medicine. national library of medicine (dem, bethesda, md

DOCUNENT RESUME

ED 158 740 IR 006 297

TITLE Communication in the Service of Aierican Health ABicentennial Report from the National Library of.Medicine.

INSTITUTION National Library of Medicine (DEM, Bethesda, Md.,SPONS AGENCY National Institutes of Health (DHEW), Bethesda

Md.REPORT NO DHEW-NIH-76-256PUB DATE 76NOTE 99p'.

EDRS PRICEDESCRIPTORS

MF-$0.83 HC-$4.67 Plus Postage.Audiovisual Aids; *Data Bases; Health Education;History; Indexing; *Information Networks; *LibraryServices; Medical Education; *Medical Libraries; OnLine Systems

ABSTRACTPrograms of the National Library of Medicine over

almost a century and a half are described, ranging from a history=of.American medical literature and the development of medical indexingto modern technological developments. Activities covered include thedevelopment cf the Toxicoldgy Information Program and the online database TOXLINE; the traditional library services which are nowmodernized thkough CATLINE (Cataloging-On-Line, REDLINE, SERLINE,and DOCLINE (Ddcum'ent Delivery On-Line) ;"the responsibilities of theHistory cf Medicine Division, a collection of pre-1870 manuscripts,printse and photographs; the extramaural programs of the library,including health sciences library construction, the Regional MedicaLibrary system, research grants, training programs, and publicationacquisition of non-U.S. biomedical literature and relationships withinstitutions abroad; the services of the Nation41 Audiovisual Centerincluding AVLINE (Audiovisuals On-Line); new technologicalapplications such as,biomedical communication, computer basededucation, and computer research.and development; and theadministrative structure of the library. (JAB) 0

************ *********************************************************** Reprod ctions supplied by EDRS are the best that can be made *

* from the original document. *

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A.

U.S DEPARTMENT OF HEALTH.EDUCATIONS WELFARENATIONAL INSTITUTE OF

EDUCATION

THIS 'DOCUMENT HAS SEEN REPRO-DUCED EXACTLY. AS RECEIVED FROMTHE PERSON OR ORGANIZATION ORIGIN-ATING IT POINTS OF VIEW OR OPINIONSSTATED DO NOT NECESSARILY REPRE-SENT OFFICIAL NATIONAL INSTITUTE OFEDUCATION POSITION OR POLICY

COMMUNICATION IN THE SERVICE,OF AMERICAN' HEALTH...

A BICENTENNIAL REPORT FROM THENATIONAL LIBRARY OF MEDICINE

DEPARTMENT OF HEALTH, EDUCATION, AN11 WELFARE Public Health Service.. National Institutes of Health

liethelda, Maryland 1976

DHEW PubWatiOn No (NIH) 76 256

o

PREFACE

' There are relatively few institutions that cancl:\irn to have witnessed two-thirds of ourn tion's`history. Founded only 60 years afterthe\ birth \of our country (1836) the NationalLibrary Of Medicine has been intimatelyinvolyed with both Federal and private healthprograms as a major collector and distributorof health related information. It is my hopethat those in the health community, for whomthis report is intended, will come tocrealizewhat an irreplaceable treasure they possess intheir National Library of Medicine..

Not only has the Library been a regularcontributor to the medical literature (havingissued. some 10 million copies -of IndexMedicus since 1879), but it has beerfa movingforce in developing new modalities forinformation dissemination. This amalgama-tion of traditional functions and services withnew technology is a theme the reader willencounter over and over in each chapter.

In honor of the Bicentennial celebrationthe Library will have a speCial° exhibit onAmerican medical literature. On display willbe early treasures from our collection includ-ing a teller from George Washington recom-mending two doctors to the Medical Depart-ment of the Army. The exhibit will be open.throughout 19''5, and I invite those interestedin the nation's medical history to visit theLibrary and view it.

Finally, I wish to acknowledge that what-ever greatness the Library has achievedthroughout its history is not because of aphysical collection of texts and journals, butthe result of vision and effort on the part of adedicated and loyal staff. American medicinecan indeed be proud of their accomplish-ments.

Martin M. Cummings, M.D.DirectorNational Library of MedicineBethesda, Maryland .

I

a

CONTENTS

List of tables 5Directors of the Library 6Officers of the Library 7Historical chronology 8I. A grief History of the American Medical Literature, 1776-1976

Martin M. Cummings, M.D 10II. From Fasciculus to On-Line Terminal: One Hundred Years of Medical Indexing

1876-1960, Scott Adams 14The Growth Years , 16The Lean Years 18The Renaissance Years 19The Age of Automation 21

1960 to Present, Davis B. McCarn 21III. Meeting the Need for Toxicological Information, Henry M. Kissman, Ph.D 26

Development of the Program 27Creation of a Query Response Capability 28The Development of On-Line Retrieval Services for Toxicology 29A Toxicology Data Retrieval System 30Interagency. Toxicology Information Activities 30

IV. Classical Services, Modern Modes, Jose ph Leiter, Ph.D 32Technical Services 35Bibliographic-Services 36Medical Subject Headings , . 38Reference Services 38

V. A Library within the LibraryThe History of Medicine CollectionsJohn B. Blake, Ph.D , .44Manuscripts and Oral History 47flints and Photographs Collections .., 49Publications , \, 49

VI. Outside Our WallsThe Extramural Programs, Ernest M. Allen, Sc. 52Construction 54Resource and Service Improvement 54Regional Medical Li-bract-les 55Research and Demonstration 57Milling 58Special Scientific Projects 58Publications .. '59

VII.: A National Resiource with Global Impact, Mary E. Corning --62 .,

MEDLARS Cooperation ,. 64Exchange Programs 07AID Services 67Public Law 480 Programs 68Foreign Visitors 69National Biomedical Information Centers 70Regional Programs for Biomedical Information , 71International Organizations 71\

CONTENTS

VIII. Not by Print AloneAudiovisual Services for Health Science EducationGeorge E. Mitchell, D.M.D 72Clearinghouse 74Educational ResearCh and Evaluation J 75Acquisition and Distribution 75.,Workshops and Conferences , 75 '

Advisory Services 76Media Developnrient ... 76New Technology and Future Directions 76

IX. New Technology, New Applications--Innovation in Health CommunicationRobert M. Bird, M.D _._

78 .

Broadband Biomedical Carnmunications 79Computer Based Educalion 83lComputerTechnolo Research and Development 85

RoleContinuing.Postgraduate EduCation for Physicians 85...,

' 'Focal Point Role or the Lister Hill. Center '86X.- Administering a Space-Age Communications Resource, Kent A. Smith 88

Board of Regents , i 89Financial Resources 91Staffing 92Awards and Honors a 93Lister Hill Center-Building 93Copyright 4 95Exhibits 95

95Equal Employment Opportunity Activities .

Appendix I: Staff BibliographyAppendix 2. PL-480 SuppOrted Publications ...

LIST OF TABLES

Table 1. Percentage distribution of on-line use by type of requestor 25

Table 2. Percentage distribution ln purpose of search 25

'Table 3. Source of requests to Toxicology Information Response Center 28

Table 4. Growth of collections 41

.

Table 5. Summary of acquisition statistics 41

Table 6. Summary of cataloging activities 41

Table 7. Binding statistics 42

Table 8. Summary of bibliographic services 42

Table 9. Summary of on-lint. services 42

Table 10. SUmmary of circulation activities! 43

Table 11. Summary of reference services 43

.Table 12. History of medicine activities 50"

-

Table 13. iiefedical Library Assistance Act history , .60

Table 14. Grant aWards, 1966-1975 61

Fable 15. Grant awards, FY 1975 '61

Table 16. Non-U.S. MEDLARS Centers 66

, Table 17. Types of P.L.480 project. s active in FY 1975 66

Table 18. Amounts obligated, FY. 1972-FY 1976

Table 19. Financial resources and allocations, FY 1975 9/

Table 20. Personnel ceilings 92

DIRECTORS OF THE LIBRARY

1865-1895 Col. John S. Billings

1896-1897 Col. David L. Huntington.

1898-1902 Maj. James,C. Merrill

1902 Maj. Walter Reed

1903-1904 Brig. Gen. Calvin DeWitt

1904-1913 Brig. Gen. Walter-D. McCaw

1913-1918 Col. Champe C. McCulloch

1918 -1919 Brig. C.:en. Framis A. Winter

1919-1924 .Maj. Gen. Robert E. Noble

1924-1927 Col. James M. Phalen

1927-1932 Col, Percy M. Ashburn

19321.1936 Maj. Edgar E. Hume

1936-1944 Col. Harold W. Jones

1945-1946 Col. L.L. Gardner

1946-1949 Col. Joseph H. McNinch

1949-1963 Col. Frank B. Rogers

1919 Col. Paul F. Straub 1964- Dr. Martin M. Cummings

John Shaw Billings (1838-191'3)

OFFERS OF THE LIBRARY

Director

Deputy Director

Assistant Deputy Director

Assistant Director for EducationAResources Development Charles F. Bridgman,.Ph.D.

Martin M. Cummings, M.D.

Melvin S. Day

Harold M. Schoolman. M.D.

Assistant Director for InternationalPrograms

Assistant Director for Administration

Associate Director, for Library Operations

Associate Director for Extramural Programs

Associate. Director for Computer andCommunications, systems

Associate Director for Specialized.InforMation Services

-Director, Lister Hill National Centerfor Bjornedical Communications

Director, National Medical Audiovisual Center

7.

'Mary E. Corning

Kent A. Smith

Joseph Leiter, Ph.D.

Ernest M. Allen,Sc.D.,

Davis B. McCarn

Henry M..Kissman, Ph.D.

Robert M. Bird, M.D.

George E. Mitchell, D.M.D.

" .113.-X.W."`" Nig

HISTORICAL. CHRONOLOGY OF THENATIONAL LIBRARY-OrNIVIEDICINE

The Library has been located in(froni left): Riggs Bank Building,Ford's Theater, and the 'ArmyMedical Library and. Museum.Present facility, is on facing page.

1836 Origin of the Library of the Surgeon General's Office with collection of books in the office of theArmy Surgeon General, Joseph Lovell.

1840 First listing of books in Library: A Catalogue of Books in the,Library of the Surgeon-General'sOffice.

1865 John Shaw Billings, M.D., assumes charge of the ,collection.

1866 Library moves to Ford's Theater.

1879 Firkt issue of Index Medicus.

1880 Publication of Volume I of the Index-Catalvgue of the Library of the Surgeon General's Office.

1887 Library .moves to newly constructed brick building on the Washington Mall.

1922 The Library of the Surgeon General's Office-Becomes the Army Medical Library.

1937 Microfilming operation begins at the Libraff.

1942 Photoduplication service incorporated into library operations.

1948 Preliminary edition of Army Medical Library Classification (now NLM: Classification) issued.

1950 Library issues its first annual catalog: Army Medical Library Catalog, 1949.

1952 Army Medical Library becomes Armed Forces Medici Library.

1956 Armed Forces Medical-Library becomes N rtional-Library of Medicine-as the result of legislationsponsored by Senators Lister Hill and John F. Vennedy.

1962 Library moves to its new seven million dollar building on_ttr:.: cainpusof Health in Bethesda.

1964 MEDLARS (computerized data trase) becomes operational 4P; produce the IndexMedia.. (January 1964).

1965 Medical Lib c;r1961 Regio

196k NLM

Natio

operati

197 t MEDLik"r2!

'remI "tilt

fav ra ahe.

CHAPTER I A BRIEF HISTORY. OFTHE AMERICAN MEDICAL tATERATURE

1776 -1976

Martin M. Cummings, M.D. Director

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.."On:th'e:OcCasiOU of the American Biceirtenniali fitting tbatoitire-Who'are concernedWith'bioinedical -comMurifcation-lOOk, back tos'arvey :;trie .,:prbud of :AinOriciig:medical literature. Before .;; the-- AMericariRevolution, many,.pu Ica wigs_ ea ing,,withealth Caine liorn :the:pet-Waif ClergyMen andexplorers To Thomas air or.dainedNeW'England:thiriistr;'.1.16*,:ti*c.ipdii.

for- --:,the.; first; :;rnedicali written. andprinted in what now the United States HisA Brief Rule ta guide the",'ContinORPeOpie Of -

New- England Order.: themselves . andtheir ,rn. theappeared in 1078. Thii.iVaS SOOri'fOildwed bythe publications !of .ReV.::.fit, ;:c640xi;'maiher,and his friend, Dr. 6 bdiel 131:?littin,.WhO=firstacIVOCated ;'and introduced in America the,practice of in0Culatibh againstamallpdx

try'sit, .! --

Prim' 16 1776 Anierican medicine was basedalmost exclusively on ideas, practices, andpublications imported from Europe. Ameri-can medical, culture generated little, scientificpublication and meager communication otherthan by word of mouth or letter. -For, thatmatter,'. there were few discoveries or inven-tions to obe,,reported. Most public health

_.triatters, were dealt with in the public press.Medical library facilities were commensurate

,) with the state of\ the literature. Although therewerea_leivrivate collections, it was not until763 that the first real American meditalibntry came into existence at the Pennsylva-'ia -Hospital.

s in Europe, where the first scientificjournals were published by learned societies,the' American scientific literature was an

,outgroWth of theemerging scientific organiza-tions.-Their proceedings soon dominated thefield of scientific- publishing. One of theseorganizations, the American PhilosophicalSociety founded in 1743, was the first .lo -use aCommittee as an 'editorial review mechanism ,in- the selection -of- manuscripts_ forpublicar_don. This peetr review has survived to thepreient and represents a. great contribution. tothe quality of 'publications.

The first American medical journal, Medi-cal Reposkory, was published in New. York in1797, more than a c-enturt . after Thacher's'publication, In 1.804, the success of the.Medical Repository led Dr. John RedmanCo : :e to publish_ the Philadelphia MedicalMuseum. In 1820 the Philadelphia Journal of.the Medical and Physical Sciences. waspublished by' Dr. Nathaniel Chapman to

... refute- the disparagirtg remark in the Edin-ew, "In the four quarters of the

globe, who rea book? or goesto an American play? or looks at an eric

. picture or statue? What does the world yet oweto American:: physicians or surgeons?" This.statement was a challenge to Chapman andWas carried on the title pi ge of th journal aslong as he remained, the editor. In 1828 thisperiodical merged with the PhiladelphiaMonthly Journal of Medicine and Sc ience and

became -the-4 me-us-an-journal-of-the-Medical_. Sciences. By 1876, when there were 46 medical

journals-published-hrtheldnited-States;John, :ShaW BillingS felt that the American Journal

was the Only periodical of real merit becauseof its editorial policies, selection of original"articles, and the presence of criticism andreviews.

John Shaw 'Billings (1838-19131 and SirWilliam Osier (1849-1919), two giants of 19thcentury ..Ainerican Inedicine, Were closefriends. Billings was. undoubtedly our coun-

. -greatest bibliographer and librarian.Osier, the Canadian_ transplant, became ourmost notable medical teacher and clinician.Billings' creation of the Index-Catalogve andIndex Medicus remains one of America'sgreatest contributions to medicine; Osler'sPrinciples and Practice of Medicine was thebest systematic textbook during this period..

Osier, discussing the importance of themedical library in the continuing education ofthe physician wrote, "'For the general practi-tioner a well sed library is one- of the fewcorrectives -oft e- prematute senility_which isso apt to over ke him. Self-centred, self-taught, he leads a olitary life, and unless hisevery-day experien is controlled by carefulreading or by the att 'don of a medical societyit soon ceases toobe o he slightest value andbecomes a mere accret on of _ facts,without correlation. , It IS, astonishing with,how little reading .a doetor can practicemedicine, but it is nokastoniihing how badlyhe may'llo it." I

During our present centurV a virtualexplosion of medical literature Itas\occurred.

_The emergence of new disciplines in basic fc

-rnediairideitteto-accompapyclinical-practice__.was clearly _reflected in the numbers and the-titles of new scientific books and journals.Before 1900, American physicians and scien-tists often Submitted manuscripts for publica-tion in foreign journals. After.the turn of thecentury most Arnericani,attempted to publishtheir scientific and clinical observations in theAmerican literature: In any examination OfAmerican medicine one Must distingUiShbetween the large amount of uncritical andanecdotal writing which ,,characterized the18th and 19th centuries and the more scientificand 'technical writing which has'appeared inthe 20th century. Although the former gives

image of medicine as a reflection 'Ol-thecivilizatto he-timea_the latter more clearly-portrays the evolution !or-geterrtifie---ideas.concepts, and inventions. When. it becamegenerally accepted- that ...,,search was incorn-.plete until published, there was a further.increase in the number of manuscripts andreports dealing :with ' scientific :and social

--aspects -of--human-health -and disease, Thepublished literature expanded at such a rate.

---that-it-was-soon-necessary-to-increasegrettthe number of abstract journals.

In recent years there has been a change inthe format as well as the character of medicalliteratUre. A relatively new type of publicationemerged, after. World War, II when Medicalnewsletters and controlled circulation medicalmagazines wereintrodUced. Supported largelyby advertising, they began to licompete with

-1.3

more conventional medical iiodicals for thetime and attention of the b sy practitioner.Much of the information ppears in laylanguage' making it easy for t re nonscholarlyor nonscientific health prof ssional to scanquickly the highlights of in dical advances.For those who later seek and study the fullmedical reports this form of writing serves auseful alerting purpose.

MediCal textbooks have a so changed incharacter. It is rare that a single authorattempts' to %.:ite a comprehet sive textbook inany field or discipline. Si cc 1950 most

_textbooks have been written y joint authorsor by a large number oC centributors whoprepare chapters for inclusion in large textscompiled and edited by experts in the field.This reflects the complexity of modernmedicine and has served to make texts moreauthoritative' and timely..

The critical review which has served as ameans of analyzing and selec.ively synthesiz-ing information has not flourished in thiscentury. Although most Physicians andscientists seek information in this form theyare apparently Unwilling or unable to preparecarefully documented objective reviews them-selves. This is a serious Shortcoming ofmodern scierice. Gresterefforts are -needed tosupport and subsidize such Writing by recog-nized leaders of American medicine.

Sir 'Theodore Fox, former editor of Lancet,has described2 the present inadequate methodsof transmitting medical information as .a crisisin communications. He characterized the roleof medical journals in tc:rmsi sugges1that .they have outliVed their usefulness. It isbecoming apparent that we are approachingthe period when the conventional journal willbe replaced by more efficient, timely, and lesscostly mechanisms for information transfer. Amedical press designed to record significantmedical events and observations will probablycontinue but it will be associated with othermore dynamiC. audiovisual and electronicmeans of communication. Physicians and

'Icts will have several options availablefor dissernrittrion-of-theidinclings and will nolonger be solely dependent upon tre-wPritt

_word (or_ priority. _or, pres

Kronick, in a stud0 of the history of earlyscientific journals, questions' whether thedevelopinent of new communications technol-ogy adversely affects scholarship. Perhaps itdoes; however, it also makes the disseminationof new knowledge much easier and thus has"more social utility. It is important thereforethat a new bibliographic apparatus, evolveconcurrently with the proliieratiOn 'of newcommunications media. If this is done the

integrity of the "literature" can be maintainedeven though it appears in radically new anddifferent formats.. Libraries are rising to the challenge bytransforming themselves from' passive reposi-tories of printed matter to active centers ofbiomedical information. The National Li-brary of Medicine now employs computers,audiovisual techniques, photographic meth-ods, television,,and satellites for disseminatingnot just bibliographic data but more completebiomedical informational messages. The"literature" thus will be expanded to includeinformation in many forms and formats andWill be :delivered rapidly to those_ who wish itor need it.

In a volume dedicated to , the nation'scentennial celebration, Billings wrote: "Atthe commencement Of the Revolutionary Warwe had one' medical book by an Americanauthor, three reprints, -and- about.,,),wentypamphlets."4 Today the National Library ofMedicine holds 1.5 million items and about 30percent of the medical journals being pub-lished originate in the United States ofAinerica. No doubt within the next severaldecades it will be possible for all medicalinformation to be transmitted with great speedand accuracy to -any ,physician located any-Where-ciii Earth. The major problem will be toselect the most appropriate information forthe prOblem at hand. To deal with this,medical educators must teach students whereto get the information they need rather thanattempt to force theM just to memorize theinformation itself. Man's brain, remarkableand versatile as' it is; simply will not becapable of acquiring and indefinitely retain-ing vast amount of new knowledgegenerated by the biomedical sciences.

REFERENCES1. Oyler, Sir William. A equanimitas

Kitadelphia-:-_13.1alsiston's Son &-Co.,--1932.p. 211.

2. Fox,' Theodore. Crisis in communication;Thee functions and future of--medicaljournals. London: Athlone Press, 1965.

3.0Kronick, David A. Studies of the early'scientific journal: I. The baSic source lists.Texas Rep Biol Med 32:61-74, 1974.

4. Billings, John S. Literature and institu-tions. In:A Century Of American Medicine,1776-1876. Edward A. Clarke, et al. Phila-delphia':'1..ea,-1876. p.' 293.

13

CHAPTER 11 FRO

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Above: Reading room of the ArmyMedical Library. Opposite: Indexer

_ reviews journal articles and assigns_ _medical subJect_headIngs.

ON-LINE TERMINAL:ONE HUNDRED YEARS OF MEDICAL INDEXINGScott Adims, DepUty Director 1960-1970, NLMDavis B. McCarn , ,Associate Director, Computer and-Communications' Systems

1876-1960*The bibliographic 'contribtition ol John

Shaw Billings and his successors is part of a'tradition in which the National Library ofMedicine Pakes justifiable pride. So, to is thetwentieth century incarnation orthe Billingstradition: the MEDLARS/MEDLINE system:The bibliographic continuum represented bythese two contributions is unique in theannals of science. No other. scientific specialty .

and no other country can demonstrate so longor so productive an indexing tradition as thatwhich has led trom the Specimen Fasciculusof a Catalogue of the National MedicalLrbrary, 1876, to today's MFDLINE Thisbicentennial Report offers an opportunity toreflect on this century of bibliographicproductivity at the National Library ofMedicine -and--its- -predecessors, _ the _ ArmedForces Medical Library, the Army Medical

BN Sdnt Adams

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Library, and the Library of the Office of theSurgeon General, 'U.S. Army.

_The history of the Library's indexpublicd-dons divides conveniently into three periods:the. first twenty years, 1876-1895, were thegrowth years, culminating in the completionunder Billings of the First...Series of the Index-Catalogue; the nexufifty yetirs, 1896-1945, werethe lean years of struggle in4survival; and thelast thirty years, 194 to dale, the years ofrenaissance.

The Growth Years -

Catizlogue of the Library of the SurgeonGeneral's Office, 1880. .

Fifteen years later, the. alphabetical serieswal to becompleted-with- Volume X-V1----W-to--,Zythus: after publishing subject entries for168,537 books and 511;112 journal articles,and author entries for 176,364 books. Until theend of the First Series, Billings saved thebibliographic slips: for the/jOurnal articlesagainst the possibility -that' 'funds -might befound to publish an author listing.

While Billings insisted that the Index-Catalogue was not a bibliography of medicine .but;-.a . catalog of the contents of one library:with the added 'advantage of being able 'toconsult the work cited. either by visitor by;

Following the successful publication of two -interlibrary borrowing, the :also took great

- book catalogs for the growing Surgeon Gen- pride in thek'..ibraryscorhPleteness. In 1878.-----CFal ri---Libidly.- (18717-arrd 1.873 )-'kur -1i- coin --'---even-before---the-publica (ion; 'of .L.th.e. ..Index

.. prehensive subject bibliography of cholera p Catalogue, 'he estimated that the Library had(1875),' Billings conceived,of a book 'catalog- more than 75 percent . of all the medical"

n.which would combine a authOr and. subject.,' periodicals published to that time. In 1891. helisting of the Library's books, 'd'isserta'tions, 'estimated that over 90 percent of the medical

. and pamphlets with'a -subjeceltseing only of literature published in the previous ten years-- the -medical papers in its :journals and was in the Library:.

transactions., In what may fairly, be described , The fact that the Index-katalogue.was a:as a .prototypes "feasibility study." Billings library catalog,. like-that of the 'Britishprinted a small edition .. of .a Specimen . . Museum, published in an alphabetical clic-Fascieulis Jor evaluation by the medical and tioriary,. form- offered, both advantages andtne library communities.. "Should:: it be -disadvantages. Publication being Constrained,publishedr, he. asked. The- question was tOr by the alphabet, the Catalogue could never beCongress to. decide_ "as. to whether the.. result ....... ____.cur:rent. On the other hantL by assenibi.ingwould be worth the,expenditure .- . . What is subject references retrospectively over periOdsthe value of such anindex to the people of the of years, the Index-Catalogue compiled peri-United States as compared with an expeditioh odic subject bibliographies which greatIv%to the North Pole, five miles of subsidized facilitated the writing of textbooks andreview.railroad. one company of cavalry,.or a small : .papers.. ThUs Sigmund. Freud, intending a,post-office bUilding?-: :-- rev iew_paper on coca ineovas at a;Joss on how

Physicians and librarians. alike responded .to assemble his references until-Ins-colleague.enthusiastically. The AMA. appointed a Dr. Ernst Von -Fleischl-MarXow, introducedcommittee to solicit the HOuse Appropria- him to Volume :=4, 1883, of 'the Index-tions Committee for funds for the subject Catalogue, recently .received by the library ofcatalog of the "National 'Library." Dr. Oliver . the Gesellschaft der Acme, Vicuna, where-heWendell Holmes, in his dedicatory address for found' the cumulated references -he. needed

. the Boston Medical Library (Dec. 3, 1878), . under Ery,throxylon (coca). It is interesting tostated that the proposed work "would have 0 speculate about the extent to . which this

.--excit0-1:The admiration ... of the profession in .feature of the Index-Catalogue promoted theall centuries."-Tand -urged CongreSs..to.'appro- quantity and quality of. American medicalpriale liberally' for-the support of the worE--liteniture,.____L_... _-_,

_-CharlesAmmi-Cutter-expressed_thehope_oLall_________Oti_the_other .hand_ ii-----71;--tiiiill--see=late.IT.' th i s_librarians and physicians "that the funds for alphabetical constraint constituted . thethe printing will be forthcoming, for nothing. "Aghilles heel" of Billings' grand. 'design.rnOre'fitting to facilitate medical study is likely :, Even as the 'First.Series drew- to a close, theto_ be.'. produced. in this- country." _probletn zrose. As reported in 1891,

,

* . Thus persuaded. Congress . appropriated with-a pUbliCationrate of a.iblunie a-year, thefundS. ara..after four years of, preparation.- backlog of unpublished referencff expanded.BillingS. now joined by his alter.ego.and lift'- The cumulation from Ig80 to '1091' of theselong colleague, Dr. Robert Fletcher, published references, under. A to S amounted to 70.000Volume I, A to iierhinski; of` the Index- author and 240.000 subject titles. By,the time

a

,,

the Firm Series would be elided (1895). Billings. estimated that. at the Current rate of increasethere would be erough references on hand topublish a."suppkment or Second Series of sixv Isms.

To complement- (or perhaps compensatefor) the alphabetically organized Index--Catalogue, Billings and Fletcher organized asa current outlet for their indexing the IndexMedicus: a Monthly Classified Record of the'Current MediCal Literature: of the. World. : -Unlike the. Index-Catalogue,. the Index :Medi-cus was to be published commercially.by thewell -known library and bibliography publish-

. er, F. LeYpoldt, at a price of $3 per year...Fletcher. ssumed the editorial burden forthisnew publication; which included an 'annualauthor index and a `miputel) ,,sadividedsubject index. The --first. Volume (1879) con-

a-monthlv-medico-historico,bibliographical Notes and Queries ,to WhichBillings, Fletcher, and Thomas AA Indsorcontributed. 7 r2 The First Series of Index Medicus 11879-

1898) did not suffer limn an overabundance ofsascribers. When Leypoldt.died in 1884. the"hazards ,'of -the- venture ''(as" -Fielding H.Garrison, its later editor, termed- them) were .

undertaken by George S. Davis of 'Detroit, andwhen he failed in 1894; Dr. Fletcher tooleover .

.and..assumed, the management as well as theeditorial responsibilities', with Rockwell and .

- - - -- Churchill--of- Boston - serving -as- publishers. -By now the price was $25 per year. .:Its

. subscription, list was Modest. In 1891 of totalof 482 subscribers. 90 were from the U.S. ArmyMedical-. Department, 224 from-other institu-.tions in the United States (mostly libraries),and 168 from other counnies. Sir William .

_ .____OSIer appealed to his fellow physicians at a...meeting of .the Ai-Orican :Medical Associationto support the palmation, but to no avail...,The.Fir§t Seri closed with its 21st- volume,April 1899.

Within. six m nths of its .closure theiiistiruter of,Bibliog by in Paris had orga-nized and announced its successor, Bibliogra.phia (Inde Medicus), a monthlypublication. represe tative of the internationalbibliography.. of . t le medical sciences And

-----7argyistitrd-by-the Tniversal Decimalcation. Two highly .respected French physicians, Dr.. C. .Pe.tain end Dr.- 'Charles' Richet.-were its... Directors, and Marcel .Baudouinserved -as its fanxging Editor 'The - Editor

mSk.tirnprovements, typographic-iifid?..,substantive. Including the. use a

1s*.rniehjAe a cOrtiposer alleged to. have ,great- advantages for bibliographic publication.

