.FISC

. f f I

NATIONAL LIBRARY OF MIU1MTHE EARLY YEARS

I/n 1836 the U.S. Army's first surgeon generalC7 included an item in his estimate of official

expenditures for the following year that read:"Medical Books for Office, $150." Viewed retro-spectively, this commitment by Dr. JosephLovell of nearly seven per cent of his annualoffice budget for this purpose may have beenthe most significant decision of his professionalcareer.

For it is from that year IIBIBBBBIand the bulging book-s h e l v e s in Lovellfstwo-room office in along-forgotten buildingin Washington Citythat the National Li-brary of Medicine of-ficially traces its his-toric origins. No medi-cal prophet could haveforeseen the inevitablecourse that followed Dr- JosePh Lovel1

until now, nearly acentury and a half later, this great library holdsthe most prestigious and important collectionof health sciences literature ever assembled

A Bostonian and Harvard graduate, Lovel! hadserved as an Army medical officer for only sixyears when in 1818 at the age of 29 he wasappointed surgeon general, a new staff posi-tion in Washington established in a Congres-sional reorganization of the Army. He initi-ated the policy of providing his officers in thefield, as well as those assigned to hospitals,with medical textbooks and professional jour-nals. Copies were also retained in his officefor the use of his small staff.

By 1840 Lovell's successor, Dr. ThomasLawson, listed "some 130 titles and about200 volumes" in a handwritten report by amember of his staff that is now a preciousarchive, "A Catalogue of Books in the Libraryof the Surgeon General's Office." Lovell's

random collection of books was officially alibrary. Actually it became a mobile librarythat accompanied the surgeon general's officearound early Washing- 1 I 'ton in its frequentmoves to borrowed orrented quarters, some-times in private dwell-ings.

During Lawson's 25-year tenure as surgeongeneral—the longest Ri«s Bank Bundingon record—an increasing number of expendi-tures for medical books, journal subscriptions,bindings, and bookcases began to appear inhis office records. When the first printed cata-log of the Library's holdings appeared in 1864it listed 1,365 volumes under nine classes ofliterature, and included the date and place ofpublication of each title. By this time the sur-geon general's office was in a brick building,formerly a residence, adjacent to the RiggsBank on the northwest corner of FifteenthStreet and Pennsylvania Avenue, N.W. TheLibrary rccupied the front parlor of the house.

After the assassinationof President Lincoln inFord's Theater on April14, 1865, the govern-ment bought the ill-fated three-story build-ing and assigned it tothe War Department asan annex of the surgeon general's office. Thestructure that was to become a Lincoln shrinewas refurbished to provide quarters and facil-ities for a new medical museum, a chemicallaboratory, mortuary records, and the booksand periodicals of the surgeon general's library,now numbering more than 2,000 volumes. Thelibrary had found its first "permanent" homeand would not move again for 20 years.

Ford's Theater

NATIONALLIBRARY

MEDICINE

PROQRAMS AND SERVICES

L.. • A_J

IP

U.S. Department of Health, Education, and WelfarePublic Health Service

National Institutes of Health

DHEW Publication No. (NIH) 73-256

Foreword

This edition of the annual report of the National Library of Medicinehighlights our activities for fiscal year 1972 in a new format. Previouslythe publication consisted of separate sections devoted to the accomplish-ments of each of the principal organizational units, usually the area ofresponsibility of an associate director. This procedure has served theLibrary well in the past. But now our expanding programs and serviceshave become more complex and far-reaching, cutting across traditionalorganizational boundaries and requiring interdisciplinary skills and talents.Our new MEDLINE system is an example of such diverse staff involve-ment. So, in reviewing the year, we have attempted a departure from afunctionally presented report to one that is more mission-oriented. We hopeyou will agree that it tells our story more coherently and effectively.

We believe that this has been a year of continuing progress. Surelyit was one that the most astute of our early founders, who are recalled inthe cover notes, scarcely could have foreseen in the Library's future. Agreat share of my gratitude goes to our Board of Regents for their judi-cious and decisive actions. I also thank the loyal and industrious membersof the Library staff for their dedication and support. Medical librariesexist to serve the health of our people and we exist to assist medicallibrarians in this effort. We will strive to continue to serve faithfully allmembers of the health professions who, in the words of Dr. John ShawBillings, "remain close, heart and hands, to the problems of disease."

Martin M. Cummings, M.D.Director

BOARD OF REGENTS

WILLIAM G. ANLYAN, M.D., ChairmanVice President for Health AffairsDuke UniversityDurham, North Carolina

WILLIAM 0. BAKER, Ph.D.Vice President in Charge of ResearchBell Telephone LaboratoriesMurray Hill, New Jersey

SUSAN N. CRAWFORD, Ph.D.Director, Archive-Library DepartmentAmerican Medical AssociationChicago, Illinois

BERNICE M. HETZNERProfessor of Library ScienceUniversity of NebraskaCollege of MedicineOmaha, Nebraska

JACK M. LAYTON, M.D.Deun, College of MedicineUniversity of ArizonaTucson, Arizona

J. STANLEY MARSHALL, Ph.D.President, Florida Stole UniversityTallahassee, Florida

ANGELO M. MAY, M.D.Sun Francisco, California

JOHN P. McGovERN, M.D.Professor and ChairmanDepartment of the History of MedicineUniversity of Texus Graduate School

of Biomcdical SciencesHouston, Texas

MAX MICHAEL, JR., M.D.Executive DirectorJacksonville Hospitals Educational

ProgramJacksonville, Florida

GEORGE W. TEUSCHER, D.D.S.Dean, Dentul SchoolNorthwestern UniversityChicago, Illinois

Ex Officio Members

LT. GENERAL HAL B. JENNINGS, JR.The Surgeon GeneralDepartment of the Army

VICE ADMIRAL GEORGE M. DAVISThe Surgeon GeneralDepartment of the Navy

LT. GENERAL ALONZO A. TOWNERThe Surgeon GeneralDepartment of the Air Force

JESSE L. STEINFELD, M.D.The Surgeon GeneralU.S. Public Health Service

MARC J. MUSSER, M.D.Chief Medical DirectorThe Veterans Administration

L. QUINCY MUMFORD, LL.D.The Librarian of Congress

HARVE J. CARLSON, D.P.H.Director, Division of Biological and

Medical SciencesNational Science Foundation

Executive Secretary

MARTIN M. CUMMINGS, M.D.Director, National Library of Medicine

CONTENTS

POLICY AND DIRECTION

Board of Regents Decisions, 7Federal Appropriations, 9Copyright Suit, 9Staffing Activities, 10Visitors to the Library, 12Educational and Historical Exhibits, 12Medical Press Reports, 13

SERVICES AND OPERATIONS 15

Highlights of the Year, 15Bibliographic Services, 16Technical Services, 16Reference Services, 18History of Medicine, 19Specialized Information Services, 20

GRANTS FOR LIBRARY ACHIEVEMENT 21

Medical Library Assistance Act, 21New Library Construction, 21Resource Grants, 21Training Grants, 24Special Projects, 24Research Grants, 24Publication Grants, 26

MEDLINE AND THE LIBRARY NETWORK 27

MEDLINE, 27TOXICON, 30Medlars I and II, 32Computer Upgrade, 32Regional Medical Library Program, 32Roster of Regional Libraries, 33

THE LIBRARY PUBLISHER 35

Current Catalog, 1965-1970, 35Toxicology Publications, 35Supported Articles and Monographs, 36Medical History, 37Foreign Authors' Works, 37NLM News, 38

INNOVATIONS IN LEARNING 39

Audiovisual Technology, 39Evaluation and Acquisition, 39Distribution of Materials, 40Advisory Services, 40Training Workshops, 41Media Development, 42Media Reference Resource, 43New Techniques, 43

AN INTERNATIONAL LIBRARY 45

Medlars Conference, May 1972, 45Foreign Participants, 45

P. L. 480 Program, 46Agreement with Israeli Journal, 46

International Organizations, 47

HEALTH COMMUNICATIONS RESEARCH 49

Alaska Satellite Voice Link, 49New England Interactive TV Network, 50New NASA ATS-F Satellite, 52Cable Television Project, 52Computer Simulation,53Lister Hill Center Report to Congress, 53

POLICY AND DIRECTIONThe 136th year of the National Library of

Medicine was significant for three notable butquite diverse occurrences, each of which willaffect in various ways this institution's futureprograms and services. They are the releaseby the President of long-awaited appropriatedfunds for design and planning of an impres-sive 15-story communications annex; the in-troduction and wide acceptance of the nation-wide MEDLINE network for rapid literaturesearching; and continued litigation betweena commercial publisher and the Governmenton the use of photocopies of copyrightedmedical publications.

The ten Presidentially-appointed membersof the Board of Regents and seven high gov-ernment officials serving as ex officio mem-bers also faced policy decisions of increasinggravity as the Library's role in national andinternational medical communication activ-ities continued to expand. At the second ofthe Board's three meetings in November1971, Dr. William G. Anlyan, chairman andvice president for health affairs of DukeUniversity, welcomed four new members:Dr. J. Stanley Marshall, president of FloridaState University, to fill the unexpired termuntil August 1974 of Dr. James C. Fletcher,who had resigned earlier to head the Na-tional Aeronautics and Space Administra-tion; Dr. Susan N. Crawford of Chicago,director of the Archive-Library Departmentof the American Medical Association; BerniceM. Hetzner of Omaha, professor of libraryscience, University of Nebraska College olMedicine; and Dr. Angelo M. May, SanFrancisco physician, who will serve untilAugust 1975.

Regents whose terms expire in August1972 include: Dr. Max Michael, Jr., of Jack-sonville; Dr. George W. Teuscher of Chicago;and Dr. Anlyan, who will be succeeded aschairman by Dr. Jack M. Layton of Tucson.Dr. Layton, chairman of the department ofpathology of the University of Arizona Col-lege of Medicine in Tucson, is also actingdean and director of the University's medicalcenter during the absence of Dr. Merlin K.

DuVal, who is serving as HEW assistant sec-retary for health and scientific affairs. Nowpresident-elect of the American Society ofClinical Pathologists, Dr. Layton will be in-ducted as president during the society'sannual meeting in San Francisco in October1972. He was elected chairman of the Boardby unanimous vote.

Board of Regents DecisionsDuring fiscal year 1972 the Board of

Regents reviewed numerous recommenda-tions of its various committees, and madethese major policy decisions:

• Approved recommendations to initiateimplementation of a detailed report* of theAssociation of American Medical Colleges toexpand the development of a national bio-medical communications network whicheventually may result in rendering "obsoletethe current systems of libraries, textbooks,medical school curricula, and total depend-ence on memory and pattern recognition inclinical decision-making and problem-solving."

• Instituted revised guidelines governingthe purpose and use of resource grant fundsapproved by the Library's Extramural Pro-grams.

• Redirected programs supporting train-ing for careers in biomedical communicationtoward postgraduate training and doctoratesin biomedical communication rather than tomaster's degrees in medical library science.

• Amended the guidelines for review andapproval of applications for extramural sup-port of publications.

• Appointed Drs. Fred L. Soper andHarry F. Dowling the first National Libraryof Medicine Scholars in Residence (visitingscholars) under a program previously estab-lished.

* Educational Ttchnolojfy for Medicine: Roles forthe Lister Hill Center. Edited by Eugene A. Snead,Jr., Cheves McC. Smythe, C. G. Gunn, and Mary H.Littlemeyer. J. Med. Educ.: 46, No. 7, July 1971,part 2.

Table 1. Financial Resources and AllocationsFiscal Year 1972

Amounts Available for ObligationAppropriation, NLM $24,086,000Unobligated balance brought forward, start of year 45,550Unobligated balance brought forward, end of year (1972/1973) -54,808Pay cost supplements 41,000Earned reimbursements 1,033,666

Total $25,151,408

Amounts Obligated by Extramural ProgramsTraining grants 1,233,000Special scientific project grants 100,000Research grants 640,000Library resources grants 2,508,000Regional medical library grants 2,093,000Publications support grants 311,000

Subtotal, grants $ 6,885,000

Amounts for Direct OperationsLister Hill National Center for Biomedical Communications __ 1,883,000National Medical Audiovisual Center 3,235,666Office of Computer and Engineering Services 3,066,000Library Operations 4,900,000Toxicology Information Program 1,315,000Review and Approval 760,000Program Direction 2,848,000

Subtotal, direct operations $18,007,666Total, National Library of Medicine — $24,892,666

3. Members of the Board of Regents pose at meeting in Atlanta, from left, front row:Dr. Faye G. Abdellah, Capt. Edward J. Rupnik, USN, Dr. James Pittman, Dr. HarveJ. Carlson, Mrs. Bernice M. Hetzner, Dr. William G. Anlyan, and Dr. Susan N. Craw-ford. Rear row: Brig. Gen. Gerrit L. Hekhuis, USAF, Dr. G. Burroughs Mider,Lt. Gen. Hal B. Jennings, Jr., USA, Dr. Martin M. Cummings, Dr. J. Stanley Marshall,Dr. Angelo M. May, Dr. John P. McGovern, Dr. William O. Baker, Dr. Jack M.Layton, Dr. George W. Teuscher and Dr. Max Michael, Jr.

8

Federal AppropriationsOn January 24, 1972 the President sub-

mitted to Congress the administration's fiscal1973 budget. The amount requested for theNational Institutes of Health totalled $2.18billion, an increase of $7 million. Within theproposed NIH budget, the Library's requestis for $28 million, which is about $4 millionabove the fiscal 1972 appropriation (Table 1).

If appropriated, the increase in funds willbe used primarily for additional support ofRegional Medical Libraries and medicallibrary training programs, and for biomedi-cal communications activities of the ListerHill Center. Emphasis also will be given toa cooperative NASA-NLM project to testtwo-way TV satellite communications forhealth care and medical education via theApplication Technology Satellite, which is tobe launched in 1973.

The Library's Extramural Programs wouldreceive $1.6 million of the total NLM in-crease, and the Lister Hill Center $1.2 mil-lion. Additional amounts would appear inthe budgets of other components of theLibrary.

Established by law in 1968 as a componentof the National Library of Medicine, theLister Hill National Center for BiomedicalCommunications will occupy a structure tobe built adjacent to the Library. The Officeof Management and Budget during the fiscalyear apportioned planning funds, appropri-ated in 1970, in the amount of $765,000 tothe General Services Administration to con-tract for the architectural and engineeringdesign of this new building.

In addition to the staff and facilities forthe Lister Hill Center, this annex to theLibrary will also house the National MedicalAudiovisual Center, now in Atlanta, and theoperations of the Extramural Programs andSpecialized Information Services.

