ARMY MEDICAL LIBRARY 
7th Street and Independence Avenue, S* W» 
Washington 25, D. C. 
MEDEL-DA 
1 May 1952 
SUBJECT: Letter of Transmittal, 
TO: The Director 
Army Medical Library 
7th Street and Independence Avenue, S. W. 
Washington 25, D. C. 
1. Transmitted herewith is the report of survey of Army Medical 
Service Libraries, which, for purposes of identification, is titled, 
''Medical Libraries of the Army Medical Service; A Survey of Services 
and Facilities of Fixed Field Installations in the Continental United 
States." This report is submitted pursuant to your verbal instructions 
given in April 1951, further instructions in conferences subsequent to 
that date, and a summarization of them in your Disposition Form of 
6 September 1951, subject, ''Survey of Libraries." 
2, Because of the scarcity of recorded information about these 
libraries it was determined early that field visits would be made. 
Since the total number of installations is too great for all of them 
to have been covered, selection of those to be visited was made in 
accordance with par 2 of the DF: 
"In making this survey you will visit a fairly large number 
of libraries throughout the country, choosing libraries which 
are representative of various types of installations, as to size, 
mission, recency of establishment, supervision (Class I or II), 
and location." 
These principles were followed and information on a sufficiently large 
number and variety of cases has been gathered to give adequate support 
to the generalizations made in the body of the report. The schedule of 
visits is given in detail in the introduction, but the following is a 
numerical summary by types: 
a. Class II hospital libraries 10 
b. Class I hospital libraries 11 
o. Libraries in non-hospital activities of the 3 
Army Medical Service 
d. Libraries in Air Force medical activities 1 
e. Libraries in Veterans Administration hospitals 3 
f. Civilian medical libraries 7 
3. Breadth of scope of the study was established by par 4 of the 
DP which stated in part that it would assume the broadest possible Letter of Transmittal Cont'd. 1 May 1952 
character, including, ''resources, organization, management, use, methods 
of supply, facilities offered, relationship with patients' libraries, 
with near-by civilian libraries, and with the Army Medical Library." The 
wide scope has added interest to the survey and the final report should 
be the more valuable because of it. 
4. In discussing the many aspects of medical library service and 
facilities the purposes of the survey, as stated in par 1 a, of the DF, 
have been borne in mind: 
1) To determine the present state of medical libraries 
and medical library service; 
2) To discover the factors that arc responsible for any 
deficiencies that may exist; and 
3) To develop recomnendations as to measures which will 
eliminate such deficiencies. 
In achieving item 3) it has been necessary in some instances to 
make recommendations that are apparently in conflict. But there arc two 
things to be considered. One is the major recommendation of the report, 
as recorded in the Conclusions. By application of this recommendation 
the deficiencies would be eliminated through central supervision. The 
second consideration is that there may be unreceptive attitudes towards 
this major recommendation and in this event there will remain deficien- 
cies that deserve attention and correction at the local level. Some of 
the recommendations included at the end of each section are designed for 
this possibility. 
5. The undersigned wishes to express his appreciation for having 
been given the opportunity to undertake a study of such large pro- 
portions, and for the latitude he has been given in making it. It is 
hoped that the recommendations will meet with approval and that steps 
may be taken to improve substantially library service to professional 
men of the Army Medical Service. 
HAROLD W. TUCKER 
Captain MSC 
Special Assistant 
to the Director MEDICAL LIBRARIES 
OF THE 
ARMY M EDI C AL SERVICE 
A Survey of Services and Facilities 
of Fixed Field Installations 
in the Continental United States 
Submitted by 
Harold W. Tucker 
Captain, MSC 
Special Assistant to the Director, 
ARMY MEDICAL LIBRARY 
April 19^2 CONTENTS 
CHAPTER PAGE 
Introduction 1 
I. The Medical Library 5 
A. Organizational Placement 5 
B Government 6 
C. The Library Officer 9 
D. Accountability and Relations with 
Post and Patients' Libraries 10 
II. Administration of the Medical Library 19 
A. Finances 19 
B. Personnel 25 
C. Reporting 33 
D. Hours 33 
E. Physical Conditions 31; 
III. The Collection of the Medical Library 14; 
A. Quantity and Quality of the Collection 
B. Journals 2; 7 
C. Indexes to Journals and Abstracts £0 
D. Book Selection, Including Journals 51 
E. Procurement of Medical Profes- 
sional Books and Journals 53 
F. Disposition of Excess Books and 58 
Journals 
IV. Technical Processes 61; 
V. Services and Use 70 
VI. Relations with Other Libraries 75 
Conclusions 79 INTRODUCTION 
The following reports a survey of the facilities of medical 
libraries in field installations of the Army Medical Service, and is 
concentrated primarily on the classes I and II hospitals in the Zone 
of the Interior. 
The. reasons for deciding to make this study are several. In the 
first place, there is concern for the security of the collection of 
the Army Medical Library in the event of air attack. It was thought 
vital to gather information about the resources in books, journals, 
and library personnel available to the Army Medical Service elsewhere 
than in Washington, D. C. In the second place, it is indicated by 
requests for service received at the Array Medical Library that either 
the collections or personnel,cr both, of medical libraries .in the field 
are not adequate, because answers to many such questions might well 
have been obtained from basic collections by trained personnel. Fur- 
thermore, it was thought that the Director of the Army Medical Library 
has some responsibilities for the service and facilities of these 
libraries because AR LiO-hO5 states that he is charged with oversight 
of all ''Array Medical Department libraries in military hospitals and 
elsewhere"$ this survey was designed to collect for him information 
on the condition of their services and facilities. 
Preparation for the study involved several items. One of them was 
the reading of such reports on medical libraries in hospitals of the 
Army Medical Service as ware to be found in the Array Medical Library. 
These were typewritten records of visits drawn up by staff members, 
and the few that existed were found to be extremely helpful. The same 
may be said for files of correspondence between librarians in the field 
and Division Chiefs at the Arny Medical Library. Most of this corres- 
pondence recorded appeals for help in organizing hospital medical 
libraries. The Array's regulations on libraries in general, account- 
ability for libraries, and supply procedures as they apply to libra- 
ries were also carefully studied, as were the Surgeon General's Code 
Letters on procurement of books and journals for medical libraries. 
Interviews were had with the Chief of the Domestic Supply Branch, 
Supply Division of the Surgeon General's Office, in an effort to learn 
as much as possible about the methods used formerly aid currently in 
supplying medical libraries with books and journals. This office was 
also consulted frequently during the course of the visits. 
In addition to this work relating specifically to libraries within 
the Array structure, more general publications on medical librarianship 
were examined in the hope that they would develop some standards or 
yardsticks that might be used in measuring the worth of the Arny Medi- 
cal Service's libraries. VJhile this reading was informative and help- 
ful to the study, no specific standards of value were discovered. 
In the hope that something more might be found in the way of 
standards for those hospitals that offer training, the American 
1 Medical Association's requirements for accrediting ("Essentials of an 
Approved Internship" and "Essentials of Approved Residencies and Fel- 
lowships") were studied, as were the minimum standards for approved 
hospitals in the American College of Surgeons' "Manual of Hospital 
Standardization." The standards given in these arc extremely general 
in nature5 stating merely that there should be an adequate medical 
library including the latest editions and journals in the fields of 
trainings that the medical library should be in the charge of a quali- 
fied librarian, without specifying what is meant by "qualified"; and 
that the library should be readily accessible to the trainees. 
Despite the generalities of these standards, it is apparent that some 
emphasis is being given to the medical library by the agencies respon- 
sible for accrediting hospitals for training, and it is possible that 
more emphasis will be given in the future to this area through the 
development of more exact and stringent requirements for the provi- 
sion of library collections, services, and personnel. 
Based on the above and on preliminary work of other Medical 
Library staff members, a check list was prepared to record information 
about the libraries. It was decided that since little information was 
available in writing, a series of field trips would have to be planned 
during the fiscal years 1951 and 1952. In mapping cut the itinerary, 
particular attention was given to selecting hospitals of various types 
to obtain a representative sampling. It was decided that all the 
class II hospitals (10) would be included, and that a few of the class 
I hospitals would be visited, choosing those located in the vicinity 
of class II hospitals for economy in travel. Visits were ma.de to 11 
of the Army Medical Service's class I hospitals. For information 
about the library facilities of non-hospital activities three other 
organizations were also surveyed: the Medical Nutrition Laboratory, 
the Army Medical Research Laboratory, and the Army Medical Service 
Graduate School. In keeping with the broad scope of the study, visits 
were also made to outstanding civilian medical libraries in the vicin- 
ity of the Army Medical Service libraries included cn the itinerary. 
& record of the installations visited appears below: 
1951 
25 June- 
6 July 
San Antonio, Texas (with Miss Estelle Brodman) 
Brooke Arny Hospital 
Medical Field Service School 
School of Aviation Medicine (Air Force) 
Bexar County Medical Society 
Denver, Colorado 
Fitzsimons Arry Hospital 
Denver City and County Medical Society 
University of Colorado Medical School 
Chicago, Illinois 
Medical Nutrition Laboratory 
Hines Veterans Administration Hospital 
2 7-8 August 
(with Lieutenant Colonel Frank B. Rogers) 
U. S. Army Hospital, Fort Lee, Virginia 
U. S. Army Hospital, Fort Eustis, Virginia 
12-13 
September 
Valley Forge Army Hospital, Phoenixville, Pennsylvania 
18-20 
September 
Murphy Array Hospital, Waltham, Massachusetts 
U. S. Any Hospital, Fort Devens, Massachusetts 
Boston Medical Library, Boston, Massachusetts 
h-5 
October 
(■with Mr. Henry Gartland) 
Columbia Veterans Administration Hospital, 
Columbia, South Carolina 
U. S. Army Hospital, Fort Jackson, South Carolina 
1£ October- 
2 November 
Madigan Any Hospital,'Tacoma, Washington 
Seattle, Washington 
U. S. Any Hospital, Fort Lawton 
University of Washington Medical Library 
San Fran cis co, Cal if omia 
Letterman Any Hospital 
Lane Medical Library (Stanford University) 
University of California Medical Library 
U. S. Any Hospital, Camp Stoneman 
U. S. Any Hospital, Fort Ord, California 
William Beaumont Army Hospital, El Paso, Texas 
Any and Navy Hospital, Hot Springs, Arkansas 
1982 
7-11 January 
U. S. Any Hospital, Fort McPherson, Atlanta, Georgia 
U. S. Any Hospital, Fort Benning, Columbus, Georgia 
U. S. Any Hospital, Fort Bragg, Fayetteville, 
Nbrth Carolina 
28 January- 
1 February 
Battle Creek, Michigan 
Percy Jones Any Hospital 
U. S. Army Hospital, Fort Custer 
&>Sy Medical Research Lab ora ton/, Fort Knox, Kentucky 
12-20 
February 
Walter Reed Any Medical Center, Washington, D< C. 
Walter Reed Any Hospital 
Any Medical Service Graduate School 
27-23 March 
Lav/son Veterans Administration Hospital, 
Chamblee, Georgie. 
3 Prior to3 and during the course of the study, considerable atten- 
tion was paid to the library organization and operations of another 
Federal agency that has similar problems in the supplying of library 
services to medical installations; namely, the Library Service of the 
Veterans Administration. The Central Office organization of this 
agency was carefully studied, as was their manual of operations for 
medical libraries in stations in the field. Both the Director and 
Assistant Director have been most helpful in offering advice and in 
giving this survey the benefit of any standards developed by their 
agency over the period of several years it has been in existence. 
Considerable assistance in survey methods was obtained from a trip 
to observe an Army and a Veterans Administration medical library, 
made jointly by the surveyor and the Assistant Director of the Veter- 
ans Administration Library Service. 
As a by-product of this survey there are fairly detailed reports 
on file covering each of the class II activities and installations 
that were visited. These have proved of some value to the staff of 
the Reference Division of the Army Medical Library in giving them a 
better idea of the organizations that send in the greatest number of 
requests for information and medical literature. For the class I 
hospitals the only full reports written for individual installations 
cover the two that were visited jointly by the Director of the Army 
Medical Library and the surveyor. The condition of the libraries in 
class I hospitals was generally so poor that full reports on each were 
not deemed necessary or desirable. Information obtained about them 
is available in individually labeled folders on file at the Army Medi- 
cal Library. 
In the following pages ths information collected on the medical 
libraries of Army Medical Service agencies in the field is gathered 
together in an effort to determine a pattern. Frequently methods are 
so divergent that it is impossible to generalize, but this, in itself, 
is a good indication of what the conditions are. Recommendations as 
to what should be done to provide the best and most economical kind 
of medical library service at the station level are included. The re- 
mainder of this report is divided into seven major chapters, as follows: 
I. The Medical Library; Organizational Placement 
and Administrative Control. 
II. Administration of the Medical Library. 
III. The Collection.of the Medical Library. 
IV. Technical Processes. 
V. Services and Use. 
VI. Relations with other Libraries. 
Conclusions. 
4 CHAPTER I 
THE MEDICAL LIBRARY; ORGANIZATIONAL PLACEMENT, 
GOVERNMENT AND ADMINISTRATIVE CONTROL 
k. Organizational Placement 
Visits to class II hospitals have revealed that the medical 
professional library occupies varying positions in the organizational 
plan. This is true despite the fact that the organizational place of 
the medical library is prescribed by SGO Circular 119, 1990$ ''Organ- 
ization of U. S. Army Hospitals Designated as Class II Installations 
or Activities." 
The Circular itself, however, permits some confusion. Under the 
duties of the deputy commanding officer it is stated in the Circular 
that he supervises operation of the medical library. But under the 
section on the Welfare Division it is mentioned that the Special Serv- 
ices Branch "operates libraries." It is obvious from the context that 
"operates libraries" refers to general libraries of the Special Serv- 
ices typo designed to furnish recreational and other reading to 
patients and operating personnel, and not to the technical nodical 
library. It is apparent, however, that the use of the words "super- 
vises operation" as applied to the duties of the deputy commander, 
and "operates libraries" in the case of the Special Services Branch 
allows misinterprotation. 
