Foundations of Medical Librarianship* BY ERICH MEYERHOFF, Librarian and Assistant Dean for Information Resources Cornell University Medical College New York, New York ABSTRACT The development of medical librarianship during the last forty years is examined as reflected in the changes of its resources, technology, education, and knowledge base. A shift from historical to scientific inquiry constitutes the direction of medical librarianship. Its nexus is the gathering of information and the transfer of knowledge. The social and human resources for this ongoing change and the basis for a quest for excellence is seen in the pool of talent represented by hospital librarians and the aspirations of the women's movement for equality.

Darling's examination of certification; Rogers's analysis of a runaway MeSH; and Gertrude Annan's review of the association's history from 1937 to 1967. Doubt rather than affirmation has characterized the intellectual and artistic analysis of our times and my own beginnings in the profession in the fifties. Auden [1] spoke of the Age of Anxiety; 1984 became the catchword for the dehumanization and harsh conformity of our society in Orwell's [2] apocalyptic vision. Hannah Arendt [3] could speak of the banality of evil in describing Eichmann, a bureaucrat who managed the unprecedented extermination of several million human beings. In our own field the past fifteen years have been a period of immense growth of ideas, resources, and services. It was a period of marvelous advances which conferred professional satisfaction on those who came into the field as well as the older, established practitioners. Yet the temper of our times no longer equates change with progress, and buoyant notions of abundance are challenged by admonitions of physical and personal limits in a new age of scarcity. "Are we really on the threshold of a renaissance for the library profession, or are these the long days of a twilight in which libraries continue to be exhausted by budget cuts and abandoned by their constituencies?. . ." Nina Matheson [4] asked, examining the future of our profession. This is also the uncertainty that I bring to the task. Change has been the most prominent characteristic of the immediate past anrd a personal experience. To stand at the end or close to the end is neither tragic nor

BEFORE you stands a reluctant Janet Doe Lecturer, uncertain in purpose, of limited vision, and feeling unequal to the task with which you have honored him. David Bishop, my immediate predecessor, wondered about his mission and whether the call had already placed him among the ancients, among the dinosaurs whose faulty adaptation led to extinction. Diplomatically and with witty assurance, however, we were reminded of the dinosaurs' hardiness and on the authority of one of our successful contemporary novelists, of their millennia-long rule of the earth. Ambiguity seemed evident in the presentations of the two lectures which preceded that of David Bishop. The late Jacqueline Felter asked whether cooperation was a wave of the future or a ripple. Harold Bloomquist, ever so incisively, looked at fads and fashions in the management of medical libraries in a somber, introspective appraisal. How different in approach and feeling from Scott Adams's "The Way of the Innovator," a celebration of the achievement of Frank Rogers in transforming the form and function of the National Library of unpleasant. Medicine; Estelle Brodman's affirmation of inI would like to bear witness, then, to some of tellectual excellence; Alfred Brandon's review and the changes in our profession, its resources and support of faculty status for librarians; Louise services, its education and its knowledge base as they occurred in the United States of America. In this review persons and contributions serve as *The Janet Doe Lecture on the History or Philosophy types and illustrations. Exhaustive attribution to of Medical Librarianship, presented June 14, 1977, at the Seventy-seventh Annual Meeting of the Medical Li- all who may have been involved has not been attempted. The title of this paper then is a little brary Association, Seattle, Washington. Bull. Med. Libr. Assoc. 65(4) October 1977