Copyright SuitOn February 16, 1972, in the suit Williams

& Wilkins v. United States, a commissionerof the United States Court of Claims fileda report recommending that plaintiff pub-

Flanking recently unveiled bust of PresidentKennedy, Dr. Jack M. Layton, left, chairman-electof Board of Regents, accepts gavel from Dr. WilliamG. Anlyan, retiring chairman.

lisher "is entitled to recover reasonable andentire compensation for infringement ofcopyright" involving medical journals pub-lished by it. The agencies specified in the com-plaint, which was filed in February 1968, arethe National Library of Medicine and thestaff library of the National Institutes ofHealth.

The commissioner's report states that theNational Library of Medicine infringed thepublisher's copyright by providing inter-library loans of single photocopies of journalarticles to medical libraries for the use ofphysicians, and of scientists and students inthe biomedical fields, and that NIH infringedthe plaintiff's copyright by supplying photo-copies of medical journal articles to its staff.This photocopying, the report states, dimin-ishes the publisher's potential market, andthe plaintiff is, therefore, entitled to com-pensation.

The commissioner's report was promptlyexcepted to by the United States. The Gov-ernment's brief, expressing in detail its ob-jections to this report, was filed on August 2,1972. The American Library Association, theNational Education Association, and theAssociation of Research Libraries jointlywith the American Medical Association, theMedical Library Association, and other na-tional societies filed "friend of the court"briefs in support of the Government's posi-

tion. A decision by the full seven-judge Courtof Claims, which may be appealed to theSupreme Court, is not expected until 1973.Meanwhile, the National Library ofMedicine,on the advice of the Department of Justice, iscontinuing its thirty-year policy of providingphotocopied material in interlibrary loans.

The commissioner's report received wideattention in the medical and library presses.The Journal of Medical Education revised itsmasthead in the May issue to read: "Copy-right by the Association of American Medi-cal Colleges. All material subject to this copy-right may be photocopied for the non-commercial purpose of scientific or educa-tional advancement." At the same time,AAMC president Dr. John A. D. Cooper, ina letter to Williams & Wilkins' president,stated that "this Association vigorously op-poses any action which would tax or other-wise inhibit the free distribution of necessaryinformation to scientific investigation."

In an editorial upholding the right ofscientific and scholarly communities to gainaccess to the intellectual resources of thiscountry, in its June 5 issue, the Journal ofthe American Medical Association remindedits readers that "the Association reiteratesits position that the scientific community maycontinue to reproduce single articles from theAMA publications."

Dr. Franz J. Ingelfinger, editor of the NewEngland Journal of Medicine, told his readersthat NEJM "joins in this protest against amove that threatens a communicationmechanism evolving in response to today'sand tomorrow's needs. The Journal reaffirmsits policy with respect to photocopying:libraries and other nonprofit institutions mayphotocopy Journal articles at will."

The director of one of the nation's mostprestigious university medical libraries prob-ably spoke for most medical librarians whenhe wrote in the institution's newsletter, ". . .a final ruling against 'fair use' (policy of sin-gle photocopying) would have catastrophiceffect upon the use of scholarly libraries and,in turn, upon the use of the literature inhealth care institutions and by their staffs."

Most librarians and medical educators

favor a section of the commissioner's reportwhich states that the copyright issue shouldbe resolved through the legislative processrather than through the courts. Library as-sociations reportedly are urging their mem-bers to await a decision by the Court ofClaims and to shun publishers' offers ofgranting licenses for photocopying privilegesin return for payment of increased subscrip-tion rates for their journals—a practice that,if adopted by all publishers, might increaseacquisition costs of academic and publiclibraries, it has been estimated, by severalmillion dollars a year.

Staffing ActivitiesThe major staff change in the Library for

this fiscal year was the retirement on June30 of G. Burroughs Mider, M.D., a distin-guished pathologist and administrator whohas served as deputy director since 1968.

At retirement reception, Dr. G. Burroughs Mider,left, shares a laugh with NIH Director Robert Q.Marston.

Prior to his assignment to the Library, hehad served in senior staff positions in theNational Institutes of Health for 24 years,most recently as director of laboratories andclinics. Dr. Mider, who accepted a position inBethesda, Maryland as executive officerjointly for the Universities Associated forResearch and Education in Pathology andthe American Society for ExperimentalPathology, will be succeeded in the fall of1972 by Melvin S. Day, head of the NationalScience Foundation's Office of Science In-formation Service. Previously, Mr. Day

10

served ten years in technical informationposts at the National Aeronautics and SpaceAdministration, rising to deputy assistantadministrator.

Melvin S. Day is new deputy director of NationalLibrary of Medicine.

Early in the year Ralph A. Simmons, asso-ciate director for Computer and EngineeringServices, was succeeded by Davis B. McCarn,formerly deputy director of the Lister HillCenter. Mr. Simmons is now staff assistantfor international computer technology at theNational Bureau of Standards' Center forComputer Sciences and Technology. In JuneGeorge E. Mitchell, D.M.D., chief of audio-visual development of the NIH Bureau ofHealth Manpower Education, was appointeddeputy director of the National MedicalAudiovisual Center. During the same monthMorton J. Oppenheimer, M.D., previouslychairman of the department of physiology atTemple University School of Medicine, joinedthe Center's staff as chief of the educationalresearch and training branch.

Formerly director of libraries of the Bow-man Gray School of Medicine of Wake ForestUniversity, Erika B. Love was named deputyassociate director for Library Operations.

Robert B. Mehnert, former NLM staff mem-ber, and more recently an information officerin the National Institute of Mental Health,returned as chief of the Office of Public In-formation and Publications Management.Robert H. Cross transferred from NIH tothe position of NLM personnel officer.

Promotions among key staff members dur-ing the year included the appointment ofAlbert M. Berkowitz to chief of the Refer-ences Services Division and Edith D. Blair tohead of the reference section of the division.Fred Buschmeyer, Jr., formerly of the Na-tional Medical Audiovisual Center, wasnamed special assistant for audiovisual com-munications on the retirement of Dr. Mal-colm S. Ferguson after 30 years of govern-ment service. Dr. Roger W. Dahlen trans-ferred from the National Heart and LungInstitute to join the staff as chief of theResearch, Training and Publications Divi-sion for Extramural Programs, and NinaWoo Matheson, formerly librarian and fac-ulty member of the University of MissouriInstitute of Psychiatry in St. Louis, was ap-pointed a project officer. Dr. Galina Zarech-nak was reassigned from the Technical Serv-ices Division to the International ProgramsDivision.

The Library's full-time staff of 465 hasnot increased significantly in the past threefiscal years (Table 2). Of this total, 331 per-sons are assigned to the Library on the NIHcampus, 104 are in the National MedicalAudiovisual Center in Atlanta, and 30 inExtramural Programs are located in agovernment office building in Bethesda,Maryland.

Two associate directors of the Library, Dr.Joseph Leiter and Davis B. McCarn, receivedthe HEW Superior Service Honor Awardfrom NIH Director Robert Q. Marston at theceremonies in the Clinical Center's JackMasur Auditorium.

Thelma G. Charen was chosen the thirdrecipient of the Regents' Award for Scholar-ship or Technical Achievement "for conceiv-ing, developing and implementing the Med-lars indexing manual and training program."Mrs. Charen is a technical information spe-

ll

cialist in the indexing section of the Biblio-graphic Services Division.

Dr. John B. Blake, chief of the History ofMedicine Division, was installed as presidentof the American Association for the Historyof Medicineat the society's 45th annual meet-ing in Montreal in May.

The director of the Library, Dr. Martin M.Cummings, received the honorary degree ofdoctor of medicine from the Karolinska Insti-tute following his presentation of the honorsconvocation address in Stockholm.

Visitors to the LibraryThe National Library of Medicine attracts

scholars, scientists, public health officialsand students in increasing numbers fromall parts of the United States and fromscores of foreign countries. Hundreds of in-terested travelers visit the Library each yearseeking guided tours and information abouttheir special areas of interest. These visitors,of course, are in addition to the thousands ofpatrons of the Library who spend days, andeven weeks, in continuous study and research.

The past fiscal year was no exception inbringing to the Library a variety of interest-ing and interested visitors. In scanning therecords of tours, the names of an endocrinolo-gist from Lisbon, a Moscow professor of pedi-atrics, a University of Zambia medical li-brarian, Egypt's minister of health planning,an official of the Japanese ministry of edu-

cation, a reference librarian from Tel Aviv,a Finnish computer specialist, a Bucharestphysician, the Netherlands minister of health,and an ophthalmologist from India appear,along with many others.

Groups of visitors have ranged from 30Japanese pharmacists to the wives of WhiteHouse Fellows, and from students fromGallaudet College for the Deaf to a juris-prudence class of Air Force legal officers andthe regional laboratory librarians of theEnvironmental Protection Agency. The ma-jority of larger groups visiting the library,however, are students from U.S. schools ofmedicine, dentistry, pharmacy, nursing, andlibrary science.

In addition to an orientation tour of themain reading room, catalog, and referenceareas, visitors are given an opportunity tosee the Library's computerized Medlars sys-tem in action, witness a demonstration of thenew MEDLINE rapid retrieval of literaturecitations, and observe the entire process ofthe Library's unique photocopying service.

Educational and Historical ExhibitsThe entrance foyer of the building pro-

vides a natural setting for the Library'scontinuing exhibit series depicting educa-tional and historical subjects of medical sig-nificance. Each exhibit is based on displaysof related literature from the Library's vastcollections. The year 1971 marking the Li-

Table 2. Assignment of Personnel on Duty (June 30)

FY 1970 PY 1971 FY 1972

Office of the Director 11 13 13Office of Public Information and Publications

Management 5 5 5Office of Administrative Management 30 33 37Office of Computer and Engineering Services 53 54 54Extramural Programs 31 34 30Lister Hil l National Center for Biomedical

Communications 10 14 15Specialized Information Services 17 16 16National Medical Audiovisual Center 109 99 104Library Operations 195 194 191

Total full-time permanentpositions occupied . 461 462 465

12

brary's 135th anniversary was observed byan historical exhibit depicting its transitionfrom modest beginnings to the present com-puterized programs.

Mrs. Paula Scherer-Goossens, left, visiting docu-ments systems analyst from Brussels, is shownpoints of interest in Library by Ruth E. Armstrong,NLM tour director.

Another exhibit, "Pathology: The Scienceof Disease," featured selections from a re-markable collection of portrait photographsof distinguished American pathologists, madeby Dr. William H. Feldman of the MayoClinic emeritus staff as an outgrowth of aboyhood camera hobby that had led him toimprovise equipment and make some of hisown early photomicrographs. Dr. and Mrs.Feldman were present for ceremonies open-ing the exhibit.

The third exhibit of the year paid tributeto Dr. Abraham Jacobi, the founder of Amer-ican pediatrics, and to other physicians con-cerned with the health of children in a eraprior to the acceptance of pasteurization ofmilk, preschool medical examinations, andproper care for the blind, deaf, and mentally

Col. James L. Hansen, USA, right, deputy directorof the Armed Forces Institute of Pathology, greetsDr. William Hugh Feldman, of the emeritus staffof the Mayo Clinic, whose portrait photographs ofnoted pathologists were feature of Library exhibit.

ill. Entitled "The Emergence of Modern ChildHealth Care in America," the exhibit traceddevelopments from 1873, when the AmericanMedical Association established a section onobstetrics and diseases of women and chil-dren, until 1931, when the American Acad-emy of Pediatrics held its first meeting.

Medical Press ReportsEditors of biomedical journals joined in

the observance of the recent 135th anniver-sary of the National Library of Medicine bycommenting in editorials on the institution'slong and steady growth toward its modernrole, as outlined in the cover notes of thispublication.

Dr. Dwight L. Wilbur, editor of Postgrad-uate Medicine, wrote that "the Library is nomere repository of medical literature; it canbe looked upon almost as a merchant of allrecorded medical knowledge."

The Journal of Dental Education, editedby Dr. George W. Teuscher, predicted thatthe Library, "in addition to being the world'sgreatest repository of books in health andmedical fields . . . is destined to become theresearch center in biomedical communica-tions ..." The Journal of the American Medi-cal Association called the Library "one ofthe nation's prime biomedical resources" andadded that "its importance to the health pro-fessions grows steadily as the years pass."

An editorial in the Medical Annals of theDistrict of Columbia said: "Improved com-

13

puterized systems, remote information sys-tems, data transmission via satellite, andother products of electronic communicationare transforming medical libraries into liv-ing, vibrant information centers to meet the

NOCigarette smoking please.

it may be dangerous toour priceless collection..

as well as your health.

Following announcement of HEW smoking restric-tions, this warning sign appeared in many areas ofthe Library.

increasing demands of bioscientific progress.The hub of this worldwide network is theNational Library of Medicine." The Journalof Medical Education stated that "the Na-tional Library of Medicine and its regionallibraries give us the example of a (communi-cations) network in operation."

Dr. Irvine H. Page, editor of ModernMedicine, after a visit to the Library, con-cluded :

"It is unwise to promise physicians thatwithin a short time they will painlessly bemade highly educated men with all available—and assumedly reliable—information attheir fingertips. There are already more thanenough excellent ways of learning and com-municating. The Abridged Index Medicuamakes an excellent key to this literature.Comprehensive and even rare bits of infor-mation can now be gotten from Medlars. Oneof the best libraries with a generous loanservice is available through the NationalLibrary of Medicine and the network ofregional libraries . . . The National Libraryof Medicine and its staff at the Lister HillNational Center for Biomedical Communica-tions will experiment but will not promiseUtopia or education without effort."

A "no smoking" sign used in the Library,that attracted attention because it protectsbooks as well as health, was reproduced inMedical World News.

14

SERVICES AND OPERATIONS

It was a year marked by the advent ofMEDLINE and its emerging progeny, addi-tional refinements in the Regional MedicalLibrary system, and a sobering appraisal ofliterature copyright in the wake of a U.S.Court of Claims report. Paradoxically, pa-trons of the National Library of Medicineborrowed more original materials than pre-viously from the collections and at the sametime requested the loan of more than 100,000photocopies of journal articles. Medlarssearches dropped slightly below the past year,while MEDLINE search requests increasedexplosively.

To support the operation of a total librarynetwork, the Library began to strengthenits own resources. A revision of the Scopeand Coverage Manual produced a new work-ing document providing the basis for a thor-ough revision of the reference collection.A major effort was initiated to fill gaps inthe collection, and to increase activity inacquisitions. The document collection alsounderwent a thorough scrutiny and recom-mendations are being developed for plans toenhance its usefulness.

An agreement was reached with the Li-brary of Congress to participate in the Cata-loging in Publication Program. Because ofthe concentration of biomedical publicationsin a few publishing houses, it will be possibleto provide cataloging information to librariesfor most of the important titles prior toactual publication. This will reduce the needfor original cataloging in many libraries.

