no single agency can do the job. Only a cooperative effort by the medical schools, the Federal and State Governments, and private organizations can do the job that has to be done.

Mr. Chairman, in all the years we have worked together on health legislation in these two decades-I can't recall a health measure that had more unanimous support than is enjoyed by this measure. In part this is a tribute to the care with which this legislation was written. It wisely assumes that private, local, and State resources will continue to carry most of the expense of our Nation's library system. At the same time it assumes that the leadership role of the National Library of Medicine should be recognized, utilized, and strengthened.

I need not review before this group all the details of the Medical Library Assistance Act of 1965. I would like to summarize its major provisions to emphasize in specific terms how this measure would benefit the health of the American people.

First, funds for the construction of facilities.

Second, grants for training in medical library information science.

Third, assistance to special scientific projects, such as studies in the history of medicine.

Fourth, research and development in medical library science and related fields.

Fifth, grants for improving and expanding the basic resources of medical libraries and related instrumentalities.

Sixth, grants for establishment of regional medical libraries. Seventh, financial support of biomedical scientific publications. These specific provisions of the bill will enable our health professions to utilize to a higher degree than ever before the fruits of research which are being produced in greater quantity. If I may, I would like to suggest-in order to remove any doubt as to the application of this measure and to clarify the intent of this body-that the term "sciences related to health" (p. 3, line 21, H.R. 6001) be amended. to include optometry. This specialty is being increasingly recognized as a vital part of the entire field of professions related to health. Now, this bill recognizes that the chronic neglect of the Nation's medical libraries has reached the point where significant Federal assistance is needed to build up libraries to a reasonable standard. In addition, it will promote the acquisition of new types of equipment for the processing of materials. In this connection, it is interesting to consider the role to be played by regional libraries to be established under one section of this bill.

These regional libraries will collect materials in depth and make their resources and services available to other medical libraries in broad geographic areas so that resources of the smaller libraries can be limited to the most used class of materials. Even with the efficiency and economy which the regional medical library mechanism will foster, the need for basic resources will be tremendous.

Mr. Chairman, just 2 months ago you and I-along with that great statesman for health, Senator Lister Hill, and others--were honored by taking part in the John Shaw Billings Centennial marking the first century of the existence of the National Library of Medicine. I recall that in your speech presented by the distinguished Representative from New York, Leo O'Brien, you made an excellent reference

to the role the regional libraries will play in fostering American medical education.

You noted that, in addition to the 81,000 medical students, interns, and residents, there are an additional 170,000 students of dentistry, nursing, osteopathy, public health, and other health sciences who need library services. You were making a point which should never be forgotten-which we in Congress have a special duty to rememberthat is, that these young people and their institutions are scattered all across this Nation, and all require access to the medical literature for their training and education.

The need for regionalization has become acute with the growth in the magnitude of the medical literature and the speed with which information is required. As you know, the National Library of Medicine is serving as a libraries' library in meeting the needs for increasing amounts of materials which local medical libraries do not have on their shelves. Assistance in meeting the need for local library resources will help relieve this problem.

The development of a system of regional libraries locally operated and controlled but with Federal assistance in the collection of materials and equipment and staff will do much to make for the maximum use of scarce trained medical library manpower while assuring fast, quality library service.

And if in some region of the Nation there is not now some medical library adequate to serve area needs, regional libraries may be established as branches of the National Library of Medicine for that purpose.

The National Library of Medicine has had more experience than any library in the world in providing library services in the medical area, and its splendid reputation is international. The NLM will provide the kind of leadership needed-and is prepared to do so just as quickly as this medical library assistance bill is signed into law.

When this measure comes before the House I think it is important that our colleagues be made aware immediately that medical libraries are the leaky and already flooded reservoirs into which are flowing the many research accomplishments of our increasingly productive national biomedical research effort. Equally important, I think, is that they be made aware of the extraordinary unanimity of support this measure enjoys. It has not only the endorsement of all those directly concerned the Medical Library Association, the Special Libraries Association, the Association of Research Libraries, the Association of American Medical Colleges-it also has the support of the voluntary health agencies such as the American Heart Association and the professional organizations such as the American Dental Association, American Public Health Association, and the American Medical Association.

Yes; let me emphasize, the American Medical Association joins in the support of this measure. Our colleague, Senator Hill, was informed earlier this year through testimony before the Senate Committee on Labor and Public Welfare that the AMA strongly supports the intent and purposes of this measure.

