nearly all of it that is valuable could be reproduced without difficulty. 
What is to be the result of this steadily increasing production of books 1 What 
will the libraries and catalogues and bibliographies of a thousand, or even of a 
hundred years hence be like, if we are thus to go on in the ratio of geometric 
progression, which has governed the press for the last few decades? The 
mathematical formula which would express this, based on the data of the past 
century, gives an absurd and impossible conclusion, for it shows that if we go 
on as we have been going there is coming a time when our libraries will become 
large cities, and when it will require the services of every one in the world, not 
engaged in writing, to catalogue and care for the annual product. The truth is, 
however, that the ratio has changed, and that the rate of increase is becoming 
smaller. In western Europe, which is now the great centre of literary production, 
it does not seem probable that the number of writers or readers will materially 
increase in the future, and it is in America, Russia, and southern Asia, that the 
greatest difference will, be found between the present amount of annual literary 
product and that of a century hence. 
The analogies between the mental and physical development of an individual, 
and of a nation or society, have been often set forth and commented on, but there 
is one point where the analogy fails as regards the products o mental activity,— 
and that is that as yet we have devised no process for getting rid of the exuviae. 
Growth and development in the physical world imply the changes of death as well 
as of life—that with the increase of the living tissues there shall also be the 
excretion and destruction of dead, outgrown and useless' matters which have had tlieir day and served tlieir purpose. But litera scripta manet. There is a vast 
amount of this effete and worthless material in the literature of medicine, and it 
is increasing rapidly. Our literature is in fact something like the inheritance of 
the golden dustman, but with this important difference, viz: that when the 
children raked a few shells or bits of bone from the dust-man’s heap,—and, after 
stringing them together and playing with them a little while, threw them back,— 
they did not thereby add to the bulk of the pile,—whereas our preparers of 
compilations and compendiums, big and little, acknowledged or not, are continually 
increasing the collection, and for the most part with material which has been 
characterized as “ superlatively middling, the quintessential extract of mediocrity.” 
A large medical library is in itself discouraging to many inquirers, and I have 
become quite familiar with the peculiar expression of mingled surprise, awe and 
despair which is apt to steal over the face of one not accustomed to such work 
when he first finds himself fairly in the presence of the mass of material which he 
wishes to examine for the purpose of completing his ideal bibliography of,—let us 
say epilepsy,—or excisions,—or the functions of the liver. 
Let such enquirers, as well as those who regret that they have no access to 
large libraries, and must therefore rely on the common text books and current 
periodicals for bibliography, console themselves with the reflection that much the 
larger part of all of our literature which has any practical value belongs to the 
present century, and indeed will be found in the publications of the last 20 years. 
There are a few books written prior to 1800 which every well educated medical 
man should,—I will not say read but—dip into, such as some of the works of 
Hippocrates and Galen, of Harvey and Hunter, of Morgagni and Sydenham—but 
this is to be done to learn their methods and style rather than tlieir facts or 
theories, and by the great majority of physicians it can be done with much more 
profit in modern translations than in the originals. The really valuable part of 
the observations of these old masters has long ago become a part of the common 
stock, and the results are to be found in every text book. 
If, perchance, among the dusty folios there are stray golden grains yet un- 
gleaned, remember that just in front are whole fields waiting the reaper. There is 
not, and has not been any lack of men who have the taste and time to search the 
records of the past, and the man who has opportunities to make experiments or 
observations for himself wastes his time, to a certain extent, if he tries to do 
bibliographical work so long as he can get it done for him. He wishes to know 
whether this problem has been attacked before, and with what result—whether 
there are accounts of any other cases like the one he lias in hand. In ninety-nine 
instances out of a hundred if the answer to these questions is not given in the 
current text books or monographs it is not worth prolonged search by the original 
investigator. Yet he should know how to make this search, if only to enable 
him to direct others, and it is for this reason that a little acquaintance with 
bibliographical methods of work ought to be obtained by the student. 
When a physician has observed or (thinks he has observed), a fact, or has 
evolved from his inner consciousness a theory Avliich he wishes to examine by the 
light of medical literature, he is often very much at a loss to know how to begin, 
even when he has a large library accessible for the purpose. 
The information he desires may be in the volume next his hand, but how is he 
to know that1? And even when the usual subject-catalogue is placed before him 
he finds it very difficult to use it, especially when, as is often the case, he has by 
no means a well defined idea as to what it is he wishes to look for. Upon the 9 
title page of the Washington City Directory is printed the following aphorism, 
lo find a name you must know how to spell it.” This has a very extensive 
application in medical bibliography. To find accounts oi cases similar to your 
own rare case you must know what your own case is. 
