Plans for the Development of a Medical Library Network, 1968 [I]
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plans for the development of a medical library network by martin m cummings m d mr president officers and members of the cleveland library association ladies and gentlemen several years ago i had the pleasure of addressing a small group here at the allen memorial library the occasion was i believe a pre-marital luncheon meeting when i first learned of your plans to merge your libraries to better serve the needs of your community at the time i thought of george bernard shaws statement that marriage is popular because it combines the maximum of temptation with the maximum of opportunity im glad you succumbed to both in his address of dedication for the allen memorial library on november 13 1926 dr harvey cushing related that the fine collection housed here began with a subscription to the london lancet ordered in 1878 by dr isaac n himes dr himes prevailed upon the authorities of the case library to accept this presented to the cleveland medical library association february 16 1968 based on a presentation to the association of college and research libraries osium on communication in london

Page  2 2 journal and a collection fenced off in a wire cage as dangerous to the general reader began to grow a formal organization the cleveland medical library association soon sprang up to add to the collection and its acquisitions have thrived over the years until i am told it quite recently acquired a great university seriously i believe the cooperative venture between the cleveland medical library association and western reserve university to form the cleveland health sciences library is an exciting one and augurs well for the development of library resources to better meet the needs of health professionals in the cleveland area i would like this evening to describe briefly for you the background of the problems we face nationally today in biomedical communication having presented the problems i plan to suggest our approach to its solution the so-called information explosion has been in recent years the subject of much discussion explication and dissection we have reached the point i believe where no one can entertain serious doubts concerning the existence or urgency of the problem

Page  3 3 in fact we rarely call it a problem nowadays—it is more often referred to as a crisis the problem is not a lack of information but rather a lack of organization and access to an abundance of information the formal mechanisms for disseminating information have always been in disarray the physician or scientist who is faced with todays bewildering multitude of information sources any one of which may or may not have the information he seeks is little better off than his counterpart of 2000 years ago who discovered that the material he needed was in the library at alexandria while he was conducting research in athens as information needs grew greater new methods of communication have inevitably been born the invention of paper the movable type printing press and the scientific journal are examples of such advances in the five centuries since the invention of the printing press the number of publications has grown to fantastic levels tom masson american humorist and editor

Page  4 4 wrote at the turn of the century there are 70 million books in american libraries but the one you want to read is always out it is estimated that some 30000000 books are alive today according to figures published by fremont rider in the scholar and the 2 future of the research library major university libraries double their collections every 16 years the yale library for example comprised 50000 volumes in 1849 with 1 1/4 miles of shelving and a card catalog of some 160 card drawers if the growth of the yale library continues in the future at the same rate as that of the last century rider postulates by the year 2040 its collection will contain about 200000000 volumes occupying a staggering amount of shelf space if a card catalog were used it would consist of nearly 3/4 of a million catalog drawers occupying some eight acres of floor space we must obviously find means to deal with this problem and later i shall address myself to this issue the scientific journal however is more appropriate to my discussion here for it is the phenomenal growth of this medium

Page  5 which presents the greatest problem and challenge to the orderly communication of modern scientific information prior to the appearance of the scientific journal in the 17th century scientists ie men of sufficient means and leisure to pursue their interest in man and nature in systematic fashion communicated their observations and discoveries by word of mouth and by letter the coffee house and the post were in todays jargon their primary modalities for information-transfer the appearance of the royal societys philosophical trans actions in 1665 gave rise to a new form for communicating scien tific and technical information papers read before the royal society letters summaries and abstracts of scientific books in short the scientific news of the day was summed up in this 3 journal philosophical transactions was followed rapidly by similar journals published by other national academies in europe the rise of the scientific journal has been described by slide 1 derek de solid price who has estimated that some 100 journals

Page  6 6 existed by 1800 1000 by 1850 10000 by 1900 and 100000 by 1950 he demonstrated that there is an exponential growth of the literature increasing by a factor of 10 every half century if this rate of increase remains constant there will be approximately 1000000 journals by the year 2000 this proliferation of scientific journals can be laid directly to the growth and complexity of science itself and the number of men and women engaged in its pursuit more physicians and scientists are alive and working today than in the entire recorded history of science in the health sciences a breakdown in the transmission of information is more than just an inconvenience to the re searcher more than the wasteful duplication of an experiment previously conducted and reported on a breakdown in the communication of biomedical research information technical data and clinical findings may be a serious disservice to the patient the ultimate beneficiary of this information thus anything that

