and Technology. In the legislative branch communication of scientific information has been under intensive study by a number of House and Senate committees and subcommittees. In reports on the communication problem, there have been references to apparent need for an increase of efforts in the area of communications, based on certain premises: 1. Present biomedical research is slower and more wasteful than necessary because of needless and unplanned duplication of effort. This, in turn, is due to the inadequate awareness of scientists of past and current scientific information. Communication between scientists is thought to be relatively weak and steadily deteriorating. 2. Facts exist which are not brought to the attention of potential users at a time when they would be useful. 3. The results of research are not being applied by the health practitioners fast enough, principally because communications from scientists to health practitioners are not as effective as they should be. 4. The general public is not sufficiently aware of new knowledge about health. An informed public is essential to public acceptance of improved health measures as they are discovered. Also the public needs health information as a basis for insisting on the best available facilities and health care, whether from private or public sources. Methods of handling information have not kept pace with the acceleration in research, in publication, or in population. It is being suggested that biomedical research could be made much more valuable if for every dollar paid into research, a significant amount could be invested in efforts to manage the information obtained from research. Improving communication will probably take two directions, pursued concurrently. One will be the development and expansion of conventional, timetested methods. The other will be experimental use of novel techniques. We are in a period of rapid transition in the rate and accuracy with which information can be transmitted, with new methods, machines, and knowledge of human behavior becoming available for use. Pursuit of improvement through using new techniques or by the conventional methods will require removing some limitations now hampering development of communication programs: lack of facilities, shortage of personnel, inadequate financial support, and lack of imaginative solution to significant problems. III. WHERE DOES THE PUBLIC HEALTH SERVICE STAND AT PRESENT? During the spring of 1962 the Surgeon General, addressing the House Appropriations Committee, stated the interest which the Public Health Service has in health communications and suggested that the Service intended to convene a working conference on health communications before the end of the year. In June 1962 the Surgeon General appointed Dr. F. Ellis Kelsey his special assistant to prepare for such a conference. Thereupon the Office of the Surgeon General began a review of the communication activities of each component of the Service. As a result of this survey and continuing attention to communication activities, the Public Health Service is now well equipped to evaluate its current science information programs in detail. The information collected about each Bureau is extensive and no attempt is made here to transmit that information. Comprehensive reports have been prepared on the communication programs of each of the following major components of the Public Health Service. The Office of the Surgeon General, through the Office of Information and Publications, provides overall direction for the Service's information activities. This office also develops and manages its own information programs to inform the general public about advances in our knowledge about health. The nine regional offices of the Service bring new information to State, county, and municipal health departments as well as to various public and voluntary groups. The Division of International Health has a variety of activities designed to facilitate international exchange of information. The Bureau of State Services has as one of its major activities the packaging and distribution of scientific information to health practitioners. The Bureau of Medical Services facilitates the use of scientific information by projects designed to inform its own health personnel, and others, of new advances. The National Institutes of Health scientific information activities have a specific statutory base in the categorical areas of cancer, heart, dental, and mental health research. Other communication activities derive from and are subordinate to the primary NIH mission for the conduct and support of biomedical research. The National Library of Medicine collects the literature of medicine on a global scale, prepares and distributes a variety of indexes to the literature, and lends or provides facsimile copies of otherwise unobtainable materials to libraries on request. IV. ORGANIZATIONAL ROLES IN COMMUNICATION As with most institution, the Public Health Service plays a variety of roles in communication. The Service must manage its own operations competently. At the same time the Service, as a component of the Department of Health, Education, and Welfare, has concern for the Department's communication efforts, makes a contribution to them, and relates its own programs to others in the Department. The Service also has functions which involve Government agencies outside its own Department. Finally and concurrently, the Service works with groups outside the Government and makes its own unique contribution to the scientific community. Interagency committee on scientific information Through Department membership on the Committee on Scientific and Technical Information of the Federal Council for Science and Technology, the Public Health Service makes its contribution to the Council's mission; "to promote coordination and improve planning and management of Federal programs in science and technology." This committee serves as a channel for ideas to and from the separate agencies. It is a valuable means of information exchange in its own operations. HEW Committee on Science Information The Public Health Service is represented, along with all other major components, on the Department Committee on Science Information. The Committee's aim is to help provide clear-cut demarcation of responsibility among subdivisions of the parent body, The HEW Committee also acts as a communicating device linking components of the Department with the Office of Science and Technology. The need for cooperation between components of the Department varies considerably, from close cooperation on projects of joint interest to a clear-cut separation of responsibilities and fuctions. Providing compatibility in computer operations, in indexing, in abstracting, and in other aspects of communication may require closer association among components of the Department as communication activities increase. Public Health Service focus on science information. The recently established Public Health Service Committee on Science Information will serve the agency