To return to the Subject-Catalogue. If it is a classed catalogue, a catalogue 
raisonnee—it will often seem to be a very blind guide to one who is not familiar 
with the classification and nomenclature adopted by the compiler. And certainly 
some of these classifications are very curious—reminding one of Heine’s division 
of ideas into reasonable ideas, unreasonable ideas, and ideas covered with green 
leather. But if the enquirer has mastered the arrangement of the catalogue it is 
two to one that it will not help him. It is a catalogue of the titles of books, but 
very often the title of a book gives very little information as to its contents, if 
indeed it is not actually misleading. How suppose the particular case he has in 
hand is one of a new-born infant having one leg much larger and longer than the 
other. lie will find no book title relating to this. There may be a book in the 
library on diseases of the lymphatics which contains just what he wants, but 
unless he knows that his case is one affecting the lymphatics he will hardly get 
the clue. There may also be in the library twenty papers, in as many different 
volumes of journals and transactions, the titles of which show that they probably 
relate to similar cases, but the titles of such papers do not appear in the 
catalogue. 
It should also be observed that Subject-Catalogues may easily be put to im- 
proper uses, or thought to give more information than they really do. They are 
not bibliographies, but mechanical aids in bibliograpical work. 
You will, perhaps, pardon me for taking as an illustration the Index Catalogue 
-of the library of the Surgeon-General’s office in Washington, as being one with 
which I am familiar, and which I can venture to comment on without risk of its 
being tnouglit that I wish to depreciate its value. Taking any given subject in 
medicine, it is possible for a fairly educated physician to obtain from this catalogue 
large proportion of all the references which have any special value, and by so 
doing to save a vast amount of time and labour. On the other hand, he will find 
when he comes to examine thelbooks and articles referred to, that at least one- 
half of them are of no value so long as the other half are accessible, seeing that 
they are dilutions and dilatations, re-hashes and summaries of the really original 
papers. If the seeker is in the library itself, this does not cause a great waste of 
time, as he can rapidly examine and lay aside those that do not serve his purpose. 
But if he is using this catalogue in another library—say here in London, the case 
is different. It is highly improbable that he will find in any other collection all 
the books referred to, and then comes the annoyance of the doubt as to whether 
lie may not be missing some very valuable paper. How is he to know whether 
or not Smith, in his pamphlet on the functions of the pneumogastric, has anti- 
cipated his own theory of its relations to enlarged tonsils ? And in all such 
cases “omne ignotum est pro magnifico.” In a bibliography of the subject, pre 
pared from the same material as the catalogue, he would either find no mention of 
Smith’s paper, or, better still, a note that his paper is merely an abstract, or com- 
pilation. Hie fact that he does not find Smiths book in the London library, nor 
any allusion to it in the best works on the subject, ought to induce him to ignore 
it altogether. 
In proportion to the energy of the young writer, and his determination to not 
only note everything that has been written about his subject, but to carryout the golden rule of verifying all liis references, lie is apt to be led off from his direct 
research into the many attractive by-paths of quaint and curious speculation which 
he will find branching off on every side, and this danger must be guarded against, 
or he will find that he is wasting his time and energy in turning over chaff which 
has long ago been pretty thoroughly threshed and winnowed. 
It is, however, no part of my present purpose to set forth the methods and 
principles of bibliography; it is sufficient to point out their importance, and to 
call attention to the point that a knowledge of how and where to find the record of 
a fact is often of more practical use than a knowledge of the fact itself, just as we 
value an encyclopaedia for occasional reference, and not for the purpose of reading 
through from cover to cover. 
Instruction in the history and literature of medicine forms no part of the course 
of medical education in English and American schools; nor should I be disposed to 
recommend its introduction into the curriculum if it were to be based on French 
and German models but it does seem possible to take a step in this direction which 
would be of great value, not only as a means of general culture, as teaching students 
how to think, but from a purely practical point of view, in teaching them how to 
use the implements of their profession to the best advantage—for books are pro- 
perly compared to tools of which the index is the handle. Such instruction should 
be given in a library, just as chemistry should be taught in a laboratory. The way 
to learn history and bibliography is to make them—the best work of the instructor 
is to show his students how to make them. 
