By Elizabeth Fee
In the two decades after World War II, America’s medical libraries were in very poor shape. Funding for medical research and education had dramatically increased, but no such provision had been made for the libraries. At the National Library of Medicine, created by the U.S. Congress in 1956 by transferring the Armed Forces Medical Library into the Department of Health, Education and Welfare, Scott Adams and Estelle Brodman began to discuss the need for extramural programs and draft plans for them. They hired Harold Bloomquist, assistant librarian of the Harvard University Schools of Medicine and Public Health, to study the condition of medical libraries across the country. He found that, too often, the libraries were unable to provide even basic services; he said that federal funding would be needed to improve medical library collections, upgrade their facilities, and train more medical librarians. He suggested the creation of a system of regional resource libraries to be supported by the National Library of Medicine through a significant grant program.
Bloomquist’s report generated considerable interest, followed by meetings between representatives of NLM, NIH, medical schools, and medical librarians to discuss plans for a regional medical library system. The President’s Commission on Heart Disease, Cancer, and Stroke, chaired by heart surgeon Michael E. DeBakey, now played a key role by stating that proposed efforts to accelerate research and knowledge to defeat these diseases would be an “exercise in futility” unless a major effort was made to improve medical libraries and thus access to biomedical information. The Commission recommended that the National Library of Medicine be authorized, and adequately funded, to strengthen the nation’s medical library system, study new methods for the efficient management and dissemination of biomedical information, and provide grants to improve medical libraries. Given the prominence of the President’s Commission, and especially the international reputation of Michael DeBakey, these recommendations received a great deal of attention. NLM drafted legislation, the Medical Library Assistance Act (MLAA), which was introduced to the Senate by Lister Hill and to the House by Representative John E. Fogarty in January 1965. Thanks to the enthusiastic support of health and library professionals, the act was signed into law by President Lyndon Johnson in October, 1965.
Martin Cummings, Director of NLM (1964–1983), said that NLM would be responsible for planning, selecting, and coordinating the Regional Medical Library Program, and continue to collect and make available the world’s biomedical literature. The Regional Medical Libraries (RMLs) would be responsible for disseminating biomedical literature within their geographical areas, and provide computer searches, copies of documents, reference services, specialized information centers, and training for library staff. NLM management felt that the policies established by the RMLs should be as uniform as possible—given minor regional differences—and should be compatible with the NLM’s own policies.
Over time, several modifications were made to the original act. One was that NLM could issue contracts rather than grants to the regional medical libraries. This particular ruling received a mixed response as it gave NLM more control over the use of the funds awarded to RMLs, and by establishing uniform standards, required, in some cases, that institutions had to change their policies and practices. As the NLM Board of Regents explained in 1970, “…the intent of the conversion to contracts is to use this as a mechanism for a more controlled and coordinated allocation of resources to insure maximum service.” The organization of the network of libraries was to be hierarchical, with NLM at the apex of the pyramid, the regional medical libraries on the second layer, the resource libraries, primarily those in medical schools, on the third, and the “basic units,” primarily hospital libraries, on the fourth. NLM would select and provide the funds for the RMLs, and the RMLs, while improving their own collections and resources, would assist and supplement the resources of all cooperating libraries within their region.
Planning for the regional library system entailed a number of difficulties: uncertainty about the number of libraries to be supported; the selection of the institutions to serve as RMLs; and the relationship of the RMLs to the Regional Medical Programs (RMPs). The Regional Medical Program was intended to create regional cooperative organizations of medical schools, research institutions, and hospitals. A separate federal program, it too had been recommended by the President’s Commission on Heart Disease Cancer, and Stroke. NLM maintained close relationships with the RMPs until they were all abolished in 1973.
The first RML to be selected was the Countway Library of Medicine at the Harvard Medical School, the second, the library of the New York Academy of Medicine, and the third, the library of the College of Physicians of Philadelphia. In all, eleven RMLs were established—later reduced to seven because of federal budget cuts, and then expanded to eight as New England became a separate region. Soon, the libraries would have to compete for RML contracts, leading to the inevitable stresses between the libraries selected and those unsuccessful in obtaining a coveted contract.
Initially, medical and health professionals would access the resources of the National Library of Medicine by going to their local medical library to request interlibrary loans and research materials. The problem here was that many doctors, especially in rural areas, had no easy access to a medical library. Michael DeBakey, a tireless advocate of the library, chaired the Outreach Long Range Planning Panel which produced a 1989 report, “Improving Health Professionals’ Access to Information” which recommended that direct outreach be made to such medical professionals. From that point, the provision of services directly to health professionals, and later to the general public as a whole, became a central mission of NLM.
Especially in the early years, the continuing problem with the full implementation of MLAA was the budget; from 1965 to 1970, only 40% of the authorized funds were actually appropriated. In spite of such difficulties, the Regional Medical Library Program, now the National Network of Libraries of Medicine (NN/LM) has continued to thrive and now consists of a remarkable network of libraries of medicine across the county, so organized that medical library services, such as interlibrary loans and many others, can efficiently and effectively serve everyone with ready access to biomedical information, whether for research, medical practice, or teaching. Many new resources, especially created for the general public, have again broadened the reach of the national network of libraries of medicine to every member of the public seeking health information.
Elizabeth Fee is Chief Historian in Office of the Associate Director for Library Operations at the National Library of Medicine.