Computerized Bibliographic Services for Biomedicine, 1965
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Computerized Bibliographic Services for Biomedicine Leonard Karel, Charles J. Austin, Martin M. Cummings Reprinted with permission by the U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Reprinted from Science, May 7, 1965, Vol. 148, No. 3671, pages 766-722

Page  2 Computerized Bibliographic Services for Biomedicine Library-based automated storage, retrieval, and publication of literature citations is feasible. Leonard Karel, Charles J. Austin, Martin M. Cummings [Dr. Karel is chief of the Bibliographic Services Division, Mr. Austin is chief of the Data Processing Division, and Dr. Cummings is director, of the National Library of Medicine, Bethesda, Maryland.] The recording of medical knowledge dates back to the 3rd millennium B.C., when prescriptions of various drugs and other methods of dealing with diseases were written on Sumerian tablets and Egyptian papyri. Among the earliest evidence of logical classification of such records is the catalog of hieratical books graven on one of the walls of the ancient Egyptian library at Edfu (1). Centuries elapsed before private collecting of books led to the establishment of public libraries, and before the ever-increasing volume of literature led to the establishment of specialized scientific and medical libraries. The National Library of Medicine (Fig. 1), at present the largest medical library in the United States and one of the largest in the world devoted to the biomedical sciences, had its origin in 1836 with the formation of the Library of the Surgeon General's Office, United States Army. Price has stated (2) that both the number of scientific periodicals and the number of papers in them have increased tenfold every half century, beginning with 1750, when there were about ten scientific journals in the world. The biomedical literature has followed this trend. Bearing on this growth is the rapid increase throughout the world of persons involved in medical and health-related activities. Indeed, in the United States alone, the number of people engaged in health professions multiplied by a factor of 5.8 between 1900 and 1960 (3), while the total population multiplied by a factor of only 2.4(4). The phenomenal increase in the volume of biomedical literature and in the numbers of contributors and users has not, however, been paralleled by equivalent growth of medical libraries. This lack of parallel growth of medical libraries and of information storage and retrieval methods and facilities adequate for today's needs has led to serious inadequacies in the capability of libraries to catalog, index, store, and retrieve published literature for the use of scientists, physicians, and others (5, 6). The computer has been seized upon as a new means of assisting and supplementing the traditional library approach to management of the published literature. At the National Library of Medicine the computer has been successfully used for retrieval of reference material, and this success portends an exciting future for the entire field of information retrieval. History of Bibliographic Control The first comprehensive index of medical journal literature was the Index Medicus published by the Library from 1879 to 1927. Replaced from 1927 to 1956 by Quarterly Cumulative Index Medicus, published by the American Medical Association, Index Medicus reappeared as a monthly library publication in 1960, superseding the monthly Current List of Medical Literature. The Current List of Medical Literature was prepared manually by typing citations on 71h- by 121/2-centimeter cards, which were then mounted on a large panel for photographing. This laborious process was replaced in 1960 by a partially mechanized system. In this system special papertape typewriters were used to imprint citations on tabulating cards; these were then machine-sorted and automatically photographed, by a Listomatic camera, on rolls of film. The developed film was cut and assembled into pages for printing. This partially mechanized system, although better than manual techniques for preparing Index Medicus, could not meet demands for quick retrieval of citations from the rapidly expanding biomedical literature. To provide better control of this literature (7), the National Library of Medicine in 1961 developed specifications for a computer-oriented information storage and retrieval system, which it called MEDLARS (Medical Literature Analysis and Retrieval System) (8). The objectives of this system were as follows. 1) To improve the quality of Index Medicus while increasing the number of journals indexed in it. 2) To reduce the time required for preparing the monthly editions of Index Medicus. 3) To provide for increased depth of indexing. 4) To provide for the production of compilations similar to Index Medicus in form and content but devoted to specialized subject fields. 5) To provide for prompt and efficient searching of a large computer store of information for citations to biomedical and biomedically related literature. 6) To reduce duplication of literature-screening activities carried on by academic and other institutions and organizations in the United States. 7) To provide for the incorporation of monographs and other nonjournal literature into MEDLARS (9). The system design was completed in January 1962. The preparation of computer programs, installation of equipment, training of personnel, and detailed system testing took approximately 2 years. The new system went into operation in January 1964.

