Medical library marks 75 years of supporting research and patient care

Dr. Harvey Cushing, a path-breaking neurosurgeon and Sterling Professor of Neurosurgery at Yale, had books on his mind when he wrote to his friend Dr. Arnold Klebs on Oct. 4, 1936.
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An undergraduate class examines materials in the medical historical library.

Dr. Harvey Cushing, a path-breaking neurosurgeon and Sterling Professor of Neurosurgery at Yale, had books on his mind when he wrote to his friend Dr. Arnold Klebs on Oct. 4, 1936.

Cushing, a passionate bibliophile, had amassed over his career a vast collection of rare and historical medical and scientific texts. He had always planned to have his books and manuscripts sold on the open market after he died so that other collectors could enjoy them as he had.

“This idea has begun to wane in favor of leaving them to Yale to be kept together … as the basis of a medico-historical collection,” Cushing wrote to Klebs, a noted collector of medical texts.

Cushing, an 1891 graduate of Yale College, encouraged Klebs to consider leaving his collection to Yale. Dr. John Fulton, Sterling Professor of Physiology and Cushing’s former pupil at Peter Bent Brigham Hospital in Boston, had agreed to donate his significant collection to the university as well. 

“Let us play with the idea and see what comes of it,” Cushing wrote.

The medical historical library in 1941. (Photo by Samuel Kravitt)

The idea came to full flower on June 15, 1941 when Yale’s medical-historical library opened within the Sterling Hall of Medicine. The library, now the Harvey Cushing/John Hay Whitney Medical Library, is marking 75 years of serving the Yale community — supporting the university’s clinical, research, and educational missions.

John Gallagher, who was recently appointed the library’s director after two years filling the role on an interim basis, said the 75th anniversary provides an opportunity to reflect on the vision of the library’s three founders: Cushing, Fulton, and Klebs.  

“Had they not donated their collections to Yale, there wouldn’t be a medical library,” said Gallagher, who began his career at the medical library in 2000 as the evening and weekends circulation supervisor. “They left us a world-renowned collection of rare books and manuscripts, as well as a remarkable collection of rare prints and drawings. I’m proud in my role as director to shepherd those collections going forward.”

Pioneering surgeon, devoted collector

Cushing arrived at Yale in the fall of 1933 after retiring from Harvard Medical School, where he had served on the faculty for 21 years. Over the course of his surgical career, which began in the 1890s, he had performed more than 2,000 surgeries on brain tumors and had pioneered numerous techniques and procedures that greatly improved surgical outcomes, particularly in the emerging field of neurosurgery.

Cushing developed one of his most important and enduring innovations while still a medical student. Following a patient’s death due to the overuse of ether, Cushing and classmate Amory Codman developed a method for monitoring a patient’s vital signs — pulse, temperature, and respiratory rates — while under anesthesia. He later added blood pressure to the measurements. Anesthesiologists continue the practice to this day.

“Cushing was the first patient safety advocate and that probably has more lasting implications than his being the father of neurosurgery,” said Dr. Paul Barash, professor of anesthesiology at the Yale School of Medicine. “Every patient in a hospital owes a debt of thanks to Harvey Cushing.”

Cushing made headlines in 1910 for successfully removing a fibrous brain tumor from General Leonard Wood, chief of staff of the U.S. Army and a former Rough Rider. Wood, who had suffered seizures before the surgery, made a full recovery. (A new tumor formed in 1927. Cushing operated but Wood died hours after the surgery.) 

Dr. Harvey Cushing poses with a pediatric patient in this undated photo. Cushing performed more than 2,000 surgeries on brain tumors over the course of his groundbreaking career. (Photo by T.W. Dixon)

During World War I, Cushing served in the U.S. Army Medical Corps and directed a U.S. military hospital in France, among other appointments. A committed diarist, he kept a detailed journal of his war experiences, portions of which were published in 1936.

Cushing was an acclaimed writer and published several books over his career. His two-volume biography of Sir William Osler, who had mentored him at Johns Hopkins Hospital, won the Pulitzer Prize in 1926.

