History of Medicine
Commentary by Dr. Martin M. Cummings on his testimony before the U.S. Senate Appropriations Subcommittee concerning the National Library of Medicine, for fiscal year 1965
From interviews with Dr. Cheryl Dee, 2009
Excerpts of U.S. Senate subcommittee testimony concerning the National Library of Medicine, followed by an interview with Dr. Martin M. Cummings, Director Emeritus, National Library of Medicine, reflecting upon the testimony
DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE AND RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 1965
Friday, May 22, 1964
U.S. SENATE . . . Subcommittee of the Committee on Appropriations
LISTER HILL Alabama, (Chairman of the Subcommittee) presiding
Present: Senators Hill and Byrd.
STATEMENTS OF DR. MARTIN M. CUMMINGS, DIRECTOR, NATIONAL LIBRARY OF MEDICINE;ACCOMPANIED BY SCOTT ADAMS, DEPUTY DIRECTOR; RAY W. GRIM, EXECUTIVE OFFICER; DR. DAVID E. PRICE, ACTING SURGEON GENERAL; AND JAMES F. KELLY, DEPARTMENT BUDGET OFFICER
Senator Hill. The subcommittee will kindly come to order. Doctor, we are happy to have you here with us. You may proceed now and make any statement you see fit, sir.
Dr. Cummings. Thank you, Mr. Chairman. Since this is my first appearance before this subcommittee as Director of the National Library of Medicine, I should like to preface my remarks by sharing with you some of my personal convictions as a physician, as scientist-administrator, and now as Librarian, of the significance of the work which NLM is performing.
Senator Hill. We will be glad to have you do that, Doctor.
Interview with Dr Martin Cummings, Director Emeritus, National Library of Medicine, 1964-84; interviewed by Cheryl Dee, PhD, 2009.
Dr. Dee. Dr. Cummings, please tell us a little about the Senators that are on the Senate Subcommittee of the Committee on Appropriations, and tell us if you knew them before you testified before them in the Senate.
Dr. Cummings. I will be glad to comment on the contributions to NLM of several fine Senators on the Subcommittee of the Committee on Appropriations. From the list of senators on the Subcommittee I can comment on several Senators who were significant contributors to the National Library of Medicine's programs.
Lister Hill, Alabama, Chairman
I first met Senator Lister Hill of Alabama in the late 1950s, when I was Director of Research for the Veterans Administration. He was a member of the committee concerned with the medical affairs of the VA. I also knew that he and Senator John F. Kennedy of Massachusetts were both interested in establishing a new facility for the Armed Forces Medical Library which was being transferred from the Defense Department to the US Public Health Service.
I came to know Senator Hill better in 1960 when I served as Chief of the Office of International Research at the National Institutes of Health. In this capacity I learned of his astuteness and his intense interest in medical libraries. It was from this association that I had the temerity to ask Senator Hill whether I should accept the position offered as Director of the National Library of Medicine. When I was invited to become Director of the National Library of Medicine I made arrangements to meet with Senator Lister Hill to learn whether Senator Hill considered me a suitable person to accept this position. He encouraged me to do so and this made it possible for me to begin my planning for new programs which I knew would require new and large budgets for the National Library of Medicine.
Senator Hill had the unique distinction of serving both as Chair of the Subcommittee for the Committee on Appropriations, and the Subcommittee on Legislation. I had to deal with Senator Hill when I sought new authorities to create extramural grant programs, intramural research programs, and other special NLM needs that were met through his control of construction budgets.
As some background, the U.S. legislation provides the legal statutory authority to obtain funds for these programs. This of course had to be approved similarly in the U.S. House of Representatives.
For the 20 years that I served as Director, Senator Lister Hill was always attentive to the needs of the National Library of Medicine. It was clear that he personally reviewed each request and was knowledgeable of the history and past accomplishments of the National Library of Medicine and had an open mind with respect to the application of new technologies to better serve the needs of library users.