Billings, in the meantime, had become aprincipal adviser to Andrew Carnegie inmatters relating to libraries and bibliograph.When the Carnegie Institution of-Washingtonwas-organized-13-illings-became-a-member-oF---.the Executive Committee and later Chairmanof the Board of Trustees. In this capacity hemade a gram of. $12,000 to. Fletcher for theresumption of the Index Medicus,and the firstvolume of the new series, under Fletcher'seditorship, appeared in 1903, while theBibliographia Medica closed down , after , .

publishing three volumes, 1900, 1901,-1902.The bibliographic, techniques Used- by

Billing's and FletCher in compiling the. FirstSeries 'of. the Index-Catalogue and the Index .

Medicus have a parti ular fascination for us,.today. As Garrison de tribes it, as the boundfiles of, jcittinals bo ght -for the'Catalogue arrived,."Dr. Billings, with charae-teristic energy, .setabou the task of checkingtheir contents for indexing, occupying evenhis private leisure with this work. Almost

'{-every day, a government van would leave awagon load , of bound periodicals at hisresidence in GeorgetoWn and the next morn-ing would find their principal articles, cases,and essays carefully checked by lead pencilmarkings, for the..copyiSts in\the office.. This.night work continued Until the gigantic taskof indexing all the bound 'periodicals wasaccomplished, but even in later day's, when-fiehad- only -thecurrent unbound periodicals =todeal with, Billings still continued to take someof these home in his overcoat pocket or wouldhave them sent; up in baskets for checking../".

.With..; minor variations. throughout its-history the work plan involved the assignmentof responsibility for descriptive 'bibliographi-cal work to trained clerks (converted Army

-hospital_stewards_irt-Billings' time), and the'...reservation.of mediearindeiting,ifideditorialControl to the physician-editors. _ .

A thorOugh study of the subject organiza-tion of the Index-Catalogue would providerich. materials ,for a history .of medicine.' :Anearly- student of posology, Billings based hisstructure on the. Royal College of 'Physiciansof London's classification of kliseasei whichwas in turn' founded on 'the system of Dr.

William-Tail.-HoweveiTarGarrison notes inhis Merrioir of Billing., the rapidit}sagioWthof medical knowledge in the latter half of the

. 19th century. convinced.'Billings that any, .

arbitrary.- and ,fixed scheme v..as doomed- t'.early obsolescence; the sti uctures of thesuccessive volumes of the' 'IndeXCatalogueand the Index Medicus alike reflect the.evolution of 'medical conceptS.andgy of the time. ('

By 1891, thelndex-Catalogue required some20,000 main and subordinate subject , head-ings, and Billings and Fletcher were required

commit to memory some four to five_thousand of these. Each issu of-the' Second

Seriei-of-the Index Medicus (1902-1920), edited.by .Fleichei'.and_ Garrison, carried ''at its.masthead the following -cautionary notice:."The classification . . . is-Hb4ed as far aspossible on the latest accepteTh--vies,. inmedicine. Neverthek,ss,,it is to be remembered--that the bibliographer has had`to deal with allthe matter which comes to his hand, sonic-ofwhich may be unassignable under a strictclassification."

General Walter D. McCaw. and Col. ChanipC. McCulloch, cops and appropriations werefound to assure their regular publication, onepet %ear, by the Government Printing Office.

Toward the end of . the Second. Series, ,a. number of-circumstances conjoined toThreat-'en the continuation' of the Index- CatalogueBillings.atid.-Fletcher were gone, Garrison wasoverworked, the War in Europe had cutjournal receipts by -50 percent, the card files

... were .'bidging:. with unpublished-, references._Following long discussions, Garrison and

Col. McCulloch, then Librarian, distributed acircular letter p-roposing the replacement ofthe Index-Catalogue on the-completion orthe.Second Series with aliernatiYe.

. The responSes of the mediCal professionfthe -librarians alike during the spring and

--summer-of--19-1b---w-Ere-pi-o-infx-anit vigorous,The. faculty...ofjohns Hopkins. Uhiversity,

. 'medical societies of MassachusettS;. New York,-.Philadelphia, Chicago and Marylandadopted2resolutions .of protest.. The MediCal Library

".Association . resolved that., the scheme todepend. on the monthly. issues of the Index

. Medietc; or special subject bibliographies.-,Would not do. The Index-catalogue was

indispensable. Ityraist-gO on to a Third Series.-With Volume 1 of the Third Series (1918), ...

reprints and less significant titles were omitted.to conSetvespace. Funds' for Ihe third volume-.were first withheld 'and later -withdrawn-,

publication. In '. contrast to the annualpublication of-volumes of the Second Series,volumes of the Third Series did not appearduring the years 1917r:1919, 1921, 1.924, 1927

The Lean Years '-

The' fatefate ,,of Fri:it...Series Index---------'111edieueS foreshadowed the struggle-tot-sun:iv-

. al_ endured by both 6f the -Libtaiy's indexpublications during ,the following.fifty years,.1896-1945.

On the death . Of Fletcher. in 1912, Dr...Fielding .H. Garrison became. Principal-

-A-ssisiant-Librarian and.assuined responsibili-ty not only for editing the Index Medicus but

--for the preparation Of ihe-subject bibliographies'' of the Index-Catalogue as well. TheSubvention from the Carnegie Institutionassured its continuation through a SecondSeries (1902-1920) and well into a Third Series.

_.(1921.1927)..edited_by.f.Garrison..and.Dr..AlbertAllem-ann. ,

An editorial in the July 1-,J1,6, issue-of theJournal of The Arrierican Medtetil Associationcriticizing the Index-Catalbgtte as ';out of date

__ and valuable only for research puiposes andthe Index 'Medicus 'as'Solt-laiiiiiate and soinclusive that it is ofpractical value to few butresearch .workers," announced the puktlicationof a. new medical index,. the --'QuarterlyCurnulative-Index_to,Current_i_VediCal Literal-

.The AMA index had two novel featureS':-its four issues per year were cumulative anddictionary in arrangement, Its appearanceprecipitated a series of' efforts ovet the, nextforty-three years, o, rationalize the coexistence-(Ai the partially cainpetitive medical indexes:the Index Medicus the Index-Catalogue, and

the-new-Quarterly-cum/Wive Incte:t.For -ati--understanding of 'the- Library's

plight, a brief retrospective look a'. the fate L,thelndex-Catalogiie during these_ lean. yearsis

-- necessary _I he "supplement 0,i. six. volumesforeseen by .Billings became twenty-onw by theclosing of the SeCondSeries in 1915. t'nder theeditorship of Fletcher and Garrison,. and aseries. of distinguished Library Directorswhose names included Maj. Walter .Reed

In his 1921 report-ukthe Surgeon General.General Robert E. Noble-,-the-Librariammadc---the first of a series of proposals tconvert thealphabetical order of the Index-Catalogue toan annual serial-- form. The backlog of the

-uq-published-references would-bca crash progra,m over. the ensuing severryears,..thus closing out the Third Series. Subsequent.ly, each volume would be an annual catalogueof the current medicalliterature. By 1925 the'Librarian, Colv James' M. Phalen, had tzlenadrastic step. to., insure prompt publication. of

it,Eurretirlifdexing. The sublct <'nCries foxmaterial- published'afierianiiiir-'1. 1926. wereto be omined.frorn the lest _of the Third- eriesof- the 1-de.Y:Catalogue. and to be publisi;4-11only. in_ the.../ndex

This decision coincided With the negotia-.

tiOns between the Library, the CarnegieInstitrition; and the American Medical Asso-ciatiOn' for the 'merger of the Index Medicusand the Quarterly Cumulative Index to

°

'Current Medical Literature. These ,weresuccessfully concluded, and the first volume ofthe Qyarterly Cumulative Index Mediusappeared in April 1927. The cooperative

. venture involved the indexing of the foreignliterature-and-supplemental-English-lan-guageliterature by the Library's .staff.. and theediting, printing )nd distribution by theAmerican Medical Association. This coopera-tion continued until. December 1931, whenlogistics and other 'technical difficulties con-spired to:defeat- it AlleinatinEditor :of the Index-Catalogui, in February'1932 and wr.s suCCeeded'bYttr: Claudius Fran,Mauer. Their combined talents helped toproduce the tenth, and last volUme of theThird SerieS'.of the Index - Catalogue,Which-- -also -.:--saiC .;a7.7011aboratiiv effort by:GarriSon and Mayer' to produce a supplemen-.tal catalog of -the. Library's Arictifiabilla and

-..-16th century books (1500-1525).-Threeears' of lapsed appropriations during

th&Gte.at Depression deferred the initiation of .

the fdurt,h Series until .1936, although the firstliak&.of the first fvolume had been Set-in

tYpeifoiir.*ears earlier. In 'a historical prefaceto tliiiv,,5-tarn. Major Edgar .Erskine Hume,.Librarain from 19324936, promised to remedy..

'Ithe deficiency resultirieirom. Phalen's. -decision to omit currently publiihed-rnaterial.

The,-.:Jentries; rePresenting publications-1926-1932..would be published as-the

of-LtheFourth_Series_appearedUnder' Dr. Mayer:s.editorship. a number; of

valuable bibliographical: Supplements to theIndex-Catalogue appeared. The Garrison-Mayer listing ofjnunabula has been men-tioned. The third- volume included a provi-

. siOnal__:_reference list of congresses and 'conferences; the. fourth volume a prospectdi ofa Bio-Bibliography of Sixteenth.. CenturyMedical 4uthors, plannedfor use in faScicideswith future volumes of the Catalogue. -To-gether with Col. .Harold W1 Jones.. whodirected thee. Library . from 1936-1945. Dr.

ayer conceived the idea 61-a-world-catalog-ofMedical boOks..--

The, Fourth Series appeared destined, in the.years immediately -preceding World War to:.

Ome an exemplary archive for medico-historical-,scholarshi-0;71eaving"--toTthe-Amei 1-

-:-zcanTMedical- Association the-responsibility-for,: -'subsidizing the indeking of current medical .

publications..

The Renaissance Years

With. the coming of World. War II, unprece -.dented demands-were made on:the Library and

. on its. bibliographical apparatus. The research

programS sponsored by the Office of ScientificResearch and Development depended. on its

. collections for biomedical information. Medi-,. cal intelligence services in the Armed Forces

severely tested its resources for geomedicine in-preparat;on forglobal -combat--Medicalofficers in the Armed. Services, Stationed allover the world, looked to it as a. source ofcurrent professional' information. .

It was in response, to this latter need that the .Current List of Medical Literature waslaunched. In 1934 Dr: Atherton Seidell; aretired government research biochemist, to-gether ,with Dr. Watson Davis persuaded- theDepartment of. Agriculture "Library to es-tablish Bibliofilm Service as a means ofincreasing,.the_availability of the materials Of-research: in 1937, Seidell persuaded.. Col.Harold W. Jones to establish a MedicOfilinService the Army Medical Libiary. To.promote the Use of _the microfilmS, Seidell__founded the "Friends of the Army MedicalLibrary;" whose function it was to publish:aweekly listing of the, tables of contents ojournals received in the Library. ,:-.. The journals were categorized in theCurrent List undei.44 broad headings, a crude

v-arrangement -which occasioned public criti-cism. Nonetheless, a."' communication toScience called it "potentially by far the most

important index of current literature in anyscrentificfield;" and in its first'year it attracted .

'700 subscrWrs::-_Further, the Current List-liad-achieved an outstandirigluccessin helping tokeep' uniformed -: medical officers _

informed. .

In 1945, . the Library decided to assumeresponsibility (Or the 'Current List, which'heretofore had been supported jointly bY=the"Friends" and the ,Medical Library- Associa---='

providing monthly subject indeZes. The firsttion, -arild-16.,:respond 'to the criticism by .,

few yearS of governmental operation, wererocky ones. Heroic efforts were made by theLibrary's Catalog Division and by volunteersto_'--rnaintairl_Prciduction; Stabilization was ,

achieved by 1950. -With-.7-aireorganization---under the direction of col. Frank B...Rogers.

The-Current List story, however;, must, be-- viewed against the backgtoUnd of a-. more:

fundamental change firthe-tibrarystokwes,a Change-which-led ultimatelythe IndexCatalogue. The Library's difficult,ies reSpondingr,to wartime ,challenges led b

Col. Harold W. Jones in 1943 to an effort to.Modernize the institution. With RoCkefellerfunds, a survey team organized.: by theAmerican Librarl, Association reviewed theLibrary's operations nncl,programs, and made

several recommendations.- for improving theIndex-Catalogue.- The medical profession's interest in the

Library had steadily risen with the growth ofwartime research. Surgeon General Norman

_______LT.-Kirk-had-appointed a nuntber:of advisers tothe Library who; in October 1944, held theirfirst meeting as an Association of HonoraryConsultants. The Consultants, took an imme-diate interest in the redirectidn of the Library'sprograms, including the future of its medicalindexing activities.

Serious consideration of thii probtem,'hoWever, was to be the task of a new advisorycommittee, conceived and organizei.L.1* Col.j.H. McNinch-,--who-had- 'succeeded 'Lb- The,Library's Directorship in 1947This commit-tee, organizethin July 1948 Under the.dhair-manship of Dr. Lewis Weed, was charged with.the responsibility of :studying the .indexingrequirements of modern medical science andthe ability of the Libraries two indexingpublications to satisfy -them. To insureconcurrent consideration of ,the QuarterlyCilmulative Medicus (QCIM), Dr.Morris Fishbein of the AMA was-made-anex-officio memb( and to provide, the Committeewith a fact-fir ding and investigatory capabili-ty, a contract was 'negotiated with JohnsHopkins University.

This contract established the Welch MedicalIndexing Project, headed. by Dr. Sanford V.

_ _1..arkey..:One_of_the-earliest-interestsighown bythe Consultants' and Library manageinent

__alike had been the potential application of:automatic data processing -equipment-to thepublication of indexes. At a December, 1947Symposium On -Medical Subject, Headings

ry_sponsored by the Library in- die Pentagon, -for_ example, Col. McNinch_led_the_participants .-

through the Medical Statistics Division of theArmy Medical Department, suggesting tothem that they consider the application of the`punched card equipment then in use tomedical 'bibliography.

It is understandable, therefore,. that theWelch .Medical Indexing Project assignedhigh priority to the investigatioriot."machine

-methods: compiled a pilcit list of 7,000medical journals? and with the help of its staff.meinberi-Eugene-Garfield;developed-a-poten---

1-system-forpreparing-the-current--Listfor- --preparing-- the Current- -List-fro punched- cards and a prototype searchsyste The also investigated thetheory .a practice of medical subject head;ings and, t ugh key-punching the CurrentList subject h dings, facilitated their later.,rev

Theision.

Project--re fed regularly to theCommittee of ,Consu 'ts for the Study of

Indexes to the-Medical Literature, which wasengaged at the time in discussing questionsrelating to the needs for and uses of medicalindexes. At its seventh meeting, December 16,1949, the Committee recommended the

--continuance-of-the-/nelvx-C-a tirlogue-and the-substitution for it of a current index based onthe Current List of Medical. Literature.

The alphabetical straitjacket in whichBillings had confined' the :Index - Cataloguewas a principal cause of its undoing.. While

_research on malaria -and antithalarials hadbeen a top wartime priority, the "M" volumewhich contained thousands upon thousands

_of_ references on malaria-courcritot be published until' the war was over. The Librarynever did publish its' thousands of referenceson penicillin, because the "P" volume wasnever issued. While many defenders, of the

----..-Index-Cataloguewere Made unhappy by thedecision, litost_users accepted the decisidnandlooked. forward' eagerly to the anew . andirriprovedtCurrent Lest.

Under the direction .of Col. Rogers and thecapable. editorship of. SeymoUr Taine, theCurrent List of Medical Literature had beenredesigned, in 1950. A register section listedarticles in serial numbered .order under theirjournal titles: An author index and a subjectindex using standardized headings were cluedto the descriptive bibliographic data includedin, the registry section. by -means of the serialnum-bers7-To-compose-the-inonthly publica-tion, car& bearing the information were"Shingled" and 'photographed.

During this developmental period, 'thePursuit of standardized subject headings formedical indexing-became a ,major preoccupa-tion of the Library. The explorator work

____done._by the Welch. Medical__Indexing_Project:.___.contributed to the efforts of the Current Liststaff to develop .a Subject Heading-AuthorityList, which Was (used Until 1959. Dr: Rogers .

laid the philosophical foundations for furtherdevelopment in apaper which concluded thatthere were basic similarities between subjectheadings to be used for Library cataloging and

= for inek4ing: This,,concept was iniplemented"in the -first edition of Medical Subject Head-ings (eSH), 1960. With the planning of

NIE1:}kARS--in-1960; a new-- approach- -was ---deVeloped

Mortimer Taube as a'mechanism 'for accom-plishing searches in accordanee'WithBooleian

- logic, dominated the intellectual approach tosubject analysis, and' the second edition ofMeSH, prepared with machine retrieval inmind;' reflects the constraint of this .approach."-The Current List steadily increased its

coverage during: the 195,qs; reaching 110,000

articles by 1958. Continuing efforts were madeto.find a basis for cooperation with the QCIM,but a workable solution eluded officials of. theLibrary-and the AMA. The costs of subsidiz7.ing_ the QCIM were_be_cOming_anincreasingConcern to AMA'management; the possibilityof .mechanizing its production were explored

-unsuccessfully, and finally AMA decided 'todiscontinue its publication in 1951.>.

The Age. of Autoination

Operational experience in producing theCurrent List had inspired the Library'smanagernsnt with the confidenC to take thenext steps toward mechanization.. Dr. Rogersreported to the Board Of Regents injNovember1957 on prOgress, problems and Possibilitiesin indexing. The.Board endorsed the solicita-.tion of .funds from an' extragovernmentalsource, the Council on Library. Resources,-,which made a two-year grant to'the Library of$73,800 to "develop .and denfonstrate- in thefield of medicine improved methods for therapid and efficient publication of compreheh-sive indexes to the literature . . . making Use ofhitherto unutilized mechanical applications."

This two-year development effort resultedin a significant breakthrottan for a media-nized index publication :,y.steni. Flexowritercomposing machine's for the index copy,.IBMkey:punches_ancLsorters-for-the-alphabetizing------of the copy by at.thor .and 'subject,' and aListomatic step-and-repeat camera' fOr com-posing column - width film were combinedinto an operational-system.

The decision was made to plrase_o.ut theCurr;mt List with its December 1959 issue,.andto restore to the Library once more the Index..

. MediCus title 'and tradition. As a* spttcialbonus, this publicatiOn rifetlioll offered arenewed opportunity to *ork out a means of

.collaborattun with the. American :MedialAssociation. An agreement was reachedwhereby/the Libraryi;ty_yessivelY1_.;cumitlated--

---and-interfilFilthe (aids after .each monthlyissu Was. cmposed,' and photographed .the .

cumulation in December. :The film was 'then._delivered to the AMA which printed, bound:and ,iiiitributed . the new annual publication;

Index-,Mtdir-ur-(eum).Although this System'provided- the process_

by Which Index Medicus was published 'fromAugust 1959 1ODeCember -1963; it was ,quicklyevident that is could 'not serve as- 4. retrievalsyStem. The state of the art in those days ofautomatic data procesging dictated that thesystem "card bound.' The fastesi card-sorter 'then available could handle 1,000 cards

per minute. To search afive-year file of 750,000subject cards would take twelve and one-halfhours.

The .conclusion reltitiantly .reached by the .

"...Library -was-that-a-retrieval-system-could-not-be successfully grafted onto a publication

.;system but that it might be more suitable toinvert the objectives; that is, to start with thedesign .-'of a retrieval system from whiCh apublication system 'could be later derived...This-Was-to 'become the-underlying strategy ofMEDLARS.

it' was this. inversion of objectives in'combination with several other factors ;a:long and'succtJssful experience in .processinglarge yolunie;Of indexing; a hard-earnedmastery 'over' -the theory and - practice ofmedical subject headings, and the success of

.the Index. Mechanization PrOject-which. generated the necessary confidence to develop '

a cu:nputer-based-Systent for ihe dual purposeof information retrieval and index publica-tion.

. .

1960 to Present*

In April 1959, Dr. Roix.rt S. Ledley of .11wGeorge Washington University School ofEtigineering was engaged to Investigate the

-feasibility of using, 4_ cumputer to- publishYndez -MFdicus tund to soie as a basis for anefficient reference and bibliographic service.

, By the end of 1960, .the: National Library ofMedicine had developed the specificationS'fOra computerized system.' 'tlw National' HeartInstitute lent sympathetic support to theLibrary's effort, and atits-..fall meeting in 1960the National 'Advisoyy Heart 'council ap-proved the transfer of $500,000 to initiate theproject.

Bids\.were 'sought in the spring of 1961.TWentyfive proposals. weft submitted: TheLibrary 'selected the General_Electrit,-Com-party to bgin-the design and development ofthe system which by now had been namedMEDLARS: (Medical Literature Analysis andRetrieval System). The MEDLARS develop-ment effOrt took'three' years and cost some $3million. A ,Horieyweil -800.200 computer'systern-wardelivered Lilfiary, in Mar-c-h-71963. During '1963, the Indexing Division ranparallel.- prOgrams-H-toHprodute_l_the. Index.Medicus on schedule', and to build up 'a database -fo-f-MEDLAR-S-karch: After final systemtesting, the first'issue of Index.M.edicus was

By Davis B. McCarri

21

EMISSIVAIIIMUIPAr /_

L

22

produced from the MEDLARS system.:--i6January 1964. Slippage in the, Completion ofthe complex ZIP Photon photocomposer.known as Graphic Arts Composing Equip-ment (GRACE), deferred its use until theAugust .1964 issue. GRACE was at that timethe nation's fastest computer-driven photo-

:-typeSetting system. Retrieval searches were'accomplished experiinentally in a batch modedurinethe fall. months of 1963, but were notmade available to other than NIFI. researchscientists until 1964.

MEDLARS not only achieved the autdma- .

tiOn of the publication_of.Index Medicus. but,-it alsomade----possihlethepublica-tion--ofrecUrring special. bibliographies and thedevelopment of a retrieval service. In.late 1964planning began for the iinplejentation .cf anetwork of search 'formulation centi-rs- and-of -decentralized search services. By 1968. therewere:12 formulation centers in the 1".S. andseveral in foreign countries. ,MEDLARS -searches were ' being perform ed on fourcomputers-,outsid.e thelibrary. Byr1974. about.

xyy

r Input typing, (left) for MLDLARS (top)MEDLARS data ha, S are accessible via

-on-line terminals (-above).

70.00() individual searches had been performedfor health professionals throughout the worldIn .1965 the Interim Catalog Module wasdeveloped and production of the Curren;Catalog on the computer was initiated.

Throughout this development program, amajor objective of the Library was theexpansion of Index Medicus to allow moretimely indexing and expanded, coverage of the

'growing medical literature. This led theLibrary to begin planning for on-line input ofindexed material in 1965. In June ;968 acontract was signed' to develop a new MED-LARS, I Vsystem- to- proV ide-on-li un

----cations--between-indekefs-and--,-the-computer-",---system;. In parallel with this development..everi-mentation with . on-line retrieval of hiblio-graph.icSinforniation was conducted. The firsttesting. -began-- in the fall- -pf---1967---and-was'directed toward testing available retrievalsystems and specifying the requirements for aretrieval serVi'te. part. of the national.Biomedical Coinmunications Network. This

tl

investigation and eval.tation resulted in thedecision to mount -nonstration serviceusing the same selected 100 journals coveredin Abridged Index ,Aledicus:..and relying, in.Bart;- on the-TeletYpewriter Exchange Net -work. This'service, called AIM-TWX; was animmediate and resounding success and attract-ed more than/90 user institutions in its firstyear of service (1970-1971). This success led tothe implem6ntation of an- expandced:service,MEDLINE/ (MEDLARS On-line), begun inOctober-,1"971 with 25 initial users, includingfornier /MEDLARS search formulation cen-terc-rh-r---Regional-Medical Libraries, andselected institutions in the W.Tiffiffgran713: .

'area/. At the same time, an information Servicein/toxicology, TOXICON (noy:.''''TOXLINE)began Operation on a contiactorperatedComputer. This service provide!` ;' On-line

,bibliographic retrieval services against acomposite data base drawn from the fnajorOafartizations indexing the literature concerti-

/ /mg the toxic effects of biochernicals. on.,biological organisms.

/ The initial MEDLARS II contract wasterminated in April 1971. In June 1971, the,

/ .,-../ National. Lilirary.of. Medicine began 'develop-.j ing under a contract with the System Develop-/ f ment C:orporatioti a. MEDLARS. II directed.

1 toward ors; line searching: This- new systemIwas delivered and accepted in January 1975

and 'is now -the. syStern-through whicirtheI. Library produces Index Medicos, its recurring

bibliographies and ea talogs,.and..proviaes. on-line retrieval 'service.

These on-line services have becotne increas-' ingly important to .the nation's health com-munity. Use of the services accelerated greatlywhen ,actual network.access capability wasachieved in .February 1972. In 55 cities,-thrOugh' MEDLINE (MEDLARS On- Line),one could obtain on-line. literature retrievalservices on the Library'S computer from aremote terminal via .a local telephone Call.The Library, was the first information organi7.anon to . make use of -a commercial "valueadded" communications network. In February1973; a second- service computer at the State

'University, of' New York (SUNY-Albany) was--.addec.17tO he-MEDLINE--ne tiVork-to providelacliiitional-Searehing4aPacitrand-l-raelcUp4Or---the Library's 'comPuter. And a, year later, theTOX1GON' serviCe: was moved, to the.Librarycomputer to become TOXLIN.E.(Toxicology

...,Information-On-Line)iandyroVide improved, .'less costly on-line searching service across. the

-'country-4.o.,agrowing_riumber of:users,. ,

The National Library ofMedicine-now.-operates one of the most advanced computerfacilities. Two IBM- 370/158 coMputers;

coupled together as a.tnultiprocessor system toOperate as .one; provide 66, hours of on-linesearch .service per week to more thicn 400institution's in this country and Canada,.England, France, as well as to the WorldHealth Organization in Geneva. In support ofthe Library's computer operation; the SUNYcomputer provides 49 hours of searchingservice, making'a total of 78 hours of availableservice per week. The computer' programs ofthe Library and its MEDLINE data bases also

7 operate on computers in Australia, Brazil, andSweden. F.4:h month in the. U.S. the Library's,cotnpu ter/networl& provides 6500 terminalhoursof sei vice acid allows users to perform atotal or-35,000-searehe annual rate of420,000).

By the end of FY 1975, the Library wasproviding on-line services from ten major databaies 'containing over 2,000,000 citations orother information records. - .,These bases aredescribed below. . .

MEDLINE (NlediCal Literature Analysisand Retrieval System On- Line), is a database containing references to about half amillion citations from 3,000 biomedicaljournals. It is designed to help healthprofessionals find out easily and quicklywhat has been published recently on any .

specific biomedical subject. MEDLINEcontains -thE-airrelif-yeaf's cstatsons plustwo- previous' years. Further coverage isprovided 1*ancillaxy files such asBACK66.--(545,000 , citatiolis),,BACK69(649,000 citations); iiid-BACK72 (230,000 .

citations) which cover,' the biomedicalliterature from 1,966 to 1972, A data base,containing only the current nlonth'scitations, called SDILJNE, is a subset ofMEDLINE that provides a current aWate:ness ("Selettivedissenun'a don of informa-tion") service. MEDLINEls updated and'.SD:ILINE replaced,each month..

IF

-roxLINE (Toxicology Information On.-Line) contains more than 375,000.,refer- ,

ences to published human and animaltoxicity studies, effect". of environmental...cheinitals pollutants.,:adverse drug

---reactionsT-and--ana I y tical-iriettrEd6Wy..(see Chapter III).

SERLINE (Serials On-Line) is 'a cTtta base.of serial records containing bibliographicand locator information for about 6,500:biomedical serial titles which are current .or which teased publication after 1969.S.ERLINE -is . searchable so that. it is

^ possible to determine which titles are held

by .a particular library or are availablewithin a particular region. .51:LINEincludes all journals currently indexed inIndex Medicus and many; of the biomedi-cal journals covered by/. Biological_Ab-stracts, Chemical Abstracts. Science Cit-ation Index, and many &her substantivesecondary biomedical journals.

I \CATLINE (Catalog On-Line) is a database containing more than 140,000 refer-ences to monographs and serials catal-oged since 1965., The data base wasdeveloped to give medical libraries in theBiomedical Communications Networkquicker access to cataloging data and thusreduce duplicative original cataloging.CATLINE is-also useful as a supportingtool for other ibrarinctions includingacquisitions, refer e. and interlibrary.loan. activities. ,

CANCERLINE ((ancer Information On-Line). is the National 'Cancer Institute'sonline data base of approthmately 44,000citanonkciepaling with cancer therapy and-cherhical, hysical, and viral carcinoge--nesis. Secondary sources presently in-

,cluded-_,are Carona-genesis Abstiacts,1963-1973-, and Cancer Therapy Abstracts.1967-1974.. This data base will be ex-panded to include other aspects of cancer

--research as well is abstracts and protocolsof, on-going-cancer research. All citations.in CANCERLINbha&r abstracts.

