The National Library of Medicine and the Library Component in Communication, 1963
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The National Library of Medicine and the Library Component in Communication A Report Prepared for The House Committee on Interstate and Foreign Commerce Bethesda, Maryland The National Library of Medicine Public Health Service U. S. Department of Health, Education, and Welfare March, 1963

Page  1 THE NATIONAL LIBRARY OF MEDICINE AND THE LIBRARY COMPONENT IN COMMUNICATION I. NLM ORGANIZATION. AND PROGRAMS The National Library of Medicine was founded in 1836 as the Library of the Surgeon General's Office, U. S. Army. It enjoyed a period of great growth, and acquired an international reputation as a scholarly library, during the last half of the nineteenth century, under the leadership of its great Director, John Shaw Billings. In 1956 the National Library of Medicine Act (P.L. 941, 84th Congress) was passed, transferring the institution to the jurisdiction of the Public Health Service. The Library's new $7 million building in Bethesda was occupied in April 1962. The overall management and policy guidance of the Library is subject to the scrutiny and review of the NLM Board of Regents, advisory to the Surgeon General, PHS. The Board consists of 7 ex-officio members, including the four Surgeons General of the uniformed services, the Chief Medical Director of the Veterans Administration, an Assistant Director of the National Science Foundation, and the Librarian of Congress, and 10 members appointed by the President, for terms of four years each, chosen from persons prominent in the various fields of medicine. The operations of the Library are carried out by a staff of 237, all in Washington, organized in five operating divisions. Library Objectives. As a national institution, the Library has for years conducted its programs with two general objectives: the provision of bibliographic access to the literature of medicine, and the provision of physical

Page  2 2 access to that literature. Bibliographic access embraces the areas of cataloging, indexing, and bibliographical listing, and the publication and dissemination of the resulting products. It responds to the question "What materials exist that are directly pertinent to the subject of my inquiry?" The nature of the problems of bibliographic access and the means available for their solution lend themselves readily to centralization. This is what the Library is attempting to do -- to compile centrally, and distribute widely, the bibliographic record of medicine, so that all members of the health professions, wherever they may be, may have knowledge of what of interest to them is appearing in the world literature. Physical access embraces the area of acquisitions, at one end of the line, and as a representative area at the other end, the provision of interlibrary loans. Only a universal acquisition program such as NLM's can at once provide the base for a universal bibliographic record, and at the $ame time provide the rich and broad store of materials on which lesser libraries may rely for the provision of works which lie on the more exotic side. Provisions for physical access respond to the question "How can I put my hands on these items known to be pertinent?" Here the problem can be suitably fitted only to a de- centralized arrangement of facilities. The fundamental characteristic of the printing press is that it provides multiple copies, which may be stored in multiple locations, convenient to the needs of users spread over wide geographical areas. The interlibrary loan program of the Library, enormous as it is, can properly be conceived of as a central facility which functions only as a very necessary supplement to the basic decentralized stores of the medical library network.

Page  3 3 Bibliographic Access. The chief instrument in the Library's program is the Index Medicus. This publication and its predecessors have had a continuous history back to 1876, and together they have provided the medical sciences with a better control over their published record than exists in any other scientific area. The Index Medicus is prepared by a semi-automated system employing Justowriters for typography, IBM equipment for sorting and merging, and a Listomatic camera for rapid-fire photographic composition. During this fiscal year the publication will carry citations for over 150,000 journal articles from 2,000 journals, listed under multiple author and subject rubrics. The publication appears monthly, in a print order of 7,500 copies. Approximately 900 copies are distributed free to Federal medical installations; another 900 are used for exchange )urposes, to insure receipt of foreign publications; the balance of the copies are subscribed to through the Superintendent of Documents at a price of $26 per year. The Library invests 207 of its manpower and 20% of its funds ,n this one operation. Besides the Index Medicus, the Library publishes two major annual lists, the Bibliography of Medical Reviews, and the National Library of Medicine Catalog. The Library also brings out occasional publications, as, for example, the recent Biomedical Serials, 1950-1960 Early American Medical Imprints Russian Surgical Staplers.