Warren G. Magnuson, Washington
Warren Magnuson, the Senator from Washington, was keenly interested in the National Institutes of Health research programs and I came to know him when I worked in NIH as an advocate for medical research and as a special advocate for the University of Washington, School of Medicine. In later years during my tenure at the National Library of Medicine he became interested in the programs of the Lister Hill Center because of the university's interest in using our satellite technology to provide medical services to Alaska. I found him to be a very intelligent and diligent person with whom to interact in later years.
Hubert H. Humphrey, Minnesota
Senator Hubert Humphrey of Minnesota was interested in certain features of library services. He was particularly concerned that past accomplishments of medical research took a long time to be translated from the time of their original publication into publications which were available for health care practitioners for their treatment of patients.
He was also keenly interested in seeing the development of a national system which dealt with toxic effects of drugs and chemicals on man. In this context he asked the National Institutes of Health to establish a program based on computer technology which could be used for the purpose of having public access to information dealing with toxic drugs and chemicals. On the recommendation of the Director of the National Institutes of Health this toxicology program was assigned to the National Library of Medicine. From that point forward, Senator Humphrey retained a keen interest in the work of the National Library of Medicine and was supportive during many years when access to increasing budgets became difficult.
Norris Cotton, New Hampshire
I first met Senator Cotton when I testified as Chief of the Office of International Research, NIH, on behalf of, and in support of the international medical research programs at the NIH. In this context he came to know me as well.
Senator Norris Cotton of New Hampshire was approached by a member of my staff, Mr. Kent Smith who was helping me develop the budget to acquire a new building to house the Lister Hill Center for Biomedical Communications. Kent was able to establish this contact because his father, who was a distinguished corporate businessman in New Hampshire, knew Senator Cotton.
During one critical phase in the development of the Graphic Arts Composing Equipment, known as GRACE, Senator Cotton was able to expedite the completion of GRACE for the development of MEDLARS that was so essential for us to produce computer-generated publications.
Medical Literature Explosion
Dr. Dee. Dr. Cummings, please tell us about the impact of the "medical literature explosion" on the National Library of Medicine.
Dr. Cummings. The capability of the local libraries to deal with the explosion of medical literature was reflected in the increasing number of requests for services from the National Library of Medicine. It was apparent from several studies that the publication explosion, was attributed to an increase in funding for medical research, but there was not a parallel funding increase for the resources required by libraries to handle the increased number of publications. It was also apparent that the number of articles increased to a point when it was no longer expeditious for the National Library of Medicine to index the publications in time to make their availability known to the reader community in a manner that was useful for ongoing research. Thus I believed that it would be important for Congress to make funds available to increase staff capable of indexing the literature. It also was important to make the bibliographic services of the National Library of Medicine more accessible by decentralizing MEDLARS. To test this hypothesis I later suggested that we make our tapes available to the UCLA School of Medicine Library to determine whether this project would prove to be effective and efficient.
Dr. Cummings's MEDLARS Background
Dr. Dee. Dr. Cummings, what background did you have related to the projects, including MEDLARS, that you presented to the Senate? You were vastly informed on the subjects.
Dr. Cummings. I will respond to your question as to what background I had prior to NLM that related to the projects presented in 1964. The insights that I brought to NLM I gained by service on committees dealing with the National Science Foundation and with the Defense Department. I was aware of the advances being made in the fields of computer technology, photocopying, and microfiche production. It was tempting to consider the use of these technologies as appropriate modalities for advancing library operations and services.
With regard to the performance of the MEDLARS indexing system, I used my own research experience using MEDLARS to learn more about the current methods of treating tuberculosis. My searches indicated that there were some deficiencies in the MEDLARS bibliographic analysis. It is for this reason that I suggested we put together teams of experts im various fields of medicine to review the nomenclature, vocabulary, and use of medical language for improving the quality of indexing, while at the same time expanding the coverage on a global basis.
Dr. Brad Rogers and his staff had already examined the prospect of decentralizing the MEDLARS program. The problem of decentralizing the MEDLARS program was made somewhat difficult because NLM used Honeywell computers for its batch processing whereas most of the other institutions used IBM equipment. This required a degree of reprogramming of the MEDLARS tapes so that they were compatible in different technical systems in other libraries.
