Purpose: This lecture addresses the history and philosophy of librarianship, in general, and medical librarianship, in particular. The author discusses the profession and attempts to set its place in the context of the social and cultural worlds in which we function and in the context of the professions which we serve.

Discussion: Goals are identified that are common and immutable. Examined are the changing methods by which we meet these ends, particularly the impact of technology and other factors on how we function now and in the future. Change itself is identified as the one constant of which we can be certain. That we strive and achieve is because of a sense of purpose that has guided so many of our profession's leaders. Acknowledging an embarrassment of riches, I point to the achievements of some of the most notable of my colleagues and friends, as examples of what such an extraordinary dedication to the pursuit of purpose makes possible.

Conclusions: So long as we maintain this pursuit of purpose, which is, as Estelle Brodman said of the pursuit of excellence, a statement of faith in ourselves, our future is secure.

There is a marvelous Japanese tradition called “Ga No Iwai,”a rite of passage, celebrated when one attains one's sixtieth birthday. This is considered very special and for the Japanese signifies a new beginning. You are born again and, as swaddling cloths are red in Japan, the celebrant is presented with a red hood and a red vest to wear. These clothes are typically worn by babies and thus symbolize the celebrant's return to birth. Having reached this venerable stage in life, some line their kimono in red, which signifies that they can now speak on any topic with impunity. I often thought that a wonderful title for an autobiography would be: The Red Lined Kimono. Not having a kimono and having some time ago celebrated my sixtieth birthday, I choose to wear this red scarf to let all know that I have reached that stage of life where I too can now feel free to speak with impunity.

License aside, I am truly humbled, to think that I honor with my words, Janet Doe, a wonderful human being, who happened through her humanity, intellect, and generosity of spirit to bring greatness to our profession. That I am linked with her through this talk is an honor to which I always aspired, but never felt I would deserve. I knew Janet Doe and had visited her along with Gilbert Clausman, AHIP, FMLA, and Tom Williams just two weeks before she died. I can still see the twinkle in her eye and the smile on her lips when she offered us a drink and bent an elbow with us. She was as interesting and interested and alive as she ever was in her life.

She was everything Estelle Brodman said of her. Estelle, with Gertrude Annan, the first Doe lecturer, was one of the two in our profession who knew her best. I can pay no greater tribute to Janet Doe than to repeat Estelle's words:

Estelle made these remarks to introduce her Janet Doe Lecture, given at MLA's Seventieth Annual Meeting held in New York City in 1971. Janet Doe was at that meeting, and many of us, myself included, had the opportunity to visit with her there.

As I stand here, in the footsteps of so many distinguished Doe lecturers that I was privileged to hear, I will do my best to avoid pomposity and arrogance by keeping in mind a quote from a short essay that a little boy wrote on Socrates. He wrote, “Socrates was the father of and the greatest of philosophers; Socrates taught Plato, and Plato taught Aristotle; Socrates told all the people all their faults. They poisoned him” [2].

I think not only of Estelle in 1971, but of Dave Bishop in 1976, and while, like Dave, I think, “Dear God, I've joined the dinosaurs,” I am more conscious of being at the end of life than the beginning. While Dave was trying to read, unsuccessfully, Michener's, Centennial, I was trying to read Joyce's, Finnegans Wake. Old age is implicit in the generation of a child: the child's old age is there waiting. Similarly, the older you get, the more you realize that you are still a kid, and your early experiences are the ones that are now just opening out. It is one system all the same. This is one of the big themes in Joyce's novel. The first half of life we serve society—engagement. The second half of life we turn inward—disengagement. In Finnegans Wake, Joyce has this image of the heroine, Anna Livia Plurabelle, as being the personification of the River Liffey that flows through Dublin. She is the same person, the same river, all the time. Joyce makes it so you can feel the old woman in the little girl and the little girl in the old woman [3]. It is marvelous. It is the way you feel as you get older, if you pay attention to the experiences you are having inside. It is this realization that gave me the courage to accept when I was honored by being asked to give this Janet Doe Lecture on the History or Philosophy of Medical Librarianship and to expound on “Constants, Context, and Change: The Pursuit of Purpose.”

