NATIONAL

MEDICINE

Ii;rirri r
BRARY PI- HFOICIHI:

THE EARLY YEARS

\Jn 1836 the U.S. Army's first surgeon general

C/ included an item in his estimate of official

expenditures for the following year that read:

"Medical Books for Office, $150." Viewed retrospectively, this commitment by Dr. Joseph

Lovell of nearly seven per cent of his annual

office budget for this purpose may have been

the most significant decision of his professional

career.

For it is from that year

and the bulging books helve s in Lovell's

two-room office in a

long-forgotten building

in Washington City

that the National Library of Medicine officially traces its historic origins. No medical prophet could have

foreseen the inevitable

course that followed

until now, nearly a

century and a half later, this great library holds

the most prestigious and important collection

of health sciences literature ever assembled.

A Bostonian and Harvard graduate, Lovell had

served as an Army medical officer for only six

years when in 1818 at the age of 29 he was

appointed surgeon general, a new staff position in Washington established in a Congressional reorganization of the Army. He initiated the policy of providing his officers in the

field, as well as those assigned to hospitals,

with medical textbooks and professional journals. Copies were also retained in his office

for the use of his small staff.

By 1840 Lovell's successor, Dr. Thomas

Lawson, listed "some 130 titles and about

200 volumes" in a handwritten report by a

member of his staff that is now a precious

archive, "A Catalogue of Books in the Library

of the Surgeon General's Office." Lovell's

Dr. Joseph Lovell

random collection of books was officially a

library. Actually it became a mobile library

that accompanied the surgeon general's office

around early Washington in its frequent

moves to borrowed or

rented quarters, sometimes in private dwellings.

During Lawson's 25-

year tenure as surgeon

genera I—the longest

 Riggs Bank

 Building

on record—an increasing number of expenditures for medical books, journal subscriptions,

bindings, and bookcases began to appear in

his office records. When the first printed catalog of the Library's holdings appeared in 1864

it listed 1,365 volumes under nine classes of

literature, and included the date and place of

publication of each title. By this time the surgeon general's office was in a brick building,

formerly a residence, adjacent to the Riggs

Bank on the northwest corner of Fifteenth

Street and Pennsylvania Avenue, N.W. The

Library occupied the front parlor of the house.

After the assassination

of President Lincoln in

Ford's Theater on April

14, 1865, the government bought the illfated three-story building and assigned it to

the War Department as

an annex of the surgeon general's office. The

structure that was to become a Lincoln shrine

was refurbished to provide quarters and facilities for a new medical museum, a chemical

laboratory, mortuary records, and the books

and periodicals of the surgeon general's library,

now numbering more than 2,000 volumes. The

library had found its first "permanent" home

and would not move again for 20 years.

1. *M A

Ford's Theater
NATIONAL

LIBRARY

MEDICINE

135th ANNIVERSARY

1836 - 1971

U.S. Department of Health, Education, and Welfare

Public Health Service

National Institutes of Health

DHEW Publication No. (NIH) 72-266
BOARD OF REGENTS

ROBERT H. EBERT, M.D., Chairman

Dean, Harvard Medical School

FREDERICK H. WAGMAN, Ph.D.

Director, University of Michigan

Library

WILLIAM G. ANLYAN, M.D.

Vice President for Health Affairs

Duke University Ex Offieio Members

BRUNO W. AUGENSTEIN

Vice President for Research

The Rand Corporation

LT. GENERAL HAL B. JENNINGS, JR.

The Surgeon General

Department of the Army

WILLIAM 0. BAKER, Ph.D.

Vice President in Charge of Research

Bell Telephone Laboratories

VICE ADMIRAL GEORGE M. DAVIS

The Surgeon General

Department of the Navy

JAMES C. FLETCHER, Ph.D.

President, University of Utah and

College of Eastern Utah

LT. GENERAL ALONZO A. TOWNER

The Surgeon General

Department of the Air Force

JACK M. LAYTON, M.D.

Dean, College of Medicine

University of Arizona

JESSE L. STEINFELD, M.D.

The Surgeon General

U.S. Public Health Service

JOHN P. MCGOVERN, M.D.

Professor and Chairman

Department of the History of Medicine

University of Texas Graduate School

of Biomedical Sciences

MARC J. MUSSER, M.D.

Chief Medical Director

The Veterans Administration

MAX MICHAEL, M.D.

Executive Director

Jacksonville Hospitals Educational

Program

GEORGE W. TEUSCHER, D.D.S.

Dean, Dental School

Northwestern University

L. QUINCY MUMFORD, LL.D.

The Librarian of Congress

HARVE J. CARLSON, D.P.H.

Division Director of Biological and

Medical Sciences

National Science Foundation
CONTENTS

Introduction __. 1

Administration 6

Library Operations . 9

Computer and Engineering Services .. _ _ 19

Specialized Information Services _ 21

National Medical Audiovisual Center _. 23

Lister Hill National Center for Biomedical Communications 27

Extramural Programs . 31

Appendices

Organization of the Library ._._. . 36

Financial Resources and Allocations - 36

Assignment of Personnel on Duty 37

Staff Awards and Honors . 37

Publications by Staff Members - 88

Regional Medical Libraries . ._ . _ 39

HIGHLIGHTS OF ACTIVITIES

FY 1969 FY 1970 FY 1971

Size of Collections 1,272,355 1,312,956 1,347,521

Additions to Collections 33,010 36,637 34,565

Reader Requests Filled 82,412 78,779 83,585

Reference Services Provided 24,205 21,702 20,286

Readers and Visitors 29,302 27,186 23,782

Intel-library Loans 117,049 100,611 102,559

Serial Titles Received 22,918 20,964 22,161

Journal Articles Indexed 210,602 210,000 224,619

Literature Searches Distributed 15,475 20,740 23,717

Recurring Bibliographies 16 18 23

Professional and Technical Staff 470 461 462

Projects Supported by Grants 483 498 548

Appropriations $18,160,000 $19,573,000 $21,436,000
INTRODUCTION

When the National Library of Medicine

was established 135 years ago in the office of

the Army's first surgeon general, American

medical literature was in its infancy. Only 11

medical journals were being published in the

United States, the survivors of 47 launched

following the Revolutionary War, and American physicians were authors of less than a

score of textbooks and treatises a year. This

is reflected in the Library's first "catalog of

books," compiled four years after its inception in 1836, that included at least 10 of

these journals and many of the books among

its 228 volumes. Today the total collections

exceed 1,300,000 items.

Almost from the beginning the Library

served as a national resource for the medical

profession although it was not officially so

designated until 1956. Ably directed through

the years by dedicated physicians, it grew

with the literature and advances of medicine,

as the cover notes reveal. Ten years ago an

historic milestone was reached in the dedication of the modern building the Library now

occupies. The date was December 14,1961.

Within the respective spans of these two

significant anniversaries, medicine gained

the status of a scientific profession and the

medical library became a learning center for

its practitioners. This came about, in great

part, because of a continuing proliferation of

new clinical discoveries applicable in the prevention, diagnosis, and treatment of disease

and disability, and through the adoption of

major technological developments in the support and prolongation of human life. In the

nearly century and a half of the existence of

the National Library of Medicine, more new

and useful medical knowledge probably was

attained than in all the ages of the past.

The colossal task of a large medical library

in collecting, organizing, indexing, and disseminating the masses of medical literature

that communicate new knowledge may be exceeded only by the ordeal it presents to the

physician or medical student in selecting,

judging, discriminating, and then learning

what he needs to know. The 11 U.S. medical

journals of 1836, and others in foreign countries, have multiplied unceasingly. They
now number more than 6,000 currently

active titles.

This year the National Library of Medi- cine is adding to its international computerized Medlars system nearly a quarter of a

million new citations to the world's medical

literature gleaned from the 2,200 most useful

and important current biomedical journals.

Coupled with the need for ready access to

specific and useful information, however,

there is always the problem of how much can

be remembered for practical application. There is a growing trend among medical educators to emphasize how to find, not recall, needed information. One has suggested

"eliminating almost all memory efforts" in

the belief that "the student's capacity to define problems and find and use knowledge

effectively are the most important qualities

to develop/' Another physician put it this

way: "The amount of information now both

available and necessary for proper patient

care has grown far beyond the ability of any

person to carry in his head." The same author deplores the traditional practice of medical schools and specialty examining boards

of conducting tests that reveal only what information has been retained. He suggests

that use of the library resources be permitted during these written examinations to

"shift our emphasis toward the skillful obtaining of information rather than on its re- tention."

Such seemingly unconventional procedures

presuppose, of course, that the physician or

student has learned how to use the library's

resources, and is familiar with the catalogs, indexes, bibliographies, reference volumes

and the staff assistance available to him.

Also, it would be assumed that he knows

something about maintaining his own information filing system. Experienced professional librarians readily provide this assist- ance and, in many medical centers, the instruction is augmented by physicians who

offer guidance in the clinical discrimination

and judgment involved in using the literature.

If, as has been said, the medical library is

"the single most important factor" in proIn 1894 Dr. John S. Billings, right, the institution's

first librarian, posed for this photograph in the main

reading room of the familiar red brick Library on

the Mall. The building was razed in 1970.
grams of continuing medical education it will

truly come into its own as an information

and learning center. This is further con- firmed by the growing practice of locating

new libraries in proximity to patients, and

not in a remote area of the hospital or the

medical campus. Such innovations lead more

directly to "patient-related learning," and

follow from the belief that when a need-toknow exists, the information sought is

promptly used in practical application and

retained longer. Some libraries, in an effort

to be of maximum benefit, are open at all

hours to accommodate physicians with sick

patients.