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high-flown and unfortunately pretentious. My tional Library of Medicine. The development of library-based patient education programs is beginreach was so much higher than my grasp. ning to add a new and exciting dimension to library service in hospitals and health care centers. RESOURCES What is the relationship of resource developThe growth and development of resources, ment to the growth of the biomedical literature? technology, and services in all medical libraries is Corning and Cummings [11], in a cogent review of an astonishing achievement. In 1898 a total of 48 the development of biomedical communications in libraries were recorded in the February issue of the United States, found that of the 19,000 periMedical Libraries, the predecessor of the Bulletin. odical titles received by the National Library of In 1940, 842 [5] and in 1973, 2,984 [6] were listed. Medicine in 1974, 6,318 are included in SERLINE In 1940, 5 million [5] bound volumes constituted because they are deemed sufficiently important to total holdings. There were more than 30 million in be part of this on-line location service, and 2,244 1973 [6]. Susan Crawford [7] has just documented of these are indexed in Index Medicus because an even greater growth of the resources of they are substantive journals. Current subscripmedical school libraries. She reported average li- tions in the libraries reported in Hendricks's [9] brary budgets of medical schools in 1960/61 as survey varied from 6,836 at the Biomedical Li$57,471 compared to $328,093 in 1973/74. brary of the University of California, Los Angeles, Bloomquist [8], in his survey of medical school li- to 520 at the newly established Wright State braries, reported a median of 992 current serial University in Ohio. The median number of titles held in 1960, while in 1975 the median was subscriptions was 1,942. Thus 50% of the libraries 1,942, -according to Hendricks [9]. A threefold surveyed were not receiving all of the journals increase in the number of professional librarians indexed in the Index Medicus. To attain subscripoccurred in the fifteen-year period following tions to all journals covered by this index was once Bloomquist's [8] findings in 1960, and eighty-six a prominent goal of collection development in new library buildings were constructed between medical school libraries, just as the magic one 1966 and 1975 [7]. hundred titles in the Abridged Index Medicus beThe acceleration of change after the imple- came a convenient goal for smaller collections. mentation of the Medical Library Assistance Act Inflation, the devaluation of the dollar, and the of 1965 is so marked that a causal relationship ap- sharp curtailment of funds in the health sector of pears self-evident. Of the appropriated funds, our economy suddenly put a halt to the euphoric $11.8 million or 29% were expended for the hopes of continuous resource development. improvement of resources during its first five Instead, desperate measures became commonyears [10]. These funds were used mainly for the place. Some libraries placed a moratorium on new purchase of journals and books in medical school subscriptions. Five hundred or even 2,000 titles libraries. Not only did the library collections show were discontinued in some larger libraries. Unable growth in their book and periodical holdings but to hold what was useful, libraries had to define with the advent of self-instructional materials, what was necessary. Not all were equally affected audiocassettes, tape-slides, and videocassettes and we need to assess again the quality of were acquired at a time when this educational resources and their distribution. technology was still undergoing rapid changes in To deal with these adverse economic conditions format and was extremely costly. Computer- by discontinuing all journals published in lanassisted instruction became another library-based guages other than English, for example, as dimension of new modes of learning. Libraries Truelson [12] suggests, implies an unfortunate paaccepted these new materials easily as part of rochialism and intellectual isolation. Our troubles their acquisition and dissemination function. had the salutary effect of beginning an examinaCrawford [7] suggests that the rise in the rate of tion of the rationale of our acquisitions policies. It development of resources in medical school li- also emphasized how much we have indeed bebraries has come to an end. The resources for come part of a national medical library system health care institutions directly concerned with which so far has had an enviable success in reachpatient care, however, must expand. To meet in- ing the goal of equality of access to biomedical information needs in the community, hospitals, and formation. The provision of sufficient resources other health care establishments, support is pro- and the viability of the system is, and remains, a vided by consortium resource grants from the Na- national responsibility. Only on the basis of con410

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tinuing and adequate government funding can our network retain and improve its reliability. TECHNOLOGY

Times when automation consisted of punched cards, a sorter, and an accounting machine are beyond the recollection of some of us because the one central element of technology applied to medical library practice has been, and continues to be, the computer. While the Index Medicus was fashioned in 1960 with the use of punched cards and the step and repeat camera, the capability of automating the arrangement of citations to make these searchable by the computer was achieved in 1964 through the Medical Literature Analysis and Retrieval System at the National Library of Medicine. The National Library of Medicine led not only all other libraries, but the country, in the development of a large-scale computer-aided indexing and information retrieval system. Especially noteworthy was Rogers's insistence that the bibliographic integrity of the record should not be sacrificed to the limitations of the machine, as was frequently the custom when "quick and dirty" often characterized computerproduced bibliographies. The controlled indexing vocabulary of MeSH became what is to date the last major effort by a librarian to cope systematically with the organization of information in medicine. Large-scale data systems in biology, psychology, chemistry, and engineering, which developed subsequently, either abandoned the effort or never attempted it and left us with some of the vagaries of free text searching. MEDLARS developed into an international biomedical information system. Another of its major accomplishments was the significant enlargement of the productivity of librarians in providing bibliographic information. Manual literature searches were then and continue to be performed in libraries, and complete literature searches require them. But the number of searches which could be performed by journal scanning and the use of printed indexes and abstracts was so time-consuming that such a service was offered in few libraries. Computerassisted searching satisfied the real and immediate demand for this service. Librarians trained in search formulations acquired a unique expertise which could be learned by others devoting sufficient time and practice to it, but it compared to other analytical skills found in a medical setting, best left to those with the training and Bull. Med. Libr. Assoc. 65(4) October 1977