Page  7 7 impedes the flow of biomedical communications can ultimately be reflected in the health statistics of the nation new mechanisms for knowledge transfer must therefore be created to make the latest medical findings available as rapidly as possible to scientists educators and practitioners it is to reach this goal that the national library of medicine and the medical library community are now striving the foundation on which a rapid and efficient system of biomedical communications is today being built was laid about 100 years ago the idea of a great repository of medical information to serve one day as a truly national library of medicine and of an all-embracing index-catalogue of such a library came to john shaw billings a 22 year-old medical student at the medical college of ohio in the middle of the nineteenth century planning a thesis to satisfy requirements for the doctorate he took as his subject surgical treatment of epilepsy but found himself handi capped by the lack of both a good medical library and a reliable

Page  8 8 comprehensive index to the medical literature remembering this need years later when billings became librarian of the library of the surgeon-generals office the forerunner of the national library of medicine he compiled an index-catalogue for this library which has been described by dr william h welch as americas most important contribution to medicine index medicus a periodically issued listing of references to journal articles in the field of medicine was also initiated by billings the royal society of medicine described index medicus as americas greatest contribution to medicine on the occasion of our 100th anniversary in 1965 it is clear however that published catalogues and indices are not sufficient to serve todays medical information requirements to billings concept we must add another one made possible by the application of the enormous capability of the electronic computer to store process and retrieve scientific and technical information the new concept is that of a closely-integrated network

Page  9 9 of health science libraries and specialized information centers that use modern communications technologies to deliver information directly to the user the first large-scale application of computers to the handling of biomedical information came through the national library of medicines medical literature analysis and retrieval system medlars which became operational in 1964 articles from about 2300 biomedical journals in some 40 languages are regularly indexed at the library and the citations transferred to magnetic tape for storage in the computers memory bank as of this date there are some 750000 augmented bibliographic citations in this store the manipulative skills of the computer are most impressive when the vast store of references is rapidly searched and a bibliography tailored to the precisely-stated needs of a requestor is produced as many as 30 reference searches can be processed simultaneously in 1967 more than 5000 demand bibliographies

Page  10 10 were produced by the system certain of these bibliographies are chosen as being of interest to a wide audience and reproduced in quantity these bibliographies are called literature searches and more than 24000 were distributed on request last year an evaluation of the quality of the demand bibliography made by an objective outside user group reveals that the system has 70 recall and 65 relevance a most satisfactory performance affording health professionals greater access to medlars six decentralized medlars stations have become operational in the united states they are located at harvard ucla ohio state university and the universities of colorado alabama and michigan two overseas stations are also operational at the karolinska institut in stockholm sweden and at the university of newcastie-upon-tyne in england i have described in some detail the products and services performed by medlars as one example of how the introduction of modern technology can extend the traditional role of the health-sciences library much remains to be done in furthering the

Page  11 11 application of the new technology in such areas as graphic image storage and retrieval and the rapid facsimile transmission of documents if sophisticated technology such as medlars offers us one system to combat the problems of medical communications the much larger question of how to develop other systems to serve national information needs remains for the past two years we at the national library of medicine have been planning the design and logistical support for a national biomedical communications network because of the great difference in the resources of medical libraries ranging from those of small hospital collections with perhaps a few hundred volumes through the extensive collection of the cleveland health sciences library to the approximately 1500000 items at nlm we came naturally to the conclusion that the national library of medicine should continue to serve as the backstop for all othenology in such areas as granology in such areas as graphic image storage and retrieval and the rapid facsimile transmission of documents if sophisticated technology such as medlars offers us one system to combat the problems of medical communications the much larger question of how to develop other systems to serve national information needs remains for the past two years we at the national library of medicine have been planning the design and logistical support for a national biomedical communications network because of the great difference in the resources of medical libraries ranging from those of small hospital collections with perhaps a few hundred volumes through the extensive collection of the cleveland health sciences library to the approximately 1500000 items at nlm we came naturally to the conclusion that the national library of medicine should continue to serve as the backstop for all othenology in such areas as graphic image storage and retrieval and the rapid facsimile transmission of documents if sophisticated technology such as medlars offers us one system to combat the problems of medical communications the much larger question of how to develop other systems to serve national information needs remains for the past two years we at the national library of medicine have been planning the design and logistical support for a national biomedical communications network because of the great difference in the resources of medical libraries ranging from those of small hospital collections with perhaps a few hundred volumes through the extensive collection of the cleveland health sciences library to the approximately 1500000 items at nlm we came naturally to the conclusion that the national library of medicine should continue to serve as the backstop for all other