Service is the hallmark of a medical library's utility. The extent and kinds of services available are dependent in part on the

size and scope of the collection, but rapid

access to needed information is the true

gauge of usefulness. Are new types of services needed to improve and enhance library

usefulness ? Recently the National Library of

Medicine supported a major study of 92 medical school libraries, and one of the conclusions reached was "that increases in the

staffs and budgets of medical school libraries

over the past two decades have gone largely

to supporting a rapidly increasing volumeof

service, rather than any striking increase in

the breadth of services." This seems to be

another way of saying that the expense of

handling the increasing amount of medical

literature and providing for the needs of ad- ditional staff and faculty members, and more

students, left no funds available for addi- tional and innovative services. Fortunately, a

solution may be at hand.

The traditional spirit of cooperation

among libraries in sharing their resources

with one another has now been recognized by

statute as a logical and effective means of

improving and expanding the services provided. For the first time in our history a

program of Federal grants of assistance to

medical and other health science libraries

has been provided in the Medical Library Assistance Act, together with the framework of

a system to support and legalize the depend- ence of smaller libraries upon larger facilities. As a result, improved communications

First meeting of the Board of Regents in the new

National Library of Medicine in Bethesda on December 14, 1961, Dr. Worth B. Daniels, chairman.

by means of teletypewriter (TWX) and wide

area telephone systems are increasing.

Faster and more reliable copying machines

have speeded interlibrary loans. Libraries

are being established in small community

hospitals where none existed before by procurement of a preassembled packaged unit of

basic textbooks, journals, and reference volumes. More medical librarians are-receiving

advanced academic training in the knowl- edge and skills of this profession.

Since passage of the Act in 1965 and its

extension in 1970, the National Library of

Medicine has supported 600 projects of medical libraries throughout the country in 49

states in the amount of $46.7 million. This

essential program is continuing.

The formalization of cooperative support

among medical libraries has been attained by

the designation of ten outstanding libraries,

and the National Library of Medicine, each

to serve a specific geographic area of the

country under the Regional Medical Library

Program. Within each region of several

states, the smaller community hospital and

medical society libraries rely on aid from the

larger hospital and medical school facilities.

They are backed up by the regional library

which looks to the National Library of Medi- cine as the ultimate source of assistance or

loan of material. The gratis interlibrary loan and photocopy

services provided by the regional libraries

are supported by contracts with the National

Library of Medicine. Each regional library

also offers guidance and information services

to its constituent libraries, and teaching

workshops for their staff members. All main-
tain direct communication with the National

Library of Medicine by means of telephone

and TWX.

This cooperative linking of the nation's

medical libraries into a developing biomedical communications network is made possible

by the ready access to 1,400,000 citations

that have been accumulated in the Medlars

system since 1964. It has enabled the National Library of Medicine to sponsor a publications program of indexes, bibliographies,

and literature searches, organized under precise subject headings, printed promptly in

attractive formats and circulated widely

throughout the world.

Senator Lister Hill turned the first spade of dirt

at the ground-breaking ceremony of the National

Library of Medicine on June 12, 1959. Looking on,

from left, are Dr. Champ Lyons, chairman of the

Board of Regents, Rep. Melvin R. Laird, and HEW

Secretary Arthur S. Flemming.

Experimental projects currently conducted

by the National Library of Medicine provide

a glimpse of future developments that may

lead to innovative programs. With the participation of several clinical centers, the Library is developing a satellite communications system to bring consultation services

by voice and data transmission to physicians

in remote areas of Alaska where telephone

and radio reception is unreliable. Another

project in New England involves the use of a

two-way television network to assist in continuing education and support of patient

care activities. A successful experimental

service, known as AIM-TWX, soon will permit libraries anywhere in the country to tap

a part of the Medlars bibliographic base for

rapid literature searches through a teletypewriter terminal connected to telephone lines.

With the cooperation of a number of medical

schools and professional groups, innovative

teaching-learning modules and new audiovisual aids are being created in support of pedagogical research. Present toxicological and

pesticide information programs are being

geared to share in the vast data bases of

physical, chemical, and environmental hazards assembled in the computers of government agencies, professional societies and industry. A new automated, computer-assisted

development, the Graphic Image Storage and

Retrieval System, designed to speed photocopy reproduction for interlibrary loan service, will soon be in operation for test and

evaluation.

This report reveals some highlights of the

National Library of Medicine's services during this anniversary year. It recounts the

accomplishments of its diversified professional staff of more than 450 library and

biomedical scientists, physicians, medical educators, historians, literature analysts and

translators, computer and electronic communications engineers, and the many persons

working in their support. It describes the expanding progress both of established services

and developing programs toward their goal

of improving access to useful information

and new medical knowledge for all who are

dedicated to the prevention and treatment of

disease and disability.

MARTIN M. CUMMINGS, M.D.

Director

National Library of Medicine
ADMINISTRATION

The Board of Regents of the National Library of Medicine, the institution's governing and policy-makingbody, held its customary three meetings during the year under the

chairmanship of Dr. Robert H. Ebert of Boston.

The Board has the statutory obligation "to

advise, consult with, and make recommendations to the Secretary on important matters

of policy in regard to the Library. . . ." Ten

of its members are appointed by the President for four year terms. Serving as ex

officio members are the surgeons general of

the Army, Navy, Air Force and Public

Health Service, the chief medical director of

the Veterans Administration, the assistant

director of biological and medical sciences of

the National Science Foundation, and the Librarian of Congress. The Director of the Library is the Executive Secretary of the

Board.

Following a review of the budgetary history of the Library since Fiscal Year 1968,

the Board unanimously adopted a resolution

expressing its concern "with the inadequacy

of that support in the face of rapidly rising,

uncontrollable costs, and more importantly

in the light of the current administration's

avowed purpose of making excellent health

resources more readily available to the

American public."

The Library's appropriations for the fiscal

years included in the Board's study are:

1968

1969

1970

1971

$21,674,000

18,160,000

19,573,000

21,436,000

The resolution also stated that "the Board

of Regents entreats the Secretary of Health,

Education, and Welfare to concern himself

with the impact of an array of Federal

health programs on the activities of the National Library of Medicine. It is convinced

that more effective delivery of health services and economies of scale in health professional education can be realized by greater

familiarity with the Library's activities and

capabilities. . . . Without additional support

the resources of 'the National Library of
The Library's Board of Regents at a meeting in

Bethesda in 1971 under the chairmanship of Dr.

Medicine are unable to cope with the increased demands for information services

generated by programs for health care deliv- ery, health education and health research."

In another action the Board approved both

new policy guidelines for contracts negotiated with the Regional Medical Libraries and

a review of existing policies related to the

Library's grant program. The regents also

studied an extensive report on the possible

roles of the Lister Hill National Center for

Dr. William G. Anlyan, right, new chairman of the

Board of Regents, accepts the gavel from Dr, Ebert.

Robert H. Ebert, seated center. Appointed by the

President, the Regents guide major policies.

Biomedical Communications in medical edu- cational technology, prepared by the Association of American Medical Colleges, and concurred in a progress report on the Alaska

Health Sciences Library in Anchorage presented by Brig. Gen. Thomas J. Whelan, MC, USA, following a site visit.

The National Library of Medicine Scholars in Residence Program for visiting schol- ars was established by the Board "to encourage and to recognize scholarly research requiring use of the Library's collection." Candidates for appointment under the new program would pursue their chosen research

projects on a full-time basis for a minimum

of six months, a substantial portion of which

would be spent in the Library.

The Board presented an inscribed plaque

expressing its appreciation and esteem to Dr.

Ruth M. Davis, the first director of the

Lister Hill Center, for her leadership, management, and technical contributions. Dr.

Davis is now director of the Center for Computer Sciences and Technology of the National Bureau of Standards.

The second annual Regents' Award, given

for scholarship and technical achievement,

was won by Mr. Stanley Jablonski of the Library's staff, for his unique volume, Him-
trated Dictionary of Eponymic Syndromes

and Diseases and their Synonyms (Saunders,

1969).

To succeed Dr. Ebert3 whose appointment

as a regent is fulfilled on August 3, 1971, the

Board elected as its next chairman, Dr. William G. Anlyan. Other retiring members of

the Board are Mr. Bruno W. Augenstein and

Dr. Frederick H. Wagman.

Tours and Exhibits

Tours of the Library were arranged for

about 1,400 visitors. Replies were made to

more than 3,800 inquiries received about the

Library's various services and publications.

Four timely exhibits, each presented separately for about four months during the year

in the Library's main entrance foyer, atA trephined skull was among more than 100 publications and artifacts in a 1971 exhibit of "Medicine

of the American Indians" in the entrance foyer of

the Library.

An exhibit of books and journals for a basic

hospital library is displayed for visitors to the National Library of Medicine. The size of the core

library can be modified, as desired.
tracted considerable attention and comments.

They included "The Darkening Day," a portrayal of environmental pollution; "The Art

of Learning Medicine"; a collection of

sketches, drawings, and paintings of U.S.

