center in the health sciences would provide the resources for research, training, and experience in service which will be essential before a comprehensive national library can be most effectively designed. The established systems of the National Library of Medicine make it uniquely competent to lead such developments.

There are only a few institutions whose libraries are in a position to carry on this kind of research and development but their role as models is of crucial importance to the Nation.

SECTION 397, GRANTS FOR IMPROVING AND EXPANDING THE BASIC RESOURCES OF MEDICAL LIBRARIES AND RELATED INSTRUMENTALITIES

This section recognizes that we are not undertaking a dissolution of the existing library system but rather seeking full advantage of its optimum potential while adding to it the modern electronic developments which will give a new dimension to its power.

The provisions in this section will allow for those medical libraries which have heretofore been unable to take advantage of well-established methods of improving library service to acquire this enhanced potential. Such a simple matter as being unable to photoduplicate rapidly articles in journals so that the volumes themselves do not have to circulate is a distressingly frequent defect in existing medical libraries. It is a rare medical library that has a budget for the acquisition of magnetic tapes and films and the facilities for using them.

While I recognize that we must plan immediately for the development of an electronic computer-based national system for communications, I would assert that we should not forget that we have in existence a library system which, if given adequate support, will continue to be an essential component of any communication system in the health sciences. Home circulation of volumes from the medical library of the University of Michigan has increased 43 percent in the past 3 years. Loans within the library itself have increased by approximately 75 percent in that same period. I cite these figures to emphasize that we are by no means suggesting that we abandon the existing system since it is clearly a very attractive resource to its users. Rather, we look forward to securing the advantages of the present system while adding new and improved capacities.

SECTION 398, GRANTS FOR ESTABLISHMENT OF REGIONAL MEDICAL LIBRARIES More and more in the United States we are recognizing that health services of all kinds must be planned on a regional basis. The unnecessary duplication and self-seeking competition that can develop when isolated institutions pursue their own development without reference to regional needs is a luxury that we cannot afford. Some early beginnings have been made in this kind of regional development. The New York Academy of Medicine, as an example, has for years collaborated with the hospitals, the medical society, and the universities in the greater metropolitan area in providing a central repository library and reference source. More recently, Harvard, Yale, and Columbia have announced their intention of developing communications that would allow their medical science libraries to collaborate more effectively. There are a few more instances that could be cited.

In general, however, the support necessary to function as a regional resource which can provide free loan services to qualified users and make available photoduplicated or facsimile copies wherever qualified requesters wish to retain them is unavailable. This section, therefore, addresses itself to those medical libraries which might wish to provide regional service and free loan service in addition to their traditional obligations. Where the budget of a medical library is sharply limited-as all of them are—it is very difficult to add the personnel and equipment that is necessary to meet the regional responsibility described in this section. The development of a physical plant which would provide this regional service without diminishing service to the existing users of the library makes necessary the provision for construction that is within this section.

As we look forward to the development of regionalization of health services of all kinds, it is essential that we have the means for developing regional medical libraries to serve as health science information centers.

SECTION 399, FINANCIAL SUPPORT OF BIOMEDICAL SCIENTIFIC PUBLICATIONS An essential component of our present method of distributing new research information related to health is the publishing capacity of nonprofit societies and organizations. The costs of publication have risen to the point that, even where

advertising is solicited by the journal, the costs of publication are an important limiting factor in the journal's dissemination. Many journals are sharply limited in the extent to which they will accept charts and illustrations or bibliographic references.

Of particular importance is the need to supply biomedical scientific publications wth the resources which will allow them to adapt their present indexing and abstracting to the needs of existing and projected computerized forms of bibliographic storage and retrieval. As we look forward to the development of a computer-based national network of libraries, the form of the information put into this system must be adapted to the needs of the electronic means of retrieving it. These changes in abstracting and indexing journals is an essential element of the development of a national system of libraries where free interchange of information is available. The grants authorized in this section will allow for a more complete and expeditious transmittal of information to those investigators and practitioners who have a need for it.

REGIONAL BRANCHES OF THE NATIONAL LIBRARY OF MEDICINE

There are in the United States geographic areas which do not now contain a medical library or group of medical libraries which are able to undertake the role of a regional resource. Where such a circumstance exists, the need of the people. in my opinion, should be met by the establishment of regional branches of the National Library of Medicine.

Mr. Chairman, it is obvious that we are not talking about support of the library function which is confined to giving readers access to printed materials. We are talking instead about the need for securing an essential regional health source which is capable of providing to students, teachers, researchers, and practitioners the up-to-date information which they must have in order to serve their role in providing for the health of the Nation. I urge passage of this Medical Library Assistance Act of 1965 as an essential component of the programs necessary to meet the health needs of the Nation.

The CHAIRMAN. Now, I notice we have with us today, although he was not on our list of witnesses, our friend, Dr. Stafford Warren, who has been very much interested in this matter of libraries. Anything you would like to add, Doctor?

Dr. WARREN. No, I think not, Senator. Everything seems to be in good order and under good control. I have been very much pleased, though, to be here at this historic occasion.

The CHAIRMAN. Well, would you like to add to this good testimony we have had?

Dr. WARREN. I think it would be quite appropriate for me to do so, sir, but not at this moment. In another 4 weeks I would be very pleased to.

The CHAIRMAN. Well, if you should like to put anything in this record before we have it printed, I would be happy to have you submit it. We will be glad to have it, sir.