Page  12 12 medical libraries in the united states a central resource to which they could turn for material not in their collections and for assistance in improving services to their users slide 2 the flow of information within this network is self-perpetuating information disseminated to users ultimately returns to the libraries and information centers in the form of new publications i think your director mr robert cheshier identified the key to the network concept when he wrote in the january 1967 issue of the bulletin of the cleveland medical library regard less of whether we look at those who use us or those we use we see a hierarchy of library resources this is an exciting view because if we can see the hierarchy we can explain it to our users and others although the next slide may seem a page straight out of mr cheshier s hierarchy thesis i assure you we reached our conclusions independently slide 3 in order to maintain and control the flow of information we envision a network stratified

Page  13 13 according to the resources of the libraries and the services they would be able to provide activities within such a network would be designed to be compatible with a future national information system and the practices and plans of the library of congress and the national agricultural library the network would work closely with organizations and groups in specialized fields within the bio medical sciences to meet their information needs and would provide assistance as needed to the specialized information centers which have been established by mission-oriented groups slide 4 segmenting the hierarchical system presented in the previous slide we must first examine the apical functions although other network configurations may be possible for other information systems we believe that a medical library network cannot be if i may use the expression topless the resources of the national library of medicine the worlds largest biomedical library we believe make its choice as the central element in the network a logical one in addition a center for biomedical

Page  14 14 communications is a planned element of nlm whose primary function would be research and development leading to improved systems and modes of biomedical communications no 1 on chart the library strives to acquire all new literature of direct concern to medicine and all applicable literature from the allied sciences no 2 on chart this literature is cataloged and indexed at nlm and the resulting citations published in the nlm current catalog and index medicus no 3 on chart i have already described the bibliographic services made available through medlars items four and five would be a part of the functions of the center for biomedical communications number 6 was made a reality on october 22 1965 when president johnson signed the medical library assistance act i would like to go back to the first item for a moment for audiovisual are especially worthy of note here on last july 1 the public health service audiovisual facility at the communicable disease center in atlanta was transferred organizationally to the

Page  15 15 national library of medicine the facility has been renamed the national medical audiovisual center and its placement under nlm will result in the librarys being able to serve better as a truly comprehensive repository and distributor of biomedical information in all forms slide 5 the center slice of our triangle is composed of regional and academic medical libraries the latter would include substantial university health science and medical school libraries it is at this level that regional medical programs will transmit and receive medical information and data the establishment of what we call regional medical libraries is provided for in the medical library assistance act we are now in the process of reviewing grant applications from existing institutions in defined geographic areas of the country to enable these libraries to expand their collections and provide increased and more efficient services to local medical libraries in june 1967 the board of regents of the national library of medicine reviewed and approved a grant establishing the first regional medical library at the francis a

Page  16 16 countway library of medicine in boston the countway library which began its regional services on october 1 serves the new england states of maine vermont new hampshire rhode island and connecticut countway will expand and improve its interlibrary and reference services to readers served by local medical and hospital libraries thus providing health professionals in the region with faster access to biomedical information the second regional library will be in seattle washington to serve the north west pacific area including alaska there will be six or seven such libraries operating by 1970 and ultimately if they are successful some 25-30 regional libraries serving their respective geographic areas may be supported these libraries will have medlars capability via electronic linkage to the central facility at nlm slide 6 the local medical library is the base of the triangle and indeed the base of the whole system it is to the local library that most health professionals will turn for information