Page  4 4 The, Library's newest bibliographic project is called MEDLARS, for Medical Literature Analysis and Retrieval System. MEDLARS has been under development for two years, and will become operational at the end of 1963. At the heart of MEDLARS will be a digital computer. Information will be fed into the system through punched-paper tape, representing the indexing done by the Library staff. This information is converted to magnetic tape and manipulated in the computer. The magnetic tape so prozessed is used 'to activate a very high-speed composing device capable of producing photographic masters for printing. Three types of products will be derived from MEDLARS. First, it will provide increased high-speed composition capacity for the production of the Index Medicus. Second, it will provide recurring bibliographic listings of references selected in accordance with the predetermined requirements of particular research fields; for example, it will supply a weekly listing of ti.e world's medical literature on cardiovascular disease to that research group for its dissemination. Third, it will provide search and retrieval capacity to answer on demand queries from individual research installations concerning newly published information bearing on their immediate problems. In its first year of operation, MEDLARS will contain 180,C00 references; this will increase by annual increments up to the point where over a million references will be stored on magnetic tape for searching. MEDLARS will turn out 50 recurring bibliographies of varying periodicity, and it will accept up to 90 complex demand search questions daily. On success.... :ompletion of this project, the medical sciences in the United Stat.E _11 have access to a powerful bibliographic search tool equaled by none the world.

Page  5 5 Physical Access. Since the 1860's, the Library has been engaged in collecting the literature of medicine on a global scale, This means all medical writing, from all countries, and of all times. Currently it operates under a formalized "scope and coverage policy," which surveys in terms of a general classification the entire domain of human knowledge, and establishes four levels of library collecting: 1) exhaustive (in the medical sciences), 2) research (in the basic supportive sciences), 3) reference (in pertinent and related areas), and 4) skeletal (in fringe areas). This attempt to rationalize the medico-centric universe of the world's literature is unique, and results in a planned and controlled expansion of the Library's collections. The NLM constitutes the largest assemblage of medical literature in the world. As of July 1, 1962, this collection totals 1,084,256 units including 1,009,228 books, journals, theses, and pamphlets. The collection is a national resource of great extent and depth. By law, it is accessible to researchers and scholars for use This use takes two principal forms: 1) consultation and reference; 2) interlibrary loans, accomplished mainly through photoduplication. Among the researchers using the Library in person are scientists and scholars engaged in the writing of books, review papers, historical treatises and the like. A phenomenon of recent years has been the systematic use by teams of researchers; for example the Surgeon General's Committee on Smoking and Health is currently quartered in the Library. Other agencies establish continuing work groups for the purpose of reviewing and monitoring the literature bearing on research topics. Over 10,000 reference requests are received

Page  6 6 at the Library each year; the bulk of this load originates from a service population outside the Library rather than from the Library's visitors. To respond to requests for literature coming in from all over the country, the Library has developed a Photoduplication Service which embraces as one of its parts one of the largest microfilming operations in the Federal Government. Using. six mobile cameras, which, roam the book stacks, and a continuous xerographic printer capable of producing 20 feet of paper print a minute, the Library each year responds to over 125,000 requests. This amounts to the filling of requests at the rate of one every minute of every working day throughout the year. Last year some 2,000 libraries around the world received 2,250,000 pages of material; one in eight of these requests went to libraries overseas to whom the NLM represents a primary international resource. About 12% of the Library's funds are committed to this activity. Extramural Programs. The Library's Extramural Programs seek to reinforce both the functions of bibliographic access and physical access but through agencies and institutions outside the Library's walls. UnGc-:r existing authorities and appropriations, the only activity currently conductec --a a program to strengthen channels of international communication to the -enefit of American scientists -- the NLM Science Translation Program. This program serves as a principal focus.within the PHS for meeting the needs of the American medical research community for acce the reports of foreign medical research published in infrequently read iaaguages. The program includes, for example, a project carried out by the Federation of American Societies for Experimental Biology, which monitors Soviet experimental

