The National Library of Medicine, 1980
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the national library of medicine it is a pleasure for me to be here today and to tell you a little about your national library of medicine flrst however i wish to thank my good friend emmet ferguson for extending this invitation to me let me tell you that novembers are cold in washington despite all the hot air there in an election year i thank emmet for the timing of his invitation and you for choosing such a sensible climate in which to live i understand that dr ferguson has told you that i will be speaking on the topic a library without books i hope you will not take this topic literally however for the national library of medicine is first and foremost a collec tion of medical books and journals the largest in the world emmet's point is well taken however in the sense that the national library of medicine perhaps more than any other institution has been involved in using modern electronic communications technology to disseminate medical information this title a library without books reminds me of an incident last fiay we had just finished the dedication ceremony for our new building known as the lister hill center at which a series of prominent scientists and librarians had extolled the virtues of the modern technology available in the new building at the reception following the presented at the jacksonville florida notary club november 10 1980 by martin h lummings h-u director national library of medicine

Page  2 2 ceremony a long-time member of our staff came up to me and said i noticed that a certain fourletter word was avoided in all the presentations today not knowing what to expect 1 asked him what it was he leaned over to me and whispered conspiratiorially book 10 set the stage for my remarks let me offer two brief historical quotes that illustrate the problem health professionals face when approaching the biomedical literature john itayow in 1668 wrote disease as it stalks through the land cannot keep pace with the incurable vice of scribbling about it he second quote is from boerhaave the most accomplished and celebrated physician of the 18th century when he died he left behind him an elegant volume the title page of which declared that it contained all the secrets of medicine on opening the volume every page except one was blank un that page was written keep the head cool the feet warm and the bowels open somewhere between these extremes of too much and too little lies the difficult path of today's medical information systems t begin slides the national library of medicine is an institution with a long and proud tradition of service to the medical profession it is located just outside washington dc on the grounds of the national institutes of health in bethesda maryland nih

Page  3 3 is one of the six agencies that make up the public health service a part of the us department of health and human services the library traces its history back to 1836 when a collection of medical books was established in the army surgeon general's office this is a page from the first catalog of the collection dated 1840 we maintained our connection with the military becoming successively the army medical library and the armed forces medical library until 1956 when the library became part of what we today call the department of health and human services 3 the legislation that formally named the national library of medicine and made it part of the department was cosponsored by senators lister hill and john f kennedy the act also called for the creation of a board of regents to advise the secretary on matters of policy in regard to the library dr ferguson is a member of this board here are a few pictures of the library in different stages of its evolution 4 from the kiggs bank building in 1862 to ford's theatre in 1866 to the army medical museum and library building in 1887 and finally to the present building in 1962 the tall building to the left of the library in this photograph is our new llster hlll national center for biomedical communications i will tell you a bit more about the center in a few minutes

Page  4 4 within the walls of the national library of hedicine is the world's largest collection of medical literature from 11th century manuscripts to audiovisual material the library attempts to collect all the substantive biomedical literature regardless of form the holdings today number well over two and a half million books journals technical reports manuscripts theses pamphlets micro films audiovisual material and prints and photographs tiore than 70 languages are represented in this vast collection the reference staff is kept busy answering some 40000 reference queries each year received by phone, cable mail and from readers the library also has a separate collection of historical material one of the finest in the world it consists of books and journals published before 18/1 manuscripts oral history tapes and prints and photographs ihe history of medicine division has its own reading room and staff of reference librarians and scholars the single most important influence on the early development of the library was john shaw blllings an army surgeon who directed the library from 1865 to 1895 under his guidance the collection became a truly national resource seeking out and acquiring medical literature published all over the world and providing services to all american physici ans--not just those connected with the military