Osler, often described as the father of modern medicine, was a bibliophile who encouraged Cushing to begin collecting books. He had suggested that Cushing focus his collecting around the writings of Andreas Vesalius, the 16th-century Flemish physician who founded the modern field of anatomy. Cushing subsequently acquired an unmatched collection of Vesalius.

According to an obituary of Cushing published in the January 1940 edition of the Yale Library Gazette, the famous surgeon approached caring for his books with the same fastidious attention that he devoted to perfecting surgical techniques, “oiling them himself, labeling them, repairing and arranging them tight on the shelves so the bindings would not warp.” He carefully annotated his books, writing notes in light pencil on the flyleaves or on yellow slips laid between the pages, according to the obituary.

By the time he arrived at Yale, he had amassed a massive collection that featured many excellent examples of incunabula — books printed before 1501. Cushing was a lifelong smoker; his health had begun to fail and pain in his legs had made performing surgeries more challenging, which allowed him to focus more energy and time curating his collection.

The “trinitarian scheme”

A visit to the Osler Library of the History of Medicine at McGill University in Montreal crystalized Cushing’s decision to donate his books to Yale. He believed that his collection, combined with those of Klebs and Fulton, would create a superior library.

Shortly after returning from Montreal, he wrote the letter to Klebs, who lived in Switzerland, explaining his plans.

Klebs, an expert on tuberculosis, had been Cushing’s colleague at Johns Hopkins.  He was receptive to the proposal and, in a response dated Oct. 14, 1934, suggested they “continue to play” with the idea.

Fulton, who was an authority on the comparative physiology of the primate brain, had enthusiastically endorsed Cushing’s proposal to combine the three collections, which he playfully labeled a “trinitarian scheme.”

Dr. Arnold Klebs befriended Cushing while they were colleagues at Johns Hopkins Hospital during the early 1900s.

Thirty years younger than Cushing, Fulton pledged to carry on with the library plan should his friend not live to see it realized.

“You can count on me to help carry out all of your wishes at that time — may it be ever remote — and I shall do it with loving care,” he wrote to Cushing on Jan. 25, 1935.  (He called Cushing “Chief” in their correspondence.)

The younger man’s involvement was also important to Klebs, who worried that their collections would become “a pious cemetery” without an engaging personality to stimulate interest in them.

“[Cushing] described you grey-haired and prominently foreheaded talking to the seminar on old books and chuckling over absurd annotations found here and there in them,” Klebs wrote to Fulton on April 1, 1935. “I found that dream of the future most attractive and hope that the Sterling Trustees will feel equally interested in it.”

On June 5, 1935, Cushing broached the subject of the library with M.C. Winternitz, then dean of the School of Medicine, who quickly embraced the idea, according to an entry in Fulton’s diary.

Within days of the conversation, Winternitz presented a 12-page memorandum about the library to the Yale Corporation, which “immediately authorized him to employ an architect to draw up plans with a view to raising the necessary funds,” Fulton wrote.

The architect, Grosvenor Atterbury, drafted “most engaging” plans for a library building on Davenport Avenue that would consist of a large auditorium and separate wings for a historical library and a working medical library, Fulton wrote in his diary late in the summer of 1935.

The plan for a separate building proved too expensive. By March 1937, it had been abandoned in favor of putting an addition on the Sterling Hall of Medicine.  Atterbury drew up plans for a Y-shaped structure with one branch housing the historical collections and the other serving as a general medical library.

Dr. John F. Fulton was the youngest of the library’s three founders. (Photo by Samuel Kravitt)

Cushing, Klebs, and Fulton continued to build their collections in a coordinated fashion as they waited for the Yale Corporation to approve funding for the $600,000 project.

On June 21, 1939, Fulton and Cushing sent Klebs a telegram declaring, “Library Funds Granted.”

Cushing’s health had been declining, and he was hospitalized with chest pains on Oct. 4, 1939 and lying underneath an oxygen tent, when Fulton visited to report that the steel for the new structure had been ordered and would arrive in December.

