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 1975
From interviews with Dr. Cheryl Dee, 2010-2011
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 1975
TUESDAY, MAY 14, 1974
SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS
Senator Norris Cotton, Presiding
Fogarty Name Perpetuated
Senator Cotton. ... [T]hose of us on the committee, and I know I speak for others who served with John Fogarty, take continuing pride in the fact that his name is being perpetuated in the Fogarty International Center, and I am happy to see it continue, and am gratified that it is being administered in such a dedicated manner by you who are administrating it.
Dr. McCrumb. Thank you, sir.
Public Service Award of the Rockefeller Foundation
Senator Cotton. ... To testify on behalf of the budget request for the National Library of Medicine is Dr. Martin Cummings, who is the director. First, it is my pride and pleasure that I bring to my colleagues' attention the fact that Dr. Cummings was awarded the Public Service Award of the Rockefeller Foundation this year. This is a most prestigious citation and one in which he can take justifiable pride. The committee is glad the National Library of Medicine is in such capable hands. Dr. Cummings, I congratulate you for the great honor you received.
Dr. Cummings. Thank you, Mr. Chairman.
STATEMENT OF DR. MARTIN M. CUMMINGS, DIRECTOR,
Excerpts from the Opening Statement:
In 1971, a more timely and cost-efficient system was inaugurated [and was] known as MEDLINE--MEDLARS On-line. This on-line interactive bibliographic service allows the health scientists to "converse" with the computer through a remote terminal to get more precisely what he needs, when he needs it. Searches now are completed in approximately ten minutes rather than several weeks and cost approximately $7.00 rather than $60.00, the average cost of a previous MEDLARS search.
MEDLINE services are now being used by 225 institutions in 46 states and internationally by eight foreign countries. In return for MEDLINE service foreign centers provide the equivalent of $250,000 in indexing of foreign language journal literature for input into the MEDLARS data base.
We have continued to expand the on-line services through the implementation of new data bases. Three such services include: SDILINE, which is a complete file of those citations for the next month's Index Medicus; CATLINE, which provides access to catalog data on the monographic collection of the NLM; and SERLINE, which offers access to descriptive information on the 5,500 major biomedical serial titles and data identifying which libraries hold those titles.
Finally, I would like to report on a new service planned for FY1975, namely the addition of author abstracts to the MEDLINE data base. The inclusion of abstracts will provide increased text searching capability and will enable health professionals to retrieve more specific medical information. In entering approximately 100,000 author abstracts in FY 1975, NLM will have achieved another milestone in providing informative and ready access to the world's biomedical literature.
Before turning to other specific programs of the NLM, I would like to inform the Committee on the status of the copyright suit against the government. The United States Court of Claims has ruled in favor of the government in the alleged copyright infringement suit. An unfavorable decision would have required the NLM to pay for licenses and royalties for providing single copies of journal articles for use by health professionals and students. This would have greatly increased the operational costs of the NLM and other libraries throughout the country. While the decision of the Court of Claims may be appealed to the Supreme Court, we are very encouraged by the initial decision.
I would like, however, to continue to stress the need for new copyright legislation.
Biomedical Communications Research and Development Lister Hill Center
In 1968 Joint Resolution 193 was signed into law creating the Lister Hill National Center for Biomedical Communications to serve as the focal point within the Department of Health, Education, and Welfare for the development and coordination of communication networks and systems to improve health education, medical research and the delivery of health services. While many advances in biomedical communications technology have already resulted from this program, full potential will not be realized until the Lister Hill Building is constructed. The architectural and engineering final drawings will be completed by the end of calendar year 1974. I would like to describe briefly some of the experimental and operational systems which the Center is currently supporting.
Satellite Networks: . . . a modern communications technology . . . in Alaska [where] residents are widely dispersed in geographically remote regions, health professionals are few and far between, and conventional radio communications are unreliable. . . . The Lister Hill Center set out over two and one-half years ago to demonstrate the potential of satellite communications for improving health care and education. We funded an experimental voice network linking over twenty Alaskan native villages with Indian Health Service hospitals and major medical centers.