See Chapter VIII, "Audiovisual Servicesfor Health Science Education," for moreinformation on AVLINE. The data baseis currently in the test phase of itsdevelopment.

The Medical Subject Headings .(MeSH)Vocabulary File contains complete infor-mation on all MeSH main headings andqualifiers (topical, form, time, geogra-phic, and language subheadings). Eachmain heading or qualifier forms a unitrecord in the data base. This file-Contains -

more than 11,000 records aria is updated __--annually for the _new. edition-ofSubject Headings. The Name AuthorityFile is an on-line list of personal names,corporate names,. and '"series decisions'.'used by the National Library of. Medi-cinelt is designed to enable catalogers toverify the proper Ionia of entry for namesand series.

File10-

The. Journal Authority l containsbibliographic information for all theserials ever indexed. for MEDLARS. Itcontains more than 4,500' records and isupdated periodically.

,.

,

During, FY. 1975. the :Library completed .

transition from ; it early ., retrieval 'system(ELHILL II) to a ...neW':'citie, (ELHILL III)developed:: under. the revised MEDLARS IIcontract; and all .fileS:, were converted to thenew systeM.' In this ."ProCess the hierarchicalstructure of "MeS1,1:,.tvas ..exPanded:::tp-*venlevels. In early 1975 the MEDLINE files weeregenerated \: and 7 several , additional major .iMproVements, made.; $e with selected1975 : journals;;..- Englis language ., author,abstracts." were added to 'the ret*i.' Val file. Atpresent 38 percent of 1975 -4. .tiOris 'have.abstracts;...- 'It is . anticipated :( will ..:.;increase to more than 50.iiercent1n addition,citations now inClude;, the öanizationalafftjation, of the senior 4.Itlitor4*clUded in

. 7 ,0To improve reirieVal,".MEDMO. files are

now searChable, on any 'word"..; in 'a: title . or .

abstract; thus, it is now poiSible tO. search onhoth-subject-headings-andAext-Words-anclAoUse.the_two:interactive4. The new .retrieval .

, service also allows -searches. to lx' run against.files not actually on-line through an

. . .

.

CHEMLINE (ChemiCal Dictionary: On-Line) is the chemical dictionary built bythe National Library of. Medicine incollaboration with Chemical AbstractsService (CAS). It proVides a mechanismwhereby . 270,000 chemical substancenames representingstances can be searched and retrieved on-line. (See Chapter III for moreinformation on CHEMLINE.)

AVLINE (AudioVisuals Oh-Line) is anexperimental data base containing refer-ences to audiovisual instructional materi-

---als -irr-the-,healthrmaterials areare professionally reviewed fortechnical quality, currency, accuracy of-Subject-content, and educational design.

search" capability,This permits searching file?,of older citations. Finally;\a rrpability, to store .a search, has. also been added along With aDrecurring current' awareness service whetieinthe search tormu la tion,is entered on-lbe by theuser but actual retrievals are performed by-"thecomputers 'during non -on -line, search servicetimes to provide monthly; individualizedcurrent-awareness searches. In ApriI41975 anon -line survey was conducted 'to determine, thedistribution of use of the new systerri bgtypeofuser and purpose. It-'updates a similar surveydone in March 19Z3. The results are shown inTables 1 and 2. It is worth noting that therewasa. -41 percent increase in vital use in April 1975over March 197."

-

Table 1 Percentage Distribution of Op-Line'. Use bY,Type of Requestor

March 1973 April 19754119101020

Physician -N . 51,Noriphysician scientist 12Librarian 3Student 2Q

.Other 14

Total WO 2 00TableTable 2 Percentage Distribution by Purpose of

Search

:Patient care-EducationResearchOtherUnknown

Total

March. 1973 April 1975171444'19

100 100

During most of the year TOXLINE wasoperated-under the ELHILL II systerri. It is

, being converted to ELHILL HI in 1975consistent with the other on-line services. To.control the. groWth ana overall size of theTOXLINE file, the decision was wade to splitdr file during this'ELHILL 11-ELHILLconversion into two_segmerus Thus, the-on-..1licie TOXLINE file will provide about 300,000records from 1971 to the present; a TOXLINEbackfile (i.e.:. pre-1971 literature, .about 80,000

recoras) willbe available only, for off -linesearching.

_The ,:citation-duplicate checking softwarefor TOXLINE, by the' ComputerSciences Division of the Oak Ridge NationalLaboratories,Is.ni.m. operational. lid, used toscreen Certain ,:specialty _files that are beingused t6 enrich the baSiC'TOXLINE file and topreclude the inclusion of duPlicate records:,Such i'specialty, files are in the .areas ofMutagenesiS,: teraiogenesis, and drug interac-tions. The duplicate citation checking systemis being applied firstta theabstractfiles.on the,toxicology of beaVY'sinetals andOther materialsassembled, by the TOxiC Materials InformationCenter, Oak Ride! :Natibnal Labaratories.

During 'this year an' agreement was madewith the In ternatiOnal.tancer Research DataBank of the National Cancer InStitute. Under'

- This arrangement. the.,Librarymounted a new,on-line- retrieval file :C.called ANCERLINElforrilerly (;CALINE.):..; '7

The plans of the International CancerResearch Data,Bank-are to maintain 'this filewith records taken from the Institute's. twoabstract joUrnals and to include a file 'of about6.000 research,in-progress . records annuathat are being prepared for the ,NationalCancer Institute by tile; Smithsonian ScienceInformation Exchange: GANCIAPNE usage

. during the last _three months of the year hasbeen approXiniately,60 hours per"Month, andis increasing as the file becomes richer incontent. CA.NCERLINE is available to all'MEDLINE and .TOXLINE users.And also,tocertain' specific Cancer ...InforManon Centersdesignated by_the Institute.: It is .now alSOavailable internationally 'through the Li-brary's foreign MEDLINE Center- partners.

The Board of Regents of the Library twicethis year has studied the question-of chargingfor on-line."-seniices., In November 197,1 . theBoard recommended a price increase frOm.16per hour to $8 per hour which becaMe,..,effective on February. 1, 1975: In. a secondaction in March 1975, the th rBoardthe need for a premium price for prime:time.

usage and established policy concerningcharges which the LibrarY .;shouldincreasing the prime-time (10:00 a.mi..-' 5 :DOp in

perfor -MEDLIN-Eto-------

$15 per hour and equalizing the'Charges (or allits services. Despite these increased_ Charges,Usage has continued to .grow.

0

CHAPTER III MEETING THENEED_

Henry M. Kissman, Ph.D.,Associate Director, Specialized Infoernation Services

Toxicology Information ResponseCenter,-Oak-Ridge- National Laboratory, ---Tennessee.

u

t2,-.JVY6

:474,4111

ar

4

4

TOXICOLOGICAL INFORMATION

The Toxicology Information Program ofthe National Library of Medicine, establishedin 1967, owes its origin to a Panel of thePresident's'Scienee Advisory Committee con-vened to discuss the 'probleinS involved inhandling toxicological information. PresidentLyndon B. Johnson, in his preamble to thgPanel's.1966 report, stated: "The Panel on theHandling of Toxicological Information has

. . made a number of retOrnmendatithis..Among these is the recommendation that.there be. established, by the Department ofHealth, Education, and Welfare, a, computer-

. based facility to. cope with the flood oftoxiCologiCal information and to make itquickly, avaibble . : ."

Toxicological information was defined asAll information descriptive of the effects of

Chemicals on living organisMs . or theircomponent subsystems." The Panel membersfound that toxicological information was

. generatedand needed by' many segments ofsociety including universities, industries, andstate and 'Federal governments; that thisinformation was widely dispersed thrOughthousands of journals of clinical medicine,pathology, biochemistry, microbiology, etc.;that a significant fraction of this informationis neither abstracted nor indexed; and that alarge portion7exists only in report's that areunavailable to the general investigator.

Experience during the intervening 10 yearshas proven that the. Panel's analyses of some ofthe basic problems of toxicology and itsinformation support systems were pertinent.These problems have increased(in magnitude.While in 1966 there was much-Concern with

. the potential adverse effects or. nil drugs,society is now,even more concerned with thebiological effects of many newand not sonewchemicals to which man and his lifesupport systems are exposed. This concerncontinues to shift from compounds that causeacute adverse reactions to those that havelong-term deleteriPuS effects. A toxicologicalinformation.prograrn must provide methodsto make the results of toxicological investiga-tions qtuckly,_accurately, ana widely availableco those experts who perform researehmakeregulatory decisions, and monitor the enyi-

, ronment. It must help to.prevcnt. unknowingduplication of expensive. labPra tory work.

The Toxicology InforthatiOn Program wasplaced in the National Library. The Library

has three attributes to accommodat' such aneffort: (1) it is the world's largest archive inbiomedicine; (2) it has"as no regulatory functionsand, therefore, can be neutral in any disputebetween Federal agencies and industry; and (3it is at the forefront of practically all thosetechnological developments on which agrowing information program must depend.

Development of the Program

The Toxicology Information Program 'staffbegan its work 'with three questions: (I) Whowere the scientists active .in toxicology andrelated areas of science? (2) What types oftoxicology iiiformation did these scientistsneed? (3) What information resources were.available to this user community? During1967-1971; the following activities were ini-tiated to answer these questions.

A computerized "Roster of IndividualAuthorities in Toxicology" was ,pre-pared; it contained information ibout3,200 scientists.

An on-line retrieval file incorporating thedata from a survey of "User Needs forToxicological Information and Data"_was created for in-house applications andused to develop some subsequent projectsof the Program,

The National Referral Center for Scienceand Technology of the Library of Con-gress, under a Library contract, created a"Directory of Information Resources inthe United States: General Toxicology."

The University of Pittsburgh analyzedabout 25,000 primary journals for theircontent of toxicological information tocreate a "core" list-of journal sources..

To provide a new literature awarenessservice, the Toxicity Bibliography, atoxicology subset of the Library's MEDLARSdata base has been published quarterly.

The Toxicology Information ProgramCommittee was created' under a contract withthe :National -Reseal-eh Council, NationalAcademy of Sciences, as an advisory group toinclude experts in'toxicology and pharmacol-

' ogy serving for till !e-year terms.." . .

28 27

; the. first years of the Program the2..d raw of growth of resources andas not realized. Funding, projected to,,.9 million by 1969, reached $1.38staffing, expected- to reach 57, wasonly 18 in 1969. In recognition ofcts, the Toxicology Informationnarrowed its'scope and concentratedn sub-areas of toxicology such asrental pollutants (especially pesti-1 drug interactions: this produced the

results:

puterization, for eventual on-lineof 4-lealth Aspects of Pesticides

'acts Bulletin (HAPAB), now,, aication of the Environmental Protec-Agency.

uction of an Index td the Report ofecretary's Commission on PesticidesTheir Relation. 4o Environmental!h by complete computerizations andne text searching and indexing.

ion of a. computer system to,rrianagelata generated by the Communityes on Pesticides firr. collaborationthe Food and Drug Administration

the Environmental Protectioncy.

acts on Health Effects of Environ-21 Pollutants (HEEP); was crea ted'in)oration with Biological Abstracts,nonthly journal.

charge of $25 for the first hour:Bibliographiesproduced in -response to requests consist ofMixtures of print-outs from machine' searchesof the MEDLINE and TOXLINE data bases,co ies of abstracts from Chemical Abstract }s orBiological Abstracts, and typed citations ofrelevant articles: In , May 1975, the Centercornpleted its 2,000th literature search.

rch bibliographieS in subject areas ofhik ,public 'interest are also published :andsold through the National Technical Infonna-non rvice. Extensive state,of-the-art bibliog-.raph es' on_ particularly important subjects

_i_ __ (e.g.. nylshloride,.asbestos, cb_loroprehe) are_.prepa ed directly for journal or other publica-tion, rather than in response to specificrequests. Several such , bibliographies havebeen published in the journal Environmental

e 'Health Perspectives. The Toxicology. Infor=mation

\Response Center has also sponsored,.

e,pre aratton of a series of state-of-the-artreviews in toxicology for publication in,.- .-'.-.. review. j urnals. .

'Several Government agencies, including theNational Center for Toxicological Researchand the B au of Foods (both of the Food andDrug Ad inistration), the National CancerInstitute, nd Edgewood Arsenal use the

' Toxicolog,) Information Response!, Centerextensively for literature services and similarsupport u cuons..The '. De elpment of On-Line Retrieval

iSevice5 for roxicology

Startin in \1970, the ,Toicicology Inforrna-. tion Frog am formulated two major objectiveswhich sr. 1 "guide its overall planning: (1)create da Ibase.. with information taken fromthe scient he iiteiature and from .the files ofcooperati r. gcvernmental, academiC,- and

TUXIC'OL:'W, INfr ACS ATION PROSAAM FUNCTIONS

/3111 k'fr111 MWJELT ISPEIVIS(41rE ACADEMIC

INDITITMAL EKTS

MIS JOGMAPICYVIEWS

NASAL:DNI'iI

IMUS

nr,DA TA SANS%

cimuNi

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(`Industrial organizations; and (2) provide__toxicology information services or the scien-tific community.

PublicationS created by the ToxicologyInformation Program and the query response

- activities of the Tox:Ioloky InformationResponse Center represent two major outputModes of the Program. A third method ofbringing informatio to users was ,throughthe establishment of an retrievservice based on the journal literature oftoxicology. This service is called TOXLINE.

While a was natural:to follow the*"MED-LINE model" for toxicology, this could onlybe up-toa-certain point. In MEDLaS,the medical literature had a struciured,computerized system With a controlled, journalliSt; vocabulary, and display format. Thissystem lent itself readily for conversion to theon-line retrieval service which eventuallybecame MEDLINE: However, these elementsof structure and control are not as readilyavailable for the literature of toxicolOgy. That-literaturels-not onlydiiperse'd over a largenumber of primary 4-urna Is, but it is alsocontained in secondi..y sources that coverbiomedicine (e:g., Chemical Abstracts, Biolog-ical Abstracts, Index. Medina). Therefore, itwas decided to proceed by extracting "toxicol-ogy' subsets" £rom the computer-readableversions of .such secondary ources.

TOXLINE contains full bibliographiccitations, almost all with abstracts_ and/orindexing terms, and Chemical AbstractsService (CAS) Registry numbers. TOXLINEinformation is derived, from five majorsecondary sources and one archival collectionof citations. The cOniponenisubfiles currentlyproviding TOXLINE,'material ale: .

"Chemical AbstractS Service: ChemiCal-Biological Activities (CBAC), from 1965.BioSciences Information Service:

Abstracts on- Health Effects ofEilvironmental Polliaants, from 1972.American Society of Hospital Pharma-cists: International PharmaceuticalAbstracts, from 1970. eV

National Library of Medicine: ToxicityBibliography, from 1968.

Environmental .Protection Agency: Pes-ticide Abstracts (formerly Health Aspectsof Pesticides Abstracts ,,,,Sulletin), from1966.

Hayes File on Pesticides, 1940-1966.

At the present time, TOXLINE serves 84commercial, 58- academic, 26gciVernmeifif:--and 2 miscellaneous users (170 total) for anaverage usage of 340 connect hours (1200Searches) each month.

Future plans for. TOXLINE call for enrich-ing the basic files ,not only' with additionalabstracts from Chemical Abstracts and Biolog-ical , AbstraCts but also with specializedliterature files covering the areas of teratogene-sis, carcinogenesis, mutagenesis, drug interac-tion, drug interference with laboratory tests,and the biological aspects of drug. abuse., -

-One of the important -entry .points -intotoxicological data files is by the chemicalsubstance involved. Proper identificatioh ofthe substance .In'these--data bases becoMesessential. Such identification is not .al%Vayseasy. or straightforward. beCause chemicalsubstances are often known by many differentnames. A new on-line chemical dictionary. file,calledl'CHEMLINE, has been, created' toprovide the TOXLINE user with capabilitiesfor effiCient an-line searches that combine thechemiCal substance concepts with biologicaleffects concepts. This file is derived from theChemical :'Abstracts Service (CAS). RegistryNomenclature. Files and contains-records forall CAS Registry. Numbers cited in, ,TOX-LINE !, TOXLINE.coiitainS some 200,000 CASabstracts with CAS Registry Nutnbers. Stepshave been taken to increase the, linkage ofsubstance. names to CAS Registry Numbers in ,.

the other parts of the TOXLINE file. It isexpected that by the end of 1975 over 80peecent of the records in the 'TOXLINE. filewill contain CASagegistry..Numberi, At thepresent time, CHEMLINE contains recordsfor over 75,000 unique substances. Each recordincludes, . besides' the ,CAS Registry Number.the molecular formula, standardized nomen-clature, and synonyins; about 10 percent of therecordS alio Contain' Wiswesser Line Nota-tions (another method of uniquely_identifyingchemical compounds)., CHEMLINE can beused as, a. "dictionary" to find a CAS RegistryNumber, synonyms, or standardized chemicalnomenclature for a particUlar substance, or bysearching for' name fragments, to '.identifyfamilieS of ` substances that have certain'structural features in common. CHEMLINEisavailable to all TOXLINE, REDLINE; andCANCERLINE users.

1,

A .Toxicological-Data Retrieval System

As stated' above, TOXLINE is an on-linebibliographic retrieval system based on thescientific literature. A successful search for a

;

30

toxicological Yfact" in TOXLINE will pro--Vide- theieardherWilli one or more references

to articles that contain or deicribe this fact.The TOXLINE search usually will notprovide the 'fact itself.

Since- on-line bibliographic searching hasproven to be Successful and highly versatile, itwagnatural to consider-data ( "fact ") retrievalas -a candidate for an on -line interactive' systemsimilar to TOXLINE, but containing infor-,Madan about' the properties of hazardouschemical compounds to which clubstar±.!human populations are exposed: This system,called the Toxicology Data Bank, will havesome of the-characteristics .of a "handbook."Unlike a printed ,handbook, the data retrieval

'system will allow the user to coordinate-easilyk----attributes of, the compounds in any., way'necessary to answer a particular question..

information for the Toxicology Data Bankis being:extracted from evaluated sources such.:as textbooks, reviews, criteria documents, andl-the files of cooperating organizations. ,Thedata' from these sources are being representediti the ToxiCology Data Bank as eithernumerical .. values or verbal descriptions,depending on the subject,, with thesourcesclearly-identified. Where possible, the descrip-tions themselves are also indexed using acannoned vocabulary.

Data elements ,in the Toxicology Data-Bankinclude': substance identification; chemiCalphySical,properties; animal toxicology in-

cluding teratogenesis. mu tageresis. carcino-genesis. and lethal,. flow' t dues. humantoxicology; Metabolism; rmacotherapy;overdose treatment; dnig interference; drugin!eractions; transportation hazards; manu-facturing 'information; and environmentalhazards. UserS can search the data bank byasking for specific data fields singly or incombination; or by specific data items withoutidentifying the data fields.

The ToxicOlogy Data, Bank is being devel-,aped using lists of hazardous substancesprepared by Federal agencieS and otherorganizations. The Toxicology Study Sectionof the National Institutes of Health servesas a review group to scan completed datarecords beforethey are made available to the .public: By the end of 1975, the system will.contain about' 1,000 compound records.

Interagency Toxicology. Information Activities

In December 1873, the HEW 'AssistantSecretary for Health established a Toxicology.Information SUbco...nittee of the HEWCommittee to Coordinate Toxicology andRelated Programs. The charter of this Sub-Committee States that. it shoUld:

311

4" ,

. deal :with thecollettion. storage. anddissemination of appropriau:_ciata. andinformation with respect to toxicologicand related activities within theDepart-malt and indeed beyond the Department.Those who are to use the data andinforMation are best able to identify. theneed and to establikh the,mechanisrns for_management of the infOrmation system".

. Managerial and operational control ::of the toxicology information activities isto.be lodged in the TOZicology Informa-don .Program of the Natidnal Libran ofMedicine.

Three.- major projects the Subcommitteeplans to beginthis year are:

LabOratory Animal Data Bankan on-line data retrieval, system to facilitateselecting proper animal specieS andstrains forstaboratory studies,.' and theimplementition and monitoring of thesestudies.

Toxicology,. Document and DataDepository to be housed within the.National Technical Information Service,this planned depository 'will includetoxicological data files that, because ofsize or other reason ha to not beenpublished 'in scientific journals.

. Q

Toxicology c. Project InformationSYstema planned quarterly director oftoxicology research-in-progresssupported or, conducted by Federalagencies, tO be extracted from the projectfiles of the Smiths'onian (ScienceInformation Exchange. , a'

. How well has the National LibrariloL__,--Medicine's Toxicology-InformatiOITProgram, .

goals? :The Program.'has accom-

_ .

plishecrsome important aims and has madeasubstantial .impact on, toxicolOgical informa-Lion handling in this country. Some of thenew projects now under way, such as the on-line Toxicology Data flank, the LaboratoryAnimal, Data Bank, and the ToxicologyDocument and Data Depositoryifsuccessful--will make 4dditional contribu-tions.

The computerized information systemscalled fOr by the President's Science AdvisoryCominittee Report now exist or are beingbuilt, but the information and. data in thesesystems come almost entirely from the pub-lished scientific = lite/attire, Few illiciadS.IhaVebeen made in funneling all the importanttoxicological information in the files ofGovernment agencies and industrial compan-ies into publicly accessible retrieval systems.However, withe.the continuing operation ofthe Toxicology Information Subdammitteeand with new legislation such as, the Freedomof Information Act, which is, opening agencyfiles to public access, the next few years mayalso bring improvements in these aspects of

_the_program!s activities, -

Finally, the potentially adverse effects ofchemicals on living 'systems are commonconcerns among developed as well as develop-ing countries. Toxicology data banks arebeing 'planned and built by other countAes,and by international ,organizations. TheToxicology Information Program is advocat-ing, and supporting, the coordination oftoxicology: information activities so that thecostly tasks inherent_in-building-these data2--bases will not be duplicated unnecessarily. Inthis way, the national-and-Internationalresbizices--devoted to scientific and technicalinformation handling can , be extended c:through sharing, and collaboration.

t 1

i>.

31

HAFT _IV ciAssjqAk.. SERVICES z:Joseph `.Leiter, AsSaciaer DiTector,Librpry.OpetatiOnt-

4:14

1.4 4,

n

fIr

With the evolution of the Biomedical. CommUnications Network 'plan in the latter

half of the 1960s, the ,Library Operationscomponent of the Nadonal Library of Medicine developed. rapidly expanding. activitiesfor the entire biomedical community. The twomajor .services,`: bibliographic retrieval. and

. document delivery ',provided the bricks; theformation of MEDLARS and its rapid decen-tralization, tc.)BOwed by the establishment ofRegional Medical , Libraries, provided themortar for this evolvement

Library Operations, the traditional libraryarm of the National Library. of Medicine; cantrace its beginnings to the years following theappointment Of Dr.Joseph Lovell as the ArmySurgeon-Geperal in 1818. The first evidence of

. a systematic attempt to organize a colleCtion,

IY '7A

,;

however, was in 1840, during the administra-tion of the new Surgeon-General, Dr. ThomasLawson v when "A Catalogue of Books in the

\Library of the Surgeon-General's Office" madeits first appearance. This alphabetical` listing' - ;- - ,in . manuscript includes about 130 titles and

- 200 volumes; the entire collection at that time. ..:;.::.--,, - ...; ...'- -- .::,.,.. - : ,-, ; ,,,:,,. . .- .. ....,;-.,40,

.

In My .1864,-- the first. printed catalog of the .

- -, -,.,J,,,tvzs,xadomootte,e4..-,*.....,:!te.:-(.....-.,,,,,,S..,..,,.;:;:,........_. oaitt4P.',

urgeon-General's' Library. Was issued.-This-. .. '

rnllcl-.1.-_-,-..;;;;,,,,,,,..,*,..._...,.......,- .- -... ,i,.....catalog was the 'first known attempt to classify . -.:'. -.-- -'.. .-,- ..,..::.' ''.'-- :-.- -, -,:-... .- - --....--,..A.k,,: !..i-!;.',"

the 1,365 volumes,. divided into nine classes, , ---...,-..--- , ,...-- -.,, -. :. ...-- .

showing the place and date of publication for - -,-:,-, -::........:.:,-,::.:,;...4;,;,.:.,,:,,,,,,,:.:,.:,-.,...:.... - - ..- ., _........._ -.... - ,- -

ie,;_

. . -

each item. In October 1865, a second printinglisted--. 2,253 volumes divided into' 'eleven

,A1,1

in 1880 the Index-Catalogue of the Libraryof the Surgeon-General's Office, United StatesArmy was first published. Under the directionof John Shaw Billings, the Liblary's collec-tion, at that time, had reached 50,000 volumesand 60,000 Painphlets. The first series of theIndex-Catalogue continued publication underBillings until its completion id 1895. By that

, time, the . collection, contained more than100,000 books and almost 200,000 pamphlets. "As described by. Scott Adams in Chapter II, the'Index-Catalogue , continued publication-through a second, third, fourth, and finally' afifth series covering books printed through

- 1950, which was completed in 1961.Prior to the cessation of the. Index

Catalogueg, the first annual Aftny Medical. -

Library--Author Cata log,--1949 -was -issued1950 and, with the help of- the Library ofCongress, was published annually. The firstquinquennial cumulation of the Catalog

,-(1950-54) was published in 1955 'in sixvolumes and contained entries for 180,000books and serial titles. The name of thepublication changed Several tinrozg, but it

. continued publication,until the beginning ofthe NatiOnal 'Library of Medicine CurrentCatalog, a fully computerized book catalogfirst produced in 1966. 4,

Over the' eyearsseveral other events were tohave their impact on the Current' Catalog andthe Library's present acquisition policies.Following a survey of the Library in 1943 bythe.American Library Association, underwrit-

. ten by the Rockefeller Foundation, the; Library issued 1171948 its first preliminary

edition of the Army Medical Library, Classifcation; an alpha-numeric scheme plgcing the .biomedical literature into broad' subjectcategthies. Finallx published in 1951, it was .

revised regularly to acknowledge new,uendsin medicifie:. When the National Library of .

Medicine Act was passed in .1956, the namewas thanged to theNil-lib-nal Library ofMedicine Classification. It was under this title

34;

- ,1 . ,.,,

. -

44.

1.1",,r ,0,14414-1f7 4 '1/4'

J

that the present (1964) edition was published.1.1. revision of the National L,ibrarof MedicineClassific'ation is being planned -for the corningyear. The schedule is used by medical librariesthroughout the world and the revision willconsolidate all-of the changes made to date. Itwill provide for expansion of existing subjectareas, including specialty areas needed bysubject specialty libraries, but not necessarilyneeded or used by the Library.'

AlmoSt coincidental with the increase ofnew terminology and classification caused bythe shifting of medical emphasis' came theneed for revamping the scope and coverageguidelines. On FebruarY S. 1897, Dr. RobertFletcher, in an address at the Army MedicalSehool said' "it is of importance in forming agreat medical library to avoid loading itsshelves with books, which, however valuablein themselves, have not a distinct relation to

'' the purpose of, the collection." Following thesurvey-by the Ameican Library Association in1943,a careful and detailed statement of poliCYwas worked out in 1951 and revised in 1956. In1969 the National. Library of Medicine issueda "Working Paper on the Scope and CoverageOf the Collection" as aselection guide. In 1971a committee composed of senior staff members

'Of the Library acid the Ditector of theNationalInstitutes of Health Library was formed toreview the'current relevancy of 'the "Working

. Paper.".The result of these deliberations was aScope and Coverage Manual. The purpose ofthe Mariiia/ as stated in the Introduction was' "tO fine thesubject fields that are pertinent,to seecify the depth of coverage in each, andthus provide selectors and others with a guide.for the intelligent choice of material foracquisition." This Marivatis being used todayto guide the collection 'development efforts ofthe National Library,or Medicine. '

Library Operations is composed of lourdivisions: History of Medici (see. ChapterV), Technical Services, Bibliogr hic Services,and Reference Services, and t e Medical-Subject Headings Section., Durin the pastyear, substantial efforts were being devoted toshoring ,up the collection and resour, inorder to maintain and continue 'the gm' tlY

-extianded---back-up .support -- for -- the - archlynetwork, and other service responsibilities othe Isibrary.

Technical Services

The Tschnical' Services Division is respon-sible for selecting and acquiring materials forthe collection, providing centralized catalog-ing services to the biomedical library commu-nity; binding and. repairing materials in the

collection, and developing did implementingscope and coverage policies. The work of theTechnical Services Division has undergone'considerable change since January 1966 whenits first *issue of a fully computerized bookcatalog, the National Library of MedicineCurrent Catalog, was published. Before then:the bibliographic files were -.manual;- today,-most of them are computerized, with on-lineaccess: That development in 1966 triggered achain of events that has brought the Divisionto its present status, for that first publicationof the Current catalog increased the demandsfor. faster and 'more comprehensive acquisi- _

tions in order to provide.currentibliographudata.