Of the ton class II hospitals visited it was found that four had 
placed the medical library under the Special Services Branch of the 
Welfare Division; four had placed it under the Deputy Commander; and 
two (both hospitals at medical centers and, as such, exempt from the 
previsions of SGO Circular 119) did not appear to have any specific 
organizational place for the medical library other than indirectly 
under the hospital commander. 
From the visits to eleven class I hospitals it was not apparent 
that the medical library has any specific place in the organizational 
structure of the hospital. The library was not even included on the 
organizational charts of those few hospitals that had them. Recently 
issued SR h0-610-9, "Medical Service - Organizational Structure for 
Hospitals in Continental United States Designated as Other than Class 
II Activities," dated 16 January 1992, places the medical library of 
those hospitals under the Medical Records and Statistics Branch of 
the Medical Records and Office Services Division. In civilian hospi- 
tals the arrangement whereby the medical records librarian and the 
medical librarian are one and the same parson is fairly common. Such 
an organizational pattern is designed for eccnory-of personnel, but 
it is nonetheless fallacious, whether within the Army or in civilian 
hospitals, to assume tint the two kinds of work are closely related. 
5 Certain files must, of course, be maintained for each, but medical 
library work, when properly and efficiently done by a qualified per- 
son, is much more concerned with services than with the keeping of 
records. It would bo much more logical to place the medical library 
of class I hospitals under the Education and Training Branch of the 
Personnel Division, since the new regulations establish that this 
Branch has responsibility for planning and preparing professional 
education training programs. Biilo the medical library must always 
supply current reference information to the operating staff, it is 
more closely allied with the professional education program than with 
any other administrative subdivision of the hospital, and should bo 
under its supervision. 
B. Government 
Y/hcther the medical library of the class II hospital is placed 
und^r the Deputy Commander or under the Special Services Branch, pro- 
fessional medical control of the collection is given over to a govern- 
ing body made up primarily of medical officers, The appointment of 
this body by the Commander is usually recorded officially by hospital 
order, with variants in its composition and title. It is known usual- 
ly as the Library Committee, although it may also be called the Library 
Board or Library Council. Regardless of the title, it is obvious from 
examination of the composition that the hospital commander has followed 
the recommendation of the Surgeon General (Code Letter DC-^O6 on the 
procurement of medical professional books and journals) that a board 
for review, comparable to the Surgeon General's Board for Review of 
Medical Professional Books and Journals, be appointed at the local 
level, consisting of the chiefs of the professional services and. cer- 
tain administrative personnel, for the purpose of selecting medical 
books and journals. In some instances this committee has remained 
simply a selection committee; in others, it has boon given, or has 
assumed, broader powers, including the making of rules and regulations 
on the use of the library, establishing policies, and oven some degree 
of administrative control. The following is an attempt at generali- 
zation of the composition and purposes of the committee as found in 
the ten class II hospitals: 
1. Only two of the hospitals have no officially appointed 
library committee. In one of these the Deputy Commander fulfills 
the functions that might be assigned to it, particularly the final 
decision on selection of books and journals. In the other there is 
an informal committee which holds no meetings and consists of the 
chiefs of services. The only function in this instance is to make 
recommendations of books and journals, with final authority on this 
and other matters remaining with the commanding officer. 
2. Seven of the hospitals have officially appointed committees 
consisting of the chiefs of services. Even hero, however, there is 
little uniformity because not all chiefs of services arc always in- 
cluded in the committee membership. Most frequently missing from 
6 the committee is the Chief of the Nursing Service. But regardless of 
its composition, wherever a library committee has been officially ap- 
pointed , professional control of the medical library has been dele- 
gated to it. It has the final say on selection of books and. journals. 
In two of these seven instances it was found that the committees, 
although officially appointed, do not meet and have not met for some 
time. Their powers have been redelegated to the chairmen, who are 
consulted by the librarians on matters of book selection, space 
requirements, etc. 
3. In the tenth hospital the library committee, instead of be- 
ing made up of the chiefs of all services or of the majority of them, 
consists of four members appointed as representatives by the commander. 
A medical officer from the Medical Service represents Medical, Neuro- 
psychiatric, Physical Medicine, Laboratory, and Pharmacy Services; a 
medical officer from the Surgical Service represents Surgical, EENT, 
Dental, and X-ray Services; a female officer represents the ANC, WSC, 
and HAC; and an MSC officer represents the Administrative Services. 
According to the hospital regulation establishing this committee, each 
service is required to take up matters pertaining to the medical li- 
brary with its representative who will present such matters to the 
committee as a whole. The duties and responsibilities of the commit- 
tee are also clearly defined, for the first time, in the same regula- 
tions : ''The Library Committee will foster and encourage the use of the 
library by those entitled to the privilege; will formulate rules 
governing use of the library; act in an advisory capacity with respect 
to the purchase of textbooks, monographs and journals, and in the sol- 
ution of problems having to do with the administration of the library... 
Ifeetings will be held once a month or more frequently if necessary. 
Linutes of the meetings will be recorded end transmitted to the Com- 
manding Officer for approval..." 
The librarian and the library officer have not been mentioned 
above in the composition of the committees because neither of those 
officials is usually appointed as a member. But the librarian is 
present at meetings of the committees at each hospital that has such 
a committee, and the library officer usually attends. 
Variation also occurs in the frequency with which library commit- 
tees hold their meetings to consider library affairs. As indicated 
above, the library committees in two of the hospitals do not meet at 
all. The committees of three of the hospitals meet only twice yearly. 
In those cases the committee chairmen are notified at the beginning 
of the fiscal year of the amount of money that will bo available for 
library purchases, and the main reason for the meetings is to select 
books and journals. With the exception of one committee that meets 
monthly in accordance with hospital regulations, the remainder meet 
irregularly on call of the chairman, usually quarterly, or on a 
scheduled quarterly basis. The quarterly period is used because of 
quarterly advices on funds. 
The library committee has, in every case (whether in operation 
it proves to be a single man or a large group consisting of all the 
chiefs of services), at least one important administrative function; 
7 namely, control of the distribution of funds for. purcho.se of medical 
literature pertinent to each of the services. Among the hospitals 
visited there is no standard method for the performance of this func- 
tion, and again extremes arc encountered. In some there is no at- 
tempt to reallocate the funds among the professional services and 
the committee makes selections on the basis of fulfilling all re- 
quests that come in, with the result that the service that takes the 
time to make recommendations gets the lion's share of the funds. 
In others, reallocation is informal and flexible, hut the committee 
attempts to make fair distribution among the services. ^t the far 
extreme, the division of funds is formally made on the basis of 
professional staff and the size of each service, with even a fund 
set aside for the librarian to use in buying literature that might 
not be required by any particular service but which would be used 
by several of them. 
Insofar as purposes and functions of the library committee are 
concerned, much that has been said above is equally applicable in 
the class I hospitals. Of the eleven hospitals visited, seven have 
officially appointed library committees, consisting of the chiefs of 
services, and ranging in number of members from four to nine. In all 
but one of these dentistry and nursing arc represented on the com- 
mittees by their chiefs. The functions of the library committee are 
theoretically performed by the commanding officer in those class 1 
hospitals that do not have appointed committees. Direct control 
by the commander is also found in three of the hospitals that have 
committees, since he is the chairman and as such would be expected 
to have considerable influence on decisions. The senior member of 
the committee is the chairman in the other four library committees. 
The medical supply officer is a member of all the officially ap- 
pointed library committees, primarily for the purpose of supplying 
information about the library's funds. 
Professional control over the medical library can bo strength- 
ened if the library committee.is made into a true governing body, 
in the nature of a public board. V.hile the commander has final 
responsibility, his duties should be delegated to the library com- 
mittee. One of the major functions of this committee should con- 
tinue to be the selection of books aid journals, but it should also 
be concerned with more general policies in connection with the medi- 
cal library, and with making recommendations to the commander. The 
members of the committee should be appointed because of interest in 
the affairs of the library, and it should be recognized that the mere 
fact that a man is the chief of a professional service does not 
necessarily mean that ho is qualified and interested in this work. 
In fact, it is entirely conceivable that one of his subordinates 
would do a better job as a library committee member. 
It has been noted above that there arc extremes in the number 
of persons on the library committee, varying from as many as the 
chiefs of fourteen services to a single individual. Neither of 
these is a healthy situation. It is impossible to get the large 
group together and chiefs of services are already so busy with other 
8 tasks that they have little time to devote to the library or its 
problems. Ch the other hand, the single man who was doing the work 
of a committee was doing a good job, but hardly representative of 
the hospital as a whole. The representative system mentioned above 
as having been found at one of the hospitals has excellent possibili- 
ties, not that the positions selected are necessarily the most ideal; 
it does not seem particularly essential to have a representative for 
the administrative personnel and one for the female officer personnel. 
It would, however, be essential to have a small and effective board 
of five members representing all the professional services of the hos- 
pital. Such members should bo appointed by official orders and should 
be rotated. The duties and responsibilities should be precisely de- 
fined, as in the hospital order quoted above. For both its bock 
selection and policy-making functions this board should meet monthly 
on a regular schedule. 
C. The Library Officer 
Typically, each of the hospitals of cither class has an officer 
assigned as library officer. In those class II hospitals where the 
medical library is operated under the supervision of the Special Serv- 
ices Branch cf the hospital, the Special Services officer is appointed 
as library officer for both the medical and general libraries. Five 
of the hospitals have this arrangement. inhere the medical library 
does not come under the Special Services Branch, assignment as library 
officer is given as an additional duty to an administrative officer. 
SGO Circular 119 says nothing about who is to be assigned this duty 
and there is no uniformity in the primary duty cf the person selected 
to serve in this capacity, ilmcng the class II hospitals it was found 
that in two cf them the administrative assistant or adjutant is the 
library officer; in one he is the Chief of the Training Branch; in 
another, an officer connected with Supply, and in the last, the 
library officer is the administrative assistant to the Chief of med- 
ical Service. 
In the eleven class I hospitals, variation in the primary duty 
of the officer assigned to the medical library is so great as to be 
almost individual for each of the installations. The primary duties 
and the number of hospitals assigning each to the library are listed 
below merely to show the complete lack of uniformity: 
Supply Officer 3 
Adjutant 2 
Pharmacy Officer 1 
Laberatory Officer 1 
Courts and Claims Officer 1 
Hospital Inspector General 1 
Administrative Assistant to 
Chief cf Professional 
Services 1 
Unknown 1 
It is not possible to state any generalities about library offi- 
cers as ccncornifig their qualifications, duties, or degree of interest 
in the medical library. The only duty that is found to be assigned 
to this officer in all hospitals is that of being the accountable 
9 officer for the medical library. Two non-hospital class II activi- 
ties have taken advantage of the provision in SR 735-80-1 on property 
accountability in libraries which permits civilian librarians to take 
over accountability responsibility. In other cases, even when the 
librarian meets the qualifications for assuming those duties, the 
hospitals have not scon fit to turn them over, but have appointed 
an Army officer to the job. 
as accountable officer, the library officer simply signs all 
papers relating to the accounts of the library. In some instances 
he has more general administrative responsibilities in that he super- 
vises the staff, makes recommendations for promotions, and generally 
acts in a liaison capacity between the library and the hospital 
administration. In none of the hospitals does the administrative 
officer assigned to this task have anything to do with the profes- 
sional operation of the library. In practically every instance this 
is indeed a fortunate state of affairs, although two of the library 
officers encountered in the visits could, if permitted, make defi- 
nitely valuable contributions to administration of their libraries. 
It is worthy of note that wherever this situation was found it was 
also discovered that the librarian was not qualified for the job 
and there was dissatisfaction with her performance of it. 
At one of the hospitals it was found that the library officer 
had had prior experience with medical libraries in that he had been 
responsible for setting up a medical library in an Army hospital 
abroad. Ho exhibited considerable interest in the work of the library 
and was having the personnel in his office maintain all accounting 
records to relieve a short personnel situation in the library. Such 
a knowledge of library problems and interest in library operation 
is the exception rather than the,rule. 
It was found that when the library officer has an interest in 
the library there is much ho can do to assist the librarian and make 
her tasks easier. He con be particularly valuable as a liaison be- 
tween the library and the hospital administration and with the sup- 
ply service. Library problems and special supply and equipment needs 
are little understood by those who do not have first hand contact 
with library operation. Often a man in uniform can, and in some of 
the hospitals does, get much done for the library that a civilian 
librarian could never accomplish. He is able to procure messenger 
service for local intcrlibrary loans, and even to obtain enlisted men 
to assist with shelving and other library tasks. 
D. Accountability and Relations with Post and Patients 1 
Libraries 
Under the sponsorship of the Adjutant General's Office, new 
regulations on accountability for library books were issued in 1951, 
SR 735-80-1, "Property Accountability - Libraries," 28 March 1951> 
and Change 1, 21 May 1951• Shortly after issuance a Department of 
the Army letter ordered that these regulations be put into effect 
beginning 1 July 19519 but a subsequent letter instructed that their 
application be withheld pending publication of an implementing let- 
ter. This last was distributed in July 1951* 
10 The regulations themselves are extremely complicated, calling 
for a thorough-going voucher register system, accounting for the re- 
ceipt or -withdrawal of every book. Librarians and auditors in the 
field have had difficulty in understanding the provisions of the 
regulations and how they are to be applied. While the regulations 
themselves are responsible for this, the implementing letter con- 
fuses rather than clarifies. 
Civilian libraries all over the country operate without such 
detailed accounting procedures. Their total volumes and using public, 
and hence potential loss of books, are many times that of library 
service within the Army. It is expected that a percentage of the 
books -will be worn out in service, that some will be lost or even 
stolen. But protections against the small number of cases in which 
there is loss or theft without reimbursement consumes too much time 
in record keeping, and is therefore too costly to be carried on by 
these institutions. This is not to say that normal precautions to 
prevent loss and theft are not taken. It does show recognition of 
the fact that spending a hundred dollars to account exactly for a 
five dollar loss is not economical. 
Within the Federal government itself an example of simplified 
accounting procedures may be drawn from the Veterans Administration, 
the Library Service of which operates a total of l?0 libraries. 
The Library Service is accountable for the books in its libraries, 
but these books are also expendable. Their expendability does not 
relieve personnel from responsibility for proper protection of books 
as Government property. The records of accountability maintained 
by the Veterans Administraticn libraries for this purpose are ade- 
quate, but simplicity itself when compared to the requirements of 
the Army's regulations. Only two records are kept, the shelflist 
and the discard file. In the shelflist is filed a card for each 
title in the library, noting date of acquisition, price, and copy 
number if more than one. This shelflist forms the record of ac- 
countability for books the library is supposed to have, and since 
it is arranged in the same order as books on the shelves a compari- 
son may be made with what is actually on hand at any time. In the 
discard file is kept a similar record of books that the library 
has had in its collection but which have been withdrawn for one 
reason or another. In addition to the same information as is on 
the shelflist card, the withdrawal card for a particular book has 
a note as to the reason for withdrawing it from the collection. 
All the time consuming work of maintaining voucher files and 
registers, as required to account for books in the Army, is dis- 
pensed with. These Veterans Administration procedures are similar 
to the accepted practices of civilian libraries. 
One of the provisions of the new regulation on accountability 
for libraries (SR 735-80-1) requires that, with certain exceptions, 
all library accounts on a post are to be consolidated into a single 
account with thezPost Library. The medical library is not among 
the exceptions and a major question is whether or not it should be 
separate. The commanders of two continental armies, the Second 
and the Sixth, have decided that the accounts of technical medical 
11 libraries should remain separate, and have recorded their decisions 
in letters distributed throughout their commands, with the result 
that three class II hospitals are not affected. The commanders of 
other armies have not seen fit to exercise generally the discretion 
granted to them by the regulations in this matter, and consolidation 
of accounts is proceeding, or 'at least is supposed to proceed. The 
wording "supposed to proceed" is used because not everyone is clear 
on the operation of the regulations, and in some instances auditors 
have suggested that consolidation be postponed pending clarification. 
Experience with consolidation and even the results of it vary 
among the hospitals that have followed the instructions; so that it 
is not possible to group them together and to state specifically 
what happens when the accounts are consolidated, or that more or 
less work always follows. The degree of difficulty and additional 
work,'or lack of it,...due to consolidation in class' II hospitals- is 
directly traceable to 'the types of organizational relationship be- 
tween the medical library and the Special Services (Post) Library. 
The following is a tabulation of these relationships: 
'Type A - 2 hospitals - Same librarian and libraries physically 
combined. 
Typo B' - 2 hospitals - Same librarian and libraries physically 
separate. 
Type C - 2 hospitals - Different librarians, libraries in separate 
quarters, same library officer. 
Type D - U hospitals - Libraries separate in all respects. 
Consolidation of accounts has already been accomplished in one 
hospital in each of the first two types, A and B. The consolidation 
of accounts does not have much effect one way or the other in these 
two hospitals. . The new accounting procedures as prescribed by the 
regulations have been put into operation, but in effect the shelflists 
for the two libraries are still separate. In the type A hospital the 
shelflists' are separate and will remain so because of differences in 
the classification schemes used for the two libraries. In the type 
B hospital the quarters are separate but the librarian is the same 
for both libraries, and she maintains all records. Authority has 
been granted by the auditor to keep the medical library shelflist 
separate and to continue to house it separately in the medical library. 
Thus, in these two cases there is no duplication of records made 
necessary by the consolidation of accounts, nor is any saving of 
effort achieved. By projection of the effect in these two libra- 
ries, this would seem to be the case wherever the two libraries 
have the same librarian in charge. 
In types C and D the effect of consolidation is considerable. 
In the two hospitals where it had been, or was benng, accomplished 
at the time of visiting, the results did not appear to be at all 
desirable, nor was the objective of reduction in the amount of work 
involved being achieved; rather, additional work was made. Consoli- 
dation of accounts under these circumstances means the duplication 
of an extensive record - the shelflist of the medical library collec- 
tion. The medical librarian is unvulling to give up the shelflist 
she has made and maintained, since it is essential to her work. 
12 On the other hand, the post librarian must have a shelflist of the 
medical library available to her assistants, since, under this system, 
she becomes responsible for all additions to the shelflist. Additional 
paper work is created because purchase and receiving documents for 
the medical library must pass through the hands of the post librarian 
and books must be issued by her on a memorandum receipt account to 
the medical library. It is obvious that the additional paper work 
will result in delays for the receipt of books in the medical library* 
There is a further effect of consolidation of accounts regardless 
of the type of library organization under which it is accomplished, 
and which should be borne in mind in any consideration of this subject. 
Consolidation of accounts opens the route to some control by a non- 
medical authority outside the influence of the hospital commander. 
The post librarian is subject to certain controls by the Arny Area 
Librarian,who operates under the supervision of the continental 
Army's Special Services Officer. 
Furthermore, it is obvious that one post librarian in a type C 
library organization interprets the regulations on consolidation of 
accounts as giving her considerably more authority over the medical 
library than is intended in the regulations. In this particular 
case, the books themselves, rather than simply the paper work, are 
being received by the post librarian, and there are examples of 
their distribution having been handled by the post librarian without 
consultation with, or the forwarding of information to the medical 
librarian. 
Although there arc these arguments against the consolidation 
of accounts and potential assimilation of the medical library by the 
post library, there are also potent arguments in favor of combining 
the administration of the two libraries in class II hospitals even 
further than is accomplished by consolidation of accounts. TJhere the 
two libraries are administered by the same individual, as in types 
A and B, it is immediately obvious that there are savings in work 
and cost, and that certain types of work for the medical library 
arc done better. A major result in that the technical work of cata- 
loging, classifying, and preparing materials for shelving is dene 
by a single unified staff instead of by two separate ones. Also, 
it has been observed too often that the staff of the separate medi- 
cal library is inadequate; consequently much of the time of the 
librarian must be devoted to technical and other tasks, reducing 
the time available for performance of services for the professional 
personnel of the hospital. 
Through combined operation with the post library, the medical 
library enjoys advantages it does not usually have when operated 
separately. Special Services libraries hire employees under 
Schedule A and can require formal library training that cannot be 
stated as an essential qualification under the Civil Service rules 
that must be observed by the medical library. Furthermore, Special 
Services Branches able to hire enlisted personnel to do library 
clerical tasks during off-duty hours. Another major area of benefit 
to the medical library under this arrangement has to do with the 
obtaining of special library supplies and equipment. Army Medical 
13 Service allocations for the medical library are for only three cate- 
gories : personnel, books and journals, and binding. Items of supply 
peculiar to library work must be obtained through regular supply 
channels, and it has been noted during the visits that rarely is the 
Supply Officer sympathetic to these needs. It was discovered in 
several of the hospitals where the medical library is operated sepa- 
rately that the medical librarian had to depend on the generosity of 
the post library in obtaining even such insignificant but essential 
items as book cards and pockets, and punched cards for the catalog. 
Similar difficulties, but much greater, arc mot in the medical libra- 
rians ' attempts to procure equipment and furniture peculiar to the 
library operation. Vihen the two libraries are combined these prob- 
lems do not exist because supplies, equipment, and furniture are 
ordered for ''the library" with no designation as to which one will 
have the use' of them. Perhaps it is not entirely legal to make pur- 
chases for the medical library from non-appropriated Special Services 
funds, but from the point of view that improvement of facilities to 
furnish the professional staff with the best of medical information 
and time-saving services is the ultimate benefit to the patients, 
the arrangement is certainly practical. 
At class I posts the post and medical libraries have been com- 
pletely separate in the past. Special Services Branch has furnished 
general library service for the post, including the operation of a 
branch in the hospital for use by patients. Because of reluctance 
of the hospital commanders to relinquish control over the medical 
library, and reluctance or inability of the post librarian to fur- 
nish the personnel needed to take over the medical library accounts, 
little in the way of consolidation of accounts has been accomplished 
in the class I hospitals . At the time of visiting these hospitals 
both the hospital commanders and the post librarians were awaiting 
clarification of the regulations and hoping for a change in them 
before doing anything. At one of the hospitals preparations were 
being made for consolidation of accounts. In this instance it was 
expected that the post librarian would supply all but a little cleri- 
cal help for inventorying the collection. Because the library was 
completely disorganized, the post librarian's plans went further to 
include classifying and cataloging the collection, and she planned 
to continue doing this for future acquisitions of the medical library. 
In another hospital, actual consolidation of records had been accom- 
plished, but the post librarian had not been able to spare personnel 
for any organizing of the librar}' 'and such work was also badly needed 
here. The consolidation resulted in additional paper work because 
the hospital supply officer did not think it proper to issue to the 
post librarian books bought with funds from the medical library. 
Hence, he made issue slips in triplicate; two to the post librarian 
and one to the hospital's library officer. One of the copies sent 
to the post librarian is also turned over to the library officer 
when he signs the other as a memorandum receipt redord of the loan 
of medical bocks to the medical library. 
14 For purposes of comparison, the work of another government agency 
that provides library service in hospitals - the Veterans Administra- 
tion - has been studied. Library service within the Veterans Adminis- 
tration both medical and general, is,a single unit from the Central 
Office in Washington down to the individual stations, with the entire 
operation a part of the Special Services Division. At the station 
level the medical library is physically separated from the collection 
of the general library, although it is usually within the same area. 
There is an administrative librarian to head both of the libraries 
and, depending on the size of the hospital and other factors that 
determine the extent of the library operation, either this individual 
or a librarian subordinate to her is directly responsible for the 
medical part of the library. Through its Library Services at the 
Central Office, the Veterans Administration has unified control of 
all its libraries. Within the Arny such an achievement is made almost 
impossible because of the interest of two major departments - the 
Adjutant General's Department as represented by the Arny Library 
Service, and the Arny Medical Service as represented by the hospital 
commanders, there being no central division in the Surgeon General's 
Office for medical library service. 
There is no question but that libraries, general and medical, 
within both types of hospitals of the Army Medical Service should be 
unified into a single service. The advantages in administration, 
economy, efficiency, and library prestige are all too obvious. The 
question is one of the best solution for unifying the responsibili- 
ties that are divided under present regulations. 
In the class II hospitals it would seem that no more than a 
decision by the hospital commander is required to unify the library 
services of his organization. AR 680-50, "Welfare, Recreation and 
Morale - Arny Library Service," 15 December 1950, establishes in 
paragraph U that general library service is the responsibility of 
the Adjutant General. But paragraph 5^(3) of the same regulations 
returns the responsibility in these hospitals to the hospital com- 
mander by saying: "Libraries in general hospitals and in class II 
hospitals under the control of the Surgeon General conform in organ- 
ization and administration to the post library system.11 (This term- 
inology in relation to hospitals is obsolete, end it should be noted 
that there is no distinction between class II installations and 
activities.) The Army Medical Service has recognized and accepted 
this responsibility in SGO Circular 119, 1950, "Organization of U. S. 
Army Hospitals Designated as Class II Installations or Activities," 
in which the operation of patients * libraries of class II hospitals 
is placed under the- Special Services Branch of the Welfare Division 
of the hospitals themselves. 
While authority exists for combined operation in the class II 
hospitals, the opposite is true for class I. The same paragraph, 
5a(3), of AR 680-50, goes on to say: "Libraries in hospitals under 
the jurisdiction of continental army commanders and in station hos- 
pitals outside the continental United States are operated as branches 
of the post library system." SR bO-610-5 retains responsibility for 
15 the medical library under the class I hospital commander• To effect 
the economics and advantages of combined operation of libraries in 
class I hospitals, one or the other must relinquish its responsibil- 
ity, either turning the entire library service over to the ^rmy 
Library Service or to the Army Medical Service. 
As presently constituted, it is doubtful whether the Army Library 
Service could perform the services recommended later in this report. 
It doos not have the personnel or the authority to do so, and its 
supervision is by offices where the primary interest is in the purely 
recreational aspects of Special Services. 
Starting afresh with an entirely now organization, under one of 
the alternatives in the Conclusions, to give library services to hos- 
pitals is much more possible of success. By combining all library 
operations under the hospital commander, both classes I and II, none 
of tho advantages of combination under Special Services, as discussed 
above, would be lost. Funds for tho patients' library would como 
from the same sources as at present, hospital fund and control post 
fund. The organization of the total library service could conform 
to that of tho post library system. 
16 RECOWNDATIONS 
(Chapter I) 
1. Organizational place of the medical library9 under present 
divided responsibility for operation of medical and general libraries. 
a. It is recommended that supervision of the medical 
library in all class II hospitals be a direct responsibility of the 
deputy commander• 
b. It is recommended that organizationally the medical 
library of the class I hospital be placed under the Education and 
Training Branch of the Personnel Division. 
2. The Library Committee; It is recommended that the composi- 
tion, number of members, functions, and frequency of meetings of a 
library committee be prescribed in an official document at each hos- 
pital . 
a. The committee should be composed of no less than throe 
and no more than five members. Members should bo appointed, on 
special orders, to represent all the professional services, with 
annual rotation of membership. 
b. The functions of the committee should be; 
1) Formulation of medical library policies and 
enforcement of the rules governing its use. 
2) Lherc there is a librarian, advising her on the 
selection pf medical books and journals, and where there is none, . 
the actual performance of this work. 
3) General development of the medical library and 
encouragement of the use of its facilities. 
c. The frequency of meetings should be established as 
monthly. 
3. The Library Officer. 
a. For the class II hospitals, it is recommended that 
advantage be taken of paragraph U, SR 73^-80-1, to make the civilian 
librarian the accountable property officer for the medical library, 
and that the position of library officer be abolished. Supervision 
should be directly under the deputy commander, with the chairman of 
the library committee assuming the liaison functions of the library 
officer. 
17 b. Until library personnel is provided for the medical 
library of the class I hospital, it is recommended that the position 
of library officer in these installations be continued. It is fur- 
ther recommended that the administrative officer connected with the 
professional education and training program under the Personnel Divi- 
sion (SR 40-610-5) be assigned the duty of library officer. 
4. Accountability: It is recommended 
a. That library books be made expendable. 
b. That SR 735-80-1 be revoked and replaced with simpli- 
fied regulations on accountability similar to those of the Veterans 
Administration. 
5- Responsibility for library service in hospitals: It is 
recommended that the rosponsability for library service, patients' 
and medical, within hospitals of the Aruy Medical Service be given 
to that technical service, delegated to the individual hospital com- 
manders . To implement this recommendation steps should be taken to 
a. Change paragraph 5^(3), AR 680-50, to remove the 
class I hospital libraries from the post library system. 
b. Change SR 40-610-5 to make the hospital commander of 
class I hospitals responsible for library service to patients, as 
well as being responsible for medical library service. 
18 CHAPTER II 
ADMINISTRATION OF THE MEDICAL LIBRARY 
A. Finances 
Funds for the medical library in each hospital in the Army 
Medical Service are allotted by the Domestic Section of the Supply 
Division, Surgeon General's Office. Such funds are divided into two 
categories: one is for the purchase of books aid journals, and the 
second is for binding. Funds for staff are included in the overall 
hospital budget, and it is also assumed that supplies, equipment, 
and furniture for the medical library are included in the general 
funds for these purposes for the hospital as a whole. It has been 
mentioned elsewhere what effect the practice of not budgeting for 
these items specifically for the medical library has had. Only the 
two categories of funds mentioned above will be discussed in this 
chapter. 
The practice of allotting funds for library purposes was begun 
in 1950 and is a tremendous improvement over the former automatic 
distribution system and the listing of specific titles in the Medi- 
cal Department's supply catalog, for the purpose of requisitioning. 
Under the old system it was not unusual for a library to receive 
copies of superseded editions because the depots did not wish to be 
left with large numbers of copies on hand when new editions were pro- 
duced. The present system, established by SGO Code Letter IX-506 in 
1950, permits the professional members of the hospital staff to select 
for the medical library those items which best fill the needs of that 
parti cular or gani zati on. 
Obviously, the major difficulty in such a system of allotment of 
funds is the determination of what amount for books and journals is 
to be allotted to each hospital. The Domestic Section of the Surgeon 
General's Office has been consulted on numerous occasions but a com- 
plete answer to this question has never been forthcoming. Apparently, 
the first time the allotment system was used this Section priced the 
books that would have been authorized under the automatic distribu- 
tion system, added up the total for each hospital, and then gave that 
amount of money as the allotment for local purchases as non-standard. 
The reports are that for the following year a formula was used, based 
on many factors, such as number of patients treated during the year, 
size of the staff, extent of the professional training program, etc.; 
but it has not been possible to get any precise definition of the 
formula or an example of the way in which it works. For the fiscal 
year 1952, the formula system was abandoned and assumption was made 
that the hospital commander or Amy surgeon, knowing his own needs 
for the medical library, as well as for all other operations of his 
hospital, would request the amount required for the medical library. 
If the amount wanted seemed too large to the Domestic Section, the 
local officer would be asked to make an adjustment. If he did not 
19 do so, or if his request was still too large in the opinion of the 
Domestic Section, a reduction would be made arbitrarily. 
This system is being continued in use since the estimates for 
Fiscal Year 19^3 have already been made on this basis. Its falacies 
are readily apparent. The hospital commander's estimate of library 
needs will, in a few cases, be based on his own knowledge aid recog- 
nition of the importance of a good working library. In other in- 
stances, he will have to take the word of his librarian, the chair- 
man of the library committee, or the library officer as to the needs 
of the library. It has already been shown that there is a great 
variation in the interest of the chairmen of the library committees 
and in their recognition of the value of the library. It will be 
shown later that there is considerable variation in the qualifica- 
tions of the librarians and, further, it is sometimes difficult and 
often impossible for them to impress their views on the officials 
who make recommendations for the hospital budget. 
The system is also fallacious in that it assumes that the one 
who shouts the loudest has the greatest need, The professional staff 
of a hospital where the commander is economy-minded and feels he is 
obliged to operate at the least pcs sible cost will suffer a lack of 
professional literature regardless of its importance to the staff's 
work, while the commander who builds for the sake of building may, 
conceivably, construct a medical library in excess of actual require- 
ments . 
To correct these conditions some formula should be devised that 
at least makes an attempt to provide equitable distribution of funds. 
There are many factors that must enter into such a formula, some of 
which are so variable and intangible that it is extremely difficult 
even to state them, much less to reduce them to figures of any sort. 
Others are recognized in the formula that was previously used by the 
Domestic Section. These factors are discussed in brief below. 
The number one factor for consideration is, of course, whether 
or not the hospital is a teaching hospital. This factor immediately 
separates the class II hospitals from the class I, and they should 
be considered separately for many reasons. All the class II hospi- 
tals have interns, and five of them have residents. Since both are 
expected to make use of the library and thus increase the demand on 
it for medical literature, their presence should be recognized in de- 
termining the funds for the library. In its formula for specifying 
the amounts for its training hospitals, the Veterans Administration 
adds to the basic fund depending on the number of residency programs 
at a teaching hospital. It is felt that not only the programs but 
also the actual number of residents should be recognized, since each 
resident is required to carry on a research program of his own. This 
cannot bo done without adequate facilities in the form of journals 
and books in various fields, but it also requires indexes that are 
usually quite expensive. 
20 Despite this and the other factors that follow, a fair budget 
cannot be constructed on these alone* Funds in recognition of spec- 
ial factors should be added to a basic allocation. The basic amount 
should be sufficient to supply the professional staff of the class 
II hospital with the basic literature needed to furnish information 
on the field of medicine as a whole and specific literature within 
its fields of specialized treatment. It is estimated conservatively 
that this cannot be done with less than 90 to 100 journal titles at 
the very least. At an average cost of $8 per journal title, and 
using the figure of 100 titles, the cost for basic journals would 
be $800. It is estimated that 175 books, roughly one-third of the 
American books on medicine and hygiene published in 1951^ purchased 
per year would give basic coverage of the field of medicine and 
related subjects, including materials in any specialties of the 
smallest general hospitals. At an average cost of about $7 per book, 
the required amount would be $1,200, yielding a total basic alloca- 
tion for class II hospitals of $2,000. 
To this basic amount should be added funds to supply the liter- 
ature needs of training. For interns $25 each would be adequate, 
with $50 for each resident because of greater library needs. This 
figure for residents should not be applied to the total number of 
residents in two of the hospitals (Letterman and Walter Reed) because 
of the great number of them - about 105 each. It is thought that its 
application to a maximum of 50 residents only should well cover the 
literature for research needs of the total number. 
It is also thought that the number of professional staff members 
should be recognized in the allotment because the greater their num- 
ber, the more is the variety of fields of interest and application. 
Consequently, it is suggested that $5 be added per staff member in 
the medical, dental, and nurse corps, including civilians where they 
are substituted for Army personnel in these corps. 
The Surgeon General's Office is already giving recognition to 
the fact that the length of time a library has been in existence 
should be taken into account in determining the amount of money for 
books and journals. Those hospitals which were dc-activated and re- 
opened in 1950 have been given special funds to restock their libra- 
ries. While there was variation in the amount given for this purpose 
for Fiscal Year 1951 > without apparent reason, the treatment for 
Fiscal Year 1952 is more equitable,with an additional $1,500 for each 
If this amount is added for the first three years following reactiv- 
ation of the hospital it should be sufficient, along with the help 
which the Army Medical Library can offer in the form of duplicates, 
to rebuild a working collection. 
The presence of a research and development project at the hospi- 
tal could.be expected to have an effect on the library's purchases. 
Field visits have proved this not the case because the research and 
21 development projects located at class II hospitals have funds of their 
own for research literature. If it is found that the hospital library 
is expected to acquire special journals and indexes for the project, 
this fact should be recognized by channeling some of the project's 
literature funds into the library. 
The location near by of a civilian.or another military medical 
library should also be considered in determining the amount of the 
allocation. Furthermore, the quality of those other facilities should 
also be taken into account, as should the extent to which government 
installations may rely on private collections without wearing out 
their welcome. In one instance only the surveyor uncovered an objec- 
tion to the amount of use of a civilian medical library by an Army 
library. In all the others the report is that civilian libraries 
are happy to assist local Army hospital libraries because it gives 
them an opportunity to repay partially the services they themselves 
receive from the Army Medical Library. 
In connection with this consideration specifically, there are 
three class II hospitals that have superior library facilities out- 
side their own walls in the immediate vicinity. One of these is 
Letterman, which is only a short distance away from an excellent 
medical library, Lane Medical Library of Stanford University, and 
can also borrow from the considerable collection of the University 
of California. Murphy has the considerable medical library facili- 
ties of Boston on whicia it may draw. Walter Reed has the Array Medi- 
cal Library and also the collections of other government libraries 
in Washington. At the other extreme, there are hospitals which not 
only have to furnish their own literature needs but because there are 
poor civilian medical libraries in the vicinity or none at all, they 
also serve as medical libraries for civilian doctors in private prac- 
tice. Percy Jones, Army and Navy Hospital, and Milian Beaumont fall 
in this category, and the latter erven has an international flavor 
because doctofs from Mexico make use of its library. 
The remainder of the class II hospitals fall between those ex- 
tremes, with good medical libraries from 30 to 700 or more miles away. 
Following are a few specific examples of application of the 
formula items above: 
1. Brooke 
Basic $2,000 
38 interns, $25 each 950 
37 residents, $50 each 1,850 
310 other staff members, $5 oach 1,550 
(FI 52 allotment, $5,000) $6,350 
22 2. Army and Navy- 
Basic $2,000 
6 interns, $29 each 190 
No residents 
89 other staff members, $5 each . UU9 
(FY 92 allotment, $1,800) $2,999 
3. Letterman 
Basic $2,000 
interns, $29 each 1,129 
90 of 109 residents, $90 each 2,900 
231 other staff members, $9 each 1,199 
$6,780 
Less deduction because of excellence and 
nearness of civilian library facilities 1,900 
(FY 92 allotment, $3,200) $^280 
h. Walter Reed 
Basic $2,000 
119 interns, $29 each 1,129 
90 of 109 residents, $90 each 2,900 
26h other staff members, $9 each 1,320 
. $6,9U9 
Less deduction because of excellence and 
nearness of civilian library facilities 1,900 
(FY 92 allotment, $6,000) &97IB 
Based on information gathered at the 11 class I hospitals visited, 
it may be unequivocally stated that there are great inequalities, with- 
out apparent reason, in the allotments granted for books and journals. 
The following arc cited as instances of the inequalities: 
1. A specialized treatment facility operating 1,100 bods with 
a professional staff of 190 has an allotment of $1,800 for medical 
books and journals for 1992. The nearest civilian or other medical 
library with any degree of adequacy is over a hundred miles away. 
2. Another hospital, also a specialized treatment facility, 
operating 300 beds and with a professional staff of 99 has an allot- 
ment of $2,000 for 1992. This hospital is approximately five miles 
from a class II hospital that has a medical library collection of 
h,000 volumes. 
3. Two non-specialized treatment class I hospitals compare 
as follows: 
' 1 
a. Staff, 99J Beds, U90; allotment for books 
and journals $1,000 
b. Staff, 80: Beds, 220; allotment for books 
and journals 1,200 
23 These two hospitals are performing similar services, and it is to be 
noted that not only does the smaller hospital have the greater allot- 
ment for books and journals, but it is also much closer to a civilian 
medical library than the larger one. 
Because there are fewer factors involved, a different formula 
is necessary for determining equitable allotments for class I Army- 
hospitals. Again, there must be a basic allotment for books and 
journals, but because of the more limited facilities and staff this 
amount need not be as great as in the case of the teaching hospitals. 
The factors to be considered in this case are size of staff, whether 
or not the hospital is designated as a specialized treatment facility, 
and the nearness and excellence of other military or civilian medical 
libraries. The last is a lesser factor in these cases because the 
class I hospitals are usually located at posts that are farther from 
the large cities where medical schools and libraries are found. 
The Veterans Administration allots a minimum of $l±80 for jour- 
nals for the non-training hospitals under its jurisdiction. With an 
average price of $8 per journal title this sum would provide about 60 
journals, a reasonable number to cover the medical field in American 
publications. It also provides a minimum of $720 per year for the 
purchase of books, and this sum would buy approximately 100 books. 
'The total of $1,200 should certainly be adequate for the smaller 
class I hospitals,and cannot be deem d excessive as a basic allotment. 
In considering the size of the medical staff it is apparent at 
the outset that the number of individuals will be considerably less 
in the class I hospitals than in the class II. The basic allotment 
recommended above will cover the variety of interests of a profes- 
sional staff of 100 or less. To recognize further the variety of 
interests as the staff increases above this figure, and to encourage 
those interests for present and, for what may be even more important, 
future value to the Army Medical Service, the additional amount of 
$10 for every staff member over 100 is adequate to provide a broader 
coverage of medical literature. 
Specialized treatment facilities will require additional funds 
to provide literature in the special fields. Assuming the basic 
allotments and the additional money based on staff, a minimum of 
$300 should be provided for' each field of specialization. The follow- 
ing are some hypothetical cases based on the above factors: 
1. Hospital A - professional staff, 30; 
100 beds; non-specialized. 
Basic allotment $1,200 
Additional for staff 0 
Additional for specialized treatment 0 
Allotment for books and journals $1,200 
24 2. Hospital B - professional staff, 21$; 1,^00 beds; 
specialized treatment in three fields. 
Basic allotment $1,200 
11£ professional staff members, $10 each 1,1^0 
3 fields of specialization, $300 each 900 
Allotment for books and journals $3,2^0 
3. Hospital C - professional staff,££; 300 beds; 
specialized treatment in one field. 
Basic allotment $1,200 
Additional for staff 0 
1 field of specialization 300 
Allotment for books and journals $1,^00 
B. Pers onnel 
Without a qualified librarian to organize and service library- 
material, the hospital has a pile of books and journals rather than 
an organized, useful, and valuable collection of medical literature 
in its library. There is little point in purchasing books and jour- 
nals only to place them on the shelves in the order of receipt, or 
some other illogical fashion, with no index through which a profes- 
sional staff member may locate information of value, sometimes vital, 
to him. Furthermore, the qualified librarian performs an essential 
service function in ferreting out information and its sources for the 
medical officer, thus saving valuable professional time. She relies 
on her knowledge of other libraries, since her own must be a small 
working collection, to obtain the more rare and unusual items re- 
quired by a professional staff member at a particular time. If she 
is worth her salt, she does not wait for the medical officer to come 
to the library but calls his attention to what it has for him by 
means of various devices. 
Unfortunately, the field visits do not reveal that the Army 
Medical Service has many librarians of this caliber serving as heads 
of its medical libraries in field installations. Generally, the 
class II hospitals are the more fortunate because of their greater 
needs for medical literature. Because it is difficult to arrange 
the part-time librarianships needed by many of the class I hospitals, 
these installations have been almost completely neglected. Some 
suggestions for remedying the situation in the class I hospitals 
will bo made later, but first comes an examination of the "better'' 
situation in the class II organizations. . 
On the reverse of this sheet is a tabulation of the personnel 
situation in thd medical libraries of the 10 class II hospitals cur- 
rently in operation. Several statements may be made about the defi- 
ciencies this chart brings to light: 
25 HOSPITALS 
CHIEF LIBRARIAN ; 
J ASSISTANTS (MED LIB) 
Education and Training 
- ' ■ ■ ' • ■ 
• 
Respon- : 
sible for: 
patients': 
library : 
:No. 
No'.vith: Experience 
library: 
Grade 
experience 
uraae 
GS 
Medical:Other 
Library.than 
present _ 
Job :Library 
uonege 
Graduate 
noraiy 
School 
neaicai 
Library 
Lraunngsuen. li- 
brarians 
meet, li- 
brarians 
uivman 
GS 
Military 
A 
B 
C 
D 
E 
F 
G 
H 
I 
J 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
No^ 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
No 
No 
No 
No 
Yes 
Yes 
Yesc 
No 
No 
No 
No . 
Noa 
No 
No 
Yes 
No 
No 
No 
No 
No 
No 
Yes 
Yes 
No 
Yes 
No 
No 
Yes 
Yes 
Yes 
Yes 
No 
No 
Yes 
Yes 
Yes 
Yes 
9 
9 
9 
5 
7 
7 
5 
7 
7 
7 
Yes : 
Yes : 
Yes ; 
No : 
No : 
No : 
No : 
No : 
No : 
Yes : 
: ld 
: 0 
: 1 
: 1 
: 1 
: 2 
: 2 
OrHrHOrHOOOOO 
0 
OHHO<-!OOOOO 
OOOHOOOHHO 
3 and 4- 
5 
5 
5 
4 
Sgt. 
0 
0 
0 
0 
Cpl. 
Cpl. 
Cpl•-2 
Pvt-1,Cpl-1 
0 
PERSONNEL IN MEDICAL LIBRARIES 
OF CLASS II HOSPITALS 
a. Background of education and experience as a dentist. 
b. Two years of college. 
c. No degree but has had sone library courses. 
d. Combined operation of general and medical 
libraries. Clerical staff serves both, 
e. Graduate of a public library training class. 
26 1. The qualifications of the librarians for their jobs may be 
compared with the requirements of the various types of medical libra- 
rian certified under the Medical Library Association^ rtCdde for 
Training and Certification of Medical Librarians." These require- 
ments are used as a basis for comparison because Civil Service quali- 
fications do not recognize that medical librarianship is a special 
field of work and, in fact, permit the awarding of professional grades 
to employees who lack the education and training to be recognized as 
professional librarians outside the Federal government. The code 
referred to above was established for the purpose of improving the 
standards of medical librarianship. Certification under this code 
gives evidence of special training or recognition of special knowl- 
edge and experience in the field of medical librarianship. 
The ''Code" provides for several grades of certificates. The 
first is the Charter Certificate which is designed to provide for 
those medical librarians who have gained their positions through ex- 
perience alone rather than in combination with formal training. It 
is a device to protect those who do not meet the higher requirements 
of the other types of certificates. Charter certificates require 
simply five years of professional experience, and will be discontin- 
ued entirely five years after adoption of the code. For grades one, 
two, and three, the librarian is required to present to the Committee 
on Standards for Medical Librarianship proper credentials in evidence 
of completion of the prescribed training. Grade 1 requires the com- 
pletion of college and library school training, including an approved 
course in medical library service. Grade 2 has the additional re- 
quirement of a term of supervised experience of at least six months 
in an approved medical library. For the highest grade of certificate 
tion, 3, all the above is required plus graduate work in library 
science and in medical and related subject fields, leading to an 
advanced degree. 
a. Of the ten librarians, one might possibly be awarded 
the highest degree of certification (Grade 3)j although there is some 
question about her meeting the requirements. Only this one out of 
the ten librarians has had a course in medical librarianship in ad- 
dition to the regular college education and general library training. 
She has done some graduate work but has not fulfilled with a higher 
degree the final requirements for a Grade 3 certificate. 
b. Seven of the chief medical librarians could qualify 
only for charted certificates. The charter certificate is designed 
to provide for those librarians who have gained their positions through 
experience alone rather than in combination with formal training. It 
is a device to protect the jobs of those who do not meet the require- 
ments of other types of certificates. Charter certificates require 
only five years of professional experience and, in order to raise the 
standards of the profession, will be discontinued entirely five years 
after adoption of the ''Code," Four of the seven come close to quali- 
fying for Grade 1 certificates because they have college educations 
27 and library training. Included in the latter, however, are no 
courses in nodical library service, a highly specialized field. 
The remaining three, having no library training of any kind (and 
one has completed only two years of college), qualify for the charter 
certificate solely on the basis of five years of experience that will 
be completed before expiration of the provision for charter certifi- 
cates . 
c. It should be noted that five of the chief medical 
librarians could be qualified for Grade 2 certificates in very short 
order. They already have the basic training in librarianship. A 
summer course in medical librarianship would complete the qualifica- 
tions and be of great value to them in their work. Naturally, those 
who qualify only for charter certificates would also benefit greatly 
from such a course. 
2. At the Amy's two medical centers there is no qualified 
medical librarian in charge of the medical library. This is not in- 
tended to cast any aspersions on the qualifications of the chief 
librarians, at these two installations. Rather the opposite is in- . 
tended, for this point is raised in recognition of the fact that in 
both of these instances the librarian is also in charge of the gen- 
eral library, and both of them are administrative librarians. Super- 
vision of the operation of the libraries under their control is a 
full time job in itself. At both places there are professional 
librarians under the librarian, who are charged with the actual oper- 
ation of the general library service. So also, in order to give the 
best possible medical library service to the professional staff and 
numerous trainees, should there be a trained librarian with medical 
library training and experience to take charge of the services of 
the medical library. * 
3. The Civil Service grade of the chief medical librarian 
deserves reconsideration in the light of proper qualifications for 
the position. In preparing its "Classification Guide," the Library 
Service of the Veterans Administration has set up its positions for 
medical librarian at no less than GS-7 rating. This ranges up to 
GS-9, depending upon the number of professional staff members and 
the extent of the training program in the training hospitals. It 
may be noted on the table (page 26) that the Amy's hospitals have 
two GS-5, five GS-7, and three GS-9 ratings. All three of the high- 
est grade are what the Veterans Administration would designate as 
administrative librarians rather than medical, since they also have 
responsibility for the general library service of their hospitals. 
Such jobs in the Veterans Administration service begin at GS-7 and 
range up to GS-11. 
4. Except for three of the hospitals, subprofessional and 
clerical help is almost entirely lacking, or is changed with such 
frequency as to be of little help to the librarian. In the three 
which appear to have adequate assistance of this nature, operation 
28 of the general and medical libraries is cento in ed under a single 
librarian. Employees hired from non-appropriated funds for the 
general library are found to be doing the subprofessional and cleri- 
cal work needed to keep the medical library going also. . For some 
unknown reason, the fourth hospital in which the operation of the 
libraries is combined is almost as desperately in need of help as 
those medical libraries that are separate. Even here the time of 
one civilian clerk is partly available to the medical library and 
distribution of her time is under the control of the librarian. Of 
the remaining six libraries: 
a. One has no assistance in ary form, for the enlisted 
men and women that are hired from Special Services funds to stay in 
the medical library after the close of the librarian's day are 
simply monitors. 
b. In another, the librarian and her professional assist- 
ant must do all typing, preparation of materials for binding, and 
other routine tasks. In this instance the medical library is kept 
open extremely long hours (75 per week), and because of a large train- 
ing program and professionally alert library staff there is heavy use 
of the medical libraiy and very heavy demand on the time of the 
librarians for their services. 
c. The remaining four have enlisted personnel to assist 
the librarian in clerical and other duties. The disadvantage of us- 
ing military personnel in the medical library should be immediately 
obvious. In the first place, it was observed in several instances 
that only those who could not be used in any other position ended up 
in the medical library. Frequently, they have no background or apti- 
tude that fit them for the work, and much of the time of the librarian 
must be spent in training them. On that rare occasion when a good 
man is sent to the library to work, or when the librarian has suc- 
ceeded in making an abler worker out of him, it is usual to lose him 
within a relatively short span of time and to have the training situ- 
ation begin over again. All in all, it may bo said that assignment 
of enlisted personnel to the medical library is unsatisfactory. 
In addition to this critical analysis of the medical library per- 
sonnel in class II hospitals, it is all too apparent that librarians 
are not recognized by the medical staff as being members of a profes- 
sion of their own. It is impossible to say whether this stems from 
the generally poor qualifications of the medical librarians in class 
II hospitals or whether bettor personnel have not been selected because 
this lack of recognition of the importance of qualified librarians 
existed in the first place. Regardless of the reasons, the fact is 
that librarians in these institutions, in all but one or two instances, 
arc so hemmed ^in by supervisors aid committees that even the fully 
qualified personnel are not able to practice the profession of libra- 
rianship to achieve the best results in service. Lack of recognition 
29 of librarianship as a profession is specifically pointed up by the 
description of duties and responsibilities of the librarian in one 
of the few hospitals that has issued a hospital order on the medical 
library: 
"Librarian - Arrange for the binding and shelving of the current 
journals and for the necessary classifying, cataloging and in- 
dexing of the textbooks and monographs. Keep a record of all 
books and journals borrowed and of their return. Maintain a 
record of journal issues received in the library and notify 
the publishers of any discrepancies.1' 
Except for classifying and cataloging, all of the above listed duties 
arc clerical tasks that should be supervised by the librarian - not 
done by her. There is no mention at all of reference, bibliographic, 
or other professional service functions. 
Further, it is significant that in only four of the hospitals are 
any of the journals of librarianship received in the medical library. 
At a minimum, the medical library's subscription list should include 
the Bulletin of the Medical Library Association, Special Libraries, 
and for general library coverage it should also have the Library Jour- 
nal . These three periodicals are essential to keep the librarian 
informed on developments and methods. 
While librarians of the Army Library Service and medical librar- 
ians of the Veterans Administration are much in evidence at profes- 
sional library meetings, medical librarians of the Army Medical Serv- 
ice arc noticeable only by their absence. At the 19^1 meeting of the 
Medical Library Association, only one librarian of the Army Medical 
Service was present, and in all likelihood sho would not have been 
there had not the meeting been held.in the city where her hospital 
is located. One of the librarians attended the more general meeting 
of the American Library Association. Only two Army Medical Service 
librarians present at two major professional library meetings during 
a year is extremely poor representation. 
Wile the medical library personnel situation in the class II 
hospitals leaves much to be desired, they are well off by comparison 
with conditions in the 11 class I hospitals visited. Not one of the 
11, regardless of size or mission of the hospital, has a qualified 
librarian of any sort assigned, whether full or part tine, to the 
medical library. The following gathers together the information col- 
lected about personnel in the medical libraries of the 11 hospitals: 
1. Three of the hospitals have no assistant of any kind to 
help the library officer with the library. 
2. One library has half the tine of a GS-3 clerk. 
3. One lias 10^ of the tine of the library officer's secretary• 
30 b. One library officer is assisted in the maintenance of 
records for the medical library by his office personnel. 
In one hospital a captain, WSC, performs the record-keeping 
for the library. 
6. Four of the hospitals have full time enlisted personnel 
ranging in rank from private first-class to sergeant first-class. 
In every case aSovc where there is a full or part tine person 
assigned to the medical library of a class I hospital, it is found 
that the duties are almost entirely clerical. The number one job 
has been to keep the records of accountability or responsibility, 
depending on whether or not consolidation with the post library has 
been effected, for the library officer. In one instance a WAC ser- 
geant first-class has been assigned to the medical library specifi- 
cally for this purpose. She is doing an admirable job of getting 
the library records into order according to regulations. Like all 
others, however, she was offering almost nothing in the way of pro- 
fessional libraiy services. Other duties found were preparation of 
documents for purchase of books and journals, shelving books and 
locating them when requested specifically by author and title, rout- 
ing journals, and simply keeping the library open. In some few, 
crude attempts at classification and cataloging were found, but in 
most of these new systems had been invented out of ignorance of the 
tried and tested ones. 
The new regulations SR UO-61O-5, ''Medical Service - Organizational 
Structure for Hospitals in Continental United States Designated as 
Other than Class II Activities," 16 January 1952, provide for some 
uniformity in supervision of the medical library by placing it under 
the Medical Records and Office Services Division. Presumably this 
also means that personnel will be authorized to this Division for 
performance of the record keeping and other clerical tasks mentioned 
above. 
But there is still no solution to the provision of professional 
library personnel for the class I hospital library. It is true, of 
course, that the construction of personnel allocations for the medi- 
cal library is extremely difficult because of the wide range in the 
number of professional staff members and the differences in missions 
of the hospitals. Some are so small and so restricted in the treat- 
ment offered that the services of a librarian are not at all warranted. 
Also in most of the class I hospitals the professional staff is so 
besieged with duties, including enormous sick-call loads at basic 
training centers, that they actually have little time for reading 
medical literature. This fact may be used as an argument against 
having professional library assistance available. Conversely, it is 
also a potent argument in favor of a qualified librarian in the class 
I hospital, for here more than ever it is essential to conserve the 
time of the medical officer by having an expert who can dig out for 
him the sources of vital information. Not only must his time be 
31 saved for him, but the medical officer in this situation needs encour- 
agement to read recorded medical experience for his professional de- 
velopment and improved value to the Army Medical Service and the 
medical profession as a whole. One of the services of a professional 
librarian is to call attention to items of interest to promote such 
personal development. 