“The word once said is dead, some say; but I say it just begins to live that day” [4]. A word, indeed life itself, is given meaning by those who hear it and live it. I am sure this is what Emily Dickinson meant to convey with her short, beautiful, and eloquent poem. As our lives are informed and given purpose by the influences that surround us, so too, the professions we serve. In looking at our profession of medical librarianship, it is necessary to be cognizant of the culture of the professions we serve, as well as the institutional, professional, and social/cultural worlds in which we function now or in which we functioned in times past.

Such an examination often brings recognition of constants that have remained unchanged throughout the ages and the epiphany that the single greatest constant is change. One of the most dynamic changes, one that has great impact on our profession, is the exponential increase in the knowledgebase of medicine. In his recent Ralph and Ruth Gross Lecture, Clarkson noted Broad's comments on this literal explosion of information. She suggested that, by the year 2012, information will be doubling every twelve days [5]!

From the conceptual beginnings of libraries to the introduction of the first electronic computer, UNIVAC, in 1951, man used all sorts of methods and devices to transmit thoughts: images, symbols, or arbitrary signs were carved, engraved, drawn, or painted and were eventually arranged according to their religious, mythical, artistic, or archival purpose; all functions still found in the contemporary library of today. In our time, we have witnessed an emergence of format diversity and new communication media that have resulted in such innovations as the option of on-site and remote access to resources. Further, we see the acceleration of the changing role of the library from an information storage facility into a cultural and educational resource center. Electronic formats are changing the ways in which information is transmitted. In future, a book or article will be experienced rather than read and print will be available primarily in archival and historical collections, and even here digitization is the order of the day. Libraries will no longer house large collections of print and therefore no longer have to devote most of their space to stacks. It is easy to see a direction where, except for an institutional archive or special collections, technical service functions will be outsourced or the responsibility of others. We know that all technologies in use today will be replaced and that communication systems are continually changing the way information is accessed. We have already transitioned from a time when information was scarce to a time where information is vast and readily available. One thing is certain and that is that accessing information will evolve from the fairly simple search technology of today to one that is infinitely more complex, including the ability to search for attributes other than text, such things as taste, sound, speed, density, volume, and mass [6]. As we conduct more and more sophisticated searches, the need for professional assistance and the role of the librarian becomes ever more essential. These developments of our time are no different from those of times past, in that each stage of library development brought different options as to which directions to follow. One constant is that the direction chosen has always reflected the cultural environment at the time, the state of technology and the intellectual curiosity of the period.

In examining my career and personal and professional development, I realized that I had insufficient background in those events that could help in understanding the intellectual and emotional development of our culture as it was reflected in the questions that come up in medical librarianship and in medical science. These questions are better answered, or at least helpfully answered, in collateral events as to what was going on simultaneously in other intellectual and practical societal movements. I began to realize how important was the changing face of the religious development of the Western World and world civilizations to understanding the development of the traditions of clinical and scientific medicine and of medical librarianship; we cannot know the latter without understanding the former. Christianity is one of the three world religions. The first was Buddhism, which began in the late sixth or early fifth century BC. With Christ, we have the beginning of the second of the world religions. The third of the world religions is Islam, whose beginning date is associated with the Hefira in AD 622. What binds together these world religions, as opposed to the ethnic religions, is that they are religions of confession or creed and their impact and influence on society and culture—and even more importantly on our own sense of meaning, worth, and purpose—is evident, even from the most cursory introspection.

Since the nineteenth century, physicians and historians of medicine have constructed a history that begins with the “primitive” precursors of our medicine, usually a mere preface. Remember that this is a history of Western, allopathic medicine and does not take into account many other traditions of health care that are still practiced throughout the world, the most highly developed of these are traditional Chinese medicine, Tibetan medicine, and the Ayurvedic traditions of India and Sri Lanka. The presumption is that medicine in the early phases of settled, human prehistory resembled the varieties of medicine found among tribal societies discovered and studied as part of an optimistic extension of Enlightenment ideals. Ancient Egyptians, Greeks, Romans, or others about whom we know even less surely had no vision of themselves as part of an evolutionary march of medicine. The Western discovery of truly “other” medical systems, codifying that which failed to conform to established norms, belongs with contemporary nineteenth and twentieth century medical inquiry. Though medical historians can, and usually do, debate the particulars of a break in the story of medicine becoming modern, it is not difficult to locate this generally alongside the revolutionary secularization of religious ideas that we associate with the Enlightenment. The standard story of medicine runs roughly like this. Once past the “primitives,” the medicine of antiquity is often presented as a heroic saga leading to, or from, Hippocrates, “father” to Western medicine.