Dr. WARREN. Thank you.

The CHAIRMAN. We certainly would. Anyone else-anything anyone else they would like to say?

If not, the subcommittee will stand in recess and meet in the morning at 10 o'clock.

(Whereupon, at 11:35 o'clock a.m., the subcommittee was adjourned, to reconvene at 10 a.m., June 15, 1965.)

TO AMEND THE PUBLIC HEALTH SERVICE ACT TO PROVIDE FOR ADEQUATE MEDICAL LIBRARY SERVICES AND FACILITIES

TUESDAY, JUNE 15, 1965

U.S. SENATE,

SUBCOMMITTEE ON HEALTH OF THE

COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C.

The subcommittee met, pursuant to notice, at 10 a.m., in room 4232, New Senate Office Building, Senator Lister Hill, chairman of the committee, presiding.

Present: Senators Hill (presiding), Yarborough, Pell, and Javits. Committee staff members present: Stewart E. McClure, chief clerk, Robert W. Barclay, professional staff member, Roy H. Millenson, minority clerk, and Stephen Kurzman, minority counsel.

The CHAIRMAN. The subcommittee will kindly come to order.

Dr. George A. Wolf, Jr., president, Association of American Medical Colleges, and vice president of medical and dental affairs, Tufts University.

Doctor, we are glad to have you here. Will you proceed in your own way, sir?

STATEMENT OF DR. GEORGE A. WOLF, JR., PRESIDENT, ASSOCIATION OF AMERICAN MEDICAL COLLEGES, VICE PRESIDENT OF MEDICAL AND DENTAL AFFAIRS, TUFTS UNIVERSITY, BOSTON, MASS.; ACCOMPANIED BY DR. ROBERT C. BERSON, EXECUTIVE DIRECTOR, ASSOCIATION OF AMERICAN MEDICAL COLLEGES

Dr. WOLF. If I may, I would like to introduce into the record testimony on behalf of the Association of American Medical Colleges in support of S. 597 which has been prepared by Dr. Berson.

The CHAIRMAN. We will have that appear in full in the record, Doctor, immediately following your remarks.

Dr. WOLF. This statement has been approved in full by the AAMC's Committee on Federal Relations which includes Dr. John Parks, dean of George Washington University Medical School here, Dr. John Deitrick, dean of Cornell University Medical School, Dr. Alden Miller, dean of University of Kansas Medical School, Dr. Thomas Turner, dean of Johns Hopkins Medical School, Dr. Donald Anderson, dean of the University of Rochester Medical School. I would like to add a few brief remarks of my own as president of the AAMC. As you have undoubtedly heard, libraries are the most important resource of medical schools and of universities. Medical libraries play a very

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important part in the education of research scientists in the health field.

Federal support of research has resulted in the growth of libraries in terms of holdings and in terms of usage of libraries. The interlibrary loan system has flourished in recent years. The development of photo reproduction, of miniaturization, computer technology have made libraries more efficient than they have been in the past.

However, in spite of all these factors, operating under the supervision of trained medical librarians, libraries have increased in size, have increased their holdings, are experiencing a shortage of trained personnel and are increasingly using the interlibrary loan system. It is clear to me that demand is outstripping resources and the medical library's future is dependent upon additional resources. These resources will answer a need to improve and expand existing library facilities and create new library facilities. Resources are needed to train new personnel in the library field, to expand holdings, to exploit to the fullest the interlibrary loan technique, particularly by developing regional centers.

There is the necessity of exploiting by experimentation and demonstration the use of modern technology, particularly improving the efficiency of library operation and recognizing some of the problems which are peculiar to libraries in the health professional areas.

Inasmuch as S. 597 provides for meeting these needs in part, I think I can speak for the deans of the medical schools of this Nation in urging the passage of this bill.

Thank you, sir.

(Statement on behalf of the AAMC follows:)

PREPARED STATEMENT OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES

Speaking for all the 87 medical schools in this country who constitute the institutional membership of the Association of American Medical Colleges, I want to express unequivocal support for all parts of this legislation and urge its passage at an early date.

Throughout the long history of man's struggle against disease, countless observations and a vast amount of knowledge have been recorded. These records are stored in libraries-chiefly in the libraries of medical schools and universities but also in the libraries of medical societies, hospitals and other scientific institutions-where they can be made available to seekers of knowledge. The faculty and the students of a medical school need ready access to these archives for, to paraphrase Osler, to study medicine without books is to go to sea without a compass.

While the major medical libraries in this country are to be found in medical schools, medical centers, major research complexes, and the medical societies of a few metropolitan areas, it is important to bear in mind that there are a total of over 6,000 medical libraries in smaller medical societies and particularly in hospitals throughout the Nation.

For a number of years there have been responsible reports that the medical libraries of the Nation are in a serious state of disrepair and are finding it impossible to keep pace with the growing volume of scientific literature of great importance to medicine. In 1953, John Deitrick wrote:

"Little evidence was found by this survey of attempts to meet the libraries' increased needs during a period of tremendous expansion in the research and other activities of the schools. Faculty members, research workers, and students will be severely handicapped unless the new demands placed upon the libraries are met by careful administrative and budgetary planning. In a nation dependent upon medical research to a greater degree than ever before, surprisingly little is being expended on the housing of the reports of that research and on making those reports available.” (1)