Page  3 Fig. 1. The National Library of Medicine, Bethesda, Maryland. Description of the System MEDLARS has three major subdivisions (see Fig. 2). (i) an input subsystem in which the skills of professional indexers are used in connection with the capabilities of a large-scale digital computer; (ii) a retrieval subsystem in which the capabilities of professional literature searchers are used in connection with computer manipulations; and (iii) a publication subsystem that converts retrieved citations, and descriptors characterizing these citations, into photopositive film. Input subsystem. Through the input subsystem, citations and other information are fed into MEDLARS. In the initial step toward storage of information, journals are analyzed by intensively trained literature analysts who assign to each article appropriate descriptors from the Library's controlled vocabulary, called "Medical Subject Headings." After the journal articles have been indexed, Flexowriter typewriter operators prepare basic-unit records by converting information on the indexers' data sheets to codes on paper tape. The basic-unit record entering the computer consists of journal reference, article title, authors, and subject descriptors. Typewriter copy produced concurrently with the coded paper tape is checked for accuracy by a staff of proofreaders; then the tapes are spliced in batches and fed into the computer. Through the computer's input programs, the information on the paper tape is recorded on reels of magnetic tape, edited, and incorporated into two major data files-the Compressed Citation File and the Processed Citation File. The Compressed Citation File contains highly coded citations that can be retrieved as "demand bibliographies"-that is, bibliographies intended not for publication but for individual use of the requester, and providing references on highly specific subjects (see Fig. 3). The Processed Citation File on the other hand, contains citations used in publishing Index Medicus and other "recurring bibliographies"-that is, bibliographies intended for serial publication and wide dissemination (see Figs. 4 and 5). Retrieval subsystem. Through the retrieval subsystem, citations stored in the computer are recovered. Requests for bibliographic citations from physicians, scientists, librarians, and others are forwarded to a staff of specialists with extensive training in indexing and in the logic of computer searching. These search specialists analyze the requests, enumerate the relevant search elements, and formulate search statements linking these elements logically. Formulated statements designed to retrieve demand bibliographies are punched into paper tape and fed into the computer. Formulated requests for recurring bibliographies are punched into cards rather than paper tape. The retrieved citations, machine-edited and sorted, are recorded on magnetic tape and decoded into natural language prior to being printed, either on cards or on continuous tabulating paper, by the computer printer. Publication subsystem. The publication subsystem (see Fig. 2) provides recurring bibliographies by processing citations for eventual printing from photopositive film. The magnetic-tape files of retrieved citations are used for preparation of print copy by a computer-driven phototypesetter called GRACE, an acronym for Graphic Arts Composing Equipment. GRACE is also used occasionally for preparing demand bibliographies. Operating at a speed of about 300 characters per second, GRACE can use 226 different characters in preparing 23-centimeter-wide positive photographic film or paper. Character sets include a 6-point font of regular and bold-faced upper- and lower-case characters, a 10-point font of upper-case characters only, and a 14-point font of upper-case characters only. The exposed film is developed by an automatic film processor, inspected, and cut into page-sized sheets (see Figs. 4 and 5). Man-Machine Relationships Because MEDLARS is a man-machine system, its success is directly dependent on the "intellectual input." Such input is provided by several kinds of specialists. Specialists in medical subject headings are responsible for formulating the controlled vocabulary basic to consistent, efficient, and accurate analysis, indexing, and searching of biomedical literature. This controlled vocabulary, known as "Medical Subject Headings," is the dictionary to Index Medicus and its related publications. It is the key to retrieval of information for recurring and for demand bibliographies, and the base for most of the computer programs. Not only does it provide descriptors for indexing and for retrieving citations to the biomedical literature stored in the computer, it also provides descriptors for cataloging books and for preparing the public card catalog used at the National Library of Medicine and elsewhere.