A program was begin to obtain reviewcopies of medical publications from publish;ers, and another to re-establish blanket orderarrangernents With foreian dealers. It isinteresting, to note that the former programclosely paralleled one, used by Billings, who inthe first issue of Index Medicus, dated January31, 1879, wrote, "All books, pamphlets, andperiodicals sent by their authors or pubriShersto the Index Medicus will after record andanalysis for the Journal, be placed in theLibrary of the Surgeon-General's Office." Thereview copy program was phasectout in 1972in favor of the Division's participation in the!Library ; of Congress' .Cataloging-in-Publication Program. This program! permitsthe cataloging of medical titles at the galleyproof stage. Cataloging information is thenprinted in;the book at the time of publiCation,Including National .Library of. Medicine callnumbers and MeSH subject headings. Thisarrangement led tour present shared catalog-ing program with the Library of CongresswhiCh provides for National Library ofMedicine call numbers and MeSH subject'headings to be printed.on Library of Congresscards for the 'medical Publications acquired.

In 1968 the Division began publishingsemiweekly, and in 1975 weekly, proof sheetsof'Currept Catalog entries. These containcataloging data for current English ianguagepublished Materiali. Proasheets are availableto the medical library community on stibscrip-tion_frorn.the Medical 'Library Association.

In 1971 the Library? published the computerproduced setefinial cumulation (1965-1970) Of

\ the National .Library _of. Medkine- Current--N Catalog.- ThiS cumulation provided Medical

"brarians with the Library's complete store ofm. chine - readable cataloging for the .six year

. and repreSented a complete: update ofe to conform to:'the. Anglo-American

ng Rules. anclthe 1970 MeSH. In 1974'ea Headings

access to the Library's file of machine-readablecataloging was provided :7On-line through

, CATLINE (Cataloging On-Line): Accessiblethrough the MEDLINE user network, itprovides support for such library activities ascataloging, _acquisitions; reference, and intee-library loan:

Ini 1972 the Division published a computerproduced Index of NLM Serial Titles, akeyWord7out-of-context (KWOC) index to theapproximately .19,000 serial titles then re-:ceived at the Library. It became a' "b6t seller."Plans are" .underway to publish, -a revisededition.

SERLINE (Serials On-Line) became opera-tional in '1973. SERLINE provides direct andimmediate access, for all MEDLINE users, tobibliographic and location data for approxi-mately 6;500 substantive serial titles held by117 resource libraries in the Regional MedicalLibrary Netwoik.

Also in 1973, an on-line Inprocess' file(INPROC) and an. on-line INVOICE filebecame operational. INPROC reflects thecurrent status of every item ordered, received,or in the process Of being cataloged. INVOICEcontrols, monitors, an regulates, the flow of

'invoices, and produces regular managementreports on the status of items in the file andup -to -date reports .on the status of fundsexpended from the literature budget.

In 1974, under the aegis of the FederalLibrary Committee, the Division beganparticipating with other Federal libraries in

c- an experiment to assess the usefulness of theOhio College Library Center (OCLC) systemfor, the Federal library community. TerminalsWere installed at the Library for on-line accessto the Center's data base so that the systemcould be searched for entries that could not be

.Mound at NLM.A number of new activities were begun in

FY -1975. A gaps file containing bibliographicdata on journal issues missing from thecollection became operational.. This file cangenerate order lists to be used in filling gaps inthecollection. It is updated regularly to reflectreceipts s'2Well as new missing issues.':

Plans for a Master ..Serials System areunderway which include an expansion ofSERLINE and its interconnection with anumber Of other modules s that all a theNational Library of Medicine's serial require-ments can be satisfied by one unified system. Asubscription control' file, which will includesubscription' data for all currently receivedserial titles as 'well as the bibliographic datafor the non-SERLINE titles, will follow thepresent gaps file as the .next module in*building the Master stem.

"During.. the year the Technical ServicesDivision began encoding serial entries into theLibrary of Congress' MARC format for inputinto the Ohio College Library Center systemfor the CONSER" program. CONSER is aneffort by the U.S. and Canada to build an on-line international data base _for serials inMARC format. A conversion program is nowbeing written at the Library to provide forinput of its retrospective records in MARCformat into the CONSER data base.

CONSER, OCLC, and the National SerialsData Program all will require continuedcooperation With the other two" . nationallibraries (Library of Congress and NationalAgricultural Library) and active participationin the work of the Federal Library Committee,.The' momentum that has been .generatedbuilding national and international biblio-,graphic data, bases, and in establishingnational and international standards forbibliographic descriptions can only result inincreasing demands on'the National Library ofMedicine to participate in their development.

Bibliographic Services

. . the practi:ionerwill find the titles ofparallels for his anomalous cases.accountsof he'll) remedies, and the latestmethods in therapeutics. The tedcherwill observe Whit is being,written ortaught by the masters of his,art in allcountries. The-author will be enabled toadd, the latest views and cases to hisforthcoming Work .: .

With these words. Index Medicus waslaunched alinost a hundred years ago. Despitethe ..incariny foresight demonstrated. by Dr.Billings so many times, it is doubtful that everhe could have imagined, in 1879, the impactthat Index Medicus would continue to make id.1975. More than "8,000 copies of the'bibliography were distributed each month thisyearthe result of 'a steady indeaie insubscriptions since 1891, at which time therewere fewer than 500 subscribers.

The' production of index .Medicus has .changed considerably over the yeaiii Far morepeople are engaged in the preparation of

.materials for it now, and at the same time theMEDLARS computer and automatic- photo-typeg,et ter permit larger volumes.of data to beprocessed. As a result, 220;800 articles wereindexed during FY 1975. compared with theworks of about 4,000 authors in the 1879 issue:One hundred new journals were 'added to the

Mad tie Readable Cataloging"Convex ion of Serial Data Baks

A

1.1'ilr't

list of those indexed during 1975, bringin

year-end total to 2,353; 'approximately

serials were indexed by Dr, Billings and his

staff in the first year. In that year the user of

Index Medicus wzs directed to references of

interest by approXiinaielY .1,300 subject de

scriptors and crosselerences; this numbercontinues to increase, and the user of the.1975

Index Medicus is guided by more than 20,000

such terms;

Early issues 'of' Index. Medicus cited- many ;

foreign-language articles, a practice 'begin by

Billings and still considered to be.vital to the

value of the work as an international reference

tool, In keepingmith that tradition, half of the

material 'cited during 1975 was in .a language

'other than English. Moreover, 40 percent of

the articlegited were indexed on-"that side of

the: water,"..as Billings 'put it, as a result of

cooperative foreign bilateral agreements for

mulated by the Library three-quarters of a'.

century after his time.

The . Recurring .Bibliography program,

initiated in.. 1965 to serve the' needs of

specialists in discrete '!subject areas such as

'cerebrovascular disease, rheumatology, etc.,

continued to be a valuable service during 1975,

A new title was, added during the yearPsychojiharmacology , Bibliography -as

cooperative venture between the National ,

MEDLINE training clam

Library of Medicine and .tlie Natidial Insti-

tute of Mental fkalth. The total number of

such Index Meaicusderived publicatims

now stands at 28, not including the popular

.Abridged Index Medicus and the Bibliography

of Medical Regina Each of these special.ptiblicationslisisubset of the computerized

MEDLARS da base.

Day-to-day opiration of the National

Library of Medicine's onlineservicemetwork

has proceeded smoothly despite troublesome

delays caused.by the transition to MEDLARS

II. Demand for search services continued to

. rise, and. a total ] of 402,058 searches were

performed during the Year, Of these,' 280,182

were searches done on MEDLINE and related

files; searches on TOXLINE, CATLINE, and

other, data bases accounted for the remainder,

Approximately 25 .pereent of all on -line

searches resulted in . an off-line computer

printout at the request of the searcher; hence,

about 100,000 searches (one and a half million

pages) were mailed to requesters.,

Concentrated training for' medical librari-

ans and other information 'specialists using

the MEDLINE, service proceeded during the

year. Sixty-seven individuals from around the

.U.S. attended Eve, training courses; each

course was of three 'weeks' duration..

0

10

Several important new directions are beingtaken for the future. The inclusion of English

languige author abstracts in .the searchablecAEDLINE file has already begun; about10,000 abstracts were added during. the latterpart of the year. It is anti; ipated that upwardsof 100,000 abstracts will input each yepr byFY 1977. Recei t of indexing- in machine=

. :readable form from some of the non-U.S.MEDLARS centers is expeeted to beginduring-FY 1976. This will not only reduce,the:amount of in-house keyboarding required, but:will make, for more efficient :handling., andtransmission of data from abroad.'

Closely. allied with receipt of machine-readable indexing-from abroad is an in-houseeffori'tO begin inputting of indexing: ata on-line.--In-house indexers, and oche::;; in loca-tions supported by reliable communicationsservices are expected 'soon to be keying, datadirectly via on-line terminals. Quality review

. . of this, indexing', will also be possible, withnecessary .Corrections being made by -seniorindexers (also on-line) prior to release of the'citations into 'the data base.

The . Library -expec" ts to expand. on its. .prodtictiOn of ..:library service audiovisual

teaching aids. Videotapes and slide-tape unitsprepared to date have been extremely wellreceived by librarians, and others wishing tolearn more about the NLM's services,' andthere is a clear need for other such aids.

Medical Subject Headings. ..

Great strides have been made, iri the area ofvocabulary: development. The:1975. ei ition of .

MedicaVAttibject 'Headings `(MeSH)..has :.a.'niinibei-lOf-subjeasheadin 'in:common- Withthose used on the.; firstvolume. .'of: thetatalogue. Under.: the :letter A, . the termsAbbatOirs;:and Abdonien areto.*-..foiinct.both.:2But: over the:: yeart,': the.. list 'of subject.headings;haschanged greatly:toaccoinniodate....Abate,..-AbetalipoprOteineinia,':'Abney

. and:thciuSandS.of 'othef'conCePts' not dreamedof When indexing began at the Library..:.'

In 196.1, with the advent :O1..rtheMEDLARS'.. ,system -- called MEDLARScomputer--processing affected the:ilk `of thetheSaurus ternts;in.significant ways. Whereasone usually refers `:in a printed index:.'tocitations_; isted 'tindefOnly.one..term pt. time,the ,cOrrilitner 'search.,tnilhoili:Ofcitations through 'the use,oflOgiCaFOinbina-'don's of any terms, making;pOSSiblearapidsearch that is more responsive and morespecificteide.user's needs Innovations in theMEDLARS I MiSH enableTlhe4ser to. eareh

easily for all citations indexed under a general

heading and all specific headings, subsumedthereunder in the hierarchically *- arrangedcategories of WeSH terms. Nevertheless,certain constrains of. MEDLARS .I imposed alimitation on the degree of' specificity thatcould be-built-into Meat. --In the design ofMEDLARS II this was ;recognized,. and asystem has now been developed to Optimizethe thesaurus for the needs of users of both ourpublications and our computer services.

In FY 1975 almost 5,060 new terms wereadded to' MeSH. Citations will appear in theprinted .Index Medscas under only a fewhundred of' these. Most of ,the other newheadings are highly specific, including manydrug and chemical entities and biologicaltaxa. All are available for computer Searching.However, for the purpose of listing citationsin IndextMedicus the comptiter will substitutea: pre-assigned general . heading for each ofthese specifics. The, more Specific terms will be .

- 'available" to thelndex Medina tiseras cross-referenCes, enhancing the user's facility forfinding the citations he needs:-

A further vocabtdarY development of notein 1975 has been the expansion of ourcapability for retrieving all citations -havingany given -word appearing -.in the tide or

. abstract. This capability is a powerful adjunctto he on-line interactive search system .

containing citations indexed' with MeSHterms. Thus, in 1975_we. have entered a newMeSH era, with a thesanrus. deSigned to (takefull' 'advantage of the power of modern-Computers'_without sacrificing the interests ofthose whose needs are better served by thetraditional printed volume. .

Reference Services

The Reference. Services Division, as one ofthe principal" communication centeri3Of theLibrary, uses _thy services and products of theOther 'Library 'components, both .traditiOnaland, innovative, to meet patrons'; Varied needs:Thus,- compUter-prOduced journal listings,on -line searches_of..compiner: data-baset;', andteletypewriter interlibrary loan Communica-tion go hand-in handWith traditional libraryservices. In fact, the:histOry,Of:"informationservices!' antedates the establishment' of theLibrary. As 'early. as 1818' he archives:'Of the

. U.S. Army . Surge Genet-airs Office 1.shoWexpenditures for..thedipl works; which ',Were

fiel&By 1836 the Sur on General!s'Office hadsent:out medicallOffi'cers in the

deVeloped a' lively c in books. This markedthe beginning of a Icing hiStory of

PinformatiOn service" to indiVidtialphysicians. Not until September 1:1957 was

0

this service replaced by the inauguraticn)of anew loan policy. Instead of lending librarymaterials to individual- physician's directly,they are now made available by NLA.throughanother requesting library. The AnnuaReport for 1958 stated: "When the-new policywent into :effect. it ,Was anticipated that therewould be a sizable but ternpOrary decrease inthe number of requests received by theLiterary:'' The use of the word "temporary".showed great foresight.

A decade later the same could have been saidof the beginnings of the Regional MedicalLibrary Network which provided for decen-tralization of the Library's document deliveryservice. Requests for interlibrary loansdropped from 160,000 in FY. 1968 to a low of126;000 in 1971. By 1973 requests were back upto 165,000,,climbed to 180,000" in 1974, andreached ariall time high of 228,755 this pastyear. In the. last 'half of the year, requestsaveraged some 21,000 each month or, abOut1,000 each working day. In spite of staffreductionS; -the Division has filled 81 percentof the requests accepted; 86.percent of thesewithin four working days.

Last year marked the. start-up of anexperimental referral system named DOC-LINE (Document Delivery On-Line) whichutilized Telex to transmit selected unfilledinterlibrary loan requests to the BritishLibrary Lending Division in .Boston Spa,England. Begun as an experiment, DOCLINEhas now developed successfully into the firstphase of a computerLbased interlibrary loanverification, routing, and management infor-mation system. At presets, requests, for referralare fed into the Library's computer which isaccessed by the British Library 'LendingDivision. The requesits are then trArismittedelectronically to that Division.. During thenex,t few,tyears automatic interregional rout-ing of referrals as well as referrals between theNational Library of Medicine and majorlibraries abroad, will be developed. DOC-LINE will interface with the Library'S seriallocator file (SERLINE)':and file of catalog data(CATLIE). permitting development' of hier-archical routing and bibliographic verifica-tion. .

Reference inquiries reached a new peak thisyear with 29,406 requests for reference assist-ance received by, mail, telephone, and in,person ITable 11), In the.aggregate; 320,079requests, probably the greatest demand in theLibrary's historywere made to the Divisionthis year for retrieval of material from thegeneral i:ollection for both on- and off -sitesite use (Table 10).

The DiviSion took the lead in an effort to.,hire handicapped persons for temporary \t)ositions under special authorities. In everycase these. staff members proved to be strongly-motivated'and their work was of high quality...Three .handicapped persons on temporaryappointments. applied for and were seletted tofill permanent positions. All have becomevalued members -of the Library staff.

In addition to its rciponsibilitie4-to acquireand. make available the world's biomedical .

literature, the Library alsp haS the responsibil-ity to preserve this material. This function .isaccomplished through 'micropreservation, theconversion o'i deteriorating portions of the,collection -to microfilm' .form. By 1964, 37rn;llic_tn pages of the Library's collection wereconsidered deteriorated, and this figure wasexpected to reach 262 million, by 1989.Beginriing_in 1966; through a combination offilming within the Library and filming byoutside contractors, an expanded program of

0 Photocopy being processed for interlibrary loan.

mKropreServation'rwas.irtitiatedOyer the past1.,ter,,yos;

deteriorating Inateriali have...been. COnVerted,toarChiVal

..:-'25,000:lialiAMOSY and added tO4lie-Library's:.fili*IarchiVei::'In.. FY .1-975.*er:::.71.5:-.Millionpages were Microfilmed; of itfiliMect.iby the .-,Library.'stakaSZMaterial too,brittletObe sine:Out to a. COntraCtOr.,

Prior. to the Library's centennial celebration'in ,1986; Librartah'srepOrkitheSttrgeonGe*..iFor assessed hiSStO'rag:pronlei4i4,Way:"Everywhere you ,ii;!eveY:4111CUbbYhrlethat .0?.O.Pened up. in the .,baiiinerit;:s=.shOWsSiackil'airid'aCks ',Of : .400kk

-:.rising'io'ikec*iliniv,theshelves'grOartineand. befit under::ilie*eigbiarid.really the confu- :-

siOn cif:s0ace.Y;.is .

an absolutely, pressing immediate thing;

;which will not only not wait, but is aConditiOri that, has :Already existed far toolong."'

Today we must report that without addi-tional-"shelf space, bea estimates indicate thatstacks for:the.jOurnalc011ection will be filled

caPacicY-by1180.719 alleviate the situation,plans were completed toward `the CloSe of theyear :for.installation of mOtoriredf.coMpact

. shelving'in three:bays of .the C level stack area(seldom' requested,materials)ThiS':sYtern ofstack ranges, controlled .by; electric motors androlling on railS,.eliniinates all but One-iiile. forevery 'lair:ranges,: and will alMOsCdOuble: the"capacity Of the area.

'For the Reference Services; Division..:thepublic service funCtion remains ihe-Same;' thethrust for the = fature is to improve 'the toolsand techniques kir performing that function.

C:

I.CK.,

- 4V

-c (

s

Octok Material

Bound Monographs- Prior to 1800 ........ . ...... .. . .. ... . .

1801-19131914-present ... . . . ..... . .......Bound issuesUnboUnd issues .. . ... . ..... . . .

Theses. .. . . -. . . . ....Parhphlets. ./Total Book,Material

Table 4. Growth Of Colleclions, FY 1975

Nonhook ,Material

MicrOfilMs (archival), .MiCrofiche :

:-.Pictures, Total Notibook Material

TotaL-Book and -NonbookMaterial

-*Almost 60. .000 theses were withdrawn frt;flp the collection. during FY 1975

Serial Record

New titlesadded ... ... ...........Discontinued titles .. .....Current titles received

Volumes Added

360441 .

^ 056

586(-59,707) ,

32(-14,804)*

1,903

7622,670

-12,134)*

.

Table 5. Summaiy of Acquisition Statistics4'

Publications. ProceSsed

.......... ... ... .

Serial piece ...... . .. .. . . .- Other ......... ... .....

Total

Obligations for Publications ....... ... . ....... .

,,Inciided for rare books

-

. FY 1973

\74186

. 23.787'\- ,

. ......... . . .. .

-Total.Volumes'.:

40,07091,028

276,952475,457

48,642280,878172,021

1,385,048

19,4286,648

70,76596,841

1,481,889r.

FY 1974 FY 197;

960 '990105 . 404 ,

2,f,642 25.228

:*\

100;930 I 93;371 137,180.20;548 16,148. 21,553

121,478 169;519 158,733

$57.5,000 $689,740 $723,571

41118 ,133 :101,769 32336

Table=6. Summary of Cataloging Activities

, . .'Completed catalOgin

_Catalog cards*. filed-.44. Volumes shelf-listed

, FY 1973

. ........ . 13,161r

.. .

112,716

42

FY 192,4 FY 197.5

11,382 .14044:134;190 118,463

9,494 9,900 11.843

7t,

Table 7. Binding Statistics

FY 1973 FY 1974 F1'r/975

Number of VoluthesSendio binder l .... .`,. !- ." .... .... ... 32,362 31,900 38,178Obligations for binding... . . . . .... . .1114,787. 1110,595 $136.409

Table 8. Summary of Bibliographic Services

FY, 73 FY 74 F1 75

Atticles IndexedNLM 30,894 .44.106 . 49,492Other U.S 74,276 74 001 . 98.701Foreign 102,646 106,217 72,607

Total 207,816 224,318 220.800^

Recurring Bibliographies . ... . .. .. . 24 , 24 28.Journals Indexed for:,Index M edicus ... . . . 2,194.. 2.275-

Table 9. Summary of On-Line-SeGicei)FY 73

Searches:.

MEDLINE.. .... . . . . ..... .. .. .. . 141,730. " ' ' ....

SDILINE 13,363CATLINE ..... .... . . . 1,601SERLINE 477

.

TOXLINE 6,000"CHEMLINECANCERLINE .. . . . . . . . . . ... ... .. ... .AVLINE

Fr 74

178,98.327,646.45,771

2,880.13,000

FY 75

232,62345.28586,890

2,09411,728

1909285

a.

BA,CKFILES* . ...... .. . .. ... , 1,651 10,138 9,633

Total. 164,822 278,418 402,058. .

Off-Line Prints:

MEDLINE . . .. . . ............... . . .. .. . ... . ..... 40,115 40,924 -52,851

SDILINE , . ........ .... ..... 5:865' 13,866 15,506CATLINE 9 . 382 , 536SERLINE 134 102

TOXLINE. .... . .. . ... . .. . ... 1,034 6307CHEMLINE 64

CANCERLINE 373 : .

AVLINE I.. ........ .....BACKFILES* ' 1,611 11,143

15..2070

.-fix

STORED SEARCH .. ...... .... ...... . 3 315,

Total

*Includes BACK69, BACK72, MEDFILE, and COMPFILE.

47;600. ' 67 .4$3 100,639 .

ztr

-F:

Table 10. Summary of Circulation Activities

.., FY 1973 FY 1974 FY 1975

Nuniber.of Requesti Received 256,715 262,733 320,079For Interlibrary Loan ..'. .... . .............. .....?.... , 165,247 ' 179,747 228,755' For Readerse

91,468 82 $86 , 91,324,. .

Number of Requests Filled 194,341 '205,894 247,614For Interlibrary Loan , - 123$11 138$99 - _173,642Photocopy 114228 126,689 -- 158,493Original 9,683 12,310. 15,149For Readers 70,430 66,895 73$72.

,Number of Requests Unfilled 62,374 56,839 -72,465 '-Interlibrary Loan 41,336 40,748 55,113Rejected 12,228 7,521 15,446-Referred ' . NA 6,561 ' 6,645 _Returned as unavailable-- 29,108 26,666 33;022Reader Service returned as unavailable 21,038 16,091 17,352

L.

.,..,

Table 11. SuMmary of Reference Services

Requests by telephoneGovernmentNongovemment

,Requests by mailGovernmentNongovemment -

\\

\

FY 1973

11,8034,507

296

1,229

,, 63

1,166 e

FY 1974

13,316 .

5,3977,919

1,398200

1,198

FY 1q75

11,509 -

4;028'' -7,481,,

1,488 ' '385

1,103

Readers assisted. ,.

11,107 ' 12,594 16,409Government 3,207- 4$07 4,718Nongdvernment . '7,900 8287 11,69.1.

Total' 24,139, 27$0 . 29,406:Government 7,777 9$04 9,131Nongovemment 16,362. 17,404 '20275

Reading room user's regiskred . ......... 16,638 15,209 22,426

CHAPTER A LIBRARY WITHITHE BRAR

Aslclepios, god of medicine (with staff),.,.Telesphoros, a lesser healing god'

sometimes associated with

THE HISTORY OF MOICINE COLLECTIONSJohn -B. Blake, Ph.D., Chief, History of Medicine Division

The History of Medicine Division is oftencalleI. "a library within the library," and withsome justification, Within its area ofresponsibility] -books Old. journals, to 51870,manuscripts and oral history materials, andfine prints and photographs-'the History, of(Medicine Division carries out all of thetraditional library functions of acquisition,cataloging, reference, and what is nowadayscalled "document deli ;cry." Like other areasof the Library; the 1::fivision also - servesnational bibliographic needs through thepublication of catalogsand indexes and servesas a back-up, library. cif medical historicalmaterials, for the nation,-

pgACTICA

. In. other ,respects, however, the designation _of the historical collection as a "library within'

- the library" may lead to a.misconception ofp9rpose and activities. It may suggest some

. that it is a .thing set-apart ratherth-arralkactivefunctioning center of library work. The.holdings of.historical source material 'Consti-tute -a national treasure.- The History of

, . Medicine Division has many,rare and,valukblebOoks.. Yet it holds them, not as jewels to beadmired through the glass windows of heavilyguarded locked cases, but as the accumulatedrecord of the. health.sciences and professions,to be used by 'Scholars. seeking knowledge ofthe past so that we may better understand thepresent and strive more enlightenedfuture.. The collect' )ns of the History ofMedicine Division, like..,,the more recent

. literature and newer educational-media avail-,

. .

. .

.."

,f-

able elsewhere in the Library, are here to servethe needs of the 'nation, not- as -a-group ofmuseum specimens to bemarveled at, but as are arch .resource to be used. The library is thehistorian's laboratory, without which he canno more operate than can the bacteriologistwithout his Petri dishes.

During the past fiscal ..year, the History ofMedicine Division supplied nearly 9,000reader requests for books and journals andsent out-some 2,200 items an special order orthrough interlibrary loan, usually ip the formof .photocopy. The ability thus to serveresearch needs of scholars, around the countrydepends on many .factors, but none is Ptorecrucial than the foresight of our predecessorswho over more than 190 years have built agreat library.

r3.1 I)

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Arallic Manuscript by al-Razi, dealingwith gastrointestinal diseases; oldestwork in he Library. (1(:194),

Thej-lpresenthistoricatcollection -of the'National Library of Medicine originates from.a time in 1816 when the Surgeon General ofthe Army, Joseph. Low11,Purchased the firstbooks of...seferenCe for his Small oifice.-

,perhaps with hiS own money, for across the',title pages of some still in the Library todayshewrote his name and rank. Over 'the yearsLovell and his successorso gradually addedmore books by .purchase and gift. When theLibrary's first handwritten' catalog' was pre-pared in 1840 if contained hardly more than200 volumes, Not until the Civil .War did therate. of expansion increase, necessitated by theheavy wartime demands plaCed on the inediCaldepartment and by research needs at the newlycreated Army Medical Museum. After the CivilWar, 'care of the Library fell into the hands ofJohn Shaw Billings, who was deiermined thatthere should be one place within the countrywhere a phy'sician could find all the literatureof medicine. With the assistance- of fellow :

officers acting as book scouts'and of the manyfriends .-he Made through ;correspondence,Billings 'collected medical literature,: at anunprecedented' rate, turning the SurgeOnGeneral's Office Library, withina decade, intoa true national medical library.The journals,books, reports, and pamphlets he collectedbefore his retirement in 1895 forrn the basis of,,what are now the historical collections. Partlythis has come through. the naturaf process ofaging: what Billings acquired as currentliterature is historical literature now. But'Billings ilso acquired older bcioks as well, forhe had a. strong sense of the value of Medicalhistory and . demonstrated his interest andCompetence in many of his writings.

Though hampered often by. too littlemoneyand a.lack of continuity inthe post of director,most of Billings' successors continued to. addin a modest way to the Library's historicalresources----crlderbouks and . journals. inrecent years it has been. poisible to,coritinuethis practice and also to expand the horizon's

of the historical 'collection in some degree to'correspond with thr, .broadening outlook of,the health sciences generally, and the newer . .

demands of historical research. The ..Library\ ..bas been able' to add seventeen incunabula.during the last decade and significant classics.

. such as the first' edition . of Roberti,Burton'sThe Anatomy of Melancholy as well as fillingin gaps. in the writings of lesser known menwhose works, are 'nonetheless essential for. \understanding the past. Today, the4listory ofMedicine .Division-holds over 70,000 imprints ;

of the. 18th century and earlier and .perhaps'three times that number printed .from '1801-1870.. 7--/

4,

. During the past fiscal .year; significant or'typical acquisitions . included 'Recenliorum.disceptationes de inotu:cordis, Leyden, 1647;containing the sixth printing of William-Harvey's great work; three Iltb century workson "political arithmetic". by William Petty, akey figure in the early history of vitalstatistics;a collection of over 600 16th, 17th, and 18thcentury dissertationS in psychiatry and relatedfieldi;' a rare edition of Palen's De'osSibus adtyrones, Padua, 1551;_ and Johann Wier's :psychiaiiic 'elasit; De prizesigiis claemonum,in an early French translation. Other acquisi-tions included works hy--s.uth authors asXavier Bic.hat, Robert Boyle,' William Cullen,Konrad Pesner, Albrecht von Haller;rich Hoffniann, and John Howard.

Of particular interest in the bicentennialyear was the acquisition.of- a rare pamphlet,Directions for. Preseiving. .the',-lealth ofSoldiers, written by, America's- most ;famodsphysician of the RevolutionaFy era, BenjaminRush, and printed .in LancaSter, Pennsylva-nia, in.1778 by direCtion.,of the:Board of War.Rushrecornmended a sound diet, temperance,cleanliness, and regular exercise. Callingupon officers to ._promote the health of those.under their commands, he reminded them that .

"your country and posterity look up to you forthe preservatiOrr of the only means of estab,lishing the liberties. of ,Arrierica:"

Manuscripts and Oral History

Medicine is a discipline which traditionallyhas relied on the printed word for itsauthoritative sources. Credit for a discovery inmedicine 'is generally allocated to whoeverpublished it first. Similarly medical historianshave and still dO rely primarily 'on printedsources to trace the development of. medicalideas, for prirvecf works have represented theavallabredy-Tof medical knowledge. Increas-ingly, however, medical historians interestedin the growth of institutions, the developmentOf a researcher's thought- or the relations ofniediCine and society have turned to Manu-script ..sources -for a more comprehensiveUnderstanding of subject tharican often befound in the publ record. For this.reason the.History of MediCine Division has givengreater' attention in recent years to acquiringand Preserving for the benefit of scholarS therecent., unpublished' records that will beessential for future. historical research.