But there is little argument against the desirability of having 
professional library personnel to administer ,the medical library of 
the class I hospital. Few of them would require a full time librarian 
so the problem is to provide an amount of professional library time 
proportionate to the size of the medical staff, and in line with the 
mission of the individual hospital. Since professional librarians 
are in short supply, it is practically impossible to hire one on a 
part-time basis. 
At two of the class I installations visited some progress in 
organizing'collections is already being accomplished through the 
cooperation of the post librarian as accountability is being taken 
over. At both of these the post librarian is going further than the 
regulations require to catalog and classify the medical libraries. 
In both, the collections are completely disorganized and the avail- 
ability of information will be improved practically 100^ by the ef- 
forts of the post librarian and her staff. At the other posts no 
steps had been taken in this direction, and in fact the post librar- 
ian complained in most cases about even the .consolidation of accounts 
and the accompanying clerical work, because of reluctance to take on 
additional tasks with a staff already strained to meet post library 
service obligations. 
Even if the post library staff could take on the responsibility 
for organizing the medical library collection and for continuing 
classification and cataloging in the future, in no case would it bo 
possible fcr the post librarian to provide the time of a librarian to 
help make the most of the library through professional servicing. 
This would seen to point toward the desirability cf the Arny Medical 
Service taking over the entire responsibility for library service, 
both general and medical, in its hospitals. In this event the per- 
sonnel allocations for patients' libraries as given in paragraph 7b, 
AR 680-3'0, "Welfare, Recreation, and Morale - Army Library Service," 
dated 15 December l%>0, should be followed. These are: 
Bed Strength 
0-300 
301-1,000 
Above 1,000 beds 
Civilian Personnel 
1 librarian, 1 library assistant 
2 librarians, 2 library assistants 
1 additional librarian and 1 additional 
library assistant for each additional 
300 beds or major fraction thereof 
32 If augmented by volunteer workers to take books to patients on wards, 
personnel in the above numbers would be sufficient to operate both 
the patients' and the medical libraries* Training in medical library 
work of one librarian in each class would be necessary. 
C. Reporting 
The necessity for reporting on the accomplishments, development, 
and future plans of an activity is one of the major tenets of good 
administration. Yet it was found that the medical libraries in only 
half of the class II hospitals make any kind of written report, and 
in the class I hospitals no reports on the medical library were found. 
Of the five hospitals in which written reports are submitted, 
two operate combined general and medical libraries* Their reports 
on the medical library are made as a part of the regular monthly 
Special Services library report. These are mainly statistical but 
include space for remarks to bring out pertinent additional informa- 
tion. There is a good deal of variation in the reports made on the 
other three class II hospital medical libraries. One produces a com- 
plete monthly statistical record for use of the library, cumulated 
annually. At another the report is a very brief narrative that talks 
more about the use of the library for conferences and professional 
meetings than about its actual use as a library. The last submits a 
fairly complete report, including statistics of accessions, with- 
drawals, inter-library loans, use of the library, projects undertaken 
during the year, and personnel, but there is nothing on needs or 
plans for the future. 
Reports, monthly and annual, on the medical library should be 
prepared in all of the hospitals. In the class II hospital the re- 
sponsibility for reporting should bo the librarian's, for the process 
of preparing reports would serve to call her attention to deficien- 
cies and need of the library's service. They would be useful as 
supporting documents in calling attention of the management office 
to the library's personnel situation. Furthermore, when submitted 
to the commander such reports are public relations tools in that 
they give this officer a quick look at the performance of the library. 
Reports on the medical library in the class I hospital probably 
will have to be made by the library officer where there is no librar- 
ian assigned. 
D. Hours of Opening 
In the class II hospitals hours of opening for the medical 
library range all the way from h3 to 92 per week. At the extreme 
high end of this range there are only two libraries and both of these 
are operated in conjunction with the general library, by the same 
staff, and keep the same long hours. In these two cases personnel 
with some experience in medical library work are available for 
hO hours per week. 
33 All but one of the libraries has evening hours. The key to the 
one library that is not open during the evening is available from the 
medicol officer of the day fcr use of materials in the library only. 
All the libraries are open for use until noon or 1 p.m. on Saturdays, 
but Sunday hours are not usual. 
In the class I hospitals the range of hours of opening fcr the 
medical library is from 0 to 49 hours, depending on the availability 
of personnel. In three of them there is no attendant .for the medical 
library and it is kept locked at all times, with the key at the in- 
formation desk where an officer of the professional staff may obtain 
it on signature. In two others the library is open during day duty 
hours, but with no attendant. For these five hospitals it is spoci 
fically mentioned by one or another official interviewed that an 
''honor system" is used and each officer is expected to sign out the 
materials he borrows for use outside the library. This system is 
also used after day duty hours even where there is an attendant. 
E. Physical Conditions 
Several factors enter into any consideration of the physical 
conditions of a library. These include location and accessibility, 
space available to the library, adequacy of equipment and furnishings, 
general attractiveness and comfort, and provision of work space sep- 
arated from the reading room. The following principles arc quoted 
from tentative standards for medical libraries developed by a joint 
committee on the Medical, Special and American Library Associations, 
and will serve as points of reference in discussing ccnditions found 
in the hospitals visited: 
"III. Location and Equipment of the Medical Library. 
A. The Medical Library should be so located as to be 
easily and conveniently accessible to its patrons, preferably 
in that part of the hospital which is most frequented by the 
medical staff. 
B. The reading room should be used for research and 
study, not for conference purposes. 
C. The Medical Library should be attractively and com- 
fortably furnished, with stress on good lighting. 
D. Open shelves and sufficient stack space for expansion 
of the collection should be provided. 
E. An office and workroom for the Medical Librarian 
should be provided. 
1. The Medical Librarian's office is essential for 
administrative work and personal' conferences and 
should contain adequate space for desk, typewriter, 
and for the shelving of special reference tools. 
34 2. The workroom should be sufficiently spacious for 
the processing and repair of books} assemblage of 
material for binding, and contain enclosed shelves, 
a lavatory and electrical outlets." 
The conditions found in the installations visited will be dis- 
cussed in relation to these statements of principles or standards. 
1. Location and accessibility of the medical library. 
In only three of the class II hospitals can it be said that the 
medical library is poorly located and not readily accessible to the 
majority of the nodical staff. V/hile those throe hospitals have per- 
manent buildings, they arc laid out on a plan similar to the temporary 
cantonment type building, with literally miles of enclosed corridors 
to which buildings housing the hospital's facilities arc attached. 
In this hospital plan it would be difficult to say just what is a good 
location for the medical library, for locating it close to one area of 
concentration of medical personnel means that it is usually far from 
some other group. One of these three has the library close to the 
headquarters, at another it is moderately well located in the area 
that includes two conference rooms and the offices of the chiefs of 
the services. The third has the poorest location, on a second floor 
next to the general library and in the patients' recreation area. 
This cannot be criticized, however, for the condition was recognized 
by the administration and plans were in the making at the time of the 
visit to move the medical library to more desirable quarters. 
The remaining seven class II hospitals have a fairly heavy con- 
centration of services in a large central building. Since, with 
exceptions in the larger hospitals where wards and some services must 
operate at quite a distance from the central building, this plan is 
more compact, it is easier to find a good location for the medical 
library. Four of these may be said to have good locations, right in 
the areas of concentration of the professional staff. In the other 
three the location is fair, and probably when all factors are con- 
sidered are as good as could be found. 
Of the eleven class I hospitals visited all but two are of the 
cantonment type. One of these hospitals has a permanent building for 
its headquarters and some wards, with most of the hospital in an ad- 
joining temporary structure. As in the spread-out type of building 
for the class II hospital, there is really no good location in the 
cantonment plan hospital for a medical library. Seven of the eleven 
hospitals, including the one with permnent buildings and the one with 
a permanent headquarters building, have placed the medical library in 
the general'area of the headquarters. Probably somewhere in the head- 
quarters is the most accessible location. This is frequently a good 
long distance from the place where the professional staff may usually 
be found, but at least it is a part of the hospital everyone knows 
and can find. 
35 At several of the class I hospitals the commanding officer or 
his executive officer brought up for discussion the possibility of 
combining the medical library with the patients ' library. This idea 
was apparently engendered in every case by the thought that the re- 
quirements for consolidation of accounts would inevitably be extended 
to the point where the medical library would be operated by Special 
Services, and the hospital's medical library staff problen would be 
solved, b-herever this question of physically combining the two 
libraries was raised, the official usually answered his own question 
by saying that the location of the patients' library was good for its 
purpose but would be very inconvenient for the medical staff to have 
to go for medical literature. On the other hand, placing combined 
libraries in a good location for the medical staff would result in a 
poor one from the patients ' point of view. In the one hospital that 
had placed the' two libraries in a single ward building, a compromise 
was made, and it was the opinion of the administrative staff that the 
location was not good, whether for service to patients or to the pro- 
fessions.! staff. 
.2. Interference of conference, class room or professional meet- 
ing use of the medical library with the library function. 
The reading room should be used for research and study and not 
for various other purposes. Fortunately, it was not found that the 
quarters of the medical library arc used for other than the purpose 
for -which designed at most of the installations visited. But wherever 
the library's quarters are so used, interference with the library 
function is serious. 
Three of the class II hospitals use the library quarters for one 
or more non-library purposes. 
At hospital A the interference is constant because the confer- 
ence room setup is permanent. This library has three rooms, a large 
center one and a very small''bn a on each end. 'In the center room about 
thirty large armchairs are lined up in rows, and together with pro- 
jector, movie screen, X-ray viewers, and large viewing box for trans- 
parent photographs, are kept in this arrangement permanently. With 
all these extraneous items of furniture in the room, there is no 
space remaining for tables to seat readers; in fact it is even diffi- 
cult to obtain access to some of the wall shelving. The small rooms 
at each end of this large one provide very little reader space and 
bound journals are shelved to the ceiling of a lO^xlO' room with only 
one small table for readers. For the month of October 19513 there 
were 23 meetings scheduled for this main room of the library and many 
unscheduled ones were held. With meetings running from thirty minutes 
to two hours, it is obvious that the library was not available for 
many hours of its scheduled opening during the month. Furthermore, 
the permanent conference room setup means that the librarian must 
place her desk in one of the small cm rooms while the entrance to 
36 the library is into the large center room, and she is thus not imme- 
diately available to give assistance to users. 
Except for the fact that the conference room setup is not perma- 
nent and the librarian has her desk in the main room, the library at 
hospital B is in the same condition as the above. In this case no 
shelving is allowed in the large center room and the collection is 
housed in two long and narrow rooms on each side. While the center 
room may be used for reader space when there are no conferences in 
session, there is only one table there. The librarian and her assist- 
ant must move large easy chairs and sofas into place for the meetings 
and also see to it that folding chairs arc set up in the remainder of 
the room. The librarian is required to be present for all profession- 
al meetings and conferences to get such literature as may be needed; 
hence her services are denied for a considerable amount of time to 
those who are not in attendance at the meetings. Library readers may 
not pass through the center room when meetings arc in session and 
since books are housed in one of the side rooms and journals in the 
other, they must go out and around the building from one' side to the 
other if their reading requires the use of both kinds of materials. 
Three services and one board hold weekly meetings in this room, in 
addition to monthly professional conferences. 
At hospital C, conference room use of the library probably inter- 
feres most with the library function because the library cannot be 
properly equipped. The room is lined with large overstuffed chairs 
which are arranged in rows for each meeting. When there is no meet- 
ing in session, these chairs arc arranged around the perimeter of the 
room, but since the center must be kept vacant the library ray not 
have the tables and chairs so necessary to the reader who must con- 
sult a number of sources in the course of research and study. In 
this hospital daily meetings are held in the library consuming two 
hours each, considering the time needed to prepare the room for con- 
ference use and to rearrange it as a library. Tying up the medical 
library daily for conferences has a discouraging effect on those who 
would make use of the collection, for they never know if they will 
find a "conference in session" sign on the door. Much of the librar- 
ian's time is wasted for she must haul her work away to some other 
spot, as the library is usually darkened during conferences, or just 
sit and do nothing while a conference is in session. Much of her 
workroom space is lost for library purposes because a large X-ray 
viewing box and the other paraphernalia used for conferences must bo 
stored there. 
In all throe of those hospitals there are conference rooms that 
could bo used for these purposes instead of the library. True, they 
arc not furnished with comfortable easy chairs, or the location is 
not quite as convenient, but other space is available and should be 
used, rather then interfering with the library. 
37 One of the class II hospitals has practically ideal arrangements 
for conferences, with the medical library and conference rooms lo- 
cated in the same area but completely separate. There is one large 
room for professional meetings requiring attendance of a majority of 
the staff and smaller conference rooms for meetings of smaller 
groups and boards. 
Of the eleven class I hospitals visited only three used the 
library's quarters, or parts of them, for conferences, aside from 
meetings of journal clubs. At only one of the three hospitals do the 
meetings seriously interfere with library use. In this particular 
case the medical library has one room for journals and books arc 
housed in a portion of a second, vdth the remainder permanently ar- 
ranged for meetings. Meetings held in the second room interfere with 
use of the book collection, but more serious is the fact that entry 
is only through the journal room where clinics are hold by the staffs 
of various services, thus denying access to the entire library for 
throe to four mornings a week. 
3. The medical library should be attractively and comfortably 
furnished vdth stress on good lighting. (Further, it should have the 
necessary special items of library furniture and equipment for its 
operation.) 
Attractiveness and comfort are conducive to use of the library 
and within the bounds of financial limitations every effort should be 
made to make the library as attractive as possible. Good lighting, 
both artificial and natural, is essential aid the adequacy of the 
latter type should bo considered in assigning a location for the 
library. Comfort, of course, can be carried too far, and it has al- 
ready been indicated above that while there should be some easy chairs 
available for casual reading, these and overstuffed sofas should not 
be present to the exclusion of furniture that is more practical for 
the research worker or student. 