Page  4 Fig. 2. MEDLARS flow chart (see text). The controlled-vocabulary list is developed from recommendations made by (i) trained professionals engaged in indexing and in searching the biomedical literature, (ii) users of Index Medicus and MEDLARS, and (iii) advisory panels composed of physicians, biomedical scientists, and other health specialists. Prior to its acceptance or rejection, a recommended medical subject heading is examined for potential usefulness, possible ambiguity, synonymity with existing controlled-vocabulary terms, and compatibility with subject headings in vocabularies of other organizations concerned with biomedical literature. Collaboration on development of subject headings is maintained with the American Medical Association, the American Dental Association, the American Rheumatism Association, and a number of other groups. The 1965 edition of "Medical Subject Headings," published as part 2 of the January 1965 issue of Index Medicus, contains over 6300 subject headings, arranged in two sections: alphabetically with cross references, and in subject categories. Despite the number of subject headings in the controlled vocabulary, there is still a deficiency of descriptors for categories such as psychiatry-psychology, public health, epidemiology, and environmental health, and these categories are currently being reexamined. Furthermore, because of increasing interdisciplinary research, demands are growing for development of more research-oriented descriptors; for development of descriptors in biophysics, biomathematics, veterinary medicine, and the social and behavioral sciences, among others; and for greater hierarchical structuring among the individual categories of headings. Activities to meet these needs are now in progress. Other specialists engaged in preparing input for the computer are the indexers. Using the "Medical Subject Headings" list as a guide for accuracy, consistency, and specificity, trained indexers assign to each journal article those medical headings which best describe its subject content and ideas. The magnitude and significance of the indexers' task may be seen from the fact that 152,030 articles were indexed in 1964, and that the library's Indexing Section plans to index 300,000 articles annually by 1970. Worldwide surveys have shown that some 15,000 biomedical and related serial publications are published annually (10). Of these, 6000 serial publications, containing over 300,000 articles annually, are regarded as worthy of being indexed by the National Library of Medicine. The magnitude and significance of the indexers' task may be further seen from the various publications that are dependent on indexing -Index Medicus, Bibliography of Medical Reviews, and a number of specialized bibliographies. Preparation of the basic publication, Index Medicus, is a demanding and difficult task. In 1961 an average monthly issue of Index Medicus had 450 pages and contained references to more than 10,000 articles. The January 1965 issue of Index Medicus had 691 pages, cited 14,665 articles, and, in addition, contained two special features-( 450 pages and contained references to more than 10,000 articles. The January 1965 issue of Index Medicus had 691 pages, cited 14,665 articles, and, in addition, contained two special features-(i) the latest revision of "Medical Subject Headi 450 pages and contained references to more than 10,000 articles. The January 1965 issue of Index Medicus had 691 pages, cited 14,665 articles, and, in addition, contained two special features-(i) the latest revision of "Medical Subject Headings" and (ii) the "List of Journals Indexed in Index Medicus," giving the titles of the 2472 journals then indexed by the library. In 1961 the annual total of articles indexed was 132,154; in 1964 it was 152,030. In 1961, 12,661 journal issues were indexed; in 1964, the figure rose to 15,497. Decisions on the inclusion of new journals or the omission of journals previously listed are made with the assistance of an advisory committee of medical librarians, physicians, and biomedical scientists. This committee also assists the library in establishing indexing policies. Beginning with the March 1965 issue, Index Medicus contains a monthly "Bibliography of Medical Reviews."