The network, which employs a NASA Applications Technology Satellite (ATS-1) clearly demonstrated the benefits of improved voice communications for the health care of widely dispersed populations, [for example] an experimental communications link to the Indian Health Service's information service in Arizona. . . to obtain up-to-date medical records on patients. . . .
. . . In May NASA will launch an Applications Technology Satellite-F (ATS-F) [with] experiments [to] evaluate the effectiveness of live television consultation between physicians at the Indian Health Service Hospitals and health aides at several remote clinics in Alaska. In addition, with NLM support the University of Washington will use the ATS-F satellite to provide instruction for first-year medical students at the University of Alaska . . . in selected isolated rural areas of Washington.
Computer-Assisted Instruction (CAI): The Lister Hill Center is operating a national network to promote the sharing of programmed educational resources among medical institutions. University medical centers are connected through to the NLM national communications network. The use of their computers and programs are then offered to other institutions which integrate the programs into their own curricula, evaluate them, and produce additional "units" of instruction.
Cable TV: During FY 1974 the LHC introduced the concept of "cable television for health" to the elderly population of a public housing unit in New York City....
The aim of the project is to use cable TV creatively to reduce the social isolation of the residents and to disseminate health information to them. Operating on the premise that television is probably the most important communications medium in the lives of older people, the project will use a cable television system with interactive capabilities to establish two-way communication.
Senator Cotton. The other question that occurred to me is obvious, I guess. You have accumulations of data going way back to 1836?
Dr. Cummings. Sir, we have medical information that goes back before the time of Christ. The library was founded in 1836, but we have, over the years, acquired incunabula, the earliest printed records of medicine in all languages. In fact, our earliest items go back to Arabic, Hebraic, Mediterranean medicine, oriental medicine prior to the invention of the printing press: beautiful documents printed by monks' hands. It is really a remarkable collection. Immodest as it appears, it is probably the greatest collection of its kind in the world.
Senator Cotton. Well, that is indeed impressive. However, forgetting antiquity even going back to 1836, many medical theories or beliefs or practices throughout those years have proven to be fallacious and have been replaced by something new, so that you have in your files a great number of publications that are valuable only as historical value.
Dr. Cummings. Certainly, that is correct. Much of the world's earlier medical literature, in of light of modern thinking and modern science is no longer valid -- and you are correct in suggesting that it has historical importance in portraying at least, the concepts and thoughts of society at a particular point in history. These were all building blocks toward modern science. But we have the good and the bad.
Senator Cotton. But it is only the good that is useful to present practicing physicians and surgeons, and medical schools and so forth.
Dr. Cummings. That is true, and because of this, we use a distinguished body of physicians, scientists, editors, and librarians to examine the totality of the world's contemporary medical literature, and to identify that segment which they deem to be original, creative, substantive; and those articles are listed and indexed regularly on a monthly basis in our Index Medicus and in our card catalog.
I should add that we in the library do not pass judgment on whether a man's writing is good or bad, but try to identify, on the basis of long experience, those journals that are apt to contain the cream of medical knowledge.
Senator Cotton. . . . When Washington had pneumonia, the first thing a physician did was to bleed a patient, and they took I do not know how many ounces of blood from him, and he had this pneumonia attack and they took some more the next day and weakened him so that presumably he died fast.
What do you do with all of that information? That is historical.
Dr. Cummings. That information is kept in its original form as part of the archives, but the contemporary literature of medicine is the literature that the body of experts examines. It is the massive outpouring of today's writing that is used in medical practice or education that goes through the screening process.
Senator Cotton. And you say this interest is historical? It is pretty well completed and except for a place to house it, it ceases to be of use - we are not spending any taxpayers' money on it nor is it used except by scholars who are writing historically.