In the absence of some instruction of this kind the student is liable to waste 
much time in bibliographical research. There has been much more done in this 
direction than many writers seem to suppose, and there are not many subjects in 
medicine which have not been treated from this point of view. Of course all is 
not bibliography which pretends to be such. Very many of the exhaustive and 
exhausting lists of references which are now so common in medical journal articles 
have been taken largely at second-hand, and thereby originate or perpetuate errors. 
It is well to avoid false pride in this matter. To overlook a reference is by no 
means discreditable,—but a wrong reference, or an unwitting reference to the 
same thing twice, gives a strong presumption of carelessness and second-hand 
work. Journal articles, however, and especially reports of cases, undergo strange 
transmogrifications sometimes, and I have watched this with interest in the case 
of a French or German paper, translated and condensed in the London Record, 
then appearing in abstract under the name of the translator in a leading journal, 
then translated again, with a few new circumstances, in a continental periodical, 
and finally perhaps reversed and appearing as an original contribution in the pages 
of the “ Little Peddlington Medical Universe.” 
In this connection it is well to remember that a mere accumulation of observa- 
tions, no matter how great the number, does not constitute science, especially if 
these observations have been recorded under the influence of the same theories 
and in essentially similar conditions. 
Science seeks the law which governs or explains the phenomena, and when 
this is found the records of isolated instances of its action usually become of 
small importance so far as that law is concerned. We care little now for the 
records of the chemical experiments of a century ago, and the many detailed 
accounts of the earlier cases of the use of ether or chloroform are of so little 
interest at the present time that it is not worth while to refer to them in a biblio- 
graphy of the subject. And although much has been done towards classifying 11 
and indexing our medical records (more in fact than most physicians suppose- 
still, as Helmholtz points out, such knowledge as this hardly deserves the name 
of science, since it neither enables us to see the complete connection nor to predict 
the result under new conditions yet untried. 
Do I seem to depreciate the value of the thoughts which our masters have left 
us, and which have furnished the foundations on which we build 1—or to under- 
value the importance of the great medical libraries in which are stored these 
thoughts?—or to speak slightly of the utility of the catalogues, and indexes, and 
bibliographies, without which such libraries are trackless and howling wildernesses 1 
If so, I have said what I did not mean to say. The subject has been considered 
from the point of view of what used to be called the division of labour, but which 
now I suppose should be called evolution and differentiation, and this has been 
done because life is short and the art is long,—with fair prospect of becoming 
longer. It is surely unnecessary for me to enter upon any panegyric of books or 
libraries. As Dr. Holmes says: “ It is not necessary to maintain the direct 
practical utility of all kinds of learning. Our shelves contain many books which 
only a certain class of medical scholars will be likely to consult. There is a dead 
medical literature, and there is a live one. The dead is not all ancient, the live is 
not all modern. There is none, modern or ancient, which, if it has no living 
value for the student, will not teach him something by its autopsy. But it is 
with the live literature of his profession that the medical practitioner is first of 
all concerned.” 
In medicine, as in social science, we must depend for many facts upon the 
observation of conditions which occur very rarely, and which cannot be repeated 
at pleasure. I have already alluded to the importance of Nature’s vivisections to 
the physiologist, and a record of a case written a century ago may be just the link 
that is needed to correlate the results of his experiments of yesterday with existing 
theories. The case, which at first seems unique and inexplicable, both receives 
and furnishes light when compared with ancient records. 
A science of medicine, like other sciences, must depend upon the classification 
of facts, upon the comparison of cases alike in many respects, but differing some- 
what either in their phenomena or in the environment. The great obstacle to 
the development of a science of medicine is the difficulty in ascertaining what 
cases are sufficiently similar to be comparable—which difficulty is in its turn largely 
due to insufficient and erroneous records of the phenomena observed. This defect 
in the records is largely due—first, to ignorance on the part of observers ; second, 
to the want of proper means for precisely recording the phenomena; and 
third, to the confused and faulty condition of our nomenclature and nosological 
classification. 
Let us consider each of these points briefly. Very, very few are the men who 
can, by and for themselves, see and describe the things that are before them. 
