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THE COLLEGE OF PHYSICIANS OF PHILADELPHIA

MEDICINE & HISTORY

Series V Volume III N9 1 March 1981 Published Since 1793

Fielding H. Garrison: The Man and His Book

GERT H. BRIEGER

SAMUEL X RADBILL LECTURE

IT must say something about our field, the history of medicine, that its standard reference work is a book that is now more than half a century old. Thus Fielding H. Garrison's bibliographic endeavors have kept his name predominant for almost seven decades. His most important book, An Introduction to the History of Medicine, was first published in 1913. Further editions appeared in 1917 and 192 1 ; the fourth edition, still in print, first came off the presses in 1929, 51 years ago. As Henry Viets has pointed out, no one before his time had stimulated so widespread an interest in the history of medicine in this country. "In the minds of American physicians from 1913 on, Garrison and medical history became synonymous..."1

I

Fielding Garrison was born in Washington, D.C. on the fifth of November, 1870, the older of two children. His father, a middle-level government employee, was from a Virginia family of Scottish descent. His mother's ancestors fought in the Revolution, but it was from her that he believed he had inherited a "French mind which sees things as they are and believes nothing it does not factually know."2 Virtually no information remains about Garrison's childhood except that he grew up in a family that valued education. He studied music, which was to become a lifelong interest and a solace from the literary tedium of his later life. His father urged him to study German instead of Latin at

1. Henry R. Viets, "Fielding H. Garrison and His Influence on American Medicine," Bulletin History of Medicine 5(1937): 347-52; 347. For a more recent appraisal see Erwin H. Ackerknecht, "Zum hundertsten Geburtstag von Fielding H. Garrison," Gesnerus 27(1970): 229-30.

2. F. L. Tietsch, "Self-portrait of Fielding H. Garrison, Autobiographic Excerpts Compiled from His Letters," Bulletin History of Medicine 7(1939): 365-73; 366. For further biographical information see Solomon R. Kagan, Life and Letters of Fielding H. Garrison (Boston: Medico- Historical Press, 1938), and Fielding H. Garrison, A Biography (Boston: Medico-Historical Press, 1948). I shall refer to these as Kagan, 1938, and Kagan, 1948. Both edi tions contain many Garrison letters and a bibliography of his writings. Unfortunately, the books also contain many misspellings, some factual errors, and were not very well received. There has as yet been no full biography of Garrison, a very rich subject for anyone inclined to such a study. The present article and some additional material will be part of a long introduction to a fifth edition of the History that I am preparing. I do not plan to pursue the biographical aspect of Garrison much further, however.

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Washington High School, but he made up the deficiency in classical languages without difficulty in later years.

After a year spent at home following graduation from Washington's Central High School, Garrison enrolled at the Johns Hopkins University in the fall of 1887, and received his bachelor's degree three years later. Study at Hopkins in those days was organized in groups of subjects; Garrison chose mostly languages, ancient and modern, as well as some physics and mathematics. Hopkins, only eleven years in existence when Garrison began, had relatively low tuition fees, and room and board were cheaper than those in schools farther north. The students were treated like mature adults. "It was assumed that a student who attended the University was serious enough to be left in his own devices..." recalled Abraham Flexner, who had preceded Garrison in Baltimore by a few years.3

I have found little indication that Garrison intended to study medicine and no evidence as to why he enrolled in the Medical Department of Georgetown University. Because in those days — the autumn of 1890 — medicine could be studied in the hours after government offices closed, and quite probably because of his family's financial needs, Garrison followed his father and many other Washingtonians into government service. His experience at medical school doubtless led him to accept probationary appointment, beginning in March 1891, as a clerk at the Surgeon General's Library at $700 per year. Here he quickly came under the influence of the awesome John Shaw Billings, long-time director of the Library. Garrison completed his medical studies in 1893, receiving the M.D. degree. He never practiced medicine but chose instead to remain at the Army Library for nearly forty years. In 1930 he accepted the directorship of the newly established Welch Medical Library at Johns Hopkins, where he worked and participated in the teaching at the Institute of the History of Medicine in its early days. On April 18, 1935, a few days after a surgical operation, Garrison died of cancer of the colon.4

The Surgeon General's Library provided information for military surgeons and for patrons living outside the Washington area. The staff divided the work. To Garrison fell responsibility for medical research, general questions, psychology,

3. Abraham Flexner, An Autobiography (New York: Simon and Schuster, 1960), p. 33. Flexner was a student at Hopkins in 1884-1886. See also Hugh Hawkins, Pioneer: A History of the Johns Hopkms University, 1874-1889 (Ithaca: Cornell University Press, 1960); and Kagan, 1948.