Dr. Cummings. It is used in the constant search and research for overlooked observations of the past. For example many of the scholars working for the Fogarty Center work intensively in the National Library of Medicine in an effort to reexamine observations which may have been interpreted or misunderstood, and from time to time new drugs based on old findings emerge. And so it is not a totally dead collection of historical material.
Senator Cotton. They occasionally find a pearl in the dust heap of the past?
Dr. Cummings. Yes, sir.
Senator Cotton. That has been overlooked.
Dr. Cummings. Yes, sir.
Senator Cotton. . . . Our current chairman was on the subcommittee while Mr. Hill was chairman, and also Senator Humphrey and others are deeply interested in what progress you made in designing the Lister Hill Center building. In fact I have a letter here from Senator Humphrey I will insert into the record.
United States Senate
March 20, 1974
The Honorable Warren G. Magnuson
Room 127 Russell Senate Office Bldg.
Washington, D.C. 20510
As you know, my outspoken and long-standing interest in the National Institutes of Health, particularly in the National Library of Medicine and its Lister Hill Center, is a matter of public record.
I have vigorously supported these essential research and health programs. Like you, I was privileged to work with one of the great authors and creators of health legislation, our former colleague Lister Hill.
It has occurred to me that it would be a great accomplishment if we could honor Lister for his inestimable contributions to health research in the ripeness of his life, by making it possible now to build and to complete the Lister Hill Building on the grounds of the NIH.
You will recall that the Lister Hill National Center for Biomedical Communications was authorized in the 90th Congress by Senate Resolution 193 in August, 1968. But no monies were appropriated at that time or since for the completion of the building, which would house the many innovative programs of biomedical communications and educational technology.
Aside from the honor that we would bestow on our good friend and former colleague, it is important to provide adequate space now for these important computer and educational technology programs, which will go far in developing methods to improve health care, medical education, and medical research.
One of the exciting and challenging operations now in progress at the Lister Hill Center is the continuing cooperation with NASA, the University of Washington, and Stanford University. This program which uses satellite communications technologies to conduct and expand technical experiments, permits verbal consultation and data transmission between physicians in remote areas in Alaska, the medical facilities of the University of Washington, and the NLM. This activity and others need appropriate and adequate space for their developing experiments and research. . . .
I hope it will be possible during this session of the Senate for your Health Subcommittee to recommend an appropriation for this structure on the NIH campus as a part of the National Library of Medicine.
The architectural drawings were finished last November and detailed architectural plans already are being developed. It is expected they will be complete by the first of the year. So there really is a timeliness in getting the appropriation as soon as possible for this facility.
Hubert H. Humphrey
Interview with Martin Cummings, MD, Director Emeritus, National Library of Medicine, 1964-84; by Cheryl Dee, PhD, 2010-11.
Rockefeller Public Service Award
Dr. Dee. Dr. Cummings, you were given the Rockefeller Public Service Award, the highest honor given to those in U.S. Government Civil Service. I know you do not like to talk about your awards but do you have any comments?
Dr. Cummings. I shared the Rockefeller Public Service Award with my colleague Dr. Ruth M. Davis [Institute for Computer Science and Technology]. The Award is given to individuals selected from the entire U.S. Government Civil Service and represents a special place in my memory. The Award was established by the Rockefeller Foundation and administered by the Woodrow Wilson School of Public and International Affairs at Princeton University. The Rockefeller Award represented a significant amount of money to the awardees and afforded recognition for work which was done by the Lister Hill Center for Biomedical Communication.
Fogarty International Center
Dr. Dee. Dr. Cummings, please tell us about your background as it relates to the Fogarty International Center.
Dr. Cummings. In 1960 I joined the National Institutes of Health as Chief of the Office of International Research. I served in this capacity for several years. The Office has the responsibility for monitoring and coordinating all NIH grants and contracts overseas. The program was large enough to justify the creation of offices in India, Great Britain, France, and Brazil.