Just as it took thousands of years to produce a man who could see what nowr 
any one can see when shown him, that the star Alpha in Capricorn is really two 
separate stars, so we had to wait long before the man came who could see the 
difference between measles and scarlatina, and still longer for the one who could 
distinguish between typhus and typhoid. Said Plato, “ He shall be as a god to 
me, who can rightly divide and define.” Men who have this faculty—the “Blick” 
of the Germans—wre cannot produce directly-by any system of education; they 
come we know not when or why, “ forming a small band, a mere understanding 
of whose thoughts and works is a test of our highest powers. A single English dramatist, and a single English mathematician have probably equalled in scope 
and excellence of original work in their several fields all the like labours of their 
countrymen put together.”* 
But cannot we do something to increase the number of observers by telling 
them what to observe ? It is probable that much may be accomplished in this 
direction provided that care be taken to limit the field. Manuals of “what to 
observe at the bedside and in the post-mortem room” are very well in their way, 
but can never be made to reach the great majority of the profession, nor would 
they be of much use if they did. If a few, a very few, distinct specific questions 
are brought to the attention of the general practitioner, he will often be on the 
alert for their answer. And it should be remembered that chance may present to 
the most obscure practitioner an opportunity for observation which the greatest 
master may never meet. 
The great difficulty is to get such questions prepared. They must relate to 
matters that are just in the nebulous region between the known and unknown—to 
points not yet clear, but of which we know enough to make it probable that by 
observing in a definite direction they can be made clear; and to prepare them 
requires not only knowledge, but a certain reaching out beyond knowledge. It 
usually happens that the man who has this faculty strives to answer his questions 
himself; and no doubt he can usually do it better than another. But much can be 
done towards defining and marking out what we do not know, and this has 
been a powerful aid to the progress of physiology in recent years. 
I have had occasion to refer to this in speaking of Professor Forster’s work on 
physiology, in each section of which an attempt is made to separate that which 
may be considered as proved from that which is merely probable ; and thus almost 
every page becomes suggestive of work to be done. 
Another example of what I mean will be found in a paper on the collection of 
data at autopsies by Professor H. P. Bowditch of Boston (Trans. Mass. Med. 
Legal Soc. 1, 1880, p. 139). Taking the results of an investigation into the 
absolute and relative size of organs at different periods of life, and in connection 
with different morbid tendencies, recently published by Professor Beneke of 
Warburg—Dr. Bowditch urges the securing as large a number as possible of such 
data, and selects certain of Professor Beneke’s results for special inquiry; as for 
instance that “ the cancerous diathesis is associated with a large and powerful 
heart, capacious arteries, but a relatively small pulmonary artery, small lungs 
well developed bones and muscles, and tolerably abundant adipose tissue.” It 
can hardly be doubted that those who read the papers of Professors Bowditch 
and Beneke will be induced to examine things which before would have had for 
them no interest, and therefore to make and record observations in pathological 
anatomy which otherwise would have been lost. 
The second difficulty referred to—viz.: the want of means for making accurate 
records, is one that is yearly growing less. It behoves us to be modest in our 
predictions as to what may be accomplished in the future towards the solution of 
■our Sphynx’s riddle. We see as through a glass darkly, and except through the 
glass, in no wise ; but at least we have made such progress that what we do see, 
we can to a great extent so record that our successors yet unborn can also see— 
and it is owing to this fact that a part of the medical literature of the last quarter 
of a 19th century will be more valuable than all that has preceded it. 
* lies, Mathematics in Evolution. Pop. Sci. Monthly, 1876, IX. p. 207. The word-pictures of disease traced by Hippocrates and Sydenham, or even 
those of Graves and Trosseau, interesting and valuable as they are, are not com- 
parable with the records upon which the skilled clinical teacher of tlie present 
day relies. Yet how imperfect in many cases are even the best of these records as 
compared with what might be given with the resources which we have at our 
command. The temperature chart has done away with the errors which neces- 
sarily follow attempts to compare the memory of sensations perceived last Aveek 
with the sensations of to-day—and the balance and the burette enable us to 
estimate Avitli some approach to precision the tissue changes of our patients by 
the records of change in the excretions which they furnish; but Ave must still trust 
to our memory, or to the imperfect descriptions of Avhat others remember, Avhen 
Ave attempt to compare the results obtained on successive days by auscultation or 
percussion, although the phonograph and microphone strongly hint to us the 
possibility of either accurately reproducing the sounds of yesterday, or of trans- 
lating them into visible signs, perhaps something like the dot and dash record of 
the telegraph code, which could then be given to the press, and so compared with 
each other by readers at the Antipodes. 
We are beginning to count the blood corpuscles, and to use photomicrography, 
but we do not yet apply the latter process to the former so as to enable every 
reader to count for himself. 