The Library conducted numerous educa-tional activities, such as in-service trainingprograms, regional and national workshops,and seminars. A one-year postgraduate li-brary associate training program, begun in1966, continued a well-rounded curriculumof formal presentations, practical experience,and concentrated, individually supervised re-search in preparation for a career in bio-medical communication services and medicallibrary management. More than 200inquirieswere received concerning a special libraryassociate program scheduled to begin onSeptember 1, 1972. Five candidates wereselected after a review of 64 applicationssubmitted by graduates of 28 academic insti-tutions.

Table 3. Summary of Bibliographic Services

Number of Journals Indexed inIndex Medicns

Articles IndexedNLMOther U.S.Foreign

Total

Medlars Searches PerformedNLMU.S. CentersForeign

Total

M E D L I N E Searches Performed

Recurring Bibliographies

Literature Searches Distributed

FY 1970

2,251

3,55010,7376,453

20,740

18

23,351

FY 1971

2,199

3,88914,1805,048

23,717

23

36,570

FY 1972

2,240

90,85975,52843,013210,000

65,88582,22476,610224,619

39,809120,73972,709233,377

2,40110,8005,808

19,015

6,277

24

34,054

15

Bibliographic ServicesAbout 233,000 articles were indexed for

Medlars during fiscal year 1972, an increaseof 5 percent over 1971. Indexing performedfor the Library under contracts and throughagreements with cooperating agencies con-tributed more than four-fifths of the totalproduction (Table 3).

Despite restrictions placed upon the num-ber of search requests accepted after May1971, more than 13,000 Medlars demandsearches were conducted for domestic users.At the beginning of the fiscal year searcheswere being conducted at a rate which wouldhave reached an estimated 25,000 searchesannually. The restrictions placed upon thenumber of searches accepted by the Medlarscenters, coupled with the increasing avail-ability of the MEDLINE service, reducedthe annual rate of Medlars searches to about7,000 by the end of the fiscal year.

Continuing feedback was obtained fromall institutions participating in MEDLINE,and coordination of all technical aspects ofthe use of the Library's bibliographic database by a national network of medical insti-tutions was maintained.

the

Techrtical ServicesDuring this reporting period, revision of

Library's Scope and Coverage Policy

produced a working document that reflectsthe current needs of the health community.A committee of senior staff members andthe director of the National Institutes ofHealth Library completed the revision ofthis working paper. The revised edition wasapproved by the NLM director on January25, 1972.

The sexennial cumulation (1965-1970) ofthe National Library of Medicine CurrentCatalog was published in November 1971.The published set contains the complete storeof the Library's machine-readable catalogingfor the six-year period, and represents acomplete update of the file to conform tothe Anglo-American rules for cataloging andthe 1970 Medical Subject Headings.

Participation in the Library of Congress'sCataloging in Publication Program beganthis year. The program is designed to pro-vide U.S. trade publishers with catalogingdata printed in the book at the time of pub-lication. During the first year of operation,more than 200 publishers joined the pro-gram. The Library's role is to supply catalog-ing data using NLM classification and sub-ject headings for each biomedical title in-cluded. The Library also has the responsibil-ity to identify, contact, and encourage bio-medical publishers to join the program.

Table 4. Growth of Collections in Fiscal Year 1972

Rook MaterialBound monographs

Prior to 18001801 to 19131914 to presentBound issuesUnbound issues (volumes)

ThesesPamphletsTotal book material

Non-Book MaterialMicrofilms (archival)MicrofichePicturesTotal non-book material

Grand Total

VolumesAdded

341325475

1,141

58,202

Total Volumesin Collections

626278

11,59014,98423,1326,300142

57,061

38,69889,591248,589395,21245,293334,110171,901

1,323,394

12,1734,270

08,33884,781

1,408,175

16

Table 5. Summary of Acquisition Statistics

Serial Record*New titles addedDiscontinued titlesCurrent titles received

Publications ProcessedSerial piecesOther

Totul

Obligations for PublicationsIncluded for rare books

FY 1970

2,114598

20,964

94,17527,767

121,042

$355,00060,212

PY 1971

1,534337

22,101

97,81625,499

123,315

$370,43857,945

FY 1972

1,172201

23,132

87,99520,323

108,318

$430,00079,583

• r'licurai for Hfrui l tltlei hove been corrected fur tltlcn that have been dcli'tcd or coaxed publication.

Table 6. Summary of Cataloging Activities

FY 1970 FY 1971Completed Cataloging

New titlesRecatalogcd titles

Total

Cutulog Cards Filed

Volumes Shelf-listed -

16,3441,423

17,767

113,080

10,441

15,862933

16,795

114,786

10,996

FY 1972

12,5151,080

13,595

105,236

8,549

A major gap-filling project was initiated.Contracts were made with three commercialfirms and the United States Book Exchangeto fill identified gaps in the periodical collec-tion. Beginning with Index Medicus titles,and proceeding through the entire serial rec-ord file, missing issues were ordered throughthese contractual arrangements. In addition,special arrangements were established withthe Exchange for daily pickup and deliveryof available publications required to fill inter-library loan requests.

Another contract with the Medical LibraryCenter of New York provides for production

Table 7. Binding Statistics

FY1970

FY1971

FY1972

Number of VolumesSent to binderBound at NLMRepaired at NLMObligations

15,301 16,807 20,(il95,551 5,623 6,6274,683 3,150 3,323

$52,093 $55,526 $64,852

of a Regional Medical Library serial locatorindex for medical periodicals. About 5,000substantive journals were identified in theUnion Catalog of Medical Periodicals masterfile as the initial data base for this locatortool, showing serial holdings of the regionalmedical and resource libraries. The total filewill be placed on-line in the MEDLINE sys-tem before the end of 1972.

Plans were completed for a Keyword-out-of-Context Index (KWOC) to the entire NLMserial record file. An average of four key-words is zissigned to each title, and undereach keyword are listed the appropriatejournal titles and NLM call numbers. Thus,this index will provide a fast lookup forinterlibrary loan operations. It is expectedto be published in 1972.

The Library has instituted a number ofblanket-order arrangements with many ofthe major book dealers over the past fewyears. The Library now has shared catalog-ing arrangements in Great Britain, Sweden,Belgium, France, Germany, and Italy. With

17

the selection of the Porter Libros Company,Spain was added to the blanket-order pro-gram and shared cataloging arrangementswith the Library of Congress.

Reference ServicesThe number of requests for reference serv-

ices reached a three-year high, exceeding22,000 during fiscal year 1972, with increasedactivity in mail and telephone inquiries(Table 8). A stabilizing trend, however, inthe number of health sciences practitionersand students using the Library's facilitieson-site became apparent.

MEDLINE service was made available tothe Library's patrons on computer terminalslocated in the reading room. Additional staffmembers received training in use of the sys-tem and, in February, a second terminal wasadded to accommodate the increasing re-quests for the service. The availability ofMEDLINE was extended to include Wednes-day evenings, Saturdays, and additionalhours of daily service.

Following completion and approval of theLibrary's Scope and Coverage Manual inJanuary 1972, a detailed study of the refer-ence collection was initiated. This is expectedto extend over the better part of a year.Identification was made of portions of thegeneral collection requiring .strengthening, in

addition to the updating of the reference col-lection and setting the base for a shelf list.Benefits of the study include streamlining andincreased efficiency in selection procedures,identifying areas in the catalogs requiringmaintenance, and developing a means forannouncing selections to users.

There was a sharp rise in the number offilled interlibrary loan requests (Table 9).The upward trend, which topped the figuresfor the past two years, reached the level ofactivity recorded in fiscal year 1969. Notablewas an increase of more than 46 percent inthe number of loans filled by lending mono-graphs in the original form. This upsurge inoriginal loan activity may have resulted, inpart, from the steady rise in medical bookprices, and limited funds available to aca-demic institutions.

During fiscal year 1972 the Library com-pleted negotiation of a contract for commer-cial filming of 1.5 million pages of the serialcollection for preservation. The availabilityof funds for this vital program permits con-t inuing fulfillment of archival responsibility.

During the year the installation of a newpositive printmaker enhanced photographicservices available to users. This equipmentincludes a ful ly automated, positive-to-posi-tive photostatic processor with the capabilityof producing prescrecned prints from photo-graphs, ready for reproduction, in a matterof minutes.

Table 8. Summary of Reference Services

Requests by TelephoneGovernmentNon-Government

Requests by MailGovernmentNon-Government

Readers AssistedGovernmentNon-Government

TotalGovernmentNon-Government

Readers Counted

FY 1970

10,71.r)5,2815,434

1,218145

1,073

9,7083,4870,282

21,7028,!) 13

12,789

25,786

FY1971

10,0274,6535,374

1,391133

1,258

8,8<>83,2195,649

20,28(i8,005

12,281

22,382

FY 1972

11,5054,9226,583

1,570104

1,466

9,3473,3935,954

22,4228,419

14,003

20,350

18

Table 9. Summary of Circulation Activities

Number of RequestsReceivedFilled

For readersBy interlibrary loan

PhotocopyOriginal

UnfilledRejected __.Unavailable

FY 1970

219,229179,39078,779100,61193,7466,865

39,83914,24425,595

FY 1971

218,982186,14483,585102,55995,5597,000

32,8389,27323,565

FY 1972

241,824193,00972,892120,117110,08110,036

48,81510,55838,257

History of MedicineThe year was marked by a number of out-

standing acquisitions in the field of the his-tory of medicine and related sciences. For thefirst time in several years, the collection ofearly Western manuscripts was strengthenedby the addition of three Spanish manuscriptsof the 14th and 15th centuries and a 13thcentury Oxford manuscript. The last is par-ticularly notable for its fine illuminated ini-tials. Four incunabulawere also added to theLibrary's holdings, and over 650 works ofthe 16th through 18th centuries. Among thelatter were such notable landmarks in thehistory of medicine and science as first edi-tions of John Graunt's "Natural and Politi-cal Observations . . . Made Upon the BillsofMortality" (1662) and Rene Descartes'"Discours de la Methode Pour Bien ConduireSaRaison" (1637).

During the course of the year, more than5,000 books, manuscript boxes, and oral his-tory memoirs were provided to readers bythe History of Medicine Division. About1,700 items were furnished on interlibraryloan or in photocopy, and nearly 2,000 photo-graphs and slides were supplied in responseto requests for pictorial material (Table10). As part of a continuing effort to pre-serve the valuable books in the historical col-lection for future scholars, 114 volumeswererestored or rebound by skilled hand-crafts-men. To inform present and future scholarsof the wealth of research material availablein the Library, a supplement to existing cata-logs of incunabula and 16th century bookswas published and about 3,000 books werecataloged in anticipation of the printing ofadditional catalogs in the future.

Table 10. History of Medicine Activities

AcquisitionsBooksModern manuscripts __Oral history hoursPrints and photographs

ProcessingTitles catalogedModern manuscripts catalogedPictures indexedArticles indexedPages microfilmed

Public ServicesReference questions answeredILL and pay orders filledReader requests filledPictures supplied

FY 1970

1,538159,627

66634

3,13239,070

4305,327

160,704

1,4611,9853,8761,094

FY 1971

1,284141,142

10753

1,61841,441

2053,114

173,733

1,7551,8804,7172,010

FY 1972

1,26536,325

43479

3,00220,362

5712,892

153,441

2,1131,8216,7841,888

19

Specialized Information ServicesThe Library's Specialized Information

Services administers the Toxicology Infor-mation Program, established in 1967, withthe objectives of creating computerizedtoxicology data bases with information fromcooperating governmental, industrial, andacademic institutions and providing thesetoxicology information services to the scien-tific community. The Library's program op-erates in close collaboration with its affiliatedToxicology Information Response Center ofthe Oak Ridge National Laboratory. To-gether, they create data bases and provideservices by using input from the scientificliterature, specialized files, and contributionsby subject experts. The program brings serv-ices in three modes: response to queries, pub-lications, and an on-line interactive informa-tion retrieval system.

During 1972, the Center at Oak Ridgebecame fully operational. It is funded by theLibrary through an NLM-AEC interagencyagreement. About 480 comprehensive litera-ture searches were performed in response torequests from scientists in many organiza-tions. (Fig. 1). These searches covered vari-ous segments of toxicology, with a heavyemphasis on environmental toxicology.

I I ' H I V A l l I W H V i Q I J A I S I 61

I 1 r- . I'HOH S ' l lONAI ASSIM. I A M O N S / /i

Figure 1. Source* uf toxicology search requestsprocessed from July 1, 1971 to June 30, 1972.

The output of a search usually consists ofa bibliography assembled through computersearches combined with searches throughconventional secondary literature services,such as Chemical Abstracts or BiologicalAbstracts. Some of the more extensive andimportant bibliographies created throughthis activity will be further distributed bythe National Technical Information Service.During the start-up year, these query re-sponse activities were performed withoutcharge to the requester. However, in thefuture, a modest fee-for-service will be im-posed to recover some of the costs.

The program has begun work with a largechemical manufacturer to acquire publishedtoxicology data on the products of that com-pany, formatted for input into the Library'scomputer system. Several computerized liter-ature files have been established in the fieldof pesticide toxicology and a data base isbeing compiled for the toxicology data con-tained in the pesticide petitions submittedby manufacturers and approved by the En-vironmental Protection Agency. Preliminarypermission to use the toxicology sections ofthese petitions has been obtained and plan-ning activities for work on a computerizeddata file have begun.

Endeavors to link Medlars with certaincomputerized files of Chemical AbstractsService have continued. As part of this ef-fort, the entire name-match module of theCAS chemical registry system was modifiedto a "stand-alone" system and installed inNLM's computer. In this system it is possibleto match, in several sequential computer op-erations, names of substances found in thescientific literature against a CAS file of overtwo million names. Successful matches pro-vide the user with CAS registry numbersand preferred nomenclature.

The Common Data Base, a subset of theCAS registry files, containing more than27,000 unique chemical substances in severalcomputer files, is being updated at regularintervals. Input of new substances to thefile comes from the Library and the Foodand Drug Administration.

20

GRANTS FOR LIBRARY ACHIEVEMENT

The dedication in the spring of 1973 ofthe Himmelfarb Medical Library of the newGeorge Washington University Medical Cen-ter in the Foggy Bottom section of the Dis-trict of Columbia will mark the formal open-ing of the eleventh and final health scienceslibrary funded in part by construction grantsfrom the National Library of Medicine.

Enacted by Congress in 1965, the MedicalLibrary Assistance Act (Public Law 89-291)by 1969 had provided only 0.03 percent of thegovernment's total expenditures for healthcare, and medical research and communica-tions. But the funds the law did provide werethe only means available for the exclusiveimprovement of the resources and services ofthe nation's medical libraries. The Act, ex-tended in 1970 by Congress and administeredfrom its inception by the Library'.-? Extra-mural Programs, has provided more than $54million for the following programs:

• Construction of facilities*• Training in medical library science• Special scientific projects• Research and development in medical

library science and related fields• Improvement and expansion of the basic

resources of medical libraries and related in-strumentalities

• Establishment of regional medical li-braries

• Biomedical publications.•This authority was transferred in December l!)f>8to the Division of Physician and Health ProfessionsEducation, Nutional Institutes of Health.

