Laws, leaders, and legends of the modern National Library of Medicine.

PURPOSE
The paper is an expanded version of the 2007 Joseph Leiter National Library of Medicine (NLM)/Medical Library Association Lecture presented at MLA '07, the Medical Library Association annual meeting in Philadelphia in May 2007. It presents an historical accounting of four major pieces of legislation, beginning with the NLM Act of 1956 up through the creation of the National Center for Biotechnology Information.


BRIEF DESCRIPTION
The transition from the United States Armed Forces Medical Library to the United States National Library of Medicine in 1956 was a major turning point in NLM's history, scope, and direction. The succeeding landmark legislative achievements--namely, the 1965 Medical Library Assistance Act, the 1968 Joint Resolution forming the Lister Hill National Center for Biomedical Communications, and the 1988 authorization for the National Center for Biotechnology Information--transformed the library into a major biomedical communications institution and a leader and supporter of an effective national network of libraries of medicine. The leaders of the library and its major advocates--including Dr. Michael DeBakey, Senator Lister Hill, and Senator Claude Pepper-together contributed to the creation of the modern NLM.


INTRODUCTION
American citizens, for whom the health of their loved ones is always of primary concern, can take great pride in their National Library of Medicine [NLM], which takes life-giving knowledge from research, organizes it, and transmits it to those who can best use it to fight disease and disability and to improve the quality of life for all of us.
These words, expressed at the time of NLM's sesquicentennial by then President Ronald Reagan, attest to the integral part the library has played in fostering the nation's biomedical research and public health agenda. This dynamic role would not have been fully realized had it not been for the laws, leaders, and legends of the modern NLM. This talk in honor of Dr. Joseph Leiter at the 2007 MLA annual meeting provides an historical accounting of that important period between 1956 and 1988 when major laws were passed, leaders excelled, and legendary supporters of NLM helped secure landmark pieces of legislation.

LECTURE
It is a distinct honor for me to be associated with this lecture named for Joe Leiter. Joe Leiter was for many years NLM's associate director for Library Operations, and he was one of the most important figures in the history of the 171-year-old National Library of Medicine. Although Joe Leiter was a tough manager, he had strong humanistic qualities. He did much for advancing librarianship and recruiting women and minorities into the profession. Joe Leiter stamped ''quality'' on everything he pursued, and to lecture in his name is to have the bar set high.
This lecture, in his name, will be a bit of a trip down memory lane, for Joe Leiter and I traveled much of this road together. It will be like a play with four acts featuring three leading actors and a distinguished cast of supporting actors. Our play deals with the modern NLM, so we will dispense with 1836 and those early beginnings and focus our examination beginning in 1956. That year was marked by interesting people and events: the United States presidential ticket of Dwight D. Eisenhower and Richard M. Nixon was elected, Martin Luther King emerged as a leader of desegregation, Fidel Castro began his invasion of Cuba and the overthrow of Fulgencia Batista, and Elvis Presley burst onto the scene with ''Blue Suede Shoes.'' Science was advancing, with Bell Labs beginning the development of the visual telephone and Albert Sabin creating the oral polio vaccine. Of greatest importance, however, to the future of the library was the passage of the 1956 NLM Act, which in 2006 celebrated its fiftieth anniversary and was so noted in Congress through a concurrent resolution [1].

HOW THE NATIONAL LIBRARY OF MEDICINE (NLM) WAS ESTABLISHED IN UNITED STATES LAW: NLM ACT OF AUGUST 3, 1956
Dr. Michael DeBakey must be considered one of the major prime movers of this 1956 legislation and a legend who played a key role in what became a most arduous struggle to make NLM a reality. Let me highlight some of the major stops along the road. Each action, study, or report-of which there were very many-leading up to the eventual signing of the NLM Act by President Eisenhower on August 3, 1956, dealt really with one or more of the following issues: (1) the need to establish clear legal authority for the library, (2) the need to ascertain the organizational and physical location to carry out the mission of a national medical library, and (3) the very pressing need to replace a dilapidated facility.
Actually, talk of a new building to replace the Army Medical Museum and Library that was located on the Washington Mall began around World War I when William Owen, director of the Army Medical Museum, began plans in 1916 for a structure that would house the museum, library, Army Medical School, and the Field Medical Supply Depot. Some wanted this new three-story structure on the Mall, while others favored it near Walter Reed Hospital. The debate lingered on, and, in the early 1930s, activist Dr. Harvey Cushing appealed to President Franklin Delano Roosevelt that a new building was needed to replace what he termed an ''outgrown and unsightly'' library building. Now, Dr. Cushing was not without influence, as his daughter was married to James Roosevelt, the president's son. The librarian of congress, Archibald MacLeish, concurred with the need and offered, no doubt with pure motives, that the new library could nicely be located on Capitol Hill, adjacent to the Library of Congress. This option was seriously considered, in fact a photograph was produced depicting ''Owen's Dream'' superimposed on the site where the Supreme Court stands today [2].
It was clear that Roosevelt wanted to help Dr. Cushing, but the library and its price tag of two million dollars never were quite high enough up on the Depression-laden list of public works. In 1936, an interesting approach was taken to secure the building when Army Librarian Edgar E. Hume created a Centenary Celebration for the library, deciding somewhat arbitrarily that the library had been formed in 1836. Dr. Cushing used this as an opportunity to once again write Roosevelt with a new proposition to tie the approval of the building construction to that of the 100th anniversary. Roosevelt replied, ''I most assuredly do want to get the proper housing for the Surgeon General's Library started but it must be a monumental building and cannot be done out of Work Relief Funds, it will require an Act of Congress'' [3]. On June 15, 1938, legislation was signed authorizing construction of a new library, but no appropriation was forthcoming, and plans were dropped completely when the country entered World War II. The only move that took place was the movement of books, for in 1942 the library's historical collection, for safety reasons, was transported to Cleveland, Ohio, to a building owned by the Cleveland Medical Library Association.
That same year, a major turning point in the future of the Army Medical Library took place with the assignment of a young army medical officer by the name of Dr. Michael DeBakey to the Surgical Consultants Division of the Office of the Surgeon General. There, he was given the responsibility for preparing, as he put it, ''military orders without any background in military medicine'' [4]. Dr. DeBakey made frequent use of the library and saw firsthand its deplorable physical and crowded conditions. As he told Dr. Allen B. Weisse in his oral history, Heart to Heart, ''I was impressed with the library's extensive scope, but the building that housed the collection was very old. The roof leaked: they had to put tarpaulins over the books when it rained. And they even had to use an outhouse for toilet facilities . . . it was incredible'' [5]. He soon learned of the futile efforts that had been made to secure a new facility and concluded that, in a military environment, a library did not stack up very well next to tanks and artillery. Dr. DeBakey, in his oral history for the Johnson Library, indicated that this governmental experience was the first opportunity for him to become interested ''in what might be called the socioeconomic, administrative and organizational problems in medicine in the country'' [6].
Dr. DeBakey became an effective activist on behalf of what he called ''a national treasure,'' serving as an important and influential member of the Association of Honorary Consultants to the Army Medical Library as well as other numerous committees charged with finding solutions for the library's future. His stirring speech before the honorary consultants in 1950 struck to the heart of the matter and did much to galvanize the medical community. As he put it, ''in considering the place of the library in government, I believe that emphasis should be put first upon the purpose and function of a National Medical Library . . . and then a more intelligent consideration can be given as to who should operate it.'' He then went on to emphasize that it followed that the library should be closely associated with a medical agency and therefore operated as a ''medical library,'' not a ''general'' library. He argued a medical library would be more sensitive to the needs of the medical profession, and, to ensure that sensitivity, he recommended that a board of medical scientists and medical librarians should be formed for guidance [7].
The various groups looked at the library's problem from different perspectives ranging from creating a civil function in the military; transferring it to the Department of Health, Education, and Security; attaching it to the Library of Congress; and creating a separate independent agency. All groups concurred on one point: that the library badly needed a new facility. In May of 1952, based on a recommendation of the National Research Council, the library was renamed the Armed Forces Medical Library and a new drive for construction of a building began in earnest. In 1953, Secretary of Defense Charles Wilson called for the construction of a new building, and, in August of 1955, $350,000 was appropriated for architectural and engineering plans; however, because of other competing defense priorities, the money was never spent. Dr. Frank Rogers, director of the library from 1949 to 1963, who had also fought for a new library and its expanded mission, was despondent when told by Major General Elbert DeCoursey, ''Rogers, you're never going to get that building, you're never going to get it'' [8]. Determined not to give up, Dr. DeBakey, requested Dr. Rogers provide him a comprehensive chronology of past efforts that would serve as useful background information for the various battles ahead [9].
The opportunity for a real breakthrough came in 1955 with the second Hoover Commission's release of its Report on Federal Medical Services. Dr. DeBakey, Alan Gregg of the Rockefeller Foundation, and Dr. Theodore Klumpp, chairman of the Medical Services Taskforce, were particularly influential in their input to this report. Speaking of the library, it said, ''no other medical agency of the federal government serves the future of Laws, leaders, and legends of NLM medical research so intimately and so widely as does this unequaled collection of books, journals and bibliographic services'' [10]. The Hoover Commission's overall mandate was to suggest ways to more efficiently organize the executive branch and, in so doing, save money. This meant that proposals to increase spending were vulnerable, such as that proposed for the library. Dr. DeBakey reports, however, that in a luncheon meeting arranged with former President Herbert Hoover by Tracy Voorhees, chairman of the First Hoover Medical Task Force, he told Hoover that the library was the most important recommendation [11].
That recommendation carried the day, and soon thereafter Senators Lister Hill and John F. Kennedy cosponsored Senate bill S.3430, and Representative Percy Priest entered the companion House bill, H.R.11524, both calling for the creation of a national library of medicine to promote the progress of medicine and to advance the national health and welfare. Senator Hill was the clear driver of the bill in both the House of Representatives and Senate, as he was regarded by his colleagues as ''the statesman of health.'' This was to be just the beginning of his championing support for the NLM.
When the bill was introduced a month earlier, press reports across the country cited the need for legislation ''to rescue a sadly neglected institution from its stepchild role in the Defense Department and reestablish it as an indispensable public health asset'' [12]. The Hoover Commission report was quoted widely, in particular pointing out that no other medical agency of the federal government serves the future of medical research ''so intimately and so widely as does the unequaled collection.'' And, as the Boston Herald so nicely put it, ''One 3 by 5 card mailed for 10 cents can keep a team of medical researchers from needlessly duplicating a previous experiment'' [13].
On April 10 and 11, 1956, Senator Hill convened hearings on S.3430 in the old Supreme Court chamber of the Capitol. Senator Kennedy, who testified first, was a fellow member of Hill's Senate Committee on Labor and Public Welfare as well as chairman of the Reorganization Subcommittee of Government Operations, the very committee that was charged with considering the recommendations of the Hoover Commission report. Senator Kennedy entered the report into the record, thereby creating sort of a template for the bill being considered [14].
Senator Hill, however, objected to one section of the medical services report, namely the commission's recommendation to place the library as a relatively autonomous division in the Smithsonian Institution. He argued that ''it must be so placed that it will be in a climate of medical opinion where the primary concern of those in charge is the physical and mental health of the nation'' [15]. The senator went on to subtly remind the assembled group that he chaired both the authorization committee in the health arena as well as the appropriation committee. One intriguing aspect of the commission's Smithsonian recommendation was rather politically appealing, namely the proposed advisory board of trustees. The proposed board included a jus-tice of the Supreme Court and a member of the US Senate and House of Representatives amongst its proposed membership.
The testimony before the committee debating S.3430 was riveting but clearly more complimentary of the Department of Defense as custodian of the library than was the press. Some of the key outside witnesses at these committee hearings included Dr. DeBakey, Dr. Rogers, and librarian Janet Doe. Dr. DeBakey went out of his way to mention that the army surgeon general had in fact called for the establishment of the National Library of Medicine. While this was in part an effort, I suspect, to ensure that the Department of Defense would not oppose the bill, it was also true that the library had grown over the years. The functional activities had grown beyond a military departmental library to the level of a national library. Yet as Dr. DeBakey, Senator Hill, Senator Kennedy, and Dr. Rogers pointed out in the hearings, the authorization for the expanded activities was tenuous at best. Dr. De-Bakey testified that the weak legislative authorization for the library was contained in provisions of the Joint Congressional Resolution of April 12, 1892, and the Act of March 3, 1901, which placed the resources of the Army Medical Library at the disposal of the duly qualified individuals in the states and territories and the District of Columbia [16].
Doe's testimony echoed that of Dr. DeBakey's 1950 remarks to the honorary consultants. Speaking on behalf of the Medical Library Association, as the librarian of the New York Academy of Medicine, and as one who had participated in a 1944 survey of the Army Medical Library, she was well versed in the library's situation. As she put it, the library's ''growth and efficiency while in the Army's hands vacillated distressingly between feast and famine.'' Saying that the problems of medical literature are quite different from those of general literature, she made the point that medical libraries thrive best under medical authorities. She also strongly objected to a provision calling for the library to impose charges for special services that benefitted particular patrons. Doe was not shy about commenting on this, stating, ''you can't make distinctions between users, services should be provided alike to all-the whole provision in this bill is impossible'' [17]. I did not know Janet Doe, but this speech gave me a better understanding of why she has always been held in such high esteem by the Medical Library Association.
On June 11, 1956, the Senate bill passed quickly along with a provision calling for the construction of the library in or near the District of Columbia. Given that Senator Hill was actively lobbying for the bill among his House colleagues, the realization of the new library seemed inevitable.
Earlier, however, actually April Fools Day, the Chicago Sunday Tribune ran an editorial proposing that the library be located in Chicago, ''in the communication center of the nation'' [18]. Even with the combined efforts of influential Illinois Senators Paul Douglas and Everett Dirksen, this idea received little traction in the Senate. In the House, however, some eleven alternative bills calling for location of the library in Chicago were offered. Mayor Richard J. Daley, with the strong urging of the noted Journal of the American Medical Association (JAMA) Editor Dr. Morris Fishbein, formed a pressure group of some nineteen prominent medical deans, health officials, and corporate leaders, known as the Chicago National Medical Library Committee, to lobby Congress [19]. Nine acres of land was offered free by the Chicago Medical Center Commission [20]. House Speaker Sam Rayburn provided tacit approval of this effort by blocking the quick passage of the Priest Bill (H.R.11524) and directing that hearings be held on the numerous Chicago bills in the House Administration Committee, chaired by Representative Thomas O'Brien of Illinois [21].
On June 19, 1956, the committee was called to order to begin testimony from a spirited set of witnesses, highlighted by Mayor Daley and his colleagues, who contended the library belonged in Chicago because: Ⅲ It was the center of the country and the center of the population-easily accessible by railroad and air. Ⅲ It was the center of education for it had 5 major medical schools and 100 hospitals. Ⅲ There were a number of major medical societies located in the city, which was also the home of 24 national medical journals. Ⅲ Other than New York City, it had more physicians, surgeons, and dentists than any other city in the US. Ⅲ It was a city with great medical libraries [22].
Senator Paul Howard Douglas, bearing a letter from the American Medical Association (AMA), appeared before the committee to, as he said, set the record straight. Contrary to testimony in the Senate that the AMA preferred that the library be in Washington, DC, he pointed out that actually AMA had been neutral on the matter. Douglass had claimed that his motion in the Senate to change the location to Chicago had failed in major part because of this misunderstanding [23]. Arguments followed that the current library was not easily accessible by railroad and that it had essentially become a library for mostly only governmental agencies. As Dr. Fishbein said, ''We have to consider not only the medical professions associated with government, . . . but consider the fact there are something in excess of 227,000 physicians, all of whom, if urged, would avail themselves of the services of this library.'' Further he said, ''I would like to point out that a careful scientific study . . . would show definitely that . . . location and the ease of access are the chief factors in determining the extent to which a library is used'' [24].
On June 27, 1956, the Washington advocates had their chance for rebuttal. Some of the most powerful testimony was given by three librarians. Dr. Rogers, NLM director, made the case that the library served both as a national library and as the regional medical library for the Washington area. As he said, ''If the Armed Forces Medical Library were to be removed outside the Washington area, it is inevitable that new large collections of medical literature would have to be built here, at considerable additional expense to the federal government'' [25]. Mary Louise Marshall, from Tulane University, followed that up, stating, ''Moving the Library to Chicago would create almost insurmountable problems in administration resulting from loss in staff . . . and to recreate the expertise would take years'' [26].
Frederick Kilgour, librarian of the Yale Medical Library, delivered a resolution on behalf of the Medical Library Association and testified as to the naivete of the Chicago group's ''concept of a library being only an organization for servicing readers and mailing out books and photocopies'' [27]. He emphasized that the bill envisioned a library concerned with ''an over-all program for maintaining and increasing the availability of medical information throughout the government and the nation.'' He pointed out these programs needed to be integrated with other national health programs located in the Washington area and powerfully stated that ''a dollar spent on a national library of medicine would contribute more to the national health than a dollar spent on any other type of medical activity . . . But to go on and waste money on a move that could be better spent on an important natural resource would be tragic'' [28].
Unfortunately, about this time House leadership sent out word to all committee chairs that because the congressional session was coming to a close, only noncontroversial bills would be considered for passage. The library bill was considered controversial. On July 14, 1956, the Washington Post reported: ''the Chicago boys are said to have gone to Speaker Rayburn with demands that the bill for location of the library in Washington also be killed.'' The editorial went on to say, ''Instead of bottling up the bill, the House leadership should insist on a green light for its transmission to the floor'' [29].
Dr. Klumpp sought out Hoover who told him, ''Do you know anyone who can get to Mr. Rayburn? The bill is really not controversial'' [30]. Dr. DeBakey, being from Texas, was called on by Dr. Klumpp as well as by Senator Hill to intervene. Dr. DeBakey felt he could not personally ask Senator Rayburn to release the bill, but he had an idea. I know Mrs. Dorothy Vredenburgh, Democratic Committee Woman from Texas and Secretary of the Democratic Party. I operated on her husband and put in a plastic aorta. She was most grateful and told me that I should not hesitate to call her if there were anything she could ever do to help me. [30] Dr. DeBakey called her, she got in touch with the speaker, and soon the bill was released. The last major hurdle had been cleared, and the bill was promptly passed by voice vote, with the caveat that the library's actual location be left to the future Board of Regents.
Senator Hill secured $7.3 million for planning and constructing a facility, and the board selected a site for the building on the campus of the National Institutes of Health (NIH), at the location of the old Glenbrook Golf Course. Amazingly enough, NIH Director Dr. James Shannon initially opposed having the facility on the NIH grounds on the basis that it was not a research facility. Senator Hill called Dr. DeBakey and Dr. Shannon to his office to settle the difference of opinion. Dr. DeBakey told the story of the meeting this way: Ground was broken on June 12, 1959. Construction soon encountered a solid layer of rock, and blasting became a way of life, but nevertheless, by December of 1961, the building was virtually complete. On the 14th of that month, dedication ceremonies were held with Senator Hill and Secretary of Health, Education and Welfare (HEW) Abraham A. Ribicoff speaking to the assembled group.
When NLM Director Dr. Rogers retired in 1963, it had to have been with a great sense of accomplishment, for he had spearheaded a drive for a muchneeded building that finally had become a reality, he had begun the development of the Medical Literature Analysis and Retrieval System (MEDLARS), and, most importantly, the NLM Act had become law. Those marvelous words-acquire, organize, preserve, publish, and make available with or without charge-have served the institution well over the years. The ultimate purpose, to assist medical science with information important to the progress of public health, essentially created a mandate on which the library's mission has been advanced and from which all subsequent legislation has ultimately been derived.
In Politics, Science and Dread Disease, Strickland describes the period from 1955 to 1968 as the ''lush times for medical research'' [33]. From the time Senator Hill in the Senate, Representative John Fogarty in the House, and Dr. Shannon at NIH assumed their respective posts, neither presidents, cabinet secretaries, nor other high-level governmental officials could control the direction or pace of biomedical research in the country. Support for biomedical research received a major impetus with the emergence of the public activist team of Mary Lasker and Florence Mahoney. They met through their husbands: Lasker's a millionaire advertising executive and Mahoney's an investor and owner of numerous key newspapers, including the Miami Daily News. From the early 1940s, when they entered the scene and first visited with Senator Claude Pepper of Florida, the case for biomedical research as a national priority had been building. Teamed with medical giants Dr. Sidney Farber and Dr. DeBakey as well as others like Mike Gorman, the noted journalist and lobbyist working with Lasker, the alarms were sounded, and Congress took up the gauntlet and did the job [33].
While creating the 1956 act was a long and laborious struggle, the next two major NLM pieces of legislation came somewhat easier, although hardly a ''slam dunk,'' for they arose as the lush times for medical research were reaching their peak.

MEDICAL LIBRARY ASSISTANCE ACT
On New Year's Day of 1964, Dr. Martin Cummings was officially appointed director of NLM. Having previously been both the NIH chief of the office of international research and associate director for research grants under Dr. Shannon, Dr. Cummings brought to the institution a new perspective on its mission. Speaking to the NLM Board of Regents two weeks before assuming his duties, he said, ''The library has an unmatched opportunity to serve national and international needs in the health communications area . . . and it has a need to broaden its interest to provide a creative, imaginative contribution to the increasing complexities of communications'' [34]. He moved quickly to more fully develop the MEDLARS system, but his eyes were also on expanding the NLM mission to include legislation for a vigorous grants program and creating a research and development program. This vision would lead to a major expansion of the library and ultimately to the need for a new building.
Dr. Cummings's arrival at NLM coincided with a number of propitious circumstances: (1) the federal government was entering into an unprecedented development of scientific and technical information (STI) initiatives in part in response to the launching of Sputnik and the fear of Soviet STI dominance; (2) the NIH research program, as just mentioned, was expanding rapidly; (3) the President's Commission on Heart Disease, Cancer and Stroke, chaired by Dr. DeBakey, was gearing up to release its landmark report; and (4) much preparatory work was being advanced in NLM and the medical library community to support the need for increased resources for medical libraries across the nation.
As Dickens said in A Tale of Two Cities, ''it was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness.'' Despite the fact that biomedical research, education, and health care had been blossoming since the 1940s and 1950s, medical libraries had received little attention. The 1953 survey by John E. Deitrick and Robert C. Berson first chronicled the fact that medical libraries were dangerously inadequate in meeting the needs of medical research and education. Ten years later, Harold Bloomquist, in his excellent 1963 report on the status and needs of medical school libraries, carefully detailed the weak conditions libraries were encountering and posited the need for a comprehensive grant and aid program to ''support the essential bibliographic apparatus needed in medical research'' [35]. Despite the evergrowing demands for information services, data showed that, from 1953 to 1963, the percentage of medical school research funds going to medical libraries actually decreased, while biomedical research increased fourfold.
Other notable efforts pointed out this serious deficiency in the effectiveness of the research process: (1) the surgeon general's 1962 Conference on Health Com-munications held at Airlie House [36], (2) the National Academy of Sciences study of ''Communication Problems in Biomedical Research'' [37], and (3) the numerous substantive articles that appeared in library and educational association journals. In addition, Dr. DeBakey once again came to the aid of medical libraries with a powerful article in the April 1963 issue of Medical World News, ''Chaos Among the Stacks.'' He scolded the medical community, telling them they were allowing their libraries ''to deteriorate into inefficient, poorly staffed, badly housed, decaying repositories'' [38]. Meanwhile NLM's Deputy Director Scott Adams, ably assisted by Estelle Brodman, was quietly but busily formulating a plan to help medical libraries should the opportunity present itself.
NLM Director Dr. Cummings decided that the imbalance between library resources and the user's demand for services had to be rectified, and, as a politically astute administrator, he set out to do just that. In defending the legislation he had in mind for providing library assistance locally and regionally, he eloquently spoke these words at Countway Library: It is my view that the time has come for rapid expansion of library resources locally. Continued dependence of the more than 6,000 medical libraries upon the services of the NLM would lead ultimately to the evolution of a monolithic medical library resource in this nation. For the convenience of the user, for the inspiration which the presence of the local library gives to its own community, for the serendipity which accompanies browsing and search, strong medical libraries must exist wherever there are strong biomedical interests. [39] Dr. Cummings often invoked H. G. Wells, who at the beginning of the twentieth century, proposed a ''world brain'' in which all scientific knowledge would be stored systematically and would be easily accessible to all. Society's mechanism for this purpose was the scientific library [40]. Cummings argued the medical library was interwoven into the basic fabric of research, teaching, and practice and was therefore an integral part of these pursuits. In a series of speeches, he contended that the neglect that had been going on for the past twenty-five years, at a time when the health sciences enterprise was healthy, was a situation that could not be tolerated.
In previous years, multiple attempts had been made to use existing Pubic Health Service (PHS) authority for a grants program, but the Surgeon General's Office, the General Accounting Office (GAO), and the Bureau of the Budget (BOB) were uncertain as to its legality. While the comptroller general's decision finally ruled in favor of a limited program, it hardly allowed for a comprehensive one. As in the case of the 1956 act, definitive legislation was needed. Dr. Cummings decided he must pay a visit to see Senator Hill, something he could comfortably arrange given that he had known him quite well while testifying for NIH before his congressional committee.
Dr. Cummings told me, in fact, before deciding to take the NLM directorship, that NIH Director Dr. Shannon suggested that he visit the senator and seek out his advice on the matter. Senator Hill encouraged Dr. Cummings to take the directorship, and, through this contact, an important bond was established. Senator Hill invited Dr. Cummings and his extramural advisor, Dr. Marjorie Wilson, to come to Alabama and discuss assistance for medical libraries. With the help of the University of Alabama Dean Dr. Richardson Hill, a secret meeting on the Alabama campus was arranged. They discussed in great detail the need for an extramural program and what it might look like. The senator committed to it and sent Dr. Cummings back to Bethesda to draft a final bill that was subsequently introduced as S.597 in January of 1965. Shortly thereafter, Representatives Orin Harris, with H.R.3142, and Fogarty, with H.R.6001, entered companion bills in the House [41].
It is important to emphasize that the backbone for much of the 1965 act rests with the recommendations of the President's Commission on Heart Disease, Cancer and Stroke, a commission appointed in March of 1964 by President Lyndon Johnson and chaired by Dr. DeBakey. One key recommendation called for the ''establishment of a network of medical libraries including a limited number of regional libraries; library facility construction; training for medical librarians; and a program of research designed to improve systems and methods of handling medical literature'' [42]. What was interesting to me in researching this was that there were a number of special subcommittees to the commission, and one specifically on facilities produced the report, A Program for Developing Medical Libraries [43]. One of the three members of that group was Mahoney, so the library had an influential consumer advocate on its side. In preparing the report, Mahoney sought out Dr. Cummings, someone she had known from the time he had been director of research at the Veteran's Administration. Dr. Cummings, Scott Adams, and Dan Bailey from NLM provided key information valuable to preparing the report.
Considering the rapid growth in the nation's health programs and activities shown in Table 1, one could readily see the heavy stresses being put on the medical library network [44]. As the study group put it: Inefficiency in the medical library network creates an insidious ignorance which neither science nor the practice of medicine can condone. It results in the unplanned and unnecessary duplication of research efforts. It postpones the application of new knowledge potentially important to the alleviation of human suffering. An inadequate library system acts as a brake upon the entirety of national health programs. [45] Hearings in both the Senate and the House went smoothly, with the president of the Medical Library Association, Alfred Brandon, providing convincing testimony on behalf of the medical library community. There was no opposition to the bills. In the House, Representative Fogarty outlined the seven provisions of the bill: Ⅲ funds for construction of facilities Ⅲ grants for training in medical library information science Laws, leaders, and legends of NLM  (1954)(1955)(1956)(1957)(1958)(1959)(1960)(1961)(1962)(1963)(1964) 19,000 50,000 ϩ165% Physicians  175,000 283,000 ϩ62% Dentists  70,000 108,000 ϩ54% Nurses  284,000 532,000 ϩ87% Nongovernment support for research (1947)(1948)(1949)(1950)(1951)(1952)(1953)(1954)(1955)(1956)(1957)(1958)(1959)(1960)(1961)(1962)(1963)(1964) $60 million $541 million ϩ900% Ⅲ assistance to special scientific projects, such as studies in the history of medicine Ⅲ research and development in medical library science and related fields Ⅲ grants for improving and expanding the basic resources of medical libraries and related instrumentalities Ⅲ grants for establishment of regional medical libraries Ⅲ financial support of biomedical scientific publications In closing, he forcefully stated, ''Libraries must be helped to channel the information that is flowing into them at an accelerating rate in such ways that the knowledge they are receiving may pass on to irrigate the vast regions of man's ignorance'' [46]. Amazingly enough, some 9 months after Senator Hill proposed the Medical Library Assistance Act (MLAA) legislation, it was signed into law by President Johnson on October 22, 1965, and along with its groundbreaking provisions was an authorization for 5 years at $105 million.

LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATIONS
With the passage of the MLAA, the notion of a true biomedical communications network became a bit more than just a vision. Dr. Cummings invoked the words of Dr. John Shaw Billings when he spoke to the American Library Association many years before: It is wise to try to know something of the pattern, and to guess at some of the problems of tomorrow, but in the meantime we may not fold our hands and wait because we do not see clearly the way to go. We must do our best to meet the plain demands of today bearing in mind the warning of Ecclesiastes, ''He that observeth the wind shall not sow, and he that regardeth the clouds shall not reap.'' [47] Dr. Cummings was convinced that, if he were to convert traditional libraries into active information centers, then research in the application of new technologies was needed.
The 1963 Weinberger report-Science, Government and Information-pointed out that the transfer of information was an integral and inseparable part of the research and development process. This was followed by the Baker report, which explored both the roles of the government and nongovernmental organizations in scientific and technical information activities. The report (named after Dr. William Baker of Bell Labs and NLM regent) along with two presidential taskforces, namely, Eugene Rostow's National Telecommunications Policy Taskforce and Donald Hornig's Network for Knowledge Taskforce, provided plenty of impetus for developing national information networks. The NLM Board of Regents, with the encouragement of PHS Surgeon General Dr. Luther Terry, quickly developed a five-year plan for the creation of a biomedical communications network, or, as it was to be known in the library world, the BCN.
Dr. Cummings' effort was greatly assisted by the Report of the Special Subcommittee on Investigation of the Department of Health, Education and Welfare (HEW), conducted by Representative Paul Rogers of Florida (Rogers report) [48]. Dr. Cummings went to seek the support of Senator Hill and Representative Fogarty for his plan. They said they were prepared to appropriate funding as long as some congressional authority could be created. The 1963 Rogers report filled the bill, calling for the: 1. establishment of a research center in biomedical communications 2. establishment of a national biomedical information clearinghouse 3. integration of audiovisual activities with biomedical communication services by transfer of such functions from the Centers for Disease Control (CDC) to NLM 4. coordination of all health communications activities in the PHS.
In introducing its report, the committee returned to the theme of the DeBakey Commission that stated, ''in an age when a message travels around the world in a second, it is unthinkable that it should take months or even years for physicians and their patients to learn essential medical truths'' [49]. With the Rogers report in his back pocket, Dr. Cummings asked for and received an appropriation of $118,000 and authority for 4 positions to begin a research and development effort to create a center for biomedical communications at NLM. Dr. Ruth Davis, a highly skilled scientific administrator, became its first director. Along with the pioneering efforts of Davis McCarn and Ralph Simmons, Abridged Index Medicus Online over Teletypewriter Exchange Network (AIM-TWX) was developed. This pilot soon led to a robust medical online retrieval system, MEDLINE. Additionally, experimentation with the use of satellites for health communications in the Pacific Northwest and demonstrations of interactive television in Vermont and New Hampshire clearly expanded the horizons of biomedical communications.
Like the director before him and the one that would eventually follow him, Dr. Cummings wanted a building to house his new program initiatives. With the advent of a new grants program, a toxicology information program, the transfer of the National Medical Audiovisual Center from Atlanta's CDC, the ever-expanding MEDLARS initiative, and the emerging biomedical communications network, the existing facilities were clearly inadequate. Dr. Cummings went forward and commissioned three feasibility studies for a new building with the architectural firm of O'Connor and Kilham.
In 1968, Senator Lister Hill retired, closing a major chapter in the advancement of public health legislation. Dr. Cummings decided it might be a nice gesture to name the proposed annex after him to recognize his contributions to public health and biomedical communications. Dr. Joseph Volker, a member of the NLM Board of Regents and vice president of health affairs of the University of Alabama, passed along this suggestion to Senator John Sparkman of Alabama and other Alabama congressional members. The enthusiasm for the suggestion was overwhelming. At a dinner arranged by Dr. Cummings that included the NLM Board of Regents, HEW Secretary Wilbur Cohen, numerous congress members, and Senator Hill, Senator Sparkman addressed the group with a stirring speech. The speech chronicled much of the history of medicine from Hippocrates in 460 BC on up to the time of Senator Hill's leadership and support for medical research. The speech closed with the proposal to honor the nation's ''Statesman for Health'' by asking that his name be perpetuated through linkage to the proposed facility by naming it the Lister Hill Center for Biomedical Communications. The following day, June 21, 1968, the speech was entered into the congressional record by Senator Wayne Morse of Oregon [50] and soon thereafter, at the request of Senator Sparkman, Dr. Cummings prepared the wording for a joint resolution to name the facility after Senator Hill. On July 19, Senator Sparkman introduced Senate Joint Resolution (S.J.Res.193) [51]-it was read twice, considered, read a third time, and passed. On the 24th, it flew through the House and was signed by President Johnson on August 3, 1968, as PL90-456.
In the spring of 1970, $900,000 was appropriated for the design of the facility but the times they had changed. The lush years for biomedical research had ended: Senator Hill had retired, Representative Fogarty had died, and Dr. Shannon had left. The Nixon administration had begun, and the ever-helpful Office of Management and Budget (OMB) decided not to release the design funds until 1972. By that time, the priority of the facility in the NIH had dropped to 8th on the list.
The year 1970, however, also brought with it a pleasant surprise. HEW Secretary Robert Finch's office called Dr. Cummings to tell him they wished to place an employee in the library, Frances (Fran) Howard, who currently was the liaison for HEW volunteer hunger programs. The following day, Howard arrived in Dr. Cummings office, where his political antennae quivered as he quickly realized that sitting before him was Hubert Humphrey's sister. He appointed her special assistant for outreach in the NLM Extramural Programs Office. And, boy, did she have a knack for outreach, not only to the biomedical community, but up on the Hill and around town. As Dr. Cummings told me in my interview with him, ''Fran was the best gift the Republicans ever gave me'' [41]. She pushed some key buttons in Washington, and soon Cummings was invited to one-on-one lunches on the Hill with numerous congress members and senators. Key visits were made in the Senate with ranking members of the Appropriations Committee, namely Warren Magnuson of Washington and Norris Cotton of New Hampshire. As Cummings reminded me, actually the contact with Senator Cotton had come from my father, who was a good friend of the senator back in New Hampshire. On the House side, the two key contacts were Daniel Flood and Bob Michel [41].
Perhaps the most interesting was the flamboyant Representative Flood, who before becoming a Congress member was a Shakespearean actor. With his waxed handle bar mustache and his glass of apparently spiked orange juice, he theatrically presided over the House Appropriations Subcommittee. He supported the NLM mission and the need for a building, but hardly was its prime mover. According to Dr. Cummings, the man who deserved a great deal of credit for eventual success was Representative Michel of Illinois, the House minority leader, who quietly worked behind the scenes to get his fellow Republicans on board.
Congress appropriated $26 million for the construction of the Lister Hill center in January of 1976, and soon thereafter construction began in earnest. The facility was dedicated on May 22, 1980, with the aging Senator Hill in attendance, and that day, Dr. Cummings's dream came true.
While the Cummings era posted two major pieces of landmark legislation, it would be remiss not to record the major defense NLM put forth before the US Supreme Court to protect the doctrine of ''fair use'' as it applied to photocopying and disseminating medical literature. Publisher Williams & Wilkins alleged that NLM's photocopying activities infringed on their copyright. After a lengthy battle, however, the library prevailed, winning this groundbreaking case not only for biomedicine, but for library and information centers nationwide. As Dr. Cummings put it, ''Winning the right to photocopy literature under controlled conditions was the most important contribution NLM made to all library users in all fields of research and education and a major benefit to society as a whole'' [41].
Dr. Cummings retired in 1984, having significantly bolstered the quality of US health sciences libraries and having transformed the NLM into a national biomedical communications center.

THE NATIONAL CENTER FOR BIOTECHNOLOGY INFORMATION
In August of 1984, Dr. Donald A. B. Lindberg took over the reins of NLM, and I was pleased to remain Laws, leaders, and legends of NLM at his side as his deputy. As I said in a 1984 interview with JAMA, the choice of Dr. Lindberg brought ''a whole new perspective on information science, really one unparalleled in the history of the institution.'' From the beginning Dr. Lindberg set the tone, when he cautioned, ''We have to be interested in advanced information management systems, but we also have a great interest in making sure that what results is affordable, that it contributes to solving medical problems and reducing costs and increasing access to the best care'' [52]. It was that perspective that would lead to significant advances over the succeeding twenty years as major initiatives in imaging, telemedicine, medical language development, high performance computing, outreach, and consumer health took center stage at NLM. But perhaps the most mission-altering activity was the emergence of a whole new category of information: biotechnology information.
Indeed, it was a sea change event when on March 6, 1987, Chair Claude Pepper called to order his Select Committee on Aging to deal, as he put it, ''with nothing less than the mystery of human life and the unfolding scroll of knowledge, seeking to penetrate that mystery, which is life itself'' [53]. With these words Senator Pepper introduced H.R.393, a bill to establish a National Center for Biotechnology Information (NCBI) at NLM.
Two months earlier, the NLM Board of Regents had just published its ambitious long-range plan to guide, as Dr. Lindberg would say, the institution into the twenty-first century. From the moment Dr. Lindberg assumed the directorship, planning became a consuming way of life at the library. Over 100 leaders in medicine, librarianship, academia, government, and industry participated in the rigorous process, forming 5 panels covering the principal domains of NLM. Of particular note in panel 3, ''Obtaining Factual Information from Data Bases,'' an impassioned and instructive discussion emerged led by Dr. Allan Maxam, assistant professor of biological chemistry at Harvard University, on the importance of the field of biotechnology and the need to somehow harness the large volume of data from the oncoming genetic revolution in science. The panel and the regents quickly recognized that a singular and immediate window of opportunity existed for NLM to play a major role in the arena of molecular biology information. Their resulting recommendation was to create the NCBI as an intramural component of NLM to serve as both a repository and distribution center for the growing body of knowledge and as a unique resource for developing new information analysis and communications tools for molecular biology [54].
The 1986 Long Range Plan had many worthwhile suggestions, but the challenge facing the director was to select the right one that would most move the institution forward. He chose wisely amongst competing priorities and, in so doing, set the course to extend NLM's sphere beyond its traditional bibliographic databases to encompass biotechnology data.
Meanwhile, on the Hill, Bradie Metheny, on behalf of the Delegation for Basic Biomedical Research, was sponsoring briefings for congressional members and staff on the importance to the country of supporting genomic research. Nobelists Drs. James Watson and David Baltimore, in particular, were tireless in their efforts and most persuasive [55]. The newly formed Friends of the NLM saw this as an opportune time to approach the Hill on the need for a biotechnology information center and sought out Senator Pepper, a champion for medical research, and incidentally a close friend of Fran Howard. At a meeting arranged by the Friends of the NLM, the senator listened attentively, expressed his interest in fostering the creation of the center, and sent us back home to write a piece on the benefits of biotechnology research that would be pegged, as he said, ''at the fifth grade level so folks up here in the Congress can understand it.'' With important assistance from Lister Hill Center Director Dr. Daniel Masys, freelance writer Natalie Spingarn, and NLM's Information Officer Robert Mehnert, ''Talking One Genetic Language'' was prepared and sent downtown to the senator's office [56].
After several weeks, one morning Senator Pepper called and asked to speak with Dr. Lindberg. As he was out of town, I was put on the phone. The senator explained that he had read the piece, and then said, ''Dr. Smith, please come down to my office so we can talk about biotechnology.'' On the way downtown, all I could think of was, ''please don't ask Dr. Smith a medical question.'' Fortunately, the inquiries were nonmedical: he expressed his delight with the write-up, the contents of which he had already used at a Florida State University commencement speech. At that meeting, he indicated a bill would be prepared, and shortly thereafter H.R.5271 was introduced. Little action was taken, as the bill was entered late in the congressional session, but, to the library's delight, it was reintroduced in the following session as H.R.393. Senator Pepper was determined this time to give it some substantial visibility.
On the day of the hearing for H.R.393, room 2359, Rayburn Office Building, was packed with government officials representing virtually the entire bureaucratic alphabet including OMB, OTA, GAO, HHS, and, of course, NLM and NIH. Senator Pepper entered the hearing room followed by his staff director, Kathleen Cravedi, and her assistant, Melanie Modlin. As he passed the NLM delegation, he offered his hand to Fran Howard and escorted her up front to sit next to him, much to the amazement of the crowd. NIH Director Dr. James Wyngaarden, seated behind me, tapped me on the shoulder and whispered to me, ''Doesn't she work for you at NLM?'' The hearing began with Senator Pepper indicating H.R.393 ''brought to mind the memory of one of the noblest and . . . most enlightened men. . . . Hubert Humphrey, who first championed the improvement of federal science information programs.'' Senator Pepper then turned to Howard and asked if she would like to make an opening statement, which she proceeded to do. Our political superiors having no advance notice of Howard's role in this, Dr. Lindberg and I figured if we were to ever be given our ''pink slips,'' that would be the day.
It was a masterfully put-together hearing with some fifteen witnesses, including five patients. One of the patients was Randy Rodriguez, a seventeen-year-old victim of growth hormone deficiency who captured the attention of the audience and the senator. Rodriguez told how as a sixth grader he had been ridiculed, called a ''shrimp,'' ''shorty,'' and the like and that he had attempted suicide twice. Without the miracle of biotechnology, he reported he would not have grown a foot and a half, from four foot, two inches, to five foot, seven inches. As he told Senator Pepper, for the first time, he had a social life that included the opposite sex.
The bill nevertheless had major impediments to its passage, for Senator Pepper's Select Committee on Aging had no legislative authority, as that rested with Representative Henry Waxman's Energy and Commerce Committee. NIH was not up for reauthorization in 1987, so essentially the bill was forced to proceed in its freestanding state, making passage much more difficult. Senator Pepper, nevertheless, seeking support for the concept of the bill, testified before the Health and Human Services (HHS) Appropriation Subcommittee, which resulted in $3.85 million being given to NLM to get the program rolling.
The following year, the NIH authorization did come up for renewal and the languishing Pepper Bill was referred to the Energy and Commerce Committee, where it remained dormant. Senator Pepper, who chaired the Rules Committee through which all bills must pass, had one more card to play. Sitting in his office, I witnessed a deal being struck in a most polite telephone conversation, in which essentially Senator Pepper agreed to move a bill of Representative Waxman's out of the Rules Committee and Representative Waxman promised he would nicely fold the provisions of H.R.393 into the NIH Reauthorization Bill. This was formally accomplished through hearings held on February 22,1988. As agreed, Representative Waxman invited Senator Pepper to testify along with Dr. Victor McKusik of Johns Hopkins University, Dr. Wyngaarden, and Dr. Lindberg, and together they built the necessary congressional record to support passage.
Over on the Senate side, Senator Lawton Chiles entered the companion bill, which was later merged with one that had been introduced by Senator Pete Domenici. The latter bill addressed biotechnology research and information handling but had conveniently not included a role for NLM. The turf battles between the Energy Department and NIH were ever apparent, but a compromise bill by Senator Edward Kennedy, which included NCBI, finally emerged and was passed. President Ronald Reagan, on November 4, 1988, made it all official when he signed the Health Omnibus Extension Act, P.L.100-607.
On February 21, 1989, in the Capitol's Mike Mansfield Room, the Friends of NLM celebrated and honored the ''architect'' of the NCBI. Senator Pepper with his characteristic down-to-earth approach said, ''They tell us that this little thing that we call the DNA is the architect's plans for the human body.'' Referring to biotechnology and the new center, he said, ''I hope and pray that it's going to realize the dreams that many of us have cherished for a long, long time, by being able to prolong the lives and promote the health and happiness of human beings'' [57]. It was at this event that the Medical Library Association, under the innovative leadership of Executive Director Carla J. Funk, CAE, presented to Senator Pepper its first Award for Distinguished Public Service, an award that not only recognizes those who support medical library interests but one that provides important visibility for the association.
Dr. Lindberg's great aspiration for the NCBI was that it could somehow pull together the fragmented and uncoordinated efforts going on in biotechnology information and create an information resource that could make optimum progress in the field. Dr. Lindberg made the right planning choice in seeking a biotechnology center and the right choice to deal with the challenge ahead, namely the appointment of its director, Dr. David Lipman. Under his direction and with the support of three key appointees-Dr. James Ostell, chief, Information Engineering Branch; Dr. Dennis Benson, chief, Information Resources Branch; and Dr. David Landsman, chief, Computational Biology Branch-the center has rapidly become the information hub in the molecular biology revolution. Each day, approximately 2 million visitors go to the NCBI website, downloading 3.5 terabytes of information. The growth in data managed and curated, the growing number of users served, and the variety of services provided is enormous. It is a true success story and one vital to the discovery process. With NCBI's recent initiative to create a database to connect clinical and genotype data from large, long-term studies, such an information resource may someday lead to the development of therapeutic agents that are targeted to a patient's genetic makeup, ushering in an era of personalized medicine.
To foster these promises on the horizon, to meet the needs of the ever-growing physical collection, and to support NLM's expanded role, a new physical facility has been high on NLM's agenda. The current buildings, which predate the 1988 NCBI, were made to hold fewer than 650 staff. NLM now houses more than 1,300.
Despite significant odds, Dr. Lindberg secured the funds for the building's design. This was accomplished in spite of tight budgets, a reluctant NIH management, and a silent House Appropriations Subcommittee. Fortunately with the strong backing of the Senate Appropriations Subcommittee, a sleight of hand took place in the House, when Representative C. W. Bill Young's Full Appropriations Committee inserted the necessary design language into the Supplemental Appropriation Act for 2001, an act geared heavily to support a supplement for military pay [58]. The details of the rest of this story will remain embargoed to protect the innocent.

CONCLUSIONS
The history lesson is virtually over, but medicine's ''Library of the Twenty-first Century'' is just beginning.
The latest long-range plan released by the library asks the question, ''What Might the Next 20 Years Hold?'' [59]. Having seen the way information technology has advanced in the past twenty years and dramatically changed the modes of information access, we must, of course, approach future forecasting with a good deal of trepidation. We must keep in mind the old Chinese proverb that ''to prophesy is extremely difficult . . . especially with regard to the future,'' and likewise one must be careful not to be too ambitious, as Edgar Fielder reminds us: ''he who lives by the crystal ball soon learns to eat ground glass.'' But as Dr. Billings told us, we must certainly know something of the emerging patterns of tomorrow, have some good guesses of the problems ahead, and therefore we cannot hesitate to begin the journey. It is that spirit and the sense of the public good that has motivated those who have created legislation, launched new programs, provided leadership, and become legends themselves.
In the recent planning sessions, it was stated that the role of NLM in the twenty-first century is: to gather, connect, store, analyze and repackage into understandable units the emerging health knowledge so it can be used at the level needed from senior researchers to individuals and families. In this world the NLM will be running a real time, interactive encyclopedia of today's health knowledge at all levels of usability. [60] Clearly, medical librarians and information specialists at NLM and throughout the National Network of Libraries of Medicine will have a major role to play in this new environment. As NLM's two leaders, Dr. Lindberg and Betsy L. Humphreys, AHIP, correctly stated, ''Today's medical libraries have unprecedented opportunities to contribute to better quality and efficiency in health care, education, and research. Those who support and lead medical libraries should seize these opportunities. The future is in their hands'' [61]. They have it right, and I couldn't agree more.