The connections of medicine with the physical sciences are yearly becoming 
closer, and the methods by Avliich these sciences have been brought to their 
present condition are those by which progress has been, and is to be, made in 
therapeutics as well as in diagnosis or in physiological research. These methods 
turn mainly upon increasing the delicacy and accuracy of measurements: of 
expressing manifestations of force in terms of another force, or of dimension in 
space or time. The balance and the galvanometer, the microscope and the 
pendulum, the camera, the spliygmograpli and the thermometer are some of 
the means by which investigators, at the bedside and in the laboratory, are 
seeking to obtain records which shall be independent of their own sensations or 
personal equations ; which shall be taken and used as expressing not opinions 
but facts; and with every addition to or improvement in these means of 
measurement and record, the field of observation widens, and new and more 
reliable materials are furnished for the application of logical and mathematical 
methods. 
Upon the third difficulty which has been referred to,—viz : our confused and 
defective terminology I need not dwell. “ Science,” said Condillac, “ is a language 
Avell made,” and though this is far from being the Avliole truth, it is an important 
part of it. In examining medical reports and statistics, it is necessary to bear 
constantly in mind that to understand many terms you must knoAv Avhat the 
individual Avriter means by them. When, for example, Ave find in such statistics 
a certain number of deaths attributed to gastro-enteritis, or croup, or scrofula, Ave 
have to take into account the country, the period and the individual author in 
order to get even a fair presumption as to Avhat is meant. 
The three difficulties which have been referred to, although the most important, 
are by no means the only causes of the confusion and imperfection of our records. 
Prominent among the minor troubles of the investigator are defective or mis- 
leading titles and in behalf of the readers and bibliographers of the future I 
would appeal to authors, and more especially to editors, to pay more attention 
than many of them do to the matter of titles and indexes. The men to whom your papers are most important, and wlio will make the best use of them provided 
they knew of their existence, are for the most part hard workers, busy men, who 
have a right to demand that their literary table shall be provided with properly 
prepared materials and not with shapeless lumps. 
The editors of transactions of societies, whether these are sent to journals, or 
published in separate form, often commit numerous sins of omission in the 
matter of titles. The rule should be that every article which is worth printing 
is worth a distinct title, which should be as concise as a telegram, and be printed 
in a special type. If the author does not furnish such a title it is the editors 
business to make it, and he should not be satisfied with such headings as 
“ Clinical Cases,” “ Difficult Labour,” “A Remarkable Tumour,” “Case of Wound, 
with Remarks.” The four rules for the preparation of an article for a journal 
will then be : ]. Have something to say ; 2. Say it : 3. Stop as soon as you have 
said it; 4. Give the paper a proper title. 
Some societies and editors do not seem to appreciate fully their responsibility 
for the articles which they accept for publication, a responsibility which cannot 
be altogether avoided by any formal declaration disclaiming it. This is due to 
the fact that while the merits of a paper can usually be determined by examina- 
tion, this is by no means always the case. In every country there are writers 
and speakers whose statements are received with very great distrust by those 
best acquainted with them. Supposing these statements to be true, the papers 
would be of much interest and importance ; but the editor should remember 
that a certain number of readers, and especially those in foreign countries, have 
no clue to the character, of the author, beyond the fact that they find his works 
in good company. 1 In medical literature, as in other departments, we find books 
and papers from men who are either constitutionally incapable of telling the 
simple literal truth as to their observations and experiments, although they may 
not write with fixed intention to deceive, or from men who seek to advertise 
themselves by deliberate falsehoods as to the results of their practice. Such men 
are usually appreciated at their true value in their immediate neighbourhood, 
and find it necessary to send their communications to distant journals and societies 
in order to secure publication. j 
I presume that you are all familiar with the peculiar feeling of distrust which 
is roused by too complete an explanation. The report of a case in which every 
symptom observed, and the effect of every remedy given, is fully accounted for, 
and in which no residual unexplained phenomena appear, is usually suspicious, 
for it implies either superficial observation, or suppression, or distortion of some 
of the facts. A diagrammatic representation is usually much plainer than a good 
photograph, but also of much less value as a basis for further work. 
No fact is more familiar to this audience than the vast extent of the field of 
the science of to-day—so vast that few may hope to master more than a small part 
of it, and yet so closely connected that even the small part cannot be fully grasped 
without some acquaintance with a much wider field. 
