Happy Anniversary [editorial], 1972
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HAPPY ANNIVERSARY Libraries, medical or otherwise, do not usually engage in such seemingly esoteric activities as evaluating a VHF satellite voice link between a U.S. Public Health Service physician in Alaska and a native health aide in a remote village. Yet such a dialog provides a form of clinical consultation in an area where climate, terrain, absence of transportation and--most of all--lack of reliable communication produce almost insurmountable isolation. Telephones are practically nonexistent, and conventional high frequency radio is completely unreliable because of ionospheric disturbances in the auroral region. Actually, this is an intriguing example of modern biomedical communications investigation, designed to improve diagnostic and therapeutic procedures for patients unattended by physicians in 26 Alaskan villages, that has been undertaken by the National Library of Medicine and described in its recently published 135th Annual Report, 1836-1971. A revealing document, it traces the gradual transition of the medical library from its traditional role of an archival depository for books and journals into an active and dynamic information center for rapid communication of new knowledge to members of the health professions. The National Library of Medicine is leading the way in this evolutionary adaptation of advancing communications technology to the ultimate benefit of the patient. Historical notes in the report reveal that the Library traces its origins from a collection of medical books and journals assembled in the office of the Army's first surgeon general "in a long forgotten building in

Page  2 Washington City." Later this great institution, which now holds medical literature and historical collections that exceed 1.3 million titles, was housed for 20 years in Ford's Theatre in downtown Washington following President Lincoln's assassination. In 1887 it was moved for another 75 years to a red brick building on the Mall which was both undistinguished and inadequate, and also crowded with offices of other government agencies. Now observing its tenth year in a modern, functional structure of unusual design in suburban Bethesda, Maryland, the Library is not only a prestigious national resource but has increasing ties with medical institutions in many parts of the world. Among its six operational units are the National Medical Audiovisual Center in Atlanta, the Lister Hill National Center for Biomedical Communications, and the far-flung computerized Medlars literature citation storage and retrieval system with its supporting centers in 15 strategic locations in the United States, and in Canada, England, Sweden, France, Germany, Japan and Australia. The Library is governed by a Board of Regents, appointed by the President, that formulates policy and acts in an advisory capacity to the Secretary of Health, Education and Welfare, and is under the direction of a physician with a long line of distinguished predecessors. The present chairman of the Board of Regents is Dr. William G. Anlyan, vice president for health affairs of Duke University, who recently succeeded Dr. Robert H. Ebert, dean of Harvard Medical School. The broad variety of services provided by the Library for its users during the past fiscal year is impressive. The size of its permanent collections was increased by the acquisition of more than 34,000 titles. Requests

Page  3 filled for readers exceeded 83,000, and over 20,000 reference services were provided users by mail, telephone, and directly. Nearly a quarter of a million journal articles were indexed, more than 100,000 interlibrary loans were made, and almost 24,000 copies of literature searches were furnished on request. In addition, the growing list of professional publications (available from the Superintendent of Documents), long made up of catalogs, indexes and special titles, now includes 23 recurring bibliographies in special fields most of which are sent to subscribers monthly or quarterly. The most widely used publication, Index Medicus, was established in 1879 by the Library's most distinguished director, Dr. John S. Billings. One of its newest bibliographies, the monthly Abridged Index Medicus, now in its third year, is of special value to internists because of the thousand or so citations it prints in each issue from the 100 most important clinical journals printed in English. Medline, now under development, is the Library's newest and most ambitious system to provide rapid access to the increasing avalanche of medical literature. This on-line bibliographic searching service, operating through a TWX-like terminal of keyboard and printer, is gradually being expanded to include citations in more than 1,000 biomedical journals in the vast Medlars data base. It is designed to support up to 25 simultaneous users in libraries and medical centers in producing prompt print outs of medical literature searches. In its administration of the Medical Library Assistance Act, the National Library of Medicine has supported with grants of nearly $50 million more than 600 training, resources, publication and other projects in the nation's medical libraries. Also under the Act it has continued the development of a chain of

Page  4 regional medical libraries, geographically selected and mostly university based, to provide a nationwide network in sharing resources and enabling medical school and hospital libraries to bring new clinical and research information to their users. A number of national professional societies, including academic groups, are collaborating with the National Medical Audiovisual Center in the design and development of pilot models of teaching packages as instructional aids in medical schools. The first such multimedia units are devoted to special topics in anatomy. Others are planned in the specialties of pediatrics, ophthalmology, and of obstetrics and gynecology. Active support of a broadened program has been proposed by the Association of American Medical Colleges in a recent and extensive report 2 urging the participation of the Library's Lister Hill Center in a national biomedical communications network. The Library is experimenting with interactive television communication between two New England medical schools and selected area hospitals to provide various consultative and teaching services. In both projects, the ultimate objectives are to study effective conduct of remote consultation supported by useful clinical data and facsimile transmission. The National Library of Medicine through its developing biomedical network with other medical libraries is a basic resource of all continuing medical education. In print and audiovisual media, and through experimental communications systems, it is bringing new knowledge promptly from worldwide literature sources to where it is needed. It provides access to current journal citations by swift electronic methods that virtually extend to the physician at the patient's bedside. These notable benefits and services that are available to internists

Page  5 and all members of the health professions make the National Library of Medicine's 135th anniversary truly a happy--and significant--landmark in medicine.