4. Edgar Erskine Hume, "Garrison and the Army Medical Library, 1891-1930," Bulletin History of Medicme 5(1937): 301-45. This entire issue of the Bulletin was the Fielding Garrison Memorial Number Dr. Wyndham H. Miles of the National Library of Medicine has very kindly allowed me to read four of the chapters from his manuscript of a history of the Library, which contain much additional information about the environment in which Garrison toiled for forty years. A brief medical note about his final illness may be seen in a letter by Dean Lewis, who operated on him three days prior to his death, to Garrison's long time friend and correspondent Harvey Cushing, 15 April 1935, in Garrison-Cushing letters, Yale Medical Library, Historical Collections.

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Fielding H. Garrison: The Man and His Book

history, and bibliography. With Billings, and later with the elderly Dr. Robert Fletcher, Garrison worked on both the Index Catalogue and the Index Medicus. John Shaw Billings believed that the librarian is in one respect

a sort of hod-carrier who brings together the bricks made by one set of men in order that another set may build therewith — he is apt to take quite as much pride and satisfaction in the resulting structure, provided it be a good one, as if he had built it himself;...5

Garrison's approach to his own historical work is also evident in this sentiment.

There is little doubt about the extent of the Billings influence on Garrison's career. While Billings was Garrison's model, they were of almost opposite character. Billings was very much a man of the world, Garrison was a man of the world of books and music. Both shared an intense devotion and need for literary work, and both seemed somewhat distant to those who worked with them. For all of his association with Billings, which included the writing of a 430-page biographical memoir, Garrison was in the Billings home only once, very briefly, to deliver some papers late one evening.6

Surely the intellectual climate of the Library and the example of Billings and Fletcher could easily account for Garrison's interest in the history of medicine. That interest, however, as intense as it was to become, was late in starting. It was not until fifteen years after he began to work in the Library that Garrison, then 36 years of age, published his first historical paper, a short biographical note in the Old Dominion journal of Medicine and Surgery of 1906 about James B. McCaw, the father of Garrison's chief at the Library, Major W.D. McCaw.7 The June 1906 issue of the Medical Library and Historical journal carried another Garrison paper, this one about the Surgeon General's Library.8 A brief editorial by A.T. Huntington in the same issue of the journal is supposed to have been a strong stimulus to Garrison's future work.9 Huntington, a medical librarian in Brooklyn, bemoaned that one subject — medical history — stood in striking need of more work by American and British authors. What does one find in English on the library shelves? he asked — only antiquated and inaccurate histories and a small number of special monographs demonstrating the kind of scholarship of which

5. Quoted by Hume, op. cit., p. 307, who took it from Garrison's John Shaw Billings, A Memoir (New York: Putnam's, 1915), p. 276. A new work on the history of Index Medicus is John B. Blake, ed., Centenary of Index Medicus 1879-1979 (Bethesda, Md.: National Library of Medicine, 1980).

6. Hume, op. cit., p. 308. To Charles Perry Fisher, the Librarian of the College of Physicians, Philadelphia, Garrison wrote in 1914 asking for information about Billing's Pennsylvania career. Garrison noted, "...I don't suppose he was popular with many members of the profession, on account of his manner which has been described by one of his friends as 'cold and distant,' by another 'occasionally brusque and austere.' " Letter, F. H. Garrison, to CP. Fisher, 31 January 1914, Historical Collections, Library of the College of Physicians of Philadelphia.

7. "James Brown McCaw," Old Dominion Journal of Medicine and Surgery 5(1906): 65-6.

8. "A sketch of the Library of the Surgeon-General's Office," Medical Library and Historical Journal 4(1906): 211-16.

9. Ibid., pp. 221-22.

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Gert H. Brieger

we might be proud. For complete histories we had to turn to the French and German writers, whose heavy, wordy tomes did not really meet our needs.

Huntington suggested that an American medico-historical association be formed, and that groups of scholars work together to produce a proper history. He believed that the time was ripe for such a society, as well as for a complete history of medicine written in English. Surely Garrison read this editorial, since it appeared only a few pages after his own paper. Just how much of a stimulus he needed and how much Huntington's call provided we can only guess. What is of interest is that in less than seven years he did finish a major book on the history of medicine. This was not an overly long time, considering the magnitude of the task and the scope of the accomplishment.

