Monday, 29 June 2015

Medical periodicals: mining the past

“The medical women question is perennial”, an anonymous contributor to The Lancet's editorial pages wearily opined in a November issue of 1877. “It knows no limits; we encounter it at every turn…its appeals to periodical literature, instead of awakening a spirit of conciliation, have usually aroused a feeling of resentment.” Alison Moulds, of the University of Oxford, who has explored the periodical literature of the time, found that opinion on the medical training of women was far from uniform. One Lancet contributor ventured that women might treat female patients and children, whereas another harrumphed that “women hate one another, often at first sight”. Moulds' study of the “medical women question” points to the dangers of leaping to conclusions about past opinions or practices without exploring the historical context.
Medical journals offer an unparalleled source of historical data not only on doctors, diseases, and medical practice, but also on social transformations such as the participation of women in professional life. Working with Nineteenth-Century Medical and Health Periodicals, a recent conference at St Anne's College, Oxford, UK, brought together various examples of the gold that is to be found between the yellowing pages. However, participants also set out the challenges that face prospectors.
Medical periodicals began to circulate in the mid-18th century, and by end of the 19th century some hundreds had been launched. As Thalia Knight, Librarian at the Royal College of Surgeons of England, pointed out, scientific commentators were already worrying about information overload before the century was over. “At the present time, the accumulation of material is so rapid that there is danger of indigestion”, lamented physicist Lord Rayleigh in 1877. He added that “it is often forgotten that the rediscovery in the library may be a more difficult and uncertain process than the first discovery in the laboratory”.
Modern scholars face no less difficulty making such rediscoveries. Like endangered species, complete sets of 19th-century journals have become isolated in few and widely spaced reserves in Europe and the USA, while in less well-resourced libraries they face the scrapheap. Even when they are protected, they may not be accessible. Sally Shuttleworth heads the historical research projects at the University of Oxford that jointly sponsored the conference, which include the Constructing Scientific Communities project. The projects rely on early medical journals, and she recalls frantically rifling through the shelves of Oxford's Bodleian Library to get some idea of what was in the bound volumes before they were shipped off to an automated depository.
Digitisation offers only a partial solution. Searching a database is a different process from browsing through volume runs that physically preserve the temporal ordering and context of articles. So far, only a tiny proportion of the total corpus has been digitised. Journals that are still current, such asThe BMJ and The Lancet, are on digital platforms that make sense to medical researchers, but not necessarily to historians. Many digitised journals from the 19th century are accessible only to subscribing institutions or individuals. And searching for keywords risks missing the evolution of terminology and ideas, and the contexts in which these took place.
The Mining the History of Medicine project at the University of Manchester, a research collaboration between the Centre for the History of Science, Technology and Medicine (CHSTM) and the National Centre for Text Mining, is exploring how some of these shortcomings might be addressed. As Elizabeth Toon of the CHSTM explained at the conference, the project is “teaching” a computer system to recognise semantic entities rather than words—for example, proper names, medical conditions, and addresses—in The BMJ and the London Medical Officer of Health Reports so that searches return related terms and allow you to browse by category. The project's leaders have had to address the inconsistent and evolving use of language among 19th-century practitioners. How to categorise “inflammatory mischief”, for example?
The UK's Wellcome Library has a long-term strategy for digitising some of its holdings. As a test-case for a journal it chose Chemist & Druggist, a trade periodical rich in images and advertisements documenting the history of the pharmaceutical industry; launched in 1859, it has been published continuously ever since. The task facing Damian Nicolaou, who managed the project, included handling more than half a million pages of print, bound into volumes that each weighed between 6 and 7 kg, and not all of which were correctly numbered. The Wellcome Library worked in partnership with the Internet Archive to complete this task, which is now available online to anyone. Readers can download a whole issue or a page, and search within issues—searching the whole resource is still under development.