In the story of Aesculapius, a mortal acquires godlike healing powers, powers that depend upon his strict observance of taboos and sanctions. But breaking the trust, Aesculapius begins to resurrect the dead, clearly overstepping the boundary of human medical possibilities, a boundary we will allow only a Christ figure to cross. At once, the story speaks to human limitations and human aspirations, signaling not only doctor-centeredness, but also the reason why so many believe that with the ancient Greeks we first glimpse the birth of medical science: the modern Western drive to control nature. The overwhelming temptation is to highlight the discontinuities and dissimilarities between cultures, which will in turn illustrate and explain the story just crafted: true medicine begins in Greece. For example, emphasizing the liminal restrictions of human medicine, medieval medicine appears strapped by stifling subservience to authority and order, unduly constricting Aesculapian possibilities, a backward era failing to realize medicine's birthright. During the Middle Ages, the influence of Christian theology affected medicine in several ways. The Christian emphasis on charity and concern for the sick and injured led to the establishment of hospitals often related to and maintained by monastic orders. The first hospitals grew out of hospices for needy people more than from places for cures. As you know the modern words—hospital, hotel, hostel, hospsitality—all stem from the same root—hospes, meaning visitor or host—and commemorate this Catholic tradition. Here, in the United States, one can see this same pattern in the missions of California.

These hospitals were not of course the same as those in ancient Greece or Salerno. Salerno was but the first in a whole stream of medical schools in Europe, which were based upon the patient as the unit of training. Medical learning and practice in Salerno were nourished by the Greek past of southern Italy, favored by healing shrines in the tradition of Cos and Epidauros, energized by trade with Sicily and across the Mediterranean, and fostered by monastic bibliophiles at Monte Cassino.

In the later middle Ages, fine hospitals were built by the Knights of St. John, including St. Bartholomew's in London and one at Rhodes. The concern of Christian theology, on the other hand, was to cure the soul rather than the body. Disease usually was considered supernatural in origin and cured by religious means. In fact, the doors of mediaeval hospitals were positioned toward the Vatican so that the Holy Spirit was more likely to enter [7]. As a result, scientific investigation was inhibited during this time. Brothers of various monasteries copied and preserved those scientific manuscripts and documents that were thought to be consistent with prevailing religious thought, notably the works of Galen and Aristotle. This was the society devastated by the plague, a story Tuchman tells so well [8].

It was as the two streams of history, the Salarnan and Greek hospital on the one hand and the church hospital on the other, came together that the use of such institutions for teaching became standard. The great hospital schools—L'Hotel Dieu and Le Charité in Paris, St. Bartholomew and St. George's in London—became preeminent as teaching establishments. One need only read of the constant lobbying carried on by David Hosack, who was on the first faculty of Columbia College of Physicians and Surgeons and a founder of Bellevue Hospital in New York City, and Daniel Drake of Ohio for the exclusive rights to bring their medical schools into the hospital, to realize how long into the nineteenth century that the hospital was the sine qua non of medical education. In fact, Drake founded the Commercial Hospital in Cincinnati in 1827 primarily for teaching.

Sociologist Jewson and historian Foucault independently and in quite different terms observed that the period launching modern hospital and scientific medicine was one during which even elite patients lost their privileges “negotiating” diagnosis and therapy. In the world, sometime before 1800, educated patients could read much of what was available in medical thought and practice, cooperating in their own therapy. Jewson observed that by the seventeenth century, medicine was practiced under a patronage system. Doctors were employed by wealthy patrons to attend to their needs. However, theories of disease were tied to superstition, and medical systems of knowledge were primitive by today's standards. To make a diagnosis, the physician required that the patient tell a story of symptoms, as elaborately as possible. Examination was infrequent, and in any event often revealed little, since both signs and symptoms bore little relation to the physiological events of the illness. Doctors of the time were entirely dependent on their patients for diagnosis and management of illness [9]. By the turn of the twentieth century, however, medicine had transformed itself into a profession that could diagnose without the full participation of the patient. By the 1950s, doctors were able to discover and interpret signs, send human tissue samples to laboratories, and consult a growing research-based literature to make a diagnosis. Now, the doctor literally “knew best” [10]. The modern role of the patient became increasingly passive and compliant. We already have been given a strong sense of this power of the medical triangle (disease, doctor, patient) in Petrarch's complaints. Petrarch, called the father of the Renaissance, was less impressed with the learning of natural philosophers— including university doctors—than with the nobler calling of literature. His distaste for the arrogance and theories of learned physicians increased with the inevitable infirmities attending old age.