Page  5 5 in 1879 dr billings developed an index to the world's biomedical jouknal literature which he published as index medicus one of his greatest achievements however was the publication beginning in 1880 of the index-catalogue of the library of the surgeon-general's office this covered all of the world's published literature in the library's collection organized by subject and author it was to take fifteen years for the entire sixteen volume catalog to be published these two publications continue to this day the index mjedlc_y_s now a monthly listing of articles from over 2,601 medical journals and the catalogr"now known as the national library o medicine dr blllings had a healthy skepticism about the enduring value of much of what he collected one hundred years later i can subscribe to his wry statement that the proportion of what is both new and true is not much greater in medicine than it is in theology the difficulties of publishing catalogs and indexes to the biomedical literature are made much easier today by computers a high-speed computer can phoduce in a matter of hours the typeset copy for a thou sand page monthly issue of index medicus a job that previously took weeks by conventional methods lven in discussing computers however we cannot avoid the long shadow of ljr hillings in addition to his duties at the library ur billings was in charge of vital statistics for the tenth census 1880 he discussed with herman hollerith a

Page  6 6 young engineer in the census office the need for a machine to do the purely mechanical work of tabulating the census and population statistics billings suggested that statistical data might be recorded on a card by punching small holes in it and that these cards might be counted and sorted mechnaically 18 based on these principles hollerith developed an electronic tabulator that was used with great success in the 1890 census kith his equipment the classification and counting were done in a third the time of the 1880 census now you may have heard it said that physicians have little business sense if you haven't you might talk to the descendants of ur billings he declined hollerith's invitation to join in developing and patenting the tabulator hollerith sub sequently improved and refined his machine and eventually sold his patents to what is now ibm 19 the computer system we use at the library today is called i an acronym for medical literature analysis and retrieval system medlars became operational in 1964 20 medlaks is based on the skilled indexing and cataloging of published materials received by the national library of medicine this aspect of the system — extracting pertinent data from the printed page would be quite familiar to ur billings and in fact is essentially similar to the abstracting and indexing he accomplished for the index-catalogue and the original index-medicus since 1964 almost four million articles have been indexed and entered into the medlaks computers

Page  7 7 the most remarkable demonstration of the computer's capability is in allowing a person to search the machine's memory to retrieve references on a particular sub ject 21 this system is called medline an acronym for medlars on-line the library began providing medline service in october 1971 using medline it is now possible for health professionals throughout the united states and in several foreign countries to have immediate access to a data base of about half a million references to articles from the most recent biomedical journals and selected monographs 22 this is done by using computer terminals that are linked to the national library of medicine's computer by telephone and other communication lines 23 more than 1500 medical institutions in the united states and in other countries have medline terminals and almost two million computer searches are performed each year to do a medline search a librarian or even the health professional himself dials the tied line telephone number for his area and connects his terminal with the library's computer in bethesda 25 in the simplified example you see here the user has asked for a search on the terms vitamin c and common cold and then further narrowed the search down to only articles written in english you see three of the references here many of the references include abstracts which may also be printed out at the terminal

Page  8 8 the medline search service has received enthusiastic acceptance by the medical profession by practitioners researchers and educators throughout the world 26 this acceptance is reflected not only in the growing number of terminals and their geographic distribution but also in additional information services and products we are making available here you see a list of additional data bases available over the library's network the national library of medicine charges institutions with on-line access to these data bases medline is accessible 90 hours each week and the charge is based on the number of hours a terminal is actually connected to the computer 15/hour some institutions pass this cost along to the user others absorb all the costs and make no charge after identifying the medical literature needed there is still the task of acquiring the journal articles themselves not all health science libraries of course have all the journals physicians and scientists require in fact no other medical library in the us has all 3,000 of the titles indexed and put in medline to help other libraries provide service for their clientele the national library of tiedicine will photocopy articles from its journals and send them without charge to the requesting library to make this an orderly and manageable process nlm has supported the establishment of eleven regional medical libraries each responsible for a different geographic area of the country i might mention that your