Since the days of John Shaw Billings; theLibrary has acquired; occasional manuscripts,usually in bOcik foinClif additidn to a numberof early western codiCes and a significantgroup of -Arabic texts--.-including the i

A.'44.364,4*.

brary's oldest volumethe manuscriptscollection includes items from France,Germany, and other European countries. Thebulk of the older material pertains ko 18th andearly 19th century American and Britishmedicine. Lecture notes written by students ofJohn Hunter, Sir Astley Paston CoOPer, andPercivall Pott stand on the shelves beside thoseof Benjamin gush, -William Shippen, and

. Daniel Drake. A nuMber. of 18th ;centurymedical recipe books give a realistic picture -of -,therapy. The manuscriptg collection is partic-ularly rich in materials pertaining tomedicine, in part because of the Library's longassociation with the Office of the SurgeonGeneral of the Army. Numerous diaries,collections of cprrespondence, and official.:medical reports are available from most of themajor military: conflicts from the ReVolution

.through World War I.

In the 1960s a separate manuscripts sectionwas established in the History of MedicineDivision and a trained librarian employed, tocatalog the 'Library's_ collection according toaccepted modern standards. Simultaneously:an active acquisitions polity was initiated andfurther professional staff tnade available toassist in _the_clevelopment of the manuscriptsprogram. Today the modern manuscriptscollection has over 700 individual collectionsranging in size from single items to someeighty-manuscript boxes, and it continues togrow by the, acquisition of unusual andfin-portant materials. Collections acquired, asgifts far eXceed'the occasional items, generallyfrom ry,the 19th century or earlier, that arepurchased. Selected individuals who havemade significant contributions to coritempo

, rary`niedicine or .whose pampers'contribute to an undo-Standing of "in

Anatomical theatre at Altdorf, Germany.Seventeenth- century- engraving.

med.-cal history are encouraged to deposittheir papers in the National Library ofMedicine. In recent years the collection hasbeen enriched through the addition of thepapers of such important medical figures asStanhope Bayne-Jones, Henry , Nelson.Harkins, Alan Gregg, William B. Bean, WardDarley, Chauncey Leake, and William S.Middleton. The archives of a number ofprofessional' organizations and societies arealso preserved in the .Library 's collection,including, the National League for Nursing,the. Association of Military Surgeons, theAmerican- Clinical And ClimatologicalAssociation, and-Alpha Omega Alpha HonorMedical Society.

Interesting acquisitions during the,past yearhave included the papers of Chevalier Jacksonand Lawrence Kolb-. To the older material wasadded the Journal of Assistant Surgeon JohnL. Fox, assigned to the USS Vincennes under 7 -the command of Lt. Charles Wilkes on thefamous exploring !expedition to the South

-Pacific and Antarctic? !n 1838-42;At the same time that the Library's program

to acquire modern manuscripts was getting'under way, attention was also directed to thepreparation of oral histoiy 'materialsconsisting_of tape recorded and transcribedinterviews with contemporary figures. From1966..to the ,present, the Library :las acquired519 hours of oral history materials, including140 interviews, most of which are included inthe 10,880 pages_ of transcript. About one fifthhas resulted from interviews conducted byPeter Olch, M.D., the one staff memberavailable 'for this program. The remainingmaterial has been acquired through contractwith other interviewers, as gifts, or from theother oral h is tory prOgranis

The orat history interviews in the collectioncover a wide area of medicine and vary_inlength from one to--3,5hourt_Among thelonger ones are those With Stanhope Bayne-Jones, Albert Baird -Hastings, William S.Middleton, Shields Warren, Emile 'Holman,and Owen FL Wangensteen. The mqstfrepientirconsulted oral Listory collection is'the Series of 83 interviews conducted by Dr.Milton Senn in connection with a history' ofthe chi elopment movement in the

.. -United

including' ,woodcuts, engravings, etchingS,lithographs, and photographs, as Well as anumber of drawings, watercolors, and oils.They range image from 15th century woodcutsto photographs of contemporary medicalscenes and figures and include fine printsdealing:with medical topiCs by artists of suchdiverse styles as Albrecht Diner, 'KatheKollwitz, Ben_Shahn; and Norman RockWell.In addition to some 30,000 individualportraits; there are many picture's' Of medicalinstitutions, including schools, howitals, andlaboratories. O'ver 600 otthe finest prints in-- ...the collection- are caricatures., manybeautifully hand-colored, from the 18th and19th centuries.. Numerous pictures' from 19thcentury \ periodicals' document earlyequipment and medical techniques:' I

The Collection, now totaling over 60;000items, continues to .grow through purchase,

-gift', or transfer from -!other goVernmentagencies.' During the part year 762 pictures'Were added and some 1890 photographs and

.slides proyided to scholars; book publishers,magazine, editors, television producers, andother patrons.

Publications

With its steady enlargement in recentdeddes, the Library has had an expandingresponsibility to ptovide users with finding

. guides to the various kindS' of invaluablehistorical as well as current, literatUre in: itsCollections. A pumber of suchpublicaticims have been prepared since 1950. Inthat year there appeared A Catalogue ofInctintzbula and Manuscripts in the ArmyMedical Library, by Dorothy M. Schullianand Sonimer. In 1961 the Libraryissued Early American Medical Imprints: AGuide to Works Printed.in the United-States

followed i 967 by Medical Reference Works1679-1966: Selected Bibliography, edited by -

John 11 Blake and Charles Roos,.PUblished bythe Medical Libiary Association. !

The year 1967 likewise Marked . thepublication ,of . A Catalogue of SixteenthCentury Printed BOoks in the) NationalLibrary of Medicine compiled by Richard J.Durling. Later acqdisitions of early printedworks were similarTy" desCribed ; in asuppleinent to this work:conapiled by PeterKrivagy and published in 1971: Staff nienibeis : :are now working on, a coniparable catalog ofthe Library's 'rich holdings of 17th centuryprinted medical books,. as well as on a shortttitle catalog, of -its . large 118thcollection, neatly 40 per cent' of which is not

Prints and- Photographs Collection

The Library's print collection originated in1879 with the acqUiSition of a large group of

.`pOrtraits by .. 'John\ Shaw, Billings.Subsequentiy the 'collection was enlarged bythe addition of rnany:types-oUgraphic media

represented in the Index-Catalogue or othef7published guides to the Library's holdings.

Since 1965; History, of Medicine Divisionstaff members have compiled detailed indexesto the voluminous curre4t secondary literaturepertaining to the' history of medicine. Fromthese, the Bibliography of the History. ofMedicine is issued annually, with as,cumula-tive volume published every fifth year. Issue

AcquiSitionsBooksModern manuscripts

-Oral history hoursPrinti and photographs

Processing-Titles catalogedModem manuscripts catalogedPictures indexedArticles'indexedPages _microfilmed

Public serviceReference questions answeredILL and pay orders filledReader requests filled

ictures supplied

number 8;. for material published in 1972,appeared during the past year. The Diviiionalso prepares or assists, with the compilationof smaller sized catalogs in connection withvarious historical exhibits' at the Library. Thestaff 'have collaborated in. -historicalpublication projects 'of such outside 'relatedorganizations as the Oral History Associationand the American Association for the Historyof Medicine.

Table 12. History,of Medicine Activities

ki

-41:1410.

1,

FY 1973 FY 1974, FY 19'75

936 1,142 86313,819 42,970 89,563

52 40 981,100 - 565' /62

. .

2,192 2,473 2,86645,890 20,000 59,355'

526 355 4044,270 5,354 4,236

160,220 148,952 151,130

1,936 1,8802,140 2,233- 2,2146,278 4,085 8,9621,782 1,877 1,797

Reading History of-MediCine Division.

/ Physician-Patriots: Four' Signers of the // ,Declarationsof.Independcnce

Arr long the 56 signers of the Declaration of/ Independence were foul. practicing

'/ phySicianstwo famous for their work inmedicine, Rush and Bartlett, and two wh6

/ were better knOwn for. their political. activities,Hall and Thornton. (A fifth signer, Oliver.Wolcott, studied medicine for a time but neverpracticed.) Benjamin Rushwhose system ofbleeding in the treatment for yel/oVI fever wasdenounced as "one of the great discoveries . .

which have contributed to the depopulationof the earth"was probably the best-knoWnAmerican phySician of his day,: and despitesome of his Mistaken theories', made outstand-

' ing contributions in hii field. Josiah Bartlett'scareer was primarily in public affairs, but hewas a notable physician as well and founder ofthe New Hampshire Medical Society. Lyman

'Hall and Matthew Thornton also practiced:'medicine, but most of ther energy was'devoted to careers as statesmen.,

Benamm Rush (1745k

"1Benjaniin Rink (17454813), ,deSpite,Mistaken :. that _"depletioill' throughbleeding and putging was the one, treatmentkir most diseases,:: made many iinportantcontributions tp AMerican medicine andsocial reform. . He .eStablished the first free

\ I

dispensary in the country, was probably the- first to advocate the study of veterinarymedicine, made notable contribution§ ltipsychiatry,- and was the first Medical than in =the country to achieve .a general literary

- reputation: Alihough a controversial figure jnhis medical theories, he was greatly admired asa teacher, having taught about 3,000 studentsin his lifetime. A imajor result of his instruc-tion was the emergence of Philadelphia as the 'leading American, center of medical trainingduring the WI half of the nineteenth century.

' [Engraving by Lodis Le..Met from the History.of. Medicine DivisiOn, NLM.]

1

'Josiah Bartlett (1729:1795) was a notablephysician, and chief justice and governor ofNew Hampshire. The first to vote for adoption.of the Declaration of _Independence, he wasone of the most influential members of the twoContinental,. Congresses in which he served.His interest in the Medical profession did notabate during his long career en public affairs,and in 1791 he secured from the statelegiSlature,a charter for She New HampshireMedical Society.,

I

Lyman Hall (1724-1790) /began his career as apreacher in Connecticut, but he later aban-

' 'cloned thiS in favoof the study and practice ofmedicine. He moved with- a. group of NewEngland Congregi.:-tionalistS to Georgia.where he practiced Medicine before becOrn-

: T. ihg a delegate to the Continental COngress:After the war, he returned to Georgia to

-- practice medicine, wfierebe-Was elected- governor- in L783. I--

Matthew Thornton (c. 714-1803) was born inIreland and emigrated 6 America about 1718.He began to practice .medicine;' in 'London-derniNew Hampshir ;. in 1740, and was an!'undei-:.surgeon" in /the , New Hampshiremitilia, under the royal. government. Promi-nent in the agitation against the Stamp Act, heWas .later elected presider& of the proVincial

. congress of 1775'. He was \alSo chairman of thecommittee. of: safety: that organized resistanceand exercised: general powers of governmentduring the early: ta:ge iir the war. He never

',returned to the praCt C Of medicine, butdevoted. most of his - remaining years top6litical affairs in Ne . Hampshire:

-:

.CHAPTER VI OUTSIDE060

Clinical librarian: project at ,the Uni-versity Of Connecticut (far right) andconstruction:of the library at theSouth

;,ern,',.College, of Optometry (be)ow) -re-,a`

re-ceived NLM 'grant assistance. - -

17ekr 1V1

D Associate Director, Extramural Programs

Since 19651he National Library of Medi-cine's interactions, with the health sciencelibraries of the U.S. have gone far beyond thetraditional le in acquiring and indexing the

literature. In the mid-sixtiesmedical libr ries and biomedical communica-tions in gen ral in this, country were in a stateof disrepair,. The unprecedented increases inhealth actiOties in the 1950s and3the early1960s; the Accelerated growth rate of medicalresearch,' and the rapid advance of interdisci-plinary effort precipitated a Critical period forscientific communication. In 1960 a reportprepared or the Senate. AppropriationsCommittee -stated: "One urgent need althostall. medical schools have 'in common is ,theimprovement: of their libraries, which are

` essential to the -functions of education,.research, and good medical care.",

Financial' support , had not kept pace withIthe increased' information demands: Thequality of research and patient care wasthreatened.. For years librarians had, lamentedthe adverse, effect of their poorly supportedinStitutions: .Finally, in the mid-sixties, the : .voices of physicians and scientists' joined themin a plea for suPPort: On April 3; 1964; theNational'. Advisory. Health Council passed' a \

strong resolution urging prOmpt.and,effettiVereMedial,action for this problem: In'1965:,the,,,

,

ti

President's 'Commission on Heart DiseaSe;Cancer, and Stroke reported that the disrepairof the medical library system constituted amajor weakness in both Federal and privatemedical programs. The Commission recornMended speCific programs to strengthen thisalarmingly weak link, noting that libraries are

,. interwoven into the basic 'fabric of research,teaching, and practice in a manner indispen-sable to progress, and that adequate libraryresources are essential to the nation's healthefforts. The National Library of Medicine wasdesigned as the logical point for planning,

'? 'developing, and managing these programs.The. Comtnission recommended to the Presi-dent that the . Department of Health, Educa-

, .uon, and Welfare propose broadly conceived',.and adequately' funded le'gislation whichwould authoriZe the -National Library ofMedicine to undertake extramural functionSdesigned to assist the nation's medical libra-ries . and to develop new and improvedcommunication systems. The Commissionrecommended-that this program, be supportedby art appropriation of not -less than $150million over the next five years,. and thatc grants and contracts to improve medical

. faCilities, resources, personnel, and secondarypublications be awarded. The Library wasencouraged to Conduct, forward-looking re-search to increase the effectiveness of medicallibrary service throughout the nation.

The Commission stressed the Urgent need-for long-range planning for an effectivenetwork and noted that existing libraryresources :were grossly, inadequate, for the .

purpose. It reported that in 1963 and 1964 the,National Library of Medicine had a:budget ofless than.$1 million for extrairiiiral programsfor simpoet of medical libraries in educationaland research ifistitUtions; hospitals, and other .

privat nonprofit health organizations. Incontra it described as desperate the need forworking and stack 'space in the more than '4,000 medical libraries maintained by healthand medicaLinStitutions. A survey of needs of .

130 medical facilities had revealed a deficiencyof .3,200,000 suave feet of space for librariesand known dollar construction needs of $128million.

By Septembe 1966, both the Senateand. theHouse of Representativei had proposed newlegislation to amend the Public Health ServiceAct .' to provide adequate medical libraryservices and facilitieS. Experts who testified

. before C.Ongress'onal Committee's in 1965indicated repeat dly. that Medical librariesmere ill housed, nderstaffed,,and inadequate-ly stocked with 'books,- journals, and Otherresources, and thaq they were functioning with

, .

anuq aced procedures and technologies.The new. Director of the National Library of

Medic tie. \ Martin M. Cummings, M.D.; in '

surmn rizing his 1965 testimony before the.House Corri ittee on Interstate and 'Foreign 'zComm rce e pressed his conviction that the.,.provisi ns of the, proposed Medical 'LibraryAssists ce Act would go far toward solvingthe seri US and ost urgent medical commu-.nications proble which existed. He said,"We are most h peful that upgrading outnation's medical library network;will prove toserve, the interests of , medical education,medical; research, an practice, whith is theultimate response to he health needs of ournation.

The Medical Library ssistance Act of 1965(Public Law 89-291) au( orized a program ofgrants. to finance cons ruction of medicallibraries, train biomedica librarians and otherinformation specialistS, p pvide for the expan-sion -and\ ,improvement Of medical libraryresources,stimulate research and developmentin MediCal library sciences, support biomedi-cal publications, and !establish regionalmedical libraries. A retroSpective view of theprogram points up substantial benefits whichhave been gained for Medical librariesthrough the seven grant programs of theoriginal act and its Subsequent revisions(TableS13;,14, arid 15).

Construction

The original Act authorized $10 million foreach year; 1967-1970. D.uring thiS period, theLibrary provided construction zrants totaling$11.25 million to assist 11 libraries associatedwith schools of health sciences. Under the1971 Extension Act, the yearly authorizationswere increased but no funds were appro;-,:..iated.In' 1974 Congress repealed the constructionauthority!

Resource and Service IMprovement

The 'R source Grant Program is one of themost important components of the MedicalLibrary' Assistance Act. Although much wasstill unknoWn in 1965 about the status andspecific n eds of the nation's health libraries,it was es imated that more than $100 mil-lion wo 1.4 be required to bring the re-sources o these libraries-up to recommendedstrength. The Resource Grant Program couldnot atte pt to meet this total need, nor wasthis Ms ntention. In the first five years of thelegisla on, less than $12 million was madeavaila Ie. During this same period the volumeof h lth information continued- to expand

rapidly; 'the cost of informational materialsrose sharply; and as new programs in healthcare, research, and education were created,there was a considerable increase -in thedemand for library services. .

The Resource Grant Progra was con-ceived as "self-help" to ,supp ement and.stimulate an increase in priv to support.Originally, the purpose was to improvelibrary service through the a quisition of

'resources. To accomplish this oal the lawprovided a formula system of gr nts in whichthe initial award was based/ on previouslibrary expenditures. In additi h, an "iinpact -.

philosophy" was adopted in hich priorityfunding would go to libra s serving thelargest number of people. Considering theformula structure of the ant and thephilosophy of funding prior ty, it is obviousthat a majority of funds w nt, to the largermedical school libraries si e these had thelargest base of institutio al support andserved the largest number o users. In spite of

--the-limitation of the form, la approach, theprogram had a substantial/ impact with morethan 400 libraries receiving support of almOst$12 million. /

By 1970, when the Medical Library Assist-ance Act was renewed and amended, consider-ably more was known about-the health sciencelibrary Populatibn. The time had arrived totransfer emphasis to programs of serviceimprovement land to provide a stimulus forthe "have-notT librariesthose which couldnot participate in the/original program. To -accomplish these goals the Resource Improve-ment Grant an the Resource Project GrantPrograms were stab ished.

The purpose of thejImproVernent Grarif wasto establish libraries Where need existed and toassist the smaller\ hei,Ith-oriented institutionsin acquiring the ece 5ary materials, particu-larly books and jo rii ls, to serve the immedi-ate and basic requ'r ments of primary users.The Improvement ant is a/ one-year awardfor a maximum of ,000. A prerequisite forapplying is a com tment by the applicantthat adequate space nd a least a half-timeindividual responsib e for the library will beprovided. These ass rants are cerigifilY notinsignificant when t co is of Space and part-time staff are relate t the amount of theImprovement Giant. e FY 1971_, when thistype of grant first bec e available;nearly 400awards have been a n e.'The program hasbeen successful be se it has stimulatedgrowth in budget a staff support for theapplicant Jibraries.

The second type e of resource support, theResource Project GT nt, is intended to stimu-

late ,established libraries to emphasize new,expanded, or improved services and to act asadjuncts to the resources provided andmaintained through local efforts. It is a way ofhelping a medical library with the start-upcosts of a new medical library service. As withthe Improvement Grant, an importantcriterion for review of the Project Gramproposal is the plan for the post-grantcontinuation of the project.

The types of activities funded With theProject Grant mechanism are varied. Since itis not financially feasible for each medicallibrary to acquire all health science, informa-tion, various kinds of cooperative efforts arcbeing explored. One method by which smallhospital libraries can stretch their informationdollar is to form a consortium for the sharingof resources. An example of such a cooperativeeffort is a group -of community hospitals insuburban Boston that have formed, with theassistance of a Resource project Gram, aConsortium., for Information Resource \toplan, develop, and eVakiate coordinatedinformation resources.

Learning Resource Centers are, being estab-lished in libraries with grant assistance. Suchcenters contain audiovisual materials,computer-assisted instruction programs, self-teaching modules, and a, number of otherdiverse educational technologies. Funds wereawarded to the College of Medicine andDentistry in New Jersey to create an audiovis-ual center to serve not only the .faculty andstudents of the College but also the healthprofessionals throughout the entire Region IIof the Regional Medical Library system.

Projects have also been funded to developautomated systems for library technical serv-ices. For example, at the University ofCalifornia, Los Angeles, Various aspects of thelibrary's Operations, suclv as the serial record,have been automated and the software pack-ages developed there have. been .adapted byother institutions.

Both types of Resource Grant ar Onsideredan, integral part of the Regions edicalLibrary system. The basic philosophy thissystem is resource sharing ,and the ResOurceprogram is supportive of this concept. \\Regional Medical Libraries \

GN

The Regional Medical 1.1 rat% system I. a--network- of the health sciencethrotighout the country. It \is a\ means ofassisting health . researchers, 'educators,

' practitioners, and students, at all levels and inall health disciplines,, with their informationneeds. There are 1! regions, each administered

./

56

by a Regional Medical I.ibrary.'The m el for the network is hierarchical,

with each higher-level facility acting as theprimary s urce of information material to theechelon ow. The foundation of the networkis the "baSic unit" level, predominantly thelibraries of the nation's hospi61s, which arethe primary entry points' into the network forthe majority of health-workers. The next levelin the hierarchical chain consists of 125"resource libraries"those institutions withMore comprehensive informational resourcesthat can be shared with institutions at the

..basic unit level. /Usually these are medicalschool libraries. The backup facility for theseparticipating resource libraries within eachregion is the next level ip the system, theRegional Medical Library. As each region'sprimary health information source, the Re-gional Medical' Library has the additionalresponsibility for planning a c Adinatedsystem of library services within the region.The fourth level, the backup resource for theRegional Medical Libraries and the totallibrary network is the National Library ofMedicine.

The concept of a national interactiveRegional Medical Library network was devel-oped in response to trends which began tosurface in the early 1960s. The National.Library of Medicine and its advisors were then

creating programs which were significant'departures from the, traditional archival roleof national libraries.

Although medical libraries had alreadyestablished a reputation for coordination, andsharing, they had no organized arena withinwhich the full potential of this beneficialpractice could be realized. Consequently.confronted with requests for new and. in-creased services, libraries began to turn moleand more to the source which was identified, bythe Congress as the "libraries' library:" Thus.there began to develop a dependency on the-

. National Library of Medicine, .a.dependencywhich might have led to the evolution of amonolithic medical library resource andinformation system. This growing dependen-cy, if permitted to continue, could only haveeventually accelerated the deterioration ofinformation services and local informationcenters. As an alternative to a monolithicnational system, the National Libary ofMedicine committed itself to the developmentof a network of libraries which would extend,not only to the major prOfessional scx '.ety andmedical school libraries, but even to the .

"doctor's reading rocim" in a small ruralhospital. '

. In 1964 a Presidential Conritnission recom-mended that "a legislative proposal should bedeveloped and enacted providing for the

THE REGIONAL MEDICAL L2BRARY NETWORK

support. and stimulation of a NationalMedical Libraries Network." The Commis-sion concluded that an important solution tothe inadequacies of scientific communicationswas a flexible, network:based program ofplanning, stimulation, and coordination "toassure all areas and all medical schools,scientists, and practitioners of the benefit ofeffective access to all medical data andinformation." In October 1965 the MedicalLibrary Assistance Act authorized a programof grants for the establishment of RegionalMedical Libraries.

Given the unknowns in our informationabout existing resources and services, initialplanning, both national' and regionally, wasa difficult' ta.k. The Library sought andreceived assistance from the AssoCiation ofAmerican Media al Colleges, the AmericanHospital Associatiot, the Medical LibraryAssociation, and other groups and personsrepresenting the sources and users of healthscience information. The program was initiat-ed in October 1967, when the first RegionalMedical Library grant was awarded to theCountway. Library of Medicine in Boston. .

Almost three years after the first grant, in July1970, another award to'cornplete the establish-ment of the geographic network was made tothe Health Science Library of the University.of Nebraska Medical Center in Omaha. Thus,including the National Library of Medicine,which serves as Regional 'Medical Library forthe Mid-Atlantic states, there are, now 11Regional Medical Libraries covering all 50states.

Each Regional MediCal Library providesnetwork management and coordination ofinformation services within the region andparticipates with other Regional 'MedicalLibraries and with the National Library ofMediCine in planning for An interactivecooperating network. The basic philosophy ofthe Regional Medical Library system isresource sharing. In order to advanCe thisconcept on a national basis, emphasis isplaced on developing a program of coordinat-ed information services which will be respon-sive to.- user needs as determined- by' acontinuing assessment of these needs. A keyelement 'in the' success, of these efforts is aninterinstitutional commitment for the effec-tive and efficient utilization of major re-sources. This common commitment requiresan examination and a rational resolution ofthe issues of cooperative acquisitions and

-cooperative technical services. Current plan-ning involves the rechanneling of the fiscalresources of libraries into activities whichfacilitate cooperative development.

Since the Regional Medical Library pro-gram is designed to support health caredelivery, education, and research, planningmust begin with identifying the needs of thecommunity, and must provide an administra-tive structure and decision-Making processwhich are responsive to those needs. Assum-ing that these goals are attained, any legiti-mate health enterprise in the region.should beable to look to the Regional. Medical Libraryas its information arm and feel confident thatits,views will get carefuLconsideration in thedecision-making process.'

Research and Demonstration

Research, development, and demonstrationgrants are a significant portion of the medicallibrary assistance program. Research Supporthas been concerned primarily with the fieldsand specialties of the health informationprocess. It was recognized that critical needsfor better access, to information by the nationalhealth community required basic research andtechnical development While new processes,techniques. and methods needed investiga-tion, it also became clear that successful workhad to become part of the general informationsystem fairly quickly. Accordingly, withrenewal of, legislation in 1970 and 1974, theCongress added authority for demonstrationprojects' so that the benefits of new methodscould be exhibited in, actual. operating situa-tions.

Project to link a medical library (University of Cincinnati)with patient. care weas was supported by NIA grant.

.ksek..4

58

Members of' the National Library of Medi-cine peer review groups conducted twoconferences, in October 1974 and May 1975, to'discuss current trends in information scienceresearch. The suggestions and advice fromthese conferences helped to establish researchgoals for the future. In the it-text few yearsmore attention will be focused on the uti-lization Of the computer in the inforrnationsciences.' At these conferences; the membersemphasized the need for health. practitionersto retrieve actual inforination- rather thanreferences to'documents. Recent developmentsWhich enhance computer power make: aninformation-providing zapability feasible, butmore work remains to be done. Speakers at theconferences agreed that better understandingof decision-making processes and means bywhich those processes could be augmentedand improved through computer assistancemight yield, considerable returns in improvedpatient-care and 'health education.

In the years from 1966 through . 1974, theNational -Library of Medicine awarded$8,677,000 for 105 separate research projects.During 1975, 11 new prbjects were begun:Withtotal awards of $1,315,000. Significant projectsinclude an operations research study at theHouston AcademV of MediCine - TexasMedical Center Library and a project at theUniverSity of Minnesota to explore and adaptthe minicomputer to medical librar opera-tions.

Training

Collecting, and disseminating informationand documents requires Highly qualified ;

personnel. Since 1966, more than 88.2 millionhas been made available for the training of 558medical librarians, information specialists.and medical historians.

Twelve programs concentrated solely; ontraining- ,over 270 medical librariansbothpostgraduate internship and master's degree .prOgrains. .Achievements of these programsmay be 'measured in part by the .fiumbgir ofhighly qUalified graduates, many of whomhave atta,ned keyleadership positions such asheads of :university health science center-libraries:0 Recent studies have shown thatgraduates of LibrarOuPported internshipprograms have been significantly. more.activein enterpriseS involving the-'application ofautomatic data processing,. computers andcomputer programing; and library, adminis-tration. Such graduates are more likely toparticipate irt research and development

activities than other library school graduates.'A second4area of manpower need was for

biomedical information personnel to assiston-going scientific research.' One trainingproject, at _Stanford University, supported'_interdisciplinary graduate education in in for-ination,systems research. Another program at'the UniversitY of Nebraska concentrated ontraining audiovisual information specialistsand biomedical communication specialists.Such programs2have had an impact on theeducational technology uses. by medicalschools as they have developed. and expandedin the last, decade..

After 1971 the.shortage of medical librariansuecreased noticeably :and grant funds. tosupport specific training. in medicallibrarianship 'were no longer neeessary. In1974 the Library decided to concentrate ontraining health professionals in computerscience_ applications to medicine. Eight newprojects have been initiated in this area, and inthe present academic year -( 1975-76, 63students are enrolled.

Special Scientific Projects

SpeCial Scientific Projects are awarded tohealth professionals and scientists (and topublic or nonprofit, private institutions ontheir behalf) for -compiling existing, orwriting original, contributions on scientific,social, or cultural advancements in health-related disciplines. A need for such scholarlyactivity had been expressed by the Board ofRegents many times pr;or to 1965 and thisinterest was reconfirmed it. 1972 and 1973. Theintent of the legislation is to enable theNational Library of Medicine to assist theserious inquirer whQ needs authoritative,cornpletei and documented information on amajor health area. Unfortunately, the relevantinformation is often scattered among a greatnumber of papers, journals, reports, and

/monographs: It is difficult to consolidate the' literature and to interpret reports that areoften confusing and sometimes even contra-dictO Eminent health scientists or clinicians,who find scholarly research and writingconge ial, are encouraged to' apply theirtalents o interpretingrecorded knowledge-on-broad h alth topics.

In-1972\ the Board of Regents evaluated theprogram in terms of accomplishments, legis-lativehasis,' and underlying intent. The needstill exists for major definitive studies -on .