Page  5 THERAPY OF CHROMOBLASTOMYCOSIS, 631366 ARIEVICH AM, VATOLINA VM (RESULT OF THE TREATMENT OF CHROMOMYCOSIS PATIENTS WITH AMPHOTERICIN B) (RUS) VESTN DERM VENER 38:30-2, JAN 64 *AMPHOTERICIN B, BITES AND STINGS, *CHROMOBLASTOMYCOSIS, DRUG THERAPY, IODIDES, KNEE, REPTILES, THIGH, USSR (1), VITAMIN D 2, ZOONOSES 762521 GARDNER JT, PACE BF, FREEMAN RG CHROMOBLASTOMYCOSIS IN TEXAS, REPORT OF FOUR CASES, TEXAS J MED 60:913-7, NOV 64 AMPHOTERICIN B, *CHROMOBLASTOMYCOSIS, EPIDEMIOLOGY, PODOPHYLLUM, RADIOTHERAPY, SL 25144 SOLOMON LM, BEERMAN AMPHOTERICIN B AN ARCH DERM (CHICAG *AMPHOTERICIN B, INJECTIONS, INTRA ELECTROCARDIOGRAPHIC,VENTILATORY AND 040470 HEMODYNAMIC CHANGES WITH CHRONIC LUING DISEASE AND PHLEBOTOMY. NATIONAL LIBRARY OF MEDICINE (MEDLARS) 040470 BANTA HD, GREENFIELD JC JR, ESTES EH JR LEFT AXIS DEVIATION. AMER J CARDIOL 14:330-8, SEP 64 AMYLOIDOSIS, CORONARY DISEASE, *ELECTROCARDIOGRAPHY, FRIEDREICH'S ATAXIA, GERIATRICS, HEART ANEURYSM, HEART ENLARGEMENT, HEMOCHROMATOSIS, HYPOKALEMIA, MUSCULAR DYSTROPHY, MYOCARDIAL INFARCT, MYOCARDITIS, MYOTONIA ATROPHICA, PATHOLOGY, PULMONARYCONTINUED NATIONAL LIBRARY OF MEDICINE (MEDLARS) Fig. 3. Demand bibliographies produced by the computer printer. The March 1965 bibliography consists of selected articles indexed in the January, February, and March issues of Index Medicus. In subsequent months the bibliography will cite articles indexed in the current month's Index Medicus. As in the past, a Bibliography of Medical Reviews will be cumulated annually and published as a separate volume. The annual Bibliography of Medical Reviews now being assembled will contain references selected from over 2400 journals regularly indexed in Index Medicus and from 539 journals not regularly indexed. Volume 10, a cumulation of review articles cited in 1964, contains references to 4270 articles taken from 2300 regularly indexed journals and 240 articles from other journals. Still other specialists whose skills are used in connection with the computer are the searchers. After journal articles have been indexed and the citations have been fed into the computer, trained searchers formulate subject statements necessary for retrieving those citations that satisfy inquiries received from clinicians, scientists, teachers, and librarians. References retrieved by computer search may be organized in various formats and printed. If desired, all subject headings assigned by an indexer to a given citation can be printed with the citation, thus providing a profile that aids the requester in judging the appropriateness of the citations retrieved (see Fig. 3). Representative of recurring bibliographies are Index Medicus and Bibliography of Medical Reviews, both published by the Library; Cerebrovascular Bibliography, published by the National Institute of Neurological Diseases and Blindness and the National Heart Institute; and Index of Rheumatology, published by the American Rheumatism Association. Recurring bibliographies in various formative stages are "Index to Dental Literature" and bibliographies relative to fibrinolysis and thrombolysis, sudden death in infants and children, smoking and health, drug-induced abnormalities, and venereal diseases. Of special interest is the Index of Rheumatology. As a result of cooperation between the American Rheumatism Association and the National Library of Medicine, this index is now being produced semimonthly by the library and published by the association (11). Expected to provide over 6000 citations annually from the periodicals now indexed by the library, the index is the first regular subscription bibliography, aside from the library's own publications, to be fully attributable to MEDLARS (see Fig. 5). First Year's Experience Of particular significance is the practical experience gained in the first year of MEDLARS' operation. Despite imperfections in the controlled-vocabulary list, need for improvements in indexing practices and techniques, and some retrieval difficulties imposed by these deficiencies, the results have been most heartening. Experience gained from more than 1300 searches made for physicians, scientists, teachers, librarians, and others has established the practicability of MEDLARS beyond question. Appreciating that there is as yet no wholly satisfactory method of objectively evaluating the effectiveness of information storage and retrieval systems, the library has relied heavily on consumer reaction and appraisal. Evaluation of critical reports indicates that the percentage of missed entries is minimal; furthermore, the relevance of retrieved citations, as determined by the individual requesters' evaluation of demand bibliographies, appears to be satisfactory. New and more precise measurements of relevance are under study. In some appraisals of demand bibliographies the inclusion of papers of