The Library, with its rich collection of the older medical works, was obviously an ideal setting to arouse an interest in the history of medicine. According to Henry Sigerist, Garrison's neighbor and co-worker in Baltimore during the last three years of Garrison's life, he went into medical history by necessity. Because his salary at the Library was insufficient to support a growing family, it occurred to him that medical history might be a profitable venture. The only preparation for this work was his general culture, which included wide interests and vast reading, and his immense bibliographic knowledge. Doubtless there is some truth in Sigerist's interpretation, but it does not account entirely for Garrison's motivation.10

To George H. Simmons, editor of the Journal of the American Medical Association, Garrison explained that his mind was developed not by book learning but

10. Arthur J. Viseltear, "The George Rosen-Henry E. Sigerist Correspondence," Journal History of Medtctne 33( 1978): 281-313; 290. To his wife Clara, Garrison wrote in 1914 that he was "...going to try to make all the money I can writing editorials, which only cost me about ten to fifteen minutes brain pumping each." Solomon R. Kagan, "Letters of Colonel Fielding H. Garrison," Medical Record 1 5 1 ( 1940): 235-37; 235; also in Kagan, 1948, p. 35. In contradiction to Sigerist and to the sentiment he expressed to his wife, Garrison wrote his medical-historical colleague Victor Robinson in Philadelphia: "The Europeans do not realize that the medical and other sciences are only just beginning over here, and that articles in scientific periodicals are seldom compensated for in money, as in the older and more highly specialized civilizations. I have been paid even for a small obituary notice in the Lancet, but have never received a cent for thousands of pages sent to American periodicals." Letter, F.H. Garrison to Victor Robinson, 24 February 1921, Robinson manuscripts, N.L.M , Box 7. To Robinson in a letter on 9 March 1921, Garrison added, "As you know, I have not written for money. I have written hundreds of pages to help the cause of history of medicine without compensation." From 1925 until 1935 Garrison wrote many articles for the Bulletin of the Neu York Academy of Medicine, for which he was undoubtedly paid. This arrangement may have been what Sigerist had in mind. The New York Academy articles have been conveniently brought together in a book of 989 pages: Fielding H. Garrison, Contributions to the Htstory of Medtctne (New York: Hafner, 1966).

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Fielding H. Garrison: The Man and His Book

by intense suffering, particularly in connection with my father's lingering and painful death [ 10 September 1908], which occupied three years. I began to write papers during those long nights to keep from going crazy, and I have continued to do so, simply to keep alive mentally speaking, and not become submerged in this bibliographical drudgery which puts out eyes and bores holes into the brain.11

II

To understand the History, one must know the historian. After reading much of Garrison's prodigious published work in the history of medicine, and after sampling many hundreds of the staggering numbers of letters that he wrote — some are six or eight pages long, and were written in his neat, tight, rather small but easily legible hand — one cannot help being drawn to this shy and sensitive man.12 As he appears in the lines, and between the lines, of page after page of his correspondence, he was a highly driven, sometimes tortured, extremely erudite man. I have come to like Fielding Garrison and at times to feel intensely his private sensations of injury, knowing full well that he had some peculiar traits, that he was mildly to moderately paranoid at worst, very sensitive at best, and that the word "workaholic" must have been invented just to characterize him.

Garrison was not an easy man to know. As his letters reveal, he had long and bitter quarrels, even with old friends such as Arnold C. Klebs, the Swiss medical historian. Slights and perceived insults wounded him quickly and would call forth vituperative prose. He was considered diffident with strangers and even at times with his friends. He has been characterized in print as brilliant, tempermental, and somewhat peculiar. Henry Sigerist wrote, "Sensitive as a mimosa, he would open his heart to friends, but if ever so slightly touched, would close himself up hermetically."13 In 1937, two years after Garrison's death, Sigerist and Sanford V. Larkey, Garrison's successor at the Welch Library, described him as very reserved in personal contacts, but

11. Letter, F.H. Garrison to G.H. Simmons, 5 August 1914. N.L.M. History Division, Box 3, Garrison Papers. In this long, handwritten note Garrison included a number of autobiographical remarks, including "I am a good Tory, believe in a strong Federal Government and hate solemn nonsense, but I am rather stubborn and obstinate, if anyone crosses me, and apt to go my own way if it suits me."

12. Sigerist noted that in response to a 1937 request from the Bulletin for any Garrison letters, by 1939 the Institute of the History of Medicine at Hopkins had received about 5000. See Tietsch, op. cit. Unfortunately the book F.L. Tietsch was preparing never came to be. Major collections of Garrison letters are now at the National Library and at Yale (Garrison-Cushing, Garrison-Fulton, and Garrison-Klebs). Many have been printed by Kagan.

As late as 1941 Tietsch was apparently still collecting letters and working on the project. To Dr. Herman Radin he wrote: "Incidentally, recent world events throw some of Garrison's statements out of gear, and the man who looked upon the post-war period in bewilderment, now finds himself caught between two wars. Altogether, I do not think that the present time would be propitious for the publication of the book...." Letter, F.L. Tietsch to H.T. Radin, 9 March 1941, N.L.M. Box 3.

