In 1960, the Jones report prepared for the Senate Appropriations Committee stated, "One urgent need almost all medical schools have in common is the improvement of their libraries which are essential to the functions of education research and good medical care." (2)

In 1953, Bloomquist wrote:

"As a result of chronic inattention, the medical school library is woefully inadequate to meet the demands placed upon it as an agency of our medical communication, and the major investment made by society in these libraries is in jeopardy. Financial support has not kept pace with the increased demands, indeed, there is evidence that the libraries' share of support is shrinking. The quality of medical education, research, and patient care is thereby threatened." (3)

In February of this year, the report of the President's Commission on Heart Disease, Cancer, and Stroke (4) included considerable data on the existing situation and the needs in all types of medical libraries and recommended a national program whose major provisions are embodied in this legislation. And also in this year, a study by the Association of American Medical Colleges (5) indicated that the average medical school library needs an additional 32,000 square feet of space and an additional 18,000 volumes and periodicals to meet reasonable standards as well as having substantial needs for support for cataloging, binding, and other instructional media or equipment.

The literal dependence of intelligent medical research on access to the relevant literature is quite obvious. Naturally, each research project results in one or more published articles or periodicals and as the number of research projects underway in this and other countries has increased, the volume of published literature has grown at an astonishing rate. The protection of our national investment in research requires adequate provision for making the published results available to investigators.

It is important to emphasize, however, that every medical library plays a very important role in the education of medical students, dental students, students of public health and veterinary medicine, other students in the health disciplines, interns, and residents. It is perhaps even more important to the care of patients for practicing physicians to have access to appropriate parts of the published literature in order to keep abreast of new developments in the study and care of patients.

This triple role of the medical library in providing a service basic to research, education, and patient care has made it difficult for existing national programs to meet the needs of medical libraries.

The Hospital Construction Act provides matching funds for the construction of hospitals and outpatient departments. Local and State priorities are based on a demonstrated need for additional hospital beds for patients. Although some of these funds have been used for the construction of hospital library facilities, they have been relatively modest and, of course, no funds for the acquisition of books, periodicals, or the operation of the library are included.

The health research facilities program provides matching funds for the construction of research facilities. The fact that medical libraries subserve other functions in addition to research has, in most institutions, made it impossible to dissect out the portion of the construction cost of the library that would be solely related to research and to find the funds at the same time to provide for the other portions of the medical library and, of course, this program provides no funds for acquisition or operation.

The funds for the support of medical research have been provided largely through research projects and programs, fellowships, and grants for training in research. These programs assume the availability of adequate library resources and it is quite impractical to dissect out what portion of each project should be considered as necessary support for the medical library.

The Health Professions Educational Assistance Act of 1963 is intended to increase the total number of medical students being graduated and the direct relationship between an increase in library facilities and an increased number of students is difficult to demonstrate except in the case of entirely new schools. Medical library facility needs are of such volume and urgency that they cannot be met by other programs to which medical libraries are incidental. In the competition with more fundamental legislative and administrative purposes, adequate support for medical library construction and operation cannot be anticipated from existing programs. Even if all the exisitng programs could be so adequately funded that the needs of medical libraries for construction, acquisition of books and periodicals, and the employment of additional personnel could 49-825-65--5

be met, strengthening the cooperation and communications between medical libraries would require attention.

One of the most important traditions of science has always been the free exchange of knowledge and results between scientists wherever located. It can truly be said that the literature of medical science as well as the problems it attempts to solve transcends national boundaries. At the present time a considerable percent of the important new periodicals in medical literature are printed in languages other than English. There is a very active exchange of literature between this country and Russia, as well as our former enemies, Germany and Japan. It is obviously more efficient for translating, abstracting and bibliographic services to serve the entire English-speaking world rather than for each library to attempt its own, so there are great opportunities for strong leadership at the national level through the National Library of Medicine. The more than 6,000 medical libraries in this country reflect the efforts that have been made through hospitals, research institutes, professional societies, and medical schools to provide library services. It has been estimated that the present investment in medical libraries in this country is something over $300 million, essentially all of which has come from private, local, or State resources. The Medical Library Assistance Act of 1965 assumes that these local sources will continue to carry most of the expense. It also assumes that Federal funds should be provided to augment these local funds and to strengthen the role of leadership of the National Library of Medicine in matters that can be handled effectively on a national basis. This legislation has been carefully written and the Association of American Medical Colleges believes that it is entirely sound.

Assistance for Construction of Facilities, section 393, will provide matching grants for the construction of libraries, providing up to 75 percent of the necessary cost of construction, and for this purpose not more than $10 million for each fiscal year 1966 through 1970 is provided. We are convinced that this is fully justified and will bring tremendous benefits. As this program develops, applications to be reviewed by the proposed National Medical Libraries' Assistance Advisory Board will bring into clear focus whether the real need exceeds the amount provided in this legislation or not. The Association of American Medical Colleges is convinced that the need is substantially larger than can be met by the funds proposed, but we consider it important to begin the program at this level of funding.