National Library of Medicine's Publications Support Program
Dr. Dee. Dr. Cummings, please tell us about the National Library of Medicine's Publications Support Program.
Dr. Cummings. The library had access to surplus foreign currencies gained through the sale of agricultural products to developing countries. These funds could be used to support programs and activities which could be carried out without expending U.S. dollars abroad. The library took advantage of the availability of these foreign currencies in countries that had the technical capability of indexing the medical literature produced by their own scientists. In effect these were small contractual agreements that were developed to increase the number of articles translated from foreign languages. This may be considered to be the crude prototype or predecessor of the Extramural Grant Program which followed several years later after we received authorization to use American dollars for support of research and training in library and information science.
In countries like Israel there were many physicians and scientists who came to the U.S. from Europe and other parts of the world. NLM was able to utilize their linguistic as well as scientific skills to translate into English from foreign journals which published in non-English language.
Dr. Cummings's History of Medicine Experience
Dr. Dee. Dr. Cummings, please tell us any background you recall about the NLM History of Medicine.
Dr. Cummings. I believe it was Dr. Saul Jarco, a member of the Board of Regents of the National Library of Medicine who suggested I examine the library's ability to meet the needs of scholars in the field of the history of medicine. It became clear that there were a number of outstanding historians prepared to work on the NLM collection but NLM had insufficient funding to perform their studies. It was equally clear that the National Library had insufficient staff to maintain the catalogs and provide the services required for a vigorous program in this field. For these reasons I found it advisable to raise a question before Senator Hill's Committee to determine whether there was interest on the part of the Senate, similar to the previous interest on the part of Congress, to provide funding for the history of medicine research. Fortunately it proved to be feasible to obtain a budget and staffing which allowed this activity to go forward.
For the 1965 appropriation year only, see also Dr. Cummings' commentary to his testimony to the U.S. House of Representatives Subcommittee for the Committee on Appropriations. In discussions with Dr. Dee, Dr. Cummings pointed out that the testimony to the U.S. Senate Subcommittee to the Committee on Appropriations provided much more detail than the House testimonies. For the years subsequent to the appropriation year 1965, the interviews with Dr. Cummings concern his testimony to the U.S. Senate only.
Comments of Dr. Martin M. Cummings, Director Emeritus, National Library of Medicine, reflecting upon his testimony to his Testimony to the U.S. House of Representatives Subcommittee for the Committee on Appropriations for fiscal year 1965, 2008.
Dr. Cummings. I am going to share my thoughts about the context of my first testimony before the House Appropriations Committee. I'd just left the National Institutes of Health where I was Associate Director for Research with a budget of about $800 or $900 million. The country was blossoming with a vast medical research endeavor, so large that the publications which resulted from research were overwhelming medical libraries abilities to handle them. It was my purpose to persuade the Congress to give the Library sufficient funds to support the training of medical librarians, research with library technologies to improve services, and the provision of materials and facilities which would enable medical library facilities to do its work more efficiently.
Decentralization of MEDLARS
Based on a survey by the Association of American Medical Colleges NLM showed there were at least 3,000 medical librarians at an extensive expense to medical library facilities. We also learned that the application of new computer technologies such as the implementation of MEDLARS made it possible to give more rapid and more comprehensive information and services to physicians everywhere. The program had been sufficiently tested to suggest that MEDLARS should be decentralized for universities and research institutions to use our NLM databases in the same way that we were able to use databases on-site at the NLM.
I also thought it was important to inform the Congress that the old brittle paper in the collection of the National Library of Medicine was disappearing at a rate of more than a million pages a year and that we needed funds to institute a modern preservation program using microfilming to preserve this material.
Drug Information System
In addition we informed the Congress that the library was planning to establish a drug information system which would allow physicians and scientists to access the literature dealing with drugs, chemicals and the toxic effect of these materials on man and his environment. To accomplish these activities we requested an increase in our budget by a little more than a million dollars.