Page  9 9 own jhep the jacksonville hospitals educational program library network is an important component of the southeastern regional medical library program based at emory university in atlanta 29 all requests for photocopies of articles go through the libraries in this network only if an item is unavailable within the region is the request sent to nlm even with this built-in filter however the national library of medicine sends out about 200,000 photocopied articles each year 30 much of the early development for medline was done by the lister hill national center for biomedical communication the lister hill center was established at nlm in 1968 to conduct research and development to apply advanced communications technology to improve health education medical research and the delivery of health services the legislation that created this program also authorized the construction of a facility to house its activities this is the adjacent ten-story building i showed in the photograph a few minutes ago among the lister hill center's research and development programs in the sevenhospitals educational program library network is an important component of the southeastern regional medical libraryhospitals educational program library network is an important component of the southeastern regional medical library program based at emory university in atlanta 29 all requests for photocopies of articles go through the libraries in this network only if an item is unavailable within the region is the request sent to nlm even with this built-in filter however the national library of medicine sends out about 200,000 photocopied articles each year 30 much of the early development for medline was done by the lister hill national center for biomedical communication the lister hill center was established at nlm in 1968 to conduct research and development to apply advanced communications technology to improve health education medical research and the delivery of health services the legislation that created this program also authorized the construction of a facility to house its activities this is the adjacent ten-story building i showed in the photograph a few minutes ago among the lister hill center's research and development programs in the sevenhospitals educational program library network is an important component of the southeastern regional medical library program based at emory university in atlanta 29 all requests for photocopies of articles go through the libraries in this network only if an item is unavailable within the region is the request sent to nlm even with this built-in filter however the national library of medicine sends out about 200,000 photocopied articles each year 30 much of the early development for medline was done by the lister hill national center for biomedical communication the lister hill center was established at nlm in 1968 to conduct research and development to apply advanced communications technology to improve health education medical research and the delivery of health services the legislation that created this program also authorized the construction of a facility to house its activities this is the adjacent ten-story building i showed in the photograph a few minutes ago among the lister hill center's research and development programs in the seventies were several projects involving the use of communication satellites these have ranged from a voice communication network begun in alaska in 1971 using nasa's

Page  10 10 ats-1 satellite to a two-way video network in alaska and the pacific northwest using the ats-6 satellite the sophisticated communications technology satellite was used later for continuing health education and teleconfer encing nlm constructed a studio within the library to serve as the network coordinating center for this experiment today the lister hill center is engaged in using such new technologies as minicomputers and videodiscs to explore their potential for storing retrieving and disseminating medical information another component of the national library of medicine that like the llster hlll center has a mission not ordinarily associated with a library is the national medical audiovisual center formerly located in atlanta the audiovisual center moved earlier this year into the new building in bethesda audiovisuals have become extremely important in the teaching of medicine dentistry and the other health professions they are used extensively at all levels for undergraduate graduate and continuing education courses the national medical audiovisual center has responsibilities both for improving the quality of audiovisuals and for encouraging their use in schools of the health professions just as we provide books and photocopies of journal articles the center lends medical motion pictures to institutions and individual health professionals

Page  11 11 39 two other programs in the new lister hlll center building are worthy of mention the first is a toxicology information program that has developed specialized informa tion services in the areas of toxicology pharmacology and environmental pollution 40 the second is a broad program of grant support for library resources research in biomedical communications and publications since 1965 when the grant program began us health science libraries have been strengthened by grants to more than 1,000 in stitutions 41 the wide-ranging services and programs of the library cost each american the equivalent of one pack of chewing gum each year i hope i have convinced you that the return on this in vestment is not just a collection of books and journals sitting on shelves as medical knowledge continues to grow at an amazing pace the national library of medicine is striving to provide more rapid and accessible information services so that this knowledge can be turned to improved health care

Page  12 slides for jacksonville fl rotary club speech 1 nlm exterior 2 title page of 1840 catalog 3 photo of nlm entrance with nlm name visible 4 riggs bank 5 ford's theatre 6 army medical museum and library 7 nlm today aerial photo 8 arabic manuscript oldest item 9 collection today table 10 reference librarian in reading room 11 historical book with illustrations 12 hmd reading room 13 john shaw billings 14 first index medicus 15 modern im 16 current catalog 17 medlars computer room 18 electric tabulator 19 medlars acronym 20 cataloging section 21 medline data base 22 medline terminal 23 us medline map lists non-us centers also 24 dialing into the network 25 simplified sample search 26 data bases on tie network 27 photocopyinq 28 rml map 29 network pyramid 30 lhncbc name spelled out 31 photo of new building front view 32 ats-1 satellite 33 ats-6 satellite 34 cts satellite 35 cts studio 36 videodisc machine 37 audiovisual carrel is 38 film loan program 39 tip programs list 40 ep grant programs list 41 night shot of nlm