The medical “gaze,” as Foucault called it, and the dramatic expansion of the hospital as a medical laboratory rapidly distanced the physician-scientist from the patient's discourse and from the need to hear the patient's story. Foucault concluded that from visual inspection, auscultation, and palpation to the use of the microscope and biological tests, the information system has been modified. From simple anatomic-clinical correlation to the delicate analysis of physiopathological processes, the lexicon of signs and their decipherment has been entirely reconstituted. Finally, the doctor has gradually ceased to be the locus of registering and interpreting information. Today, beside the doctor, outside the doctor, there have appeared masses of documentation, instruments of correlation, and techniques of analysis, which have modified the doctor's position as an observing subject in relation to the patient [11]. After all, the stethoscope neatly circumvents the doctor's need for the patient's version of where and how the patient's chest hurts. In the physicians' narratives of this period, the story of medicine is the adversarial relationship of doctor and disease. The patient—one need only to look to Jenner, Laennec, Semmelweis, Snow, Warren, and Osler, for explicit examples—has become a case study. We can look to the literature of illness for greater insights. This literature is aided by the power of great advocates—such as Dickens, Tolstoy, and Verga—willing to draw attention to the medically disenfranchised in a way that does not portray the poor and ill as a danger and menace to the rest of society. Interestingly, physician-authors such as Treves and Conan Doyle attempt to tell the patient's story, so that we can be sure to get the right message and meaning from individual suffering. The subtext is often positive only if the patient is fully resigned to the physician's care and to the inevitable fact of mortality. Doctors' stories of the early twentieth century, however, seem most comfortable with a new autobiographical reflection, emblematic of the larger, heroic success of scientific medicine softened with the sympathetic presentation of medicine as artful caring.

Today, medical librarians are deeply involved in the development of the most recent movement of evidence-based medicine. The goal here is to establish the most effective algorithms of practice through the use of the scientific method and modern global information science by collating all the evidence and developing standard protocols that are then disseminated to health care providers. I would just caution that a possible downside with this “best practice” approach is the potential to stifle novel approaches to treatment.

What are the paradigms, the archetypical ideals that are the constants of our profession and that have served medicine throughout its history? We are defined by our perception of and adjustment to a constantly changing environment. Our mental growth is determined by the extent of our communicating our ideas of perceptions with others. We learn and grow from the experience of others. Communication from the past is only possible by the use of symbols that express abstract ideas of conceptualization. Aristotle told us to “make use of old knowledge to impart new” [12]. As librarians, we are only too well aware that the meanings of ideas are expressed predominantly in recorded formats. It is the preservation, organization, and dissemination of recorded ideas that are essential to our intellectual survival and are the constants that form the subject of our profession. Winger summarized major cultural factors in the changing concept of librarianship as follows:

The evolving nature of the library as an institution is characterized by a gradual change in its organization. The change has been prompted by the changing format of records stored in libraries: from clay tablets, to papyrus, to parchment, to paper, to nonprint and electronic data. The concept of a library as the hushed sanctuary of the scholar has long been shattered. Changing functions and techniques of today's libraries lead to questioning the very substance of the library of the future. The librarian's role should point toward a synthesis of the use of all available mechanisms into the most suitable application, so that the total library will be a living force for the enrichment of mankind. The total library is not just a depository of the literature of a subject, but rather a source of all forms of intellectual storage and all types of services. In short, the librarian should be the protector, conservator, and, more importantly, interpreter of the humanistic heritage of man. The total library is both an intellectual resource and a mechanism for the rapid transfer of current information. These constants are underscored and reinforced by immutable values, fundamental to our profession. These values—namely, access to information, universal literacy, and preservation of cultural heritage—are beautifully developed by Frances Groen, FMLA, in her new book, Access to Medical Knowledge.