experience to perform them. No small part of the professional recognition of librarians may be attributed to the use of this new and needed technology. With the support of the National Library of Medicine a burst of experimentation in computer applications to medical library tasks ensued. At the University of California, Los Angeles, under Louise Darling, and at Washington University, under Estelle Brodman, to name two prominent examples, applications were made to circulation, cataloging, production of book catalogs, and serials control. At Washington University this last developed into the PHILSOM network. The late Jacqueline Felter developed a computer-assisted union catalog at the Medical Library Center of New York and its programs spawned other union catalogs in many regions. These are only instances, as the list of librarians who have made productive use of these new resources is long and many of them are known to you. Perhaps the most fruitful applications have been those which provided centralized services for many, especially smaller, libraries. The Medical Library Center of New York, for instance, provides a catalog card procurement service through its access to the Ohio College Library Center System. The inclusion of the current catalog data in OCLC will increase the utility of this system for medical libraries. The new technology has increased labor productivity by the reduction of clerical routine. Reliable controls and ready access to management data which are crucial to planning have become readily available. The advent of the minicomputer has marked the beginning of a cost reduction of this equipment, and the expansion of the shared use of computers will make their use in smaller libraries economical and desirable. SERVICES

As resources expanded so did services. Document delivery and interlibrary loans increased steeply with the operation of the Regional Medical Library Network. The 108 institutions, nearly all medical schools, in Hendricks's [9] survey for 1975/1976 lent nearly 925,000 items, while they borrowed only 180,000. They lent five times the amount borrowed. The beneficiaries were hospitals with small or no collections. The availability of computer-assisted searches and a federally supported system of document access and delivery suddenly brought journals and books easily within 411

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the reach of practitioners. Libraries were making significant progress in replacing the "detail man" as a source of reliable information. The change which transformed medical libraries from information sources to information agencies has been going on since the founding of the association but came into prominence in the last fifteen years. Ralph Shaw [13], in his recommendation for the National Institutes of Health Library, suggested long ago that in addition to look-up services for facts in standard sources, a "bibliographic intelligence" be manned by subject literature specialists with advanced education to provide services tailored to the needs of the investigators, including state-of-the-art reports and evaluative information. These proposals were realized in part in the information centers established by the National Institute of Neurological Diseases and Stroke. Their rise and fall was reviewed by Darling [14]. Today only the Brain Information Service at the University of California, Los Angeles, and the Clinical Neurology Information Center at the University of Nebraska remain. The manual bibliographic search service and the routing of journals have been superseded by computer-aided searches and selective dissemination. The circulation of tables of contents of journals, initiated by the late J. Alan MacWatt, librarian at Lederle Laboratories, has become a vast commercial success through Current

Contents®. Clinical librarianship broke completely new ground in bringing information and librarians to the bedside. Gertrude Lamb initiated this service at the University of Missouri and has continued it at the Hartford Hospital in Connecticut. It is a mode of service which promises to establish once again a close and systematic relationship between physicians and librarian. The Regional Medical Program funded many library-based information and document delivery services. Many have continued because, the medical community found them essential and was willing to fund them. We are still at the watershed but the issues are joined and it is my own bias that we must be accepted not for the volumes on our shelves but for the information needs to which we can professionally respond. To be sure, this calls for subject expertise, which many already possess. The main problem is not one of preparation and direction but, at least in academic institutions, the demonstration and acceptance that librarians are far better than others, including graduate students, at information gathering. 412