The Congressman who was most interested in the NIH international program was John Fogarty of Rhode Island. This program came as a result of interest on the part of President John F. Kennedy in international medical affairs. The Central Office had no formal facilities to entertain international meetings and other related activities. For this reason we decided to seek funding for the creation of a place that could serve as headquarters for international affairs and provide opportunities for foreign students and scholars to work in the field. The idea of a special center for this purpose emerged. With the support of the Director, the National Institutes of Health acquired a very fine former mansion on the campus and was made available to serve this purpose as a headquarters for international affairs while NIH developed the justification for obtaining funds to create a new building. Several years after my departure this concept was fulfilled when the Congress decided to honor John Fogarty on his retirement by providing a building in his name. As a result a splendid new Center for international research was created which stands across the street from the site of the National Library of Medicine.
Hubert H. Humphrey
Dr. Dee. Dr. Cummings, I included the letter from Hubert H. Humphrey in the material that I sent to you. It is clear from his letter that he was a strong supporter of the funding of the construction of the Lister Hill National Center for Biomedical Communications.
Dr. Cummings. Hubert H. Humphrey was a valued supporter of the National Library of Medicine. He wished to see the development of a national system which dealt with toxic effects of drugs and chemicals on man. He spoke for and asked for funding from 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. Senator Humphrey retained a keen interest in the work of the National Library of Medicine. Senator Humphrey's interest was a valuable part of the Lister Hill National Center for Biomedical Communications and he was supportive during many years when access to increasing budgets became difficult. The letter from Senator Humphrey you included for me is an important piece of history.
Dr. Dee. Dr. Cummings, you announced a valuable addition to the MEDLINE database, the author abstracts. Speaking as a medical librarian and researcher I am very grateful for the abstracts.
Dr. Cummings. NLM was very proud to offer this useful searching capability for health professionals and librarians. We considered it a milestone in rapid access to biomedical research. No longer would the researchers have to wait for the journal article; the researcher could now obtain an excellent summary of the article electronically when they needed the information.
Dr. Dee. You pointed out in the Testimony that MEDLINE services were used by 225 institutions in 46 states and internationally by eight foreign countries. You make an additional statement that in return for MEDLINE service foreign centers provide the equivalent of $250,000 in indexing of foreign language journal literature for input into the MEDLARS data base.
Foreign Countries Contribution to MEDLINE
Dr. Cummings. The exchange for MEDLINE services for the foreign countries indexing and services is a vital point. We were providing valuable MEDLINE access to countries that needed MEDLINE capabilities but we were not giving free services to these countries. The countries provided NLM with a much needed service, the indexing our foreign language journals.
SDILINE, CATLINE and SERLINE
Dr. Dee. Dr. Cummings, this Testimony gives an excellent summary of MEDLINE and the implementation of SDILINE, CATLINE and SERLINE. Do you have any comments additional comments?
Dr. Cummings. With the advent of MEDLINE, it became possible to develop specialized library operations and publications to better serve user needs. They were named SDILINE, CATLINE and SERLINE.
I want to give credit to Dr. Joseph Leiter and later Mrs. Betsy Humphreys who were the administrative and technical leaders of the first databases used for this purpose. Both did superior work to develop these valuable resources.
Dr. Dee. Dr. Cummings, do you have any comments on the copyright issue in 1974?
Dr. Cummings. Although the National Library of Medicine was vindicated by the judgment of the District Court of Claims, it still appeared that existing legislation was so far out-of-date that it seemed to us desirable that Congress re-examine the entire copyright issue and create new legislation which would clarify the rights of library users and those of publishers.
The Lister Hill National Center for Biomedical Communications
Dr. Dee. This testimony reports that this was the year that the 1968 Joint Resolution 193 was signed into law creating the Lister Hill National Center for Biomedical Communications.
