professional organization in the health field has endorsed the need for this legislation. There is a wide recognition of the need for and there is confidence in the proposed solution to the problem. We urge the enactment of H.R. 3142.

Thank you.

(Dr. Dempsey's statement follows:)

STATEMENT BY EDWARD W. DEMPSEY, ACTING ASSISTANT SECRETARY,
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Mr. Chairman and members of the committee, I appear before you today in support of H. R. 3142, the Medical Library Assistance Act, which was introduced by Chairman Harris. The need for the enactment of this legislation is quite apparent when one considers the vital and overwhelming needs for information which are being generated by the expanded health programs of the Nation, both public and private. Before speaking about the provisions of the bill, I must underscore the fact that we in the Department believe that there is real need for this legislation.

The report of the Secretary to the chairman of this committee on H.R. 3142 sets forth in detail the Department's support of the specific provisions of the bill. I should therefore like to outline the provisions for you briefly this morning, and emphasize some of the things the bill would accomplish.

The bill would authorize grants-in-aid of up to 75 percent of the costs of constructing, renovating, expanding, or remodeling biomedical library facilities. We believe that this section of the bill is directed at one of the most serious problems of the libraries. More than 50 percent of all medical school libraries were constructed more than 30 years ago, long before the publication explosion was anticipated or felt. The Association of American Medical Colleges has conducted a survey of the medical libraries of their member schools to determine what their needs might be. They found that at the present time the average medical school library occupies about 18,000 square feet. This is less than one-half the amount of space required to operate a modern medical library. In many libraries there is crowding to the point that routine day-to-day activities are impeded, access to materials is made difficult or impossible, and the utilization of the libraries by scientific and medical personnel and students is inhibited. Construction grants are needed.

However, since the technology of library science has shared in the technological revolution of the last few decades, we feel that the construction program should be preceded by a careful study of the kinds of facilities which will be best suited to meeting present and future requirements in the light of these rapid technological developments. We have, therefore, recommended in our letter to you, Mr. Chairman, that this provision be amended for this purpose.

The contribution that biomedical libraries can make to the advancement of medical knowledge and medical service is directly related to the caliber and number of people who staff them. There is a tremendous deficit of professionally trained manpower in this field. For example, there are more than 6,000 medical libraries in the country today, but only about 3,000 medical librarians with any specialized training or experience are available to staff them. Trained medical librarians are being produced today at a rate of less than 50 per year, a number which replaces only a fraction of those lost by attrition.

The bill would authorize the Surgeon General to make grants to assist in the training of medical librarians and other information specialists in the health sciences. Today it is essential that the personnel responsible for the operation and future planning of the medical libraries have special training in medical librarianship. This training must be related to the specialized communication problems of the medical community. They must be well grounded in the biomedical sciences, and they must be thoroughly familiar with the design of technical information systems. Many of those presently staffing health sciences libraries are in need of intensive specialized training in order to increase and update their competence. The urgency to begin action programs in this area cannot be overstated.

The requirements of health sciences libraries for books, journals, and other resources is of such magnitude and so directly related to medical research, to the training of professional health manpower, and the information essential to the practicing community as to require special, intense attention immediately if our fundamental responsibilities for a healthy nation are to be fulfilled. In a study

made in 1963, it was found that only 14 of the 87 existing medical schools met the standards for number of volumes for medical school libraries. Published information is of little value unless it is available to those who need it when they need it.

Two sections of the bill are directed at aiding in making more and better resources available to local biomedical libraries. One of these would authorize the Public Health Service to make grants on a matching basis to expand and improve basic biomedical library and related resources. These grants would be limited to 5 years for any institution and would decrease each year. The other section of the bill is designed to increase the availability of books, journals, and other informational material to local libraries through the support of regional libraries. Grants under this section would be made to major health science libraries which would agree to provide supportive services to other libraries in the region. These grants would be made to suitable existing biomedical libraries. Where there are areas of the country in which there are no existing health science libraries of sufficient strength to serve a regional community, the bill authorizes the establishment of branches of the National Library of Medicine. The need for this regional service has become acute with the growth in the size of the medical literature and with the need for increased speed of access to it.

Presently the National Library of Medicine is serving as the libraries' library in meeting the requirements for increasing amounts of material which local medical libraries do not have on their shelves. This function of the National Library of Medicine has reached such proportions as to make mandatory the assumption of a part of the responsibility elsewhere. Regional health science resource libraries, in lending such assistance to the local libraries, would help materially in solving this problem, while taking account of the fact that it is neither economically feasible nor necessary for each biomedical library to try to build its collection to encompass the whole of the biomedical literature. Such a program would also serve to prevent the growth of a highly centralized, monolithic system of library service which could not be as responsive to local needs as could a decentralized system.