Generally speaking, it may be said that the medical libraries in 
the Amy's class II hospitals are attractive, with eight of the ten 
being so classified., Of the two that do not fit into this group, one 
is dull and drab because it is furnished only with easy chairs of 
dark brown color. It doos not have good natural lighting, and al- 
though equipped with the fixtures to give good artificial light, it 
is included in a strict electricity conservation campaign with the 
result that the medical library is always dark and uninviting. The 
other is adequately lighted, but tables and chairs arc crowded into 
the two long and narrow rooms that house the collections of books and 
journals. The atmosphere is far fron inviting,and the person seated 
at a table is inconvenienced by having to move every time another 
wishes to pass. 
Of the eight that arc good some are exceptionally well furnished. 
One has commercial library furniture and shelving, colorful upholstery 
38 and carpeting, and specially designed draperies. At another there 
must be an especially good carpenter shop on the post for its tables 
and shelving, although locally built, would do credit to any cabinet- 
maker. A third, while attractive enough in general, has not been so 
fortunate in the local construction of its shelving, which was ap- 
parently designed by someone totally without library experience; 
uniform distance between shelves was used, a distance that turns out 
to be inadequate for medical books and many of them have to be turned 
on their sides. 
It is almost impossible to make ary generalized Statements cover- 
ing the degree of attractiveness of the medical libraries in the eleven 
class I hospitals visited. In general, they arc much less attractive 
than those in the class II hospitals, poorly furnished and equipped. 
Of the elevon, three may be said to be well furnished, attractive 
and comfortable; two could be classed as fair, and the remaining six 
range from poor to terrible. All of these in the last category are of 
the type that has no library attendant of ary kind. The rooms are 
kept locked, and no one takes an interest in the condition of the 
medical library or apparently cares if it is used or not. In two of 
them it was apparent that the library was little more than a store- 
room for books, and no real library will ever develop under those 
conditions. In two others it was recognized that the medical library 
was uninviting and there was expressed intention to remove it to 
other quarters with better furnishings. 
All of the class I hospital medical libraries will be better off 
for having library furniture and equipment placed on tables of allow- 
ances. Steps in this direction have already been taken at the Sur- 
geon General's Office. Standardization for this purpose is a long 
term project, however, and these libraries are suffering in the mean- 
time. Quartermaster items, such as a typewriter for the medical li- 
brary, tables and chairs that are already standard items of issue, 
have been authorized within the last few months for these libraries. 
Unfortunately, little heed was paid to the advice solicited by the 
SGO office responsible for this work from the staff of the Army Medi- 
cal Library in deciding what items of furniture should be standard- 
ized for the medical library. The final list has such things as easy 
chairs and sofas and a student chair with arm for writing authorized 
on the basis of one per professional officer assigned. It is appar- 
ent from such items as these that the misconception of the medical 
library as a conference room, an idea that has been deplored else- 
where, is being fostered. 
U. 'Space for the medical library. 
Both items D and E of the statement of standards or principles 
are concerned with space for the library and will be discussed as a 
unit under this heading. 
39 Unfortunately, no standards of space have been developed in 
specific relation to medical libraries, whether in hospitals or other 
locations. In their book on the American Public Library Building, 
Wheeler and.Githens have established that one square foot is required 
for each ten volumes, and thirty square feet per seating space re- 
quired, a figure that includes an allowance for files, desks, etc. 
The standard of one square foot per ten volumes is based on general 
library experience, and it is found that at the -H-rmy Medical Library 
six volumes per square foot for medical books and journals is closer 
to actuality. Assuming a library of 3>000 volumes and allowing one- 
third of that amount for future growth, a floor area of 666 square 
feet is needed. 
It would be equally easy to determine the amount of space needed 
for seating if there were some standard devised to say hov/ many seats 
should bo provided per hundred staff members, or by some other cri- 
teria. The visits to libraries have not helped in this respect. 
Some of the class II hospitals which seemed at first glance to have 
ample seating space were later observed to be filled to overflowing. 
Others that appeared to provide too few seats wore used so little 
that the space was more than adequate. This factor will have to bo 
determined locally on the basis of the maximum seating capacity re- 
quired at any given time, pending the development of standards based 
on more detailed study. In the meantime it can safely be said that 
no class II hospital should provide seating facilities for less than 
twenty and no class I hospital for less than eight. Twenty seats for 
the above hypothetical library brings the total floor area required 
up to 1,266 square feet. 
Noticeably lacking in the class II hospitals, and not so urgent- 
ly needed in the class I hospitals until and unless library personnel 
are authorized, were two areas that are essential, an office for the 
librarian and a workroom. Not one of the libraries in the class II 
hospitals visited had an office for the librarian. Two of them have 
fairly large-sized workrooms in which the librarian also has a desk. 
And only one other has a workroom that is separated from the reading 
room. The librarian's office may simply be a partitioned part of the 
workroom, but some place where she can conduct administrative work 
and personal interviews is essential. The lack of a workroom was 
found to be a considerable handicap in the remaining class II hospi- 
tals. The most serious complaints about this omission came from the 
users of the libraries where this situation exists, because concentra- 
tion is required to assimilate medical literature and the noise of 
typing and other tasks is disturbing. The worst handicap to the 
librarian is that she cannot leave her work out. New books being 
processed for addition to the collection must be carefully put away 
in locked cabinets or other secure places; otherwise they arc borrowed 
before the records arc completed. For a combined workroon and office 
for the librarian, a total of 3^0 square feet must be added to the 
area for the library. 
40 RECOMMENDATIONS 
(Chapter II) 
1. Finances. It is recommended that the formulas for class II 
and class I hospitals bo tested for the Fiscal Year 195U budgets for 
these organizations} since estimates have already been submitted for 
19^3• It is further recommended that the formulas be used to test 
the individual budgets for Fiscal Year 19^3 to determine if there are 
gross inequalities remaining and that such steps as may be taken to 
eliminate them be authorized. The formulas should be adjusted to in- 
clude changes in the prices of medical books and journals, and to take 
into account any other factors that have not been recognized by the 
investigator. 
2. Personnel. 
a. Library personnel in the class II hospital medical 
library. 
1) The nine chief medical librarians who have had no 
formal training in medical bibliography and librarianship should at- 
tend a university summer course at Army expense. Through this train- 
ing five of the librarians will become fully qualified medical librar- 
ians and the services of the remaining four will be greatly improved. 
2) The medical librarians of the two medical center 
hospitals have been included in the above group because a knowledge 
of the problems of medical library work is necessary to the adminis- 
trative librarian. However, a qualified medical librarian at GS-7 
grade should be authorized for each of these installations. 
3) Examination should be made of the duties and 
responsibilities of the chief medical librarians to determine the 
proper Civil Service grades. In doing this, consideration should be 
given to the standards of the Veterans Administration, which call for 
GS-7 to GS-9 for medical librarians and GS-9 to GS-11 for administra- 
tive librarians. In the light of this examination, definite state- 
ments cf the qualifications required for these grades should be pre- 
pared, and they should be followed in employing librarians at any 
class II hospitals activated or reactivated in the future, and in 
replacing the presently unqualified librarians as their positions 
become vacant. 
U) It is expected that the medical librarian by her 
services^wi11 conserve the tine of the medical professional staff. 
In like manner the time of the librarian should not be used up by the 
performance of a majority of the clerical tasks of the library. The 
two medical libraries that do not already have a clerical assistant 
should be authorized a civilian clerk, GS-3 to GS-U- In the four 
where military personnel are employed in this capacity, they should 
be removed from work in the medical library and replaced with civil- 
ian personnel. 
41 £) In part the recommended increases in the GS 
grades of the medical librarians will recognize that they are mem- 
bers of a profession of their own. This recognition should go fur- 
ther to give the librarian the responsibility and authority for the 
professional library aspects of her work. This is especially to be 
desired where the librarian is qualified in her profession,. 
6) Professional development of the librarian increases 
her knowledge of her chosen field and results in improvement of her 
services to the professional medical staff. It should be encouraged 
by the following means: 
a) Receipt of essential professional libraiy 
literature, both that relating specifically to medical libraiy work 
and also to general library administration in the medical libraiy. 
b) Authorization of expenses to the annual 
meeting of the Medical Library Association and occasional attendance 
at the more general meetings. 
c) Authorization of expenses for a visit to the 
Army Medical Libraiy to learn more of the collection and services of 
this national medical libraiy, and of expenses for attendance at such 
institutes or training classes as may be scheduled in the future by 
this institution for the benefit of Army Medical Service librarians' 
in field installations. 
b. It is recommended that the Army Medical Service author- 
ize professional libraiy personnel and assistants for the total li- 
brary program of class I hospitals on the basis of allocations given 
in AR 680-^0 (quoted above), with due consideration of the propor- 
tionate amounts of professional time required for medical library 
work in the various types of hospitals. 
Provision should be $Hdo for the authorization of funds for 
attendance of the librarians assigned to medical library duties at 
such institutes or training classes as may be scheduled in the 
future by the Army Medical Library for the benefit of libraiy serv- 
ice in field installations of the Army Medical Service. 
3. Reporting. It is recommended that a monthly reporting form 
for use by all Medical Service libraries in the field be pre- 
pared and its use required. Such a report form should include sta- 
tistics on the following: book stock, acquisitions, withdrawals, 
circulation, indefinite loan accounts, reference questions, inter- 
library loans, and photostats and microfilms obtained. In addition 
there should bo a remarks section for comments on the statistics 
reported and for comments on library procedures, needs, and plans. 
U. Hours of Opening. Recommendations on hours of opening for 
the medical libraiy depend on the personnel available and the sched- 
ules of hospital operations. The following generalized recommenda- 
tions may, hewever, be made: 
42 a. The medical library of the class II hospitals should 
be open for an absolute minimum of Uh hours per week, and more as 
the education and training program requires. At least six hours of 
this should be evening time,with the chief medical librarian on duty. 
b. In the class I hospital the medical library should be 
open under supervision of some sort during day duty hours. 
Physical Conditions. 
a. Since each hospital is different in plan and arrange- 
ment, no specific site for the medical library can be recommended. 
In deciding on a location or reconsidering the present one, the ob- 
jective should be to make the medical library as easily accessible 
as possible to the greatest number of professional staff. If this 
turns out to be the administrative area, the library should not be 
so placed as to give the idea that its users are under surveillance. 
b. It is recommended that the reading room should be 
available at all times for research and study, and that conferences 
or other meetings be held in roons designed for that purpose. 
c. It is recommended that the medical library be comfort- 
ably and attractively furnished; that it provide seating and working 
space for research and study as well as more comfortable furniture 
for casual reading; and that it be equipped with such special items 
of library equipment as catalog cases, journal display racks, file 
cases and book trucks. 
d. It is recommended that adequate space in terms of the 
number of volumes to be housed and readers to be seated be assigned 
to the medical library. The space may be divided, with a storage 
area in a less critical area for such volumes as are not used often. 
e. An office for the librarian and a workroom should be 
provided in all class II hospital medical libraries, and similarly 
in class I hospitals when library personnel are authorized. 
43 CHAPTER III 
THE COLLECTION OF THE MEDICAL LIBRARY 
Because of the lack of a brief, adequate and up-to-date check 
list, no effort has been made to .check a list of specific titles at 
each of the medical libraries visited. Two of the larger libraries 
were rather thoroughly checked by Arny Medical Library experts in 
medical literature who accompanied the writer. The collection of the 
Remainder have been checked in a general way by observation of the 
boohs on the shelves, looking especially for late editions of stmfi- 
ard. texts, presence of obsolete titles, duplications, and indexes 
to journals. Consideration was also given to the size of the collec- 
tion and the number of journal titles received in relation to the 
sfze of the professional staff, research, training program, and 
mission of the hospital. 
Unfortunately, adequate standards of size of the collection for 
a hospital medical library in relation to the professional staff and 
the training-program have not been developed for A^ny or .civilian 
hospitals, Probably such standards would have fittle meaning in any 
case for the size of the collection comes as a result of fulfilling 
the needs, present and anticipated, of the professional staff, ft is 
more important to place some sort of limitation on the size of the 
collection, to insure that it remains a working collection and is 
not holding onto everything it receives simply to become a large 
warehouse of medical literature. There is no point' to entering into 
competition with the large.university medical librariesj rather their 
resources and those of other medical libraries should be used by the 
Army's medical libraries to supplement their collections with the 
more unusual items that are needed only occasionally. But it is 
also important that the generosity of these institutions be ppt 
imposed on to the extent that the Army's libraries call on them for 
items that are needed frequently- As working libraries, those in 
Army hospitals should have th^ essential texts and reference works, 
and the policies should be established on the extent of files of 
specific journals titles to be obtained and retained for definite 
periods of time. 
A. Quantity and Qualify of the Collection. 
It is practically impossible to discuss the collections of the 
class I and class If hospitals at the same time. Because of their 
greater degree of permanence, the class II hospitals have built 
larger and better' collections. They have been supervised by a 
librarian or someone acting in that capacity, and more direction 
has been given to the growth of their collections.. The training 
program and objectives of these hospitals have made larger and better 
COlleQtiona a necessity. 
44 BOOK AND JOURNAL COLLECTIONS OF 
MEDICAL LIBRARIES IN CLASS II HOSPITALS 
: BOOKS 
Bound 
Journals 
Total 
Volumes 
Number of 
Current 
Journals 
HOSPITAL . JT , 
* Number 
Number on in- 
definite loan 
Total 
Books 
:in Library 
Brooke ; 4,000 
2,500 
6,500 
2,000 
8,500 
192 
Arny and Navy, 1,700 
800 
2,500 
1,700 
4,200 
135 
Madigan . 2,700 
8oo 
3,500 
700 
4,200 
110 
Fitzsimons . 2,100 
1,200 
3,300 
2,897 
6,197 
157 
Beaumont . NA 
NA 
2,500 
1,1*50 
3,950 
102 
Percy Jones . NA 
1,050 
NA 
NA 
4,000 
129 
Letterman : 2,167 
928 
3,095 
it,085 
7,180 
200 
Murphy : 300 
150 
U50 
700 
1,150 
83 
■Valley Forge : 1,180 
814 
l,991t 
2,100 
b,09U 
165 
Walter Reed : 3,100 
1,400 
l»,5oo 
500 
5,000 
150 
In the class II hospitals there seems to be some relation between 
the size of the professional staff and the collection. The range, at 
the time the visits were made, was from l,l>0 volumes at the smallest 
class II hospital to over ^,000 at the four largest. These larger 
hospitals also have the most extensive training programs. The hospi- 
tal with the largest collection, over 8,^00 volumes, is also one of 
the farthest from other good medical library facilities, civilian 
or Army. 