History of Medicine
It should be noted that I also suggested that the History of Medicine Division of the Library be supported because it was important to know what had been done in medical research prior to beginning new expensive research undertakings.
As I look back I recall that the Chairman of the Appropriations Subcommittee was John Fogarty, Congressman from Rhode Island who formerly was a bricklayer. It's a tribute to him that he understood and appreciated the sophisticated needs that I articulated and I cannot resist taking this moment to tell any reader of his important role toward furthering the work of the National Library of Medicine. Mr. Fogarty's support of the National Library of Medicine's budget requests over the many years that I served while he was Chairman of the House Subcommittee on Appropriations is proof of his thoughtful and influential budgetary increases provided to the National Library of Medicine. I had earlier exposure to Congressman Fogarty when I served as Chief of the NIH International Research Program. Congressman Fogarty was an advocate of providing support for international medical research and Congressman Fogarty has subsequently been honored by having a building which houses the NIH international activities named for him.
NLM 100th Anniversary and Congressman Fogarty
I informed Mr. Fogarty that on June 17th, 1965 there would be a celebration of the 100th anniversary of the National Library of Medicine. I was pleased that he accepted my invitation to attend the ceremony and if my memory is correct I believe he also gave one of the major addresses.
John Shaw Billings and Herman Hollerith
In 1865 John Shaw Billings was assigned to supervise the Surgeon General's Library. He remained in that post until 1895.
On this occasion we took pains to point out that the pioneering work of Dr. John Shaw Billings be recognized including his creation of the Index Catalog, Index Medicus and also the design of the first electric tabulator using punched cards which was developed by Herman Hollerith when he was working for the 1890 Bureau of the Census. In some respects, this invention was a real prototype of modern computing.
- Cotton, Norris H., (1900-1989). Biographical Directory of the United States Congress. Senate Years of Service: 1954-1974; 1975-1975. https://bioguide.congress.gov/scripts/biodisplay.pl?index=c000802
- Fogarty, John Edward, (1913-1967). Biographical Directory of the United States Congress. https://bioguide.congress.gov/scripts/biodisplay.pl?index=F000233
- Humphrey, Hubert Horatio, Jr., (1911-1978). Biographical Directory of the United States Congress. Senate Years of Service: 1949-1964; 1971-1978. https://bioguide.congress.gov/scripts/biodisplay.pl?index=h000953/li>
- Magnuson, Warren G. (1905-1989). HistoryLink.org Essay 5569. https://www.historylink.org/index.cfm?DisplayPage=output.cfm&file_id=5569
- Rogers, Frank Bradway (1914-1987). Brodman, Estelle. "President's Page: Frank Bradway Rogers, M.D., President, Medical Library Association, 1962/63." Bull Med Libr Assoc. 1962 July; 50(3): 508-510. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC197872/
Institutions and Programs
- NLM History of Medicine Division. https://www.nlm.nih.gov/hmd/
Articles and Oral Histories
- Adams, Scott. "MEDLARS and the Library Community." Bull Med Libr Assoc. 1964 January; 52(1): 171-177. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198089/
- Austin, Charles J. "Data Processing Aspects of MEDLARS." Bull Med Libr Assoc. 1964 January; 52(1): 159-163. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198087/
- Lipscomb, Carolyn E. "Lister Hill and his influence." J Med Libr Assoc. 2002 January; 90(1): 109-110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC64768/
- Oppenheimer, Gerald, Interviewer. "Martin M. Cummings" Oral History. Oral History Project: Voices of the Past. Medical Library Association, June 23, 1987, 33 leaves. https://www.mlanet.org/about/history/cummings_m.html
- Phillips, Harlan B. Lister Hill Oral History, interviewed by Harlan B. Phillips, Jan.-June 1967. https://oculus.nlm.nih.gov/2935109r
- Rogers, FB. "The Development of MEDLARS." Bull Med Libr Assoc. 1964 January; 52(1): 150-151. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198085/
- Taine, Seymour I. "Bibliographic Aspects of MEDLARS." Bull Med Libr Assoc. 1964 January; 52(1): 152-158. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC198086/