13. Henry E. Sigerist, Obituary notice, Bulletin History of Medicine 3(1935): 404.

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Gert H. Brieger

...he was exuberant in his letters. His moods and whatever worried him found expression in his letters. Letter writing was his way to free himself from oppressing thoughts, and he not seldom passed harsh judgements on matters and people.14

Garrison apparently was a poor conversationalist and an even worse public speaker, though he was often called upon for both of these activities. He hated small-talk, but he would shine when conversation turned to a subject that he liked. The Baltimore businessman, F.L. Tietsch, who shared musical interests with Garrison, described him aptly:

At first meeting often shy and humble to the point where he made others feel almost ill at

ease, the subject of music would invariably bring forth the brilliant conversationalist in him,

and his stiff reticence would give way to warm relaxation.15

Many agreed that Garrison's phenomenal memory and keen interest in all phases of learning provided him with an incredible fund of information. Insomnia forced him to be a voracious reader of novels, historical works, philosophical treatises, and the literary classics of all periods. His letters and published writings are filled with reference to his astoundingly broad learning.16

If ever a man could be known through his letters, it was Fielding Garrison. To his friend M.G. Seelig he wrote: "...some people say my personal letters are better reading than what I print, although dashed off at a furious pace..."17 H.L. Mencken, with whom Garrison often corresponded, knew that Garrison loved to gossip in his letters, but also that he could "...cut loose seriously and had something really interesting to say."18

William Welch, who ultimately recruited Garrison to head the newly built Welch Medical Library in Baltimore, was a long-time admirer. "I get no letters half as good reading as yours. You have the best art," he wrote to Garrison in 192 5. 19 In that year Welch sent a Garrison letter to Abraham Flexner, who apparently had never met Garrison and thought him a rather humdrum

14. Sigerist and Larkey wrote this in a mimeographed letter sent in 1937 to all Garrison correspondents who might have letters from him in their possession. The copy I saw was addressed to Harvey Cushing and is in the Garrison-Cushing correspondence at Yale.

15. F.L. Tietsch, "The Colonel Played the Piano," Bulletin History of Medicine 5(1937): 353-68- 354. '

16. The discussions of a wide variety of authors and their works occur in a large number of his letters. Many are filled with long quotations or with numerous references. To his friend the anatomist and historian Edward C. Streeter, Garrison confessed in 1920: "I manage to read a French novelette every night after the heavy stuff is over. It gets me in the right trivial frame of mind for sleep." Kagan, 1938, p. 127.

17. Letter, Garrison to Seelig, 1 1 January 1925, Kagan, 1938, p. 167.

18. Letter, H.L. Mencken to F.L. Tietsch, 29 August 1938, N.L.M., Box 3.

L9. l etter, W.H. Welch to F.H. Garrison, 9 July 1925, in Welch Papers, Johns Hopkins Medical School Archives.

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Fielding H. Garrison: The Man and His Book

person. He was anything but, Welch assured Flexner.20 After reading the

Garrison letter, Flexner replied:

It does certainly make a different impression from the one I got from his History of Medicine, which is the driest encyclopedic sort of thing I ever read or looked into. I don't see how a man that [sic] has the literary and cultural interests that Garrison's letter shows could possibly have completed that hideous but useful book.21

Almost any of the letters reveals the Garrison style. His ability to evoke an image may be seen in a note written to Harvey Cushing in 193 1 : "I see the tail of a greenish kite in the distance which in this Baltimore summer haze, looks like a spirochete under a dark field, so I must wriggle conclusionward."22

In the letters Garrison revealed his hopes, his frustrations, the tediousness of

the daily bibliographical grind, the vexations of almost continual interruption by

visitors to the Library, as well as his opinions of the works of other scholars. Very

few of his works measured up to his own exacting standards. In 1924 he wrote to

Arnold Klebs that the recently completed history of pediatrics would be

the last lengthy arbeit I shall probably put over, and the best I've ever done, as my heart was really in the thing. I should like to have been a specialist in children's diseases, as I have learned to love the little people — far preferable to adults, I think.23

More common in Garrison's letters is a melancholy estimate of his own

work. In 1925 he wrote to Seelig that

...nothing I have ever written satisfies me, as I have nearly always had to do it between trains and in a hurry. The wonder is that over-burdened chaps like you and I [sic] have ever time to do any historical or literary composition whatever.24

It is important to remember, as Genevieve Miller's Garrison Lecture (1974) so clearly showed, that most of the medical history written in the first half of the twentieth century was prepared and finished by men who led busy lives and had

20. Letter, W.H. Welch to Abraham Flexner, 23 April 1925, Welch Papers. Welch had hoped Garrison would be interested in the chair in medical history. He did succeed in luring Garrison to be the first director of the Welch Medical Library.