EDUCATION

Medical librarians today have completed far more formal education than had practitioners in the fifties. Nearly all have a master's degree from an accredited library school, many have degrees in a subject specialty, and increasingly heads of medical libraries have doctoral degrees. Whether we are better educated than Janet Doe, who did not attend a library school, or James Ballard of the Boston Medical Library who was superbly self-educated and unencumbered by any academic scrolls, is questionable. In ever-increasing numbers we attend continuing education courses offered by the association at annual meetings and locally in our regions. We have attested to the seriousness of our purpose by employing a full-time director of education, and under this professional leadership the syllabi of the continuing education courses have been revised, improved in content and appearance, and directed toward defined educational objectives. An evaluation of the quality and effectiveness of this effort, however, is needed. Mary Louise Marshall established a twelvemonth residency at Tulane's Rudolph Matas Medical Library in 1941 and Eileen Cunningham followed in 1944 at Vanderbilt. Both ladies were endowed with formidable personalities, as those here who remember them may attest. It is perhaps for this reason that these programs did not survive their departures. In conception and content these were vigorous, dedicated, but still searching efforts to acquaint librarians with the unique features of a specialty as practiced in the libraries where the training took place. With the funding of training by the National Library of Medicine these programs took on a new and sophisticated dimension. Specialized instruction, for example, in computer applications to medical library problems was offered at Washington University, in administration and the history of medicine at Johns Hopkins, and in several specialties at the University of California, Los Angeles. The careful selection of participants to involve those most likely to benefit from and to succeed in the program, a choice of academic courses to provide an underpinning of their practical training, the evaluation of the program, and the progress of the participants characterized these efforts. They ended when training grants were discontinued as part of a general reduction of support of all federally funded training programs in the health sciences. The training coordinator at the Biomedical LiBull. Med. Libr. Assoc. 65(4) October 1977

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brary of the University of California, Los Angeles, commented (on the end of its federally funded training program which began in 1961 and continued without interruption for thirteen years to 1974) that forty-six young librarians had passed through the programs and that more than 80% of them had remained active in the field. She believed, and with justification, that the impact of the program had been felt throughout the library community. Indeed, centers of excellence with good training facilities had developed and the trainees of these programs were desirable recruits for positions in other libraries. Often several positions were available to them even under the adverse job market conditions which have prevailed these last long years [15]. An analysis of all programs and their description was undertaken by Fred Roper [16]. Their discontinuance is a political fact and a contemporary tragedy.

Courses in Medical Librarianship A course in medical literature at Columbia University's School of Library Service in 1939, and taught by Thomas P. Fleming, began formal education in our field. These courses have proliferated. Julie Virgo [17], in a full-dress review of medical library education, noted that in 1975, thirty-seven out of sixty-two accredited library schools in the United States and Canada offered such courses. With some exceptions, they are taught by part-time faculty, often the chief librarian of the medical school of the university with which the library school is associated. In the early days following the Columbia University model, an introduction to the bibliography of medicine was taught in one semester. Today, a more general approach to content is common, with emphasis on the unique aspects of medical library practice, biomedical communication, and information retrieval. Research, a basic function of university graduate programs, with some notable exceptions, for example the work of Chen at Simmons, Rees and Cheshier at Western Reserve, and Crawford when she was at Columbia, has not developed. A compilation of doctoral dissertations in library science accepted between 1925 and 1972 at American universities lists only seven dissertations related to medical librarianship out of a total of 660 118]. The absence of organized research at library schools constitutes a serious obstacle in the development of our discipline and its knowledge base. A significant educational effort, especially related to the utilization of computer-assisted inBull. Med. Libr. Assoc. 65(4) October 1977

formation retrieval from different data compilations, takes place completely outside the above mentioned channels. The National Library of Medicine, of course, is a primary site for such instruction. However, the Biomedical Communication Network, when it functioned as part of the State University of New York, the Bibliographic Retrieval System, Inc., Lockheed, and other commercial distributors of data systems provide learning opportunities for their users. Although attempts were made to develop library school programs with special options in medical librarianship, only at Case Western Reserve has such a program remained viable. An integral part of its curriculum is a unique workstudy program developed jointly with Cleveland Health Sciences Library. As training for specific skills in library schools has given way to instruction of concepts and the rationale of practice, the need for supervised work situations has become essential. While educational opportunities have increased, the dilemma which Estelle Brodman [19] posed in 1954 remains unanswered: "What is needed and has not yet been attained is a clear knowledge of the goals and philosophic aims of medical librarianship. Until the profession as a whole has decided what its functions are ... any system of education can only be the teaching of limited techniques with a limited view. The challenge of education for medical librarians today is not the how but the why of medical librarianship, and unfortunately very little has been done to answer this basic question." What appears to emerge as the nexus of our concern is communication, information, and its mode of transfer. We need to return to this in examining our knowledge base. KNOWLEDGE BASE In the recognition of a profession, its unique contribution to a segment of knowledge or the

possession of specialized training and techniques is essential. The description of books, manuscripts, the bibliographic organization of their contents and those of journals was central to our endeavors and formed a close link with academic scholarship. George Sarton [20] states, "The main point to emphasize . . . is that accuracy is as fundamental in the historical field as in the scientific one, and that it has the same meaning in both fields." With this observation he introduced the need to investigate carefully evidence for the time of occurrence of historical events, the sources of errors in dates in tombstones and books, and the