Frances reminds us that “These values are also enshrined as characteristics of liberal democratic societies, in both the print and electronic age of libraries. Two of these values—access to information and universal literacy—are also attributes of an open society and an informed and responsible citizenry” [14]. The willingness or ability of society to provide the means to reach our goals of gathering the information of the past and bringing it to bear on the problems of today and the effectiveness of us as medical librarians in devising the best methods to reach these goals all relate to our mission as gatherers, storers, preservationists, and disseminators of information. The solutions must evolve from the problems addressed as posed in the context of institutional society and cultural norms and backgrounds. In his book on science and society, John Ziman reminds us that for the three uses of scientific knowledge—the creation of new knowledge, the social use of physical resources, and the solution of social problems—information is useless unless it is communicated [15].

I use great caution in presenting a retrospective of our field, its contributions, and its history. The dangers were wonderfully illustrated by a book review I read some time ago. The review was of Lady Chatterley's Lover and was published in Field & Stream. The reviewer wrote:

With this caution in mind, in examining history, we look to see developments and events in the context of the worlds in which they take place. There is a joke about an old Jewish man who is hit by a car. Onlookers rush to his aid, and one man gently lifts him up by his shoulders and places a jacket underneath his head. “Are you comfortable?” he asks. “I make a living,” the old man answers. The joke is, of course, about different interpretations of the same word. It is context that gives meaning to events, as nothing occurs in a vacuum. That history is important is almost too obvious to note. The great eighteenth century Italian philosopher, Giambattista Vico, is generally regarded as the founder of the modern philosophy of history. Vico developed a theory of the origins of human consciousness based upon the three Egyptian periods for nations. Each age had its own kind of arts, skills, laws, and government. All human endeavors were based in the use of language, and this use indicated the age at which the society was in: the hieroglyphic, the symbolic, and the epistolary or vulgar [17]. Another twist on this fundamental scheme of Vico's theory was that these ages were cyclical. It is interesting to note that in Finnegan's Wake, Joyce begins the work with the latter part of a sentence, the beginning of which is found on the last page. This circular construction carries out Vico's philosophy of history, invites the reader to plunge in almost anywhere, and gives me comfort that I started with the contemporary.

It is interesting to look at what society requires of us now and in times past and to note, with the exception of some oddities, how little has changed. In the beginning, the library was both a passive storehouse and an active publishing institution. Each function required technical “know-how” and instruction. The history relevant to the study of libraries covers a period of approximately 5,500 years from the innovation of pictographic writing (ca. 3500 BC) to the computer revolution of the present. Almost half of that time, until the construction of the Assurbanipal Library (ca. 650 BC), can be considered a pre-library history. The Assurbanipal Library employed scribes and scholars to edit, revise, and copy texts. The tradition of the library of antiquity continued in the classical period of Greek literature. The Library of Alexandria was much like the Assurbanipal Library in its organization. Both were founded by reigning kings, and both provided universal coverage of available literature that was arranged in similar fashion. Major differences were in the format of material collected: clay tablets in the Assurbanipal Library and papyrus rolls in the Alexandrian library [18]. While there is evidence that cataloging, classification, and descriptive bibliography were performed at the library at Edfu, Egypt, known as the “House of Papyrus,” it was at Alexandria that librarian/scholars developed the critical commentary, the ancestor of today's annotated editions. Other indispensable tools of scholarship produced at Alexandria include the authoritative text, the glossary, the grammar, and the science of lexicography [19].

Medieval monasteries kept scholarship and books alive in libraries and scriptoria. In the Renaissance, we have the requirements for the librarian that were laid out by the Duke of Urbino in the fifteenth century. Federico do Montefeltro, the second Duke of Urbino, was the very model of a renaissance prince, and his greatest passion, his greatest cultural legacy was his library, which now is housed in the Vatican. He set down the rules for the library at Urbino, which were:

It was 200 years later, with the writings of Gabriel Naude that we can see the beginnings of the development of modern library science. Naude wrote the first textbook on library management and in it discussed practical aspects of library organization. Naude was the first writer to recognize the librarian as a specialist in handling sources of information. His view reinforced the then-accepted role of librarians as scholars and bookmen [21]. Fast-developing printing technology, an increased number of books, and an expanded reading public led to the gradual evolution of librarianship as it moved away from a preoccupation with the physical aspects of a library and its records, toward the emergence of librarians as mediators and brokers of information.