,59

.SchistosomiaSis: The Emilution of a Medical.Literature: Selected Abstracts and Citations,.102-1972, Margaret D. Dayhoff's Atlas ofProtein Sequence and Structure, D.R. Swin-dler and, C.D. Wood's Atlas. of Primate GrossAnatomy, and B.H. Waksman's Atlas of

"Experimental Immunobiology and lmmu-. nopathology..

Next 'in .number of awrds were studies in. the history of medicine, which have includedpublications ranging from the three, volumes,of Dr. Rudolph E. Siegel onGaleriit medicineto articles on medicine among Indian tribes inOklahoma.

An analysis of the PUblication GrantProgram .completed during FY 1975' showedthat the average length. of grant support perproject was 2.3 years; 37 percent were awardedfor only one year. University presses

outletthe most frequent publishing outlet for

Title

.Library- publication projects,. but scientificsocieties, professional journals, and commer-

. ciai Presses have alsOpublished the results ofsupported projects. .

During FY 1975-ezriOasisshifier-1 fromsecondary literatur s tolcritiCal reviews orhiomedicalinonographs Which identify thepreient status of research or Oraet,ice in varioushealth fields. DEamples of supported publica-tions received.,during FY 1975 included themulti-authored Community Medicine inDeveloping Countries and the Review ofAllied Health Education: I. A total of 40publication grants Vvas funded during theyear, of which 19 are new awards.

A revised "Guidelines for the NLM Publica7tion Grant Program" was approved during1975 by the Library's BOard of .Regents.Priority is to be given to small grants and toprojects requiring only publication assistance.

Table 13. Medical Library Assistance Act History

Medical Library AssistanceAct of 1965

Public Law 89-291

Medical.Library AssistanceExtension Act of 1970

Public Law 91-212

Health Programs ExtensionAct of 1973

Public Law 93-45

Health Services Research.;Health Statistics, andMedical Libraries Actof 1974 ,

Public Law 93-353

Programs A uihorized . FiScalTears.Construction 1966-1976

TrainingSpecial Scientific PrbjectsResearchPublicationsResourceRegional Medical Libraries

Same programs 1971.1973

Same.programs exceptconstruction authoritynot extended

Same programs exceptconstruction ithoritydeleted

61

1974

1975-1976

C.

. \Table 14. Grant Awards 1966 : 1975

Program' Numtiera\Construction11Training 17Special Scientific Projects

23Research 325Publications , 198

Regional Medical Library*2,588\--

81

Resource

Totals

Includes funding-by contract.

3,366

Table 15. Grant Awards FY 1975

Amount

$11,250,0009,253,000

632,00010,003,0004,585,000

22,916,00015,993,000 r

$74.632.000

Prdgram Number of Awards Amount AwardedTrainin g 10 $ 939,000Special Scientific Projects 4 145,000Research 18 1,327,000Publications 39 672,000Resource . 66 1,420,000Regional Medical Library* 8 2,194,000

Totals 1-15 $6,697,000

Funding by conaact.

...cH--NATIONAL RESOURCE

Among the MEDLARS partners around ,e.the: globe,- .from left:, Canada, . Great

Britain, Japan, and Australia.

f.

WITH GLOBAL IMPACTMary E. Corning, Assistant Director, International Pi.ograms

When- I say 'Our Medical Literature', itis not with reference to that of anyparticular country or nation, but to that ;I

which is the common property of theeducated physicians of the world . . . theliterature which forms the intra- andinternational bond of the medical pro-fession of all civilized countries . . .

John Shaw Billings'

In the early stages of the National Library ofMedicine there was a strong interest indeveloping relationships with :institutions

. abroad. In his preparation of . the Index-Catalogue and the Index Medicus, John ShawBillings sought and collected bioMedical'literatute published throughout the world. In1881 Army Surgeon Qeneral Barnescommissioned Dr. Billings to visit a number oflibraries on the European continent in order toinitiate exchange programs:

John. Shaw' Billings: Our Medical Literature.Transactions of the International Medical Congress, (7th1.London 11881 ):

63.

MEDLARS Cooperation

The amount of material acquired by theLibrary since those early days has nowincreased to more than 20,000 bipmedicalperiodicals annually; with approximately 64percent non-U,.S. From. this massive amount ofmaterial the National Library of Medicine hasselected, with the aid of consultants, 2300biomedical journals which form the corpus ofour compbterized 'activity, MED-LARSIMED.LINE, and our publishedIndex Mcdicus. Because of the internationalcharacter of this literature, the Library hasreceived many non-U.S. requests. for. theMEDLARS data base or for the servicesoriginating from it. Such requests werereceived even . before the system becameoperational in 1964, and often from a numberof institutions in the same country, all wishin,gto-be designated:at a MEDLARS Center.

A primary and continuing Library decisionthroughout- the years has been that anyinternational arrangements relating . to the

),MEDLARS SysteM should be based on. *substantive technical cooperation. Initial

informal , discussions which were held withofficials. in the professional'cOmmunities ofthe United Kingdom and :Sweden in 1965.resulted ,in an experimental project: TheAThited KingdOm.and Sweden wished to utilizeata existing operational,-s stern to developbiortiedical information : and theNational Library of Medicine was eager iohave an independent technical assessment ofMEDLARS performance in other -countries.Arrangerriena were made with the .Office forScientific and 'Technical Information; Depart-ment of Education and Science in the United,Kingdom and with the Medical ResearchCouncil and the Karolinska InStitutet inSwedf 1. The National Library of .Medicine.-provided magnetic tapes, technical documen-tation, and training programs. The participat-ing countries agreed to provide evaluation and'technical feedback. The U.K. began.to provideservices in '1966 and Sweden in 1967:

As:.Sweden and ,the U.K. moved from' thisexperimental phase to operatiOnal stattis,, itwas evident that this informal,' cooperativearrangement 'should become more,definitive.'In 1968 these .workingrelationshiris becamequid-Pro-quo bilatetal' g-r..eenients betweenthe Library and the: United .Kingdone andSweden-They represented a Sharing of time,talent; and resources with no transfer of funds.In return : for 'access to MEDLARS the.participating, country agreed to provide:MEDLARS seryiees"tO its biomedical commu-

nity; a document support service; indexedinput to MEDLARS; and to pay for personnelsent to NLM .fOr training in indexing andsearching: \

These initial agreements served as modelsfor future arrangements and identified techni-cal criteria which assisted .other countries indetermining their readiness and the Library'sresponse. The Library would receive andevaluate a country's proposal in terms of: thenon-U.S. institution's technical, personnel,and financial resources and capabilities; theintended use of MEDLARS to meet foreignbiomedical information needs; and the inputwhich the participating foreign institutioncould make 'to the MEDLARS data base.

Increased interest in the National Library ofMedicine and its computer data base \ wasevident within the Organization for EConomicCooperation and Development (OECD). Thesetting for discussions on cooperation' ininformation then became multilateral insteadof bilateral:The Library participated in these .4

deliberations in the spirit of inte ational

one-additional center in Europe co Id be 'collaboration, and agreed to explore hether

established- With a consortium of OECDcountries. From 1967 to 1969 discussions forthe further internationalization of MEDLARSwithin. OECD continued.. Both the UnitedKingdom and Sweden Offered trial servicesand expressed a willingness to serve a regionalarea, it desired.

These, deliberations -resulted in no. agree-: ment among OECD member countries,. but

stimulated renewed individual' requests fornational centers. Accordingly, in 1970, France,the Federal Republic of Germany, Australia, _

and Canada each became a bilateral partnerwith thetibrary. In 1972 Japan and the WorldHealth' Organization entered into similararrangenients.

In 1974 and '1975, with the development ofMEDLARS II and . the extension of the.Tiinshare network internationally,. there werethree alternatives for MEDLARS cooperationwith NLM: MEDLARS tapes, tapes plus the. :NLM.software searching package; or on-line

'access to the -Library's Cornputerin Bethesda...The selections made ty our cooperatingpartners .are as follow's:

Tapes Germany. JapanTapes and

software Australia, SwedenOn-line to

NLMTapes and .

to NI I f.

Canada, France. WHO

United (Kingdom

Sweden, now is providi g on -line services toScandinavia from the BiOmedical Documenta-tibr. Center at the Karolinska Instittitet.' ThePan American Health. Qrganization is in anexperimental trial' period and is not yet aparticipant in a full qtiid-pro-quo arrange-ment:

The administrative seiting. for these 'MED-LARS centers varies from country to country.The National Library 9f- Medicine hasmaintained a policy of requiring the/partici-pating country to select the institution fromamong the many who have requested to, tie aMEDLARS. center. ThUs, the MEDLARScenter may be in an organization Which ispriinarily concerned with! medicine or health.,or a library, or an organization devotedbroadly ,to.sCience and te0ino logy (Table 16).In each case, however, the center has been

given a national. mandate to serve the 'country.\ The pattetn of regional coverage by thenon-U.S. centers is an important and delicate:policy issue. The National Library of Mali-

Top:G. Filkenberg; biiectot; MediCal InfOrmaticitiCenter (Sweden):

Below: P. Dostatni; MD., Search Analyst, INSERM. (France).

Uri Mee. Imensdonel le enema 14/DUES MIseaweed dimes NOS

LIMA EST LE CENTRE FRANCAIS

RESEAU DES CENTRES MEDLARS

t

Jig

ms emendo de rechwelle blbeepraptMm.

NOUN! sentient estmllsteent pkto de e00.000 teNeeemsCNN*. /100 timers.* Sams utieftwee, teletypist Km tellises

0 dem les tetelethespem nidlealm ImIltuts es Ncherettehapitsm Ims Us*

4

Coos Aknenstmlle Me,. t. Me am lakes; demeifmos M. USA.DritsnepeSenme Is misils OPWnbrittillalltdu RAW MUNE

,TABLE 16. Non-U.S. Medlars :Centers

Country. Operating Organization

Australia

Canada'

France

Japan

Sweden

Parent/Funding Organization-

The. National Library Of.Australia(NLAj s:

National Stience Library'. (NSJ_.)*

Institut National:dela Sante4et de laRecherche NIcrdica)e,(INSERM)

Japan Information Center of Seienceand Technology (JICST).

Karolinslca Insututet

United Kingdom The .British LibraryWest Germany. Deutsches Institut fiir, medizinische

Dokumentation und Information(DTMDI)

intergos",ernmental ,Health Organization World Health Organization (WHO)

National Research Council;CanackiiVlinistre de. la Sante PuPliqueet tie la Seturite'SOciale

Science and Technol gy:'Agency

The-Swedish Medial ResearchCouncil

:Der 13unctesminister fiir J,ugend,Familie. und Gesundheit

Renamed Canada histitute for. Scientific and Technical InarMation, October. 1974.:.

eine- does not dem.niine for 'other countries'-how. and to what, extent each may extend.Services. beyond. :national -.boundaries...Thedecision. is made jointly by .the...pai,ticipating-

"countries, .but with :..the knoWledge.- and..consent of the National- Library of Medicine...'"The extension-...Of MEDLARS information.services dependi-on a country's-relationihipwith neighboring countries; its pricing policy.for' MEDLARS services, and a determinationof whether the -..relationship; :is' restricted. ca.;

- service or. involves a broader area of technicalassistance. The Library. .haS heen .referringrequests ffor new centers to our-',..eurrentr...

..partners, with. the .understanding .

information service pattern may be developed.,.In the event .-that this. is not possible, other..direct arrangements. with the LibrapiMay--beconsidered.: -, ; .f

It was-envisaged that a uniquerole Could-be.performed'hY the. World Health Organizationin providing .to its-technical,.staff 'but to; the developingcountries: that. would receive information notaVailable.Undeicithei'meehanisins!Of national

thisauspices.:WHO in.-the early phases-of .thisactivity.' _

All of . the inlaterali 'arrangements, wererenegOdated this year to reflect the MEDLARS

.1developments.. A meeting of the Interna-

tional MEDLARS Policy Advisory Committeewill beheld' in November, 1975. This will bethe third such meeting'of .Policy Officials,accompanied by the Directori of the MED-

:LARS Centers. It will reexamine the coopera-.tive efforts, Operational experience; regional.coverage, networking, the 'availability of1TOXLINE, andEuture collaboration:

0

TABLE 17. Types of 'Public Law 480 ProjectsActive in FY 1975

Type` NumberI. Critical review monograrslis .. . 642.:Secondary literature tools :.. 1 ,

3: Library and Information ,

- Science .....:: ..".... f. . '. . . ... . 2-':4.. Periodicals ... ........ ; ... . . .... 1

5. Histories of-medicine .... . . . ; .. 126. Foreign translations 16;7. Conference proceedings ..-..

,5

8. Multi-category agreements . 9"

TOTAL

,Exchange Programs

Through the years the Library has de-__

veloped a large number of--cooperative ex .changes. These now numberi895 exchangepartners in 85. countries. The cooperativeexchange is a mechanisrii7foracquiiing-medical literature which may not be otherwisereadily obtained. The program has been underreview this year it- ensure that there is an .

equivalence to the material being exchanged.-rife People's Republic of China is now an

integral part.of this exchange program. TheLibrary receives five .Chinese medical :Our-

. ,nalS`. This is in contrast to the 91 ChineSejournals, including 30 major medical Periodi-ails, which had been published and receivedprior to 1966.

ment with ifie'''U.S. Agency 'for InternationalDevelopment. About 20,000 such services areprovided each year to 48 deVelopingeOuntries^throughout the world. The geographic distri-

--7.--bution_is___estimated to be 29 percent lo LatinAmerica, 60.8 percent to _the, Near East, 8 :3 ,

percent to the Far East and 1.9 percent tbAfrica.. This assistance responds to a'demon-strated need in. countries where there areinsUfficient medical literature resources. Theservices .include interlibrary loanS", 'reference '.reqUests, MEDLINE searches, loan!of audio-visual materials, and.. subscriptions' ;.o Index 'MediCUS and Abridged Index Medicus. Manyaspects.of medical research, edikationl,paliciiealthand preventive medicine are encom-passed Li these serviceiThe level of activitymade possible. by this NLM/AID:agreenient,-however,- does. not respond. totally, a,11 needsof the,developing, nations. r '

'AID Services

The Library continues to provide services todeveloping countries .under a special arrange-

E15-w-.,g4.77,771

fip

World.Heilth Oiganization Library..

""'"11011111.s..___ 311111"If .14.

Public Law 480 Programs ,

The Special Foreign Currency Program isthe oldest of the extramural activities and isdependent on the expenditure of U.S.-ownedlocal foreign currencies in selected countries.Legislative, authority for this program derivesfrorri a 11958 amendment to the Agricultural.TEcie D.,evelopment and Assistance Act of.l' . 4 .(Public Law 83- 480)', as amended. UnderSection 104(b) (3) of this Act, the PublicHealth Service is . authorized to: "Collect,ecollate. translate, abstract, and disseminatescientific and technological inforrnationindconduct research and support scienific activi-ties

of Health, Education; and el,-ties overseas

a. The Library ser es as.. . " the

fire s pi incipal.resource for the improvernent\of the ,niernational exchange of biomedicalinforrratidn. 7.r:A he Library assumed responsibility for theNational Institutes of Health-Russianscientific' translation program, in 1962-63. Itthen I consisted primarily of trii-nslating bio-medical literature from the 'Union of SovietSocialist Republics, Poland, and Yugoslavia

;to make it more available .to U.S. scientists. Aseries of Russian monographs were translatedinto English in Israel. Poland and YugoSlaviaundertook the preparation and publication ofEnglish language editions of ten Polish andthree Yugoslavian biomedical journals. During this period, the scientific and techniealaspecti 1 of these , SPecial- Foreign CurrencyPrograms were the responsibility of the,National Library of Medicine, but the admin-istrative arrangements Were handled 'by/ the:National Science:' Foundation in accordancewith an earlier agreement: 1

During' Y 1965, the Library renegotiatedfh4 agreement to Permit independent 'NLIYIprogram activity , with its own managerial,program, and administrative channels, for PL

'480 funded projects in, biomedical commtini- ,

cations. The Library then began Ito broaden, _ ...the scope of its actiVities to include specialized

abstracts and digests, works on medicalhistory, and critical rviews. "Two earlyexploratory projects were', in the field of druginformationOne at the request of theSingeon General and the other in cooperationwith the Food and Drug Administration. TheLibrary also initiated in' 1964 a 'cooperativeeffort with the National Institute of DentalResearch, the DiviiiOn of Dental PublicHealth;and the 'American Dental AssOciationto utilize special Israeli expertise in dentistry;

'and the.first comprehensive abstract' service of, . the world's scientific literature inoral health

was begun., This publication, Oral Research

Abstracts, continues today as a self-si,taining.effort of the American Dental Association,

The Special Foreign Currency Prograin1vs'evaluated 'in 1965 by a distingUiShed ad hocgroup which encouraged the Library: tbdevelop a Program of critical reviews. Thesereviews Would represent an intellectual analy-sis of the past, present. and future of particularspecialty fields. 11.c program 'wasformally established in 196:: with awards forthree critical reviews to be undertaken inPoland. An agreement was also' negotiatedIsrael with the Editorial Board of the IsraelJournal of Medical "ciences; which assumedresponsibility not only for identifying poten7tial authors but for reviewing proposals before 'submission to the Library.

To date; 86 projects 'totaling $1,300,000 (inequivalent : foreign currencies) have beenactivated under this program in Israel. In 1971the Library entered into a similar 'PL 480agreement with the Coordinating Commis,sion for Polish-American Scientific Collaboration; 21 projects in Poland have beenactivated to date under this program.

Within the last few years the cover-toAcovertranslation program has been completely

"phased out because its utility had diminished.- By the early .1970s the shortage or special

foreign currencies available to Federal agen-, cies led to a-gradual curtailment of PL 48Q

projects in sortie countries. It. Israel, the1firsjto be affected, the establishment in 1972 of theU.S.-Israel Binational Science Foundationmade it possible for the Library's collaborativeprogranis with both the Israel Journal ofMedical Sciences and the Israel. Program' forScientific TranSlations to continue underawards from ..11e new Foundation.

About $10 "000,000' equivalent in foreigncurrencies of-seven Countries has been obligat-ed to date for the over-all program. At present,the Library sponsors projects in Poland,Israeli; Yugoslavia, Tunisia, Egypt, India, andPakistan, including analytic critical reviewsand biomedical monographs, histories ofmedicine, /Secondary literature tools in thehealth sciences (such as guides, atlases,-handbooks), translationof current and histor- .

iCal foreign biomedical monographs; andproceedings, of international conferences.

, There /is collaboration_with major U.S.sc ientific societies, both to detennine the needfor studies in special biomedical, areas and toarraiike-fordistribution in_thelJnitediSOtes.

_University_ presses and professionariOcreties,as well as the National Technical InformationService, are utilized in the dissemination ofstudies funded under the Library's PL 480program.-

/

69 '

t. 4

AS,

'

4121;43;k.4>0.11.;

I

44'1,OtsokIPI

During, FY 1975- the Library's SpecialFbreign Curr ncy Program numbere 110active project in the, seven partici!) Ang

/ countries, of 'hich 10 were new projects(Table 17). Ab ut 70 percent of the pro am(primarily crit cal reviews) is prepared inPoland and Isr el, ivith the remainder (lar lytranslations) c- rried out in Tunisia, Egy t,India, and Pa istan. During FY 1975 L6publications re. ulting 'from PL 480 supportwere received. (For a complete list seAppendix 2).

Foreign Visitors

The Libraryvisitors annual!physicianS, nwd(ion specialists. fItinformation andspecial prograriswith their lir,concern to th

receives more than 1,000from ,other countries

al librarians, and inforina-furthering the exchange of

ideas, the Library arrangesfor these visitors consistent

fes -lona 1 /responsibilities. Ofin my visitors. to the Library

Alexandra ilossman, M. ., indexing at DIMDI (Germany).

were topics su h as the concept of 4 national.biomedical -int rmation resource; specialized

information a livities in cancer, cardiovascu-lar diseases, a id ,toxicology; health care; andcomputer aided d instruction..There were also anumber of st dy teams including,groups fromJapan; Swed m, Pakistan, ,,Germans, . Algeria,USSR: Iran, Mexico, Trinidad and Tobago,and Egypt.:

In January 1975 'Dr. O.K. -Harlem wasappointed is a Visiting Scientist. at theNational Library OrMedicilie for one year. Dr.Harlem is z ,specia list in pediatrics, has been ageneral pr.ctitioner, a hospital physician, auniversity eacher, and an editor. Dr. Harlem'scontributions. ate in both the substance ()Imedicine and in the communications andpublican n of _biomedical information: Hewill draw upon his breadth of experience todevelop ; monograph during his .stay at theNational Library of Medicine which will, formthe basis of a course in biomedical 1.communi-cations vithin a medicaFschool curriculum.

7 69

National Biomedical Information Centers

The National Library of Medicine, funt -tioning as a national biomedical informationresource, has attracted the interest of a numberof governments who have expressed interest inestablishing national biomedical informationcenters. The Library' does try to assist on atechnical consultation basis. Although it doesnot provide foreign felloWships or: have aformal training program, it is responsive to -

requests for the specialized training of phsi-cians and information specialists who havebeen designated to direct a national in fcirma-;ion activity in their own Country.

Two . specific arrangements have beendeveloped with Egypt. and Iran. In' October1974 the 'Assistant Secretary for Health, HEW.'and the Minister of Health of 'Egypt 'held aU.S.-Egyptian Joint Working Group meetingon Medical Cooperation. As a direct result ofthis meeting, the. Chairman of the Board ofRegents and the Library's Assistant Directorfor International Programs met with Egyptianofficials to -discuss potential collaboration inbiomedical information. In July 1975 thesecond meeting of the. full Joint Working.Group met in, Washington, D.C., at which

time the Assistant Secretary, HEW; and theMinister of Health of Egypt agreed that bothparties recognize that biomedical informationis -a necessary component of biomedical-research, education, and the delivery' of healthservices. It was also agreed, to explore cooper-ative arrangements which will result inimproved biomedical communicationsbetween and within both countries. Inparticular, experiences will be shared whichrelate to. the development of a nationalbiomedical information resource and anoperational national medical library system.

At the request of the Minister of Science andHigher Education . of Iran, the AssistantDirector for International Programs served asa consultant to Iran to assist in, the planningof, a national medical library and also indetermining What bilateral cooperative rela-tionships could be developed between theImperial Medical Center of Iran and the U.S.National Library of Medicine. As a result, Iranis in the early stages of developing a NationalMedical Library and Information Resource.On May 12, 1975 the Director of the NationalLibrary of Medicine and the Minister ofScience and Higher Education of Iran signed aMemorandum of Understanding under which

Pan American Health Organization Regional Library of Medicine (BIREME).

C.>

the Library provide technical consulta-tion, training; ,and specialized services request-ed and' funded\ by Iran.

Regional Programs for BiomedicalInfbrmation

The regional approach taken by the PanAmerican Health Organization (PAHO) in itsestablishment- of a Regional Library ofMedicine (BIREME) in Sao Paulo; Brazil in1967 has resulted in an effective operationalactivity. The National Library of Medicineserves as a technical consultant and backstopto PAHO and BIREME.

Since its first full year Of operation in 1969,,the collection Of the Regional, Library hasbeen strengthened and the staff has increasedboth in.number and in professional expertise.BIREME has performed 218,000 loan services;prepared 5255 special bibliographies; ob:-tained and donated 266,000 journal issues toother Latin libraries and has provided special-

. ized' training to 263 Latin health sciencelibrarians.

AS a result of the meeting of the LatinAmerican Ministers in 1972, PAHO andBIREME have entered into agreements withArgentina, Peru, Chile, Colombia, Uruguay,and Venezuela. Each of these countries is inthe process of establishing a national center sothat the transmittal of services can be chan-neled between these centers and BIREME.HOwever. considerable effort- is still needed to,strengthen these national entities andcrystallize their relationships into effectiveservice linkages.

The success of this PAHO undertaking hasdemonstrated that, even with political con-straints and economic considerations, it is

-possible to cross boundaries with\a regional/international effort devoted to the 'substanceof biomedicine and the provision of informa-tion services. It is a recognition that improvedbiomedical communications will assist in theadvancement of medical research, education,and ultimately health care.

The World Health Organization has beeninterested in developing such regional ap-proaches in other areas of the world. To date,no forrnal step has been taken.

International Organizations

The National Library of Medicine hascontinued its in( *-ership in the InterndtionalCouncil/ of Sc,.. 4fic Unions AbstractingBoard (ICSU AB) and participates in, thedeliberations of this organization. The organi-

. zation, is a meeting ground for informationand abstracting organizations, private andgovernmental, from a number of countriesthroughout the world, including the UnitedKingdom, France, 'Germany, Poland, Japan,South Africa, Canada, Belgium, The Nether-lands, and the USSR. Important topics underconsideration by ICSU AB are standardiza-tion', the economics of, primary and secondarypublications, the relationships between pri-mary and secondary services, and the informa-tion needs of developing countries. TheAssistant Director for International Programsrepresented the Director at the 1974 Berlinmeeting of ICSU AB and presented a paper on"The Effect of Copyright on InformationDissemination," and at the '1975- Brussels'meeting, presented a paper on "BiomedicalInformation a la Carte." The 1976 meeting ofICSU AB will be hosted by the NationalLibrary of Medicine in Bethesda.

0

AUDIOVISUAL SERVICES. FOR HEALTH°SCIENCE EDUCATION'

George E. Mitchell, D.M:D.,Director, Nation& Medica.I Audiovisual Center

The National Medical Audiovisual Center,a Component of the National Library ofMedicine since 1967, is dedicated to thecommunication of health sciences informa-tion through deyeloping and distributingeffective learning materials. Its energies arefocuged on assisting Ivn the. undergraduateeducation of health professionals and, morerecently, extending its services to continuingeducation in partnership with the Library'sLister Hill National Center for BiomedicalCommunications. The Audiovisual Centerhad ifs '-feginning early in World War II whena program of malaria control in war areas wasestablished in Atlanta, Georgia. This programprovided training for scientists and techni-cians needed for a massive malaria eradicationeffort. in the southeastern United. States.Starting m.-.xlestly with one cameraman/direc-tor,; a program of motion picture' training,

d°films was undertaken to document suchtypical activities as dynamiting, ditchdigging,spraying, and ku-viciding:

From this.malaria control program evolvedthe 'Communicable Disease Center (CDC),with .a broader mission in the detection,preYention; and Control of infettious disease.M CDC grew, its audiovisual support activi-ties were expanded. By 1949, the scope oft, audiovisual production led to the creation of adivision to provide audiovisual materials for

74 73

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all 'agencies of the Public Health Service.When CDC .moved into. its -new multi-building cc iplex near Emory University in1960, the Production Division was renamedthe Medical Audiovisual Branch and housedin a, modern facility designed and equippedfor a wide variety of audiovisual development'and distribution activities.

Three years later, the branch v;as renamed\the Public Health Sei vice, Audiovisual FacilityWith responsibility.-to."serve as the focal pointfOr the 'production, utilization, and distribu-tion of all audiovisual forms in support of themission of the Public Health Service andallied governmental organizations. Thefacility continued to 'provide audiovisualsupport, and services to all programs of CDC.

This 'dual role was maintained until itsreorganization and designation in 1967 as theNational Medir:il Audiovisual Center of theNational Lii: : of Medicine. In 1970, theCenter moved t, enhance and strengthNi theinformational\ar educational services of .theLibrary by expanding its programs in non-print media inCluding a ,clearinghous,.. ofinformation on instructional materials, evalu-ation and acquisition; distribution, advisoryservices; training Workshops, z.pplied re,search, and instructional media developmentprojects. '

In July 1971 the National Library ofMedicine and :he Bureatrof Health Manixiw-

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er Education of thc Depaitment of Health,Education, and Welfare agreed to establish anOtiice of Audiovisual Educational Devel-opmentrecently renamed, the LearningResources Program, Bureau of . HealthManpower, at the Center. Under this plan, theCenter contributes its staff and facilities for.audiovisual development and, distribution,training, consultation, and otherassistance tomedical institutions, The Bureau' of HealthManpoWer furnishes such resources as grantprograms, demonstration projects,, and stu-dent assistance. The Learning ResourcesProgram reviews and implements educationand training grants and contract proposals,and coordinates many joint intramural activ-ities of the Bureau and the Library.

'The National Medical Audiovisual Centeris concentrating on a national progrpm toimprove the use and effectiveness of learningmaterials in schools of the health sciences.The major programs and projects include theactivities discussed below

Clearinghouse

in FY 1975 the Center continued to host andparticipate in peer reyiew panels convened toscreen and 'evaluate medical teaching materi-als. This review process provides input for tlitLibrary's data base known as AVIAN':

P7

(Audiovisuals On-Line), The AVLINE clear-inghouse system is designed to provideinforination on audiovisual .materials in aformat similar to the MEDLINE system. ThiSis of value, to the teacher searching forvalidated audiovisual instructional materialsacceptable . for student 'self- instruction or insupport of lectures and other learning experi-.ences.

Surveys ,of raterials in use at schoOls of thehealth sciences, conducted by the' Associationof, American' Medical Colleges, the AmericanAssociation of Dental Schools,,and the Center,

. have identified about 22,000 items for possiblereview.. As of the end of the fiscal year,' 29panels had reviewed 4,364 educational items

these,' 2,590 'were deemed suitable forinclusion in AVLINE.and 368 were rated bythe panelists as "highly recommended." Theaudiovisuals in thiS latter .category are theprincipal source for the Center's materialsacquisition program.

