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From its beginnings as the Library of the Army Surgeon General to today's Internet-driven information environment, the U.S. National Library of Medicine (NLM) has served a variety of audiences. As NLM strives to provide the best possible service to health scientists and consumers, the form of that service has changed depending on resources available and the state of technology. Throughout its history, NLM has adopted innovative programs and technology at the earliest sensible moment that would serve its patron needs. Today, NLM is a leader in providing electronic biomedical information to health professionals, researchers, the public, and anyone else with access to the Internet. These services have evolved in response to available technology and the demands of the various audiences, from clinicians to consumers. To serve the needs of this variety of patrons, NLM connects health information resources in ways that enable each audience to find the information appropriate to its need. NLM continues to improve this organization as the demand and technology and resources allow.
SERVING LIBRARIANS AND PHYSICIANS BEFORE THE ELECTRONIC AGE
The National Library of Medicine (NLM) began in 1836 as the Library of the Army Surgeon General, serving military physicians through the U.S. Civil War period. In the 1870s, under the stewardship of John Shaw Billings, the library, located in Washington, D.C., was opened to the entire medical profession Monday through Saturday (Miles, 1982, p. 91). Shortly after the Civil War, Billings began to loan books and journals to local medical officers, and by 1874 he had put in place a written policy for lending materials, through the postal service, to those who could not come to the library. He would lend books for two weeks to a medical society or librarian who assumed responsibility for the materials, allowing their use within the organization's library or reading room only. This requesting organization was to mail them back in good condition and to deposit enough money to pay for any lost materials (Miles, 1982, p. 100). This early service was not electronic, of course, but it still served the need of delivering medical information to remote clinicians and researchers who needed it, without them traveling to the library.
By 1911, NLM's interlibrary loans and personal loans totaled 7,500 per year, filling an important gap, as no other medical library in the United States sent out books on loan (Miles, 1982, p. 202). For the next forty years, the library continued to lend materials locally and to clinicians throughout the country, responding to a growing demand. Though there were many medical libraries in the United States, and cooperative arrangements existed, collections in these libraries were judged inadequate to meet the demand. The Medical Library Assistance Act of 1965 (MLAA) authorized NLM to provide grant funding to medical libraries to improve their collections, facilities, and services. Establishment of the Regional Medical Library (RML) Network in 1967 marked a major change in NLM's role from being a central source for medical information to serving as a comprehensive backup resource to a hierarchical RML Network made up of 11 geographically dispersed regional libraries, 100 academic medical libraries, and some 500-600 hospital and other local health libraries (Bunting, 1987, p. 9). NLM itself served the Mid-Atlantic Regional Library. The major services to be provided by the RML libraries were "free loans of library materials to qualified users" as well as literature search services of NLM's MEDLARS batch retrieval system and backup reference support to other libraries in the region (Bunting, 1987, p. 7). Libraries provided document delivery services for free until 1978, when the high demand for interlibrary loan forced the RML Network to institute a standard charge of $5.00 per loan. By establishing this network, NLM was able to effectively serve the health professional audiences through their libraries.
NLM SERVES LIBRARIANS AND THEIR CLIENTS ONLINE
Billings believed it was important to provide printed catalogs and indexes of biomedical literature to serve physicians and librarians (Miles, 1982, p. 112). The library printed Index Medicus and others for over a century. NLM realized early in the evolution of computers that these new machines had great potential to make publishing these extensive volumes efficient and then to enable distribution of the information to searchers, whether at the library, in another state, or in another country. In 1971 NLM made an electronic index, MEDLINE (for MEDLARS Online) accessible, eventually through nationwide telecommunications networks. Because MEDLINE required leased telecommunications lines and extensive training of three weeks, at first this online system served health professionals and researchers through librarian intermediaries (Kassebaum & Leiter, 1978, p. 166). In these early online days, clinicians, researchers, and students continued to use printed Index Medicus volumes in their local medical library. They turned to their librarian for more extensive or complicated searches where the online MEDLINE provided superior results.
To complement MEDLINE's strength in identifying biomedical literature, NLM, with the Regional Medical Library Network, launched the DOCLINE system in 1985. DOCLINE provided automated interlibrary loan (ILL) requesting and routing for librarians, a quantum leap in the …