In more recent times, we have Elizabeth Sanford's history of the Medical and Cirurgical Faculty's Library of the State of Maryland, in which she describes what was required of Marcia Noyes, the first true librarian to be appointed by the faculty. Miss Noyes was hired in 1896 by Sir William Osler, on the basis of her experience at the Enoch Pratt Free Library and because she could fulfill the requirement that she reside in the building and be on duty twenty-four hours a day! Don't feel too bad; when the faculty constructed its own building in 1908, a special apartment was built on the roof for Miss Noyes. She enjoyed referring to her living quarters as “the first true penthouse in Baltimore” [22].

The important lesson the history of these libraries teach is quite simple: “There is no single path to civilization, no pattern of uni-lineal evolution which all different early complex societies independently follow … no single centre of diffusion from which all major advances spread” [23]. Civilization like science “develops in close correspondence with the stages of man's social progress and becomes progressively more self-conscious as man's whole way of life becomes more purposive” [24].

It is illuminating to look at what we require of ourselves and note that what brings meaning is also what enables us to live purposeful lives. It is the talents and drives we bring to our jobs that determine the development, not only of our profession, but, as can be seen in so many areas, the development of the medical profession we serve, in both its clinical and scientific aspects. Earliest examples from the library and schools at Alexandria include Herophilos's establishment of the scientific bases of medicine. Among other things, he proved that the brain and not the liver or the heart was the cause of feelings and emotion. He was among the first to introduce the notion of conventional terminology, as opposed to the use of natural names, using terms he created to describe the objects of study, naming them for the first time [25]. Further, Erasistratus, known as the father of physiology, is credited with one of the first in-depth descriptions of the cerebrum and cerebellum [26].

The pursuit of purpose is essential, for as Hannah Senesh tells us: “One needs something to believe in, something for which one can have whole-hearted enthusiasm. One needs to feel that one's life has meaning, that one is needed in this world” [27]. There is a quality about seeking our purpose that separates us from others. Revolutionaries and entrepreneurs, two types of people most driven by purpose, share two traits: they act on their own instincts and are willing to differentiate themselves from the status quo. For them especially, purpose has the octane to ignite action even in the face of disappointment and rejection. Yet we must always be mindful of Marian Wright Edelman's caution that “We must not, in trying to think about how we can make a big difference, ignore the small daily differences we can make which, over time, add up to big differences that we cannot foresee” [28].

History is, as Karl Marx remarked, “nothing but the activity of men in pursuit of their ends.” We need only look to the accomplishments of some, who today are deemed greats in our profession, but whom I remember as colleagues and friends, to see the beauty and truth of that fact. Here I find we have an embarrassment of riches and, of necessity, I am guilty of sins of omission and for this, I ask your forgiveness. Because of this richness and diversity of accomplishments and contributions, what follows is of course selective.

I am reminded that the hazards of selective history were nicely illustrated in a report in the London Times, which read:

From scholarly foundations found in the writings of Janet Doe, Gertrude Annan, Estelle Brodman, Susan Crawford, AHIP, FMLA, Nina Matheson, AHIP, FMLA, and Frances Groen to specific innovations that are watersheds in the evolution of medical librarianship, we find results of a dedication to purpose that are truly inspiring:

Estelle Brodman's impact on medical librarianship as a scholar, teacher, and researcher were major. Estelle's dissertation, “The Development of Medical Bibliography,” published in 1954 remains a landmark work. She developed the PHILSOM automation project for serials control in the 1960s. This was one of the first applications of the new computer technologies to library routines.

In the early 1960s, Naomi Broering, AHIP, FMLA, perceived that the acquisitions, serials control, cataloging, and circulation functions in a library could be integrated into one system using a single database. Thus was born one of the first microcomputer-based, integrated library systems. Naomi followed this with the development of the mini MEDLINE system and went on to develop and market Georgetown University's integrated academic information management system (IAIMS).

Joseph Leiter, the first associate director of library operations at the National Library of Medicine (NLM), contributed immeasurably to a variety of important programs at NLM and in the larger medical library community. These programs are a catalog of successes that today we take for granted. The development of MEDLINE, DOCLINE, the Regional Medical Libraries, the NLM Associate Program, the introduction of contracts to expand library services are only a part of his legacy.