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problem of periodicity in history. It parallels our concern with the establishment of the main entry, the authenticity of the document, pseudonymous authors, dates of birth and death, the succession of editors in journals, the careful collation and detailed description of books, and their provenance. If the historian's task was to write history as it really occurred, then the need for the careful establishment of the authenticity of documents and the objective evaluation of evidence was a mandate for librarians. Janet Doe, herself, personifies this approach, and her Bibliography of the Works of Ambroise Pare embodies this knowledge base. In the chapter "Pare, author or plagiarist, a weighing of the evidence," she carefully establishes the authenticity of the works. But beneath the careful scholarship and attention to detail, her heartbeat is heard in every sentence. She characterizes the ninth to the thirteenth editions of the collected works of Pare as the "Lyons malprints." She gives us a preview of her deep feeling about the thirteenth edition in her introduction: "And in 1685 the last, the unlucky thirteenth, came out, to fall into an oblivion deserved by its wretched typography, worn wood blocks, and sleazy paper" [21]. Describing the book later in detail she concludes, "This edition is the most detestable of all. The pages have been compressed into eighty-five lines each, the paper is wretched, and the typography more vicious than in any of the preceding .... All the Lyons ones, beginning with the ninth edition in 1633, are abominable: the paper is inferior; the text continues, and even adds to, the indefensible alterations; and typographical errors abound. The plates for the illustrations, recut in 1633, are not so good as the originals, and have grown worn and broken by the time of the last impression in 1685. In fact, the farther from the source, the poorer the editions become" [22]. Certainty of judgment is expressed in vigorous declarative sentences. Doe dares to be righteous because she knows. Janet Doe used Geoffrey Keynes's bibliography of William Harvey [23] as a model for her own method of presentation. Keynes, a surgeon and brother of Maynard, the economist, was already acknowledged as a modern bibliographer. The meticulous description of books and journals, their bibliographic, classificatory, and subject analysis formed an identifiable foundation of knowledge and expertise for medical librarianship. It formed not only the base of a common interest but a bond of mutual respect between physicians and librarians. Corning and Cummings in the pre414

viously cited review summarized this relationship thus: One of the most exciting aspects of library development and organization at the end of the nineteenth century and the beginning of the twentieth was the close collaboration of physician and librarian. As the issues being discussed became more related to classification, union catalogues, and cooperative sharing, however, the management and organization of medical libraries no longer commanded the attention, much less the full support, of the medical community. The librarian began to carry the burden of seeking funds, of management, and of providing service. The intellectual bond between the medical and library communities began to weaken [I ].

From a long list of physician-bibliographers some representative instances may suffice. Sir William Osler [24], a founder of this association, not only brought together one of the great collec-

tions of books illustrating the history of medicine but began their bibliographic description and annotations. Harvey Cushing [25] found time for the Bio-Bibliography of Andreas Vesalius, and John F. Fulton [26] of Yale published his study of the Great Medical Bibliographers. Their books reflect the relationship with librarians, Osler and Marcia Noyes, Fulton and Helen Bayne and Madeline Stanton. Librarians in turn contributed to the history of medicine. Thomas Keys collaborated with Willius [27] on Cardiac Classics and wrote the History of Surgical Anesthesia [28]. William Postell [29] contributed a classic review of the health of slaves in the antebellum South. David Kronick [30] wrote a history of the scientific and technical periodical now in its second edition, Myrl Ebert [31] a definitive paper on the rise and development of the American medical periodical, Estelle Brodman [32] the history of medical bibliography, James Ballard [33] of the Boston Medical Library compiled a list of its incunabula, and Leslie Morton [34] has guided "Garrison and Morton," a key to the history of medicine and a boon to historians, librarians, and auctioneers, through its third edition. Classification The arrangement of materials as well as their classificatory organization also formed part of the central interest. The Bulletin of the Medical Library Association published many classification schemes. The association, no doubt in a moment of utter abandon, even adopted the Boston Medical Library Classification as its official classification in 1921 only to retract by silence after Ballard had revised the classification scheme Bull. Med. Libr. Assoc.