21. Letter, Abraham Flexner to W.H. Welch, 28 April 1925, Welch Papers.

22. Letter, F. H. Garrison to Harvey Cushing, 29 May 1931, Yale Medical Library.

23. Letter, F. H. Garrison to Arnold C. Klebs, 15 May 1924, typescript in N.L.M. This letter was written from Manila, toward the end of a two year tour of duty in the Philippines. This was Garrison's only military duty, except for brief training stints, outside of the Surgeon General's Library during his entire military career that began in 1917 and ended with his retirement in the rank of Colonel in 1930. See Appendix A, Kagan, 1948. He served the Library as a civilian from 1891 until he entered active duty with the rank of major in 1917. It was a great disappointment to him that he was not sent to Europe before World War I ended. He little realized that he was not much suited for war-time medical duties. He did not enjoy his Manila tour, and especially complained of the oppressive heat and humidity.

The history of pediatrics to which Garrison referred appeared as a 170 page section in Isaac Abt's Pediatrics, 1923. Dr. Abt had been a Hopkins schoolmate of Garrison's. Abt's son, Dr. Arthur F. Abt, brought out a new edition with chapters added about recent pediatrics (Philadelphia: W.B. Saunders Co., 1965).

24. Letter, F.H. Garrison to M.G. Seelig, 21 June 1925, Kagan, 1938, pp. 172-73.

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Gert H. Brieger

full-time careers in medicine or other fields.25 In Garrison's case, it is the more remarkable that despite many duties at the Library he was able to write so much. His complaint to Charles Singer (1927) is typical of what he occasionally wrote in his letters:

...if you realized under what difficulties I have worked in my life, you would wonder that I have been able to accomplish anything at all — constant, never ending bibliographical grind, innumerable distractions and interruptions, next to no leisure, and anything but the physical endowment one should have for excruciating toil, let alone failing eyesight for close work after a certain period.26

Perhaps the most vivid way to characterize Garrison is to borrow a phrase from Anthony Lewis of the New York Times, and to call him a man who was abroad at home, an alien among men of his own time. "I am myself," Garrison confided to Klebs in 193 1, "partically a foreigner over here, in that I have a Latin mind which sees things. ..quite different from that of other hombres americanos. At any rate, I have always felt a lonely person over here."27

World War I, when Garrison was first commissioned as an army officer, was a profoundly unsettling time for him. The "cussedness of the rackety, post-bellum world we live in, a world in which I would fain not dwell, if I had any say in the matter," he characterized it.28 It was an age lacking in ideals, anti-intellectual in approach; "The good old days, when American civilization really reached a respectable stage was the time of Emerson, Lowell, O.W. Holmes, Weir Mitchell, Jacobi, and Billings."29 Decline began with the Spanish-American War, Garrison wrote to Charles Singer, a time when a new American, derived mainly from the great West, came into being. But since the World War, "...the intellect of this species has been visibly and audibly going backwards. ..Since the War, I have lived, though highly sociable by nature and surrounded by people, the life of a very lonely man, marooned on a desert island."30

Even among the "medico-historical people," Garrison complained to Singer, he found "...a good deal of this roughneck outlawry."31 To Francis R. Packard,

25. Genevieve Miller, "In Praise of Amateurs: Medical History in America Before Garrison," Bulletin History of Medicine 47(1973): 586-615. For a good review of the teaching of medical history see also Dr. Miller's chapter in The Education of American Physicians, edited by Ronald Numbers (Berkeley: University of California Press, 1980), pp. 290-308.

26. Letter, F.H. Garrison to Charles Singer, 27 June 1927, Kagan, 1938, pp. 193-4. In 1926 Garrison explained to Klebs that he had so many interruptions at the Library that he could do his own work only at home after office hours. Letter, F.H. Garrison to A.C. Klebs, 1 September 1926, typescript in N.L.M.

27. Letter, F.H. Garrison to A.C. Klebs, 3 June 1931, typescript, N.L.M.

28. Letter, F.H. Garrison to M.G. Seelig, 2 1 June 1925, Kagan, 1938, pp. 172-4. To Howard Kelly, Garrison complained of being war-weary, and wished he could sleep the rest of his life. Letter F H Garrison to H. A. Kelly, 30 December 1920, in manuscript collections New York Academy of Medicine Library.