New Library ConstructionOf these first new libraries aided by the

Act, nine are in medical schools, and oneeach in a veterinary medicine and an optom-etry school. These structures have addedmore than 300,000 square feet of floor spacefor nearly 1.5 million volumes in completedfacilities at: Auburn University School ofVeterinary Medicine, Boston University

School of Medicine, Brown University Divi-sion of Biological and Medical Sciences,George Washington University School ofMedicine, Jefferson Medical College ofThomas Jefferson University, Rutgers Medi-cal School of the State University of NewJersey, Southern College of Optometry, Uni-versity of Nebraska College of Medicine,University of Texas Medical Branch atGalveston, University of Utah Medical Cen-ter, and Wayne State University School ofMedicine. Photographs of many of these newlibraries are included in this report.

During fiscal year 1972 the Library sup-ported various grants in the amount of $6.9million (Table 11).

Resource GrantsResource grants are made to establish, im-

prove, and expand the basic resources andservices of health science libraries. There aretwo types of grants available: a $3,000 im-provement grant for one year, and a proj-ect grant available for from one to threeyears. The improvement grant is intendedto assist in the acquisition of basic resourcesneeded by the library and to induce the insti-tution to make a commitment for futurelibrary support. The purpose of the projectgrant is to establish new services or improveand expand existing ones.

In fiscal year 1972, resource grants con-tinued to increase in popularity. A total of140 project grant applications and 187 im-provement grant applications were receivedduring this period. There has also been evi-dence of the need to coordinate this programmore closely with the regional medical li-brary activities.

Of the $2.5 million appropriated, $1.7 mil-lion was available for the resource grants. Ofthe remaining funds, $353,281 was used tosupport commitments for continuation grantsinitially made under the original Act, and$441,388 for the continuation of 19 project

21

NEWLY CONSTRUCTEE

Above: Library of Science and Medicine, Rut-gers Medical School of the State University ofNew Jersey. Upper left: Scott MemorialLibrary, Jefferson Medical College. Lower left:dedication ceremonies of Eccles Medical Sci-ences Library, University of Utah College ofMedicine. Below: Sciences Library of BrownUniversity Division of Biological and MedicalSciences.

HEALTH SCIENCES LIBRARIES

VW,'• ' .Mil ,T -as——>,-«*»— -—aajj---, ^~— •mam—— J2

mm mi• • •§ •••• •• ••%^ mm mm m m mmm* mm m*Fw

Above: Paul Himmelfarb Medical Library, inforeground, during construction of new GeorgeWashington University School of Medicine.Upper left: Boston University School of Medi-cine's new library occupies top three floors ofthe Instructional Building. Lower left: Newlibrary is on the fifth floor of the Southern Col-lege of Optometry in Memphis. Below: MoodyMedical Library of the University of TexasMedical Branch in Galveston.

grants awarded during fiscal year 1971 underthe Medical Library Assistance ExtensionAct of 1970. There were 179 new improve-ment grant awards and 40 new project grantawards made during the year. The projectssupported ranged from renovation of thephysical facilities of a community hospitallibrary to the implementation of an auto-mated cataloging project.

Training GrantsTraining of biomedical librarians and in-

formation specialists has included master'sand doctoral degree as well as advancedon-the-job programs. Training in biomedicalcommunications and information sciences,medical history, and health science writingwas also supported.

A decision was made to phase out pro-grams which providethe basic library degree,and instead emphasize those that provideadvanced training. The Library and theBureau of Health Manpower Educationagreed cooperatively to support training ofphysicians and other health scientists in theuse of computer technology for medical edu-cation and the provisions of health care.Three such training programs were approvedand funded in fiscal year 1972, with trainingscheduled to begin in July 1972.

On June 30, 1972, there were 17 activeprograms supporting 131 trainees. Two ofthe programs are to start this year. Directfellowships, awarded to individuals, are in-cluded in the training category. Support isavailable for study in the same general cate-gories for which training grants are avail-able, with the exception that fellowships arenot provided for the attainment of the basiclibrary degree. Three fellowships were activeduring this fiscal year.

Special ProjectsSpecial scientific projects may be funded

to aid recognized scholars in the productionof comprehensive treatises in their areas ofcompetence. This may include monographsin scholarly documentation, and evaluationor analysis of social, cultural, or scientific

Table 11. Summary of ExtramuralPrograms

New ActiveProgram Grants Grants &

FY1972 Contracts

Regional Medical Library 5 17Medical Library Resource

Grants 219 396Training Grants and

Fellowships 9 20Special Scientific Projects 4 6Research Grants 8 30

Total 8 23Publication Grants 253 492Special Foreign Currency

Projects 46 117

Total 299 609

advances. Six projects, including four newawards, were active during the year. Thenew awards cover the following topics:

• Development of medical education in theUnited States.

• The provision of health care during theFrench Revolution.

• Critical review of literature on thepathophysiology of respiratory disease.

• The control of infectious diseases in the20th century.

An example of a special scientific project isthe preparation of a monograph on graduateeducation in occupational medicine. Chaptersof this book will present the history of occu-pational medicine, updating the subject tocurrent occupational health practices andprograms, including a description and analy-sis of occupational medicine courses atselected universities.

Research GrantsResearch, development, and demonstration

projects are undertaken in library servicesto improve

• Theflowof health information.• Health communication tools.• Manpower and training in biomedical

librarianship and other health-informationspecialties.

• Historical research in health fields.

24

appropriate, will be translated into generalconcepts of clinical decision-making. A re-search study in pre-Listerian antisepticsurgical practices provides an excellent ex-ample of a medical history project con-cerned with wound management, prior to

Drs. Harry F. Dowling, left, and Fred L. Spperwere named the first National Library of Medicinescholars in residence by Board of Regents.

There were 30 active research grants dur-ing the reporting period, including eight newawards. These projects included a study ofthe cost-effectiveness of different methods ofselectively disseminating biomedical litera-ture and a related project concerned with thedevelopment of an automatic document re-trieval system and comparing it with moreconventional methods. Another project incomputer-aided medical decision-makingseeks to quantify subjective judgments re-lated to tests and treatment which a physi-cian must make. The results, where valid and

Kathy Wurdeman adds citations to the Medlars database using the Keymatic Encoder.

and during the evolution of antisepsis andasepsis, up to the emergence of present-daysurgery.

Evaluation of training and manpowerneeds is a timely and important researcharea. A project designed to obtain data on

Monitoring the Medlars master console and high-speed printers are, from left,Charles Heath, Mike Mock, and Jim Goldsmith.

25

the relationship of the hospital library tothe hospital's educational functions is of in-terest to medical educators. This informationwill provide a basis for developing appropri-ate and feasible instructional techniques andcourses, and a methodology to test theirvalidity.

Publication GrantsPublication grants are made to support• Studies in thefieldsof medical librarian-

ship, health-information science, and bio-medical communications.

• Critical reviews of the present state ofknowledge in health-science fields.

• Publication of abstracts, bibliographies,handbooks, atlases, dictionaries, indices, andother secondary works in the broad healthsciences.

• Serial publications in the development ofexperimental and innovative approaches toinformation packaging.

There- were 23 active grants, eight ofwhich were new awards, at the close of thefiscal year. Books prepared or published withgrant support during the year included an

atlas of brain structures to facilitate studieson the exact localization of brain functions;comprehensive surveys on medically im-portant lower organisms, such as poisonousreptiles found in the Southwest, and a groupof insects that parasitize other insects; anda study on the development of 20th centuryAmerican medicine, especially public healthaspects, as revealed by the history of onestate.

Support was provided to eight serial publi-cations including: a guide to the world'sliterature on health problems in the Arctic; aperiodical for allied health personnel con-cerned with nutrition education in the com-munity and in institutions; an innovativejournal on legal medicine printed only inmicroform; and a unique atlas illustratingthe molecular structure of proteins, whichserves as a standard reference for the rapidlygrowing fields of inborn metabolic diseaseand molecular genetics.

Titles and authors of all scientific andliterary works supported by the Library'sgrant program, that were published duringthe fiscal year, are included in the chapter,The Library Publisher.

26

MEDLINE AND THE LIBRARY NETWORK

MEDLINE is a new computerized servicefor physicians and other biomedical scien-tists, developed by the National Library ofMedicine, that provides almost instantaneousbibliographic searching of current medicalliterature. It's as close as a telephone.

Since MEDLINE was inaugurated in No-vember 1971, more than 100 biomedical in-formation centers, including the libraries of

71 medical schools, have installed on-lineterminals that connect with the system tosearch the Medlars data base in Bethesda,Maryland. By the end of 1972, it is antici-pated that this number will be increased toabout 150 in this country and to other centersin foreign countries.

The MEDLINE system enables a librarianor health professional to search the Medlars

The five government members of the House of Delegates of the American MedicalAssociation were an interested audience when William H. Caldwell, center, deputydirector of NLM's Bibliographic Services Division, demonstrated rapid retrieval ofliterature citations at a MEDLINE terminal in the NLM exhibit at the 1972 AMAannual meeting in San Francisco. Shown from left are: J. Herbert Brown, M.D., Vet-erans Administration; Lt. Gen. Hal B. Jennings, Jr., Army Surgeon General; S. PaulEhrlich, Jr., M.D., Public Health Service; Lt. Gen. Alonzo A. Towner, Air Force Sur-geon General; and Vice Adm. George M. Davis, Navy Surgeon General.

27

HC/5

QwHuj

aHHZtgUQw§

files for bibliographic information, using aremote computer entry terminal. The re-sult of the search may be printed directlyon the user's terminal (on-line) or, if a largenumber of citations is involved, it may beprinted by the central computer (off-line)and mailed to the user. MEDLINE serviceprovided more than 2,200 off-line searchesin June. When added to the on-line searches,MEDLINE is now providing more than70,000 searches per year.

The presently available data base consistsof citations from Index Medic us, referencingarticles in more than a thousand of theworld's leading medical journals. The database covers the period of time from January1969 through the latest issue of Index Medi-cus. The data base in the Library's computernow contains about half a million citationsand is growing at the rate of about 12,000citations per month.

MEDLINE service is available to qualifiedhealth sciences practitioners, teachers, andstudents through cooperating medical insti-tutions. Coordination with and assistance tothese institutions is provided both directlyand through the eleven Regional MedicalLibraries.

Development of MEDLINE was spurredby the success of AIM-TWX (Abridged IndexMcdicus via the Teletypewriter ExchangeNetwork), an experimental service inaugu-rated by the Library in early 1970. The re-sult of three years' development by the ListerHill Center, AIM-TWX demonstrated thevalue of on-line retrieval, particularly inhospitals. Citations to articles published dur-ing the last five years in more than 100clinical medicine journals were stored in alarge, time-sharing computer of the SystemDevelopment Corporation in Santa Monica,California. This original version of the MED-LINE program was only able to access asingle data base. Modificationsare now near-ing completion that will enable a user toaccess any of several data bases, includingthe Current Catalog, the audiovisual catalog,and a serials locator file, as well as Medlarsdata covering an extended period of time.

MEDLINE service is available through anationwide communications network. Thecost of the network is borne by the Library,while the cost of connecting the user to thenetwork is borne by the user. Toll-free accessmay be gained in about 35 major populationcenters. Transmission rates of 10, 15, and 30characters per second are available. Entryto the computer can also be gained throughthe familiar TWX network, if desired. Theinitial network of leased telephone lines,which was replaced in part by Western Un-ion's Datacom Service, is being phased out.The present communications system consistsof a network of message-switching compu-ters which automatically route transmissionover an optimum path from the user's ter-minals to the NLM computer in Bethesda.

TOXICONA second information retrieval system,

initiated early in 1972 and scheduled to be-come operational for users later in the year,is known as TOXICON, an acronym derivedfrom Toxicology /nformation ConversationalOn-line Network. This is another rapid re-trieval service, developed by the Library'sSpecialized Information Services to supportthe requirements of environmental and healthscientists for toxicology information anddata.

The service is designed to provide thescientist with direct access to an extensivecollection of literature citations annotatedwith index terms or abstracts, current state-of-the-art reviews, technical reports, andreferenced toxicology data.

TOXICON consists of three integral parts:a communications network, an informationstore, and a programmed computer system.The nationwide network, which is largelyidentical with that used for the MEDLINEsystem, provides a relatively inexpensivemethod of communication with the computerfacility by connecting standard telephoneequipment to the searcher's terminal device.The information base contains primary andsecondary source documents plus selectedspecial data files.

During 1972, about 175,000 citations with

30

TOXICTOXICOLOGY

INFORMATION NETWORIinformatics inc.I

At exhibit of the Library's new TOXICON service at the 1972 annual meeting of theAmerican Pharmaceutical Association in Houston, Dr. Sharon Valley, center, of theNLM staff explains operation to a visitor while Donald Hummel, left, and RobertHarcharik look on.

index terms, abstracts, and other types of en-richment were built into the TOXICON database. It now contains:

• Toxicity Bibliography; 56,000 citationsand MeSH terms, 1968-present.

• Health Aspects of Pesticide AbstractBulletin; 9,000 abstracts with Chemical Ab-stracts registry numbers, 1966-1971.

• Chemical Biological Activities (CBAC) ;110,000 abstracts with CAS registry num-bers, 1965-1972.Other files are being prepared for immediateaddition to the system.

TOXICON was demonstrated in exhibitsat the 1972 annual meetings of the AmericanPharmaceutical Association, Medical Library

Association, and American Medical As-sociation. It created wide interest and drewfavorable comments.

Additional progeny of MEDLINE are inthe Library's planning. The National Medi-cal Audiovisual Center is developing a com-puter-supported data base of information onnon-print instructional materials designed tobecome a working element of MEDLINE,tentatively to be called AVLINE (Audio-Visual On-Line).

Another, CATLINE (Catalog On-Line),is expected to put the Library's catalog intothe network, primarily to the advantage ofregional libraries. SERLINE (Serials On-Line) will provide a listing of about 5,000

31

biomedical serial titles, including locationsymbols indicating their availability at li-braries within each region. CATLINE andSERLINE are expected to be operational infiscal year 1973.

Medlars I and IIAt present, the Medlars data base and

the Current Catalog data base are generatedand maintained using a Honeywell 800/200computer system which is becoming obsolete.This computer is also used to format theLibrary's publications, generate magnetictapes which control phototypesetting ma-chines, and perform non-interactive searchesof old Medlars citations. A project is nowunder way to enable the computer used forthe MEDLINE interactive searches also toperform these functions. This will take abouttwo years to become operational.