Page  6 inferior quality among the citations has been criticized. Since evaluation of literature for quality is not part of the indexing function of the library, this criticism cannot be met. Other criticisms relate to the library's present inability to store and retrieve references from monographs, books, abstracts, and other nonjournal publications. The library is attempting to acquire sufficient personnel to expand its coverage to include books and monographs in its automated system. For the library to try to index all of the world's substantive biomedical literature in the depth required by specialized information centers seems impracticable. It is the library's intent, therefore, to avoid unnecessary duplication by supplying specialized information centers with relevant bibliographies on magnetic tapes. It is hoped that these centers will then analyze and refine the material in the light of their specialized requirements. Already, cooperative arrangements involving the library and several universities have been made to test this concept. ELECTROCARDIOGRAPHIC, VENTILATORY AND HEMODYNAMIC CHANGES WITH CHRONIC LUNG DISEASE AND PHLEBOTOMY. observed by difference spectrophotometry. Inada Y, et al. Arch Blochem 106:326-32, 20 Jul 64 Light-induced pH changes related phosphorylation by chloroplasts. Neumann J, et al. Arch Blochem 107:109-19, Jul 64. Kineticsof the hydrolysis of benzoylglycine ethyl ester catalyzed by papaln. Sluyterman LA. Blochim Blophys Acta 85:305-15, 4 May 64 Effect of pH on extraction and activity of ox-kidney urate oxidase. Truscoe R, et al. Blochim Biophys Acta 89:179-82, 8 Jul 64 A discussion of the pH dependence of the hydrogen-deuterium exchange of proteins. Hvidt A. C R Lab Carlsberg 34:299-317, 1964 Intracellular pH of ratatrial muscle fibers measured by glass micropipette electrodes. Lavallde M. Circ Res 15:185-93, Sep 64 Observations on pH and haemolytic complement. Ibe EC, et al. Immunology 7:586.94, Sep 64 Effect of environmental C02 and pH on glycerol metabolism by rat liver in vitro. Longmore WJ, et al. J Biol Chem 239:1700-4, Jun 64 Discrimination between alkali metal cations by yeast. I. Effect of pH on uptake. Armstrong WM, et al. J Gee Physiol 48:61-71, Sep 64 Relation of pH to preservative effectiveness. II. Neutral and basic media. Wickliffe B, et al. J Pharm Sci 53:769-73, Jul 64 The validity of pH and Pco2 measurements in capillary samples in sick and healthy newborn infants. Gandy G, et al. Pediatrics 34:192-7, Aug 64 [Acid-base equilibrium in acute experimental carbon monoxide poisoning] Marchiaro G, et al. Bass Med Industr 33:452-3, May-Aug 64 (It) HYDROGEN PEROXIDE (D1, D3) Generation of hydrogen peroxide in erythrocytes by hemolytic agents. Cohen G, et al. Biochemistry (Wash) 3:895.900, Jul 64 Generation of hydrogen peroxide during the reaction of nitrate with oxyhemoglobin. Cohen G, et al. Biochemistry (Wash) 3:901-3, Jul 64 Studies on the bioluminescence of Balanoglossus biminiensis extracts. 3. A kinetic comparison of luminescent and nonluminescent peroxidation reactions and a proposed mechanism for peroxidase action. Dure LS, et al. J Biol Chem 239:2351-9, Jul 64 Fluorometric study of antihistamines. Jensen RE, et al. J Pharm Sci 53:835.7, Jul 64 Preferential localization of radioisotopes in malignant tissue by regional oxygenation. Finney JW, et al. Nature (London) 202:1172-3, 20 Jun 64 rat liver] Durieu-Trautmann 0, et al. E R Arid Scl (Paris) 259:2547-50, 12 Oct 84 (Fr) [Enzymatic beta substitution of phosphoserine and cysteine by-sulfite. Some remarks on the mechanism of beta substitution in the presence of pyridoxal phosphate enzymes] Fromageot P, et al. J Blochem (Tokyo) 55:859-68, Jun 64 (Fr) HYDRONEPHROSIS (C6) Experimental renal erythrocytosls; role of the juxtaglomerular apparatus. Mitus WJ, et al. Arch Path (Chicago) 78:658-64, Dec 64 The natural history of primary pelvic hydronephrosis. Roberts JB, et al. Brit J Surg 51:759-82, Oct 64 Multicystlc and cystic dysplastic kidneys. Pathak IG, et al. Brit J Urol 36:318-31, Sep 64 Results of treatment of hydronephrosis. Balfour J, et al. J Urol 92:188-91, Sep 64 Solitary adenoma with hydronephrotic atrophy: xanthomatous papillary adenoma. Deniz E, et al. J Urol 92:263-6, Oct 64 The abdominal mass in infancy and childhood. Urol Survey 14:183-91, Oct 64 [Plastic operation (Boars-Ktiss) on the urinary bladder: technic, indications, results] Deuticke P, et al. Urol Int 18:100-12, 1964 (Ger) [Rare complication following vesicovaginal fistula surgery] Pogorelko IP, et al. Akush Ginek (Sofila) 40:127, May-Jun 64 (Rus) HYDROPHTHALMOS (C11, C16) [Tubular dysfunction and oculo-cerebral syndrome. Description of a new variety] Denys P, et al. Bull Acad Roy Med BeIg 4:485-511, 1964 (Fr) HYDROXAMIC ACID (D2) Selective modification of uridine and guanosine. Kochetkov NK, et al. Blochim Biophys. Acta 87:515.8, 22 Jul 64 Reactions catalyzed by amtdases. Acetamidase. Jakoby WB, et al. J Biol. Chem 