Nina Matheson changed everything with the publication of the Association of American Medical Colleges' “Matheson Report” on the future roles for health sciences libraries and librarians and her advocacy of the role for librarians in medical informatics.

Irwin Pizer's contributions cannot be overstated. Irwin's development of the State University of New York (SUNY) Biomedical Communication Network was the first online information retrieval service for biomedical literature.

Frank Bradway Rogers, who introduced a mechanized system for producing the new Index Medicus, was responsible for bringing data-processing machinery to the library. Rogers wrote a set of specifications, picked a contractor, and came up with a successful system that resulted in the Medical Literature Analysis and Retrieval System (MEDLARS). To my knowledge, Frank was the only director of NLM who went to library school after his appointment and received a master's degree in library service from Columbia University in 1949.

Last, to further illustrate the point, I look to the example of one of our greats, who thankfully, is still enriching all our lives today. Lucretia McClure, AHIP, FMLA, has received all the honors our association can bestow and so much more. Yet I am sure, and you can ask her, that she would echo Mary Louise Marshall's sentiments and say of her contributions that “I can assure you I have enjoyed every minute of it and I feel that I have gained much more through contact with the members of this group than they could possibly have achieved through the association with me or from anything that I have done.” For me, Lucretia exemplifies those qualities of dedication and purpose of which I speak. When I was appointed director of the Edward G. Miner Library of the University of Rochester School of Medicine, I arrived to find a staff that exemplified excellence with Lucretia setting the pace as head of reference. I realized right away that she was the one I needed by my side and appointed her my associate director. I knew that to succeed all I had to do was keep my eyes and ears open, keep my mouth shut, listen, and learn, and learn I did. Lucretia was more than the best in her field; she was a loving and devoted daughter, wife, and mother to two strapping high school footballers. I don't think Lucretia ever missed a game, come rain, snow, or shine. That sense of purpose and meaning so evident in her contributions to our profession was and is something she brought to her whole world, and it remains an inspiration to us all. Lucretia devoted herself to our new members and those seeking careers in medical librarianship. She is always there to welcome, guide, mentor, and advise. I am certain that Lucretia and all those I have already mentioned would rebel against being wrapped in sanctimonious robes and placed on that pedestal with Estelle's plaster saints. She is above all else herself; and that is the best that any of us can achieve—to be the best we can be. Picasso said: “My mother said to me, ‘If you become a soldier, you'll be a general; if you become a monk, you'll end up as the Pope.’ Instead, I became a painter and wound up as Picasso” [30].

Today, research, education, and the practice of medicine are dependent upon access to information. The measure of success is directly proportionate to this access. Today's challenge is the need to synthesize information pouring in from many disciplines that bear on matters of health and disease, yet whose languages are as disparate as talking in tongues. There is specialization with ever-narrowing interests of investigations in the face of an increasing need for a broad understanding of humans and their world. We have an ever-increasing number of specialists, becoming more denotative as each day passes, but a sorry lack of generalists, persons capable of recognizing the common denominator and suggesting unifying principles. Automation and artificial intelligence are here to stay, but unlike Paul Dukas's Sorcerer's Apprentice, I hope we may be able to maintain control. That hope rests squarely on the abilities of the librarian.

I am confident that the future of our profession is secure. We need not look only to our past, to the contributions of fellow librarians now wrapped in the mantle of greatness, but rather just look around you. Greatness is right here in this hall. One need only listen to the papers presented by our fellows and friends at this meeting, read the Journal of the Medical Library Association and its predecessor the Bulletin of the Medical Library Association, and peruse the poster exhibits to see the truth of this. Purpose is rarely given to us; more often it must be taken as we grapple with the responsibilities and obligations of our lives. The pursuit of purpose is, as Estelle says of the pursuit of excellence, a statement of faith in ourselves. We want to be men of dedication without being an escapist, of whom Frost says: “His life is a pursuit of a pursuit forever” [31]. Rather, like Thoreau let us hope that we have learned “That if one advances confidently in the direction of his dreams, and endeavors to live the life he has imagined, he will meet with a success unexpected in common hours” [32].

One day, not so many years hence, one of you will have the honor to be here, at this podium, speaking of the contributions made by your friends and colleagues to the advancement of medical librarianship. So as you bring your talents, dedication, and sense of purpose to bear on the challenges of tomorrow, the advice I want to pass along is this: