"Today, when travel is expensive, everyone is busy and there is a healthy resistance to useless meetings, it is by no means easy to bring together a representative conference of specialists." So began the paper of the Librarian of UNESCO at the First International Congress on Medical Librarianship in London in 1953, and it is a statement which is as true 32 years later as it was when it was made. Plus ca change, plus c'est la meme chose. [The more things change, the more they stay the same.]
It is a measure of the dedication of medical librarians, and the high importance that their institutions place upon them, that so many have been able to assemble at periodic intervals to examine the issues which are the major concerns of the profession at any given point in time. The congresses have always been organized around "themes," but, of course, the core topic is medical librarianship and all of the aspects of work that relate to it.
The First Congress, coming so soon as it did after the close of the second World War, might have been expected to consider the problems which had been created by that conflict and the damage wrought to the world's medical libraries, and how to resolve them. Except for one case study, it did not do so. The congress viewpoint was present and prospect, not the past (except in the consideration of various historical topics). The mood of the congress was an optimistic one, and the delegates looked forward to a future of exciting changes which were beginning to take place. An important topic was the bibliographic control of the world's medical literature, and the Current List of Medical Literature had only recently been reorganized to replace the Index Catalogue of the Library of the Surgeon General's Office. The Armed Forces Medical Library (U. S. A.) was in a state of organizational metamorphosis which would end with its designation as the National Library of Medicine in 1956.
The congress was viewed as a clear sign that the profession had come of age; that there was a critical mass of medical librarians in the world who had proven their value to the medical profession in many lands; that medical librarianship was a specialty without which the medical profession could no longer function effectively; and that much could be usefully accomplished by international discussion of problems and practices. It is interesting that this meeting took place 100 years after the world's first convention of librarians, which had occurred in New York City in 1853.
The congress sessions were divided into a series of topical symposia - on the role of the medical librarian in the world today; historical development of libraries and books; medical libraries in different countries; education and training for medical librarianship; centralization of medical library resources; and finally, an open forum which touched on a wide variety of topics, such as indexing the literature, the costs of resources, administration of medical libraries, standardization of bibliographic reference, etc. The congress concluded with a discussion on international cooperation. In all, some 64 papers were presented.
The Second Congress saw the topic which we now know as automation introduced. Dr. Tomio Ogata, an Honorary Member of the Japan Organizing Committee for the Fifth Congress, presided over the session on utilization of machines for bibliographic purposes. He wisely drew an analogy based on the fact that one does not have to understand the inner working of complex machines in order to be able to derive benefits from them. He reminded the congressists that the level of interaction with machines will not be the same for all who use and work in medical libraries and urged the attendees to learn and not adopt an attitude that machine technology will not be of use in a small or "poor" library. The coming Information Age was already presaged in the papers of the meeting, and information retrieval and the automation of library processes was to assume an increasingly important role in the subsequent congresses, mirroring its role in the world of medical libraries.
Other sessions at the Second Congress focused on education and training (a topic which continues through the entire series of congresses, and will probably be a subject of the sixth); library organization and management; interlibrary cooperation both on a national and international basis; and special problems of historical libraries.
The Third Congress continued the basic subject areas of its predecessors, with sessions on planning and administration; classification and cataloging, information storage and retrieval; bibliography; education and manpower; national and regional systems in developed countries; and individual libraries.
Professor Kazuo Urata, Chairman of the 5ICML Japan Organizing Committee Program Committee, was the principal author of a paper describing a computerized serials control system which had been developed at Keio University. This was a topic of much interest and primacy concern in the 1960s, and the pioneering work of a number of libraries and systems in different countries undertaken in that period laid a solid ground for the present high level of development of such programs.
This congress was the first which addressed the problems of medical libraries in developing countries in depth. It featured a series of survey papers on South Asia, Latin America, the Middle East, and Africa. Other papers dealt with specific countries or systems and the state of bibliographic control. There were not very many delegates from developing countries present in Amsterdam, and active participation in the congresses by developing countries first took place in Belgrade, where approximately one-third of the attendees were from these countries.
The Fourth Congress was divided into three major sub-topics: infrastructure for health services; new technology applied to health information services; and cooperation through health information systems. Ninety-one papers were given at Belgrade, and the vital involvement of Japanese librarians with international cooperation and automation was demonstrated by a number of papers given by a distinguished group of speakers, among them, Dr. Shunichi Yamamoto, and Messrs. Yoshio Amano, Toshinobu Suga, and Masaaki Tonosaki. The work and organization of SEAMIC (Southeast Asia Medical Information Centre) was outlined as were a number of automated systems.
A major concern of the delegates in Belgrade was the future planning of the congresses, as it had been a concern of each preceding congress. The period between the third and fourth meetings had been too long. At the very first congress, the attendees had hoped that the congresses would take place at five year intervals, but that goal had not yet been achieved by 1980. A major development between the third and fourth congresses had been the reorganization of IFLA and the founding of its Section of Biological and Medical Sciences Libraries in 1977. This organization now seemed to many delegates to offer the opportunity of having a permanent structure which was affiliated with a recognized international library organization which could offer support an continuity to the organization of the congress, a focus for international activities among medical libraries, and a formal "home." It had been the hope of the organizers of the First Congress that an international medical library association would be organized as an outgrowth of the Congress, but after much discussion, it appeared that more preparatory work was required before action could be taken. An interim meeting was held in Brussels in September 1955 to discuss this issue. One hundred delegates at that meeting, held in conjunction with the International Congress of Libraries and Documentation Centres, agreed to work for national groupings of medical librarians, urged closer collaboration with the medical profession, called for more instruction for medical students in the use of libraries and the medical literature, and advocated an increase in the exchange of publications. With the establishment of the IFLA Section, it is hoped that libraries will take the opportunity to join it and that it may become, in fact, the international focus of medical librarianship.
The burgeoning development of the World Health Organization's Health Literature Service Programme, which is coordinated by its Office of Library and Health Literature Services in Geneva, was a second major factor on the international scene and one that offered strong links between libraries throughout the world. The WHO Library had been represented at all of the previous congresses with reports of its activities, but at the Fourth Congress a special program was held for the librarians in its various regional offices who were brought to Belgrade, and whose participation greatly strengthened the meeting. The planning and organization of the Fifth Congress was, therefore, entrusted by the delegates to the IFLA Section, and WHO was asked to become, with IFLA, a permanent co-sponsor of the future congresses.
Many delegates at the Fourth Congress were concerned about the use of the term "medical librarianship," which they felt was now too narrow to encompass the broad range of topics which are within the scope of this branch of the profession. The desire to change the name of the congress to reflect this by using the term "health sciences librarianship" was heatedly discussed and finally voted down, but it remains an issue of concern.
For the Fifth Congress, program sessions have been organized into 44 concurrent and three theme sessions. This will be the first time that special session have been devoted specifically to papers which highlight the theme (and sub-themes) of the congress; 139 papers will be presented at the concurrent sessions offered by speakers from 36 countries, more than twice the number of papers which were delivered in 1953.
A general analysis of the papers presented at the five congresses reveals some interesting changes of emphasis which have taken place over the past 30 years. Automation and the various aspects of information storage, retrieval and use - facilitated by computers - has assumed a larger and larger role as increasing numbers of libraries have come to use machines to speed, improve, or otherwise facilitate the provision of services. The need to urge small libraries not to ignore improved technology because they think that it will not be possible for them to either acquire the means to use it or to develop the skills necessary has not disappeared since Dr. Ogata's exhortation in 1963. The spread of technology has accelerated as the potential for the availability of computers in smaller libraries has improved. The technological rate of change over the past twenty years has been exponential in nature as the generations of improved equipment appear in shorter and shorter time periods.
Of major importance is the recent emergence of networks as a vital component of the medical library scene. Networking takes many forms, from local arrangements among libraries within a small geographic area, to regional, national and international networks of great complexity. Networking does not necessarily imply connection electronically, but can be achieved through telephone, postal or other means (e.g., a group of libraries linked for the exchange of materials by a delivery truck route). The importance of the topic was demonstrated at the Fourth Congress where a great variety of systems and arrangements were described. Seven papers will be presented in Tokyo on national and regional networking from such diverse countries as Thailand, Uganda, Mexico, Pakistan, Brazil and the USSR. From these papers, it is clear that networking is a major concern of both developed and developing nations. Because of the difficulties and costs of conducting business on an international basis, it is important that regional meetings take place and regional networks develop.
Many topics which received attention in 1953 still concern us today. Education and training of professional personnel, although the emphasis on various subjects in that training has changed, is still a matter of interest and attention. The problems of training the non-librarian (or technician), although still of importance, however, have not come before the congresses in some time, and there is still a great need for such programs in developing countries and in many rural areas. A number of tools to assist processionals or to train non-professionals have been developed in many countries by several organizations and these have varying degrees of transferability to other countries. They can, however, serve as models for locally developed materials targeted to specific needs and problems. Another solution to this problem is the use of a circuit rider librarian who visits a group of libraries to assist with their administration and management.
In order to provide rapid access to the current periodical literature in the 1950s, many libraries resorted to the brief listing (indexing) of current issues as they were received. This was done due to the length of time that was required for journal citations to appear in the Current List of Medical Literature, the Quarterly Cumulative Index Medicus or Excerpta Medica. At that time, the usual delay in publication of the index from the time of the appearance of a journal issue was approximately three to six months. It was argued that the time spent in self indexing was more than repaid by the increased speed and improved quality of reference service which could be provided.
As the tasks of indexing and producing the printed indexes were assisted by the use of computers in the sixties, these times have diminished significantly. In the 1980s, indexing techniques are also changing rapidly as the entire text of journals is being computer input from the machine-readable tapes used to produce the computer type-set pages. This has enabled the development of online indexing to occur with a further reduction in the time which elapses between the appearance of the printed journal issue and the index to about six weeks. That time delay has been further reduced by some online services which provide search capabilities on the article citations (author, keywords in title, journal title, etc.) and which are available within a week after the receipt of the journal issue by the database compiler and provider. This is not to say that libraries no longer perform their own indexing of journal issues. There are many parts of the world where online access to indexed information is not yet available, and the arguments for in-house indexing are the same now as they were in the 1950s. But as online index services become more widely available, the amount of such library activity will surely diminish, as it has diminished in the United States. As a congress topic, this matter has not been discussed since 1969.
We have also stopped talking about the problems caused by publishers who charge higher subscription prices to libraries for books and journals, although the problem has not ceased to exist. Perhaps this is because of the inherent difficulty in achieving a viable solution to the dilemma. Aspects of the interrelationship between libraries and publishers have not been touched on by congress speakers. Difficulties caused by the parallel (duplicate) publication of materials are common in larger libraries, that is, when monographs appear which reprint (often under a different title) material which has appeared previously as a journal supplement. Such practices may, however, make it possible for a smaller library to obtain material which would not otherwise be available to it. Clear identification of such reprints, especially in publication announcements, would help to resolve the problem. Communication between publishers and medical librarians appears to be long overdue.
The discussions about the useful life of the literature have decreased. In the United States we have seen that older material continue to be read by what we used to consider to be surprising numbers of users. Has this affected the retention policy of libraries, i. e., have libraries which keep collections only for specified period of time - five years - changed to a longer retention period - ten years? Is this a phenomenon which has been noted in other countries?
Our interest in the study of the past (the history of the book and the problems of preservation, conservation, and treatment of historical materials) has not stopped, but has receded as a topic of concern. Possibly this is because there are so many more pressing needs, and perhaps because the topic seems to have less relevance to the libraries of the developing countries which must concern themselves with much more basic information problems.
Discussions of classification and cataloging have also lessened. This may testify to the widespread acceptance of a few major schemes, such as that of the National Library of Medicine, the Barnard System, still used at present by the WHO Library, or Dewey Decimal Classification which, unfortunately, is used by some of the medical libraries which are departments of main university libraries. The widespread availability of cataloging information prepared by libraries which have adopted the NLM Classification has obviated the need to continue to adapt older systems, or to develop local systems. It would be interesting to see a study on the number of systems which are currently used worldwide and the number of libraries using those systems. It is possible to determine the causes for the selection of one system over another taking into account the history of the development of a particular library, national practice, subject orientation, etc.?
The activity on the international scene by such organizations as IFLA, through its programs of Universal Bibliographic Control and Universal Availability of Publications, has caused major changes in the way that libraries handle materials. The use of International MARC (Machine-Readable Cataloging) records has simplified many library problems, not the least of which is the ability to identify an item uniquely. A recent development has been the development of the Common Communication Format (CCF) under the sponsorship of UNESCO to bridge the gap between the cataloging principles and practices of libraries in Abstracting and Indexing Services and libraries using MARC. CCF will help resolve the problem of handling analytic. IFLA is also working on the ISBD (International Standard Bibliographic Description) for Component Parts which addresses the problem of analytics and when this work is completed it will result in the modification of the UNIMARC format.
A major topic which has evolved in the last five years is the study of users and their characteristics, in order to better tailor services and procedures to meet their needs. Coming to the forefront in this area, is the need and desire of users to perform their own online searches, or at least to begin the search process and narrow the parameters of searches before coming to the trained online searcher in the medical library for a more exhaustive and complex search. The changes in usage patterns and user behavior will cause profound alterations in how libraries function. Libraries are changing from repository agencies to organizations which actively cause and participate in change. Users' habits will change in relation to the technologies which are used in information handling. The pattern of this change will probably reflect that of the spread of technology.
As more users employ computers in their work, especially for communication with other scientists, the issues of the "invisible college" take on a new significance. With direct computer communication possible between individuals on a worldwide basis, the possibilities for change in knowledge diffusion and difficulties in knowing what is happening at the forefront of research are increased enormously. In such cases, the only record of such communication may be a privately held computer diskette, or in some cases, only an ephemeral printout. Not only will the researcher who is not involved in such communication networks find it difficult to know what is happening, but future historians may find it difficult or impossible to trace the path of the development of significant medical or scientific advances. Studies on the extent to which such communication is taking place will provide interesting and useful information, although they will not be easy to perform.
There is still a major problem in identifying and locating medical libraries in many countries. The IFLA Section of Biological and Medical Sciences Libraries has been working on this problem for a number of years, and will publish its World List of Biological and Medical Sciences Libraries at the time of the Fifth Congress. Compiling the data for this publication has made clear that there are vast lacks in our knowledge. No studies seem to have been made on which institutions have medical libraries. Do they exist, for example, in all medical faculties, all hospitals, all government health agencies, etc.? The World List will help to identify sources, but there is still a need for national surveys to be undertaken in many countries in order to provide a complete picture of the resources available, and to facilitate access to needed information by health professionals.
The changing emphasis from the treatment of illness to the promotion of wellness in the patient is bringing increased pressures to bear on medical libraries for information which will help the consumer better understand his/her physical condition, and take steps to maintain health. It is clear that it is more economical to keep people healthy than to have to treat them when they have become sick. This topic is still a controversial one in medical libraries, and there are many medical librarians, as well as medical professionals, who do not see the provision of this information as the task of the medical library, but rather a need which should be filled by public libraries. The difficulty with the approach to this information through public libraries is the unfamiliarity of public librarians with the technical literature of medicine and of the basic medical information sources, many of which can provide useful and, in some cases, necessary, information for the patient. Public libraries have also eschewed the purchase of medical materials and many consider that medicine (or health) is outside the scope of their collections, especially at a level above popular works. This problem is exacerbated by the inclination of many medical practitioners to limit the amount of information which the patient and/or the family is given about a medical condition, its origins, and its prognosis thus creating a desire for information which is difficult for the layman to satisfy.
It is interesting to note that interlibrary cooperation and exchange of materials through lending has become much more common and effective, although the topic is still a major focus of attention. The general acceptance of this task by medical libraries is seen by the enormous numbers of transactions which take place among libraries in all countries, perhaps more in medical libraries than in any other type.
The exchange of duplicate materials has only been discussed sporadically at the congresses. The inherent problems of such exchange on an international basis have tended to discourage this activity. Not the smallest obstacle to achieving materials exchange is the cost of transportation, but the other obstacles such as customs regulations, postal restrictions and costs, etc, have all acted as deterrents. These difficulties are especially unfortunate because many libraries in developed countries would gladly provide materials which they must otherwise discard and which could be useful to libraries in many developing countries. There is, however, an increased interest in this activity on the part of IFLA and of the International Cooperation Committee of the Medical Library Association (U. S. A.), and it is possible that by the time of the Sixth Congress there will be reports of progress in this area.
A topic which has had surprisingly little exposure over the course of the congresses has been that of microforms of material and the use of audiovisual material. Little has been said about the great variety of formats for medical information other than print, although such materials are increasingly common in the developed countries. It should be noted, however, that microforms have not found acceptance in the medical community as a medium for the provision of information. The resistance to their use has discouraged many libraries from extensive collection, and they are found primarily when the information which they contain is not available in any other format or where libraries are forced to use microform techniques to cope with the problem of space limitation.
In the United States, in the 1970s, audiovisual materials were the focus of intense interest as an improved way of teaching basic skills and information in the medical curriculum, and which would allow for students to proceed with learning at their own pace. Libraries built in that decade tried to anticipate the expected demands for space, equipment, and software that extensive AV use would generate. The role of AVs in teaching has not been nearly as important as expected, although some courses such as anatomy and histology lend themselves to this method of teaching and are now taught using AV materials to a large degree. Curiously, very little has been reported about the expectations of AV instruction, and the present state of their integration into the teaching process.
A new topic which will undoubtedly assume importance in the future is that of the electronic publication and availability of medical information. As this becomes more common in the next five years, libraries and users will need to adapt to the use of primary information in this form. Just as secondary information (indexes and abstracts) is already commonly available electronically, and electronic databases have been discussed at the Fourth and Fifth Congresses, full text of books and journals will soon become common in this format. The question which must involve medical librarians is how will this information be provided when it is no longer available in a print (hard copy) version? Will libraries be involved in "demand publication," that is, the provision of a hard copy from an electronic database on request from a user? How will this affect journal subscriptions? Will the user be charged the royalty and/or other fees associated with this service? How will developing countries access electronically published source materials? What impact will this have on regional networks? Will they assume new roles as provides of hard copy from electronic databases? Will electronic publication have an effect on the dual pricing problem mentioned earlier?
Electronic databases present a new problem for both the library and the user. In the past, a user had the sense of the physical size and scope of the scholarly record in his/her field of endeavour. This was partly created by the ability to see the volumes which contained that knowledge. If the researcher visited a large research library, there was the expectation that what was needed was physically available, and if the known locations of material were visited, then the subject would have been exhaustively researched. Will users have confidence in an electronic database, the validity and completeness of which may be more difficult to verify than in printed form?
Surprisingly, the congresses have not yet dealt with the problems of fee-based services and the pass-through of such charges to the user. Will the user be expected to pay these charges in a library in which he is a member of the primary clientele? What will be the general library policy in regard to such information services? There is still too little experience with these topics to provide the basis for substantive reports, however, one can expect that the delegates to the Fifth Congress will be discussing such issues in the non-program portions of the meetings.
As has been noted in many places, it is often the informal aspects of international (and national) meetings which provide the most useful opportunities for delegates to exchange information and to make personal contacts which then help them to improve the quality of the library service which they can provide when they return to their libraries. The improved understanding of the problems of other libraries, the difficulties that libraries face in other countries, and the new viewpoint which delegates can bring to their own institutions are all benefits which are derived from participation in an international congress both for delegates from developed and developing countries. The non-tangible benefits which cannot be immediately assessed are often the important sequelae of attendance at a congress.
The review of the subject content of the congresses raises many interesting questions, which, it is hoped, will be addressed by participants in the Fifth Congress and which may provide an impetus for studies for the Sixth Congress. The comparative table which follows (see Table 3) does not include a subject heading for every paper which had been given at the congresses, but rather groups topics into broad categories. It does, however, help to make obvious where trends are taking place. It is clear that there are many important problems which need attention. Discussion of them may well be one of the most important results of this Congress, and the subsequent research the highlight of the Sixth.
It is the hope of the International Organizing Committee that many Japanese librarians will join their foreign colleagues in Tokyo and thus help to ensure that a greater understanding and exchange of information takes place in 1985 than has ever happened before, and that the momentum generated by the Fourth Congress in Belgrade is carried on in Tokyo, and will propel us over the next five years to the Sixth Congress in New Delhi.
Table 1: National Distribution of Speakers [deleted]
Table 2: Congress Statistics [deleted]
Table 3: General Subject Analysis of Papers Presented [deleted]
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