29. Letter, F.H. Garrison to Charles Singer, 27 June 1927, Kagan, 1938, pp. 193-4.

30. Ibid.

31. Ibid.

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Fielding H. Garrison: The Man and His Book

editor of the Annals of Medical History, Garrison wrote in 1916 that, "It seems odd that a quietistic subject like medical history should occasion so much feeling among men, but it is a fact. I have encountered so much of it here and there that I am almost tempted to drop the subject."32 "The time is not ripe in America," he wrote in 1927, "for appreciation of scholastic work, although Dr. Welch seems to think otherwise. I simply happened along as a skirmish liner and pioneer and did the best I could over rather rough ground, although with more relative ability than most, which again is not claiming very much.'"33

Occasionally this feeling of alienation found its way into print. For instance, in the fourth edition of the History Garrison described modern physicians in terms of efficiency, an ideal typical of the Progressive Era. He said that they are influenced despite themselves, by the social forces that impinge upon them. But he could not resist adding: "It is a noticeable fact that the picture of Americans of the Civil War generation have a more sincere and ideal look than those of the present time."34

Ill

This man of letters, who by all his acquaintances and readers was deemed a graceful and voluminous writer, did not publish his first signed paper until 1906, when he was 36 years old.35 "A Sketch of the Library of the Surgeon-General's Office," written with economy of words, described the history and growth of the Library and the evolution of its two major bibliographical publications, the Index Catalogue, which listed the Library's large and growing holdings, and the Index Medicus, the highly useful guide to the current periodical literature. Garrison also

32. Letter, F.H. Garrison to F.R. Packard, 9 September 1916, Historical Collections, Library of the College of Physicians of Philadelphia.

33. Letter, F.H. Garrison to Charles Singer, 27 June 1927, Kagan, 1938, pp. 193-4.

34. P. 75 1. It is important to remember, in fitting Garrison into his time, that he came to maturity in the decade of the 1890s, a time denoted by Henry Commager as a watershed decade in American history. See especially his The American Mind, An Interpretation of American Thought and Character Since the 1880's (New Haven: Yale University press, 1950) ; and Henry F. May, The End of American Innocence, A Study of the First Years of Our Own Time, 1912-1917 (New York: Alfred Knopf, 1959), reprinted 1979 by Oxford University Press. A more recent book that clearly discusses some of the tensions faced by Garrison's generation, one that was born in the nineteenth century but was forced to live in the twentieth, is Thomas L. Haskell's The Emergence of Professional Social Science. The American Social Science Association and the Nineteenth Century Crisis of Authority (Urbana: University of Illinois Press, 1977).

35. "A sketch of the Library...," op. cit. Dr. W.D. Miles, in the manuscript of his as yet unfinished history of the Library, refers to a 1902 article about it in the Bulletin of the Medical Library Association 1 (1902): 70-84, which he ascribes to Garrison. The article itself does not carry his name on it, but the N.L.M.'s copy of that journal has Garrison's name written on the first page of the article as the author. More conclusive proof that this indeed was Garrison's first published paper comes from his own lengthy bibliography cited in note 36, at the beginning of which he lists himself as the author of that paper. Heretofore all Garrison bio-bibliographers have said that he published his first paper four years later, in 1906.

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described the working of the Library, its methods of cataloguing, and the scope of its collection. As early as 1906 he spoke of it as not merely the Library of the Surgeon-General's Office (its official title) but as the "...National Medical Library by reason of its extent and value and its situation in the capital city..." Except for a very brief paper, also published in 1906, it was not until 1909 that Garrison's name again appeared in the medical literature, but from 1909 to 1935, the year of Garrison's death, not a single year was to pass during which he published less than four contributions. Often he wrote eight to twelve essays, editorials, and essay reviews in a single year, in addition to numerous books and forewards.

Since Garrison's main tasks at the Library involved assistance with the several bibliographic publications, it should not be a surprise that the History is, in part, a bibliographic guide; nor that its genesis is to be found in a bibliography of the historical collection of the Library. This may be seen clearly in the correspondence with Dr. George H. Simmons, editor of the Journal of the American Medical Association, in a long article about the medical classics in the Library which appeared in the JAMA in 1911, and in an even longer bibliography illustrating historical texts published up to 1800 that was printed in the Index Catalogue in 1912. 36 In these works we can see clearly the development of the important book which was to appear at the end of 1913.

The correspondence between the Library and the Journal of the American Medical Association regarding Garrison's historical work began in late March 1911 with a letter from the Librarian, Major Walter D. McCaw, to Dr. Simmons in which McCaw mentioned the large collection of first editions of great works in medicine. McCaw then elaborated:

Dr. Fielding H. Garrison, the Assistant Librarian, has written a critical essay of some length describing this collection, with remarks upon the writers and the general trend of medical science in the different centuries, which appears to me to be of exceeding great interest not only to medical men but to scholars generally. The paper when finished will be not less than 15,000 words in length and, if possible, I should like very much for it to appear in your journal.37

It was published in the issue of June 17, 1911.