Navy medical personnel and activities presented in observation of the 100th anniversary of the Medical Department of the Navy;

and a colorful exhibit depicting "Medicine of

the American Indians."

International Programs

Most of the Library's international programs, which maintain a high level of activity, are based on cooperative arrangements

with a sharing of time, talent, and resources.

The bilateral Medlars agreements now number eight with the inclusion this year of the

National Science Library in Ottawa.

The Library's activities in both regional

and national efforts to improve Latin American biomedical communications are demonstrated by its cooperation with the Pan

American Health Organization in providing

technical consultation and services to the

PAHO Regional Library of Medicine in Sao

Paulo, Brazil. This has increased the level

and kinds of library services provided.

Forty-seven developing countries now receive services from the National Library of

Medicine under a special agreement with the

Department of State's Agency for International Development. These have markedly

benefitted medical research, education, and

practice. Under the f ee-f or-service policy initiated July 1,1971, all non-AID countries are

now subject to a fee for photocopy and audiovisual loan services. This has resulted in

about a 67 percent reduction in services to

these countries.
LIBRARY OPERATIONS

Library Operations programs serve to

select, acquire, catalog, and preserve biomedical publications; index and provide access to

the material through human and machineproduced bibliographies; furnish reference

and loan service; prepare indexes, catalogs,

and other publications for the use of medical

libraries and health practitioners; and assist

in the management of the Biomedical Communications Network through Regional Medical Libraries and Medlars Centers.

The Library Operations staff processes

and analyzes publications ranging from the

earliest historical documents to the latest

journals. Services are provided requiring use

of traditional library operating methods as

well as computer, microfilm, and data processing facilities. Organizationally, Library

Operations consists of four principal elements: the Bibliographic Services Division,

the Technical Services Division, the Reference Services Division, and the History of

Medicine Division.

The Library began studying requirements

for implementing a network management

system for data collection and analysis during the coming year. Such a system would

standardize record-keeping and reporting of

the Regional Medical Libraries and permit

batch analysis of machine-readable records.

Training activities within the network

continued. Instruction units in the use of

Index Medicus, consisting of taped presentations coordinated with 35 mm color slides,

were developed for distribution to the network. These were prepared for use in seminars and workshops, and for individual

training of hospital librarians who lack

access to other training programs.

Regional Medical Library Program

In fiscal 1971 the Special Assistant to the

Director for Medical Program Development

and Evaluation was appointed to coordinate

the Regional Medical Libraries' activities in

the Extramural Programs with those of Library Operations. All Regional Medical Libraries were operational by September 1970,

and the Regional Medical Library Network
Study carrels overlook the stairway in the Francis

A. Countway Library of Medicine in Boston that

serves as the New England Regional Library. The

structure was completed in 1965.

10
processed in excess of half a million requests

for interlibrary loans during the year.

The principal change in Regional Medical

Library operations was an increased orientation toward delivery of services supported by

contract. In the four years during which the

program has developed, funding for the supply of direct services such as document delivery, as well as support for training, consultation, and other ancillary activities, has been

in the form of grants provided through the

Extramural Program. Negotiations led to

the signing of contracts with four regional

libraries and the completion of negotiations

with three others prior to the close of the

fiscal year. Contracts with the remaining

three will be negotiated during the coming

year. Other non-service oriented activities

would continue to be funded by grants

through applications to Extramural Programs.

The National Library of Medicine and Regional Medical Libraries' staffs provided 120

user-training programs to about 3,000 health

practitioners and students during the year.

The programs concentrated on Medlars and

on the more recent on-line bibliographic

search capability provided by AIM-TWX,

currently in use in over fifty institutions.

The Director appointed a Regional Medical

Library Review Committee, composed of

three members of the Biomedical Library

Review Committee, Dr. Kelly West, Mrs.

Reba Benschoter, and Dr. David Kronick.

They will undertake an in-depth review of

the current program.

Bibliographic Services Division

The Bibliographic Services Division indexes the periodical literature of medicine;

prepares Index Medicus and other published

indexes; formulates computer searches in response to individual requests for bibliographic assistance; and trains personnel

from Medlars Centers in the techniques used

in indexing the literature and searching Medlars files. It maintains technical liaison with

domestic and overseas Medlars centers and

coordinates their operations.

Indexing. During Fiscal Year 1971, about

225,000 articles were indexed for Medlars,

exceeding the record production of the previous fiscal year by seven percent. More

than two-thirds of the indexing was performed under contracts and agreements with

cooperative agencies.

The previous indexing backlog was further

reduced, by nearly 40 percent, to less than a

two-month indexing load. This approaches

the minimum back-load for optimum operating efficiency.

Searching. Approximately 18,000 Medlars

demand searches were conducted for domestic users, an increase of more than 26 percent over Fiscal Year 1970. Limitations on

processing capacity, however, required that

restrictions be put on the number of search

requests accepted after May 1971. When possible, alternate methods of bibliographic assistance were provided or suggested in place

of Medlars search service. High processing

Table 1. Summary of Bibliographic Services

FY 1969

2,260

99,447

76,249

34,906

Total 210,602

Medlars Searches Performed

Journals Indexed in Index Medicus _ _

Articles Indexed

NLM _

Other U.S.

Foreign

NLM

U.S. Centers

Foreign

Total

Recurring Bibliographies

Literature Searches Distributed

3,182

8,231

4,062

15,475

16

23,005

FY 1970

2,251

90,859

75,528

43,613

210,000

3,550

10,737

6,453

20,740

18

23,351

FY 1971

2,199

65,885

82,224

76,510

224,619

3,889

14,180

5,648

23,717

23

36,570

11
costs led to the curtailment of Medlars computer processing activity at some centers

during the year.

Publications. Abridged Index Medicus, a

monthly publication of citations of articles in

the most important 100 clinical journals

printed in English, continued to receive favorable comment. The first annual cumulation, Cumulated Abridged Index Medicus for

1970, was published early in 1971.

To meet the needs of those with an interest in the effects of the environment on

health, the Library in January 1971 began

publishing a new monthly recurring bibliography, Selected References on Environmental Quality as It Relates to Health. These

four additional new bibliographies produced

by the Library bring to 23 the number of

recurrent bibliographies available:

• Index of Tissue Culture 1966-1969, published by the Tissue Culture Association.

• Annual Bibliography of Orthopaedic

Surgery, published by the Subcommittee on

Orthopaedic Information Services of the National Research Council's Committee on the

Skeletal System.

• Bibliography on Strabismus, published

by the International Strabismological Association.

• Bibliography of Selected Reviews cm,

Cardiovascular Diseases, published monthly

in the American Journal of Cardiology beginning September 1971.

Furthering the ongoing program of distributing bibliographies on subjects of wide

interest, 32 new Literature Searches were

added to the list of available titles.

About 300 new main headings were prepared for introduction into the 1972 edition

of Medical Subject Headings (MeSH), the

controlled vocabulary which serves as the

subject heading authority list for indexing

and cataloging.

Medlars Tapes. In April 1971, the Library

made available on subscription the magnetic

computer tapes containing data from Medlars. Subscribers receive the current monthly

tape file of citations indexed for Medlars,

and dictionary files to facilitate use of the

citation file. Subscribers may also obtain up

to three years of back files by direct purchase, but programming and system documentation are not available. The National

Technical Information Service is handling

the sale and distribution of the data tapes

for the Library.

Table 2. Growth of Collections in Fiscal Year 1971

Book Material

Bound monographs

Prior to 1800

1801 to 1913

1914 to present

Bound serials

Unbound issues (volumes)

Theses

Pamphlets

Total book material

Volumes

Added

554

255

8,772

12,292

1,197

8,962

237

32,269

Total Volumes

in Collections

38,072

89,313

236,990

377,776

22,161

327,810

171,759

1,263,881

Non-Book Material

Microfilms (archival)

Microfiche

Pictures

Total non-book material

Grand Total

721

845

730

2,296

34,565

11,832

3,945

67,863

83,640

1,347,521

12
Table 3. Summary of Acquisition Statistics

Serial Record *

New titles added

Discontinued titles

Current titles received

Publications Processed

Serial pieces

Other

Total

FY 1969

1,847

1,604 **

19,448

96,920

27,353

124,273

Obligations for Publications $286,398

Included for rare books $ 41,353

FY 1970

2,114

598

20,964

94,175

27,767

121,942

$355,000

$ 60,212

FY 1971

1,534

337

22,161

97,816

25,499

123,315

$370,438

$ 57,945

* Figures for serial titles have been corrected for titles that have been deleted or ceased publication.

* Includes 1,000 titles (congresses and college catalogs) removed from serial records.

Technical Services Division

The Technical Services Division selects

and acquires the world's biomedical literature and catalogs books and monographs. It

disseminates cataloging information through

the NLM Current Catalog, and provides

camera-ready copy to the Medical Library

Association for issuance of semiweekly proof

sheets.

Negotiations with Bro-Dart, Inc., of Williamsport, Pa., were completed for commercial production and distribution of NLM

catalog card sets to medical libraries. Provision of this service came in response to requests from medical librarians who have

sought for some time to secure the Library's

cataloging data in card format. Negotiations

began late in 1970 and were concluded the

following spring. The service began in June

1971. Card sets may be purchased on subscription or selectively by using NLM citation numbers.

In August 1970, a Serial Records and

Binding Section was established within the

division. The new section absorbed the serial

record activities and associated personnel

from the Selection/Acquisition Section of the

Technical Services Division and binding operations with its associated personnel from

the Reference Services Division.