in the same manner as the HEW Committee on Science Information serves the Department. The Committee was established by the Surgeon General, to "develop a sound plan of organization for effective stimulation coordination, and direction of scientific communication." Its membership consists of representatives from each bureau, the National Center for Health Statistics, and the National Library of Medicine. A focus for science information within the Service was established shortly after the Surgeon General's Conference on Health Communications, thus permitting continuation of the efforts to improve scientific communication which were initiated in preparation for the Conference. V. THE CONFERENCE ON HEALTH COMMUNICATIONS As the Public Health Service gave increasing attention to information and its handling, it became more and more evident that solutions to the problem were not the responsibility of the Federal Government alone. Since solutions would call for the combined effort of many people, the Surgeon General invited representatives of the broad interests involved in improving the Nation's health to meet with staff members of the Public Health Service most intimately concerned in handling health information in a conference to consider some recommendations for improvement. The working sessions, November 5 through 8, 1962 The Conference was held in Warrenton, Va., at Airlie House for 4 days, November 5 through 8, 1962. The participants included 39 special consultants from all parts of the country with staff members of the Public Health Service serving primarily as resource personnel. The Conference opened November 5 with a general session consisting of reports from the major bureaus of the Service and addresses by Dr. Jerome Wiesner, Special Assistant to the President for Science and Technology, and by Dr. Alan T. Waterman, Director of the National Science Foundation. Four panels, to which consultants were assigned, met concurrently the following 2 days, with their chairmen reporting to the plenary session on the final morning of the Conference. For working convenience each panel concentrated on a specific subdivision of communication: Panel 1. Communication among scientists. Panel 2. Communication to practitioners. Panel 4. Communications research. The Public Health Service now has the detailed reports from each of these panels as well as comments and recommendations from many of the participants sent in as followup to the Conference. The Conference record provides a valuable source of ideas and cautions regarding Public Health Service activity. It may also be of value to other agencies faced with similar and related problems. The recommendations of the Conference The Conference report is available as Public Health Service Publication No. 998. THE NATIONAL LIBRARY OF MEDICINE AND THE LIBRARY COMPONENT IN COMMUNICATION I. NLM ORGANIZATION AND PROGRAMS The National Library of Medicine was founded in 1836 as the library of the Surgeon General's Office, U.S. Army. It enjoyed a period of great growth, and acquired an international reputation as a scholarly library, during the last half of the 19th century, under the leadership of its great Director, John Shaw Billings. In 1956 the National Library of Medicine Act (Public Law 941, 84th Cong.) was passed, transferring the institution to the jurisdiction of the Public Health Service. The library's new $7 million building in Bethesda was occupied in April 1962. The overall management and policy guidance of the library is subject to the scrutiny and review of the NLM Board of Regents, advisory to the Surgeon General, PHS. The Board consists of 7 ex officio members, including the 4 Surgeons General of the uniformed services, the Chief Medical Director of the Veterans 'Administration, an Assistant Director of the National Sicence Foundation, and the Librarian of Congress, and 10 members appointed by the President, for terms of 4 years each, chosen from persons prominent in the various fields of medicine. The operations of the library are carried out by a staff of 237, all in Washington, organized in 5 operating divisions. Library objectives.-As a national institution, the library has for years conducted its programs with two general objectives: the provision of bibliographic access to the literature of medicine, and the provision of physical access to that literature. Bibliographic access embraces the areas of cataloging, indexing. and bibliographical listing, and the publication and dissemination of the resulting products. It responds to the question, "What materials exist that are directly pertinent to the subject of my inquiry?" The nature of the problems of bibliographic access and the means available for their solution lend themselves readily to centralization. This is what the library is attempting to do-to compile centrally, and distribute widely, the bibliographic record of medicine, so that all members of the health professions, wherever they may be, may have knowledge of what of interest to them is appearing in the world literature. Physical access embraces the area of acquisitions, at one end of the line, and as a representative area at the other end, the provision of interlibrary loans. Only a universal acquisition program such as NLM's can at once provide the base for a universal bibliographic record, and at the same time provide the rich and broad store of materials on which lesser libraries may rely for the provision of works which lie on the more exotic side. Provisions for physical access respond to the question, "How can I put my hands on these items known to be pertinent?" Here the problem can be suitably fitted only to a decentralized arrangement of facilities. The fundamental characteristic of the printing press is that it provides multiple copies, which may be stored in multiple locations, convenient to the needs of users spread over wide geographical areas. The interlibrary loan program of the library, enormous as it is, can properly be -conceived of as a central facility which functions only as a very necessary supplement to the basic decentralized stores of the medical library network. Bibliographic access.