Apparently Simmons raised the possibility of publishing an extended version in book form. Garrison, in responding to Simmons in late April 1911, concluded that:

Such a book, if you wished to print it, could be made more attractive and saleable if its contents were remodelled according to the following title: 'A Handbook of the History of Medicine, based upon the historical collection in the Library of the Surgeon-General's Office. With select bibliographies, chronological data, specimen extracts, and examination questions.' If you should favor this idea, I could turn out for you in time for Fall publication, a little book which would give the average practitioner just what he wants to know about medical history.38

36. Index Catalogue of the Library of the Surgeon-Generals Office, 2nd Series, volume 17, 1912, pp. 89-178, and as a separate printing in the same year.

37. Letter, W.D. McCaw to G.H. Simmons, 29 March 1911, N.L.M., Box. 3.

38. Letter, F.H. Garrison to G.H. Simmons, 24 April 1911, N.L.M., Box 3.

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Fielding H. Garrison: The Man and His Book

In a letter written to Simmons early in May, Garrison realized that the project might be too much for the American Medical Association, but he wanted to finish the task before the warm Washington summer began.39 Apparently he continued to receive encouragement from Simmons, because in late August only the appendices and bibliographies needed completion. The latter Garrison would have been willing to omit, since they were independent of the text. It is fortunate that they were retained, since they came to be a valued part of the book.40

On October 18, 191 1, Garrison sent off to Simmons the completed manuscript, which he described as

a history of medicine, originally based upon the collections of medical classics in this library, but so amplified as to make it a good handbook for the general practitioner's perusal and reference. In each period a full account of all the important men and books is given, and followed in the later periods by a separate section on the cultural phases, social and governmental improvements of medicine.

Garrison wrote to Simmons that judging from the letters he received after the

bibliographic part appeared in a June number of the Journal,

I have every reason to believe such a book, if published, might have a successful sale among practitioners. In preparing it, I have aimed to put the average reader in a way to acquire his own medical culture by giving him what he wants to know in a simple, direct manner, and I have tried to put into the book the net result of the best modern research, in regard to which I have had unique advantages in twenty years work in this library.41

Garrison gave special attention to the chapters on medicine of the nineteenth and twentieth centuries, because most recent histories of medicine were weakest here, and because this was the part which most interested him.42

As late as the first day of November, Garrison was still writing hopefully to Simmons, continuing to explain his approach to history. A primer, Garrison wrote, was what he had originally intended, "But on taking my bearings, I found that such a vast subject as medical history could not be compressed into such short space without telling next to nothing about it." A scholarly work, such as Sir Clifford Allbutt had written for the recent edition of the Encyclopaedia Britannica, was not suitable for the ordinary physician, Garrison believed. He was quite willing, he told Simmons, to remove all appearances of unnecessary erudition from the body of the text.43 Whether the book was too long, or too erudite for the American Medical Association to undertake we do not know. On November 10, 1911, Simmons wrote to Garrison that he was returning the manuscript because he was "a little doubtful as to the advisability of the Association undertaking the publication of such a book." So with this rather cryptic rejection, one that Garrison did not mention in any letter that I have so far

39. Letter, F.H. Garrison to G.H. Simmons, 2 May 1911, N.L.M., Box 3.

40. Letter, F.H. Garrison to G.H. Simmons, 21 August 1911, N.L.M., Box 3.

41. Letter, F.H. Garrison to G.H. Simmons, 18 October 1911, N.L.M., Box 3.

42. Letter, F.H. Garrison to G.H. Simmons, 23 October 1911, N.L.M., Box. 3.

43. Letter, F.H. Garrison to G.H. Simmons, 1 November 1911, N.L.M., Box. 3

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Gert H. Brieger

read, he was forced to turn elsewhere if he was to enjoy having the first of his many large projects see the light of day.44

The full story of how the book came to the W.B. Saunders Company may never be known, since the company has not preserved its early correspondence. Garrison was looking for a publisher in 1912. In early September, nearly a year after the final rejection from the American Medical Association, Garrison wrote to his wife Clara from Philadelphia that he had interviewed several medical publishers. He added that, "They have all published medical histories before without success and only one of them was favorable, but he was the best of the lot, the one I should have preferred, and I have great hopes of him."45 Whether the "best of the lot" was Saunders, I do not know, but hope turned to reality within three days. On the ninth of September, 1912, Garrison wrote again to Clara with the good news: "You will be glad to know that I got a very nice friendly letter from Saunders, the Philadelphia medical publisher, very encouraging in every way, and I am to send them my manuscript directly when I get home. I'll put in my waste time here in touching it up, and shall have to work hard during the autumn to finish it if they want it good and plenty."46 Thus began a long relation, not always smooth, with the venerable Philadelphia publisher.

