A New History of NLM: Information Age

By Susan L. Speaker ~

This is the seventh post in a series of nine which serializes the new book US National Library of Medicine in the popular Images of America series of Arcadia Publishing. A hardback version of the book is available from booksellers, and an electronic version of the complete book and original versions of the 170+ images, which appear in it in black and white, are archived and freely available in NLM Digital Collections.  The Intramural Research Program of the US National Institutes of Health, National Library of Medicine, supported the research, writing, and editing of this publication. We hope that you will add it to your summer reading list!

In the early 1960s, as the Library settled into its new building, Americans were marveling at the dramatic advances in science and technology. Russian and US astronauts were making the first space flights, determined to land on the moon before 1970. The space programs spurred the growth of technologies such as transistors, integrated circuits, and mainframe computers. The first communications satellites were making transatlantic television transmissions possible. Likewise, polio vaccines, open-heart surgery, and new drugs were changing the practice of medicine. And Americans increasingly learned about these advances via television, which had existed only in science fiction a generation earlier. At the Library, a quieter but no less radical change had been under way that would revolutionize medical and scientific communication. It began with a new system to organize, store, and retrieve medical literature data with computer technology: the Medical Literature Analysis and Retrieval System (MEDLARS), developed through the leadership of Frank B. Rogers, MD, the Library’s director from 1949 to 1963.

Advances in medicine and science, as well as good medical practice, depend heavily on access to recent research publications. Recognizing this, the Library had compiled and published indexes of the medical literature since 1879. In the 20th century, as the volume of medical articles steadily grew, the indexing work became one of its chief services and occupied at least half of its staff. For each index page, the staff typed individual paper slips for each article citation and assembled them on a board to be photographed and printed. During the 1950s, the Library began to automate the process, replacing the boards with punch cards that could be machine sorted and run through an automatic high-speed camera. This streamlined index production, but with scientific publication booming and more than 100,000 new articles to index each year, the Library’s leaders knew they would need a faster, more versatile system to keep up. They also wanted a system that would allow librarians to search a database of articles and retrieve bibliographies for patrons upon request. In 1961, the Library contracted with General Electric to design MEDLARS, and in 1963, it acquired a Minneapolis-Honeywell 800 mainframe computer to run it. The system—the first computer-based bibliographic search service—became operational in 1964.

Computer operators work with the tape-driven Honeywell 800 mainframe computer, originally acquired by the Library in 1963, which ran MEDLARS. The Honeywell 800 ran an assembly language called ARGUS (Automatic Routine Generating and Updating System). Prior to the arrival of the Honeywell computers, General Electric staff trained Library staff in using ARGUS.

Technological advances helped to streamline the production of the Library’s indexes of medical literature. Beginning in the 1950s, the Index Section staff created punch cards that could be machine sorted to automate the production of the printed indexes. The glass wall above was intended to muffle the sound of the noisy machines; it remains a feature of the second-floor mezzanine of the Library.

Indexing medical literature was one of the most significant programs in the Library throughout the 20th century. Indexers created bibliographic citations for every article published in the thousands of medical journals covered by MEDLARS and, since 1971, MEDLINE. Among them was Stanley Jablonski, pictured here, a lexicographer who worked at the Library from 1949 to 1976. He was a skilled linguist who could read and index medical literature in 10 languages. Jablonski played an active part in the development of MEDLARS and became head of the Library’s Index Section.

Staff carefully analyze individual articles to identify main concepts and assign descriptors from a standard vocabulary known as the Medical Subject Headings (MeSH), which the Library began publishing in 1960 to facilitate effective search and retrieval. Staff typed individual indexed citations on paper slips and assembled them on a board to be photographed and printed as an index to current medical research.

A Library staff member guides patrons in using computer terminals introduced at the Library in the early 1980s.

