Guardians of Medical Knowledge: The Genesis of the Medical Library Association (review)

Connor reports the results of her rigorous historical investigation of the genesis and evolution of the Medical Library Association (MLA) and medical librarianship in North America. She analyzes the socioeconomic and other cultural forces that led to the MLA's inception in 1898, analyzes its subsequent development, and ends with an assessment of its status at the time of its centennial celebration. Her main thesis is that physicians founded the MLA as a subordinate arm of the medical profession and groomed the association accordingly for its first fifty years. For the first fifty years, male physicians controlled medical libraries, with full-time librarians, mostly women, as their assistants. In the second fifty years, following World War II, librarianship had acquired its own professional stature to the point where career medical librarians, still mostly women, could assume leadership of the MLA and the medical library movement at large. These medical librarians oversaw a fundamental role transition from being guardians to being purveyors of medical knowledge.

The author first describes early conceptions of the role of the medical library against the nineteenth-century backdrop of medicine's struggle to keep up with the more rapid production of its own knowledge, to be a unified and scientifically based profession, and for physicians to groom themselves for "gentlemanly" aristocratic status. She emphasizes the importance of John Shaw Billings's pioneering work in establishing the Surgeon General's Library (later the National Library of Medicine), in organizing medical collections, and in publishing the Index Medicus. The book provides lucid descriptions and personality profiles of several MLA pioneers, including a depiction of the intense missionary zeal and idealism that drove the physician George Gould to found the Association of Medical Libraries (later the MLA) and to become its first president. Gould aggressively pushed his pet publication exchange, which served as the backbone of the association for decades, and promoted services to support medical research and current awareness. In contrast, the association's second president, the aristocratic and charismatic physician Sir William Osler, reoriented the association to support the needs of medical historians and the broader, scholarly development of physicians. Medical libraries continued to grow and provided the foundation for establishment of the history of medicine as a scholarly discipline. By keeping medical libraries separate, physician leaders retained considerable control of medical knowledge and avoided the populist literature movements promoted by the Carnegie Foundation and the American Library Association.

Connor then reveals how physicians gradually dropped out of their auxiliary roles as medical library directors and left the MLA, especially after World War II. Largely through the efforts of dedicated but exploited women librarians such as Margaret R. Charlton, medical librarianship had evolved to acquire increasing professional status and develop its own identity aside from medicine. Eventually, women librarians came to dominate the membership and leadership ranks of the MLA. Connor concludes that today's medical librarians, despite having won their separate professional identity, proudly retain their historical loyalty to the medical profession and share its successes and failures.

Many readers will appreciate the book's rich historical detail and its heavy emphasis on gender equity issues. But to some extent these thrusts preempted the author's analysis of other historical forces that might have shaped the MLA. A partial list includes industrialization and the forced efficiency of scientific management (with its frequent exploitation of male and female labor); the triumph of allopathic medicine over its competitors; the parallel evolution of nursing, with its concomitant medical paternalism, and the impact of both on medical librarianship; the informatics movement in the health sciences, including the rise of the American Medical Informatics Association; and parallel medical library movements outside of North America. But Connor did a good job in pointing out most of her coverage limitations.

Overall, the book serves as an exemplar for...