Grants for Training in Medical Library Sciences, section 394, is one of the most important parts of this legislation. This section will provide up to $1 million in each of the fiscal years 1966 through 1970 for grants, (1) to individuals to enable them to accept traineeships and fellowships leading to postbaccalaureate academic degrees in the field of medical library science, in related fields pertaining to science as related to health, or in the field of the communication of information; (2) to individuals who are librarians or specialists in information on sciences relating to health to enable them to undergo intensive training or retraining so as to attain greater competence in their occupations (including competence in the fields of automatic data processing and retrieval); (3) to assist appropriate public and private nonprofit institutions in developing, expanding, and improving training programs in library science in the field of communication of information pertaining to sciences relating to health; and (4) to assist in the establishment of internship programs and establish medical libraries meeting standards which the Surgeon General shall provide.

Although there are more than 6,000 medical libraries in this country, there are only a few more than 3,000 trained professional librarians. The rate at which additional individuals are being trained is not sufficient to keep up with the normal attrition in the field. And the exciting new developments in the field of storage and retrieval of information offer great opportunities for coping with the growing volume of medical literature.

Assistance to Special Scientific Projects, section 395, authorizes up to $500,000 for each fiscal year 1966 through 1970 to establish special fellowships to be awarded to physicians and scientists for the compilation of existing or writing of original contributions relating to scientific, social, or cultural advancements in sciences related to health. It is likely that most of these special fellowships will involve working with the resources of the National Library of Medicine which represents the greatest collection of medical literature on earth.

Research and Development in Medical Library Science and Related Fields, section 396, will provide up to $3 million for each fiscal year 1966 through 1970 for grants to appropriate public or private nonprofit institutions and contracts

with the appropriate persons for the purposes of carrying out projects of research and investigations in the field of medical libary science and related activities for the development of new techniques, systems and equipment for processing, storing, and retrieving and distributing information pertaining to sciences related to health. There are exciting prospects that new techniques can result in great efficiency in the handling of literature and in its exchange between medical libraries and sciences, but these new techniques are extremely expensive. Careful research and feasibility study simply must precede heavy commitments by institutions, local, State, or National government to employ these techniques. Grants for Improving and Expanding the Basic Resources of Medical Libraries and Related Instrumentalities, section 397, will provide up to $3 million for each fiscal year 1966 through 1970 for making grants of money, materials or both to public or private nonprofit medical libraries and related scientific communication instrumentalities for the purpose of expanding and improving their basic medical library or related resources. These grants supplemented by institutional and local funds are clearly needed to make it possible for the medical libraries of this country to adequately provide services basic to research, education, and patient care.

Grants for Establishment of Regional Medical Libraries, section 398, will provide up to $2,500,000 for each fiscal year 1966 through 1970 for grants to existing public or private nonprofit medical libraries so as to enable each of them to service a regional medical library for the geographic area in which it is located. This can greatly strengthen and augment the well-established tradition of close cooperation between existing medical libraries and the sharing of resources. The concentration of many types of literature in an appropriate regional library can make it sufficiently available to all of the medical libraries in that geographic area without the need to duplicate the material in each one, thus achieving a high degree of overall effectiveness as well as economy.

Financial Support of Biomedical Scientific Publications, section 399, will provide up to $1,500,000 for each fiscal year 1966 through 1970 for making grants to and entering into appropriate contracts with public or private nonprofit institutions for education and individual scientists for the purposes of supporting biomedical scientific publications of a nonprofit nature and to procure the compilation, writing, editing, and publication of reviews, abstracts, indexes, handbooks, bibliographies, and related matter pertaining to scientific works and scientific developments. This sort of secondary publication is of growing importance in making it possible for scientists working in a given field to become quickly aware of what has been published in that field and decide whether or not he needs access to the full text.

Regional Branches of the National Library of Medicine authorizes the Surgeon General to establish as a branch of the National Library of Medicine a regional medical library to serve the needs of areas in which there is no regional medical library adequate to serve the area. It would authorize up to $2 million for each fiscal year 1966 through 1970 for this purpose. Careful study will be necessary to determine whether there is a clear need for such a regional branch of the National Library of Medicine in the area, but prior to such study, it seems likely that that will be found to be the case.

In closing, I want to repeat the unequivocal opinion of all of the medical schools of this country that it is urgently important that this legislation be passed, so that we can begin at once to correct the serious disrepair of our national library system and so that we can look forward to a future in which medical research, medical education, and the care of patients can be supported by ready access to the medical literature.

(1) Medical Schools in the United States at Mid-Century, John B. Deitrick and Robert C. Berson, Association of American Medical Colleges, 1953, Evanston, Ill.