The peer review prOcess is planned as a'. long-range, continuing program. In addition

to providing a central data base for audiovisual teaching materials and identifying thpsewhich are most appropriate for nationaldistribution, it will ultimately help to idenith

. areas in which development. of additionaleduCational materials is needed.

On May 1, 1975, the AVLINE test data basewas' released to 31 U.S.' Medical institutions._!The test .base contains about 250 reference's to'materials related to the nervous system. Afterthe on-line retrieval system is tested. it willreleased .nationwide starting with a data baseof about 900. citations.

EduCational Research an6 Evaluation I 6

A-new emphasis or research.and evalkationwas begun during the first half -of FY .1975with the creation of the Educational Researchand Evaluation Branch. This branch isresponsible for developing,: implementing,and measuring' the .effectiveness of appliedresearch projects inVolving the use.,of audio-

_visual media and educational methodology inhealth sciences education.

One example of an-applied research projectasks the question: HOwnay..we-derive a ruleof thumb method fandefinintcritical content'of learning packages and identify those testingelements _essential ;to .measuring learner*per-formance? This :would' help- distinguishperformance related "must know" from "need,to know" information in learning packages.Another example is 'that of setting tip fieldtesting of 'learning packages using a . cross-sectional national .audience of students, 1 his

;6`

;

is to determine learning effectiveness nide',pendent of any particular local conditions forinstruction.' These data would. be of greatvalue upon entry into the AVLINE data file ofevaluated learning packages, adding themostimportant, criteria of allthe results -ofstudent tryouts.

Acquisition and Distribution

During the,past year the Center's* distribu-tion program acquired 105 new audiovisualteaching packages for the collection, while 141packages were withdrawn. The new acquisi-tions represent about 13 percent of:the totalloan collection stressing continuing efforts toupgrade learning materials available to the.health sciences .commimity.-In this reportingperiod, the direct services. program' receivedand processed about 62,000 requests foraudiovisualsand shipped 51;000 films, 2,250 .

duplicate videotapes, and 4,800 duplicateaudiotapes in response. to these requests. Thedevelopment of a pilot program. for videocas-sette loans has been completed,. anddistribution is scheduled to begin next year.

In 1973 a Sales Program was begun 'incooperation with the National. AudiovisualCenter 'General Services Administration:Under this program, eight' self-instructionalteaching packages were placed for sale.through the National 'Audiovisual Center's ,

Government Film Sales Program The second,yean's operation added 224... new teaching

packages to the collection. During this year,35 new self-instructional teaching packageswere completed and added to the Sales'Program. This collection of titles covers thefollowing disciplines: anatomy-, 4astroenter-_,...ology,--mammography, ophthalmology, pa-tholoky, pediatrics; pulmonary diseases, lacli-ology, pulmonary , surgery, and veterinarymedicine.' Next year, about 72 new instruct,tional packages will be placed in the SalesProgram. New. subjects to be included will be:physiology, tissue ,culture, anesthesiology,'cardiology, nursing, and dentistry:

Workshops and Conferences

One of the Center's most effective means forreaching health- educators is-through work-

' shops and conference's focused on the develop-ment of . learning packages. The Centei'straining program attracted more than 650.participants In 18 workshop sessions , in FY1975. Examples of topics: criterion testdevelopment,. management of learning re-sources, learning spaces design. 'and basicprinciples of media management.

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The Center conducted a comprehensive..course for the- .training of regional mediaconsultants which was jointly planned andsponsored by the National Library of Medi-cine and the Medical Library Association.Eleven, trainees selected from the staffs 'oflibraries in the '=Regional Medical LibraryProgram' were given instruction in media

'selection, development, and evaluation, theorganization and management ;f of media'collections, and selecting and operatingvarious items of .audiovisual equipment.

The Certer's.!staff participated, in work-shops "held at the University. of California(Davis), the New Jersey College of Medicineand- Dentistry; a meeting of the New YorkNurses Association in Brooklyn, the UnitedStates. Military Academy, the Upstate NewYork Regional-Medical Library Association inSyraCuse, the .Mid-Atlantic Regional Medical'Library Association Meeting. at .RutgersUniversity, the :Chicago Dental Society'smidwinter meeting, and the Dental ScienceClub'of Washington, D.C:

Advisory Services

The Center offers assistance to healthsciences teaching institutions seeking torealize the full. potential of their audiovisualresources. Site visits by staff rewIlli in extensiveSurveys- and subsequently, .in collaborationwith the .requesting institutions, recommen-dations are made meeting specific needs.of theinstitutions. The staff conducted surveys orsite visits at the University of Alabama; WestVirginia ' UniverSity- Medical Center; DukeUniversity, Physician Assistant's Program;MissisStii Regional Medical Program, (Jack-.son); Creighton UniVersity; University -ofMiSsissippi Health Science Center; Florida A& M University School,of Pharmacy; 1.rniver-say. of Georgia, School of Veterinary Medi-cine; and Michigan State University.. Inaddition; assistance in facilities planning wasgiven 34 institutions including schools ofmedicine;- dentistry,' nursing; and allied

--health--I-n-a

sity of Louisville, Health.Scien6 Center, Dr.Ernest Ellison, the Director of BiornedicalEducational Resources, reported: "The natureof our, organization and the pattern of itsdevelopment is a direct- reflection of therecommendations made I:ty. the site visit teamfrom the National' Medical AudiovisualCenter."

. Direct problem-oriented consultation serv-ices- relating to educational technology and

76

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instructional media development were pro-vided 115 representatives of 35 schools of . .

Medicine, 5 schools each of ;dentistry . and .

.

nursing, 9 schools of alliedsheal t b. 20 nationalor international: agencies and professional*.societies, and 1.6, teaching-- hosPi ta

.A multi-media Learning Reseurce Centerwas established'-at the 'National, MedicalAudiovisual Center. for 'denionstration pur-poses, and, for, use. by visiting faculty andmedical librarians. The Learning ResourceCenter, has been 'Used. as a focal point foraudiovisual' mediaai the .Ceit.....n7.'s_Werkshops.and other, Meetings

.

Media Development

Most audiovisual desif , Id development..resources are being deVout, to the support ofmajor programs of the Centertraining,applied research, and distribution. Addition-ally, Many staff members' With audiovisual'production and education backgrounds areengaged in monitoring contracts for audiovis-ual development projects and services.Thiough a combination Of contractual, inhouse, and collaborative agreement efforts, 25..slide series, 22 motion' pictures, 18 videotapes,4 audiotape 'programs and 2 filmstrips werecompleted in: FY 75:

The team ;approach was adhered to irrallmedia development projects in which., theCenter was involved, including Project

./ACORDE (A ',Consortium On RestorativeDentistry Education-)'. Seven, cooperating

. institutions 'participate in .Project ACORDE:the American Association of Dental SChools,the Division Of "Dentistry (Bureau of HealthManpower);- Farwest Laboratory for Educa-tional Research and bevelopment,. andschools of dentistry at the State University ofNew York (Buffalo), .University of California(Los Angeles), and University of Florida.Fourteen . short teaching films withaccompanying instructor guides on the subjectof restoration of- cavity "preparatiOns werecompleted this year, and, addi'.ional units arenow-in-production.

New Technology-at;d- Future Directions

Advances in educational iechnolOgy duringthe last fifteen years have provided a solid basefor transforming health sciences education

and making it more responsive to the needs ofstudents and practitioners. Underlying recenteducational rationale is the concept _that-------"learning is a Jcicess-tharcan- be-treated in a

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systernavic manner,, by predesigning specificlearning' experiemes for the acquisition ofspecific competencies. Inherent in this conceptis the conviction that it should be geared to the

'attainment of performance capabilities by thelearner; rather than the tradition4lof content by the teacher. ,There is also agrowing emphasis on quality control andvalidated progtams with insistence thatinstructional -programs. be. tested and revisedUntil they can be shown to work in repeatedapplications.

The incorporation Of the;t; principles intolearning programs which make full use.of thecommunication capabilities of modern media

. systems can promote significant changes inthe training of health professionals. Some ofthe major characteristics and goals of this newapproach. are:

Health science Careers will be consideredunique, arid the need for !'customized"learning progranis to make instructionmore suitable for indiVidual learningstyles will 'be recognized

.Leatning centers will provide the spaces,media, materials, and other resourcesrequired -,to implement individualizedprogramsStudents will have greater flexibility inscheduling their learnirig experiences,includicg - the opportunity to. begin

'prof?ss studies before admission toa healt ienCeS school

Accurate descriptions of criterion com-.

petencies will enable the student to--check on his- progress and measure hisprofessiOnal growth

.

As these goals are realized; it will becomeincreasingly possible for students to assumeresponsibility for niore of theirown leirning,both in undergraduate training and through- ,

out their 'professional careers. These inno- .vations.in heal th.sciences education will make -

new demands upon institutions and theirfaculties. They will alSo influence future .

program .. efforts of the' Librar-y's NationalMedical' Audiovisual Center. Work areas that .

are currently underway and appear to holdparticular significance include:

Determination of a highly effective andefficient model for the design. of instruc-tion

Jo 0

Creating model formats for the packag-ing ofi.self-sufficient learning systems

Devising patterns of instructional man-agement to enhance independent learn-ing by large student groups . =

Identifying diffusion processes to facili-tate exchange of audiovisual materials

Continuing a national validation pro-gram to share in the review and ex-change information on educationalmaterials

Encouraging faculty development pro-grams to enhance teacher knowledge ofand commitment to the advantages ofsystematic instructional' development

By providing research, development, train-ing, and information in these areas, the Centerseeks to play an important role in theimprovement of.health sciences education andthereby contribute to better health care for thenation..

-C,

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Above: ATS-6 conmgnications satelliteRight: Dish ant: znas used for video transmission via ATS-6.

-NOVATIORAN HEALTH-COMMONICATION..Robert M. Bird, M.D., 'Director

it

Lister Hill National Center fo. Biomedical Communications

+4.

tra nt.g.re.

Public Law 90-456 established the ListerHill National Center for Biomedical Commu-nications in 1968 as an organizational compo-

: nenLof the National LibrarY of Medicine withtwo broad responsibilities. 'The; first was:

;.research and development, demonstration,and evaluation Of the' applicability of ad,vanced communications and compute: tech-

, nology to improved networks and informa-`tion systems for the betterment of healtheducation; medical research,and the deliveryof health services:As a parallel and secondresponsibility, the Center was identified as'afocal-point-within the Department of Health,Education, and Welfare for coordinating .

interagency efforts towards improving bio-,'-medical communications. 1-

Solutions to major' .biomedicalcommunication problems are sought bysupplying technological competence andexperimentally :derived information to thedesign of new communication systems andnetworks. These activities can -be classified inthe following progrliNatk areas:

,

Broadband Biomedical CominunicationsComputer Based EducationComputer 1 echnolog-y Researth' and

PevelopmentPoStgraduate -Education for the Piactic-

ing Healtfi/YrofessionalFocal Point and.' Coordination Role,

HEW

Broadband ,Biomedical Communications.

. Since July: 1970 the Lister. Hill Center hasbeen working. with Darunoutlil College' andthe University of Vermont in planning":building,'.. :and. helping....-to-iitCpport ..theOperations; of. the-1-larrtpshire Vermont

'.1gedical . :Interactive ''.NetwOrk"known as 'INTERAT. The -network is , a

dedicated, closed-eircuit,, two-way microwavetelevision .. system.. which. Connects ..twoacademic health centers

. Hitchcock_ Medical Center -and the MedicalfCenter of Vermont) with three con..inisitityhOspitals .(Claremont:; General Hospital,

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Central Vermont Medical Center. andRockingham. Memorial, Hospital), acommunity \ college (New Hampshire /Vocational-Technical College), :and a starprison, (Vermont State Correctional l'acilityatWindsor). It spans approXimately. 180 airmiles and ,share many of its transmissiontowers Withi, the Vermont Educational ,

Television Sy tem. A mobile vaii containingtransmitters and. receivers is: used io connectthe three taid 'ler statioas. The initial periodOf operation and construction of this networkwas, ,ievoted to `exploring the, uses and benefitsof interactive television in aremOte rural area.The past two years have tested the hypothesisthat the programs can demonstrate Costbenefits, to the users. to the point where theusers will assume . :a substantial _part of thecosts of providing these services.

Interactive television he racticing pro-obtain timely consu to services

and postgraduate education which re tes toimmediate clinical problenis. Certain medicalservices can be rendered over interactive

',television quite as well \ as with a. directphysician/patient encounter. Consultation indermatology is one example; Another ishandicapped children whO make 5:IA:prog-ress in speech 'therapy sessions' even thoughthe therapist is seen and heard Only via thetelevision set. 1. \

Achieving oPerational solvency has been aproblem for the network. Dartmouth isincreasing its 'efforts in this area and antic-ipates that the network wilt become ' self-supporting with the initiation of impiO4edmanagement practices and the assumptIon byall users of the prorated operational costs.Important lessOns have been learned whichapply to any future planning. of irgeraCaetelevision, networks for healdr.Tnteractivetelevision projectsshouldustified f m thestart in _terms-6f operational. benefits. The

rauanal products. have to :be cleclamed. in terms Of the needs of the 'usermarket. Management planning is as import-ant as Program planning it projects are torealize a cost effective end prOduct.

Since 1972 the Lister Hill Center hasworked wit's the partment of CommunityMedicine, Mount Sinai School of .Medicine,-New York City, to explore the potential ofcable 'television for disseminating healthinformation to an inner city geriatric popularnon. The'site, of the prOject is the GaylordWhite -House,--a. 248- apartment, high .risepublic .hOusing building in East Harlem.There are some 340 'tenants whose average ageis about 70. ThiS is the final year for this

./ -Projeer and. the Lister ,Hill Center..contem=Y;.=plates, no additional :funding. for the opera-tional,, support of thejtefwork.

Teclinically.,-the network has, been 'suet sszful.. The -,tenants : are very reeeptive to' the'

-.- programs .nd 'an. increasing number aite ' .'become inVolVed. . in .. the Production .pera- :.

tions.1 PrOgraini include derrionstrati ns onI , ,

hypertension; 'dental ';he.alth,T..diabete detec-. tiOn, mental ;health; .arid bri vision.- V deo tape

material in geriatric, medicine is ing..de-veloped for resident physicians:. fforts..,are

'underway with.the state and city agencies to.' .

. - evolve a mechanism for continuing this,cabletel:Siision health. link at the conclusion of the

- present project in August .1975.. '-.Since 1971. the CenterhaS been engaged in a .

series 'of ' experiments ' and.. demonstration' projects 'which \ apply: satellite ,commnnica-

.

non& technOldgiA to the 'stoltition DE recognized.problems in health education andhe deliveryof \- health serviees:2 Two. satellites,. in .rheNational. Aeronautics .and Space Administra-.tion'S Application Technology Satellite (ATS) .

series have .been. involved-FATS-1 and AT&.6.ATS -1, launched lin 1966, wasi designed for

'... two -way ._ voice. and data transmission. TheATS-6..Satellite was Placed in orbit in 1974 and 7possesses sufficient. power . to provide quality. 1- :television images ukng simple and relatively

.inexpensive ground terminals. (In May,1975,the ATS-6. ..Satellite. was .repositionecko coverthe Indian subcowinent4The projeiti inyOlvirig the combinerse of TS -.l and ATS-6Were (1). experitnetits. \With -the. Indian 'Health.

. . .

Servite in establiihing a MediCal ConsultativeNetwork Jorfeniote reat. in- Alaska; and -(2)eitperinients with the Univeriity:of.WaShing-

:_:--;----ton in Regionalized. edicalEduCation for thefour-state region 1.91 Washington, Alaska,Montana; and Idaho, (WAMI).

. LI ,

:----As---a-result-cif-the experiments to a.coordinated tclemeiliCine and health inforrna-' .' r'don system was dev.elopecLCOmmunity-basednative health aides 'in small and..inaccessiblevillages "had 'andiDtdatalvideo communica- -

. lion links with. physiCians at the 8ervice UnitHospital: in ,Tanana,Bodi. groups had avail-able to them meclicA,SpeCialiSti-in Anchorageand PairbankS for- consultation:. The Primary'. '

purpose of this Medical Consultative Networkwas-to enable., physicians at Tanana- to widethe village health (aide in the proper diagnosisand treatment of/village residents without theneedlortravel by the physiain or the\patient. 'The facilitation of constiltatitie . se -vices by.-

, .medical specialists was a.secondary.oklective.'Although' video: capability .ended with the,repositioning of the ATS-6, voice consultationis still7being. provided via\ ATS-1. ''

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The Regionalized Medical Education pros,ect (WAMI) wilh the University of Wishing-ton.; applied at; interactive audio data tele- .-.vision nett;: 'rk to the of antiluptiOnaVprogr am for niedifial stUdetits and .

residentWAMI

Afremote areas: The sitesof /the 'WAMI0 project were in Seattle,. Wash-

/ ..,ingtOn;' at the .UntVer§ity. Medical Center; in' Ornak, ..Washington,. at ak family medicine.

clinic; 'and. in Fairbanks; llaska, at :'the' .

University. ol'Alaska:The lirik'rtt Fairbanks .

tied the five sites of ilieMedical ConsUltative.NetWOrk with the three .sitescOf the 'WAMIexperiment. The .WAM.I. experimental prck, jgrarti,continues apd..has -two-objectives (1) to /incieise enrollment opportunities for medical'`studentS fqur -state regiOn without. the'need ,. for increasing the nuntbet, of medicalschools; and GO to structure undergraduateand. gracluate.?thedithl education. so as toencourage students .and-. resident physiCiah:graduates to locate in Medically underserved-.areas.

-

0: 0.00'

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tver tC

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Mal

ian at theTannoa-Hospital,log speCialis;:insatellite IS:',1:ett; Corn-

specialist Alaskacenter (

ae .

This program permits the first alcademicyear of medical school to be offered at aperipheral institution such, is the Uhnversityof Alaska. On completion, the siu ent ma-triculates at- the University of,-Wa hingtonSchool of Medicine for the three r maining

., yeas. Clinical clerkships conducte at co.munity clinical training unit ,are emphasiz

,. Seattle _segment of the prograResident PhysiciangSpend- up to three.monthsin these same community units.

Valuable lessons have been learned fromthese two major health experiments usingSatellite-based communications systems'. The

satellite system is highly reliable and avcidsmost of the I interference which 'aguesconventional high-frequency radio communi-cation in Alaska. ,fit is possible to extend theservices, of a hospital-based physician todistant villages by the use of telemedicineconferences supported by a good medicalrecord system: Thesvillage-based health aidefeels more secure and less isolated; the patientsare more confident Of the quality of the serv-

--ices received; travel by patients a\nd physicianscan be reduced to that which is indicatedmedically; the community as a whole im-proves its understanding. of health and the

/ delivery system.

The .WAMI ,Program demonstr tes thepossibilities inherent in regional sh ring ofpeople and -facilities- in the medical ed Cation-al process. The interactive video, aud'o, anddata communications network allows acuityand students located on multiple ca pusesand at rf:mote. clinical training locati ns toPartake; of one coordinated and inter atedMedical educational program.

Program planning for health expel.' entsand demonstrations: projects using the newComMunicatiOnsi Technology Satellite ( S)is'the'major cUrrent,activity of the Com uni-cations Engineering Branch of the Lister illCenter: This new satellite, a joint yen tire

-

between the Um ed Statesand_Canada, will belaunche in Ja uary 1976. Participation inthe CTS Biomedi al Communications Experi-ment dvantage us to the Lister Hill Centerfor two easons. T e'experimental period willbe relati ely long, he CTS satellite has beendesigne to allow c ast to coast communica-tions.

The nitial plann'ng phase for the CTSBiomed cal Commun ations Experiment canbe divi ed into three reas of activity.

The first area is the coordination ofprogra and evaluation planning, technicalengine ring sUpport and program manage-

' ment f r fdur health ag nciesthe NationalInstitu es of Health, th Health ResourcesAdmi istration, the Food and Drug Adminis-tratio , and the Alcohol, Drug Abuse, andMen Health Administra ion.

Th second area of pla ning involves an,

expa sion of the Universit of Washington'sWA I experiment The scope is to design andspec' y all. of the commuhications /system.

1 requ rernents to ensure flexibility iior ex-, pan ed utilization. The Uni ersity of Wash-

.--= ingt n7projects a greatly ex anded etwork.user population. The inclusi n of po tgradu-ate educatiOnal programs for p acticinghea th professionals within th experiment indec ntralized , medical educat'on opens anent rely new category of users nd addresses anationally recognized need.

he third area is plijifcal mac lity planning.Th goal is to provide the.sta of the ? .isterHill Center .a laboratory in whi h to conducttheir own experiments and de onstrations.Plans and specifications are bei g developed..(aria communications and bro dcast facilitywi hin the National Library of edicine. This

.. ., faof

ility, combined with a mobile van.which isalso in planning, will allow the nter to testp ojects in any area within the 'ountry.

.

mputer Based Education

a

The,current_year is the .erminproject which lOstered the inter nstitutionalsharing of computer assisted instr ction (CAI)resouices among .medical school, hospitals,and other health related orp.3ni dons. CAIprograms produced,.at the Orli° Statesity College of Medicine and at th Massachu-setts General Hospital were put o -line via acommercial nationwide timetharing commu-nications network, TYMSHARE, IInc

More than 80 medical schools have used.thenetwork for a variety of purpose, and newproblem areas requiring further xploration

1 have been identified. The opera tin cost of theretl.vork was large, however.:A.He 1th Educa-

83

Lion Netwg4 User Group has developed afunding mechanism which will assure theself-sustained continuation of the network.

The CAI experimental network served toidentify several factors inhibiting a morewidespread incorporation of computer-basededucational material into the, core curricula ofmedical schools. The cost of large\ hostcomputers, needed by many current \ CALprogram offerings, can be a significantdeterrent. Computer-based educational mate:rials are written in many languages anddialects. There is a need for language stand-ardization.

The needs of practicing health professionalsfor postgraduate education are great. Preserva-tion- of professional competence is -one goal.To address thiS goal, the Computer Technol-ogy Branch of the Lister Hill Center isplanning collaborative projects with theAmerican Academy of Orthopedic Surgeons,the American Academt. of Emergency RoomPhysicians, and the Department of Pediatricsof the Columbia Presbyterian Hospital ofNew York City. The objective underlying allof the current activities in CAI is to facilitatethe ease of production and use and evaluation

o;ae

ns

O

of 'computer-based learning materials andthereby maks the wider Use of computerlbasededucational programs an attractive option:

Computer Technflogy Researchand Development

A current activity with great promise is thedevelopment within the National Library- ofMedicine of a. training laboratory designed toconsolidate computer-based medical educa-tional resources in a single area toprovide:

Centralized review of course matetitl.,.,' and comparison of modalities:'Development of per review techniques;Evaluation of various techniques for

producing CAI materials:A learning resource for evaluation of

programs by area physicians andstudents; .

A state-of-the-art-equipment resourcesdemonstration area;

A focal. point for research and develop-ment using minicomputers andmicroprocessors in ..upport of var-ious library and educationalfunctions.

Three equipment items which will be placedin the training laboratory require furthercomment. The minicOmphter will be evaluat-.ed in computer-based programs for education,in its application, to library systems, and in thedevelopment of minicomputer systems. Thedesktop equipment item known as a "micro-processor laboratory" will be oriented towardsresearch in. tailored editing and file mainte-nance design, .in code conversion, and in datacommunications. An interactive,terminal willbe installed to permit experiments involvingmultiple users. .

ontinuing Postgraduate Educationfor Physicians

The lifetime of learning which is expectedof every competent medical practitionerrepresents in us aggregate a very largeeducational responsibility:There exists a vast

°- array of educational opportunities havingvaried sponsorship and effectiveness. Despiteall of these, there also,exists a disturbing sense.that current efforts'in continuing postgradu-,ate education are relatively ineffectual, ineffi-ci2nk, or of ,less than desirable 'quality orapplicability. Is there a place where the ListerHill Center can make a meaningful contribiption? In what type of laboratory os. clinicalsetting should experiments in postgraduateeducation be conducted? What experimentalprotocols are apprdpriate? Who should design

Speech therapy session on file New Hampshire VerinontMedical Interactive Television NetWork (INTERACT).

oi

the experiments? The answers to these ques-tions are being sought 'and should give theLister Hill Center 'ptiorities to ,be used inallocating its resources.

Your planning activities were directlyrelated to the Center's concern for thedevelopment of more timely, more relevant,and more accessible postgraduate educationalmaterials:

1. The Association for Hospital Medica!Education was supported in a national surveyof community hospitals and hospital consor-tia to determine the nature of the resourcesavailable for postgraduate educational pro-grams. Four of these institutions, not associat-ed with academic h 1,th centers, are beingstudied in depth. 0/1 knowledge of thesecommunity resources is essential to programdesign.2.2_,CollabOrative-planning is -underwaY withthe Health Services Administration and theHealth Resources Administration to developan information-consultation-education net-work for physicians in the National HealthService Corps. These Public Health Servicephysicians have just completed their residencytraining. Most are practicing in isolated ruralareas Tacking adequate health 'service re-sources. They appear to be an ideal group tostudy the problem of providing a communica-tions network dedicated to the disserninationof information direCtly related to medicalproblems occurringcuffing in practices involvingambulatory patients. The question being. tasked is: Can such efforts improve the quality

:of the serviCes.delivered and at the same timereduce he sense of isolation which is experi-enced by many who serve in remote areas?3. Administrative and management issues ofgreat magnitude confront administrators inacademic health centers. Accommodation tochange and management. of conflictinginterests and priorities perplex those whohead these :onstitutions. The turnover rate oftop administrators is rapid. Can the academictiealth community collectively learn from theexperiences of its individual' members? Canone develop a cadre of professionag who areprepared to attack the administrative :andmanagement °problems which 'they °willencounter on assuming any keyadministrative post? This represents a uniquearea of postgraduate education. The ListerHill Center and the Association of AinericanMedical Colleges are planning jointly todevelop communication and informationsystems, together with operational models, toimprove the managerial performance of tOpadministratirm in our academic health

,

centers.

8685

4. In May 1975 the Lister Hill Centersponsored a two-day conference devoted todeveloping priorities in ,programs inContinuing postgraduate education forpracticing physicians. Ten consultants wereinvited from the fields of community practice,medical education, university administration,and organized medicine. Some of thequestions which were asked included:

What should be the objectives ofpostgraduate continuing 'eduCation?

What is the most effective 'way oftransmitting knowledge, skills, andattitudes?

What are the best ways to identify thesubject matter needed by. foactitioners?

Does the nature of the subject. matteractate_themanner-of-deliVEff?-

What is the future for medical journals?Can-One docurneht educational goalsL....which are fundamentally unique to

the three phases of medical education:medical school, intern-resident, andcontinuing postgraduate?

Who is responsible for educating thepublic in matters of preventivemedicine and _ire various types ofpractice?

Focal Point Role for tb.: Lister,Hill Center0 .

The "Statement of Organization andFunctions and Delegations of Authority" forthe Lister Hill Center defines 'the Center's roleas, a focal point in biomedicalcommunications as follows

4 4 (5) represents DHEW in Federalactivities related to biomedicalcommunications activities; and (6) servesas the focal point in the Department fordevelopment and coordination ofbiomedical communication:- systemsand network projects."

Responding to p the desires of the'Telecommunications Policy Working Groupof Health, an Ad Hoc Workshop onTelecommunicationS' for Health was held atthe National' Library of Medicine inNovember 1974. The task of this workshop;with members representing the Department's,ix health agencies, was to formulate a policystatement for conaderatio7 by the Policy.Group:- The recommendation which wasdeveloperl'feads in part as follows:

It was the consensus of the Workshop torecommend to, the six agency heath io\eito the Assistant Secretary fo He:ati*that:

1. Agency heads assign an appropriatepriority and commitment of staff todeveloping the potential oftelecommunications systemsapplication. to health activities.

.2. An interagency group be establishedfor policy formulation andfaciiitatiqn of telecommunicationactivities:

3.. The Lister Hill National Center. forBiomedical Communications of theNational Library of Medicine beresponsible for providing technicalassistance and administrative supportto the group.

4. The interagency group, workingthrough and with the. Lister

Center for BiomedicalCommunications develop:a. A mechanism to assure

coordinated planning fortelecommunications needs ofhealth programs.

b. A 'means for encouraging activeassessment-of the potential use oftelecommuniCations in theprograms of H* and in the healthprogramg of the private sector;

c. A means of assuring that the Hagencies be informed oftechnical developments, andcontemplated politiCal,administrative and legislativeactions which may affect theagencies' access to and utilizationof telecommunications systems.

G. 7 A means of assuring that Hagencies have an 'appropriate rolein the decision-making process inDHEW regarding future

:developments in tele-communications.

The planning activities being coordinatedby the Communications Engineering Branch-of the Lister Hill Center for theCominunications Technology Satellite are indirect response to the policies `recommendedby the Ad Hoc Workshop.

The Lister Hill Center has assumed anactive coordinating and technical support rolein planning a broadband communicationsutility for the Public Health Service. Theplanning objective' is to develop for HEWShealth agencies .a mechanism for the'coordinated planning of health programsinvolving the use of telecommunications, and

That part-of the Department repreienteci I 'i''Health) in HEW.

