Leafing Through the Pages of Medical Library History

Walking through the halls of Pennsylvania Hospital (PAH) often feels like embarking on a treasure hunt. Whether you stumble upon an old apothecary photo hanging in what is now the Great Court Conference Room, or you find centuries-old notes scrawled underneath archived weather records, your discoveries are sure to have fascinating stories behind them. The Historic Medical Library in the Pine Building — the first of its kind in the country — is home to many of these historic gems, making it no surprise that it was designated the “largest and most important” medical library nationwide by the American Medical Association in 1847. But amidst the rare incunabula (books printed before 1501) and beautifully illustrated anatomical and botanical volumes, there are also some unexpected sources of history and intrigue — including the humble library catalog.

While the Historic Medical Library would eventually amass a collection of more than 13,000 volumes, its early days would best be described as slow and steady. In 1762 — 11 years after the hospital was founded — Dr. John Fothergill, a British friend of co-founder Benjamin Franklin, secured his place in PAH history by donating the first book: a copy of An Experimental History of the Materia Medica by William Lewis, FRS (Fellow of the Royal Society). He also provided three anatomical casts of a pregnant woman and 16 anatomical drawings by Dutch artist Jan Van Rymsdyk, a gesture that sparked interest among hospital leaders in establishing an up-to-date reference library that could be used by managers, physicians, and students. Using students’ fees to purchase additional materials, the Board of Managers connected with another London-based friend of Franklin, Dr. John Coakley Lettsom, who hand-selected a variety of medical volumes and had them shipped to the steadily-growing library. The collection was initially housed in the board’s office, indicating that they were so highly valued that they couldn’t be lent out or used without the knowledge and consent of the board.

The Revolutionary War put a temporary hold on book purchases, but the library still received gifts and bequests from the estates of local physicians. Notably, despite the fact that it would be quite some time before women could utilize the library, several played integral roles in filling the shelves. Deborah Morris, for example, donated 55 volumes after the death of her brother, Dr. Benjamin Morris, and a “wealthy maiden lady” named Sarah Zane bestowed an extensive collection of 142 medical and scientific texts upon the library after she inherited a massive family library.

When the Board of Managers realized that the collection was starting to become outdated towards the end of the eighteenth century, PAH’s attitude shifted from leisurely accumulation to seeking out books in earnest. However, there was another problem they needed to address too: borrowed books were regularly lost. The students supervising the library were required to account for — and pay for — all lost texts at the end of their year-long appointments, but since there was no clear system for managing the collection, it was difficult to even know what was on the shelves or lent out. The library was in need of some serious Marie Kondo-inspired assistance.

Enter: the printed library catalog.

Maintaining a catalog sounds like an obvious enough requirement for any library today, but it’s important to remember that the Board of Managers didn’t have any other medical libraries to look to for procedural advice. Theirs was the first, and they had to deal with the growing pains associated with a clumsy sign-out process and a barely-there accountability system. The first catalog, which was assembled by Drs. Benjamin Rush and Thomas Parke in 1790, laid out strict rules for librarians and borrowers to abide by and listed fewer than 400 titles, with some scribbled in later.

“Folios could be borrowed for four weeks, quartos for three weeks, octavos for two, and duodecimos for two, with limited options for renewal,” said Stacey C. Peeples, MA, curator and lead archivist of PAH’s historic collections. “They wanted to be fair to all borrowers, whether they were physicians or students, so if someone requested a book while it was out, it could not be renewed.”

In addition to the lectures, pharmacopoeias, and medical, surgical, and philosophical commentaries listed in the first catalog, there are treatises on ailments ranging from smallpox to dropsy (edema), dysentery to puerperal fever (postpartum infections), and even the effects of “viper venom and other poisons.” Some titles are clear and to the point, such as A Full and Plain Account of the Gout, while others are charmingly vague, like Advice to the People in General, with Regard to Their Health. Volumes like An Essay on the Virtues of Lime-Water and Soap in the Cure of the [Bladder] Stone have since proven obsolete, but others are sure to be absorbing even centuries later, such as An Alphabetical Table of Herbs and Plants; Also What Planet Governeth Every One of Them and An Essay on the Recovery of the Apparently Dead.

One rule listed in the original catalog gives major Hogwarts Restricted Section vibes, noting that a handful of volumes were only accessible under the watchful eye of the librarian and could not be taken off the premises, including A New Medical Dictionary by George Motherby. Additional volumes were added to the list of non-circulating books with each new catalog. Though the catalog was updated and reorganized over the years, and policies were clarified (ex: overdue fines were adjusted from the colonial shilling per week to the American quarter), its role as a guide remained the same. For users, it was a guide of the borrowing rules and the materials available to them. For the “honorary librarians” — harried students, physicians, and apothecaries who juggled library hours twice a week along with their own hospital responsibilities — it was a guide to their duties and to the whereabouts of the current volumes. And for today’s readers, the catalogs serve as guides through the history of PAH and American medicine.

It may be that only a true bibliophile can enjoy poring over the contents of historic library catalogs; it’s a niche interest to say the least. The honorary librarians certainly weren’t designing the catalogs to be thrilling reads, after all; the lengthy historical introductions that started showing up in the mid-nineteenth century added a bit of style, but the true aim was practicality and brevity. Still, the evolving contents of the catalogs offer a unique glimpse into the burgeoning American medical landscape.

The timing of the accessions show how medical knowledge made its way over from Europe to the United States, while the catalog categories show what topics were prioritized and given shelf space. The list of non-circulating volumes indicates what texts were referenced most often and considered so valuable that the board couldn’t risk them being borrowed, while lending records indicate what practices were considered standard at the time and which took longer to be accepted. The acquisition of rare and unusual titles (with donated texts covering everything from horticulture to classic literature) also shows that despite the library’s initial focus on reference materials, it evolved into a more wide-ranging historical collection. All of this information can be gleaned from a few comprehensive lists created because some folks didn’t feel like making a trip back to the library.

“We actually owe a debt to those physicians and students who forgot to return their books!” Peeples said. “Because of them, we have an amazing record of what they owned when, where they came from, and even how much was paid for them in some cases. Researchers still utilize these catalogs today, allowing them to reconstruct other libraries, see how our focus shifted, and how medicine changed over time.”

Today, the Historic Medical Library is part of PAH’s historic collections and maintained separately from the staff clinical library, which aims to return to the library’s roots by providing current reference materials across a range of disciplines. These days, a professional librarian, Ene Belleh, MLS, AHIP, and easily accessible online catalog are available to expedite the clinical research process, and the library’s readers are far more diverse than the initial audience. The clinical library offers 24/7 access to all PAH health care professionals, plus staffed hours for members of the Penn Medicine and University of Pennsylvania communities and visitors.

The Historic Medical Library, now maintained like the rare book collection the early library committees never intended it to be, is also accessible to interested researchers via appointment with Peeples. Many of the materials are also available on the online catalog FRANKLIN, including its paper predecessors, which makes it clear that even as PAH and its libraries continue to evolve, nothing will be left in the past.

Even if you haven’t been convinced that centuries-old library catalogs are historic gold mines in disguise, the Historic Medical Library is certainly worth a visit. If you’re interested in learning more about Pennsylvania Hospital’s history, call 215-829-3370 to arrange a tour of the historic Pine Building.