The Medlars I system was put into oper-ation in 1964. It is still functioning success-fully although the requirement for demandsearches has been met in part by use of acomputer in the Department of Defense. Dur-ing this year, search programs developed atthe Karolinska Institute in Stockholm be-came operational on the NLM IBM 370/155.Now more than half the searches are per-formed on this system.

Other programs were completed that haveenabled the Library to use magnetic taperather than punched-paper tape as an inputmedium for the Medlars file-building process.The increased reliability and productivity ofthe new equipment have significantly im-proved the cost effectiveness of this activity.

Computer UpgradeThe effectiveness of the interactive search

technique depends strongly on the ability ofthe computer to respond quickly, accurately,and in depth from a broad base of informa-tion. Analysis has indicated that the equip-ment used for the development work wouldnot provide sufficiently rapid response to thepotential user population. The determiningfactor was the speed of response of the massstorage units used to contain the MEDLINE

data base. Of lesser importance was the speedof the central processing unit. To meet per-formance requirements with currently avail-able equipment, the MEDLINE computerwas upgraded from an IBM 360/50 to anIBM 370/155 in December 1971.

The capacity of the mass storage unitshas been increased to keep pace with theexpanding data base. However, the newequipment is not only more than twice asfast as previously available equipment, butit costs less per unit of storage. Thus, theoperational configuration is also less expen-sive than the development configuration forthe amount of storage required. The newsystem will be able to accept an additionalload from the Honeywell 800/200 systemwhen the Medlars II computer programs arecomplete.

Regional Medical Library ProgramSince the first Regional Medical Library

was established in October of 1967, consider-able progress has been made towards extend-ing resources to health science librariesthroughout the country. Fiscal year 1972 wit-nessed the completion of conversion fromgrant support to contract support for theestablished service aspects of the regionallibraries. Grants, however, are made to sup-port other Regional Medical Library activ-ities.

Highlighting this year's regional programwas the implementation of the MEDLINEsystem. The eleven Regional Medical Librar-ies form the backbone of this network inachieving rapid, nationwide geographic cov-erage. In the development of the network, theregional libraries were used to introduceMEDLINE to medical librarians. MEDLINEbriefings and demonstration sessions werescheduled at each Regional Medical Library.

The expansion of the user network wasachieved through the cooperation of theRegional Medical Library directors. Eachdirector developed a preliminary regionalbibliographic service plan and identified po-tential MEDLINE centers.

Besides the service functions of the re-gional library program, an in-depth review

32

of the current program was completed bythree members of the Biomedical LibraryReview Committee. The report was presentedat the June 1971 meeting of the Board ofRegents and implementation of the recom-mendations will begin in fiscal year 1973.

The most significant contribution to theprogram during fiscal year 1972 was therelease of the National Library of Medicine'sRegional Medical Library Program PolicyStatement. This policy statement, endorsedby the Board of Regents, presented programobjectives with an identification of broadoperational guidelines. The network opera-tional model, identified in the policy state-ment, is hierarchical in structure, with fourdefinable levels: the basic unit library, amedical school library, a regional library,and the National Library of Medicine. Eachof these levels has specific responsibilitieswhich were clearly defined in the policy state-ment. Implementation of the new policy wasaccomplished with little difficulty, becausemany of the specific responsibilities identi-fied for each of the four levels already hadbeen assumed at a particular level.

To help monitor and manage the documentdelivery service activity, the library networkidentified and standardized the data elementsrequired in operation of the interlibrary loanservice. Network standards relating to docu-ment delivery service were developed forfilling interlibrary loans and for clearing un-filled requests. Other activities provided byregional libraries include education and con-sultation, traditional reference service, andMedlars and MEDLINE services.

The educational activities center aroundtraining programs for hospital librarianssuch as those given by the regional staff ofthe Francis A. Countway Library of Medicinein Boston and the hospital workshops of thestaff of the UCLA Biomedical Library in LosAngeles. More than 300 hospital librarianshave been trained through these educationalprograms. Besides the more formal programs,library orientation courses covering topicssuch as Medlars, MEDLINE, major indexingtools, and the use of library facilities havebeen taken by several thousand health sci-

ences practitioners and students.Document delivery continues to be the

major service activity in the regional libraryprogram. This service receives nearly 50 per-cent of the resource allocation of the pro-gram. During fiscal year 1972 more than450,000 reimbursable interlibrary loans were

Five young librarians, who received postgraduatetraining in the NLM associate program for 1971-72are, from left, Dr. Clair W. Gudmundsen, JinnetF. Lewis, Arlene M. Aufderheide, Paula Meise, andDr. Joseph A. Vignone.

provided through the library network. Sincethe beginning of the program five years ago,about 2 million loans have been filled.

By the end of fiscal year 1972, the contractfunding mechanism was operating in tenregional libraries, of which seven were in thesecond year of contract funding. Only serviceand management components, however, arefunded through the contract mechanism. Re-search and development, educational, andconsulting activities are funded through thegrant mechanism, with peer review.

Roster of Regional Libraries

1. New England Region (Conn., Me., Mass., N.H.,R.I., Vt.)

Francis A. Countway Library of Medicine10 Shattuck St., Boston, Mass. 02115Librarian: Harold BloomquistRML Director: Mary E. FeeneyTelephone: 617-734-8900 X126TWX: 710-388-6702

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2. New York and Northern New Jersey Region(New York and 11 northern New Jerseycounties)

Now York Academy of Medicine Library2 East 103 St., New York, N.Y. 10029Librarian: Florence Lyons, actingTelephone: 212-876-2531TWX: 710-581-2531

3. Mid-Eastern Region (Pa., Del., and ten southernNew Jersey counties)

Library of the College of Physicians10 South 22 St., Philadelphia, Pa. 10103Librarian: Elliott H. MorseTelephone: 216-661-6050TWX: 710-670-1646

4. Mid-Atlantlc Region (Va, W. Va., Md, D.C.,N.C.)

National Library of Medicine8600 Rockville Pike, Bethesda, Md. 20014Librarian: Martin M. Cummings, M.D.RML Director: Erika B. LoveTelephone: 301-406-2370TWX: 710-824-0615

5. East Central Region (Ky., Mich., Ohio)Wayne State University Medical Library4325 Brush St., Detroit, Mich. 18201Librarian: Vern M. Pings, Ph.D.RML Director: Elizabeth G. MonroeTelephone: 313-577-1001TWX: 810-221-5163

6. Southeastern Region (Ala., Fla., Ga., Miss., S.C.,Tenn., Puerto Rico)

A. W. Calhoun Medical LibraryEmory University, Atlanta, Ga. 30322Librarian: Miriam H. LibbeyTelephone: 404-377-9201TWX: 810-751-8512

7. Midwest Region (111., Ind., Town, Minn., N.D.,Wis.)

John Crerar Library,')5 West 33 St., Chicago, 111. GOC1CLibrur iun: Wil l iam S. BudingtonRML Director: Chester J. PlctzkeTelephone: 312-225-2520 (Ext. 78, 79, or 47)TWX: 910-221-5131

H. Midcontincntal Region (Colo., Kans., Mo., Neb.,8.D., Utuh, Wyo.)

University of Nebraska College of Medicine42nd St. & Duwey Ave., Omaha, Nebr. 68105Librarian: Bernicc M. HetznerRML Director: Elizabeth A. PetgcnTelephone: 402-541-4C46TWX: 910-622-8353

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

University of Texas Southwestern MedicalSchool at Dallas

5323 Harry Mines Blvd., Dallas, Texas 75235Librarian: Donald M. HendricksTelephone: 214-631-1813TWX: 910-861-4046

10. Pacific Northwest Region (Alaska, Idaho, Mont,Oregon, Wash.)

University of WashingtonHealth Sciences LibrarySeattle, Wash. 98105Librarian: Gerald J. OppenheimerTelephone: 206-543-8262TWX: 910-444-1385

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

Center for the Health SciencesUniversity of California at Los AngelesLos Angeles, Calif. 90024Librarian: Louise DarlingTelephone: 213-825-1200TWX: 910-342-6897

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THE LIBRARY PUBLISHER

In the library of the Peking Academy ofthe Medical Sciences in the People's Republicof China, a massive, eight-volume, maroon-bound catalog of the world's most importantmedical literature published during the pastsix years occupies nearly two feet of shelfspace and the attention of many of the acad-emy's scholarly members. No other libraryin Mainland China has this important refer-ence work, which lists nearly one hundredbooks on acupuncture alone, and there arefew sets anywhere else in the Orient.

It is the Current Catalog 1965-1970 of theNational Library of Medicine, a sexennialcumulation of acquisitions and one of thelargest and most comprehensive publicationsin the institution's 136-year history. The workcontains nearly 8,000 pages listing more than90,000 titles, weighs 60 pounds and costs$71.75—a reasonable price tag among thebest sellers of the Government PrintingOffice. It was presented to the Peking Acad-emy on February 23, 1972, by Dr. Walter R.Tkach, Physician to the President, duringMr. Nixon's historic visit to China.

NLM Director Martin M. Cummings, right, wel-comes Dr. Walter R. Tkach, Physician to the Presi-dent, on his arrival at the Library to tell the Boardof Regents of some of his medical experiences inPeking during the President's recent visit to China.

Since the first printed catalog appeared in1864, listing the titles of the entire collectionof 1,356 volumes, the Library has continued

to gain recognition as a major publisher ofmedical bibliographies and indexes. Its bestknown work, Index Medicus, has been a ref-erence source to the world's bioscience litera-ture since 1879. The Index-Catalog, now theCurrent Catalog, dates from 1880. Today,with rapid, computer-assisted cumulation,composition, and production, the Library'svast output includes 24 recurring bibliogra-phies, the monthly Abridged Index Medicusfor clinicians, an increasing number of spon-sored monographs and serial publications,numerous pamphlets and brochures, and itsown NLM News, a monthly informationsource about the Library directed primarilyto the staffs of the nation's health scienceslibraries.

Toxicology PublicationsIn the specialized field of toxicology, in

addition to the quarterly Toxicity Bibliogra-phy, four publication projects were com-pleted during fiscal year 1972:

• "Index to the Report of the Secretary'sCommission on Pesticides and their Relation-ship to Environmental Health." Use of thisdocument, published in 1969, and known asthe "Mrak Report" after the commissionchairman, Dr. Emil M. Mrak, chancelloremeritus of the University of California atDavis, previously had been impeded by lackof a proper index, which has now been com-piled by NLM staff member Sharon L. Valley,Ph.D. The 310-page volume contains a chem-ical substance index, subject index, andbibliography. It is available from the Govern-ment Printing Office.

• "A Bibliography of Polychlorinated Bi-phenyls (PCBs) and Related Chlorophenyls:Effect on Health and Environment." ByGriffith E. Quimby, Wenatchee, Washington.

• "Requirements for Mathematical Modelsin the Toxicology Information Program."By Ernest Heilberg and Martin N. Chase ofChase, Rosen and Wallace, Inc.

35

• "Abstracts on the Health Effects of En-vironmental Pollutants." This new monthlyabstract journal began publication in Jan-uary 1972 with NLM support of the publish-er, BioSciences Information Service. Con-tents of this new serial are selected fromBiological Abstracts, BioResearch Index, andthe Medlars data base. Each issue containsabout 1,000 citations and abstracts with au-thor and subject cross-indexing. The ancil-lary magnetic tape service consists of com-plete bibliographic citations plus searchterms, but no abstracts. Chemical AbstractsService registry numbers are included.

U.S. Representative Durward G. Hall, right,Missouri physician, visits the Library's stacks withhis son-in-law, Dr. Monty R. Ellison of Albany,Oregon.

The Library's Specialized InformationServices is cooperating with the Universityof Rochester School of Medicine and Den-tistry and Dartmouth Medical School in thepreparation and publication of a new editionof the handbook, "Clinical Toxicology ofCommercial Products." A totally automatedsystem has been designed and is being imple-mented at the two medical schools to supportthe collection, maintenance, and publicationof the components and toxicology of more

than 17,000 trade name products. Computeri-zation of the main tabular sections of thehandbook will speed the flow of this informa-tion to the public in book-form and will alsomake the data available for use in the on-lineretrieval system.

Also in preparation is a toxicology vocabu-ulary that will be published late in 1972. Itis intended to be compatible with MedicalSubject Headings (MeSH) of the Medlarsvocabulary.

Supported Articles and MonographsUnder the provisions of the Medical Li-

brary Assistance Act, authors may be givengrants to support work in the preparation ofmanuscripts in the broad field of biology, andthe health and biomedical communicationsciences. During the year the following fourmonographs were published as a part of thisprogram:

The Genera of Ichneumonidae, Part 4-By Henry Townes. American EntomologicalInstitute, Ann Arbor, Michigan, 1971, 372pages.

A History of Medicine in South Carolina,1900-1970. By Joseph I. Waring. SouthCarolina Medical Association, Charleston,South Carolina, 1971, 198 pages.

Synopsis of the Herpetofauna of Mexico.By Hobart Smith and Rozella B. Smith. Pub-lished by Eric Lundberg, Augusta, West Vir-ginia, 1971, 198 pages.

Life Cycles of Coccidia of Domestic Ani-mals. By Hevgeniy M. Kheysin. Edited byKenneth S. Todd, Jr. Translated by FrederickK. Pious, Jr. University Park Press, Balti-more, 1972, 264 pages.

Eight serials, some published irregularly,were also given support this year. They are:Arctic Bibliography, published in Montrealby the Arctic Institute of North America;Literature References to Mosquitoes and Mos-quito-Borne Diseases, American MosquitoControl Association, Albany, New York;Journal of Nutrition Education, Society ofNutrition Education, Berkeley, California;International Microfilm Journal of LegalMedicine, Milton Helpern Library of LegalMedicine, Ann Arbor, Michigan; Current

36

Bibliography of Epidemiology, AmericanPublic Health Association, New York; NewJersey Mosquito Extermination AssociationProceedings, Entomological Society of Amer-ica, New Brunswick, New Jersey; Interna-tional Journal of Systematic Bacteriology,International Association of MicrobiologicalSocieties, Bethesda, Maryland; and Atlas ofProtein Sequence and Structure, NationalBiomedical Research Foundation, Washing-ton, D.C.

Medical HistoryA Catalogue of Incunabula and Sixteenth

Century Printed Books in the National Li-brary of Medicine: First Supplement. This51-page, casebound volume lists 27 incunab-ula and 272 sixteenth century books. It sup-plements A Catalogue of Incunabula andManuscripts in the Army Medical Library(1950), prepared by Dorothy M. Schullianand Francis E. Sommer, and A Catalogueof Sixteenth Century Printed Books in, theNational Library of Medicine (1967), com-piled by Richard J. Durling. The former isout of print.

Bibliography of the History of Medicine,1964-1969. A cumulative volume, whichcovers material published from 1964 through1969, is the fifth of its series. The volumeincludes and supersedes the material con-tained in the preceding four annual bibli-ographies. It also introduces citations to sev-eral thousand additional articles and mono-graphs indexed since the appearance ofBibliography Number 4 (1968).