Library staff used punched paper tapes to enter MEDLARS data into the computer, and stored this data on magnetic tape reels. To search MEDLARS, a patron filled out a search form, which was then given to a search specialist, who built a search formulation using subject terms and other elements. Search requests were processed in batches, and patrons received the results in two to four weeks. From the start, the Library intended the system to be decentralized—staff gave copies of MEDLARS (on magnetic tapes) to other large medical libraries to use with their own computers, and trained the search specialists at these institutions. The Library also used MEDLARS to create automated catalog records for new books. MEDLARS was an important first step in a new vision of medical libraries generally; no longer just places to store books and journals, they would be active information centers, using television, telephone, and computer technology to develop networks for communicating biomedical information quickly and to evaluate and develop new systems for information storage and retrieval.

In 1965, Congress authorized two major federal health programs, Medicare and Medicaid, as well as the Medical Library Assistance Act. Together, these initiatives would rapidly increase medical services and research and set the stage for developing better health care communication networks, including a network of regional medical libraries led by the Library. Furthermore, Library staff and the board of regents recommended to US surgeon general Luther Terry that the Library should support experimental programs to test multiple approaches to meet the needs for biomedical information and be a national resource for information systems research and development within the public health service. Library leadership proposed establishing a national center for biomedical communications in a new building staffed by scientists doing research and development in information systems and developing and demonstrating methods for the continuing education of workers in the health professions. Congress authorized the center in 1968, and at the suggestion of the Library’s director, Martin M. Cummings, MD, named it in honor of Alabama senator Joseph Lister Hill, longtime advocate for health legislation and co-sponsor of the 1956 National Library of Medicine Act.

Martin M. Cummings, MD, was director of the Library from 1964 to 1983. During his tenure, which began two years after the Library’s new building opened on the Bethesda campus of the National Institutes of Health, the mission of the institution as a health information resource expanded substantially. In the years that followed, the Library emerged as a leader in the computer age, pioneering the use of the US Department of Defense Advanced Research Projects Agency Network (ARPANET), the precursor to the Internet, and becoming a major biomedical communications center.

Dating from the 1970s, this graphic depicts the original 11 regions of the Regional Medical Library Network, established by the 1965 Medical Library Assistance Act, which had its roots in President Johnson’s 1964 Commission on Heart Disease, Cancer, and Stroke. Proponents intended the Medical Library Assistance Act, and the networks it created, to strengthen America’s system of medical libraries, to enable them to disseminate biomedical literature within their geographical areas, and to provide computer searches, copies of documents, reference services, specialized information centers, and training for Library staff.

An Application Technology Satellite-1 (ATS-1) antenna sits next to a Native Health Clinic, established by the US Department of Health Education and Welfare, Public Health Service, in Galena, Alaska, around 1970. This technology, combined with the Teletypewriter Exchange System, or TWX, enabled the Library to pioneer long-distance medical education and consultation.

During its first decade, the Lister Hill Center staff tackled many challenges in cooperation with staff across the Library. Together, they developed and tested an online system for MEDLARS, called MEDLINE (MEDLARS Online), which enabled users to enter search requests from remote terminals, via the Teletypewriter Exchange System, or TWX. The center also applied communications technology to medical education via an interactive television network and a computer-assisted instructional network that included a number of medical schools. In other projects, they demonstrated the usefulness of satellite communication for medical education   and consultation, setting up connections to Alaska, Montana, Idaho, and Washington. Thus, medical students in Alaska could attend classes given at the University of Washington via satellite television transmissions. Physicians in remote areas could send electrocardiograms and other images to colleagues at larger medical centers and confer with them in real time.

In 1979, long before the Internet became part of people’s daily lives, the Library began to convert the remainder of its vast card catalog to machine-readable form so that the bibliographic information about its holdings dating from the 12th century to 1965 could be accessible to patrons online. This landmark accomplishment, one of the first of its kind in the nation, was completed in the early 1980s. When searching on the Internet became commonplace in the 1990s, the Library, in 1993, was one of the first federal agencies to set up an Internet site. Since then, it has continued to lead in the field of medical informatics, support training and research through a variety of programs and grants, and play a major role in making the published results of biomedical research publicly available worldwide.

Susan Speaker, PhD, is Historian for the Digital Manuscripts Program of the History of Medicine Division at the National Library of Medicine.