In the ‘old days’, textbooks were the source of information and wisdom. They were solid chunks of black and white knowledge painstakingly written over many years, each chapter compiled by an authority in the field, often one suspects a friend or collaborator of the editor. They were the final word in the respective fields, until... well, until the next revision appeared some 5-10 years later with an upholstered cover and extra lustre to the pages. only to be superseded again in due course. Key facts from each edition were pontificated over on ward rounds imbuing the consultant an air of (not always overtly specious) authority. They contained phrases like: ‘in my opinion’; ‘33 of children have a sweat chloride of >62mmol/L’; ‘the olfactory part of the examination is crucial in the differentiation between a primary and secondary amino aciduria’ and ‘dwarfism is a sine qua non of thanatophoric bone disease’. Time has moved on and authorial ego is now more fettered: well, perhaps not the ego itself, but the degree of certainty and dogma with which facts are represented. With the passage of time, we’ve been able to let go of a few old favourites (the secondhand bookshop, the departmental library, the house moving recycling cull) but some are simply immovable for emotional reasons, somehow etched in and adherent to our learning souls. While we can applaud the forward march of evidence rather than eminence-based medicine, it feels as if we’ve also lost something en route—the nous and passion of the clinical observer and the (quite touching) naivete in believing one’s own opinion to the exclusion of all others and the gall to assert it. As we fast forward to ever more online consumption, spare a thought for the real pioneers without whom we would not be here.
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