Page  7 science, selecting those papers considered by American scientists to be of particular significance, and publishing them in translation as a supplement to the journal Federation Proceedings, which reaches 11,000 scientists. Under P.L. 480, the Library conducts programs for translation in Israel, Yugoslavia, and Poland. A part of this effort has resulted in five Polish medical research journals being published in the English language originally, instead of in Polish. 7

Page  8 II. SIGNIFICANCE OF NLM FUNCTIONS Alone among the Federal libraries, the National Library of Medicine by statute is a national library of the.United States, the first so designated by the Congress. While it shares certain nationwide functions with the Library of Congress and the National Agricultural Library, NLM has by law unique responsibilities in the public interest. These are, in the words of the Act, "to assist the advancement of medical and related sciences, and to aid in the dissemination and exchange of scientific and other information important to the progress of medicine and to public health." Service to the National Medical Community. The Library subserves the needs of the entire medical and health-related community of the country. While established and maintained within the Public Health Service, its service public includes not only the totality of Public Health Service program interests, and those of all medically-oriented agencies of the Federal establishment as well, but the entire complex of public and private institutions and agencies, which, taken together, constitute the medical establishment of the United States. In the interests of maximizing its benefits, the Library customarily works with and on behalf of organized groups, established agencies, and institutions of great variety. A recent survey of the Library's Interlibrary loan operation illustrates the scope and variety of the Library's institutional public. The following types of institutions extend their local resources by borrowing from NLM: Medical school libraries: Libraries of medical schools, colleges of medicine, schools of pharmacy, dentistry, nursing,osteopathy, veterinary medicine, public health, etc.

Page  9 9 Medical society libraries: Medical and allied science association, society and, academy libraries whether. organized on a national, state, or municipal basis or by subject fields such as cancer, heart, etc. Federal Government medical libraries: Medical libraries of any branch of the Federal Government. Hospital libraries: Libraries for both professional staff use and patients' use in hospitals. Industrial, research, and foundation libraries, medical and nonmedical: Libraries in both profit and nonprofit organizations in any field. Other medical libraries: Libraries of state boards of health, city boards, etc. International organization, medical or nonmedical. For these libraries, the NLM constitutes a national resource, on which they can depend, and which they can use to augment their smaller collections, thereby guaranteeing to their users the availability of the scientific references desired. An analogy to the Federal Reserve System is appropriate. Like the Federal Reserve Bank, the NLM is at the pinnacle of a national complex of local components. The Federal Reserve guarantees to local banks the security of their resources; the National Library of Medicine guarantees to local medical

Page  10 10 libraries ultimate access to the total resources of medical information. These are the conventional channels through which the Library conducts its national supportive mission. Each of these agencies, in turn, is concerned with one or more aspects of improving the nation's health: the discovery of,new medical knowledge through research, the improvement of health practices through the application of this knowledge, and education for the health professions. Only infrequently can any one of these objectives be isolated in terms of library functions. Usually, as in a medical school library, it is a question of degree of orientation u a library',, loan, reference and bibliographic activities to one of - several purposes. This is certainly true of the NLM, which, by virtue of the universality of its collections and services, provides national support for all three objectives. The Research Process. Scientific knowledge is accretional. Its records are built of reports of original investigations, the verifications, disproofs, and re-verifications of these reports, their integration and consolidation into the pre-existing body of knowledge. The published record of scientific research is voluminous, and of great complexity. In the case of biology and medicine, research is probabilistic in its methodology) this results in more attempts at verification employing differing methodol'ogies, a process which swells the published record of the biomedical sciences to a greater volume than that existing in any other broad scientific field. Three ingredients exist in the research process: the scientist himself, with his experience, his professional skills, and his curiosity; the laboratory, with its tools, facilities and resources; and the library, the custodian of the scientific record. The scientist uses the library's bibliographical tools

