The Lister Hill Center for Biomedical Communication highrise building underconstruction alongside the National Library of Medicine

New History of the 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.

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.

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.

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