Many of the tools and methods used today to operate health science libraries are hopelessly inadequate. Research and development is required to devise new and more efficient techniques to deal with biomedical information requirements. The bill would authorize the award of grants and contracts to accomplish this. The bill would authorize a program of grants and contracts for support of nonprofit publications and to procure the preparation and publication of reviews, abstracts, indexes, handbooks, bibliographies, and other forms of secondary publications. Effective access to the medical literature requires a variety of these forms of publications. This is particularly true now that the biomedical literature is so complex and voluminous.

This increase in complexity and volume of the literature has given rise to the need for a program of support for individual scholars for the preparation of critical reviews and similar compilations of original contributions of a high degree of excellence and reliability. These works are needed to make more readily available to the biomedical community knowledge of advances in the health sciences which have been carefully evaluated and interpreted by experts in the particular field. The bill would authorize a program of grants to scholars in the medical sciences to accomplish these ends.

All sections of H.R. 3142 are interrelated and together constitute a comprehensive plan which can effectively repair the devastation of many years of neglect, maximize the resources, functions, and services which do exist, and bring biomedical library practice and facilities to the frontiers of knowledge and capability, both theoretical and practical. in this field.

The existing informal health science library network is a logical base upon which to build our overall effort to improve and perfect a health information system. A well-developed program of assistance is necessary and timely. I am confident the program, as conceived in H.R. 3142, is entirely feasible and practical. I wish to stress the close relationship between this bill and the other health legislation which this committee has considered during this session and to point out that the success of these other programs is dependent on a strong system of health science libraries.

In conclusion, I again emphasize the Department's support of this bill for the strengthening of our Nation's health science libraries and its important relationship to many of our other programs. Virtually every professional organization in the health field has endorsed the need for this legislation. This recognition of need for, and confidence in, the proposed solution of the problem is shared by the Department. We urge enactment of H.R. 3142.

Mr. COHEN. Dr. Terry.

Dr. TERRY. Mr. Chairman, I too would like to urge the enactment of this legislation. I feel that it represents one of the most important parts of our entire developmental program in the health and biomedical sciences today, because this represents the basic underpining for so many of our other programs in the Public Health Service, virtually all of them, whether they be research training, medical service, or whatever they may be.

The manner in which our other programs develop is going to depend a great deal upon the proper development of an adequate medical library and information system throughout this country. It is for that reason that I am particularly happy that this bill is up for hearings, and I hope that we can get favorable and rapid action.

For several years, my principal advisory council, the National Advisory Health Council; the Board of Regents, which is a Presidentially appointed Board of the National Library of Medicine; and our other important advisory groups, have strongly urged this sort of legislation. So that I feel that we have the background and the support.

And in speaking of background, I would not like to let it pass, Mr. Chairman, without referring to the development of many of the technological aspects of this program which have been developed in the National Library of Medicine. I would refer specifically to the medlars which has been developed and installed and is in operation at the National Library of Medicine.

Medlars (Medical Literature Analysis and Retrieval System) is a system for storage and rapid retrieval of information. This represents an outstanding development, and this can be the core of a national system by feeding out from our National Library of Medicine to medical libraries over the country.

If I may inject one personal note, Mr. Chairman, I think this is probably the last opportunity that I will have to appear before this committee, since I am shortly retiring from the Public Health Service. I couldn't let this occasion pass without expressing to all of the members of this committee my deep appreciation for the work which you have done over the past several years. At no time in the history of our Nation, Mr. Chairman, has so much and such important health legislation been enacted, been heard, recommended, and enacted by a committee and by the Congress than has happened in the past four and a half years. For that reason, I consider it has been a real privilege for me to have played a part in this.

I would like to take this opportunity of saying thank you, and, Mr. Chairman Designate, I can assure you that during your time as chairman of this committee you are going to have a hard time meeting the record that this committee has made during the past 4 years. I am sure you are capable of it, and I would like to extend my thanks and best wishes to all of the members of the committee.

(Dr. Terry's statement follows:)

STATEMENT BY LUTHER L. TERRY, M.D., SURGEON GENERAL, U.S. PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Mr. Chairman and members of the committee, I am very pleased to appear before you today in support of H.R. 3142, the Medical Library Assistance Act, introduced by the distinguished chairman of this committee. I strongly urge the

enactment of this legislation as essential to the success of all of the programs of the Public Health Service. The programs of the Service encompass health research, professional education, and services, as you know. In order for these programs to function effectively and contribute to the achievement of our national goals in health, a modern national system of biomedical information in an absolute requirement. All elements of the Public Health Service recognize this and join me in enthusiastic support of the Medical Library Assistance Act.

The National Advisory Health Council, the distinguished panel of health scientists and lay citizens which advises me on matters relating to the activities and functions of the entire Service, has for several years recognized the serious condition in which the biomedical libraries of the Nation find themselves. The Health Council and the Board of Regents of the National Library of Medicine have urged that legislation such as that before you now be enacted in order to strength biomedical libraries.

In addition, the President's Commission on Heart Disease, Cancer, and Stroke has found serious weaknesses in the libraries serving the health sciences and has strongly recommended that legislative action be taken to rectify these deficiencies as soon as possible.