Preparations were completed for the publication in November 1971 of a sexennial

cumulation of the NLM Current Catalog.

The cumulation will include all of the Library's cataloging for the years 1965-1970,

comprising its complete store of machinereadable cataloging data.

For security purposes, the Library arranged for the recording on 16 mm microfilm

of its main card catalogs.

An in-house scope and coverage committee

was reestablished to review and revise the

existing scope and coverage working paper

used as a guideline for selection and acquisiTable 4. Summary of Cataloging Activities

FY 1969 FY 1970

Completed Cataloging

New titles

Recataloged titles

Total

14,273

1,253

15,526

Volumes Reclassified and/or Transferred 1,582

Catalog Cards Filed 119,904

Volumes Shelflisted 10,380

16,344

1,423

17,767

2,055

113,080

10,441

FY 1971

15,862*

933

16,795

683

114,786

10,996

* Includes 1,133 cataloged by Suny and Countway, and 449 cataloged by Keio University.

13
Number of Volumes

Sent to binder

Table 5. Binding Statistics

FY 1969

16,650

Returned from binder and processed

New volumes

Rebinds

Bound at NLM __

Repaired at NLM

15,606

14,805

801

6,330

4,787

FY 1970

15,361

17,157*

15,999*

1,158

5,551

4,683

FY 1971

16,807

16,397

15,111

1,286

5,623

3,150

* Correction of figures in 1970 report

tion. Procedural changes were made to provide closer control over the nature of materials accepted for the Library's collection.

The Library has continued to supply serial

holdings to the data base of the Union

Catalog of Medical Periodicals, produced by

the Medical Library Center of New York.

Data for 18,000 titles of the Library's holdings have now been input.

References Services Division

The Reference Services Division provides

reference, bibliographic, and reader services

to users at the Library and, in conjunction

with the Regional Medical Library Network,

supplies material from the Library's collections to the biomedical community by means

of an extensive inter library loan program. It

also maintains and preserves, through the

microrecording of deteriorating publications,

the collection of library materials published

from 1871 to date.

Services. The Reference Services Division received over 20,000 reference inquiries during

the fiscal year. More than 22,000 health

science professionals and students used the

Reading Room and requested over 92,000

items from the collection.

Ililii mill LULU iLUIIL uLLLL LLLLLB

The new Florence Bioinformation Center of the

University of Texas Southwestern Medical School

at Dallas, shown in an architect's rendering, will be

completed in the fall of 1973 to provide expanded

facilities for the South Central Region. It is part of

a $19 million building program.

14
The development of a basic multimedia resource area in the Reading Room was completed during the fiscal year. Three study

carrels were remodeled to provide soundproof, comfortable viewing and listening

rooms. In an adjacent area are arranged the

Library's current audiovisual periodicals

collection, cassette playing devices, and a

large color television receiver equipped with

earphones. A card catalog contains about

1,000 titles in the multimedia collection that

are listed by subject, name, and medium.

Other equipment includes microfiche and microfilm readers, 8 mm loop cartridge film

projectors, a reel-to-reel tape recorder, cassette recorder, slide projector and screen,

and a record player. Current materials of

particular interest are available for ready

use. One carrel contains special exhibits, and

another is a projection room in which eight

viewers may be seated. Equipment includes a

16 mm motion picture projector, slide projector, and a reel-to-reel stereophonic tape recorder. The multimedia resource area was

planned as a showcase of materials and

equipment available, and as a prototype for

other medical libraries.

A portable computer terminal located in

the Reading Room provides the Library's

users with direct on-line bibliographic access

to the AIM-TWX data base for four hours

each day. Members of the Reference Section

The innovative AIM-TWX service provides rapid,

responsive searching of the medical literature.

staff are trained in the demonstration and

use of the system and the Library's patrons

have been encouraged to become their own

search formulators. Public reaction to the

system has been enthusiastic.

A second pilot issue of the Bibliography of

Medical Bibliographies was prepared by the

Health Science Bibliographic Clearinghouse,

a unit of the Reference Section. This publication reports NLM Literature Searches, bibTable 6. Summary of Reference Services

Requests by Telephone

Government

Non-government

Requests by Mail

Government

Non-government

Readers Assisted

Government

Non-government

Total

Government

Non-government

Readers Counted

FY 1969

11,698

5,500

6,198

1,322

161

1,161

11,185

3,795

7,390

24,205

9,456

14,749

27,303

FY 1970

10,715

5,281

5,434

1,218

145

1,073

9,769

3,487

6,282

21,702

8,913

12,789

25,786

FY 1971

10,027

4,653

5,374

1,391

133

1,258

8,868

3,219

5,649

20,286

8,005

12,281

22,382

15
liographies prepared by specialized information centers, bibliographies appearing in

books and journals or as separate publications, and unpublished bibliographies from

medical libraries. It includes a citation section, containing descriptive and source information, and a keyword-in-context (KWIC)

index which is composed of titles and a select

number of subject headings.

Intel-library Loan. The division received

more than 126,000 interlibrary loan requests

during the year. More than 93 percent of

those requests filled were in the form of photocopies of journal articles.

Photoduplication. In addition to support for

the interlibrary loan and preservation programs, the Photoduplication Section undertook the filming of material for use in the

Graphic Image System, processed over

163,000 photocomposed pages for Index Medicus and other publications, and produced almost 1,900 photographs and slides. A total of

almost 2,700,000 pages were microfilmed for

all programs during the year.

Table 7. Summary of Circulation Activities

Number of Requests

Received

Filled

For readers

By interlibrary loan

Photocopy

Original

Unfilled

Rejected

Unavailable

FY 1969

234,666

199,461

82,412

117,049

110,573

6,476

35,205

7,510

27,695

FY

219,229

179,390

78,779

100,611

93,746

6,865

39,829

14,244

25,595

FY 1971

218,982

186,144

83,585

102,559

95,559

7,000

32,838

9,273

23,565

A multimedia resource area is a new addition to

the main reading room of the National Library of

Medicine. The collection contains about 1,000 titles

for use in soundproof study carrels.

16
The new Vera Parshall Shiffman Medical Library Medical Center. The $2.3 million facility serves as

of Wayne State University School of Medicine is the East Central Regional Library for Kentucky, located in a 236-acre site of the developing Detroit Michigan, and Ohio.

The Biomedical Library of the Center for the

Health Sciences of the University of California at

Los Angeles is the hub of the Pacific Southwest

Region. This is a view of the main reading room.

The library also houses the subregional Medical

Communications Information Service.

17
Table 8. History of Medicine Activities

Acquisitions

Books

Modern manuscripts

Oral history hours

Prints and photographs

Processing

Titles cataloged

Modern manuscripts cataloged

Pictures indexed

Articles indexed

Pages microfilmed

Public Services

Reference questions answered

ILL and pay orders filled

Reader requests filled

Pictures supplied

FY 1969

456

23,250

83

2,286

1,384

39,831

486

4,620

139,003

1,652

2,234

4,742

1,409

FY 1970

1,538

159,627

66

634

3,132

39,070

430

5,327

160,704

1,461

1,985

3,876

1,094

FY 1971

1,284

141,142

10

753

1,618

41,441

205

3,114

173,733

1,755

1,880

4,717

2,010

History of Medicine Division

The History of Medicine Division acquires,

organizes, and services the Library's original

source materials for study and research in

the history of medicine and related sciences.

It prepares catalogs, bibliographies, and

work of independent historical scholarship.

The Division has custody of manuscripts,

fine prints, and all publications in the Library's possession that were issued prior to

1871.

During Fiscal Year 1971, this Division

provided about 4,700 books, manuscript

boxes, and microfilm reels to readers in the

Library. It filled nearly 1,900 requests for

photocopies and interlibrary loans, and supplied more than 2,000 photographs and slides

in response to requests for pictorial material.

Almost 1,300 volumes were added to the Library's historical collections, and more than

140,000 manuscript items, including papers

of Henry N. Hark ins, Yandell Henderson,

Chauncey D. Leake, William S. Middleton,

and Milton Senn. Oral history memoirs were

completed for William S. Middletonand Donald Dexter Van Slyke. To improve access to

the collection, and in anticipation of future

publication, the Division cataloged more than

1,500 monographs and serial titles and indexed over 3,000 articles.

18
COMPUTER AND ENGINEERING SERVICES

The Office of Computer and Engineering

Services is responsible for providing computer and related automated data processing

support to all program areas of the Library.

This support includes the development and

implementation of new systems, the maintenance of existing systems, the Medlars input

preparation, and the operations of the Library's computers and photocomposing

equipment. As a part of this effort, the staff

accomplishes systems analysis and design,

and computer programming.

Medlars I Activities

The Medlars I production activity continued to operate efficiently. Supported by the

Honeywell 800/200 computers, the system

has been extended beyond its planned life because of the delays and problems associated

with the development of Medlars II. In spite

of this, the system has been able to handle

ever-increasing work loads. During Fiscal

Year 1971, there were 226,945 citations

added to the indexed citation file and 21,407

entries added to the catalog file. A total of

75,265 pages of photocomposed publications

were produced and 10,068 retrospective demand searches were processed. Computer

time was obtained from the Department of

Defense to enable the Library to process this

large load of demand searches. In addition to

producing the wide range of Library publications, this Office also completed the process- ing of a sexennial cumulation of the NLM

Current Catalog.