239:1978-82, Jun 64 HYDROXIDES (D1, D8) The solubility of heavy metal hydroxides in water, sewage and sewage sludge. I. The solubility of some metal hydroxides. Jenkins SH, et al. Air Water Pollut 8:537-56, Oct 64 [On the effect of gamma-aluminum hydroxide and gamma-aluminum oxide on the antigenic activity of Fig. 4. Part of a page of Index Medicus printed from film produced by GRACE (see text). Because MEDLARS was designed to serve three purposes-to provide demand bibliographies, recurring bibliographies, and high-speed printing-it is likely to prove more economical and more utilitarian than a system designed to serve a single function. Also, its location in a research library increases the efficiency of the system, since the library can provide original documents or photocopies of the articles required by the user, and traditional reference services are available to supplement the services of the computer system. Research and Development The library realizes that MEDLARS is only an initial response to the need for improved documentation technology directed toward better biomedical communication and modernization of library techniques. It is in this spirit that the following activities have been planned for implementation within the near future. Decentralization. In accordance with the library's legal responsibility for wide dissemination of scientific and technical information in medicine, a three-phase program to decentralize the MEDLARS search and retrieval capability was begun in late 1964. This program calls for production of compatible, duplicate tapes which would be made available to medical schools, research institutions, governmental organizations, and industry for use in their own computer facilities. These groups would then have the same search and retrieval capabilities as MEDLARS. In the first phase of decentralization, the library has initiated two pilot studies, one at the University of California, Los Angeles, with computer equipment not compatible with that installed at the library, and the second at the University of Colorado, with compatible equipment. The University of California is reprogramming the library's Honeywell tapes for use on IBM computers and will test the concept of regionalization of services. It will also use the tapes to support the activities of a specialized brain research center. The contract with the University of Colorado provides for experimental use of MEDLARS, as in studies of selective dissemination of information. The second phase will be the formation of a network of additional search centers in areas with large concentrations of scientific manpower. Interest in this part of the program is so high that requests for sharing in the MEDLARS' searching capability have already been received from more than 40 university medical centers, private corporations, and government agencies. As an aid in the selection of additional search centers, the library has developed certain criteria: the serviice potential of the institution; its computer resources and consequent responsiveness to bibliographic demands generated by the automated system; its interest in conducting further research and development based on use of MEDLARS tapes; and its ability to provide services on a regional basis, such as distribution of specialized monthly bibliographies to physicians and scientists at local institutions. The third phase of the decentra-

Page  7 lization program will be the provision of data tapes and program tapes, at cost, to interested institutions within the United States and abroad, and experimentation with the linkage of established centers in the United States through the use of data transmission equipment. Automated acquisitions and cataloging system. The acquisition of new books by a library is comparable to the purchase-order and accounts-payable function of a private firm. This library function and the related cataloging of acquisitions are obvious candidates for automation. A systems analysis of these functions has been made by the National Library of Medicine, and an automated system has been designed to improve the capacity and efficiency of these processes through the use of available computer equipment. Computer programming to implement the first step of this new system is now under way. Mechanization of the cataloging operation will produce: (i) a rapid cataloging service that can be used by other libraries for their acquisitions and cataloging activities; (ii) a printed book catalog listing all new acquisitions in the National Library of Medicine each year, with a cumulative list published every 5 years; and (iii) incorporation into MEDLARS of citations to selected monographs. On-line input. In an effort to improve the quality and extent of bibliographic input into MEDLARS, the library is exploring a system for direct communication between the indexer and the computer. Such a system would have the following characteristics. 