Page  11 11 for access to the scientific record, and its collections to consult the record itself. He needs to do this to see whether anything like his proposed study has ever been done, and if so, by what methods and with what results. He then conducts the investigation, using his personal skills and laboratory resources, and on completion of his work, publishes to disseminate his findings, to contribute to the record, and to deposit copies in the library. The library function is an essential part of the research cycl,, without which the scientists cannot function, nor scientific knowledge advance. NLM Support Activities. The NLM functions to strengthen these processes through its various programs. For over 80 years the 1.ibrary has published the principal indexes for access to the research record u the medical sciences. In addition, specialized bibliographies, such as the definitive bibliography on Psychopharmaca, are published by the Library to provide underpinning for emergent research fields. The Bibliography of Medical Reviews facilitates the access of researchers to that part of the published record which consolidates advances and developments on the frontiers of science. Through its loan and photoduplication activities, the Library acts to extend the resources of all other medical libraries. About 40% of the Library's loans goes to Federal medical institutions and other Federal agencies, 20% goes to medical schools and societies, 20% goes to hospitals, and 20% goes to industrial, independent research, and other libraries. The 'significance of this activity is that it permits the alert scientist, practitioner, and educator, wherever he may be, to follow, study, and evaluate developments in his special field wherever they may occur throughout the world.

Page  12 12 The Library's translation activities are performed on behalf of large segments of the medical community. They aim, not at the researcher's ability to locate and acquire an obscure publication which may contain a highly significant finding, but rather at overcoming the serious inhibitory factor of his inability to read it, once found. After all, only 2% of all American scientists read Russian, and only one-half of one percent read Japanese. The distribution of selected translated papers helps to alleviate this problem.

Page  13 13 III. TRENDS AND NEEDS Science functibns in an evolving society, and its institutional directions, practices, and forms are molded by the requirements of that society. Two major trends are dominant in our time. While observable in' all developed countries) they are particularly marked in the United States. The Publication Explosion. The first has to do with growth. Conscious of the successes and benefits of research, society has increased its support a hundred fold. The great increases of dollars, of manpower, of facilities, and of research projects have been frequently reported to the Congress. Less well known is the effect of these increases on the scientific record and on libraries. According to NIH data*, each project grant generates 1.1 published papers; since 1945 NIH grants alone have swollen the scientific record by 50,000 articles. Comparable increases have occurred in all countries, resulting in what has been called "the publication explosion," a phenomenon which has overburdened scientific publication media and libraries equally. The Interdisciplinary Revolution. The second has to do with a change in the organization of scientific research. Its 19th century form followed academic lines; institutes, laboratories and careers alike were cast in the mold of disciplines: e.g. microbiology, physiology, biochemistry. World War II demonstrated dramatically to the supporters of research that society could achieve scientific breakthroughs through interdisciplinary combinations, through the assemblage of research teams representative of multiple related disciplines. *Lindsay, D.R. and Allen, E.M. Medical Research:. Past Support, Future Directions. Science, 134:2017-24,,,1961.

Page  14 14 Common now are areas of science comprising twenty or more disciplines, associated for work on a problem complex, or a specific disease (e.E. space biology, diabetes, molecular. biology). This interdisciplinary revolution in the sciences has been accelerated by large scale funding; it has changed the organization of research drastically within a generation. In terms of the scientific record, its effects are profound. Each new interdisciplinary field, for example, has its own communication requirements: journals, abstracting services, bibliographies, critical reviews. Since the organization of the traditional scientific record followed discipline lines, the need to repackage the record has resulted in great dislocation: the fields staked out by journals overlap; new abstract services are generated to supplant time-honored ones; and there is a general insecurity about the adequacy and the permanence of the scientific record. It is these two forces, taken together, which underlie the "crisis in scientific communication." The national research effort is generating vast amounts of new published information, and the traditional forms of organizing it for furthering the effort appear to be inadequate. Impact on the National Library of Medicine. These two circumstances have profound and far-reaching implications for the NLM, and for the medical library network with which it is affiliated. The world in which they had their historical development has been disoriented, and its axis shifted. The fundamental problem facing the NLM, as well as other institutions involved in the communications process, is to accommodate to this new orientation and new magnitude of research.