-The chief instrument in the Library's program is the Index Medicus. This publication and its predecessors have had a continuous history back to 1876, and together they have provided the medical sciences with a better control over their published record than exists in any other scientific area. The Index Medicus is prepared by a semiautomated system employing Justowriters for typography, IBM equipment for sorting and merging, and a Listomatic camera for rapid-fire photographic composition. During this fiscal year the publication will carry citations for over 150,000 journal articles from 2,000 journals, listed under multiple author and subject rubrics. The publication appears monthly, in a print order of 7,500 copies. Approximately 900 copies are distributed free to Federal medical installations; another 900 copies are used for exchange purposes, to insure receipt of foreign publications; the balance of the copies are subscribed to through the Superintendent of Documents at a price of $26 per year. The Library invests 20 percent of its manpower and 20 percent of its funds in this one operation. Besides the Index Medicus, the Library publishes two major annual lists, the Bibliograhpy of Medical Reviews, and the National Library of Medicine Catalog. The Library also brings out occasional publications, as, for example, the recent Biomedical Serials, 1950-1960. Early American Medical Imprints. The Library's newest bibliographic project is called MEDLARS, for medical literature analysis and retrieval system. MEDLARS has been under development for 2 years, and will become operational at the end of 1963. At the heart of MEDLARS will be a digital computer. Information will be fed into the system through punched paper tape, representing the indexing done by the Library staff. This information is converted to magnetic tape and manipulated in the computer. The magnetic tape so processed is used to activate a very high-speed composing device capable of producing photographic masters for printing. Three types of products will be derived from MEDLARS. First, it will provide increased high-speed composition capacity for the production of the Index Medicus. Second, it will provide recurring bibliographic listings of references selected in accordance with the predetermined requirements of particular research fields; for example, it will supply a weekly listing of the world's medical literature on cardiovascular disease to that research group for its dissemination. Third, it will provide search and retrieval capacity to answer on demand queries from individual research installations concerning newly published information bearing on their immediate problems. In its first year of operation MEDLARS will contain 180,000 references; this will increase by annual increments up to the point where over a million references will be stored on magnetic tape for searching. MEDLARS will turn out 50 recurring bibliographies of varying periodicity, and it will accept up to 90 complex demand search questions daily. On successful completion of this project, the medical sciences in the United States will have access to a powerful bibliographic search tool equaled by none in the world. Physical access. Since the 1860's, the library has been engaged in collecting the literature of medicine on a global scale. This means all medical writing, from all countries, and of all times. Currently it operates under a formalized "scope and coverage policy," which surveys in terms of a general classification the entire domain of human knowledge, and establishes four levels of library collecting: (1) exhaustive (in the medical sciences), (2) research (in the basic supportive sciences), (3) reference (in pertinent and related areas), and (4) skeletal (in fringe areas). This attempt to rationalize the medicocentric uni- Among the researchers using the library in person are scientists and scholars engaged in the writing of books, review papers, historical treatises and the like. A phenomenon of recent years has been the systematic use by teams of researchers; for example the Surgeon General's Committee on Smoking and Health is currently quartered in the library. Other agencies establish continuing work groups for the purpose of reviewing and monitoring the literature bearing on research topics. Over 10,000 reference requests are received at the library each year; the bulk of this load originates from a service population outside the library rather than from the library's visitors. To respond to requests for literature coming in from all over the country, the library has developed a photoduplication service which embraces as one of its parts one of the largest microfilming operations in the Federal Government. Using six mobile cameras, which roam the book stacks, and a continuous xerographic printer capable of producing 20 feet of paper print a minute, the library each year responds to over 125,000 requests. This amounts to the filling of requests at the rate of one every minute of every working day throughout the Last year some 2,000 libraries around the world received 2,250,000 pages year. of material; 1 in 8 of these requests went to libraries overseas to whom the About 12 percent of the NLM represents a primary international resource. library's funds are committed to this activity. Extramural programs.-The library's extramural programs seek to reinforce 'both the functions of bibliographic access and physical access but through agencies and institutions outside the library's walls. Under existing authorities and appropriations, the only activity currently conducted is a program to strengthen channels of international communication to the benefit of American scientists-the NLM science translation program. This program serves as a principal focus within the PHS for meeting the needs of the American medical research community for access to the reports of foreign medical research published in infrequently read languages. The program includes, for example, a project carried out by the Federation of American Societies for Experimental Biology, which monitors Soviet experimental science, selecting those papers considered by American scientists to be of particular Under Public Law significance, and publishing them in translation as a supplement to the journal Federation Proceedings, which reaches 11,000 scientists. 480, the library conducts program for translation in Israel, Yugoslavia, and Poland. A part of this effort has resulted in five Polish medical research journals being published in the English language originally, instead of in Polish. II. SIGNIFICANCE OF NLM FUNCTIONS Alone among the Federal libraries, the National Library of Medicine by statute is a national library of the United States, the first so designated by the Congress. While it shares certain nationwide functions with the Library of Congress and the National Agricultural Library, NLM has by law unique reThese are, in the words of the act, "to sponsibilities in the public interest. assist the advancement of medical and related sciences, and to aid in the dissemination and exchange of scientific and other information important to the progress of medicine and to public health." Service to the national medical community.-The library subserves the needs of the entire medical and health-related community of the country. While established and maintained within the Public Health Service, its service public includes not only the totality of Public Health Service program interests, and those of all medically oriented agencies of the Federal establishment as well, but the entire complex of public and private institutions and agencies, which, taken together, constitute the medical establishment of the United States. In the interests of maximizing its benefits, the library customarily works with and on behalf of organized groups, established agencies, and institutions of great variety. A recent survey of the library's interlibrary loan operation illustrates |