Foreign Authors' WorksIn October 1971 more than 500 scientists

from 28 countries met in Jerusalem to com-memorate the 50th anniversary of the dis-covery of insulin by Banting and Best intheir laboratory in Toronto. A report on theproceedings and texts of 34 papers devotedto the "Impact of Insulin on Metabolic Path-ways," edited by Dr. Eleazar Shafrir, waspublished in the March and June 1972 issuesof the Israel Journal of Medical Sciencesas part of the Library's continuing supportof foreign authors under the provisions of the

special foreign currency (P. L. 480) pro-gram. In all, 12 critical reviews were pub-lished under this program in fiscal year 1972under agreements in Israel and Poland.

In a presentation to the Board of Regentsin November, Dr. Moshe Prywes, editor ofthe Israeli journal, outlined the programunder an agreement with his journal that hasproduced 45 publications since 1966. Dr.Prywes, a former vice president of theHebrew University of Jerusalem, has servedon the WHO Expert Advisory Panel on Medi-cal Education and as a consultant in medicaleducation to the Rockefeller Foundation.

Additional reports appearing in the IsraelJournal of Medical Sciences included "Sym-posium on Cancer and Other Chronic Dis-eases in Migrants to Israel," edited by Drs.A. Michael Davies and Martin Sacks (De-cember 1971): "Proceedings of the TelAviv University Conference on Erythropoie-ais," edited by Dr. Yehuda Matoth (August1971) and published in hard cover by Aca-demic Press under the title, "Erythropoiesis:Regulatory Mechanisms and DevelopmentalAspects"; "Geographical Epidemiology ofthe Toxemias of Pregnancy," a critical re-view by Dr. A. Michael Davies (June 1971),also published as a monograph by CharlesC. Thomas; and "Control System Diagramsin Physiology, Biology and Medicine" by Dr.Cecil Allweis (1971 supplement).

Dr. G. I. Poliakov was the author of amonograph, Neuron Structure of the Brain,edited by Dr. T. Pridan and translatedby Dr. P. Robinson, that was publishedin Jerusalem by the Israel Program forScientific Translations and subsequently bythe Harvard University Press. A larger vol-ume of 385 pages from the same publishers,Loss and Restoration of Regenerative Ca-pacity in Tissues and Organs of Animals,reported the investigations of Dr. L. V.Polezhaev with a translation by Dr. Y.Halperin, edited by 0. Weiss.

Polish scientists contributed two mono-graphs to the program. Dr. Henryk G. God-lewski was the senior author of The Histo-chemistry of Glycogen and Its RelatedEnzymes in Normal and Pathological Tissues,

87

and Dr. Zdzislaw Rondio prepared a study ofSpecial Problems of Anesthesia in Infants.Both were published in Warsaw by PZWL-Polish Medical Publishers.

Dr. Zvonimir Maretic of the Pula MedicalCenter in Croatia, Yugoslavia prepared asection, "Lactrodectism in MediterraneanCountries, Including South Russia, Israel andNorth Africa," for the third volume of"Venomous Animals and Their Venoms"(Academic Press). The same publisherbrought out "Light and Electron Micro-scopic Radioautography of Lipids: Tech-niques and Biological Applications," by Drs.Olga Stein and Y. Stein of the HadassahMedical School in Jerusalem, in the 1971edition of Advances in Lipid Research. "Re-constitution of Biological Membranes," byDr. Shmuel Razin, also of the HadassahMedical School, appeared in Biochemica etBiophysica Acta (Amsterdam). Two scien-tists of the Hebrew University in Jerusalem,Drs. Yehuda Lapidot and Nathan de Groot,published their findings of "The ChemicalSynthesis and Biochemical Properties ofPeptidyl-tRNA" in the 1972 edition of Prog,ress in Nucleic Acid Research.

NLM Newt

The Library's newsletter, the monthlyNLM News, more than tripled its circulation,beginning with the issue for January 1972,

by the addition of members of the MedicalLibrary Association and librarians of federalhospitals not previously included, and theeditors of leading medical journals. In in-creasing circulation to more than 3,500copies, the NLM director told the MLA hewelcomed the opportunity to "affirm the Na-tional Library of Medicine's commitment toimprove information services to the healthprofessional," and that all medical librariansshould have "full knowledge" of the Library'spolicies and programs.

The NLM News is a descendent of theArmy Medical Library News Letter, amimeographed flyer first published in August1945 for the Library's consultants. Threemonths later the publication was renamedthe News and printed by letter-press. In June1952 it became the Armed Forces MedicalLibrary News, and in October 1956 receivedits present name. Editor of the News is AnnR. Lindsay of the Library's public informa-tion office. She is also proceedings editor ofthe Bulletin of the Medical Library Associa-tion.

Another monthly newsletter publication,the Library Network/Medlars TechnicalBulletin since May 1969 has provided infor-mation about Medlars (and now MEDLINE)developments for interested medical librarystaff members. The editor is Grace T.Jenkins, head of the Library's Medlars man-agement section.

38

INNOVATIONS IN LEARNING

If "a picture is worth a thousand words,"how much more informative is one that canbe heard as well as seen? Not only motionpictures, but many types of audiovisual tech-nology are playing an increasingly importantrole in biomedical communications.

Specialists in the Library's National Medi-cal Audiovisual Center in Atlanta havedemonstrated that this new technology canmultiply the effectiveness of the individualinstructor, enabling him to reach large audi-ences with better presentations. Self-instruc-tional units may contribute to reducing thelength of academic curricula in the healthsciences. But most important and challengingis the hope that this improved technologymay enable schools of medicine and relatedbiosciences to produce graduates of higherquality in a shorter time and in greater num-bers than is possible today with conventionalteaching procedures.

In actual operation, the staff of the Centerstrengthens the educational and informa-tional processes within the health professionsby conducting the Library's national pro-gram to improve the quality and applicationof current instructional methodology, mate-rials, systems, services, and functions in bio-medical professional schools and among itspractitioners. The various programs andactivities are complemented by collaborativepooling of resources and activities by theCenter and the Office of Audiovisual Educa-tional Development of NIH's Bureau ofHealth Manpower Education. This uniqueworking relationship of two government ac-tivities permits common pursuit of mutualprogram goals. The Center's primary contri-bution is its staff resources and expertise, andits broad experience in the various disciplinesof nonprint instructional technology. TheOffice of Audiovisual Educational Develop-ment provides the resources for expandedefforts through access to peer review andexpertise, budgetary supplementation, and

the vast program support available through-out its parent bureau.

Common areas of program activity havebeen well defined and priorities indicated bythe Board of Regents. Significant progressduring fiscal year 1972 included restructuringinformation dissemination and media distri-bution programs; the inception of discipline-oriented peer review efforts; the develop-ment of workshop and seminar programsmost pertinent to identified instructionalneeds; and efforts in support of the develop-ment of instructional materials conceived bybioscience schools best equipped to effec-tively apply the principles of instructionalmethodology.

Evaluation and AcquisitionA national evaluation and acquisition pro-

gram for instructional materials has beendeveloped by the Audiovisual Center, usingproduct assessments to insure quality acqui-sitions and a continuing quality control forenriching media distribution collections.

During this initial effort, an analysis ofmore than 48,000 user evaluation forms indi-cated that the overall excellent quality ofmaterials now distributed was generallygood. A cooperative peer review system isbeing used to evaluate present holdings andto find and assess new materials. Cooperat-ing national organizations actively involvedare the American Association for CancerEducation, American GastroenterologicalAssociation, American Physiological So-ciety, Association of Medical School Pedi-atric Department Chairmen, Association ofProfessors of Gynecology and Obstetrics,Veterans Administration, American Collegeof Radiology, American Academy of Der-matology, Society of Nuclear Medicine,American Association of Anatomists, Asso-ciation of Anatomy Department Chairmen,and the Restorative Dentistry EducationDevelopment Committee.

39

In addition, plans are being established toexpand the peer review system to include theAmerican College of Anesthesiology, Ameri-can College of Cardiology, American Dia-betes Association, Association of AmericanMedical Colleges, American Physical Ther-apy Association, American Academy ofOrthopaedic Surgeons, American Society ofInternal Medicine, American Academy ofOphthalmology and Otolaryngology, Ameri-can Association of Schools of Public Health,American Association of Colleges of Phar-macy, and the American Urological Associa-tion.

One promising project in progress is anevaluation of three different methods of in-struction in the same topic. The Universityof Texas Southwestern Medical School atDallas has been commissioned to conduct theevaluation of second-year medical studentson the teaching of ophthalmoscopy.

Three sub-groups of students chosen atrandom each will receive instruction, usingthe department's normal classroom-lecturemethod; a set of self-instructional materialsin use for about two years; and a set ofnewly completed self-instructional materials.Comparative results will be carefully ana-lyzed and evaluated.

Distribution of MaterialsDuring the second full year of operation of

the automated audiovisual distribution sys-tem for the booking and scheduling of mo-tion picture films available for loan, about100,000 requests were received and pro-cessed, and 60,000 films were loaned. Thereare now 975 active titles in the collection.All have been reviewed and evaluated toverify their relevance in the support of bio-medical education. During this year, ar-rangements were completed to transfer theremainder of the films for public audiencesfrom the Center's loan collection to alter-nate distribution centers.

Instructional programs in the Center'svideotape collection were reproduced andcopies furnished to about 1,500 schools foruse in teaching programs. The collection was

selectively increased during the year to ex-pand the scope of content coverage, and nowincludes about 175 titles. Arrangements werealso concluded with the General ServicesAdministration to begin offering self-instruc-tional materials for sale through the U.S.Government Film Sales program.

New, updated catalogs of holdings in boththe film loan collection and the videotapereplication collection were published duringthe year. They were disseminated to healthprofessions schools and to health scienceslibraries. These printed catalogs will servetemporarily in lieu of computer-generatedcatalogs and searches possible within the an-ticipated AVLINE (AudioVisuals On-LINE)system. Ultimately, computer searches willallow a far greater response to user needsthan is possible now with conventional cata-loging techniques.

Advisory ServicesThirteen site surveys of educational insti-

tutions were conducted in the AudiovisualCenter's consultation programs, including:the Medical College of Pennsylvania, Uni-versity of Alabama School of Medicine,Hahnemann Medical College and Hospital,Dartmouth Medical School, University ofMississippi Medical Center, Howard Univer-sity College of Medicine, University of Wash-ington School of Medicine, University ofMaryland School of Medicine, University ofTexas Medical Branch at Galveston, M. J.Lewi College of Podiatry, and the TuskegeeInstitute School of Veterinary Medicine.

The first of a series of post-survey assess-ment visits was made to the University ofVermont's division of health sciences. Thisreturn visit indicated, among other evalua-tive feedback, that an in-depth survey initi-ally conducted in 1966 was instrumentalin the eventual development of a success-fully implemented biomedicalcommunicationsprogram.

Consultation and advice relating to specificproblems and requests were provided bothat the schools and at the Center on 106 dif-

40

ferent occasions with representatives of 71schools of medicine, five schools of nursing,nine hospitals, seven schools of dentistry, oneschool of pharmacy, one school of osteopathicmedicine, one school of veterinary medicine,and 11 health-related institutions.

View of a television workshop in action on thesound stage of the Library's National MedicalAudiovisual Center.

Another new program effort was initiatedto send media dissemination teams for thepurpose of providing on-site media awareness

and motivational faculty conferences. Thefirst program, entitled "Media Awareness'72," was held at Howard University in May1972 with 125 faculty members in attendance.Six medical schools and one school of nursingparticipated in a project of innovative edu-cational programs to documentphotographic-ally instructional media program activitiesthat could be shared with other schools fororientation and motivational purposes.

A unique demonstration learning resourcearea was developed and is currently in op-eration at the Center to provide an oppor-tunity for health professionals to obtain prac-tical hands-on experience with a variety ofinstructional media modes, different types oflearning carrels, experimental student sta-tions, and innovative audiovisual hardwaresystems. This special area enables the medi-cal educator to conduct a personal assessmentof various systems before committing sub-stantial expenditures of funds and time.

Training WorkshopsThrough a series of 31 well-attended con-

ferences, seminars, and workshops, theAudiovisual Center has provided specializedtraining for about 1,200 health sciencesteachers and practitioners in:

• The management of audiovisual mediain the library or learning resources center.

• The design of learning spaces.• Evaluation of instructional media.• Audiovisual production techniques.The second national two-day conferenceof

directors of biomedical communication, rep-resenting 74 medical schools and other healthsciences institutions, was held at the Centerin October 1971 and again in the fall of 1972.A series of specialized workshops in mediamanagement, held at selected locations, waspresented in response to an increasing inter-est in recent years. Sessions were conductedat four medical library society meetings andat the annual meeting of the Medical LibraryAssociation in San Diego. Members of theCenter's staff also participated as speakers inthe annual meetings of the Association ofSchools of Allied Health Professions and theAmerican Association of Medical Assistants.

41

In a unique series of three instructionaldesign workshops, held in cooperation withthe Association of Medical School PediatricDepartment Chairmen, 35 pediatriciansgained familiarity with the methods ofdesign and evaluation of self-instructionalmedia. During a five-day workshop, effectiveself-instructional packages were designedand faculty participants gained the neces-sary expertise to develop other effectiveunits. In a supplementary effort, a cluster often self-instructional units was designed tosupplement medical student teaching in thenewborn nursery. These are now in final fin-ishing stages at the schools and will beshared when completed. Thus, pediatric de-partments will have usable material at aminimal investment to experiment with self-instructional media.

Media Development

Pilot instructional units were producedduring the year, in a three-part series, withthe cooperation of the Emory University

School of Medicine department of anatomy:on the anatomy of the femoral triangle, thescapula, and the extensors of the forearm;an eight-part series on ophthalmoscopy; anda three-part series on tonometry, in coopera-tion with the Association of University Pro-fessors for Ophthalmology. All units involvedexperimental package design and a modularapproach. They were evaluated through stu-dent tryouts during production, and arepresently undergoing field tryouts at selectedmedical schools.

In the television medium, a significant de-velopment was the production of 24 units onneuroanatomy with Dr. Howard Matzke ofthe University of Kansas School of Medicine.Total running time of the series is nine hours.Included also are correlated slides, a text-book, atlas, and dissection manual. These,together with the tapes, form a completemultimedia teaching package.

A number of instructional design and de-velopment efforts are currently being sup-ported by contract in medical schools. TheSouthern Medical School Consortium, includ-

Close-up photography during the production of a series of dental team managementfilms at the National Medical Audiovisual Center.