Dr. Cummings. These were very stimulating times. Dr. Davis and her able staff accomplished innovative and broadly applicable resources that paved the way for many future projects.
Dr. Dee. Dr. Cummings, I provided a summary of the Lister Hill National Center for Biomedical Communications projects for you to review. I included the NASA Applications Technology Satellite (ATS-1) that allowed the use of an experimental communications link between physicians at the Indian Health Service Hospital in Arizona and health aides at remote clinics in Alaska to obtain up-to-date medical records on patients. Would you consider this particular project a forerunner to the current electronic medical records?
Dr. Cummings. The experiments with linking hospitals and related institutions using electronic communications were a primitive prototype to demonstrate the importance of rapid sharing of patient records between physicians and institutions.
Dr. Dee. After the Lister Hill Center was signed into law according to the testimony, I know there was more work to do.
Dr. Cummings. The Lister Hill National Center for Biomedical Communications had become an important part of the Department of Health, Education, and Welfare. The program was designed for the development and coordination of communication networks and systems to improve health education, medical research and the delivery of health services. At the time the Center was signed into law Dr. Ruth Davis and her staff accomplished many advances in biomedical communications technology from this program. At this point the Center had developed satellite networks in cooperation with NASA, university medical centers with strong computer-assisted instruction programs were connected to the National Library of Medicine's national communications network, and the Lister Hill Center had introduced cable-television to help the elderly in in New York City. The Lister Hill Center tested the application of advanced communications technology to help the community at large with medical information problems.
However, the full potential of the program was yet to come with the construction of the Lister Hill building.
NLM History of Medicine Collection
Dr. Dee. Dr. Cummings, I know that as an interviewer I need to remain unbiased; however, I personally thought that you made brilliant political responses to the questions from Senator Cotton when he questioned you about the library's storage of historical documents that contained medical documents that were no longer valid. You turned his challenges into an opportunity to showcase the NLM History of Medicine collection.
Dr. Cummings. The dialogue with Senator Cotton about the NLM's collection of historical documents presented a unique opportunity to defend the importance of the studies in the field of the history of medicine. It is hoped that in the future there is a better understanding on the part of legislators on the values derived from studies of the history of medicine.
- 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.
- Humphreys, Betsy L., Deputy Director, National Library of Medicine. https://www.nlm.nih.gov/od/roster/humphreys.html.
- Leiter, Joseph Kotzin, Sheldon, "Joseph Leiter, FMLA, 1915-2005." J Med Libr Assoc. 2005 October; 93(4): 512-513. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1250335/.
Institutions and Programs
- Fogarty International Center. https://www.fic.nih.gov/Pages/Default.aspx.
- Joseph Leiter NLM/MLA Lectureship. https://www.mlanet.org/awards/honors/leiter.html.
Articles and Oral Histories
- Bell, CL. "A SERLINE-based union list of serials for basic health sciences libraries: a detailed protocol." Bull Med Libr Assoc. 1982 October; 70(4): 380-388. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC226745/.
- Ellison, D., Betsy L Humphreys, Joyce Mitchell. "Presentation of the 2009 Morris F. Collen Award to Betsy L Humphreys, with remarks from the recipient." J Am Med Inform Assoc. 2010 July; 17(4): 481-485. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995660/.
- Humphreys, BL. "Adjusting to progress: interactions between the National Library of Medicine and health sciences librarians, 1961-2001." J Med Libr Assoc. 2002 January; 90(1): 4-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC64753/.
- Rockefeller Public Service Award, picture of Princeton President William G. Bowen (left) presenting the Rockefeller Public Service Award to NLM Director Dr. Martin M. Cummings. Sponsor of the award is John D. Rockefeller, III (pictured on the right). National Library of Medicine Programs and Services Fiscal Year 1974, page 11. https://www.nlm.nih.gov/hmd/manuscripts/nlmarchives/annualreport/1974.pdf.