4

for evolving a National BroadbandBiomedical Corrimunications Utility. Major

'milestones, in this effort will be:, Development of a clearinghouse on

technology relevant to health. _

programDevelopmern, of traffic and network

models.Development of recoinmendationF for

National Broadband BiomedicalCommunications Network.

Development of a coordinated plan for aBroadband BiomedicalCommunications Ne-twork responsiveto-the current and evolving.needs ofthe health agencies.

The Department of Health, Education, andWelfare directed the Public Health Service 'toplan a consolidated PHS Data Communica-

0

tions Utility with a two-level structure. Thereis to be an executive steering, committee ofagency administrative officers and a planningtask force of computer and communicationsspecialists from each PHS agency. The task:orce developed an approach planand recom-mended that the Lister Hill Center be the lead.organization, with task force control over ,theplanning:effort. -In-house and contract re-sources have been mobilized to support thisplannit.g activity.

The responsibilities, inherent in serving asthe -focal point for biomedical communica- ,tions for theheHtlfagencies plates continuingdemands on ..he professional and fiscalresources of the Lister Hill Center. Althoughthe responsibilities are great, they serve asopportunities for making significant contri-butions to .the health of the nation.

87

'CHAPTER X ADMINISTERING A SPACE-AGE

Artist's rendering of the proposedLister Hill National Center for .

Biomedical Communications.

COMMUNICATIONS RESOURCE

Kent Smith, Assistant Director,Administration

The steady increase in the scope of theLibrary's programs over almost a century anda half has been accompanied by increasinglycomplex administrative and managementsupport services. Personnel, budget, andfacilities (i.e., people, money, and space) haveconcerned the Library's administrators sincethe 1836 estimate of expenses for the ArmySurgeon General's Office included an item of$150'for "Medical Books.'

In the last decade a number of major newprograms have come into being; increasingsignificantly the task of managing the Library.In 1965 the Medical Library Assistance Actauthorized a .grant program (Chapter VI); theToxicology Information Program was createdin 1967 (Chapter III); also in 1967 theNational Medical Audiovisual Center becamea part of the Library (Chapter VIII); and in1968 the Lister. Hill National Center lotBiomedical Communications was established(Chapter IX).

li

Board of Regents

The National Library of Medicine's Boardof Regents was established on August 3, 1956by P.L. 941, 84th Congress. The Boardconsists of the Surgeons General of the PublicHealth Service, the .` rmy, the Navy, and theAir Force; the Chief Medical Directorial theDepartment of Medicine and Surgery, Veter-

.. ans Administration; the Msistant Director forBiological and Medical Sciences of theNational Science Foundation; and the Librar-ian of Congress, all of whom serve as.ex officiomembers; and ten members appointed by thePresident, with .the advice and consent of theSenate. The ten appointed memberselected from among leaders in thefields of the fundamental es,dentistry, public health,tion, pharmacology, methin public affairs. At leasmembers are selected frthe fields of medical, den aresearch and education. rshOld office for a term o r ye

O

,

Financial Resources

TABI.i 18. Amounts Obligated by NLMFY 1972 - FY 1476*

n contrast to the 1836 "budg, . quest" of$150, in January 1975 the Presidt. submittedto Congress' the Administration's budget forfiscal year 1976 which inciUded 0,015,000 Eta'the Library. The increase over coversonly.mandatory costs for such items' as salariesand, benefits and does not provide, for anyexpansion of NLM program activities. ThePresident's budget also called for a reductionof seven positions.

0

-31

20

A 15.s

10

GRANTS

CONTRACTSANDAGREEMENTS

DIRECTOPERATIONS

1972 1973 1974 '1975 1976*

*Amounts for 1976 are estimates

TABLE 19. Financial Resources and .Allocations - Fiscal Year 1975

Amounts Available for ObligationAppropriation, NLM $28,450,000PIUS: Unobligated.Balance Brought Forward,

Start of FY 1975 182,000Pay cost supplement 403,000Earned Reimbursements 1,298,000

Total 30,330,000

Amounts Obligated by Extramural Programs 6;687,000

Amotints Obligated for Direct Operations -

Liiter Hill National Center for Biomedical Communications 2,234,000National MediCal Audiovisual Center 4,049,000Office of Computer and COmmunications Services 4,233;000.

'Library Operationso

6 219 000Toxicology Information Program J

1,881,000 a"Review andApproval of Grants 803,000Progrard-Oirection 4,035,000

`Subtotal, nirect Operations 23,454,000

Total Obligation's, NLM ° 30,141,000

91

a.-

1?.

TABLE 20. Personnel Ceilings

FY.1969 FY 1970 FY 1971 F'Y 1972 -FY1973 FY 1974 FY1975

OFFICE OF THE DIRECTOR 14 12 13 12 12 11 9

OFFICE OF INQUIRIES ANDPUBLICATIONS MANAGEMENT 7 6 6 5 6 5 5

OFFICE OF ADMINISTRATION 35 32 , 34 37- 36 16 34.

OFFICE OF COMPUTER ANDCOMMUNICATIONS SERVICES 55 57 --58 55 54 51 52

1,

EXTRAMURAL PROGRAMS 30 32 34 31 30 27, 22

LISTER HILL NATIONALCENTER FOR BIOMEDICALCOMMUNICATIONS

12 11 13 15 17 20 .22SPECIALIZED INFORMATIONSERVICES 18 18 17 17 16 17 17

NATIONAL MEDICAL AUDIOVISUALCENTER 122 109 104 105 103 100 101

LIBRARY OPERATIONS 196 198 188 192 192 .199 196

.

TOTALS 489 475 .467 r69 466 46.6 . 458:

In -April 1975 subcc 'ittees of Loth theHouse and Senate Ac iations Comniit-tees held hearings_ on L.,i. Library's request.Considerable interest was focused on the

o progress of the proposed Lister -Hill_Center:building: Dr. Cummings'" `informed bothCoMmittees that final architectural andengineering. plans /had been .completed andthat constructicip.. of this 'spe: 7.'1,ized facilityCould begin as,soon as funds were appropriat-ed. Both the' House and Senate Appropria-etions COnimittee Reifortsw on the HEWappropriation bill issued in June 1975 calledfor the' inclusion of $26 Million for construc-

/ tion/and expressed the: belief that the ListerHill Center building should not be .further

9. deelayed. .

The : Library continued to experience the; debilitating effects of inflation in . 1975,

particularly in the acquisition of serials andmonographs. The Library also continues toencounter difficulties in meeting 'its servicedemands because of loWer personnel leveK

Staffing

The Library has continued to operatewithin tight_personnel restrictions: A person-

ceiling of 468 at the beginning.of FY 1975was reduced at mid-year. by 10 positions. Theactual number of employees .as Of -June 30,1975, included 340 assigned at the Library, 98at the National Medical Audiovisual Center inAtlanta; and 25 in the Extramural PrOgrams,in an off-campus government office- buildingIn Bethesda.

Robert M. Bird, M.D., was named Directorof the Lister Hill National Center forBiomedical Communications in September1974. Dr. Bird came to the Library from theUniversity of Oklahoma School of Medicinewhere he had been a member of. the facultr_since 1952 and had served as Dean since 1970.He is the author of more than 50 articles and amember of numerous professional and.scien-

N.,.., tific societies. Dr. Bird received the Universityof 'Oklahoma Regents Award for Superior

Teaching, and, was Governor of the AmeiricanCollege of Physicians in Oklahoma. i .

Ben- Erdman,' B.S., was appointed ilputyDirector of the 'Lister Hill Center in March1975. A former instructor in: electricalengineering at Northeastern University,Erdman served more than ten /Years as ¢aspecialist in. computer and communicationssystems with the Depaxtmenrof Defense priorto joining the Library staff. .

Another addition to the Lister Hill Centerstaff was Charles M.\ Goldstein, (B.S., M.S.,who was appointed Chief of the Computei%.Technology Branch in September 1974. Aformer Fulbright scholar who studied mathe-matics and physics in Gerrriany, Mr. Gold-stein served for 18 years With 'the NationalAeronautics and Space Adrninistratiop, mostrecently as chief of 'the Computerized Infonta-don Systems Office of t r. Lewis, ResearchCenter in Cleveland, Ohi ..'.

R. Brian Makoff wa.. appointed.- the Li-brary's Persolrinel Officeijn August 1974. Mr.Makoff formerly held Personnel positions in

_the_ Environmental Protection Ageney; theNational Bureau of Standards, the DefenseMapping Agency, and,the Agency for Interna-

Mr. Day also received the annual Director>Award at the June 1975 meeting of the Board

of 'Regents: In presenting the. award. Di.Cummings cited Mr1 Day's highly effectiveleadership and management during his past

-, 21/2 years as. Deputy Director. "He luls repre-,sensed NLM at highest levels of policy andtechnical Conft ':z':!:..,:eslk.vith great dignity anddistinction."

'In October 1974, Mr ;Day was installed aspresiolem-elect of the American Society forInfortation Science. After he becomes presi-dent in Octpber 1975, Mr: Day will preside atall business meetings of.the7SOciety and will ;also serve as chairman of its Cduncil.

. Harold M. Schoolman, M.Q. , AssistantDeputy/Director, received an H1W SuperiorService Honor Award for .his..."notable contri-bution to the planning, development, coordi- /nation, and eValuation of the NLM pro- /grams." Dr. Sehoolfnan alscoireceived the/Alumnus- of the Year Award for,. Service toGovernment from the Medical Alumni Asso-ciation of the University of Illinois.

John Cox; Chief;. General APplicatipns. Branch, Office of. Computer and Communicar__

tions SyStems, received the -Sixth A- nualtional Development..He was president-of the, Regents Award TechTechnicalMontgomery County Chapter of\ the International Personnel Management Association in1973-1974.

Clifford A. Bachrach, M.D., was Selected tohead. the Medical Subject' Headings. Section inthe Office of the Associate Director for Library-Operations. Dr. Bachrach had been ;chief ofthe Bibliographic Services Division. Hisformer deputy, William H. Caldwell, waspromoted to the position of Chief of the --.Division.

RithaTd T. West was selected to beComechief of the Office of Program Planning andEvaluation of the Extramural, Programs. Mr.West had served as-a-Prograin Officer.An theExtramural Programs since 1970. \

,

Awards and Honors

The Venezuelan Academy Of Physical.MatheMatical, and Natural Sciences in late1974 electedDirector Martin M. Cummings,

. M.D., arid Melvin-S. Day, Deputy Director, tobe HoruTtary -resPornding Members. TheVenezuelan Academy is the oldest such grogpin the .Western Hemisphere. Dr. Cummingsand Mr. Day were honored for their pioneer-ing work in the field of information techricilogy and, in the words of the Academy:contributions have changed the course ofScience-communicatiT."

Achievement. Mr. Cox was citedfor- his"exceptional techniCal and managerial contri-butions to the development and implementa-tion of MEDLARS II."

Lister Hill Center Building

Several factors :h led to the ration; -

that the' Library must .expand,it hysicalplant. The most significant of -these N.,4as the

- recognition that the Library' must /becomemore than a traditional. medical library:. it_

become a comprehensive natiOnal_.;center fOr biomedical communications. The

-- legislative basis for this eipanded ink 'isfound in the Joint Resolution of Congress (PL90-456), signed . by President Johnson onAugust 3, 1968, which .established the ListerHill National Center for Bioniedical Coirrinu-nicatioris:- Specifically.; this.'resolutionf6r . a National Center for BiomedicalComniunicationS .to be constructed andlocated.as part of this Library . . .

Three other events w.lich occurred prior tothe formal ,establishment "of. the Lister Hill

. ',Center -dist:. increased 'pressure for physicil'expansion: The Medical Library Assistance -;.Act of 1965 created -a grants and contracts.program within' the Library to assist the ,nation in meeting the need for adequate,medical library services and facilities. Space.

94 93

- for the staff required to administer this. program is currently provided in off-Site ot-fices. A Toxicology informatidn Program was s °

.:'.' established in 1961. Staff. for this programcurrently occupy space originally deSignated

_ stack area. "Flut Public Health ServiceAudiovisual FaCility, then a part of theCommunicable Disease Center in AtlantaiwaS'transferred to the Library in 1957 and Wasredesignated the National Medical Audiovisu-al Center. Though closely tied .programmati-

with other areas of the. Library, especial-.,',Iy.the Ester. Hill Center. the Center remained

physically ,in Atlanta. t..,

This program `growth . was not foreSeenduring plannv:tg for the, .present. Library

. facility,' which was Occupied in 1962:The. 1"

problemof providing space for theexpandirigcollection as been compounded as a result of:convertin 25,000 square feet -of spacenally desi ated as stack area to office sp4ce.

prese t facility, designed to.acCommodatea staff of 50, now houses about 340 employ-

ees. They have -been accommodatgd, only: byseriously vex:crowding available..work space.

a /

Congress has been in the. forefront both inrecognizing the need for the new

'Center facility*. and in expressing strongupport, for its construction. The Senate,ppropriatiOns.. Committee's formal !, 1:itortsn HEW, appropriation bills for 1973and 1974

stated very forcefully ir, position regarding:construction of this much needed facility.'

'hithe `19731 report . the Committee 'expresseddisappointment 2"that funds available in, FY,1970' for architectural. and _engineering s t tidies

. have. not yet: been obligated :I by the.Departmeut\: -aiid further stated thauthe need 7for this .facility .1:ras'"imperative;" In the 1974report the - Committee 'stated "that adequatespace may becomean -acute problem because.of the rapidly grciwing iomeditalliterature." HOuseof Reprecritatives .supporthas been equally /'strong. The -House-Approp-nations Committees Report .on HEW'sappropriatiOn bill for FY 1974 stated,space available\ in the present building May.'soon be inadequate. Architectural planS areunderway and it\ is expected theseplans will beCompleted in time before the space problem'becomeS acute.`''

1 .

_

,-_1 I

John Cox (right) receives egente award-from W. N Hubbard; M.D.Chairman, (left) and NLM- :rector Cummings.

Planningenoney for the architectural andengineering design efforts was requested andappropriated in FY 1970, but not released bythe o f f i c e of Mailagemen t-a nd_Budge t: tint ii:

,,,, January 1972'. :Ah architectural and engineer '' mg contract was.awarded in November 197...and. finai IX, brking drawings )--".? now com pie e,

ilaltieh..icunstruction funds are applopria, ed;bids for: the;-actual construction-contlact-..can /:

' be solieitedimmediately.-The Lister- Hifi Center will be c nsttucted

adjacent' Co - the ,present Library and willcontain .200,000 gross sqUare feet. I will riseten stories -aboVegrade; three eves will bebelow grade and will form a podium- y pe basefor the .ten story tower. The Center -.:will...: .co ta, offices, conferenCe rooms; an auditori:u ; . Ornedical communications laboratories, 7exhi t areas,- computer anct,coniniunication

'lady ies;:audioyisual piodlictioii rooms, and - .,, lie aty.serVice.faCilittes. Current Consfirtirf- ..

'.` i':Oti4ost is estimated at: $28;000,000. ' .

- The new building would 'hOuse' staff of the .

Lister Hill :Center,: the National Medical-Audiovisualf, Cehter, the Extramural Pro-grains, the Specialized- Information_ ServicesProgram, the Office of ,Computer a. d Corry -.

municatiom Systems, and small _onion ofary pera'Libr Operations.. ,. 5 , .

CopyrightA' .

'Sti.:en years almost_ to._ the__cla..y_af ter theWiftains & Wilkins Company filed a petitionagainst the .Federal Goverpment. allegingcriF ,-, -ig!--. . infringethent. the U:S.--SupremeCourt that it would not overturn alower court adsion in ,favOr of the:Govern-

. ment. -The -final. ruling was announced onFebruary 25,.`1975. The J6ticesvere split fourt;.; four on the question, but by their deadlockthey affiOned__a_197A ,U.S. Court Of --Claimsdecision :that photocopying by the NationalLibrary ,Of MediCifie and the National 'Insti-tute&of 'Health Library of:cdpyrighted journal

. articles/kir interlibrary: loan is-not a;copyrightviolation, I

On February:16, 1972, CoimnisSiimer JamesF.-Davis of the US: Court of Claims; where"the` case was first argued, filed a trepart to, t_ hatCourt in which he, held in 'fa'Or,-of theplaintiff-- Government attorney3,-,,,filed an 4exception to the report and on Novenhbef 27\,11973; by :a vote of four tq three; the full Giaurtof Claims found in faVor of the GrivernmentAThat decision was appeaiedr to 'the:'.U.8:1Supreme _Colin by Williams &Among the organizations filing brief's with thecourr.l. on _behalf of the Library were :the,-..ionerican Library Association, National Edu-cation 'Association, AssOciation of ResearchLibraries, :Special Libraries Association,Medical Library Associatiwi, American Asso-,elation of Law Librarie, American Medical.

,Association; American tental Association;Mayo :Foundation, UniVen:ity =of Michigan

.Medical: School; UniVersfiV Of Rochester ,Schoolsof Medicine and Deritistrj', AmericanSociological AssociatiOn, Modern LanguageAssociation, History of MOicine Society, andRobert H. Ebert, M4D.,- (in his capacity asDean-of/ the, - Faculty of' ,Medicine, HarvardUniverii-qi). Although much of the activity todate relating to stems from the court .

.action,/ we believe/ that. the issue ,must ulti-mately be settled lh Congress,' where legisla-tion for the general revision'of the, copyrightlaw is pending.

TheLlengthy legal priiiceedings _started onFebritlry_27, 1968, wheni_Williains Sc W:ilkins,a medical publiihing firrn in Baltimore, filed asuit charging. that the Library and:NIH, by'providing. 'health_ profetssionals- with Singlephothcopies of journal 'artick's; had infringed.The publisherl-ToTTright The Governinent.argued that such copying -for.. interlibrary. loan,Was within(' the definitiOn ..fair. Use, andthat:such refirot,..tction was tiecessary to insure'the :dissemination -of publi-:hed research re-sults:

2.xhibits

1 -be Library put three exhibits on display inits lOblay in FY 1975. The first two, comprised !

of material frotiLthe Histoty of Medicinecollectici, were .on 'Wed/tine_ Of World

--P-tand The :Hopkins Foo:f." The la trei.:' /exhibit displayed material_relating to the

careers of\ foil!. famous U..S. physiciansassociated with_the Johns Hopkins S(hool ofMedicine: S. Halsted,__--.William H. Welch, and Howard A. Kelly: Thethird exhibit, entitled !*The PirySician asArtist," . was a ccillection of paintings., anddraWings by a prominent uicipathelogiSt,Meyer M. .

Equal :Employment Opportunity .Activitiess

After- the Library's EEO ` OriferenceHarrier's Ferryln March 1971, the pdsition ofEEO .tcriclinator was established and"' twoAffiitntitive,Action Plans were developed TheBethesda plan was comple.ed in August 1972and the'Atlanta plan :inFtbrUary..1971....

'Vital to the Library'sEEOlatog.am Is opencommunication betWeen empleyees:and- monagement. The situation at the Libiarir has

'by /Vain,- Robincin, EEO Coordinator

- .

been enhanced by the establishment of anEEO Committee. Employees are encouragedto bring their concerns to the elected repre-sentatives who form'. the Committee. Atpresent, the Committee is reviewing the EEOprogram's effectiveness in each of the programareas, and the involvement of minority staff inprofessional meetings.

In the area of promotions, with 28 percentof the workforce minority employees, minori-ty promotions have gone from 27 percent ofthe total promotions in 1970 to a high of 60percent__ in 1973, a positive influence of the197r conferente: In 'FY_.- 1975 a drop to 42percent occurred. It is expected thaGas-former.inequities are corrected, ' the number ofminority employees promoted will come intoline with their proportional share of theLibrary's workforce. Promotions for Women,who represent 51 percent of the workforce,have gone from 56 percent of the .totalpromotions in 1970 to 70 percent in 1973(again. a positive result of the conference), to57 percent ini1975. Here, a leveling off is alsoexpected.

Progress has been made in minority hiringdue in part to an increase in EEO awareness,among Library supervisors and staff. Recenthirings of ilE10 significance include twolibrarians, two adminiStrative officers, oneengineer (all minority members), two femalecomputer operators, and a male secretary.Several of these positions have been. in thehigher grades.

Some positions were created as a result ofjob engineering and restructuring whichprovided greater responsibility and opportu-nity for minbrity employees. Among these

/ n

were an administrative trainee position estab-lished in 1972 in the Office of Administra-tion, and an in-house training program forfive library technicians interested in qualify-ing as librarians. In addition, attempts arebeing made to attract more minority librariansinto the highly competitive Library AssociateTraining Program.

The Library participates in the variousHEW Upward Mobility Programs. Theseinclude: Project Stridea program combin-ing college courses and on -the -job training fornonprofessionals; Project 'Accessa coopera-tive work-study program involving alternatingperiods of. full -time work and full-time collegeattendance; and Upward-Mobility Collegeacollege degree and precollege preparatoryprogram on the campus of the NationalInstitutes of Health. The Library has threestudents enrolled in Project Stride, one inProject Access, and 23 in the Upward MobilityCollege. Four Library employees have receivedcollege degrees through the Upward MobilityCollege.

An annual EEO awards ceremony was-instituted in 1972 to recognize employees who

have demonstrated outstanding accomplish-ments in fostering equal employment oppor-tunity objectives. During this ceremony theDirector. presents highlights of the Library'sEEO program and announces his support ofrecommendations he feels will assist theLibrary to reach its EEO objectives. In 1974the National Institutes of Health EEO Awardwas presented to Rita Orr, Personnel Special-ist at the Library.

97

Appendix 1. Staff Bibliography

The following articles and other. works were published by National Library of Medicine authors inFY 1975:

Aines, A.A. and Day, M.S.: National planning. In Cuadra, G.A. (Ed.): Annual Riview ofInformation Science and Technology. Washington, D.C., American Society for Information Science.1975, Vol. 10.

Blake, J.B.: The anatomical lectures of WiAiam-Shippen, 1766. Transactions and Studies of theCollege of Physicians of Philadelphia. 42:61-66, July 1974.

Blake, J.B.: The compleat housewife. Bulletin of the History of Medicine. 49: 30-42, Spring 1975.

Blake; J.B.: Health reform. In Gaustad, E.S. (Ed.): The Rise of Adventism: Religion and Society inMid-nineteenth-century America. "New York, Harper & Row, 1975, pp. 30-49.

Calhoun, E.G.: Information sources. In Lieberman, E.J. (Ed.): Mental Health: The Public HealthChallenge. Washington, D.C., American Public Health Association, 1975, pp. 261-269,

Cassedy, J.H.: Early uses of acupuncture in the United States. Bulletin of the New York Academic'Medicine. 50: 892-906, 1974.

Cassedy, J.H.: Medicine and the rise of statistics. In Debus, A.G. (Ed.): Medicine in SeventeenthCentury England. Symposium held at UCLA in Honor of C.D. O'Malley. Berkeley, University ofCalifornia Press, 1974, pp. 283-312.

Cassedy, J.H.: The roots of American sanitary reform 1843-47: seven letters from John H. Griscomto Lemuel Shattuck. Journal of the History of Medicine. 30: 136-147, April 1975.

Corning, M.E.: Effect of copyright on dissemination of information. In Proceedings of the GeneralAssembly Meeting, International Council of Scientific Unions Abstracting Board (ICSU AB), Berlin.Germany', July 1971, pp. 203-214.

Corning, M.E.: National Library of Medicine: international cooperation for biomedicalcommunications. Bulletin of the Medical Library Association. 63(1.): 14-22, 1973.

Cosmides, G.J.: Human 'variabilityand safer, more effective pharmacotherapy. Orthopaedic.Review. 3(8): 7-12, 1974.

Cummings, M.M.: A comment on William B. Bean's medical writing. Archives of InternalMedicine. 134(11): 834-835, 1974.

Gluckstein, F.P.: Liseases of public health significance. In-Weisbroth, S.H., Flatt, R.E., and Kraus,A.L. (Eds.): The Biology of the Laboratory Rabbit. New York Ac demic Press, 1974, pp. 453-462.

unrphrearching_the_MEni ARS citation file on-line uskt.g ELHILL 2 and STAIRS: acomparison. Information Storage and Retrieval. 10: 321-329, 1974.

Kissman, H.M. and Oxman, M.A.: The .Toxicology Data Bank. United Nations EnvironmentProgramme, Expert Workshop on an International Register of Potentially Toxic Chemicals,Bilthoven. The Netherlands, January 6-11, 1975.

Krivatsy, P.: Paracelsus in Basel: the time of change. In Proceedings of the XXIII InternationalCongress of the History of Medicine, London, 2,-9 September 1972. London, Wellcome Institute of theHistory of Medicine, 1974, vol. 2, pp. 1106-1110.

Lee, M.O., Lee, D.C., Kim, S., and Clifford, D.H.: Cardiovascular effects of acupuncture at Isu SanLi (St-36) in dogs. Journal of Surgical Research. 18:51-63, 1975.

McCarn, D.B.: Trends in information. In Zunde, P. (Ed.): Information Utilities: Proceedings of theASIS Annual Meeting. Washington, D.C., ASIS, 1974, vol. 11, pp. 145-150.

plch, P.D.: The Halsted society, 1924-1974. The Johns Hopkins Medical Journal. 135: 33-41, 1974.

Olch, P.D.: William S. Halsted and local anesthesia: contributions and complications.Anesthesiology. 42: 479-486, 1975.

Schootnrani-IL-M,i-The-future4-libraries,libr2rians,. and users 1,.ibrary Trends July 1974,pp. 165-175.

97

Waserman, M.J.: Two early case reports. Journal of the History of Medicine. 30: 165-167, April1975.

Wooster, H.: Eheu fugaces .not quite posthumously. Bulletin of the American Society forInformation'Science (ASIS). 1: 9, 31-32, 1974.

Wooster, H.: Marking and parkinga sexist fable. Journal of Documentation. 30: 224-227, 1974.

Wooster, H. and Lewis, J.F.: The utility of computer assisted instructionan experimental .network. In -Zune, P. (Ed.): Information Utilities: Proceedings of the ASIS Annual. .Meeting.W'ashington,.D.C., ASIS, 1974, vol. 11, pp. 213-217.

-Appendix 2. P.L. 480 Supported Publications

Fiscal Year 1975

Arnon, Ruth, "Immunochemistry of Enzymes," The Antigens, Volume 1. New York, New York:Academic Press, 1973, pp. 87-159.

Heinroth, Johann Christian. Textbook of Disturbances on Mental Life or Disturbances of the Souland Their Treatment, Volume 1 - Thcory. Translated by J. SchmOrak, Jerusalem, Israel Programfor Scientific Translations. Baltimore, Maryland: The Johns Hopkins University Press, 1975. 229pp.

Kohn, Alexander, and Fuchs, Pinhas, "Initial Effects of Viral Infection in Bacterial and Animal Host.Cells," Advances in Virus Research,' Volume 18, New York, New York: Academic Press, c 1973. pp.159-194.

Laufer, A. "Human and Experimental Myocarditis," Israel Journal of Medical Sciences, Volume 11,Number 1, January 1975. pp. 37-66.

'Leibowitz, J.D. and Marcus, S. (eds.) Moses Maimonides on the Causes of Symptoms, Berkeley,California: University of California Press. 1974. 263 pp.

Masfinski, Czeslaur (ed.) Histamine. Stroudsburg, Pennsylvania: Dowden, Hutchinson & Ross, inc.1973. 363 pp. .

Rabinowitz, David, and Roth, Jesse. (eds.). "Heterogeneity of Polypeptide Hormbnes," IsraelJournal of Medical Sciences. Volume 10, No. 10, October 1974. pp. 1183-1363.

Samueloff, Shiomo. "Metabolic Aspects of Desert Adaptation (Man),". Advances in MetabolicDisorders, Volume 7, 1974, pp. 95-138.

Sandbank; U. and .Bubis, J.J. The Development of Synapses; a Review of the EmbryologicalDevelopment of Synapses in the Central Nervous System. Los Angeles, California: BrainInformation Service, Brain Research Institute, University. of California, 1974. 39 pp.

98

Sandbank U. and Bubis, J.J. The Morphology of Motor Endplates. Los Angeles, California: BrainInformation Service, Brain Research Institute, University of California, 1974. 72 pp.

The Pathology of Synapses. Los Angeles, California: Brain Information Service, BrainResearch Institute, University of California, 1974. 49 pp.

Rachmilewitz, Eliezar, A. 'Denaturation of the Normal and Abnormal Hemoglobin Molecule,"Seminars in Hematology, Volume 11, Number 4, 1974. pp. 441-462.

Shoshan, Shmuel, and Gross, Jerome. "Biosynthesis and Metabolism of Collages' and 'Its Role inTissue Repair Processes," Israel Journal of Medical Sciences, Volume 10, Number 5, May 1974. pp.463-576.

Trainin; N. "Thymic Hormones and the Immune Response," Physiological Review, Volume 54.Number 2, April 1974; pp. 272:315:

Weiss, David W. (ed.). "Immunological" Parameters of Host-Tumor Relationships III," IsraelJournal of Medical Sciences, Volume 10, Number 8, August 1974, pp. 815-1074.

Zathorski, Witold W. (ed.). Coal Workers' Pneumoconiosis: A Critical Review. Hanover, NewHampshire: The University Press of New England, 197g. 108pp.

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