sibility of our information distribution system in the medical field falls into the international field as well. We have important connections with other countries in both receiving and distributing medical information and in such places as the Pacific basin again a regional installation would be required simply because there is not an existing one that could immediately be adapted to the problem.

Dr. TERRY. May I add some points here, Senator?

The CHAIRMAN. Sure.

Dr. TERRY. Our delegation to the World Health assembly which met in May of this year has just returned. We felt that we had a very successful meeting of the World Health assembly. One of the very important parts of the action which took place at this time was to further define the role of the World Health Organization in relation to responsibility for the development, collection, and distribution of information in the medical and health field.

This is in support of the point that Dr. Dempsey was just making and we very clearly have defined a role for the World Health Organization in this respect and we would expect that our national library system through the National Library of Medicine would work closely with this international system both in terms of the distribution as well as receiving biomedical information which would be important to the people of this Nation. So that I think that we have made a substantial step in this direction already in the international field as well as the beginning developments of an adequate system at the national level.

The CHAIRMAN. Anything you would like to add, Doctor? Dr. Cummings, anything else?

Well, gentlemen, we want to thank you very, very much for your testimony here. We appreciate it. Thank you.

Dr. DEMPSEY. Thank you, sir.

The CHAIRMAN. Dr. Alfred Brandon, president of the Medical Library Association, and librarian, Welch Medical Library, Johns Hopkins University.

STATEMENT OF DR. ALFRED BRANDON, PRESIDENT, MEDICAL LIBRARY ASSOCIATION, AND LIBRARIAN, WELCH MEDICAL LIBRARY, JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD.

The CHAIRMAN. Doctor, we are happy to have you here, sir. We welcome you. We will be glad to have you proceed in your own way. Dr. BRANDON. Thank you, Senator Hill.

It is a privilege to appear before this distinguished committee to urge your recommendation of this bill which is of incalculable importance in the revitalizing of medical libraries whose mission it is to preserve, organize, and transfer published knowledge resulting from the research efforts this committee has, itself, done so much to foster through its long and splendid support of health legislation.

SECTION 393

Despite other programs of support for the construction of healthrelated facilities, medical libraries have never received an adequate share of assistance. A recent survey of 116 established medical, dental, osteopathic, and public health schools shows that 86 of their libraries

were in need of funds for construction of new facilities and 18 needed funds for renovating existing library quarters.

During the last 8 years I have visited most of the medical school libraries in the United States. With few exceptions, I found them overcrowded with little expansion possibilities in their present stacks. Seating capacities were generally low in relation to the clientele served and work areas for the librarians were at a premium.

The enactment of this bill would do much to improve the physical facilities of medical libraries. The total estimated need for construction for medical, dental, osteopathic, and public health schools, both established and new, at 75 percent matching, is over $96 million. The kind of support included in this bill for construction would represent a significant step toward meeting this critical need.

SECTION 394

The most important element in the success of any venture are the people who operate it. Funds for books, for buildings, for equipment-key punches, sorters, computers-will avail little if we do not have knowledgeable, imaginative, and dedicated people to transmute them into live library service.

The critical shortage of qualified personnel in all areas of science information handling has been emphasized over and over in reports of recent years on communication problems in science, notably in the Surgeon General's Conference on Health Communications (1962), the President's Science Advisory Committee's Science Government and Information (1963), the National Academy of Sciences-National Research Council's Communication Problems in Biomedical Research (1964) and in the recommendations of President's Commission on Heart Disease, Cancer, and Stroke. The Medical Library Association has made the problem the pivot of its activities, for example, its programs for continuing education, certification, and recruiting. I think it would be accurate to say that we consider shortage of personnel plus shortage of professional training opportunities our No. 1 problem. This point of view is brought out well in "Guidelines for Medical School Libraries," published this year which was prepared by a joint committee of the Association of American Medical Colleges and the Medical Library Association.