Enjoying the support of such varied elements-governmental and voluntary, academic, professional organizations-this measure cannot fail to pass this Congress.

As we consider the many humanitarian measures coming out of Congress this session-under the leadership of our health-oriented

President-it is imperative that we improve the flow of new medical information from the Nation's laboratories to this Nation's physicians, who are moving in on the domain of disease. There is only one way to do this, and that is by repairing our medical library system and bringing it up to date. Libraries must be helped to channel the information that is flowing into them at an accelerating rate in such ways that the knowledge they are receiving may pass on to irrigate the vast regions of man's ignorance. When these reservoirs of knowledge are used as they can and should be used, medical research, medical education and above all, medical practice-will flourish as never before.

Mr. STAGGERS. Thank you for your testimony, Mr. Fogarty.

Mr. FOGARTY. Thank you for the opportunity, Mr. Chairman. Mr. STAGGERS. Next we will hear from Dr. Luther L. Terry, Surgeon General of the Public Health Service.

Dr. Terry, you may proceed.

STATEMENT OF DR. LUTHER L. TERRY, SURGEON GENERAL, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY DR. EDWARD W. DEMPSEY, SPECIAL ASSISTANT TO THE SECRETARY, HEALTH AND MEDICAL AFFAIRS; AND WILBUR J. COHEN, ASSISTANT SECRETARY FOR LEGISLATION Dr. TERRY. Thank you, Mr. Chairman.

Under Secretary Wilbur Cohen is our principal witness. If we may, we would like to open with his testimony, sir.

Mr. STAGGERS. Yes, sir. You may proceed as you see fit. We would like to identify for the record all the gentlemen you have with you, please.

Mr. COHEN. Mr. Chairman, on my left is Dr. Luther Terry, the Surgeon General, Public Health Service. On my right, Dr. Edward Dempsey, the Acting Assistant Secretary for Health. On my far right, Dr. Martin Cummings, the Director of the National Library of Medicine. On the far left is Mr. Ralph Huitt, the Assistant Secretary for Legislation.

Mr. Chairman, I have a statement, and Dr. Dempsey and Dr. Terry have statements. My suggestion would be that all three of these be printed in the record, in compliance with your request. Then I think each of us will make a brief statement which will summarize our views.

Mr. STAGGERS. That certainly is agreeable with the committee, Mr. Cohen.

Mr. COHEN. I think the basic argument as to why we are strongly in favor of this legislation, Mr. Chairman, is contained in the paragraph in my testimony on the top of page 3. I think by reading this one paragraph I can summarize the whole argument that is in favor of this legislation.

The plight of the Nation's medical libraries is critical. During a period of intensive development of health research institutions, medical schools, and other medical facilities, support for medical libraries has been seriously neglected. The condition of medical libraries has steadily deteriorated under the pressures of rapid development of other programs and activities of medical institutions, most of which make increasing demands upon the medical library. In addition, the

broadening base of medical research and practice, calling for literature from many ancillary fields, has added to the magnitude and complexity of medical literature. Medical libraries are cramped for space, critically deficient in trained manpower, deplorably inadequate in resources and desperately in need of new methods for handling the growing medical literature. A large-scale national effort is needed now to rehabilitate medical libraries.

For that reason, Mr. Chairman, we wholeheartedly support the bill pending before you today and urge its prompt enactment. (Mr. Cohen's full statement follows:)

STATEMENT BY WILBUR J. COHEN, UNDER SECRETARY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Mr. Chairman and members of the committee, before I comment on the legislation before you today, I wish to take this opportunity to thank all the members of this committee, and particularly its distinguished chairman, on behalf of the administration for the leadership and vision which you have shown in the consideration and enactment of very important health legislation during this session of the Congress. I sincerely believe that your efforts will be rewarded by the improved health of the American people. We, in the Department of Health, Education, and Welfare, are grateful for the splendid cooperation we have received from this committee.

I appear before you today in support of H.R. 3142, the Medical Library Assistance Act, introduced by Chairman Harris.

Among the bills which you have considered during this session are those which would:

Expand the Nation's capacity for education in the health professions, Establish regional programs which would serve to further research into the prevention and treatment of the killer diseases-heart disease, cancer, and stroke and bring the fruits of this research more rapidly to their victims through improved diagnosis and treatment,

Extend the effectiveness of our health research institutions through the provision of improved research facilities.

These and other programs which have come before you are estremely significant in terms of better health for all of us. These programs may not fully succeed, however, unless there is a very considerable improvement in society's mechanisms for the communication of health information.