Our Nation has a considerable capital investment in the health science library. It forms the basis of the development of a medical information and communications system. The medical sciences have a long tradition of concentrating their information resources in libraries. In the present and future planning of health programs and their essential communications capabilities, we must take full advantage of these basic resources and the investments already made in our biomedical libraries. There is a further characteristic in the health science libraries which is almost unique. I refer to the tradition established some 50 or 60 years ago of interdependence and cooperation among these libraries. Interlibrary loan activity is so characteristic in the medical field that an informal but very viable network relationship has long been in existence. (To cite an example of local needs, the National Library of Medicine made more than 200,000 loans of its materials last year.) There is need to formalize and strengthen this network relationship so that consumers may gain access to this information locally.

The Public Health Service is proud of the fact that the first successful use of computers for storage and retrieval of medical information was developed by our National Library of Medicine. This automated system called Medlars (medical literature analysis and retrieval system) contains more than 350,000 citations to the world medical literature which may be retrieved by subject or author within a matter of minutes. In addition it prints monthly Index Medicus, the most comprehensive bibliography of our medical publications, as well as specialized bibliographies of the medical literature of the world. The National Library of Medicine has proven that it can economically decentralize this power of storage and retrieval of medical literature to medical schools, hospitals, and other health-oriented institutions by providing its magnetic tapes to users in various communities throughout the Nation.

Programs are being designed to rehabilitate and maximize the contributions of the existing medical library establishment and at the same time plan for the conversion of the traditional medical library form to serve more efficiently the communication purposes of contemporary health sciences.

The Medical Library Assistance Act of 1965 through the support of construction, resources, research, manpower development, regional and branch libraries, and scientific publications provides a sound and comprehensive legislative base with which to accomplish both the rehabilitation and conversion.

Finally, I should say that the Public Health Service considers the National Library of Medicine, with its Presidentially appointed Board of Regents and already the leader in medical library technology, to be the appropriate organizational element to carry out the programs called for in this bill.

I cannot close without expressing to you my deep appreciation for the fine cooperation which the Public Health Service has always received from this committee and I would like also to extend my own personal thanks to the distinguished chairman for his many outstanding accomplishments over the years in the interest of health.

Mr. COHEN. I think we might hear a word from Dr. Cummings, Director of the National Library of Medicine.

STATEMENT OF DR. MARTIN M. CUMMINGS, DIRECTOR, NATIONAL LIBRARY OF MEDICINE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Dr. CUMMINGS. Mr. Chairman, I, too, share the enthusiasm of the administration in support of H.R. 3142. As Director of the National Library of Medicine, I have confidence that the provisions of this act will go far towards solving the serious, most urgent medical communications problem which exists in our Nation. We are most hopeful that upgrading our Nation's medical library network will prove to serve the interests of medical education, medical research and practice, which is the ultimate response to the health needs of our Nation.

Mr. COHEN. That completes our testimony, Mr. Chairman.

I think you can see the unanimity with which we support this bill. We feel very strongly that it is a very important part of the total legislation that you are considering in this session.

Mr. STAGGERS. Thank you, Mr. Secretary.

I want to thank all of you very kindly and to you, Dr. Terry, I would like to say that I do believe the committee has passed legislation which will affect all America and you are part of it. I know, Dr. Terry, every American who is affected by the health legislation in any way will thank you because I am certain that some of the legislation that you have presented and have come here to testify for will make for a better way of life not only for all Americans but for all civilization. I think you have contributed greatly.

I think that every American owes you a debt and certainly the best wishes of this committee go with you, and we wish you well. Dr. TERRY. Thank you, sir.

Mr. STAGGERS. I thank all of you for your testimony.

I notice one thing you emphasized, Mr. Cohen, is the word "now." I believe Dr. Dempsey mentioned the fact that we had 6,000 libraries with only 3,000 librarians. Certainly we are in need of those.

Dr. Terry, the thing that I thought you emphasized is the fact that your system is making available to the American medical profession the data that you have in the files so that they can get to them for information.

Dr. Cummings, yours is the fact of communications between the groups. I think all four of the key words are essential now. Mr. O'Brien.

Mr. O'BRIEN. Mr. Chairman, I have no questions. I would like to join you in what you said to Dr. Terry. I have had the good. fortune of sitting on this committee during the 4%1⁄2 years that Dr. Terry mentioned. I will say quite frankly that many of the things of which you spoke would not have been accomplished had it not been for him. I think all of us will agree that when he retires, he will retire not only as a good Surgeon General but as a great Surgeon General.

I also was impressed by the testimony on the things that are to be done this year in the various fields and the enormous amount of data that will be stored up. It does strike me, Mr. Chairman, that it would be very, very foolish economy to place any barriers in the way of dissemination of knowledge that is going to cost us hundreds of millions of dollars to acquire. There is no use storing up on the