The usual minimum professional preparation for librarianship is a bachelor's degree followed by a year of graduate study for the master's degree in one of the country's 33 graduate library schools. Ten of these schools now offer a single course in medical librarianship varying from 30 to 45 semester hours. Three medical libraries offer postmaster's training programs with a total of eight places each year available. These offerings are tied in with the Medical Library Association's certification plan. They are very useful, but they do not go far in alleviating the overall shortages and there is nothing more except scattered courses in information science which are not directly concerned with the health sciences field.

Information assembled by the President's Commission on Heart Disease, Cancer, and Stroke shows that we are short at least 3,000 professional librarians in the 6,300 health science libraries at the present time. We lose 150 through normal attrition each year and we

bring in from the library schools 100 of whom 60 already hold medical library positions. Thus, only an approximate 40 new people, many of whom have neither subject background nor special training of any sort for the health sciences, are added annually. Positions are commonly open for 6 to 8 months, not infrequently for a year or more even in top locations and situations. Veteran head librarians are flooded with requests for recommendations for vacant positions from every part of the land. The well qualified, sometimes even the half qualified, are courted on all sides at all levels. There is constant reshuffling of people and jobs. To fully appreciate existing conditions one must remember that medical libraries are, for the most part, very seriously undermanned even when all positions are filled. The effects of such conditions on service are obvious.

Meanwhile the demands on libraries become both larger and more complex as we struggle not only with the size of the literature, but also with its rapidly evolving interdisciplinary nature which requires a whole realining of the traditional concept of scope of collections and public services. Expansion and change in literature are, of course, the direct result of expansion and change in research personnel, the same personnel who account, in turn, directly or indirectly, for all calls on the library for larger collections and greater services. The cycle continually winds back on itself in wider and wider circles. A few of the larger libraries are beginning to attempt to hold this spiral in place by the automation of library operations and the pioneering of library-based information and search centers, but these experiments only increase the need for staff, and highly qualified staff at that. Too, any success in finding new ways of handling information processing affects the profession as a whole and steps up the urgency of equipping everyone in it to take as much advantage as possible of the innovations. For example, the librarian in the field needs some insight into the system to obtain for his clientele full benefits from medlars. The more he knows about both medicine and data processing the better his insight will be.

Our personnel shortages then are in both number and kind. There is no choice but to find recruits with subject background in the sciences for many of our positions and recruits who are acquainted with at least the elements of data processing and information science for others. There must be people on the staff who can interpret the library to programers, systems designers, computer experts, and so forth, and work with them to devise new and better patterns and procedures. But can we, indeed, find these recruits?

From what experience we have had, we know that students with appropriate subject background and academic qualifications can be drawn into librarianship and other areas of information work once they are aware the field exists. Awareness increases as scholarships, fellowships, and traineeships become available, as new programs are offered in the library schools and related institutions and as salary and status improve. Moreover, so far as shortage in kind of personnel is concerned, we are not without a backstop of able practicing librarians eager to learn as much as they can of the new technology, eager to improve their subject competence, and to add to their foreign language proficiency. This has been demonstrated by attendance at the Association's continuing education classes, in the organization of

workshops and short courses in some parts of the country, and by individual enrollment in university courses.

The truism holds as elsewhere that people go where opportunity beckons. S. 597 provides for most of the opportunities we have long sought: assistance for developing programs in medical library science and in the general field of communication in the health sciences, traineeships and fellowships for students seeking graduate degrees in these areas, internship programs in medical libraries, and retraining for those already working in the health information area.

SECTION 396

Medical libraries are twice as old as medical schools, and during the 3,000 long years of their existence, their librarians have accumulated a large store of experience which has served them well until the past decade.

The CHAIRMAN. Excuse me. May I ask a question there?

Dr. BRANDON. Go right ahead, Senator.

The CHAIRMAN. You speak, Dr. Brandon, of medical libraries. Do we have any evidence as to which is the oldest medical library in the world today?

Dr. BRANDON. I have a short article on medical history I would like to insert in the record.

