XXV

Extensions of Traditional Library Services

HE additions of MEDLARS, the Lister Hill Center, the grants program,

TH

the National Medical Audiovisual Center, and the Specialized Information Services to the basic library structure were the major events within the National Library of Medicine during the 1960's and 1970's, but other important activities occurred during this period.

The Library strengthened its resources in subjects allied to medicine in order to improve its ability to render services to all health practitioners. An increased emphasis on dental literature was catalyzed by two regents: George W. Teuscher, dean of the School of Dentistry at Northwestern, and Russell A. Dixon, head of the School of Dentistry at Howard. Teuscher and Dixon heightened Cummings' awareness of the needs of the dental profession, and in July 1965 he recruited Kenneth C. Lynn, a PHS dental officer, as NLM's coordinator for dental affairs. Lynn helped define the scope and coverage of the dentistry collection, made arrangements for the American Dental Association to cooperate in refining the MESH terminology, assisted in organizing conferences on continuing education in dentistry, represented the Library at dental meetings, reviewed NLM publications relating to dentistry, and furthered the interests of the dental profession in other ways. The new emphasis on the subject also benefitted from the advice of Dixon, whom NLM retained as consultant-inresidence on dental affairs. Through its agreement with the American Dental Association, NLM was provided with the services of two dentists, Faith Stephan and Raquel Halegua, who indexed for Index Medicus and Index to Dental Literature and developed the dental vocabulary for MESH. Within a relatively short time the Library was providing greater support than ever before for the dental profession.1

Improvements in the collection of veterinary literature were stimulated by James Steele, the chief veterinary officer of the Public Health Service. Steele, talking to Cummings, emphasized the importance of NLM to his profession, and pointed out that neither NLM nor the National Agricultural Library completely satisfied its needs. Cummings conferred with Foster Mohrhardt of the Agricultural Library, and the two agreed that their institutions would cooperate in developing the scope and coverage of their veterinary health sciences collections, so that between them they would cover the subject completely, with

minimum duplication. Cummings recruited Fritz P. Gluckstein as coordinator of veterinary affairs. Gluckstein, a veterinarian, who had been chief of the Microbiology Branch, Science Information Exchange, Smithsonian Institution, came to NLM in January 1966. He brought to the Library a philosophical point of view that permitted the institution to serve veterinary medicine without becoming involved in subjects properly belonging to Agriculture, and he made a careful study of the scope and coverage policy, differentiating the literature that the Library of Medicine and the Agricultural Library should each acquire. The Library set up a panel on veterinary medicine composed of representatives of NLM, the National Agricultural Library, and the American Veterinary Medical Association to develop an authoritative, precise vocabulary of veterinary terms for use by both libraries and for MESH. As the Library's support of the veterinary profession improved, more and more veterinarians came to rely on NLM for information.2

To accommodate writers, historians, literature researchers, and others who needed library facilities for long periods of time, Cummings in 1964 expanded the offices set aside for them in the stacks. This had been desirable earlier but not possible because of lack of space in the old building. Among the first to use the facilities were Stanhope Bayne-Jones, writing about the history of preventive medicine in the Army during World War II; James P. Leake, revising manuals on smallpox and vaccination; Bess Furman Armstrong, compiling a popular history of the Public Health Service; and Robert Pollitzer, the WHO expert on plague. A few years later the Library established a formal Scholarsin-Residence Program. Appointments were made by the Board of Regents. Researchers were provided with offices and reference assistance. The first scholars were Fred L. Soper, epidemiologist, former director of Pan American Sanitary Bureau and WHO Regional Office for the Americas, studying the evolution of international health; and Harry F. Dowling, former professor at George Washington University and University of Illinois medical schools, author of works on drugs, researching the history of drug regulations.3

The continued expansion of the mission, personnel, and facilities of the Library made necessary major and minor changes in its organizational structure. Molded by Rogers in 1960 into five operating divisions and an Office of the Director, the structure was revised again in 1962 following recommendations of the Study Group on Mission and Reorganization of the Public Health Service. In 1964 as a result of a decision of the Comptroller General and the opening of MEDLARS, the staff rewrote NLM's functional statement and divided the operations among seven divisions. The following year a management analysis, requested by Cummings, led to a major reorganization; the five service divisions were grouped into an Intramural Program (later Library Operations) and three new grants divisions in an Extramural Program, each program under an associate director. In 1967 the two programs were joined by the Toxicology Information Program (later Specialized Information Services), the Research and Development Program (later the Lister Hill Center), and the National Medical

Audiovisual Center, all under associate directors. On April 1, 1968, the Library, which had been under the Office of the Surgeon General of the Public Health Service since 1956, was made a component of the National Institutes of Health. The five programs, along with the Office of the Director and Office of Computer and Communications Services, remained the basic units of the organization, alterations thereafter consisting of shifts and regroupings, additions and deletions of groups, and changes in name.1

CONTINUING EDUCATION

Before midcentury county medical societies and hospital staffs played the major role in stimulating the continuing education of physicians although large medical societies such as the American Medical Association, American College of Surgeons, and American College of Physicians held annual meetings for the purpose. In the 1950's and 1960's medical school facilities increasingly cooperated in the process of continuing education by presenting courses for practitioners. In 1955 the Council on Medical Education established an advisory committee on continuing medical education, which later reviewed programs on continuing education and accredited organizations that presented them.