In order to permit the Library to respond

to the increasing requests for demand bibliographic search service without continued

computer assistance from the Department of

Defense, the search programs of the Karolinska Institut in Stockholm that operate on

an IBM 360/50 computer are being acquired.

This will give the Library the capability of

processing retrospective searches on its own

360/50 computer as well as on the Honeywell

equipment.

19
Medlars II Development

Initiated in June 1968, the Medlars II project had as its purposes the development of

an improved computer-aided system for the

production of the Library's various bibliographic publications and the support of retrospective literature searching through the

application of the latest technical developments in the computer field. The new system

was to provide access to the computerized

bibliographic files through remote terminals

permitting interrogation of the files with

direct and immediate response. In addition,

it was to support an augmented vocabulary

and to extend automation to selected library

functions such as acquisitions.

The development of Medlars II, however,

was plagued by a series of problems and delays. Concurrent with this effort's being conducted on contract, the Library began the

development of an on-line, interactive bibliographic search and retrieval capability

(AIM-TWX), in an experimental effort with

another contractor, using the citations from

Abridged Index Medicus as the data base.

These two projects were reviewed in detail

by responsible members of the Library's

staff, assisted by computer consultants, in

the latter part of the fiscal year. On the basis

of this study, the Director of the Library

concluded that it would not be in the best

interests of the Government to continue the

Medlars II contract as negotiated in June

1969. The on-line experimental effort, on the

contrary, was judged to be very successful.

Therefore, a conversion will be accomplished

to place Medlars on the third-generation

hardware, add certain features including an

This new GPO Linolron 1010 photocomposer replaces the Photon 901 used in production of many of

the Library's bibliographies and other publications.

expanded vocabulary, and design the new

system around the file structure, logic and

design of the experimental on-line, interactive system. In June 1971, a new contract

was let for the performance of these tasks.

Two major system changes were begun

when it was apparent that there would be

continuing delays in the development of Medlars II. Work was begun in late Fiscal Year

1971 to prepare programs to permit the use

of the Keymatic encoders (a keyboard-tomagnetic tape device) for the preparation of

input to the computer, rather than the

punched paper tape process used in the past.

In addition, programming is being accomplished to support the use of the Government

Printing Office's new photocomposing device,

Linotron 1010, in place of the Photon 901

currently in use at the Library. These

changes were originally to be performed as

a part of the Medlars II project. The programming for the input conversion has been

completed and production will begin in early

Fiscal Year 1972. The photocomposing transition will also be ready early in the year.

20
SPECIALIZED INFORMATION SERVICES

The Library's Specialized Information

Services was established to meet national

needs for information in toxicology and related fields. Its staff receives guidance concerning scope and operational priorities from

the Toxicology Information Program Committee in the Division of Medical Sciences of

the National Academy of Sciences-National

Research Council.

The Toxicology Information Program has

produced computer-based files of toxicology

information and data. Extensive collaboration with the Food and Drug Administration

and the new Environmental Protection

Agency has resulted in the development and

use of several automated data banks and systems, including:

• A central data management system for

the Environmental Protection Agency's Division of Community Studies, directed to epidemiological studies of persons occupationally exposed to pesticides.

• An on-line whole-t€',xt search system for

the abstracts from the Health Aspects of

Pesticide? Abstract Bulletin (1966 to present) and the Report of the Secretary's Commission on Pesticides and Their Relationship

to Environmental Health (Mrak Report).

• Initiation of a data bank of toxicological

data extracted from 400 approved) pesticide

petitions from the files of the Environmental

Protection Agency and the Food and Drug

Administration.

New Projects

Among projects under development is a

drug interaction bibliography (1967-70),

with selected excerpts. Articles for this compilation will be excerpted to highlight the

interacting substances and the observed biological effects. Publication is planned for the

end of 1971.

Another project under contract is the

preparation of a toxicology vocabulary,

structured in thesaurus format and compatible with Medical Subject Headings, the Medlars vocabulary. It will be completed in 1972.

Through an agreement with the Atomic

Energy Commission, a Toxicology Information Query Response Center has been established at the Oak Ridge National Laboratory.

It is intended to be the service arm of the

Toxicology Information Program, performing in-depth literature searches, evaluating

and analyzing information, and preparing

21
state-of-the-art reports. The Center will be

able to draw on a wide spectrum of scientific

disciplines represented at the Oak Ridge National Laboratory as well as the information

resources being created by the Toxicology Information Program in other activities. Using

the extensive library and computer facilities

at Oak Ridge, the Center will also have

access to most of the commercially available

literature tape services. It is expected that

requests for services will come to the new

Center either directly through the Toxicology Information Program or through the Li- brary's Reference Services Division.

The new on-line, computer-based Roster of

Authorities in Specialized Subtopics of Toxicology and Related Fields is operational.

Data Files

Activities associated with the development

of specialized Toxicological Information Program computer systems have been phased

out in order to use the resources for the

collection of data for commercially available

systems. A contract has been negotiated to

adopt a system capable of storing and retrieving large amounts of data via on-line,

remote terminals. The data bases to be incor- porated into this system include free-text information as well as highly structured data.

Extensive use of these data files is expected

to lead to an increase in present collaborative

efforts with other Federal agencies and the

initiation of agreements with industry to

enhance the quality, quantity, and diversity

of the toxicological data files.

To increase access to the Medlars data

base through chemical and drug names, a

link between Medlars and certain data bases

of Chemical Abstracts Service is being estab- lished. This system should enable the Library

to connect a substance name, found by an

indexer in an article, to a Chemical Abstracts Service registry number, an accepted

name for that substance, and the Medlars

citation number. Through a link into a file of

biomedical compounds, called the Common

Data Base, the Library will also have the

capability of performing chemical structure

searches, using existing Chemical Abstracts

Service computer programs.

Some of the other activities formerly conducted under the Drug Literature Program

were transferred to other Library areas.

The John Crerar Library in Chicago, a privately

supported public library devoted to science, technology, and medicine, serves as the Midwest Regional

Library. One fifth of its million-volume collection is

devoted to health sciences. The library also operates

the National Translations Center.

22
NATIONAL MEDICAL AUDIOVISUAL CENTER

The National Medical Audiovisual Center

in Atlanta, Georgia, strengthens the information and education services of the National Library of Medicine by planning and

administering a national biomedical audiovisual program.

The Center's staff works with health

science practitioners and educators, national

organizations, and federal health programs.

It encourages the development, utilization,

and sharing of audiovisual educational materials and systems through consultative and

educational support programs; provides audiovisual reference and search services; and

distributes professionally oriented audiovisuals either produced by the Center or

acquired from other sources.

In May 1971, the National Library of

Medicine signed an agreement with the Bureau of Health Manpower Education of the

National Institutes of Health to establish an

Office of Audiovisual Educational Development in the Center. In Fiscal Year 1972, up

to 50 percent of the Center's productive capabilities will be devoted to the Bureau's programs and projects which coincide with, or

complement, the Center's programs.

Media Development

In cooperation with national professional

medical organizations, health science professionals, and medical educational institutions,

the Center is developing and producing pilot

instructional units for medicine, dentistry,

nursing, and allied health professionals.

These units are designed according to objectives stated by the cooperating group, many

in modules to permit economical updating

and interchangeable use within several disciplines.

Twenty-eight schools, comprising the Association of Deans of Southern Medical

Schools, have agreed to develop teaching

packages for sharing among all the schools.

Each participant has named a program coor23
One of 15 seminar-workshops held during the year

at the Library's National Medical Audiovisual Center

in Atlanta. This training session was devoted to

dmator, and a full-time program director has

been appointed by the Association. The

Center will refine and finish each unit to production standards and provide specialized

segments, such as animation, which individual schools may not be equipped to handle.

In cooperation with the Division of Dental

Health of the Bureau of Health Manpower

Education, the Center produced a slide/

sound package on the team approach to dentistry. Completed in May, it was used by

Dental Health Manpower Training personnel

to indoctrinate dental faculty members.

Media Evaluation

As part of its mission to serve medicine

and allied health education, the Center is carrying out a two-pronged evaluation program.

In May 1970, a review was initiated of its

existing motion picture collection for

accuracy and currency. More than 100 titles

were eliminated and the present collection of

about 950 motion pictures is now up-to-date

and educationally oriented. A cooperative

peer review system is utilized to evaluate

both present film holdings and future acquisitions. Cooperating national organizations

include the Association of Medical School Pediatric Department Chairmen, American Association for Cancer Education, American

College of Radiology, Veterans Administration Hospitals' surgical staffs, American College of Cardiology, American Academy of

Dermatology and American Physiological

Society.

cataloging and management of medical audiovisual

information and media The Center lends about

85,000 audiovisuals each y ear to professional groups.

Acquisition and Distribution

This was the first full year of operation

for a new, automated audiovisual distribution system. The entire operation of receiving requests for, booking, and scheduling of

audiovisuals is now computer-supported.

About 120,000 requests were received and

processed during the year. About 85,000 audiovisuals were loaned to professional users.