Digitised journals do offer advantages in terms of speed and quantitative analysis. A team at the Centre for History in Public Health at the London School of Hygiene & Tropical Medicine is exploring the history of changing terminology in addiction as part of ALICE RAP, a European project on addiction and lifestyle. Searching for words such as dypsomania in The BMJ and the British Journal of Inebriety, Alex Mold and her colleagues were able to identify patterns of usage. For example, they found use of the term addiction peaked in the 1920s, coinciding with the period of prohibition in the USA; more surprisingly, use of the term alcoholism peaked a decade earlier. But the project's partners in Italy, Austria, and Poland were unable to use the same methodology because the relevant journals were not available in digital form.
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Wellcome Library, London
Overcoming such difficulties could accelerate the historical analysis already emerging from studies that use medical periodicals as a primary resource. In her exploration of Scandinavian medical missionary publications, Malin Gregersen at the University of Bergen found stories of the cure of bodies and souls in India or China that clearly served the missions' fundraising agenda. She also discovered ethnographic accounts of local life not widely available elsewhere, and was able to document an interesting affiliation of western science with Christian religion as missionaries sought converts through offering health care. Meanwhile, in a selection of Russian medical journals, such asVrach and Meditsinskii Vestnik, held in the National Library of Medicine in Washington DC, Michelle DenBeste of California State University found evidence of the pioneering work of individual Russian women doctors, among the first in the world to practise in large numbers. Much more remains to be discovered in Russia's libraries and archives, but the sources are frustratingly inaccessible.
Despite difficulties in accessing some archives, 19th-century medical periodicals remain a rich resource for historians. Hilary Marland, of the University of Warwick, is interested in the way the debate about girls' health moved between a range of popular and medical periodicals. Hilarious debates on the merits or dangers of young women riding bicycles included a warning (by a female author) that girls risked trading their femininity for fitness and acquiring a (clearly undesirable) “bicycle face”. Other writers, however, enthusiastically supported the trend for young women to engage in active pursuits, and there is evidence that contributors to popular magazines influenced the opinions in medical journals as well as vice versa.
In the early days, when their editorial range extended from the consulting room to society at large, periodicals found readers well beyond the confines of the profession. Some of the best-known founders consciously used medical journals as a vehicle for social and political influence. Thomas Wakley, who founded this very journal in 1823, was a key figure in the radicalisation of medical professionals as a route to social reform. Michael Brown of the University of Roehampton has looked at the influence of William Cobbett's reformist Political Register in Wakley's decision to produce a low-cost, high-circulation publication with a reputation for fearless outspokenness. Wakley aimed to empower the individual against the establishment by making medical knowledge directly accessible and exposing nepotism and incompetence in the medical profession—even if his calls for transparency were somewhat contradicted by his use of secret informants to record lectures and report on botched operations.
Ana Carneiro and her colleagues at the New University of Lisbon found that a similar reformist agenda motivated some two dozen medical journals launched in Portugal in the late 19th century, explicitly as “scientific propaganda”. Doctors, who had not previously enjoyed high status, proposed to cure not only the ills of individuals but also the country as a whole, within a framework of anticlericalism and the new science. By the early years of the 20th century their campaign had led to the foundation of medical institutions in key cities, and doctors had achieved a new level of respect and influence.
Jonathan Topham of the University of Leeds enumerated some of the lessons to be learned from the studies reviewed at the conference. He reminded his audience that the modern medical journal is a very different animal from its 19th-century predecessor, even if it bears the same title. Journals were commercial productions aimed at specific markets, but they underwent reinvention as they sought to hold on to their markets, or as the motives of their creators shifted. The value of studying early medical periodicals lies in recognising the richness of the layering of scientific advance, medical practice, social impulse, and commercial imperative that define these fascinating publications. Now that historians and specialist librarians are actively engaged in designing digital resources that more fully exploit the potential of this literature, there is ample scope to explore the historical context in which the practice of modern medicine began to emerge.