42

ing 29 institutions, is developing 60 hours ofinstruction in a number of curriculum topicareas. The University of California at Irvineis producing 30 units of instructional video-tape materials in the clinical neurosciences.The Society of Nuclear Medicine is planningtwo sample instructional units. The Ameri-can Gastroenterological Association is pre-paring a series of 12 slide/tape lectures. TheUniversity of California at San Diego iscreating a curriculum definition and a proto-type module of instruction in basic medicalneurology. Finally, a series of self-instruc-tional units is being built at the Universityof Florida School of Dentistry. The materialsdeveloped for these projects will be dissemi-nated and shared as widely as possible withother biosciences institutions.

Media Reference ResourceA multimedia reference resource was de-

veloped in the reference section of the Li-brary during fiscal years 1970 and 1971.Use of this collection has increased four-fold and requests for audiovisual materialsin conjunction with books and journals hasbecome common. In addition to personal usein the reading room, interested groups inthe Washington area have used the collec-tion for in-service training and as a supple-ment to classroom lectures.

The collection now includes more than1,200 items, comprising 8mm and 16mmmotion pictures, videotapes, cassette audio-tapes, reel-to-reel audiotapes, and audiovisualkits. The number of media packages receivedfrom book publishers, as well as media sup-plements to texts, has grown steadily. Avail-able for study and as special exhibits in theaudiovisual carrels are such media packagesas The Femoral Triangle, an ExperimentalCooperative Media Development Project inGross Anatomy; Introduction to the Neuro-vascular Examination; and CardiovascularSelf-Teaching Materials.

The Library now provides consultationservice in connection with media availability,cost, selection, acquisition, cataloging, main-tenance, and storage of both media andaudiovisual equipment. A notable increase in

the establishment of multimedia collectionsin other medical libraries has become evident.

A multimedia package (slides, cassetteaudiotape, and booklet) for the presentationof "Medlars: What It Is, What It Does"was completed and distributed to the Re-gional Medical Libraries and Medlars centersfor use in explaining these services to libraryusers.

New TechniquesAre notebooks and handwritten lecture

notes obsolete? Can today's medical studentslearn more effectively through the use of atape recorder, instead? Does one have tospend 45 minutes listening to a play-backof a lecture?

These are some of the questions posed inan experiment conducted by the Library'sLister Hill Center at the George WashingtonUniversity School of Medicine. Two deviceshave made this experiment possible: the in-expensive, durable, battery-operated cassettetape recorder, and the "speech compressor,"a machine that can reduce the time requiredto play back a recorded lecture by half.

Last fall, each entering medical studentwas loaned a tape recorder and encouragedto use it as if it were his own. Only twominor repairs have been needed during theyear, and no replacements were necessary.Classroom-taped lectures were made avail-able to the students upon request. Single-concept tapes and slide-sync-tapes were re-corded and made available at both normallistening rates and at compressed rates.Tapes recorded in lecture halls, however,because of the high background noise, couldnot be reproduced at compressed rates.

A student subjective evaluation question-naire indicated that:

• Sixty percent of the students used theirrecorders for medical education on an aver-age of three hours per week.

• Eighty-seven percent of the studentsfound the recorder good to excellent. Theremaining 13 percent who found it fair topoor did not use the recorder for medicaleducation.

43

• Forty percent of the students borrowed • Sixty-seven percent of the studentsrecorded cassettes from GWU's audiovisual would like to see this program extended toservices. the sophomore year.

„. , * .» 4.1. * j 4. j This experiment will be continued for• Sixty-one percent of the students made another ufling & new &nd improved

recordings on their own. gpeech compressol.( with increased emphasis• Forty-five percent of the students would on training the students in the various audio-

like more compressed tapes made available. visual services available to them.

44

AN INTERNATIONALLIBRARY

The Library's international accomplish-ments are based in great part on cooperativearrangements for the sharing of time, talent,and resources with foreign libraries, includ-ing an acquisition and document exchangeprogram with 700 partners in 70 countries.Under a continuingagreement with the StateDepartment's Agency for International De-velopment, the Library is providing specificservices to medical libraries in 47developingcountries. In 1971 these services included17,000 in te r l ib ra ry loans, 265 Medlarssearches, 51 reference requests, 33 audio-visual loans, and 56 periodical subscriptions.

Medlars Conference, May 1972The first International Medlars Policy

Meeting was held at the Library with thedirectors of foreign institutions in whichthere is a Medlars center, and directors ofthe Medlars centers. The meeting presentedan opportunity to examine the fundamentalquid-pro-quo principle of cooperation, toassess operations and experience against thisprinciple, and to identify common goals andspecific programs for the future.

Recommendations were made on continu-ing the mechanism of bilateral cooperation;regional coverage; elimination of duplicationof effort; the interchange of information andpeople; and technical cooperation and coordi-nation in medical subject headings, journalselection, and systems cooperation. The groupapproved the establishment of an Inter-national Policy Advisory Group which willinclude policy-level representatives, accom-panied by technical managers, to meet peri-odically to examine policy issues.

The basic conclusions were that the moti-vating forces for improving informationhandling in biomedical communications areenhanced medical research, medical educa-tion, and health care. It was recognized that,through new technologic systems, equal andmore timely access to medical informationcan be provided to the user. Future cooper-

ation will depend more intimately on theselection and quality of information, andtechnology will not be the principle con-straint.

Major presentations were made by Dr.Joseph Leiter, Associate Director for Li-brary Operations, and Mary E. Corning,Special Assistant to the Director for Inter-national Programs, who reviewed a com-parative summary of the various centers'organizations and operational activities.Current programs and planning within theirresponsibilities were discussed by AssociateDirectors Davis B. McCarn and Dr. HenryM. Kissman.

Representatives of the various overseascenters at the meeting included DenisRichardson, assistant librarian, and JohnVaughn, Medlars center director of the Na-tional Library of Australia; Jack E. Brown,chief librarian, National Science Library,National Research Council of Canada, andAnn D. Nevill, director, Canadian Medlarsservice; Dr. J. F. Duplan, scientific directorand Dr. J. Zeraffa, Medlars project officer,of France's Institut National de la Santg etde la Recherche Mgdicale; H. Theisel of theGerman Federal Ministry for Youth, FamilyAffairs and Health, and Dr. Rolf Fritz, di-rector of the Medlars center, Deutches Insti-tut fur Medizinische Dokumentation undInformation; Yukio Yamamoto, executivedirector, Japan Information Center for Sci-ence and Technology; Dr. Sune Bergstrom,rector of Sweden's Karolinska Institute, andDr. Gunvor Svartz-Malmberg of the Insti-tute's Biomedical Documentation Center; H.T. Hookway, United Kingdom assistant undersecretary of state, Department of Educationand Science, and Dr. A. J. Harley, director,U. K. Medlars service, National LendingLibrary for Science and Technology; andE. R. Lannon of the Pan American HealthOrganization (representing Dr. E. Braga,director of the World Health Organization'sdivision of education and training), and H.

45

A. Izant, WHO chief librarian and Medlarsproject officer.

P. L. 480 ProgramA 54 percent increase in major foreign

projects was attained by the Library duringfiscal year 1972 under the international ex-change of publications provided by the Ag-riculture, Trade, Development and Assis-tance Act of 1954 (Public Law 83-480).Climaxing ten years of the Library's parti-cipation in these programs, 117 scientificwriting projects were assured support usingspecial foreign currencies in Poland, Yugo-slavia, Israel, Egypt, Tunisia, India, andPakistan.

Two members of the Library's Board ofRegents, who visited Israel, Poland, andYugoslavia during the summer of 1971 toreview the P. L. 480 program and conferwith the participating scientists, emphasizedits important role in providing for an inter-

publication of biomedical journals to includethe more selective commissioning of criticalreviews of biomedical research and practicein priority health fields. Included also arethe translation and publication of significantcurrent and historical monographs in thebiomedical sciences; publication of majorinternational symposia and conference pro-ceedings ; indexing of foreign-language liter-ature for Medlars and MEDLINE; publica-tion of authoritative bibliographies of worldliterature in special public health fields; andsupport of a pilot audiovisual demonstra-tion program for cross-cultural evaluationof audiovisual instructional methods at alllevels of medical and paramedical learning.

In addition to the growth in numbers ofprojects and a rapid development of newcritical reviews and biomedical monographs,sponsored under the Library's bloc grant inPoland with the Coordinating Commissionfor Polish-American Scientific Cooperation,

NLM Director Martin M. Cummings, center, recipient of honorary degree of doctor ofmedicine from the Karolinska Institute, is shown in Stockholm with Prof. HerbertOlivecrona of Stockholm, left, and Prof. Auguste-Louis Loubatieres of Montpellier,France.

national exchange of ideas and knowledgein the biomedical sciences.

Under Public Law 480, appropriations ofblocked currencies are available for scien-tific writing projects in cooperating coun-tries. Emphasis in this program has gradu-ally shifted from initial support of cover-to-cover, English-language translation, and

expansion of the Library's program for thetranslation and publication of major histori-cal studies was accomplished in collabora-tion with the American Association for theHistory of Medicine.

Through the continuing productive NLMmulticategorical Public Law 480 Agreementwith the Israel Journal of Medical Sciences

46

Table 12. Numbers and Types of Active Public Law 480 Projects

FY 1970 FY 1971 FY 1972

Critical Reviews 19 34 56Histories o f Medicine 3 6 9Translation and Publication of 13 13 13

Biomedical JournalsTranslation o f Biomedical Monographs 1 5 8Demand Translations 0 2 3Monographs (Research and Publication) 1 2 6Publication o f Conference Proceedings 0 2 5Audiovisual Programs 1 2 2Bibliographies 1 0 2Handbooks 2 3 2Multi-Category Projects 4 4 9Other 3 3 2

Total 48 76 117

in Jerusalem, 13 critical reviews and specialprojects were published in fiscal year 1972.The Library has also expanded its programfor the translation and publication of signi-ficant current biomedical monographs andhistorical reports, with subsequent distribu-

Two of Poland's leading scientists, Dr. WitoldRudowski, left, chairman of the ministry of healthand social welfare's scientific council, and Dr.Janusz Jeljaszewicz, right, chairman of the co-ordinating commission for Polish-American scien-tific collaboration, visit with Dr. Jeanne Brand, chiefof NLM's International Programs Division.

tion by collaborating U.S. university pressesand other publishing houses. In developingthis program, the Library's staff has workedwith many professional organizations, in-cluding the American Public Health Associa-tion, American Association for the Historyof Medicine, American Society for Micro-biology, American Society of Zoologists, In-fectious Diseases Society of America, and

other scientific groups, in obtaining recom-mendations of priority needs for significantmonograph translations.

International OrganizationsIn an effort to assist Latin countries to

achieve a degree of self-sufficiency in medicallibrary services, the Library continued itscooperation with the Pan American HealthOrganization and its Regional Library ofMedicine in Sao Paulo, Brazil. Special con-sultation was also provided to the GorgasMemorial Institute in its deliberations withCentral American governmental officials todetermine the feasibility of a regional HealthSciences Information Center for the CentralAmerican area.

The director served as a member of theU.S. Delegation to the UNESCO intergovern-mental meeting which considered the Feasi-bility Study of a World Science InformationSystem (UNISIST). His special assistantrepresented the Library at the InternationalCouncil of Scientific Unions AbstractingBoard (ICSU-AB) which the Library hasnow joined. Both of these activities relatethe Library to governmental and non-govern-mental international efforts in other majordisciplines.

47

Fifty years ago, in ceremonies at the Library, a portrait of Major Gen. William C.Gorgas of yellow fever fame, who was World War I Army surgeon general, wasunveiled following his death in London. Twenty-five years later, below, the samereading room, reference desk, and part of stacks looked like this on an average day.

48

HEALTH COMMUNICATIONS RESEARCH

An experimental satellite radio medicalvoice network has been credited by Alaskaphysicians for helping save the lives of sevenseriously ill patients in remote areas of thestate by expediting their removal to a hospitalor transmitting effective therapeutic advicefrom physicians to village health aides.

This pioneering effort in health communi-cations research is one of many projectsundertaken by the Library's Lister Hill Na-tional Center for Biomedical Communica-tions. Envisioned in the Board of Regents1966 recommendations that created an Officeof Associate Director for Research and De-velopment, the Center was named by Con-gress to honor the distinguished UnitedStates senator from Alabama.

The significance of reliable communicationin the provision of health services was em-phasized by a young Public Health Servicephysician, Dr. Brian A. Beattie, the satellitecommunications project officer in Alaska,when he reported recently that "the generalpopulation (now) realizes that they can haveregular daily access to a physician, eventhough that access is remote and indirect."

If an emergency occurs, he said, a villagehealth aide "can be almost 100 percent cer-tain" of obtaining advice from a physicianimmediately, whereas previously there wasno reliable method of communication. Trans-portation, if required, can usually be ar-ranged within 24 hours.

"Health aides in villages with a satelliteradio state that they feel much less pressureif they can talk with a physician at a regulartime," Dr. Beattie said. "Some say they sendfewer people to the hospital because theycan talk with the doctor. Frequently, patientsare asked to listen to the doctor's voice sothat they will know that the health aide'sadvice has been supported by a physicianor has come from a physician."

Dr. Brian A. Beattie, PHS physician and projectofficer for the Library's Alaskan satellite com-munications operations, at his office in Anchorage.

Alaska Satellite Voice LinkLike Alaska, other areas in the United

States may receive inadequate health servicebecause of geographic isolation or severe cli-matic conditions. Shortwave radio wavescan travel from a ground station, to a com-munications satellite, and back to anotherground station with far more reliability thannormal transmission routes parallel to theearth's surface. A communication satellitecan reliably connect isolated communitieswith physicians, thus providing needed con-sultation and direction.

Such an experimental network wasinstalled in Alaska, using the National Aero-nautics and Space Administration's Applica-tion Technology Satellite, ATS-1. This satel-lite is located in stationary orbit over the

49

equator at 150° west longitude. It is visible24 hours a day to more than a third ofthe earth. The Alaskan network consists ofsimple, inexpensive terminals in 26 remotevillages, and in field service unit hospitalsand medical centers, interconnected with avoice link operating through the satellite.Medical traffic is carried two hours a day,seven days a week and has been functioningsuccessfully with very little time lost fromionospheric interference which makes con-ventional radio useless for long periods.

,* \ -

Health aide in Alaskan village receives medicaladvice from physician via satellite communicationnetwork.

The services provided include:• Voice consultation between community

health aides and physicians at Native HealthService Unit Hospitals, and between physi-cians and consultants at medical centers.

• Continuing education of health aides,nurses, and physicians.

• Education of villagers in personal healthmatters.

• Communications between hospitalizedpatients and their families in native villages.