Reference Activities

The Center has completed the second year

of operating the International Index of Medical Film Data, a major computerized data

base. For greater relevance to the current

needs of health science professionals, citations were reviewed and reduced from about

25,000 to 4,000. Proposed additions to the

data base will be screened in advance by peer

groups. The reference staff provided major

input to audiovisual resource publications

for a number of national organizations.

During the year, plans were made to add

audiovisual citation data to Medlars so the

Center's distribution collection acquisitions

would be included in the NLM Current

Catalog.

Training

The Center presented a series of ten seminar workshops on specialized audiovisual

production techniques, management of audiovisual information, and facilities planning

for medical and allied health sciences person24
nel. Three conferences were cosponsored

with national medical organizations. Two

staff members gave nine presentations to the

Royal College of Physicians and Surgeons in

Glasgow.

Consultations

An overview of the Center's activities and

physical facilities was given to 217 visitors

from medical schools, medical centers, and

health-related organizations in the United

States and from 20 foreign countries. A total

of 259 consultations, surveys, site visits, design projects, and educational programs

were provided for 139 schools of the health

sciences, hospitals, medical libraries, and

other related agencies. This figure includes

57 medical schools, 11 dental schools, 14

nursing schools, four schools of veterinary

medicine, one school of pharmacy, two

schools of optometry, 24 hospitals, 9 medical

libraries, and 17 schools of allied health and

health-affiliated agencies. Complete survey

reports were prepared for the ColumbiaPresbyterian Medical Center, University of

Iowa College of Medicine, Stanford University Medical Center, and Marquette School of

Medicine.

Videotape Program

Since the announcement of its free videotape duplicating program in September 1970,

the Center has duplicated about 800 tapes

for 115 schools and hospitals. The inventory

of master tapes is being expanded and updated. Additional equipment now on order

will provide for increased volume and higher

quality color duplicating.

999999-

t -

•fir

Dedicated in May 1971, the University of Nebraska

Medical Center Library in Omaha occupies 71,000

square feet on three levels, plus an open terrace,

built atop the Basic Science Building of the College

of Medicine. The Midcontinental Regional Medical

Library Program is directed from this new facility.

25
The Health Sciences Library of the University of

Washington in Seattle will occupy the second and

third floors of the new Health Sciences Center, shown

in an architect's model, when the structure is completed in October 1972. The library directs services

for the vast Pacific Northwest Region.

The headquarters of the Southeastern Medical

Library Program is in the A. W. Calhoun Medical

Library of the Emory University School of Medicine

in Atlanta. Shown is a partial view of the current

periodical area and entrance to book stacks. The

region comprises six states and Puerto Rico.

26
LISTER HILL NATIONAL CENTER

FOR BIOMEDICAL COMMUNICATIONS

The Lister Hill National Center for

Biomedical Communications is responsible

within the National Library of Medicine for

applying computer and other communications technologies to the improvement of

health care, medical education, and biomedical research.

Fiscal Year 1971 was a year of transition

for the Center. The previous year was one of

pilot projects, limited experiments, and feasibility demonstrations. Now three of these

projects—the satellite communications effort, AIM-TWX, and the New England Interactive Television network—are expanding

towards full-fledged experimental systems.

Communications Network

Since June of 1970 the Center, in cooperation with Library Operations staff, has been

providing an experimental, on-line, remote

access bibliographic service called AIMTWX, based on the citations from 100 English-language clinical journals in Abridged

Index Medicus. The citations are sent to the

Systems Development Corporation in Santa

Monica, California, where they are stored on

an IBM 360/67 computer. The data base is

now made up of more than 160,000 citations

from 122 journals. Users, who range from

trained Medlars searchers to practicing physicians, may query the system from remote

terminals which can be connected by TWX

or ordinary telephone lines.

The system is available for use four hours

a day. There are now about 50 institutions

regularly using this service, with more than

600 hours of connect time a month. As many

as 18 searchers can use it simultaneously,

with an average of over nine searches being

conducted at any given time.

Plans are under way to increase the number of journals covered and the number of

users served, and to decrease the cost of communicating with the central computer. Widespread availability of such an improved service could reduce the volume and expense of

the present batch searching system.

27
The Alaska Native Medical Center in Anchorage

is the focal point for relaying medical care consultation by satellite to remote villages throughout the

Satellite Experiments

The success of preliminary experiments in

using the National Aeronautics and Space

Administration's Applications Technology

Satellite (ATS-1) for voice and data communications between the Center, the University

of Wisconsin, Stanford University, and the

University of Alaska in Fairbanks has stimulated plans for expansion into an experimental project for improved health care

services in Alaska. A two-level network will

be developed between the universities and

from the Alaskan Native Medical Center to

the field service units of the Alaskan Native

Medical service, and then from these service

units to selected villages. This network will

permit direct consultation between physicians and also between physicians and health

aides in native villages. Twenty-six sites

have been selected for the Alaskan portion of

the experiment.

state. Professional care is provided to village residents by the area field services units of the Alaska

Nathe Health Service.

The development of new capabilities beyond voice will be tested first by the above

universities, the University of Washington,

and the Lister Hill Center in the continental

U.S. Such tests will investigate the usefulness of the transmission of physiologic and

computer data, facsimile, and slowscan tele- vision.

Television Network

In June 1970, the Center started funding

an experimental two-way, closed-circuit television link, using leased lines, between the

Dartmouth Medical School and the Mary

Hitchcock Memorial Hospital in Hanover,

New Hampshire, and Claremont General

Hospital about 30 miles distant.

The purpose of the contract was to use

video technology to extend the consultative

facilities of a university medical center to

physicians and other health care professionals

who, because of terrain and climate, are

28
somewhat isolated from major medical resources. The link has been heavily used for

such services as psychiatric and mental

health consultations, cancer clinics, coronary

care unit nurses* conferences, social service

activities, and medical and surgical grand

rounds. An auxiliary data link is available

three hours a day for transmitting electrocardiograms.

A contract has been signed with Dartmouth College and the University of Vermont to extend the network. The major part

of this effort is devoted to building a microwave network with mountain-top relay

points connecting Dartmouth and the University of Vermont with Claremont Hospital

and the Central Vermont Hospital.

Educational Technology

The Association of American Medical Colleges, under contract with the Lister Hill

Center, prepared a major report, "Educational Technology for Medicine; Roles of the

Lister Hill Center/' that was published in

the Journal of Medical Education for July

1971. This report endorses the implementation of a biomedical communicationsnetwork. It also recommends that the Center

play a major role in such areas as developing

evaluative criteria for nonprint media and

assisting the medical community in the application of computers as aids to instruction

and diagnosis; and that the Center increase

its own internal research and development

capabilities.

Content Materials

A contract with the Universities Associated for Research and Education in Pathology provides for the development of teaching

units to support learning in specific areas of

undergraduate pathology. Each unit consists

of a monograph, a set of slides, and a list of

additional audiovisuals that would be useful.

A similar contract with the Association of

Professors of Gynecology and Obstetrics supports the identification and reproduction of

teaching units for undergraduate education

^|l!"-|!%f-3f?tl'"'?*""••'• "US?

This is the type of helical antenna used to transmit communications via satellite between Alaska

health centers and isolated villages. Satellite

terminals are being installed at 26 sites in the State.

29
in obstetrics and gynecology. More than 100

medical schools have requested the teaching

packages and have agreed to participate in

their evaluation.

On-Line Indexing

The M.I.T. Lincoln Laboratory's Listar

system, a general-purpose storage and retrieval system, was used for a series of experiments in on-line indexing. A remote display

station at the Library was connected by

leased line to an IBM 360/67 computer at

the Lincoln Laboratory. The staff time for

indexing averaged five minutes for bibliographic input, 14 minutes for subject indexing, and 21 minutes for revising, or a total of

40 minutes per article. This interactive indexing produced a machine-readable form of

the principal data in Medlars citations which

could be transformed into the main citations

file without further human handling.

The Library of the College of Physicians of Philadelphia serves as the Mid-Eastern Regional Medical Library. This is a view of the card catalog and main

reading room. The library was founded in 1788.

30
EXTRAMURAL PROGRAMS

The Office of Extramural Programs provides grants designed to meet the needs for

expanded health information services

through:

• Improvement of libraries and library

networks to facilitate the distribution of information to professional and allied health

personnel.

• Training programs to develop new types

of library and information specialists.

• Research for the development of modern

communication tools concerned with the

acquisition and use of health information.

• Support of publications of important information which is not feasible commercially.

In the seven programs authorized by the

Medical Library Assistance Extension Act of

1970, the Extramural Programs funded 102

new grants in the amount of $1,270,679 and

422 continuing grants and eight contracts in

the amount of $4,721,321 during Fiscal

Year 1971.

Resource Grants

The amended resource grant authority includes three new features: • Deletion of the method of calculating

grant amounts on the basis of previous institutional support for the library.

• Specific authority to assist in the establishment of health science libraries.

• A requirement for assurance of adequate

continuing financial support from non-Federal funds.

There are two types of resource grants, a

one-year $3,000 improvement grant and a

one- to three-year project grant. The im31
provement grant is intended to assist in the

acquisition of basic resources needed by the

library and to motivate the institution to

make a commitment for future library support. The project grant is intended to establish new services or improve and expand existing services. The amended resource grant authority attracted an unusually large number of applications—462 in Fiscal Year 1971, as compared to 594 received during the five-year

period under authority of the 1965 Act. Of

the new applications, 292 were for improvement grants and 170 for project grants. A

total in excess of $5 million was requested in

these applications.

