Chaos
Among The
Stacks

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Medical libraries almost everywhere, says renowned

Texas surgeon Michael FE. DeBakey, are understaffed
Jand underequipped, and collections are being destroyed
‘by crowding and confusion. In the following article, Dr.

DeBakey reports on the immediate need for drastic re-
habilitative measures and outlines several ways in which
medical schools, government agencies and private foun-
dations can help to overcome the problem.

crisis in medical libraries has occurred within the past
few decades almost without our being aware of it.
While we have been devoting millions to building the
world’s finest research institutions, staffing them with
highly skilled scientists and technicians, and equipping
them with costly and intricate machinery, we are allowing
our medical libraries to deteriorate into inefficient, poorly
staffed, badly housed, decaying repositories.

The end and the beginning of medical research is
the published record, essential for training new physi-
cians and for continuing the education of those already
in practice, But, as the Deitrick report put it ten years
ago, “In a nation dependent upon medical research to a
greater degree than ever before, surprisingly little is being
expended on the housing of the reports of that research
and on making those reports available.”

A large-scale national effort is needed now to rehabili-
tate medical school libraries, No temporary solution will
suffice and no one agency can take on the job single-
handedly. Not the medical schools, nor the federal and
state governments, nor private foundations can assume
the burden alone. The job must be cooperative.

Three needs are of immediate concern with regard
to improving medical libraries: housing, working and
storage space; trained library personnel; new methods of
handling the growing scientific medical literature.

Overstocked And Understaffed

Housing for libraries is in a deplorable state. A 1957
survey showed that about 55% of the 45 libraries report-
ing were filled or had exceeded their capacity. In the 45 %
with space for growth, normal growth allowed for no
more than five years’ expansion. Libraries have usually
found it necessary to store large portions of their working
collections, often a great distance away.

Well-trained, imaginative, professional library per-
sonnel are hard to come by. A good recruitment program
might attract more able young people into the field. Only
nine schools in the U.S. give courses in some aspect of
medical librarianship, and these are mostly summer
courses or are offered only in alternate years, There is
also a need to keep medical librarians up to date, Salaries
must be made commensurate with responsibility. The
median salary of medical school librarians is $6,000.

The proper management of medical literature is com-
plex, expensive and essential. Because expenditures have
been made so frugally, medical school library collections
now fall far short of what they should be. Proper main-
tenance has not been available, so the collections are be-
ing physically destroyed by crowding, dirt, improper heat-
ing and ventilation, and bad lighting.

Continued
MEDICAL LIBRARY Continued

Bibliographical apparatus has become too cumber-
some and expensive, and is breaking down. In 1880,
there were 864 medical journals in the world; at the end of
1960, the National Library of Medicine listed 5,711 in
the biomedical field. Actually, if all biomedical series
were counted (annual reports, weekly statistical reports
and so on), the current total would be around 14,000. A
library may be assumed to double in size every 12 years.
For 30 years the need for space in libraries has been de-
ferred, until now we have reached a point at which the
need must be treated as an emergency.

Col. F. B. Rogers of the NLM has stated that “A rea-
sonable standard for a medical library capable of sup-
porting research at its present accelerated level would be
100,000 volumes.” Generally, it is felt that a good medi-
cal school library should be receiving 1,200 to 1,500 cur-
rent journals. Fewer than 25% of the libraries have met
the suggested standard, and this is only minimal.

Because the needs are so extensive and so urgent, they
can be met only by outside help, The National Advisory
Health Council has made the following recommendations
to the Surgeon General, bearing in mind a planned expan-
sion of the National Library of Medicine:

> Development of a satisfactory assistance program to
permit the construction, extension and remodeling of
medical library facilities throughout the country.

> Mounting of an assistance program to augment the

MICHAEL E. DeBAKEY,
professor of surgery at
Baylor University Col-
lege of Medicine and
member of MWN’s Ed-
itorial Advisory Board,
was chairman of the
board of regents of the
National Library of
Medicine in Bethesda.

 

book stock and journal collections of existing biomedical
libraries, and to expedite their processing.

> Authorization of research grant funds for the direct
cost of library research services.

» A program to train medical librarians and docu-
mentalists at a level commensurate with the needs of the
nation.

> A support program to strengthen such components
of the conventional communications system as indexcs,
abstract services and review publications.

> A program of research and development in informa-
tion-retricval systems. This would aim at tying together
all medical libraries in a coordinated communications
system, compatible with comparable or parallel systems
which may be developed to handle literature in the physi-

MEDICAL WORLD NEWS /April 26, 1963

cal and social sciences, and with the international system
of medical libraries.

There is some feeling that libraries as we know them
are a thing of the past—antiquated, inefficient and un-
worthy of survival—and should be replaced by some new
institutional form made possible by modern technology.
Perhaps there is some merit to the idea of mechanized
storage and retrieval of volumes of published informa-
tion. The NLM has developed a new computer indexing
method for this purpose, MEDLARS (Medical Litera-
ture Analysis and Retrieval System). It produces an en-
larged Index Medicus directly from magnetic tape, pro-
vides 50 recurring specialized indexes for research fields
and has a demand search and retrieval facility capable of
handling 100 queries a day.

The NLM has proposed support for students in medi-
cal librarianship and documentation, short-term institutes
to update the skills of personnel on the job, support of
these institutions and an expanded intern program.

Federal funds should be made available to existing
and new medical schools to build up collections to mini-
mum standards of 100,000 volumes and current receipt
of 1,500 journals, and to support essential bibliographic
apparatus, Federal funds should be appropriated to ini-
tiate a program of recruitment, education and training
of medical librarians to raise their standards.

The regional reservoir library is a concept that shows
great promise. One central resource library collects mate-
rials in depth and makes its resources and services avail-
able to a broad geographic area, to smaller medical
libraries which can thus limit their collecting scope to the
most-used class of materials, and to the general medical
community.

John Shaw Billings, in 1881, said: “What is to be the
result of this steadily increasing production of books?
What will the libraries and catalogues and bibliographies
of a thousand or even a hundred years hence be like, if
we are thus to go on in the ratio of geometric progression,
which has governed the press for the last few decades?
The mathematical formula which would express this,
based on the data of the past century, gives an absurd
and impossible conclusion, for it shows that, if we go on
as we have been going, there is coming a time when our
libraries will become large cities, and will require the serv-
ices of every one in the world, not engaged in writing, to
catalogue and care for the annual product.”

Controls are not the answer, at least not controls that
state who can publish, how long an article may be, how
many journals may exist and the like. The answer is un-
doubtedly to continue to try to improve our library hous-
ing, our methods of indexing and retrieving and our
means of caring for the priceless documents that contain
the only authoritative and permanent record of the work
that is being performed so rapidly throughout the world.
Our libraries are our most valuable and precise link be-
tween generations and between people working in many
areas. We must protect them at any cost. But at the same
time we cannot afford to stand still. There is an urgent
need to revitalize these institutions for the national wel-
fare and the benefit of all. =

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