Page  15 15 The NLM's major response is the. MEDLARS system of computer-based indexing, previously described. The fundamental significance of the computer in a large scale information storage and retrieval system lies in its ability to manipulate masses of material along multiple axes. With MEDLARS, the Library will have the ability to unitize new medical information, and to put these units together again in any pattern or combination which may conform either to disciplinary or interdisciplinary requirements. MEDLARS, in short, is the bridge between the two worlds, between the past and the future. National Significance. Computer-based information systems developed or contemplated to date have been restricted to the use of a particular group or company, and are, in a real sense, private systems. The significance of MEDLARS is that it has a potential for controlling the largest of the scientific literatures for one of the largest professional groups as a public service function. On completion, this computer-based indexing system will be a unique asset for American science. The Library expects and intends to share this government-owned asset widely with other institutions, thereby to realize as completely as possible this national potential. "Current Awareness" Services. To keep scientists up to date on newly published research results published throughout the world, specialized rapidly produced listing services are an essential. With increasing frequency the Library has been approached by interdisciplinary research groups, representing both public agencies and private societies, with requests for monitoring devices which will cover the world's literature of special interest to them. In a first phase, the Library plans to provide

Page  16 16 up to 50 current listing services, each tailored to the specifications of.a research group, as one of the principal MEDLARS products. Through the duplication of MEDLARS tapes, and the use of computers at university centers, this facility can be progressively expanded in a second phase on behalf of still more groups. In a third phase, such listing services can be provided for research teams and individual laboratories in many centers. Toward a National Retrieval Network. The unprecedented search and retrieval capability of the MEDLARS system can and should be widely duplicated if the full benefits to American medical science are to be realized. Following the principal that bibliographic access and physical access should go hand in hand, the NLM has developed preliminary plans for the establishment of a national retrieval capability in which medical libraries at university centers throughout the country will have a central role. Preliminary plans have been developed, which call for the duplication of tapes from masters prepared in the NLM, and their distribution to other libraries having access to computers. Much further developmental work must be done before such a system can be an operating reality, but the Library looks forward to the day when 50 libraries in as many states will utilize the Index Medicus published in a magnetic tape edition for daily machine literature searches in support of local research needs. Depressed State of Medical Libraries. This unprecedented retrieval capability, however, has little meaning to the libraries or to the national research effort unless it is matched with adequate availability of the literature itself. For years it has been increasingly evident that medical libraries have been under-supported by the schools and institutions

Page  17 17 which they serve. Ten years ago, when the Federal funds for medical research were half what they are now, the professionally conducted survey, Medical Schools in the United States at Mid-CentuLy', found "little evidence . . of attempts to meet the libraries' increased needs during a period of tremendous expansion in the research and other activ ties of the schools." The report concluded that faculty workers, research workers and students would be "severely handicapped unless the new demands placed on libraries are met by careful administrative and budgetary planning. In a nation dependent on medical research to a greater degree than ever before, surprisingly little is being expended on the housing of the reports of that research and on making those reports available." The Deitrick Survey found the medical libraries had accumulated deficiencies through years of under-support, and judged them to be dangerously inadequate to meet the needs of medical research and education ten years ago. In the ten years since the report, with greatly increased burdens placed on them, the libraries have not held their own; research expenditures have increased eight-fold; the amount spent on libraries but doubled. Of all the resources supporting national programs of research and training, it is obvious that the stored intellectual resources, represented by the medical libraries, is the weakest. Their weakness is evident in four aspects books and journals, skilled manpower, outdated technology, and housing. *Deitrick, J. E. and Berson, R. C.; Medical Schools in the United States at Mid-Century. N. Y., McGraw-Hill, 1953.

