The Medical Library as an Active Information Center, 1965
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the medical library as an active information center by martin m cummings md i am pleased to have been invited to join you on the occasion of this 50th anniversary of the houston academy of medicine your goals and purposes relate closely to those problems with which we are concerned and this makes my assignment today a comfortable task lord boyd orr wrote civilization has evolved by the stimulus of new knowledge which gave man increased power over the forces of nature in the last few decades science has advanced more than in the previous 2000 years the accumulation of published medical knowledge during the past two centuries has been so vast that even the greatest medical libraries no longer are able to maintain the entire printed record within their own institutions the publication explosion has led to a doubling of the medical literature every 10 years a rate of increase which far exceeds the population explosion there are 35000 scientific journals published today more than 6000 of these relate substantively to the field of medicine thus problems of communication within the medical community are critically more difficult than those of the past physicians have been complaining about the quantity and quality of literature and the scarcity of time for reading it since the turn of the century it ls not only the prodigious output of medical writing which threatens to overwhelm our capacity to absorb this knowledge but also we are using 19th century devices to meet 20th century problems let me review two principal problem areas first is the great expansion presented at the 50th anniversary celebration of the houston academy of medicine houston texas october 21 1965

Page  2 2 of medical research that has been inspired and supported by society new knowledge is being generated in greater volumes and with greater rapidity than ever before in our history second is our ability to digest this new knowledge and direct it to useful applications both in the contemporary medical scene and for the use of the new generations of physicians who will succeed us this creates unprecedented problems for both continuation and academic medical education we need to convert our existing institutions to help solve these problems it is not only in the public interest to do so it is urgent if the practice of medicine as we have inherited it is to accommodate to such rapid growth i propose to talk about the possibilities of converting the existing medical library to an active information center the medical library can be made co serve as the major learning and communication resource within a given medical community an ideal system of medical communication would embrace the facilities of medical schools medical societies research institutions as well as hospitals and clinics these are the groups which use information for the benefit of peoples health everywhere modern technology including the application of computers facsimile devices and new methods of graphic image storage and retrieval now make it possible for students teachers researchers and practitioners to quickly have access to segments of information which exist in various parts of the world

Page  3 scientific information can now be transmitted from points of origin to places of use by combining the techniques of bibliographic control of the literature indexing abstracting and cataloging with technical equipment which is designed to store collate print and disseminate such information efficiently and economically new knowledge derived from medical science can be best shared when all modalities of communication are fully utilized todays communication problem requires the development of new relationships between the active scientist the active library and an active professional user group tomorrows library system should be capable of managing the published record for scholarly historical research as well as for the retrieval and distribution of current specialized information soon through optical displays a physician may examine the catalogs and data banks in many libraries select the material he wishes to read and have it available for use within a few hours or minutes the library of the future will contain books journals reference works microfilms audio-visual aids and possibly patient records the library of the future should be physically attractive and comfortable for those individuals who still prefer the intimate and deliberate exposure to original documents also it should be organized as an efficient functional mechanism for delivery of raw data or evaluated synthesized information to the desk of the physician or scientist in his home office or laboratory stated in the simplest terms the primary function of an active library is tn identify materials relevant to inquirers requests and to supply them with copies of these materials for their use

Page  4 4 a national network of libraries and information centers can be created if the biomedical community accepts the responsibility to play an active role in the conduct and management of its communications some of the criteria and desiderata for an active information system which have been suggested by licklider include the following 1 information should be available when and where it is needed 2 it should handle both documents and facts 3 it should provide access to the body of knowledge through convenient procedure-oriented and field-oriented languages 4 it should be able no adjust itself to the level of sophistication of the individual user providing terse streamlined modes for experienced users working in their fields of expertness and functions as a teaching machine to guide and improve the efforts of neophytes 5 it should systematize and expedite the indexing and cataloging of new acquisitions at the time of publication and distribute through the system the information so organized the national library of medicine is developing such programs with a view that active medical libraries supported throughout the nation will serve to advance medical knowledge stimulate creativity and enrich the nations health through better dissemination of information electronic computers emerged after world war ii as devices to provide rapid and precise mathematical processing of numerical information they have been used successfully for more than a decade for business engineering and other purposes thus it seemed logical that their speed and power

Page  5 5 might be applied for the handling of other types of information after much study and careful systems design computers have been adapted to perform certain library functions at the national library of medicine the story of medlars an acronym for medical literature analysis and retrieval system starts with the fact that as the worlds largest biomedical library the national library of medicine has the responsibility for the comprehensive indexing of the worlds literature in biology and medicine it is the only institution in the world performing this awesome task to insure that the worlds biomedical community has bibliographic access to this literature nlm since the days of dr john shaw billings 1865 published subject indexes of which the index medicus is best known but because of the tremendous growth of the biomedical literature the task several years ago became too large for the manpower and the limited degree of mechanization then being employed thus medlars was conceived to join the intellectual talents of trained literature analysts to the tremendous processing capabilities of an electronic computer trained literature analysts review each article to determine how it should be indexed the data they develop are punched on tapes input into the computer and transferred to magnetic tapes for storage and retrieval each reel of tape about 12 inches in diameter holds approximately 25000 bibliographic citations slide medlars does three principal jobs first it produces index medicus the computer is used to process ie compile and print a comprehensive author-subject monthly index to articles from more than 2400 of the worlds