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without prior notification to the association. John Shaw Billings had a scant interest in classification and one of the major recommendations of the survey of the Army Medical Library in 1944 [351, with Janet Doe as a leading participant, was the development of a new medical classification. After Rogers developed the National Library of Medicine Classification the problem came to rest and he never returned to it. Recently a large-scale revision of it, to be carried out by Emilie Wiggins, has been announced. The classification schemes of the Library of Congress and of the National Library of Medicine gained greater and greater predominance since they provided libraries with complete cataloging information, especially with the advent of the Current Catalog. One by one special classifications were discontinued; that of the New York Academy of Medicine and even the estab'tished Boston Medical Library Classification and the Cunningham Classification succumbed. The Bellevue Nursing Classification still survives in isolated instances. The problem of classification then was simply abandoned in the health sciences. Subject analysis remained an active issue. Rogers's unorthodox insistence on analyzing information in books and journals with the same indexing vocabulary raised questions which quickly subsided because practice proved him correct, and the inclusion of monographs in the Index Medicus foreshadowed by Irwin Pizer's [36] original program for the Biomedical Communication Network at the Upstate Medical Center of the State University of New York was consistent, logical, and inevitable. The development of a new subject headings list for the production of the Index Medicus in 1960 and its adaptation by Sewell for the hierarchical arrangements in MeSH was a necessary and sufficient prerequisite for the development of the machine manipulation of citations in MEDLARS. Revised and enlarged, it remains one of the most useful and best controlled indexing languages available today. In spite of the agitation and excitement which prevailed around the construction of thesauri, my limited search for a serious critique of MeSH has only revealed Rogers's concern about the too free addition of terms in his Janet Doe lecture of 1968. With the firm establishment of a national system of medical classification and subject headings the concern with the development of such systems in individual libraries atrophied. The Ohio College Library Center and the computer-aided catalog of the University of California, Los Angeles all give promise to a vast improvement in access to books Bull. Med. Libr. Assoc. 65(4) October 1977

and monographs and present a viable base for resource sharing. The organization of knowledge in the health sciences, however, remains an important unsolved problem, worthy of our best minds and their best efforts. EMERGING SCIENTIFIC INQUIRY The strength and appeal of the humanistic, historical foundation of medical librarianship is profound and continues into our times. As late as 1949 Janet Doe [37] concluded her presidential address on the development of education for librarianship with a long and affectionate review of Osler's knowledge and appreciation of medical librarians and their work. A change in the direction of library education away from training and dayto-day practice to the principles underlying practice and to a critical and experimental point of view had taken place at the Graduate Library School of the University of Chicago under the direction of Lewis Round Wilson in the 1930s. Waples, Butler, and Wilson [38] applied the methodology of the social sciences, the use of survey questionnaires and sampling statistics to the study of library users, reading and reading habits, libraries, and communication, including radio and cinema. Somewhat later, experimental inquiry was employed in medical librarianship. Estelle Brodman's [391 master's thesis at Columbia University, "Choosing physiology journals," was published in the Bulletin of the Medical Library Association in 1944. It was a carefully designed study testing the validity of the Gross and Gross [40] method of journal selection on the basis of the frequency with which they were cited. She compared a list of titles derived by the Gross and Gross method with a listing based on ratings of faculty experts. No correlation was found between the rank order of the list based on expert opinion and that established by citation count. William Postell [41] was so excited by the approach that he tested the results by an analysis of journal use in his library and found further support for Brodman's conclusions. Her findings and methodology are still germane today when citation counts are proffered as a rational method of selecting the best and most useful journals. RESEARCH EFFORTS Fact-finding studies became more frequent and attained an increasing degree of sophistication. Kilgour [42] at Yale studied the use of books and