Like every other medical library, NLM played a passive role in continuing education by providing literature to health workers keeping up with advances in their professions. Cummings took steps to change the role to an active one. He sought advice from those who had given thought to the subject, including Bernard V. Dryer, who had recently written Lifetime Learning for the Physician. In August 1965 he appointed a committee, headed by Carl Douglass, to consider the ways in which NLM could assist physicians, dentists, nurses, dietitians, medical librarians, and other health professionals desiring to further their education. A short time later he created a new position, continuing education officer, and brought Burnet Davis from the Public Health Service to fill the post. In November the interest of William Hubbard, Jr., and other Regents was reflected in a recommendation that NLM should develop and support, directly and through regional and local medical libraries, research, experiments, and demonstrations to improve techniques for the continuing education of health workers.

To obtain suggestions for a program, Douglass and Davis organized a meeting of leaders in medical education in January 1966. Following this meeting NLM moved ahead internally and externally. Within, it began to arrange conferences with professional societies, and it installed facilities for self-instruction in the main reading room. The first of these was an audiovisual carrel equipped with rear-screen motion picture projectors and earphones. The collection of audiovisuals was broadened and placed in the carrel. A year later a television set with earphones was installed, and videotapes, including those from the Network for Continuing Medical Education, were made available. The area was finally enlarged to contain three soundproofed carrels where patrons could study using the latest audiovisual equipment and a wide variety of instructional

One of the Library's learning resource carrels, in which patrons could view and listen to a wide variety of medical and audiovisual materials, including 35 mm slide/audiotapes, video cassettes and 16 mm films.

materials. These carrels not only served local users, they provided NLM with experience and served as demonstration models for other libraries.

While facilities in the Library motivated health workers in the Washington area to continue their education, encouragement to persons elsewhere was rendered through the grants program. Grants for resources stimulated libraries of community hospitals, professional societies, and medical schools to acquire audiovisual programs, microfiche readers, slide projectors, microfilm readers, tape recorders, and other equipment and materials for regular and continuing education. Grants for research enabled medical institutions to develop techniques for reaching the practitioner through visual materials, programmed instruction, and other means. 5 Grants for training permitted staff members of libraries to seek instruction in the use of new learning materials and equipment, to serve practitioners better. Each regional library that was assisted under the grants program was expected to support continuing education within its region."

In addition to awarding grants to encourage medical libraries to assist in continuing education, NLM also provided materials for, and it demonstrated the usefulness of modern communications systems in, continuing education. Through the National Medical Audiovisual Center it cooperated with professional societies, medical schools, and the Association of Professors of Gynecology and Obstetrics in developing audiovisual courses. It provided instruction in the production of high quality courses. It produced audiovisuals for distri

bution at reasonable prices, and it compiled catalogs to assist users in locating appropriate instructional materials. The Lister Hill Center cooperated with schools and organizations, among them the Universities Associated for Research and Education in Pathology, in creating materials and models for regular and continuing education. It demonstrated the use of a computerized instructional network linking schools, hospitals, and organizations. It applied satellites and broadband television in regular and continuing education. It developed the Knowledge Base Research Program, an interdisciplinary research program involving the design, demonstration, testing, and evaluation of computerized knowledge bases in specialized areas to achieve a more rapid transfer of new medical information to health professionals, particularly physicians.

Continuing education cut across most of the divisional lines in NLM's organizational structure. Therefore to oversee the program Cummings enlisted Ralph P. Christenson as successor to Burnet Davis, and in 1970 he appointed Harold M. Schoolman, former director of the Veterans Administration Education Service, as a special assistant and later as deputy director for research and education. Schoolman provided liaison between NLM and outside organizations and between NLM divisions in matters of continuing education.

Continuing education was in its infancy when the Library began its efforts to assist health professionals who desired to learn in their homes, offices, hospital libraries, or local medical libraries at their own pace, at times convenient to them. The Library attempted to respond to and to stimulate the recognition of the importance of the information component of all continuing medical education activities. It was the unresolved problems of continuing medical education that made the results of NLM's efforts less than was hoped for.8

INTERNATIONAL COOPERATION

From the 1950's onward the institution was to render much more technical assistance to medical libraries in other countries than ever before. This was owing to several circumstances, among them the policy of the United States in assisting other nations, the development of rapid communication that brought countries of the world closer together, and the policy of the Library, from its infancy, to cooperate with and assist other libraries at home and abroad as far as its resources would permit. Relationships with other countries grew so numerous, diversified, and important that Cummings established the position of special assistant to the director (later assistant director) for international programs in October 1967, and appointed Mary Corning to the post. Corning carried out subsequent negotiations for the establishment of MEDLARS and MEDLINE in other countries and assisted in planning, developing, and coordinating NLM's international activities.9

Members of the staff assisted institutions in many countries with technical advice. In accordance with President Johnson's commitment to the government of South Korea, Scott Adams and two members of the Board of Regents, William