Page  17 17 this is the underdeveloped base for continuing education consequently it is the type of library that most needs strengthening to enable it adequately to meet its users needs if we view this network as an inverted sieve of increasing fineness it is desirable to have the gaps at the local level as small as possible to preclude a torrent of requests to the academic and regional libraries i would like to return for a moment to the concept of a center for biomedical communications that i mentioned earlier basic research in modernizing and improving the techniques of transferring knowledge is still largely limited to non-library functions new developments in communications technology which could be applied with great profit to the area of biomedicine have been sadly neglected most librarians have had all they could do merely to cope with the rising flood of published material and to satisfy the increasing demands of their users the few systems which have been placed into operation are not being tested under controlled conditions and as a result many new ideas for improving and extending these

Page  18 18 systems have had to be rejected for lack of adequate data we also envision establishing a national biomedical clearing house and referral unit within the center for biomedical communications slide 7 this activity would quickly guide the user through the maze of units which collect process and disseminate biomedica information emphasis would be placed on identifying data of interest to user groups directing users to information contained in the specialized information centers and collecting forms of data that might otherwise be lost such as unpublished reports negative reports of scientific investigations and translations the referral center would be a thread to guide the user through the labryinth of biomedical information sources a single point of entry into the network for those materials not contained at the center the message will be switched to a specialized information resource much planning has gone into developing the concept of a national system of biomedical communications we must now

Page  19 19 commit ourselves to the implementation of the system the technology already exists to accelerate radically the flow of biomedical information from the researcher to the hospital classroom laboratory and physicians office and even his home what has happened here in cleveland is a step in the right direction you have pinpointed on a local level the problems which face the biomedical community on a nationwide scale and you have taken constructive intelligent steps to rectify these problems by inter-library cooperation the development of a national network of medical libraries depends on just such cooperation but on a larger scale although the federal government can assist in providing resources advice and direction the success of a biomedical communications system depends ultimately on institutions such as yours i hope others will follow your splendid example finally i would be remiss if i didn't acknowledge the indebtedness of the national library of medicine to the cleveland

Page  20 20 medical library which accepted the responsibility for housing our historical treasures during world war ii you not only protected the worlds greatest collection of medical books but added to its strength and beauty by the efforts of your bindery which restored many of our volumes during their 20-year tenure here your own esteemed dr robert stecher also deserves recognition tonight for his service as a member of our presidentially approved board of regents i doubt that any city claims a physician who has done more for the development of local and national library resources than your own thus it was with a sense of great humility that i accepted your invitation to speak here tonight i feel like the man who lived through the great youngstown flood on every occasion thereafter when given an opportunity to speak he recounted his experiences during the flood when he finally came to his resting place in heaven he was given an opportunity by st peter to say a few words about his life on earth he immediately beamed as he was being introduced but as he stepped

Page  21 21 up to speak he was reminded that noah was in the audience i close with a quotation from your own bob stecher who wrote in 1945 the first obligation of the library is to care for the needs of the practising doctor the in terns and the medical and dental students these are the men who need the services most being less able to provide for their necessities indepen dently the alert librarian senses their needs anticipates their requirements and explores the possibilities for greater aid upon his ability to recognize such opportunities depend the librarian's and the librarys success the usefulness and availability of the librarys resources are greatly enhanced by the free delivery system the administration of this great library is a serious public trust such an accumulation of

Page  22 22 the worlds recorded experience available today very largely because of the generosity and provident foresight of a former generation must be offered for study to all who are competent to profit from association with it restrictions in its use are only those which seem proper for reasonable protection and eventual preservation this is the same spirit which must pervade all elements of a national medical library network

Page  23 references 1 cushing harvey consecratio medici boston little brown and company 1940 p 250 2 rider fremont the scholar and the future of the research library new york hadham press 1944 p 8-10 3 stimson dorothy scientists and amateurs new york henry schuman 1948 4 price derek john de sol la science since babylon new haven yale university press 1961 p 93-98 5 cheshier robert g the librarian and cooperation from the librarians desk bull cleveland medical library 14 i 23-24 january 1967

Page  24 illustrations slide 1 growth of the literature slide 2 network concept information flow slide 3 overall network plan organizational slide 4 network plan nlm and cbc slide 5 network plan regional and academic libraries slide 6 network plan local libraries slide 7 center for biomedical communications