The purpose of the Alaska experiment isto determine the useful services that can beprovided by narrowband communications.Physicians and engineers at Stanford Uni-versity, the University of Washington, andUniversity of Wisconsin are experimentallytransmitting computer-generated data, re-ceiving print materials from unattended

terminals, and transmitting x-rays, otherforms of pictures, electrocardiograms, andother physiologic data via the satellite.When the quality is judged adequate and allinterfaces between equipments defined, ad-ditional services will be incorporated intothe Alaskan network to ascertain their con-tribution to the health care and education ofthe native population.

A similar network is being planned forMicronesia, the Trust Territory of the PacificIslands, and American Samoa. Ground sta-tions on at least three islands will be linkedto the major medical, educational, and libraryresources of the University of Hawaii viathe ATS-1 satellite.

A recent successful experiment includedboth the ATS-1 satellite and the wirelinenetwork for remote searching of the MED-LINE data base on the Library's computer.A query was sent via the satellite from a ter-minal at the Anchorage Native Health Serv-ice Unit Hospital to Stanford University,where the message was transferred to thedata communications network and thence tothe NLM computer. The message flow wasreversed in answering the query.

New England Interactive TV Network

Impediments to the success of programsof continuing medical education planned bymedical centers for those who practice inmountainous rural areas may be formidable.The harsh climate and rugged terrain ofNew Hampshire and Vermont encouragedthe development of a patchwork of smallcommunity hospitals served by medicalstaffs largely isolated from major medicalresources. This reduces opportunities forparticipation in educational efforts not di-rected to immediate and relevant patientproblems. Younger physicians often avoidprofessional isolation and shun service inthe smaller communities. University medicalcenters, therefore, must find appropriatemeans to extend their educational resources

50

to those who practice in relative isolationwithout compromising or seriously divertingthe limited manpower of the educationalinstitutions.

Full, two-way, interactive television is thebest, and perhaps the only, method availabletoday for bringing the medical school class-room to the small community hospital and,simultaneously, bringing the busy communitypractitioner to the university classroom.Physicians in community hospitals can nowattend hospital rounds via television withtheir university colleagues. Nurses in coro-nary care units can share instruction andexperiences in patient care. Medical schoolfaculty members can teach nursing studentsat the university hospital and at a smalllocal vocational school simultaneously.

These activities are under way through anexperimental microwave television link con-necting Dartmouth Medical School and Uni-versity Hospital in Hanover, New Hamp-shire, with Claremont General Hospital 30road-miles away. The link was initiatedunder the sponsorship of the National Insti-tute of Mental Health to provide psychiatricconsultation by Dartmouth psychiatristswith general practitioners and their patientsin Claremont.

Since July 1970, when the Library assumedsponsorship, uses of the television link havegrown and expanded until there are now tenhours of daily scheduled operation for sixdays a week. All programs are interactive.Staff members at each end of the systemactively participate with their colleagues.Prerecorded and one-way programs are notscheduled. Some Claremont physicians arecredited with four hours of continuing edu-cation a week; the average is 2.5 hours.Nineteen out of 20 of the staff members par-ticipate at least once a month. This is a sig-nificant increase over the average participa-tion rate in the New England communityhospitals reported in other studies.

Construction of a mountaintop microwavenetwork was begun in the spring of 1972,extending 150 miles to the northwest, linkingDartmouth with the University of VermontCollege of Medicine in Burlington. Central

Vermont Hospital in Berlin will also jointhis network. Plans are underway for theresident physicians at the University ofVermont to obtain some of their clinicaltraining in this hospital via television.

Artist's rendering of annex to National Library ofMedicine to be constructed for Lister Hill NationalCenter for Biomedical Communications and otherstaff operations.

Beginning in fiscal year 1973, televisionservice will be extended to other institutions,including smaller hospitals not requiring pro-grams as often as seven days a week. A van-mounted microwave unit is being designed toprovide television service to several commu-nity hospitals and clinics within line of sightof one of the network's relay points. The vanwill carry the television equipment to con-nect these smaller hospitals to the network ona regularly scheduled basis. This innovativeapproach should make it possible to provideneeded services in areas that do not justifythe cost of a fixed installation.

51

New NASA ATS-F SatelliteThe low-powered ATS-1 satellite used in

Alaska is capable only of transmitting nar-row-band information. Use of this satellitefor television transmission would requirelarge, complex, and costly ground terminals.However, to evaluate the useful services thatcould be carried via satellite, a full video ca-pability is essential. In 1974, NASA willlaunch the ATS-F, sixth in a series of experi-mental satellites designed to explore com-munications, navigation, and scientific phe-nomena in space. Recently, receiver andtransmitter terminals, specifically for experi-mentation in health and educational projects,were added to plans for this satellite to pro-vide quality television with simple, inexpen-sive ground terminals.

NASA's ATS-F satellite which is scheduled to belaunched in 1974.

Experiments in this program have not yetbeen developed fully, but will probably in-clude :

• Medical consultation between physiciansand their aides serving Indian populations,and nurses and physicians' assistants work-ing in remote areas.

• Programmed instruction between medi-cal schools, and between medical schools andremote field sites, to explore the feasibilityof sharing faculty talents and experience inproviding a well-balanced program.

• A combined education and health pro-

gram for migrant workers and their fami-lies, using a mobile terminal.

• Continuation of the Alaskan experi-mental services to remote villages with theaddition of video.

In addition to the obvious benefits accruingto health education and patient care, an im-portant objective of satellite experimentationis to develop experience and knowledge insupport of biomedical communications re-quirements for the planning, design, andultimate development of national communi-cation systems.

Cable Television ProjectDuring 1971 considerable national atten-

tion was focused on cable television. Federalagencies directly concerned with health careplanning and professional education devel-oped programs and plans for application ofthis communication medium to the improve-ment of the nation's health. The Library'sLister Hill Center supported efforts to estab-lish useful pilot projects in which cable tele-vision is incorporated into health care andeducational programs.

Several possible sites were examined fortrials of cable television among residents ofurban ghettos. Ethnic background, popula-tion densities, existing health services, andother factors influencing patient care werestudied. Rather than attempt to establishnew health care methods that use cable tele-vision, the communications system initiallywill be introduced and evaluated in existinghealth and educational settings where accept-ance is already established.

The Mount Sinai-East Harlem project pre-sents an opportunity to develop a uniquemedical information and education system.The Mount Sinai School of Medicine has re-sponsibility for the health care of the EastHarlem section of New York City, which hasa population of about 250,000 persons ofwhom 90 percent are black or Puerto Rican.Many persons are elderly and confined totheir homes. Almost one-third live in publichousing. This area has almost all the inherentinner-city problems. The residents depend toa large degree on commercial television for

52

information about the world in which theylive. Mount Sinai officials anticipate that two-way interaction with occupants of apart-ment complexes in East Harlem via cable TVwill greatly improve their ability to providethe improved services that are needed.

Computer Simulation

The computer has been likened to a medi-cal school faculty assistant, a willing, tirelesscolleague ready 24 hours a day, seven days aweek, to teach, review, conduct, and scoreexaminations and even simulate patientswith various common or complex conditions.This new service constitutes the biomedicaldata network portion of the larger DataCommunication Service.

Two institutions experienced in the appli-cation of computers to undergraduate andcontinuing medical education, Ohio StateUniversity Medical Center and the Labora-tory of Computer Sciences of MassachusettsGeneral Hospital and Harvard MedicalSchool, will initially participate in this net-work. Early next year a third universitycomputer center, at the University of Illi-nois, will be added to the biomedical datanetwork.

Lister Hill Center Report to theCongress

In April 1972, the National Library ofMedicine published a resume of current ac-complishments achieved in medical communi-cations research and development. This re-port, "The Lister Hill National Center forBiomedical Communications: Report to theCongress," was requested by the Senate Com-mittee on Appropriations on July 29, 1971in these words:

"As the success of the Center's efforts willultimately depend on their acceptance andsupport by the medical and scientific com-munities, the Director of the National Li-brary of Medicine and the staff of the ListerHill Center should prepare an informativereport on its prototype experiments—such

Former Senator Lister Hill, for whom the Library'sbiomedical communications center has been named,is shown with NLM Director Martin M. Cummings,left, and Dr. Joseph F. Volker, right, president ofthe University of Alabama, during dedication ofthe University's new Lister Hill Library of theHealth Sciences in Birmingham.

as the satellite communications link withremote regions in Alaska and the two-waytelevision network in New England—and itsplans for the future. One of the purposes ofthe report should be to stimulate awarenessof and interest in the ways in which moderncommunications techniques can be adaptedand expanded to serve all facets of healthservices, biomedical research and the train-ing of health professionals."

The Center was founded to give impetusand direction to a national program of bio-medical communications. The first three yearsof the Library's Lister Hill National Centerfor Biomedical Communications were forplanning, limited experiments, and pilotprojects.

The technologies the Center was createdto exploit—satellite communications, cable,microwave television, on-line computer net-works—are being used. Experimental andoperational networks are now providing serv-ice. The networks connect sources of medicalknowledge with those who need that knowl-edge; the swift and certain transmission ofelectrical messages is substituted wheneverand wherever possible for the slow, expen-sive, and even hazardous movement of people.

53

ORGANIZATION OF NATIONALLIBRARY OF MEDICINE

Office of AdministrativeManagement

KENT A. SMITHExecutive Officer

DIRECTORMARTIN M. CUM MINGS, M.D.

DEPUTY DIRECTORG. BURROUGHS MIDER, M.D.

Special Assistants to theDirector

HAROLD M. SCHOOLMAN, M.D.MARY E. CORNING

Lister Hill National Center forBiomedical Communications

ALBERT FEINERDirector

Computer andEngineering Services

DAVIS B. MCCARNAssociate Director

Office of Public Informationand Publications Management

ROBERT B. MEHNERTChief

Library Operations

JOSEPH LEITER, Ph.D.Associate Director

Specialized InformationServices

HENRY M. KISSMAN, Ph.D.Associate Director

Extramural Programs

LEROY L. LANGLEY, Ph.D.Associate Director

National Medical AudiovisualCenter

CHARLES F. BRIDGMAN, Ph.D.Director

56 •U.S. GOVERNMENT PRINTING OFFICC:1972 514-110/128 1-3

THE BILLINGS ERA

early one hundred years ago Army Sur-geon General Joseph K. Barnes, in his

annual report for 1873 to Secretary of War,prophetically mentioned "the interest felt bythe medical profession of the country in theattempt to establish aNational Medical Libraryworthy of the name."

A highly professional man,Barnes had more than apassing interest in thegrowing collection of med-ical books and pamphletsalready in his office whenhe became surgeon gen-eral. He also had the fore- Dr-John shaw Billin«s

sight to assign a rising young medical officerto his staff in 1865 and, among numerous ad-ministrative duties, to appoint him librarian.His name was John Shaw Billings, and he wasto become one of the medical giants of the latenineteenth and early twentieth centuries.

Billings, who gained an international reputa-tion in medical education, public health, hos-pital design and construction, and vital statis-tics, attained eminence in medical bibliographyand librarianship during the 30 years he headedthe Library. Strongly supported by Barnes, hegreatly increased acquisitions by purchase,exchanges and gifts, inaugurated loans ofbooks without fees (but required a deposit),initiated a publication program, and fought

unrelentingly for a new fire-proof building to house thegreat collection he was assem-bling to be a truly NationalMedical Library.

Billings' monumental achieve-ment as a librarian was theconception and production of

the Index-Catalogue, a colossal task of compil-ing the vast holdings of the library by subjectand author in a single alphabet, to providemedical students and practitioners with access

to the available literature. The first of the 16volumes that were to comprise the first seriesof the Index-Catalogue was published in 1880.The series contained citations to 116,847books and 191,598 pamphlets, practically allof which Billings had himself added to theLibrary. With his long-time associate and col-laborator, Dr. Robert Fletcher, he also producedthe Index Medicus, a continuing compilationof current literature.

By the fall of 1887 a new three-story red brickbuilding on the south side of the Mall, designedby Billings, was completed at a cost of $200,-000. This was $50,000 less than the amountoriginally requested and necessitated the dele-tion of many needed facilities and improvisa-tion in other areas. But the task of moving the

On the Mall, 1887-1961

collection, now grown to 51,000 books andabout 57,000 pamphlets, was completed intime to belatedly celebrate the Library's fiftiethanniversary in its new home.

The Library continued to grow in resources,services and prestige under the leadership ofthe distinguished physicians who followedBillings. In 1922 its name was changed to theArmy Medical Library. Later, during an era ofunification of agencies under the new Depart-ment of Defense, it was redesignated theArmed Forces Medical Library. In 1956 anamendment to the Public Health Service Actcreated the National Library of Medicine underthe jurisdiction of the Department of Health,Education and Welfare.

NEW HORIZONSFOR MEDICAL LIBRARIES

/he world's largest collection of healthVy sciences literature of the National Li-brary of Medicine is preserved in a modern,functional structure with an eye-catching,hyperbolic-paraboloid roof in Bethesda, Mary-land, that was dedicated in 1961.

Two important factors contribute to the expand-ing services this great center of informationand learning provides physicians and medicalstudents, and other members of the health pro-fessions. One is the Library's international com-puterized system of compiling, storing andretrieving references to medical literature,known as Medlars. The other is the passage ofthe Medical Library Assistance Act underwhich, for the first time, grants are availableto medical libraries to increase their resourcesand services. In addition, the law authorizedthe establishment of the Regional MedicalLibrary Program to develop a nationwide bio-medical communications network.

Medlars has also given impetus to the Library'sunprecedented publications program. IndexMedicus, which provides a monthly bibliog-raphy of current literature, and the CurrentCatalog are produced more promptly throughthe use of computer-driven phototypesetters. Apopular new publication, Abridged Index Med-icus, contains literature citations from the 100most important clinical medical journals

printed in English. More than a score of recur-ring specialized bibliographies cover many ofthe specialized fields of medicine.

The staff and resources of the National MedicalAudiovisual Center in Atlanta, Georgia, formerlya part of the Public Health Service's Center forCommunicable Diseases, in 1967 were assignedto the jurisdiction of the National Library ofMedicine. By a Senate Joint Resolution in1968, the Lister Hill National Center for Bio-

Main Reading Room

Medlars Computer System

medical Communications was establishedwithin the National Library of Medicine. Thisnew Center has broad research and develop-ment responsibilities in the application of com-puter and communication technology to med-ical communications, education and research.

But great advances in communication tech-nology and literature retrieval have not dimin-ished the personal gratification of visiting alibrary to experience sensory contact withbooks and their contents. Here the quest forknowledge is more pleasurable and more re-warding. Recently a physician, in concludinga list of acknowledgements in a newly-publishedbook on heart disease, wrote: "In my opinionthere is no more satisfactory source of helpthan librarians. They always seem overjoyed tofind somebody who wants to learn something."

The National Library of Medicine is such alearning place for the health professions.

8600 Rockville PikeBethesda, Maryland 20014

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health Service

National Institutes of HealthU. S. GOVERNMENT PRINTING OFFICE : 1971 O - 444 -636