Page  18 18 IihraryjlesETIes. The demands of interdisciplinary research for library materials in basic scientific fields not previously considered to be within the scope of a medical library have caught many libraries unaware, and unprepared to acquire, process and store the large amounts of new literature required. Library budgets, already inadequate for the purchase of books and journals in the conventional medical sciences, have been overpowered. The median medical school library of 53,000 volumes is about half of what it should be to support broad biomedical research programs. Regional Medical Libraries. Faced with these deficiencies, libraries in metropolitan centers have entered into cooperative agreements for the pooling of their resources. Several areas (New York, Boston, Pittsburgh, Cleveland) have preliminary plans for regional medical library centers, which would store and service on behalf of the entire metropolitan library complex, the lesser used but scientifically important literatures of medicine and its related scientific fields. Dollar resources have been lacking to support this promising trend, which is entirely compatible with the NLM plans for decentralizing the MEDLARS system. hipImyer1_..)esiLciet. Manpower deficiencies are both quantitative and qualitative. A vicious circle of low performance requirements, low salaries, low training resources, low recruitment successes, and again low performance requirements has led to a depressed situation where able, qualified medical librarians are in distressingly short supply. The median number of librarians with professional training working in schools of medicine is three; the total professional manpower pool for 80 schools of medicine is 326. The revolutionary changes in the scientific bases of medicine, the new fields of interdisciplinary research, the rapid advances being made in the

Page  19 19 organization, storage and retrieval of medical information have caught the medical librarians grossly underprepared. The talents, for example, to master the man-machine interrelationships of the proposed decentralized MEDLARS system are almost nonexistent. The strengthening of educational resources, the vigorous recruitment of new manpower, the retraining of librarians already on the job,, are essential if the human resources necessary to the servicing of the information needs of medical research and education are to be assembled. Outdated Technology. The technologies related to the provision of better bibliographic access (e.g., machine storage and retrieval of information) and to physical access (e.g., photocopy devices, facsimile transmission) have made giant strides over the last decade. Medical libraries have been slow to profit by these advances primarily because of the developmental costs involved, and the capital outlays,, which,, even though modest,, have been beyond their ability to fund. If the libraries are to become effective instruments for supporting research and education, attention must be given to research and development to bring the advantages of modernized technology to the library process. Construction Needs. Most urgent is the need for more and improved housing for medical libraries. The majority of libraries which were planned a generation ago were underplanned at the time, were hopelessly overcrowded ten years ago, and are desperately in need of more space today. The "publication explosion" cannot be accommodated within the four walls of underplanned libraries. As a consequence, in many institutions, publications essential to research programs are warehoused miles away from the school campus, making

Page  20 _20 the ready access of scientists to the literature a fiction. The operating inefficiencies of such medical libraries handicap severely the educational and research programs conducted within the schools. Seventy percent of American medical school library buildings are more than 10 years old; fifty percent more than 30 years. A 1957 survey*showed that over half of the medical school libraries reporting had exceeded their shelving capacity, and but a handful of new buildings have been achieved since. Recommendations of National Advisor Health Council. The National Advisory Health Council has passed repeated resolutions calling attention to the serious state caused by library inadequacies. Its resolution of November 1962 reads in part: "The medical library network which has been designed to make the published record of medicine available is in dire trouble. During a period of intensive development of research institutions, their essential library support has been seriously neglected. In recent years, the needs for adequate library working and storage space, for more trained library personnel, and for new methods of handling and disseminating the growing scientific medical literature have become acute." Bloomquist Survey. A 1962 study of the accumulated needs of medical school libraries -- which is equally applicable to other types of medical libraries -- iterates these deficiencies, points out that little improvement has occurred since the Deitrick survey of ten years ago, and makes the following recommendations for an action program, involving Federal assistance: * Fry, A. and Adams, S.; Medical. Library Architecture in the Last Vif y Years. Bulletin Med. Library Assoc. 45:47-79 (1957) Bloomquist, H.; The Status and Needs of School Medical Libraries in the United States. Boston, 1962.

