By Susan Crawford ~
My grandfather, John T. Brundage, MD was the only doctor in Moscow, Pennsylvania, a community of about 1000 people. Practicing medicine in the 1940s, he carried a black bag, looked for symptoms of illness, prescribed treatment, and on occasion delivered babies on a kitchen table. As an eight-year old, I sometimes tagged along and shared a thermos of hot soup which his wife prepared for him while he drove his big Cadillac and did house calls. If there were a problem, he might contact the local medical society library where the staff would eyeball lists of terms in the printed Index Medicus and send him a package of articles by mail. Forty years later, after grandfather had long passed away, his successor would meet patients in a large medical complex with specialists, machines, allied health assistants, and online access to world medical information.
The biomedical communication system in America began in 1836 with a small a collection of books in the Library of the Surgeon General’s Office. Under the jurisdiction of the Army, the library was of low priority during the first World War, the Great Depression and the Second World War. Dr. Michael DeBakey, world renowned pioneer in cardiovascular surgery, witnessed the deplorable physical condition of the library. The building had so deteriorated that staff had to place tarpaulin over the book stacks when it rained. Thus began Dr. DeBakey’s over thirty-year effort navigating the byzantine path of federal politics and promoting support to develop a national library of medicine. After decades of effort among devoted leaders of the medical profession, federal commissions and task forces, a bill was introduced in 1956 and signed into law by President Eisenhower to create the National Library of Medicine (NLM).
The period following World War II brought vast accomplishments in science and technology and the computer revolution. The broad scope of biomedical research ushered in a new era of molecular biology which would redefine the understanding of human medicine. Discovery of the DNA structure by James Watson and Francis Crick meant probing the biology of the cell and how genetic information is communicated. To address the huge volume of data that would be created, Dr. Donald A.B. Lindberg extended the NLM sphere beyond traditional publication databases to encompass a whole new category of information: biotechnology data. Its National Center for Biotechnology Information developed an integrated information system to connect and access information from research data, clinical and public health data as well as publications. As we enter the digital era, NLM is working on a system with a common architecture, an infrastructure, and new tools to support investigators, health care professionals and the public.
Dr. Brundage and his colleagues would certainly be amazed at this new world of managing the flow of information to serve health needs of the nation.
Susan Crawford, Ph.D., is Professor and Director emeritus of the Biomedical Communications Center, Washington University School of Medicine. She was an NLM Michael E. DeBakey Fellow in the History of Medicine in 2018.