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journals at his library to determine an arrangement which would best suit the needs of users so that the most frequently used journals would be placed in the most accessible locations. He confirmed Bradford's law of scattering. A relatively small number of titles commanded high usage while the largest number were moderately or little used. For comparative purposes the same study was conducted at Columbia University [43] with the same results. At the National Library of Medicine the first full-scale analysis of interlibrary loans was accomplished by Kurth [44]. The geographic distribution and the characteristics of the requesters, as well as the materials requested and the frequency of the requests were studied. Among many important findings was one, surprising at the time, that the bulk of the journal requests were for commonly available titles and not for esoteric journals. Lancet, British Medical Journal, the American Journal of Physiology, and the JAMA were in the first four positions of the most frequently requested journals. Support for research provided by the National Library of Medicine in the late sixties and early seventies accelerated the research effort. At the Medical Library of Wayne State University, Pings [45], an intellectual gadfly and iconoclast, unleashed a series of studies ranging from the effectiveness of the operation of the Regional Medical Library which he headed, to assessments of training programs, the coverage of nursing literature in MEDLARS, and an examination of the medical library as a social institution. The first comprehensive census of health sciences libraries and their resources was conducted by Susan Crawford [46] and provided the factual basis for planning. She has continued these surveys and her most recent study of medical school libraries has already been cited. At a time when uncertainty existed about the manpower needs for health sciences librarians, when little was known about their training, academic preparation, educational attainment, and needs, David Kronick [47] headed an investigation which gave the answers. The survey was carefully planned with the prominent help of Rees and others of the Library School of Case Western Reserve. These efforts approached a program of research in medical librarianship. While more limited in scope, programs of research had also been begun at Yale on the use of library materials and at the University of California, Los Angeles, and Washington University in computer applications. 416

The entire biomedical communications process and its relation to libraries was examined by Richard Orr and others [48]. At a later time he and his associates developed a new set of methodological tools to measure various library services. Users' services offered in medical school libraries were not only systematically described for the first time but were subjected to a comparative analysis derived from a national survey [49]. To give one last example, let me cite the work of Ching-chih Chen [50] on the use of monographs at the Francis A. Countway Library of Medicine at Harvard. The study tests whether the mathematical techniques used by Phillip Morse at the Massachusetts Institute of Technology to predict library use are applicable in other libraries. The evaluation of her argument requires a knowledge of mathematical statistics which I do not possess but which more and more librarians will have. What is important is the approach, the careful development of the study, the sample selection, its justification, and the attempt to validate it by comparison with data obtained in this instance by Robert Cheshier of the Cleveland Health Sciences Library. The Bulletin of the Medical Library Association, especially during the past five years, is replete with good investigations and its editorial direction contributes significantly to the enlargement of the scientific base of our profession. Medical librarians, then, are moving towards the scientific investigation of their field and are developing methodologies comparable to the scholarly, analytical skills of Janet Doe.

CONCLUSION "The prospect of fundamental theories of information phenomena is not on the horizon," Vladimir Slamecka [51] says in a recent assessment of the state of information science. He continues: "The information research community should, as soon as possible, shift from a preoccupation with document housekeeping and delivery mechanisms to the related, but much broader, problem domain that is based on the need to discover the principles of (and to develop the means for) the optimal husbandry of one of man's key resources, knowledge." A theory of medical librarianship also has not yet been developed. We are beginning, however, to study systematically, and with increasing sophistication, the facts and processes of our field. We are aided in this by an influx of those who have pursued scientific careers in other fields before becoming medical librarians. We are on the way to a Bull. Med. Libr. Assoc. 65(4) October 1977

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new self-consciousness and to a better understanding of our purposes and functions. These are clearly in the area of communication and the transfer of knowledge to researchers, teachers, students, the sick and the healthy. The detailed knowledge of bibliography and the organization of books and journals also formed the basis of peer group formations. When collections and staffs were small they did not require the administrative expertise demanded in the management of large aggregates of people and services. Those heading libraries knew them in all their aspects and the quality of this knowledge served as a measure of a practitioner's standing. Specialization has replaced this system in our libraries. At one time it seemed relatively easy to obtain a consensus as to who were our most able librarians, persons of great productivity, the intellectually keen, good organizers, and those with charisma. Those who have led us through this enormous expansion are leaving and a new leadership has not quite emerged. I think that two elements may clear Nina Matheson's cloudy crystal ball. First, the development of libraries in hospitals and other health care centers, and the emergence of hospital librarians as a creative and productive group of practitioners with professional strivings and close relationships with their clientele represents a pool of talent which has already begun to make its mark. Second, as members of a profession composed overwhelmingly of women we will gain from the drive for equality and recognition of excellence which will continue to affect our political and social life in the foreseeable future. REFERENCES 1. AUDEN, W. H. The Age of Anxiety. New York, Random House, 1947. 2. ORWELL, G. Nineteen Eighty-Four. New York, 3.

4. 5. 6.

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