But little over a hundred years ago, Haller in Gottingen was professor of 
anatomy, botany, physiology, surgery, and obstetrics, and lecturer on medical 
jurisprudence. At the same time he was writing one review a week, and summing 
up existing medical science in his bibliotheca). To-day any one of these branches 
requires all the time of the most energetic and learned of our contemporaries; 
but, on the other hand, the well-educated medical graduate of to-day could give 
Haller valuable instruction in each of the branches of which he was professor. 15 
It is also true, as I have pointed out, that our actual progress is by no means in 
pioportion to the work done, nor as great as these merely quantitative statements 
would seem to make it. 
. Science lias been termed “ the topography of ignorance.” “ From a few elevated 
points Ave triangulate vast spaces, enclosing infinite unknown details. We cast 
the lead and draAv up a little sand from abysses we shall never reach with our 
dredges. . If it is true that we understand ourselves but imperfectly in health, it 
is more signally manifest in disease, Avhere natural actions imperfectly understood, 
disturbed in an obscure Avay by half seen causes, are creeping and winding along 
in the dark toward their destined issue, sometimes using our remedies as safe 
stepping stones, occasionally, it may be, stumbling over them as obstacles.”* 
I In days of old, Avlien the profession of medicine, or of a single medical specialty 
a\ as an inheritance in certain families, a large part of their knowledge, and the 
efficiency of their remedies was thought to depend upon these being kept a pro- 
found mystery. Among the precepts of magic there Avas no more significant one 
than that Avhich declared that the communication of the formula destroyed its 
poAver, and that hence attempts to reveal the secret must always fail. We have 
changed all that. Every physician hastens to publish his discoveries and special 
knowledge, and a good many do the same by that which is not special, or which 
is not knoAvledge. / For the individual, in a degree—for the nation or the race in 
a much greater degree the literature produced is the most enduring memorial. 
Ihe Avliole result of civilization has been cynically defined as being roughly, 
Three hundred million Chinese, two hundred million natives of India, two 
hundred million Europeans and North Americans, and a miscellaneous hundred 
million or tAvo of Central Asians, Malays, South Sea Islanders, &c., and over and 
above all the rest the Library of the British Museum. This is the net result of 
an indefinitely long struggle betAveen the forces of men and the Aveights of various 
kinds in the attempt to move Avhich these forces display themselves.”+ 
And thus in our great medical libraries each of the folios or quaint little black 
letter pamphlets which mark the first two centuries of printing, or of the cheap 
and dirty volumes of more modern days with their scrofulous paper and abomin- 
able typography, represents to a great extent the life of one of our profession and 
the fruit of his labours, and it is by the fruit that Ave know him. 
After stating that modern physicists have concluded that the sun is going out, 
that the earth is falling into the sun, and therefore that it and all tilings in it will 
be either fried or frozen, Professor Clifford concludes that “ our interest lies so 
much Avith the past as may serve to guide our actions in the present, and Avith so 
much of the future as Ave may hope will be affected by our actions noAV. Beyond 
that Ave do not know and ought not to care. Does this seem to say let us eat and 
drink for tomorrow Ave die? Not so, but rather let us take hands and help for 
this day Ave are alive together.” To this I join a vmse from the Talmud 
Avhich will remind you of the first aphorism of Hippocrates, and is none the worse 
for that. “ The day is short, and Avork is great,—the reward is also great, and 
the master presses. It is not incumbent on thee to complete the work, but thou 
must not therefore cease from it. 
* “ Border Lines of Knowledge,” etc., by 0. W. Holmes, Boston, 1862, pp. 7-8. 
t “Liberty, Equality and Fraternity,” by James Eitz James Stephen, N.Y., 1873, p. 178. 16 
TABLE I. 
The Number of Volumes of Medical Journals and Transactions Published in the Years 
1879 and 1880. 
Subjects. 
Journals and 
Transactions. 
United 
States. 
Gt. Brit 
and 
Colonies. 
prance & 
German; 
Spain. 
Italy. 
All 
Others. 
Total. 
1S79 
1880 
1879 
'1880 
1879 
1880 
1879 
1880 
1879 
188c 
187c 
188c 
j87< 
188c 
18791880 
General and 
Miscellaneous, 
Journals 
75 
83 
26 
26 
60 
63 
4’ 
43 
22 
26 
42 
42 
7C 
72 
33t 
355 
Practical 
Medicine, etc. 
Transactions ... 
56 
54 
II 
12. 
3° 
19 
31 
31 
1 
I 
7 
31 
27 
I Of, 
151 
Anatomy, Pliysi- 
5 
5 
IS 
17 
1 
I 
I 
26 
27 
ology, Morpho- 
logy, Biology. 
Transactions ... 