In the field of health, the keystone of this communication system is the biomedical library. We are investing large sums of money in programs of research, education, and health services. Unless the research scientist has available complete and up-to-the-minute information in his field, progress in the understanding of disease and disability will be slowed. Unless the physician has the latest and best information on diagnosis, treatment, and rehabilitation, the well-being of the patient may be at stake. Unless our students in the health professions have available to them adequate facilities and resources during their education, the quality of their training may be affected, and the consequences serious and far reaching.

The library has been established as the major learning resource of univeristies for centuries. I know from my own experience as a teacher that the library is the place where the past and the present meet. It is also the source of ideas for the future for the faculty, students, and researchers. Medicine, as part of society, needs library resources to capitalize upon the technical, cultural, and educational advances which take place everywhere. We must not allow the progress of medicine to be impeded for lack of support of this vital activity.

The plight of the Nation's medical libraries is critical. During a period of intensive development of health research institutions, medical schools, and other medical facilities, support for medical libraries has been seriously neglected. The condition of medical libraries has steadily deteriorated under the pressures of rapid development of other programs and activities of medical institutions, most of which make increasing demands upon the medical library. In addition, the broadening base of medical research and practice, calling for literature from many ancillary fields, has added to the magnitude and complexity of medical literature. Medical libraries are cramped for space, critically deficient in trained manpower, deplorably inadequate in resources and desperately in need of new

methods for handling the growing medical literature. A large-scale national effort is needed now to rehabilitate medical libraries.

The bill would authorize the Surgeon General to make grants of up to 75 percent of the costs of constructing, renovating, expanding, or remodeling medical library facilities. In acting upon applications for grants, consideration would be given to the relative effectiveness of the proposed facilities in meeting demonstrated needs for additional or improved medical library services, and priority would be given to projects for construction of facilities for which the need is greatest. For these purposes, the bill would authorize appropriations not to exceed $10 million a year for a 5-year period beginning with fiscal year 1966.

One of the most critical needs of medical libraries is for space in which to maintain their collections and to carry out their necessary day-to-day operations. The chronic shortage of shelf space precludes the acquisition of essential additional books and materials each year. Crowding obstructs and often completely prevents access to the volumes on hand. Working space for library staffs is so restricted as to be a real barrier to effective operations (many medical libraries are so crowded that there is not even space for desks for the staff), and many libraries lack the space for up-to-date processing and laborsaving equipment. The need for space is desperate and of great magnitude. However, in order to make the most effective use of the funds that will be available for this program, we believe that initiation of the construction program should be preceded by a study of the kinds of facilities which will be most suited for meeting present and future requirements in the light of rapid technological advances. To allow time for such a study, and at the same time achieve the full objective of the construction program envisaged by the bill, we recommend that this provision of the bill be amended to provide for a 4-year construction program, beginning with fiscal year 1967, with annual appropriation authorizations of $12.5 million.

The Department believes that the Medical Library Assistance Act now before you would provide a comprehensive and imaginative program for correcting the deficiencies of the biomedical libraries of the Nation and would thereby strengthen our efforts in medical research, education, and practice.

I would like to assure the committee of the enthusiastic support of this bill by the Department with the one or two modifications we have suggested to you in our report. We are convinced that unless such a program to improve our medical libraries is undertaken, other health programs may be seriously imperiled. I urge enactment of this measure so that the very pressing problems of the communication of biomedical information may be met head on and the health of our Nation may be advanced accordingly.

Mr. COHEN. Mr. Dempsey.

Dr. DEMPSEY. Mr. Chairman, like Mr. Cohen, I would like to urge enactment of the bill and to indicate that it has the complete support of the Department, and that it is, in my opinion, greatly needed to assist the libraries in medical institutions in our country to do the job now before them.

There is a very real need for this legislation. The number of librarians who are trained as medical librarians in the United States is totally inadequate to staff the libraries that now exist. There are about 6,000 libraries, there are only 3,000 trained medical librarians, and we are training only at the rate of about 50 medical librarians per year.

The use of the libraries to assist the practicing profession has grown enormously in the past years. The great additional use of interlibrary loans as a mechanism to provide information to medical schools, to hospitals, and to centers of medicine in localities in which their own libraries are inadequate attests to the need for a greatly improved library system than we have now.

There are many other ways in which I could illustrate the plight of libraries and indicate how valuable the assistance that would be provided under this bill would be. But in the interest of time, I would simply like to emphasize again the Department's support of this bill and to indicate that to the best of my knowledge virtually every

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