(The article referred to follows:)

HISTORY OF MEDICAL LIBRARIES

Small collections of papyrus rolls were kept in the temples of ancient Egypt. We know that some of the works were medical because copies of them have come down to us. In Mesopotamia books were in the form of baked clay tablets, and the libraries containing them date back as far as 3,000 B.C. The most famous of these libraries was that of Assurbanipal, King of Assyria in the seventh century B.C. His library was divided into rooms or cubicles, according to subject. Medical works were included, many of which have survived. Libraries existed in the Greek cities. Of course the greatest library of the Hellenistic period was that at Alexandria which is said to have contained more than half a million papyrus rolls, including the medical writings of the Greek physicians. We know also of libraries in Rome and later of monastic libraries in Western Europe. With the development of hospitals and the creation of faculties of medicine in the universities at the end of the Middle Ages, libraries devoted to medicine began. For example, in the year 1391 the faculté de Médecine of Paris acquired its first books.

The first medical library in the British colonies in North America was probably that at the Pennsylvania Hospital in Philadelphia. It was started in 1762 and owed its existence largely to the efforts of Benjamin Franklin. The collection has been maintained at the hospital up to the present time.

It could be said that preparations for the first medical school library in America were made at Harvard. The Harvard College Library was established in 1636 and by 1764 it included a rather extensive medical collection, in anticipation of the founding of a medical school. The medical school, however, did not open until 1784 and by that time two other medical schools had come into existence (Pennsylvania and Columbia). The medical department of the University of Pennsylvania was the first, starting instruction in 1765. However, a library for the school was not provided until 1777 with a gift of 3,000 volumes from the private library of Dr. Alfred Stillé.

Dr. BRANDON. During the past 10 years, knowledge, including medical knowledge, has become central in our society, and there has been a tremendous increase in the urgency to have medical knowledge immediately available for the treatment of those ill, for the protection of

those well, and for the research on which cure and protection rest. In these modern circumstances, the old cut-and-try, haphazard methods for acquiring new knowledge and techniques in medical library sciences have failed. It is now necessary to adopt the methodology of the sciences and to formulate and prosecute programs of research and investigation which will yield information that will improve medical library techniques. In particular, funds are needed for research and development in the application of computers to the processing, storing, retrieving, and distributing of medical information. Such investigations have begun in some libraries, but money is sorely needed to train new investigators to support their investigations and to make available to them expensive equipment required for the development of new techniques. Thereby, the passage of S. 597 will contribute to the development of wholly new medical library systems.

SECTION 397

Section 397, Grants for Improving and Expanding the Basic Resources of Medical Libraries and Related Instrumentalities, is perhaps the most important part of this bill. Medical library collection needs based on suggested standards indicate a total of $102,732,952 would be needed to bring these libraries up to recommended strength. An analysis of needs would substantiate the propriety of suggesting a considerable larger annual appropriation for resources than the $3 million the bill presently contains. Administered wisely, this provision can in some way reach every aspect of the medical community: student, research, and practitioner of all health professions. It is important to recognize the magnitude of this need and to understand that the appropriation authorized by this section would hardly begin to provide the solution.

The CHAIRMAN. What do you think this appropriation ought to be? Dr. BRANDON. Well, I would think that in order to make a real dent in the needs today, which have existed for so many decades, that doubling this appropriation would certainly go that much further to eliminate the great gaps that we have in our research collections today.

You mentioned the University of Pennsylvania a few moments ago. I think that this is a typical example of a neglected medical school library to serve the needs of its research clientele. It is true that they rely somewhat heavily on the College of Physicians Library in Philadelphia for their research materials and I will make mention in a moment of the part that this kind of a regional library can play.

Sections 397 and 398 of the bill recognize that certain larger medical libraries extend their service beyond their immediate constituencies to share resources with nearby hospitals, medical schools, publishers, municipal, State and Federal governmental agencies, as well as other public and private institutions requiring access to medical literature. In many cases, the members of these regional resources facilities are carrying most of the costs even though their own use of the library is a small proportion of its service load.

Government grant support allocation for overhead goes to the institution where the principal investigator has his primary affiliation but does not reach the regional library to which these investigators turn when the libraries of their own institutions prove inadequate.