IV

Since the prefaces to the four editions of Garrison's History are explicit, it is easy to discern the aims and the approach. His main audience, as he stated both in the preface and in later letters, consisted of the medical student and the busy practitioner. He wished to provide "a large number of important facts which may be of use in his professional work or desirable to know as part of his medical culture."47 He wanted the book to be an outline or sketch, not a finished painting. He hoped that his guide would not be compared to the exhaustive medical histories of Haeser or Neuburger. His research was not original, but he hoped to promote further study by his readers. As he pointed out in the second edition, he never regarded his work "as anything but a primer or guide-book to a territory of vast dimensions."48 In the third edition, Garrison was pleased to report that his aim of stimulating students had in some measure been attained, judging from the "large number of friendly and sympathetic letters received..."49 In method, his

44. Letter, G.H. Simmons to F.H. Garrison, 10 November 1911, N.L.M., Box. 3. And in apparent effort to lessen the pain of rejection, Simmons added on 5 December 1911 that he doubted if the A.M. A. wished to publish any book at that time.

45. Letter, F.H. Garrison to Clara Garrison, 6 September 1912, Kagan, 1948, p. 30.

46. Letter, F.H. Garrison to C. Garrison, 9 September 1912, Kagan, 1948, p. 3 IT

47. lsted., 1913, p. 9.

48. 2nded., 1917, p. 8.

49. 3rded., 1921, p. 8.

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Fielding H. Garrison: The Man and His Book

research was distinctly that of the bibliographer: the verification of facts, dates, and bibliographical references. What this excessively modest judgment ignores, of course, is an immense amount of reading and an ability to digest large quantities of facts, trends, associations, and events. Garrison never claimed to be an analytic historian, and the interpretive task of the historian is one that he ventured gingerly. "Opinions," he wrote in 1917, "may be wrong: facts, if accurately stated can never be."50 In 1915 he wrote to Dr. Victor Robinson that although he considered himself a pretty good biographer, his attitude toward medical history was mainly interpretive.31 Insight was not one of Garrison's strengths.

That Garrison was an astute observer of the medical developments of his own time stemmed, no doubt, from his bibliographic task of editing Index Medicus, which he did from the 1890s until 1927. His duties enabled him to observe events as well as trends. Evidence of this may be seen throughout the final chapters of the History. In discussing Paul Ehrlich's work on both immunology and hematology, for instance, Garrison remarked that the trend of recent medicine from the bacterial theory of disease toward the biochemical was clearly evident here.32

In the first edition and in subsequent editions Garrison included a chapter on the twentieth century that he subtitled, "The Beginnings of Organized Preventive Medicine," in which he discussed scientific as well as cultural and social aspects. In the fourth edition he added a final chapter of fifty-seven pages titled "Cultural and Social Aspects of Modern Medicine." Here one can see most clearly his views of the world and his opinions about many things. While his intention may have been to try to compass the contemporary history of the first three decades of the twentieth century, its execution left much work to be done by those of us who follow him. Much of the material in the final chapter refers to nineteenth century events, the first two decades of the twentieth century being given minimal coverage. There are some figures for costs of medical care and numbers of physicians, with comparisons between the nineteenth century and the period between 1910 and 1920. When all is said and done, however, the entire medical history of the twentieth century is still in need of analysis and description.

To late twentieth -century readers, Garrison's writing, like that of Osier and his erudite contemporaries, seems a little turgid, and full of bits and snippets quoted from classical writers or nineteenth century essayists such as Emerson.

50. 2nd ed., 1917, p. 8. His bibliographic approach is also clear in his article "The Uses of Medical Bibliography and Medical History in the Medical Curriculum," JAMA 66 (1916): 319-24. The bibliographic method, Garrison wrote, will be as useful in keeping medical records as in historical research.

51. Kagan, 1948, p. 32. Kagan quoted from the letter but did not reproduce it.

52. 4th ed., 1929, p. 710.

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Gert H. Brieger

Like many other writers of his time, Garrison was often torn between the exhilaration implicit in the concept of progress in medicine and science, and the gloom that afflicted so many in the western world after the first World War. "Decline," as so clearly defined by Oswald Spengler and others, is often mentioned in Garrison's copious personal correspondence.

The progress and advance of medicine, with focus mainly on those who brought it about, form one of the main themes that runs throughout the thousands of pages of the four editions of Garrison's major book. The theme of progress is also apparent in the scores of essays that he published in the years 1906-1935.

Garrison stated his views clearly in an essay published in the Bulletin of the New York Academy of Medicine in 1929, the year of the fourth edition. In "Medicine As An Agency in the Advancement of Science, Art and Civilization," he argued that medicine was remarkably prominent and efficient as an agency of advancing science in periods of intellectual ferment such as those of Periclean Athens, Renaissance Europe, or the post Napoleonic period. In quieter times, such