Page  6 6 biomedical journals approximately 150000 articles are reviewed and indexed annually this process formerly required 22 days per month with medlars it is now being done in 5 days approximately 60 percent of the material in index medicus comes from journals published in foreign languages requiring a massive translation effort secondly it prepares special recurring bibliographies these are periodically issued lists of citations in specialized medical subject areas such as cancer heart disease arthritis and recent reports on drugs these specialty listings are compiled at regular intervals from data in the computer store and printed for distribution by government agencies and other national professional organizations working in the specialty fields finally it produces citations on request we call these demand bibliographies a major reason for computerizing the librarys indexing is to perform rapid machine searching of the computers data files and provide answers to complex reference questions which cannot be effectively handled by existing printed indexes or catalogs more than 300000 articles have been analyzed and stored on magnetic tape since 1963 by 1969 the medlars computer file will contain over 1000000 citations with an average of 10 subject headings for each article a search of all these citations for answers to 75 different complex reference questions will take less than three hours reports summarizing information from the computer are printed out by two processes the high speed printer which operates at the speed of 21600 words per minute and the graphic arts composing equipment grace

Page  7 7 at 3600 words per minute grace is a revolutionary computer driven photo composer developed by the library for its own needs but has been characterized by some as the most important development in printing since gutenbergs in vention of movable type slide the medlars system will now be decentralized by providing the magnetic tapes which contain this vast source of references to medical libraries throughout the country so they may share this power of storage and retrieval of the worlds biomedical literature it should be remembered however that medlars is a new instrument of the research library not a replacement for libraries this year we also completed our systems design for automation of the catalog this will provide all libraries with an express book catalogue every two weeks as well as with computer produced catalogue cards most recently teaching machines have been introduced to provide programmed instruction for students in many fields these programs will soon be available in all modern libraries in viewing recent announcements of spectacular technological advances in the field of communications none seemed more fascinating than a device described by heathorn as the ultimate teaching machine with your indulgence i should like to quote a portion of his description of this instrument a new aid to rapid-almost magical-learning has made its appearance indications are that if it catches on all the electronic gadgets will be so nuch junk the new device is known as built-in-orderly organized knowledge the makers generally call it by its initials book

Page  8 8 many advantages are claimed over the old-style learning and teaching aids on which most people are brought up nowadays it has no wires no electric circuit to break down no connection is needed to an electricity power plant it is made entirely without mechanical parts to go wrong or need replacement anyone can use book even children and it fits comfortably into the hands it can be conveniently used sitting in an armchair by the fire how does this revolutionary unbelievable easy invention work basically book consists only of a large number of paper sheets these may run to hundreds where book covers a lengthy programme of information each sheet bears a number in sequence so that the sheets cannot be used in the wrong order to make it even easier for the user to keep the sheets in the proper order they are held firmly in place by a special locking device called a binding each sheet of paper presents the user with an information sequence in the form of symbols which he absorbs optically for automatic registration on the brain when one sheet has been assimilated a flick of the finger turns it over and further information is found on the other side by using both sides of each sheet in this way a great economy is effected thus reducing both the size and cost of book no buttons need to be pressed to move from one sheet to another to open or close book or to start it working

Page  9 9 book may be taken up any time and used by merely opening it instantly it is ready for use nothing has to be connected up or switched on the user may turn it at will to any sheet going backwards or forwards as he pleases use nothing has to be connected up or switched on the user may turn it at will to any sheet going backwards or forwards as he pleases a sheet is provided near the beginning as a location finder for any required information sequence a small accessory available at tri use nothing has to be connected up or switched on the user may turn it at will to any sheet going backwards or forwards as he pleases a sheet is provided near the beginning as a location finder for any required information sequence a small accessory available at trifling extra cost is the bookmark this enables the user to pick up his programme where he left off on the previous learning session bookmark is versatile and may be used in any book book may be stored on handy shelves and for ease of reference the programmed schedule is normally indicated on the back of the binding altogether the built-in-orderly organized knowledge seems to have great advantages with no drawbacks we predict a big future for it the development of new communications devices have not replaced older ones the telephone did not replace the telegraph radio did not replace the phonograph television has not replaced the radio nor shall the computer replace books mans thirst for information and knowledge inspires him to add new means of communications to older ones we retain the wheel while we develop jet engines and rockets in like manner the printed word will be retained in the face of other technologic developments even computers print their output so man may read their calculations or findings it is now possible to have computers communicate with each other this development however results from mans urge to receive store and transmit knowledge medical libraries will continue to participate

Page  10 10 in this process that they will use computers to serve this function is no longer a matter for speculation it is merely a matter of time we must have the vision and energy to apply new ideas and techniques to assist those who are dedicated to the advancement of medical education research and practice in closing i am reminded that plato was the founder of an academy with goals similar to yours his academy proceeded with its work of training and fostering scientific and philosophic leadership from 387 bc until 529 ad when it was closed by religious intolerance another great greek callimachos developed the alexandrian library as well as the scientific approach to cataloging and classifying the literature using these materials a third greek hippocrates formalized the art of medicine into precepts and tenets which have withstood the test of time we still have the privilege of dealing with some of their original documents because mans urge to record his observations thoughts and explorations led to the invention of speech and writing and others felt the need to organize and preserve these facts for those who follow a discovery has little meaning if it is not published and preserved the interest and actions of this academy in the history of medicine as well as in its current facts assure me that there will be a centennial celebration of your group 50 years hence i am also confident that the houston academy of medicine will be a participant in the type of active medical information center i have tried to visualize tonight 1 heathorn rj learn with book jama 188 214 april 20 1964