(2) U.S. Committee of Consultants on Medical Research, Federal Support of Medical Research, Washington, D.C., 1960.

(3) Bloomquist, H. The status and needs of medical school libraries in the United States. Journal of Medical Education, 38: 145–163, 1963.

(4) A National Program to Conquer Heart Disease, Cancer, and Stroke, the President's Commission on Heart Disease, Cancer, and Stroke, Washington, D.C., 1965.

(5) Medical Library Needs. Datagrams: Association of American Medical Colleges, Evanston, Ill., April 1965.

The CHAIRMAN. Doctor, I wonder if you have any figures on how much money has gone into medical libraries in the last 15 or 20 years! Dr. WOLF. I do not have those figures at hand.

The CHAIRMAN. I imagine we can get them all right.

Dr. WOLF. I could see, if you like, if we could obtain these for you. I am sure the operating budgets of the libraries have more than doubled in the last 5 years.

The CHAIRMAN. That is what I had in mind, not only the amount for physical structures, but also the figures for the operations including personnel.

Are you finding much difficulty in getting staffs, operating personnel?

Dr. WOLF. Yes.

The CHAIRMAN. You are?

Dr. WOLF. In my own personal experience frequently we have had to wait a year to find a qualified librarian. I know there are a number of schools that have had to settle for less than qualified personnel.

The CHAIRMAN. What are we doing now to get more personnel, which we are definitely going to need?

Dr. WOLF. There are a limited number of training programs. I am not directly familiar with how many there are, but to my knowledge, they are not expanding at the present time very rapidly.

The CHAIRMAN. Well, Doctor, is it not true that our medical libraries are being used today to an increasing extent by postgraduate students in the basic medical sciences and by many categories of the paramedical students?

Dr. WOLF. Yes, sir; that is why I said the health professions before, because I think it is important to know

The CHAIRMAN. That is just what you had in mind when you spoke about the health professions. You have in mind not only the medical students, but the dental students, those in pharmacy, those in nursing. Dr. WOLF. Then the graduate students in the basic sciences for the Ph. D. degree and of course, interns and residents and physicians who are in practice.

The CHAIRMAN. Well, I find from the testimony that I hear on my appropriatons committee, particular references to the basic sciences and medical research. For instance, biochemists are playing a greater role in medical research. Is that not true?

Dr. WOLF. Oh, yes; and even broader than that, the behavioral sciences are becoming more and more important. And many medical schools are finding their holdings in these fields are sadly lacking. They should have things in their own libraries, but they are dependent on loans.

The CHAIRMAN. I wonder if we have any statistics as to the increase in the enrollment of what you might term the nonphysician students in these more recent years?

Dr. WOLF. I am sure that can be obtained.

The CHAIRMAN. You might check that and it might be of good to have it for the record.

Dr. Berson, will you come up and have a seat with the Doctor. Anything you would like to add on that last point?

Dr. BERSON. Senator, we do have some figures on the recent increase in enrollment of people in the allied health professions for whom the

medical faculties are responsible and I shall be happy to send you a letter summarizing that.

The CHAIRMAN. All right, if you will do that, we will have it inserted in the record.

(The letter referred to follows:)

Hon. LISTER HILL,

ASSOCIATION OF AMERICAN MEDICAL COLLEGES,
Washington, D.C., June 17, 1965.

Chairman, Committee on Labor and Public Welfare,
U.S. Senate, Washington, D.C.

DEAR SIR: The purpose of this letter is to provide for the record of the hearings on S. 597 some figures concerning the increases in enrollment of several categories of students for whom medical schools have total or partial responsibility. Some categories of students use medical libraries more heavily than others, but they all have some library needs which must be met.

Increases in medical and graduate students, interns, and residents and other

THE CHAIRMAN. Anything you would like to add, Dr. Wolf? Dr. WOLF. No, sir.

The CHAIRMAN. We thank you for your statement and for your presence here this morning.

Dr. Edward C. Rosenow, Jr., executive director, American College of Physicians.

STATEMENT OF EDWARD C. ROSENOW, JR., M.D., EXECUTIVE DIRECTOR, AMERICAN COLLEGE OF PHYSICIANS, PHILADELPHIA, PA.

Dr. ROSENOW. Thank you, very much, Senator.

I appreciate the opportunity of appearing. I am Dr. Edward C. Rosenow, Jr., of Philadelphia-an internist who spent 20 years in the practice of medicine before becoming executive director of the American College of Physicians.

The CHAIRMAN. Doctor, off the record.

(Discusion off the record.)

Dr. ROSENOW. During all this time in practice and since I have become executive director, I have been keeping active by actually teaching medical students. Next month, for instance, I go to take my turn in service at Philadelphia General.

The president of the American College of Physicians, Dr. A. Carlton Ernstene, of Cleveland, has asked me to appear before you today to