“I tried to convey the good news to Dr. Cushing. I think he took it in, but he was more concerned over the fact that he was in an oxygen tent,” Fulton wrote in his diary.

Three days later, Fulton wrote to Klebs with sad news.

“The dear man is gone,” he said.   

The medical library opened officially on June 15, 1941. Klebs died in 1943, but due to World War II, his books did not come to Yale until five days before Christmas in 1946.  Fulton resigned his professorship of physiology in 1952 to become the first Sterling Professor of the History of Medicine. He died in 1960.

The library today

Dr. John Booss, professor emeritus of neurology and retired national director of neurology for the U.S. Department of Veterans Affairs, first visited the medical library as a postdoc in 1969 studying neuro-virology, which was a new field that required specialized journals.

“I came over to the medical library and found it to be an extremely supportive place with great resources and terrific journals,” he said. “Invariably, the material I needed would be there.”

Booss calls the medical library “absolutely crucial” to his career.

“The library has been terrifically supportive of the research and clinical work that I’ve done, and also the teaching work that’s such a major part of Yale’s mission,” he said.

Over the years, the library has adapted and grown to meet the changing needs of its patrons. It was renovated and enlarged in 1990 through an $8 million donation from Betsey Cushing Whitney, Harvey Cushing’s daughter. The project connected the branches of its Y-shaped layout, essentially doubling the library’s size with the addition of a reference room and added stack space.

Digital technology has greatly expanded the resources the library offers its patrons. In 2004, the library began transitioning from purchasing print journals — the basis of most medical and scientific research — to digital subscriptions.  The library currently licenses more than 23,000 biomedical online journals.

“The most we ever subscribed to in print was about 2,400 or 2,500. It’s increased 10-fold in the space of 12 years,” Gallagher said. “That was a massive transition for the library. It made it much easier for researchers to access the content they need through their fingertips on a laptop rather than having to come to the library.”

The exponential growth in information has required library staff to become experts in the latest research trends and search strategies to help researchers and clinicians identify the specific kinds of information they need.

“We see ourselves as partners in research,” Gallagher said, adding that the library not only assists researchers in accessing information and data but also in advising them on how to manage both — which is important because funding organizations increasingly require making the findings of sponsored research available for use by others.

Barash, who uses the library several times a week, praised the library’s willingness and ability to adapt and tailor its service to meet the needs of researchers and clinicians.

The library’s information room was added as part of an extensive renovation in 1990.

“They’ve kept up,” he said.  “You can’t necessarily say that about every institution at Yale, but the library has done a great job of adapting its resources and services.”

For example, the library has developed a “librarian on call” program, in which research librarians performs rounds at the hospital, consulting with clinicians in operating rooms and intensive care units to help them obtain the information they need to facilitate patient care.

Barash said Denise Hersey, clinical support librarian, has become “a force” in the Anesthesiology Department and has been appointed to its research and education committees and co-authored articles.  

The library supports the educational missions of the Schools of Medicine, Nursing, and Public Health, as well as the School of Medicine’s physician associate program.  This support includes subscribing to thousands of online textbooks and other resources that students can consult for help in their coursework.

As the curricula of the schools’ programs are being redesigned, librarians are becoming more integrated into education. For example, Dr. Charles Duncan, professor of neurosurgery and of pediatrics, is working with library staff to create a series of teaching videos to guide medical students through every phase of a dissection. The idea is that students will watch the videos and come to class better prepared to learn.

The videos are narrated, and each anatomical structure is carefully labeled. They have completed 17 videos with about another 40 in the works. 

“This is labor intensive, and I can’t give the librarians enough credit for their help,” Duncan said.

Meanwhile, the historical library, which houses the three founders’ collections, boasts about 120,000 volumes.

While much of the library’s resources are available digitally, patrons still visit everyday to perform research in person, study and enjoy the rare texts, or simply spend some time in quiet reflection.

“It remains a refuge for people from the medical center to get away from the hustle and bustle and come over and find a quiet reflective space to do some thinking, particularly for students,” Gallagher said. “This continues to be very much their space for studying and research.”

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