I 
I 
4 
2 
5 
;_3 
Diseases of 
Nervous System 
and Insanity. 
Journals 
Transactions ... 
3 
5 
4 
4 
2 
I 
3 
5 
5 
3 
4 
17 
I 
2! 
Surgery. 
Journals 
Transactions ... 
I 
I 
1 
3 
1 
3 
1 
3 
2 
4 
_2 
Ophthalmology. 
Journals 
Transactions ... 
I 
1 
I 
2 
4 
4 
1 
5 
1 
3 
3 
3 
1 
3 
2 
2 
19 
2 
20 
Skin Diseases. 
Journals 
Transactions ... 
I 
I 
I 
I 
I 
I 
I 
1 
1 
1 
1 
I 
5 
1 
1 
Otology. 
Journals 
Transactions ... 
I 
2 
I 
1 
3 
3 
6 
1 
e 
Gynaecology and 
Journals 
2 
2 
I 
I 
5 
7 
6 
6 
I 
2 
2 
I 
2 
18 
20 
Obstetrics. 
Transactions ... 
3 
I 
2 
1 
5 
Hygiene and 
Medical 
Jurisprudence. 
Journals 
6 
6 
2 
3 
5 
5 
13 
13 
I 
3 
3 
4 
6 
6 
3fi 
40 
Transactions ... 
3 
3 
2 
4 
3 
2 
4 
3 
I 
I 
13 
13 
Pharmacy and 
Medical 
Chemistry. 
Journals 
Transactions ... 
7 
4 
9 
3 
7 
6 
5 
3 
5 
1 
15 
I 
15 
5 
5 
5 
5 
9 
9 
53 
8 
54 
4 
Dentistry. 
Journals 
Transactions ... 
6 
10 
2 
2 
2 
3 
IO 
15 
Homoeopathy. 
12 
16 
4 
4 
3 
3 
7 
-17 
J 
I 
3 
2 
3 
3 
33 
36 
Transactions ... 
3 
3 
2 
1 
5 
4 
Eclectic, Botanic, 
Physio-Medical, 
etc. 
Journals 
Transactions ... 
II 
2 
13 
2 
II 
2 
13 
2 
Popular, Adver- 
tising, Mineral 
Waters, etc. 
Journals 
Transactions ... 
8 
10 
4 
4 
12 
I 
8 
1 
5 
5 
2 
2 
2 
2 
2 
2 
35 
1 
33 
1 
Veterinary. 
Journals 
Transactions ... 
I 
3 
3 
3 
4 
4 
II 
to! 
4 
_l 
5 
4 
4 
27 
29 
Laryngology. 
Journals 
Transactions ... 
I 
I 
1 
2 
1 
Total 
Journals 
135 
163 
57 
58 
I09 
112 
132 
136 
3b 
4°: 
69 
70 
97 
IOI 
b3S 
680 
Transactions ... 
74 
69 
15 
45 
27 
38 
3b 
I 
'I 
IO, 
7 
32 
28 
21S 
184 17 
TABLE II. 
The Medical Literature of 1879 and 1880, 
United 
England. 
France. 
Germany. 
Italy. 
Spain. 
Others. 
Total. 
Subjects. 
No. of 
1879 
[880 
1879 
1880 
1879 
1880 
1879 
1880 
1879 
1880 
1879 
1880 
1879 
1S80 
1879 
1880 
Anatomy and 
Physiology. 
Books 
Theses 
Jour. Articles ... 
7 
162 
17 
177 
J9 
i57 
18 
176 
60 
25 
385 
32 
24 
35i 
54 
4 
458 
3i 
420 
$ 
109 
2 
105 
I 
26 
1 
32 
26 
74 
8 
6 
68 
172 
29 
1371 
106 
3° 
1329 
Books ... 
2 
3 
2 
13 
5 
7 
6 
22 
l6 
Pathology 
Theses 
II 
7 
3 
I 
2 
I 
16 
9 
Jour. Articles... 
32 
32 
25 
27 
36 
5i 
35 
56 
13 
12 
5 
5 
12 
19 
158 
202 
Practice of 
Medicine. 
Books 
Theses 
Jour. Articles... 
52 
1434 
27 
1154 
39 
1083 
51 
918 
132 
248 
1340 
104 
216 
1036 
78 
7 
1001 
56 
12 
812 
7 
316 
12 
257 
9 
198 
2 
I7i 
55 
2 
4°S 
12 
7 
348 
372 
257 
5799 
264 
235 
4716 
Books 
38 
32 
19 
3° 
33 
48 
32 
23 
I 
4 
I 
II 
7 
i35 
144 
Nervous System. 