1) Simultaneous, direct, immediate, edited indexer-to-computer input, with resulting elimination of clerical work now required for punching paper tape and elimination of errors generated by this clerical work. 2) Visual display of each data record at each indexer's station. 3) Entry of corrected input records, on magnetic tape, into the main computer files within 24 hours of indexing. Graphic storage and retrieval system. Plans are now under way for development of a graphic-image storage and retrieval system that will permit rapid photocopy retrieval of the full text of documents in the library's collection. The library envisions a system that will tie the bibliographic capabilities of MEDLARS to the graphic capabilities of this new photocopy system. ACETABULUM Articular and fibrocartilage calcification in hyperparathyroidism: associated hyperuricemia. Vix VA. Radiology 83:468.71, Sep 64 ACHILLES TENDON Trilodothyronine binding to red blood cells and Achilles tendon reflex as thyroid indices. Sabeh G, et al. Amer J Med Sci 248:253.9, Sep 64 Tendon repair using cohesive steel reinforcement. Myers HC, et al. Amer Surg 30:668-70, Oct 64 Tryptic peptides obtained from gelatins derived from normal and rheumatoid arthritic collagens. A preliminary study. Steven FS. Ann Rheum Dls 23:405-7, Sep 64 Achilles tendon areflexia in diabetic patients. An epidemiological study. Krosnick A. JAMA 190:1008-10, 14 Dec 64 [On the pathogenesis of hypercholesteremic xanthomatosis) Greiling H, et al. Deutsch Med Wschr 89:1887-91, 2 Oct 64 (Ger) ALKAPTONURIA [Alkaptonuria (observation on a 7-year-old boy)) Lopez-Linares M. Acta Pediat Esp 22:744-52, Oct 64 (Sp) AMYLOIDOSIS Multiple myeloma with paramyloidosis presenting as rheumatoid disease. Goldberg A, et al. Amer J Med 37:653-8, Oct 64 A case of Still's disease with amyloidosis demonstrated at the Postgraduate Medical School of London, Brit Med J 5421:1384-7, 28 Nov 64 ANKLE JOINT [On the Joints around the talus, with special reference to the relation between the capsula articularis and vagina tendinis) Arai K, et al. J Jap Orthop Ass 38:515.6, Sep 64 (Jap) ANKYLOSIS Audiometric manifestations of pre-clinical stapes fixation. Carhart R. Ann Otol 73:740-55, Sep 64 Experimental cervical myelopathy. I. Blood supply of the canine cervical spinal cord. Wilson CB, et al. Neurology (Mlnneap) 14:809-14, Sep 64 Non-articular rheumatism. Parry CB. Practitioner 193:288-98, Sep 64 A controlled study of carisoprodol and aspirin in periarthritis of the shoulder and cervical spondylosls. Redding JH. Practitioner 193:331.3, Sep 64 [Arthrolysis In posttraumatic stiffness of the elbow] Deburge A. Presse Med 72:2933, 21 Nov 64 (Fr) [Apropos of cervical arthrosis] Dry J. Progr Med (Paris) 92:605, 10. Oct 64 (Fr) ARACHNODACTYLY A genetical view of cardiovascular disease. The Lewis A. Conner memorial lecture. McKusick VA. Circulation 30:326-57, Sep 64 Marfan's Syndrome. Bayl[ss VD, et al. Indian Heart J 16:142-54, Apr 64 An etiologic concept concerning the obscure myocardlopathies. James TN. Progr Cardiov Dis 7:43-64, Jul 64 [Case of Marfan syndrome associated with some dermatological disorders] Mukai T, et al. Acta Derm (Kyoto) 59:175.84, Aug 64 (Jap) ARTHRITIS Role of lymph nodes In adjuvant-induced arthritis In rats. Newbould BB. Ann Rheum Dls 23:392.6, Sep 64 Parenteral vs. oral folic acid antagonists. Auerbach R. Arch Derm (Chicago) 90:553-7, Dec 64 Use of high-definition films and immersion technic in early diagnosis of metabolic and systemic disorders. Walker BQ. Cleveland CBn Quart 31:227-30, Oct 64 Vitallium patelloplasty in patellar chondromalacia. Coretti JH, et al. Osteopath Ass 64:164-9, Oct 64 Physical therapy in the treatment of temporomandibular arthritis. Altman 1. J Amer Phys Ther Ass 44:1091-2, Dec 64 Physical medicine in chronic arthritis. Bowie MA. Mod Treatm 1:1299-312, Sep 64 Surgical treatment of chronic arthritis. Marmor L. Mod Treatm 1:1313.27, Sep 64 Electrocardiogram in cervical arthritis. Galli GA, et al. Rheumatism 20:98-102, Oct 64 Horace Pern (1872-1936). Rheumatologist and remarkable member of a remarkable family. (Pern H), Kelly M. Rheumatism 20:90-2. Oct 64 [Comparative clinical studies with paramethasone and prednisone) Mathies H, et al. Arzneimittelforschung 13:1058-63, Dec 63 (Ger) [Isoenzymes of lactate dehydrogenase in clinical diagnosis) Hendrich F, et al. Z Ges Inn Med 19:351-4, 15 Apr 64 (Ger) [Calcifying and ossifying arthropathies and