Tracking over 200 Years of Medical History through the NEJM Online Archives
May 1, 2019
If you’d like to read any article from the past 207 years of the New England Journal of Medicine, you could take a stroll down to the basement level of Harvard’s storied Countway Medical Library, provided you have privileges.
But an easier way to access any of NEJM’s 150,000 articles from its 8,657 issues is through its digital archive, an invaluable tool for clinicians, researchers, and teachers that became available in 2010. “A lot of journals just have their archived articles in PDF form, but we spent a lot of money to translate our content into HTML so everything is searchable,” says Pam Miller, who headed up the three-year archive project and is assistant to the editor of NEJM. (Articles from 1812 to 1944 are in PDF form). “When you scan something and then convert it to HTML, there’s a lot of quality assurance that needs to be done. For example, we would send out word lists to the proofreaders, and in some cases one word might be spelled 12 different ways over a period of time. So we had to narrow it down to just several spellings to keep things consistent.”
Transforming Paper to Pixels
Scanning is less costly when the originals can be destroyed in the process, so Miller’s goal was to find as many old issues on eBay and other online sources as possible. For those she was unable to locate, she borrowed from the NEJM warehouse and the Countway Library. “In the end, we had to cut bindings and have them rebound. This was OK because when I had spoken to historians at the Countway Library, they said the bindings are not worth a cent,” says Miller. She sent the hard copies to two different out-of-state companies to be scanned, while the quality assurance work was done in-house. Tracking down every NEJM issue and scanning them took about two years.
Miller said a fascinating moment of personal discovery was when she came upon a review from an 1838 journal about breast cancer. “I had had breast cancer myself, so I sent it to my oncologist,” recalls Miller. “At the time, it was astonishing to me how our understanding of breast cancer hadn’t changed that much in more than a century, such as what causes it and how it is spread. They knew at the time that women got cancerous lumps in their breasts, that you had to remove it, and that it often grew back. They also had some primitive types of chemotherapy back then.”
Evolving into the Country’s Leading Medical Journal
The New England Journal of Medicine’s earliest incarnation was as the New England Journal of Medicine and Surgery and the Collateral Branches of Medical Science. It was founded at a time when one out of every four children died in infancy and if you underwent surgery, you had a 50-50 chance of dying from complications. Until the mid-19th century, NEJM published mostly medical news that had already been reported elsewhere. Then in 1947, a 54-year-old pediatrician named Joseph Garland, MD, took over the publication’s reins and began giving free subscriptions to every enlisted physician. Many of these new readers went on to distinguished careers in medicine and suddenly NEJM was being read by the most influential doctors in the country. It had become a sought after place to publish important research.
Each editor-in-chief has left his or her editorial fingerprints on NEJM, according to Miller. Current editor-in-chief Jeffrey Drazen, MD, who is a pulmonology researcher, has a preference for research over, say, epidemiology. “Some 65–70 percent of what we publish is a randomized controlled trial of something that will change how we treat patients,” says Miller.
The archives are heavily used. In 2018, readers accessed some 300,000 articles from every time period in NEJM’s history: in fact, one of the most popular articles is from the first issue in January 1812, “Remarks on Angina Pectoris,” a seminal article written by the founder and first editor of NEJM, John Collins Warren, MD, on heart disease. It is still cited today.
If you are interested in purchasing the NEJM archive for your institution, please click here to request a quote.
As part of the NEJM’s 200th birthday celebration in 2012, readers were presented with five influential NEJM articles from different time periods and asked to vote on the most important one. Here are the results, which are all available in the NEJM archive:
1812–1879: Insensibility during Surgical Operations Produced by Inhalation (1846) (Report on using ether anesthesia during a surgery at Massachusetts General Hospital)
1880–1929: Pregnancy and Diabetes Mellitus (1915)
1960–1969: Studies on an Attenuated Measles Vaccine (1960)