Theses 
Jour. Articles... 
406 
410 
342 
303 
56 
380 
Si 
355 
3 
372 
4 
332 
112 
124 
5° 
43 
4 
99 
4 
100 
63 
1761 
59 
1667 
Books ... 
18 
27 
5 
23 
62 
63 
36 
29 
2 
4 
I 
l6 
15 
i35 
I '0 
Surgery. 
Theses 
144 
144 
15 
6 
I 
5 
11 
165 
161 
Jour. Articles... 
894 
823 
844 
706 
706 
597 
539 
5i3 
198 
180 
136 
23 
160 
145 
3477 
3087 
Books ... 
10 
15 
7 
7 
13 
18 
20 
17 
I 
I 
5 
1 
s 
5 
6c 
64 
Opthalmologv. 
Theses 
41 
32 
I 
2 
1 
44 
34 
Jour. Articles... 
187 
238 
81 
IOI 
310 
252 
254 
271 
59 
58 
52 
52 
49 
45 
992 
1007 
Books ... 
3 
9 
3 
I 
2 
7 
2 
6 
2 
12 
23 
Otology. 
Theses ... 
7 
9 
I 
8 
9 
Jour. Articles... 
114 
185 
38 
74 
31 
73 
102 
358 
11 
9 
5 
16 
i2 
20 
3'3 
535 
Books 
3 
9 
2 
8 
II 
12 
15 
I 
10 
I 
2 
2 
I 
1 
33 
41 
Skin Diseases. 
Theses 
21 
24 
22 
24 
Jour. Articles... 
63 
95 
115 
IOI 
62 
138 
99 
109 
51 
53 
20 
27 
3i 
24 
441 
547 
Books 
I 
2 
4 
4 
19 
13 
5 
6 
3 
6 
1 
35 
29 
Venereal. 
Theses 
29 
'9 
19 
19 
Jour. Articles... 
76 
72 
45 
3>- 
106 
96 
94 
56 
42 
3i 
37 
22 
19 
32 
399 
348 
Books 
12 
l6 
2 
6 
12 
13 
13 
12 
3 
2 
I 
4 
1 
47 
$0 
GYnrecolosrv. 
Theses 
40 
25 
3 
2 
I 
44 
27 
Jour. Articles... 
364 
416 
239 
189 
200 
200 
I92 
186 
60 
66 
27 
27 
48 
48 
1130 
1132 
Books 
6 
7 
6 
8 
17 
l6 
8 
i£ 
5 
I 
1 
7 
1 
1 
4< 
S2 
Obstetrics. 
Theses ... 
33 
47 
2 
1 
1 
37 
49 
Jour. Articles... 
435 
43° 
216 
195 
293 
211 
173 
142 
80 
f>3 
22 
3° 
51 
57 
1270 
1114 
Books 
62 
80 
29 
48 
39 
80 
29 
28 
3 
5 
2 
16 
4 
178 
247 
Hygiene. 
Theses 
2 
13 
3 
2 
16 
Jour. Articles... 
i?3 
239 
l6l 
237 
186 
271 
235 
202 
27 
26 
33 
30 
76 
56 
891 
1061 
Books 
2 
2 
I 
I 
9 
18 
2 
4 
4 
1 
I 
15 
30 
Jurisprudence. 
Theses 
8 
9 
2 
8 
11 
Jour. Articles... 
72 
167 
44 
103 
85 
173 
80 
160 
33 
46 
18 
28 
36 
49 
368 
726 
General and 
Miscellaneous. 
Books 
Theses 
Jour. Articles... 
94 
349 
96 
476 
46 
200 
52 
274 
119 
22 
488 
144 
5° 
556 
6l 
2 
393 
04 
7 
411 
6 
99 
6 
142 
2 
94 
2 
79 
52 
5 
176 
13 
6 
178 
382 
29 
1799 
377 
63 
2116 
Total by 
Countries. 
Books 
310 
339 
182 
259 
54i 
573 
364 
306 
28 
5° 
21 
11 
197 
58 
1643 
1596 
Theses 
677 
670 
42 
36 
I 
1164 
703 
68S 
23 
40 
743 
746 
Jour. Articles... 
4781 
4904 
3592 
3443 
4608 
4380 
4037 
3828 
1210 
1248 
1183 
20,169 
19.587