During Fiscal Year 1971 the majority of

funds available was committed to the 385

continuation grants awarded under the authority of the 1965 Act. Eighty-four new

awards were made for proposals submitted

under the new authority. Thirty of these

were project grants.

Training Grants

Specialized training programs are essen- tial to the modern biosciences librarian, who

must develop skills well beyond the traditional training. With proficiency in the use of

modern technological tools and knowledge of

the information needs of health workers, the

librarian can better provide the health professionals with immediate access to needed

information.

Summary of Extramural Programs

Total

New Active

Program Grants Grants &

FY 1971 Contracts

Regional Medical Library 0 10

Medical Library Resource

Grants 84 469

Training Grants and

Fellowships 3 23

Special Scientific Projects 1 6

Research Grants 6 51

Publications Grants 8 25

Total

Special Foreign Currency

Projects

Grand Total

102

34

136

584

76

660

During 1971, 112 persons received training support from the National Library of

Medicine through 17 active training grant

programs. The training opportunities for biomedical

communications careers in Fiscal Year 1971

include masters' degree programs in library

science, and doctorate programs in health information research and in the history of

medicine. In addition there are post-doctoral

research fellowships, and library internships

for advanced training in information processing and medical librarianship.

Research Grants

The Library's research grants support the

three program areas of biomedical library

services, operations, and manpower; biomedical communication tools; and the history of

medicine. Fifty-one research projects were

active during the fiscal year, including six

new projects.

Publications Grants

There were 16 grant-supported publications in 1971, including four new grants.

Representative publications projects included a library reference work to locate the

secondary literature resources for compara- tive and veterinary medicine; a critical review on non-chromosomal inheritance fac- tors in higher organisms; an atlas on protein

sequence and structure; and a translation of

a major Russian-language book on ecology.

Special Scientific Projects

Three scholars were receiving support as

of June 30, 1971, for special scientific projects related to health. One is carrying out a

study of graduate professional education in

occupational medicine; another is making a

systems analysis of health systems; and the

third is writing a comparative historical

study of British colonial medical administration.

Regional Medical Libraries

The Regional Medical Library Program,

reported in an earlier chapter, is part of the

32
national biomedical communications network

designed for information transfer to support

health service delivery, education, and research. The program continues to extend

cooperation between and among existing institutions by making available to them the

total library resources of the Nation. Seven

regional medical library programs have been

transferred to the contract mechanism authorized by the 1970 Extension Act.

International Programs

The Library serves as the Department of

Health, Education, and Welfare's principal

resource under the Public Law 480 program

for the improvement of the international exchange of biomedical information. In Fiscal

Year 1971 the Library continued to sponsor

a series of projects in Israel, Poland, and Yugoslavia for the preparation, translation, and

publication of monographs, journals, critical

reviews, histories of medicine, abstracts, and

conference proceedings, and for indexing and

exchange of audiovisual materials.

Eighteen new projects were activated in

Israel during Fiscal Year 1971 under the Library's multicategorical Public Law 480

Agreement with the Israel Journal of Medical Sciences. At the close of Fiscal Year

1971, the Library also concluded a new

agreement which establishes a three-year

Health Sciences Research Communications

Program in Poland under the auspices of the

Coordinating Commission for Polish-American Scientific Collaboration. The decision

was made during Fiscal Year 1971 to phase

out support, after December 1972, for cover- to-cover translation and publication of biomedical journals in Yugoslavia and Poland.

33
Appendices

Organization of National Library of Medicine

Office of Administrative

Management

KENT A. SMITH

Executive Officer

DIRECTOR

MAKTIN M. CUMMINGS, M.D.

DEPUTY DIRECTOR

G. BURROUGHS MIDER, M.D.

Special Assistants to the

Director

HAROLD M. SCHOOLMAN, M.D.

MARY E. CORNING

Lister Hill National Center for

Biomedical Communications

ALBERT FEINER

Director

Computer and

Engineering Services

RALPH A. SIMMONS

Associate Director

Office of Public Information

and Publications Management

ROBERT J. BENFORD, M.D.

Consultant

Library Operations

JOSEPH LEITER, Ph.D.

Associate Director

Specialized Information

Services

HENRY M. KISSMAN, Ph.D.

Associate Director

Extramural Programs

LEROY L. LANGLEY, Ph.D.

Associate Director

National Medical Audiovisual

Center

CHARLES F. BRIDGMAN, Ph.D.

Director

35
Financial Resources andAllocations

Fiscal Year 1971

Total Available for Obligation

Appropriation, NLM $20,769,000

Less appropriation transfer 4,000

Pay cost supplements 671,000

Earned reimbursements 195,859

$21,631,859

Amounts Obligated by Program/Grants

Extramural activities

Training grants $ 1,000,000

Special scientific project grants 5,000

Research grants 590,000

Resource grants 2,225,242

Regional medical library grants 1,885,763

Publications support grants 280,000

Subtotal, grants $ 5,986,005

Direct Operations

Lister Hill National Center for Biomedical

Communications $ 1,365,794

National Medical Audiovisual Center 2,295,197

Office of Computer and Engineering Services 3,307,544

Library Operations 4,501,705

Toxicology Information Program 1,310,560

Review and Approval 689,241

Program Direction 2,165,367

Subtotal, Direct Operations $15,635,408

Total, NLM $21,621,413

36
Assignment of Personnel on Duty (June 30)

FY 1969 FY 1970 FY 1971

Office of the Director 14

Office of Public Information and

Publications Management 7

Office of Administrative Management 35

Office of Computer and Engineering

Services 55

Extramural Programs 30

Lister Hill National Center for Biomedical

Communications 12

Specialized Information Services 18

National Medical Audiovisual Center 122

Library Operations 196

Office of Associate Director

Bibliographic Services Division

Technical Services Division

Reference Services Division

History of Medicine Division

8

49

55

67

17

Total full-time permanent positions

occupied 489

11

5

30

53

31

10

17

109

195

8

49

54

66

18

461

13

5

33

54

34

14

16

99

194

10

51

59

58

16

462

Staff Awards and Honors

Mr. Jerome Barnett Second Annual NLM Director's Nov. 1970

Award for Outstanding Contribution to the Library's Programs

Mr. Stanley Jablonski Second Annual Regents' Award June 1971

for Scholarship or Technical

Achievement

Miss Mary E. Corning Department of Health, Educa- June 1971

tion, and Welfare Superior

Service Award

Dr. Peter Olch

Mr. William Caldwell

Public Health ServiceCommendation Medal for Sustained

High Quality Performance

While on Active Duty

June 1971

37
Publications by Staff Members

BLAKE, J. B.: Automation and the control of historical sources: prob- lems and possibilities. In Clarke, E. (Ed.) : Modern Methods in History of

Medicine. London, Athlone Press, 1971, pp. 260-276. BLAKE, J. B.: Commentum super Nicolaum, by Stephanus Arlandi:

an unnoticed medical incunabulum. J. Hist. Med. 25:480, 1970. BLAKE, J. B.: Literary style in American medical writing; a historical

view. J.A.M.A. 216:77-80, 1971. BRAND, J. L.: The British health system. In Medicine and Society:

Contemporary Medical Problems in Historical Context. Philadelphia, Amer- ican Philosophical Society, 1971, pp. 283-398.

CARLSON, W. M. and DAVIS, R. M.: Communicating via computers. J. Chem. Doc. 10:265-267, 1970. CASSEDY, J. H.: The "germ of laziness" in the South, 1900-1915:

Charles Wardell Stiles and the Progressive paradox. Butt. Hist. Med. 45:

159-169, 1971. CLARK, M. V. (Comp.) : Medical Reference Works 1679-1966; a

selected bibliography. Supplement I. Chicago, Medical Library Association, 1970, xv, 46 pp.

COLE, N. L.: Application of audiovisual technology in medical edu- cation. Scot. Med. J. 16:12-19, 1971. COLE, N. L.: A national programme in biomedical communication. Scot. Med. J. 16:98-103, 1971.

COLE, N. L.: An overview of medical television in the United States. Scot. Med. J. 16:50-53, 1971.

COLE, N. L., and CRAIG, R. S.: Audiovisual techniques in teaching. In

American College of Radiology: Proceedings of the 1970 Conference of Teachers of Radiology, Dallas, April 3-4, 1970. Chicago, American College

of Radiology [1971], pp. 62-75.

COLE, N. L., and DOUGHERTY, W. S. The overhead projector. Scot. Med.

J. 16:22-24, 1971.

CRAIG, R. S.: Effective photography. Scot. Med. J. 16:80-84, 1971. CRAIG, R. S.: Visual systems: Pro and con. Scot. Med. J. 16:8-11, 1971.

CUMMINGS, M. M.: Parallelisms of medical greatness. J. Okla. State

Med. Assn. 68:385-390, 1970.

DAVIS, R. M.: The Lister Hill National Center for Biomedical Com- munications—its role in teaching. In American College of Radiology:

Proceedings of the 1970 Conference of Teachers of Radiology, Dallas, April 3-4,1970. Chicago, American College of Radiology [1971] pp. 53-61.