Page  21 21 Recommendations. 1. Federal funds should be made available to both existing and new medical schools for the purpose of building up their collections to a minimum adequate standard. It is suggested that this standard in 1962 be 100,000 volumes and the current receipt of 1,500 journals. 2. Federal granting agencies should take realistic responsibility for the support of their grant programs in terms of the literature, library staff, and library services required, just as it does in terms of equivalent technicians and laboratory services required. 3. Federal funds should be made available f the support of the essential bibliographic apparatus needed in medical research. This apparatus today is breaking down. The National Library of Medicine should take national leadership in medical bibliography in its multidisciplinary aspects. 4. A system of regional reservoir libraries should be established in the United States, encouraged and supported by the National Library of Medicine through the granting of funds, the development of an improved bibliographic apparatus, and the development of an improved communications network. 5. If science information centers develop with the aid of Federal funds, maximum advantage should be taken of existing library resources in order to minimize useless and costly duplication. 6. Federal funds should be appropriated to initiate a vigorous program of recruitment, education, and training of medical librarians aimed at raising the standards of medical librarianship and creating a manpower pool. These funds should support and expand the Medical Library Association's

Page  22 22 present programs of scholarships, fellowships, internships, and continuing education. In addition funds should be made available to qualified academic institutions for the initiation or improvement of their training facilities in this area. 7. Federal matching funds should be made available for the constructing, equipping, and renovating of medical school library facilities under the Research Facilities Construction Program. Federal grants to new medical schools for library construction and equipment should be provided under the proposed Educational Facilities Construction Program. 8. A program should be established whereby non-recurring Federal grants for special projects would be made available directly to medical school libraries. These would tend to be small in amount and for the purpose of catching up with existing backlogs. 9. Experimentation in new electro-mechanical and reproductive devices relevant to library problems should be encouraged and funded. NIX Interests. As a national library, with a statutory responsibility for the dissemination of health and medical information, the NLM is deeply concerned with the health and service capabilities of other medical libraries. It is well aware of the national need for the strengthening of medical library resources and services. Even though the Library had no national system for mechanized storage and retrieval in contemplation, a large scale program to raise these libraries out of their present depressed state to a level adequate for the support of present-day research and education is still urgently required. As the world moves into the computer age, and the MEDLARS system becomes operative, the underdevelopment of medical libraries poses .a critical

Page  23 23 problem. How will the power of electronic retrieval benefit local research needs if the local medical libraries cannot supply the literature retrieved? Of the two basic research library functions, the provision of bibliographic access and the provision of access to the materials, the former can be performed with a tenfold increase of efficiency; the latter remains grossly depressed. The mismatch of capability is great,:and comparable to the installation of a turbo-fan motor in a Model T chassis. The full benefits of the MEDLARS system to the American medical establishment cannot be realized without the rehabilitation of local medical libraries. Over a long period of time, local resources have proved to be inadequate to provide for t* normal development of medical libraries at rates commensurate with the increase in research and educational requirements. Now, these chronic needs are magnified by the challenge of the electronic age. The Library believes, therefore, that a comprehensive program of Federal support, on a matching basis, is essential to rehabilitate the medical library system. This will require specific government assisted programs for education and training, to raise the skills of librarians on the job, and to increase the national manpower reservoir. It will require programs for the building of new library facilities, and the reconstruction of older ones. It will require support for the aug- mentation of library collections, for strengthening the many direct services performed for research workers, and for research and development in library technology. Only through a major rehabilitation effort can the country's medical libraries reach a status where they can be full partners of the NLM in

Page  24 24 exploiting the potential of the MEDLARS system. And only through such extensive exploitation can the country's medical research effort be supported with information services at .a level adequate to the national purpose.