para-arthropathies of the knee] Boffano M. Ann Radiol Diagn (Bologna) 37:93-150,1964 (254 ref.) (It) [On 2 cases of chondromalacia of the patella] Giordano L. Friuli Med 19:325-30, May-Jun 64 (it) [Arthritis in humans and PPLO) Arai M, et al. J Jap Orthop Ass 38:691-2, Oct 64 (lap) [Histopathological study on experimental arthritis using the fluorescent antibody technic] Hashiguchl T. J Jap Orthop Ass 38:695-6, Oct 64 (lap) [Survey on the incidence of arthritis) Shichikawa K, et al. J Jap Orthop Ass 38:529-30, Sep 64 (Jap) ARTHRITIS, INFECTIOUS Hemophilus influenzae pyarthrosis in an adult. Golstein E, et al. Arch Intern Med (Chicago) 114:647-50, Nov 64 Lactic dehydrogenase (LDH) and transaminase (GOT) activity of synov/al fluid and serum in rheumatic disease states, with a note on synovial fluid LDH Isozymes. Cohen AS. Arthritis Rheum 7:490-501, Oct 64 Complications of ACTH and corticosteroid therapy. Popov SE, et al. Fed Proc [Transl Suppl] 23:984-6, Sep-Oct 64 Infections in paregoric addicts. Oerther FJ, et al. JAMA 190:683-6, 16 Nov 64 Treatment of septic arthritis. Ward JR. Mod Treatm 1:1232-42, Sep 64 [Polyarthritis in rats induced by Mycoplasma arthritidis. 3. Characteristics; role of "pert-pneumonia-like organisms"] Amor B, et al. C R Soc Blot (Paris) 158:1244.6, 1964 (Fr) [Eperimental polyarthritis in rats induced by Mycoplasma arthritidis. IV. Immunological phenomena (animals subjected to active Immunization)) Kahan A, et al. C R Soc Biol (Paris) 158:1320-2, 1964 (Fr) (Use of dimethoxyphenyl peniccillin (Staphcillin) and methylphenylisoxazolyl peniccillin (Staphcillin V) In orthopedic surgery) Takayama T, et al. J J J J Antibiot [B] (Tokyo) 17:193-201, Aug 64 (Jap) ARTHRITIS, JUVENILE RHEUMATOID A case of Still's disease with amyloidosis demonstrated at the Postgraduate Medical School of London. Brit Med J 5421:1384-7, 28 Nov 64 Sarcoidosis among children in Utah and Idaho. Beier FR, et al. J Pediat 65:350.9, Sep 64. Management of arthritis in children. Kelley VC, et aL Mod Treatm 1:1270-87, Sep 64[Considerations on a case of Wissler's syndrome Fig. 5. Recurring bibliography (from the Index of Rhemnatology) printed from film produced by GRACE (see text).

Page  8 Conclusion By its development of improved media for dissemination of information, the National Library of Medicine is fostering a greater awareness and a better understanding of research and development efforts in behalf of public health and clinical medicine, and a more rapid translation of research into clinical application. The library's transformation from a passive repository of information to an active ally of the researcher, teacher, and clinician has led to increased use of medical library facilities and has stimulated thinking through better communication of published information. The library's success in using automation for bibliographic control of medical literature suggests that other disciplines that have not already developed automated techniques of literature-reference retrieval might profitably do so. References 1. J. W. Thompson, Ancient Libraries (Univ. of California Press, Berkeley, 1940), pp. 4-8. 2. D. J. deSolla Price, Science Since Babylon (Yale Univ. Press, New Haven, Conn., 1961), p. 97. 3. U.S. Public Health Service, Health Man- power Source Book (Government Printing Office, Washington, D.C., 1960), sec. 18. 4. U.S. Bureau of the Census, Historical Statistics of the United States (Government Printing Office, Washington, D.C., 1960). 5. U.S. President's Commission on Heart Disease, Cancer and Stroke, Report to the President: a National Program to Conquer Heart Disease, Cancer and Stroke (Government Printing Office, Washington, D.C., 1964), vol. 1; R. K. Cannan, Fed. Proc. 23, 1119 (1964); R. H. Orr, G. Abdian, C. P. Bourne, E. B. Coyl, A. A. Leeds, V. M. Pings, ibid., p. 1133; R. H. Orr and A. A. Leeds, ibid., p. 1310; R. H. Orr, G. Abdian, A. A. Leeds, ibid., p. 1297. 6. J. Becker, Amer. Library Assoc. Bull. 58, 227 (1964). 7. R. F. Garrard, in Information Retrieval Today, W. Simonton, Ed. (Univ. of Minnesota Press, Minneapolis, 1963), p. 119. 8. U.S. Public Health Service, The MEDLARS Story at the National Library of Medicine (Government Printing Office, Washington, D.C., 1963). 9. H. Schiller, Library 1. 88, 949 (1963). 10. A. Lazarow, statement before Subcommittee on Departments of Labor and Health, Education, and Welfare and Related Agencies, Departments of Labor and Health, Education, and Welfare appropriations for 1965, Hearings before the House Committee on Appropriations, 88th Congress, 2nd Session (Government Printing Office, Washington, D.C., 1964), p. 259. 11. M. J. Ruhl and L. Sokoloff, Arthritis Rheumat. 7, 615 (1964).