DAVIS, R. M.: The National Biomedical Communications Network as

a developing structure. Bull. Med. Libr. Assn. 59:1-20, 1971.

LANGLEY, L. L.: Physiology of Man. 4th ed. New York, Van Nostrand

Reinhold Company, 1971, viii, 777 pp.

LANGLEY, L. L.: Review of Physiology. 3rd ed. New York, McGraw- Hill, 1971, x, 726 pp.

McCARN, D. B.: Getting ready. Datamation 16:22-26, 1970.

McCARN, D. B.: Planning for on-line bibliographic access by the

Lister Hill National Center for Biomedical Communications. Bull. Med.

Libr. Assn. 58:303-310, 1970.

McCARN, D. B. and MORIARTY, D. G.: Computers in hospitals. Hospitals 45:37-39, 1971.

WASERMAN, M. J. and MAYFIELD, V. K.: Nicolas Chervin's yellow fever

survey, 1820-1822. /. Hist. Med. 26:40-51, 1971.

WOOSTER, H.: The future of scientific publishing—or, What will scien- tists be doing for brownie points? /. Wash. Acad. Sci. 60:41-46, 1970.

38
Regional Medical Libraries

1. New England Region (Conn., Me., Mass., N.H.,

R.I., Vt.)

Francis A. Countway Library of Medicine

10 Shattuck St., Boston, Mass. 02115

Librarian: Harold Bloomquist

RML Director: Mary E. Feeney

Telephone: 617-734-8900 X126

TWX: 710-338-6702

2. New York and Northern New Jersey Region

(New York and the 11 northern counties of

New Jersey)

New York Academy of Medicine Library

2 East 103 St., New York, N.Y. 10029

Librarian: Thomas G. Easier

Telephone: 212-876-2531

TWX: 710-581-6131

3. Mid-Eastern Region (Pa., Del., and the ten

southern counties of New Jersey)

Library of the College of Physicians

19 South 22 St., Philadelphia, Pa. 19103

Librarian: Elliott H. Morse

RML Director: Carol C. Spencer

Telephone: 215-561-6050

TWX: 710-670-1646

4. Mid-Atlantic Region (Va., W. Va., Md., D.C.,

N.C.)

National Library of Medicine

8600 Rockville Pike, Bethesda, Md. 20014

Librarian: Dr. Martin M. Cummings

RML Director: Dr. Joseph Leiter

Telephone: 301-496-5511

TWX: 710-824-9615

5. East Central Region (Ky., Mich., Ohio)

Wayne State University Medical Library

4325 Brush St., Detroit, Mich. 48201

Librarian: Dr. Vern M. Pings

RML Director: Elizabeth G. Monroe

Telephone: 313-577-1091

TWX: 810-221-5163

6. Southeastern Region (Ala., Fla., Ga., Miss., S.C.,

Tenn., Puerto Rico)

A. W. Calhoun Medical Library

Emory University, Atlanta, Georgia 30322

Librarian: Miriam H. Libbey

RML Director: T. Mark Hodges

Telephone: 404-377-9201

TWX: 810-751-8512

7. Midwest Region (111., Ind., Iowa, Minn., N.D.,

Wis.)

John Crerar Library

35 West 33 St., Chicago, 111. 60616

Librarian: William S. Budington

Telephone: 312-225-2526

TWX: 910-221-5131

8. Midcontinental Region (Colo., Kans., Mo., Neb.,

S.D., Utah, Wyo.)

University of Nebraska Medical Center

42nd St. & Dewey Ave., Omaha, Nebraska 68105

Librarian: Bernice M. Hetzner

RML Director: Elizabeth A. Petgen

Telephone: 402-541-4646

TWX: 910-622-8353

9. South Central Region (Ark., La., N.M., Okla.,

Tex.)

University of Texas Southwestern Medical

School at Dallas

5323 Harry Hines Blvd., Dallas, Texas 75235

Librarian: Donald M. Hendricks

Telephone: 214-631-3220

TWX: 910-861-4946

10. Pacific Northwest Region (Alaska, Idaho, Mont.,

Oregon, Wash.)

University of Washington

Health Sciences Library

Seattle, Washington 98105

Librarian: Gerald J. Oppenheimer

Telephone: 206-543-5530

TWX: 910-444-1385

11. Pacific Southwest Region (Ariz., Calif., Hawaii,

Nev.)

Center for the Health Sciences

University of California

Los Angeles, California 90024

Librarian: Louise Darling

RML Director: Nelson J. Gilman

Telephone: 213-825-1200

TWX: 910-342-6897

39

GP 0 9 20-199
THE BILLINGS ERA

early one hundred years ago Army Surgeon General Joseph K. Barnes, in his

annual report for 1873 to Secretary of War,

prophetically mentioned "the interest felt by

the medical profession of the country in the

attempt to establish a

National Medical Library

worthy of the name."

A highly professional man,

Barnes had more than a

passing interest in the

growing collection of medical books and pamphlets

already in his office when

he became surgeon general. He also had the fore- DrJohn shaw Bim"gs

sight to assign a rising young medical officer

to his staff in 1865 and, among numerous administrative duties, to appoint him librarian.

His name was John Shaw Billings, and he was

to become one of the medical giants of the late

nineteenth and early twentieth centuries.

Billings, who gained an international reputation in medical education, public health, hospital design and construction, and vital statistics, attained eminence in medical bibliography

and librarianship during the 30 years he headed

the Library. Strongly supported by Barnes, he

greatly increased acquisitions by purchase,

exchanges and gifts, inaugurated loans of

books without fees (but required a deposit),

initiated a publication program, and fought

unrelentingly for a new fireproof building to house the

great collection he was assembling to be a truly National

Medical Library.

Billings' monumental achievement as a librarian was the

conception and production of

the Index-Catalogue, a colossal task of compiling the vast holdings of the library by subject

and author in a single alphabet, to provide

medical students and practitioners with access

to the available literature. The first of the 16

volumes that were to comprise the first series

of the Index-Catalogue was published in 1880.

The series contained citations to 116,847

books and 191,598 pamphlets, practically all

of which Billings had himself added to the

Library. With his long-time associate and collaborator, Dr. Robert Fletcher, he also produced

the Index Medicus, a continuing compilation

of current literature.

By the fall of 1887 a new three-story red brick

building on the south side of the Mall, designed

by Billings, was completed at a cost of $200,-

000. This was $50,000 less than the amount

originally requested and necessitated the deletion of many needed facilities and improvisation in other areas. But the task of moving the

•;,:•

On the Mall, 1887-1961

collection, now grown to 51,000 books and

about 57,000 pamphlets, was completed in

time to belatedly celebrate the Library's fiftieth

anniversary in its new home.

The Library continued to grow in resources,

services and prestige under the leadership of

the distinguished physicians who followed

Billings. In 1922 its name was changed to the

Army Medical Library. Later, during an era of

unification of agencies under the new Department of Defense, it was redesignated the

Armed Forces Medical Library. In 1956 an

amendment to the Public Health Service Act

created the National Library of Medicine under

the jurisdiction of the Department of Health,

Education and Welfare.
he world's largest collection of health

v£) sciences literature of the National Library of Medicine is preserved in a modern,

functional structure with an eye-catching,

hyperbolic-paraboloid roof in Bethesda, Maryland, that was dedicated in 1961.

Two important factors contribute to the expanding services this great center of information

and learning provides physicians and medical

students, and other members of the health professions. One is the Library's international computerized system of compiling, storing and

retrieving references to medical literature,

known as Medlars. The other is the passage of

the Medical Library Assistance Act under

which, for the first time, grants are available

to medical libraries to increase their resources

and services. In addition, the law authorized

the establishment of the Regional Medical

Library Program to develop a nationwide biomedical communications network.

Medlars has also given impetus to the Library's

unprecedented publications program. Index

Medicus, which provides a monthly bibliography of current literature, and the Current

Catalog are produced more promptly through

the use of computer-driven phototypesetters. A

popular new publication, Abridged Index Medicus, contains literature citations from the 100

most important clinical medical journals

fl

i H I

printed in English. More than a score of recurring specialized bibliographies cover many of

the specialized fields of medicine.

The staff and resources of the National Medical

Audiovisual Center in Atlanta, Georgia, formerly

a part of the Public Health Service's Center for

Communicable Diseases, in 1967 were assigned

to the jurisdiction of the National Library of

Medicine. By a Senate Joint Resolution in

1968, the Lister Hill National Center for BioMedlars Computer System

Main Reading Room

medical Communications was established

within the National Library of Medicine. This

new Center has broad research and development responsibilities in the application of computer and communication technology to medical communications, education and research.

But great advances in communication technology and literature retrieval have not diminished the personal gratification of visiting a

library to experience sensory contact with

books and their contents. Here the quest for

knowledge is more pleasurable and more rewarding. Recently a physician, in concluding

a list of acknowledgements in a newly-published

book on heart disease, wrote: "In my opinion

there is no more satisfactory source of help

than librarians. They always seem overjoyed to

find somebody who wants to learn something."

The National Library of Medicine is such a

learning place for the health professions.

8600 Rockville Pike

Bethesda, Maryland 20014

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

National Institutes of Health r U. S. GOVERNMENT PRINTING OFFICE : 1971 O - 444 -636