But as has been indicated previously, mere number of volumes is 
not a good measure of the excellence of a library. For one thing, 
the texts and monographs included in the collection should be of 
recent date to provide the latest information. Only £0^ of the class 
II hospitals can be said to show up well on this score. In testing 
them numerous volumes from the shelves were examined at random at 
each of the libraries to see if a large proportion of them were pub- 
lished within the last ton years. Observation was also made to see 
if the latest editions of standard texts were present in the collec- 
tion. Of the ffve that do not fall within this class of being up 
to date, three had their collections disrupted when the hospitals 
were closed. The provision of more generous funds in the future 
will result in more up-to-date collections. 
Total number of volumes does not indicate the amount of medical 
literature available in ary one medical library because it does not 
take duplicate copies into account. Nowhere was it found possible 
to get a count of titles to give more idea of the extent of coverage. 
45 Six of the ten libraries showed heavy duplication both within the 
libraries themselves and copies out on indefinite loan. In the 
three hospitals that had been reopened recently this duplication 
was accounted for in part by the fact that they had been sent books, 
many of them in multiple copies. Two of the libraries had received 
by the same methods large quantities of handicraft books} presumably 
for use in occupational therapy programs, which have no place in the 
medical library and yet are reflected in the total nunber of volumes 
held by these libraries* 
The practice of allowing books out on indefinite loan has a 
serious effect on the collection of the medical library. Only two 
of the ten class II hospitals have any policy to keep indefinite 
loans at a minimum. In one of these, although the policy is formally 
recorded in hospital order, it is not enforced. It is difficult to 
settle the argument between doctors and librarians on this question 
of indefinite loans, although if the majority is to be benefited the 
answer should be obvious. Individual doctors, particularly the higher 
ranking chiefs of services, feel that they must have books in their 
specific fields at their places of work. But from the library point 
of view those that are so lent are completely lost to the library, 
and there is a serious question as- to how much use is made of such 
books. The percentage of the collection out on indefinite loan 
ranged from 2£ to 33% of the total collection, usually at the higher 
end of this bracket rather than the lower. For all practical pur- 
poses, a fourth or more of the books are not available to the entire 
staff, and the sad part of it is that ordinarily the books wanted on 
indefinite loan are the latest ones. At one of the hospitals, where 
the librarian could get no help from the library committee on curtail- 
ing the amount of indefinite loans, lists of new acquisitions were 
discontinued because they merely amounted to invitations to the pro 
fessional staff to call for the latest items on indefinite loan. 
The demand of professional men that books be assigned to them on 
permanent loan demonstrates lack of confidence in the medical library. 
It represents an attempt on their part to overcome library deficien- 
cies individually by making sure the materials they are likely to 
consult will be on hand when needed. This attitude is not at all 
surprising for personnel working in the class I hospitals v/here organ- 
izing and servicing medical literature has been neglected. By build- 
ing a vigorous program of medical library service in both types of 
hospitals, the demands for permanent loans will be decreased. 
In every case the collections are general, in that they include 
literature in all the fields of medicine represented by the profes- 
sional corps of the Army Medical Service. It equally may be said 
that wherever there is any specialty of the hospital, such as sur- 
gery or cancer, that specialty is reflected by completeness and ex- 
tensiveness of that subject in the collection of the library. Only in 
one instance was this found not to be true. Here the chief of the 
46 predominant service, while well versed in his field, could not recog- 
nize the need for literature for his subordinates. Nurses and interns 
at this hospital complained to the librarian about the lack of such 
literature, but it vias not within her power to do anything about it. 
VJhile the above general assessment of the collections in the med- 
ical libraries of class II hospitals is not particularly encouraging, 
the conditions of the collections in the class I hospital medical 
libraries is extremely discouraging, so much so that little can be 
said about them. In the first place, these collections are small, 
ranging from 270 volumes to 2,000 in the eleven hospitals visited. 
In every case it was found that a high proportion of the books, 
usually the-newest ones, were out on indefinite loan. This propor- 
tion ranged up to ^0% in the case of the library with only 270 vol- 
umes total. Even more discouraging is the fact that without exception 
these libraries included in their holdings multiple copies of old 
editions of standard v/orks, often without the latest edition present. 
It may conservatively be said that one-third to one-half of every 
one of these collections could be disposed of and better and more 
efficient libraries would result. 
B. Journals. 
It goes without saying that journals arc more important to the 
professional man than are books. It is in the periodical literature 
that he first learns of new developments which are later incorporated 
in standard texts and expanded in monographs. Consequently, special 
attention has been given in the visits to receipt of current jour- 
nals, extent of journal files, and policies, if any, in respect to 
the retention of journal volumes in the library. 
A tabulation of the collections of the class II hospitals reveals 
that there is at least a rough correlation between the number of cur- 
rent journals received, the size of the staff, and the extent of the 
professional training program. The hospital with the smallest staff 
subscribes to the fewest journals, but it should be mentioned here 
that this hospital is below the standard proposed in the section on 
finances, since it has less than 100 journal titles. The worthiness 
of this standard is upheld by the fact that the next smallest hospi- 
tal, with only four more staff members, has well over 100 current 
journal titles. The largest hospital in terms of staff docs not fall 
in line with the other class II hospitals in the number of current 
journal titles, but this is accounted for by the presence of other 
medical libraries with journal holdings on the same post and by the 
excellence and closeness of other medical library facilities. 
Seven of the eleven class I hospitals visited fall below the 60 
journal titles considered as essential for any hospital regardless of 
size, as proposed in the section on finances. One has just a little 
more than half this basic number, with 3h titles, the others having 
37, 38, h0(2), ^0, and respectively. All of these hospitals need 
47 to give reconsideration to the proportionate amounts of their funds 
-they are spending for books and journals. 
Surprisingly enough, a policy of routing journals to the profes- 
sional staff members was found in only two of the hospitals visited. 
One of these was one of the larger class II hospitals where almost 
the full time of one clerical worker is consumed in routing journals 
and keeping track-of journals so routed. The other was a class I 
hospital where the smaller number of journals and staff meant less 
of a clerical problem. The practice is to be deplored on the basis 
of personnel time consumed and, even more important, because the new- 
est journals are never available in the library until they are a 
month or more old. 
Accumulating files of bound journals to fulfill the daily needs 
of the professional staff in research and training programs is one of 
the major jobs of the medical librarian in the class II hospital. In 
several of the hospitals completing files of essential titles has been 
extremely difficult. Itoy gaps resulted under the automatic distri- 
bution system when a title might be an item of issue for several years, 
dropped for a year or so, and then resumed. Sometimes careful thought 
has not been given to what should be removed as excessive to the needs 
of the hospital, with the result that files are disposed of only to 
be purchased again a few years later when need for a file of that 
particular title was again felt. At one hospital a high rate of staff 
turnover had had a drastic influence on the journal files because the 
library committee operated under the policy of supplying whatever 
journals were requested by the staff. Iv&ny of the ''pet" journals 
were found later not to be of general application and were discon- 
tinued as the interested individual was-transferred elsewhere. At 
the same time this committee did not give-really careful considera- 
tion to titles of more general use; consequently, there are now many 
gaps in the files. Whatever the cause for gaps in the files of 
essential journals, it is an indisputable fact that the obtaining 
of journals after their publication is a time consuming and costly 
business. Great care should be taken by the library committee in 
its annual examination of the journal subscription lists to make 
sure it is not putting the librarian in the position of having to 
scurry around searching the country for. missing volumes at some future 
date. These injunctions also apply, to a lesser extent of course 
because they need not have such, extensive files, to the class I 
hospitals. 
It was found that only two of the class II hospitals have any 
established policy as concerns binding and retention of the journals 
received. One of these binds only those that are indexed in the 
Quarterly Cumulative Index Medicus; at the other the library commit- 
tee has considered the problem and decided on what titles shall be 
bound. In the remaining eight all journals to which the medical 
libraries subscribe are bound. This is not the result of an active 
policy but of the acquisitive instinct. With space limitations for 
48 medical libraries in class II hospitals being what they are, careful 
consideration should be given by the library committee in these hos- 
pitals as to whether or not it is necessary to bind and keep every- 
thing received. The librarian at one of the class II hospitals has 
estimated that if all titles received are bound, an additional 25 
feet of shelving space will be needed each year. The question of 
what to bind and what not to bind can only be decided by the local 
library committee in consultation with the librarian. 
Only three of the eleven class I hospitals visited have any pol- 
icy concerning the journal titles to be bound. One binds five titles 
of 94 received, one binds 16 of 55 and the third binds 20 of 75* 
One other may be said to have a policy if the decision to bind all 
journals as completed can be considered a policy. Except for one of 
these libraries that has the policy of keeping issues of journals 
it does not bind for only two years, they all have great quantities 
of unbound journals. In some crises these unbound files extend back 
as far as 1941 and take up whole walls of shelving. One of the 
libraries is even saving a few volumes of journals that have long 
since been discontinued or are no longer on the subscription list of 
the library. Obviously, these great quantities ,of unbound journals 
create a housekeeping and space problem. They are so seldon used 
that they are not worth the space they occupy, especially when 
thought is given to the difficulty of locating a specific issue in 
these great masses of journal issues. 
Eight of the ten class II hospitals have set goals of comple- 
tion for their journal files. However, it is very difficult to 
generalize on this subject for there are almost as many goals of 
completion as hospitals. But they may be grouped as follows: 
10-14 years, six hospitals; 5 years, one hospital; and 3 years, 
one hospital. It is disturbing that three in the first group have 
set their goals by year, 1938, 1939, and 1940, rather than by some 
period such as ten years. The implication is that they intend to 
continue adding to the files from, these dates onward, ad infinitum. 
Space again enters into the question, and there is the necessity 
for thinking of these libraries as the working rather than the 
storage type. Ten-year files, with certain carefully considered 
exceptions in the form of basic journals and those in the field of 
a hospital's specializations, would certainly fulfill the needs in 
almost all cases. On those rare occasions when something older is 
needed, the extensive holdings of nearby university medical school 
libraries or of the Army Medical Library are available. Since the 
hospital with the five-year goal of completion is one of the smaller 
ones, and since it is also located close to good libraries in one 
of the country's heaviest concentrations of medical library facili- 
ties, this goal is probably adequate to its needs. On the other 
hand, the hospital with the three-year goal is one of the larger 
ones with a big professional training program and much research, 
and is far from any large medical library. In this case a larger 
goal of completion is desirable. 
49 The medical library of the class I hospital need not set goals 
of completion, but rather goals of disposition. Here more than ever 
it is essential that the files of journals be restricted, because 
there is not the personnel to see that they are properly cared for 
and organized for use. As a general rule, five years will be suffi- 
cient for those journals that are essential to the hospital, and 
those of an earlier date can be borrowed from other libraries when 
needed. 
C. Indexes to journals and abstracts. 
Indexes to journals are indispensable to any medical library 
because of the importance of journal literature to the medical pro- 
fession. where there must be limitations on the journal collections, 
as in the libraries of the Army Medical Service, the importance of 
essential indexes is increased rather than decreased; with a knowl- 
edge of where to go for the specific items found through them, all 
medical literature needs can be supplied. 
The number and types of indexes required depend on the type of 
hospital and the training and research programs. For the most part 
only the minimum is required by the class I hospital libraries. The 
basic index is the Current List of Medical Literature, published by 
the Arny Medical Library and distributed tree of charge to all Army 
Medical Service installations. At four of the eleven class I hospi- 
tals visited this index vias not found in the medical library or 
located anywhere else in the hospital. Subsequent check of records 
at the Army Medical Library showed that these hospitals had been 
receiving the index. Without any true explanation of why these could 
not be found, the Army Medical Library shipped complete sets (July 
19^0 to date) to all installations where the Current List was not 
found. Since it is suspected that the issues were retained by the 
individual to whom addressed, it should be the job of the library 
officer to see that this publication is placed and retained in the 
medical library. 
Six of the eleven class I hospital libraries were found to have 
some issues of the Quarterly Cumulative Index Medicus, usually the 
last few years. This index is essential to these hospitals because 
the Current List1s present usable format dates only from July 19^0. 
The QCIM antedates this period and is useful as a journal literature 
index to cover, at a minimum, the last five years. 
One of the class I hospital libraries is purchasing two sections 
of Excerpta Mediea. This is a specialized treatment facility and the 
two sections fall within its field of specialization. 
Generally speaking, the index and abstract holdings of the 
class II hospital medical library must be more extensive for obvious 
reasons. The three basic items considered essential for these li- 
braries were found in all of them. These are the Quarterly Cumula- 
tive Index Medicus, the Current List of Medical Literature, and at 
50 least the fourth series (although some have all) of the Index- 
Catalogue. . For these hospitals the holdings of QCIM should, and were 
found to, cover at least ten years, with some of them having con- 
siderably more. 
Lhile the holdings of the class II hospital medical libraries 
are good in these basic indexes, the same cannot be said about special- 
ized ones that cover fields of particular local interest. At the hos- 
pital where surgery is a subject of major interest, the library has 
only spotty holdings of the International Abstracts of Surgery, and 
the Tuberculosis Index is not to be found in a hospital that special- 
izes in that field. Only one of the hospitals at which considerable 
research is conducted was found to have holdings of Biological 
Abstracts and Chemical Abstracts. Another with an enormous research 
and training program had a few volumes of these but had had to drop 
them because of lack of funds. 
Four of the ten class II hospital libraries were found not to 
have any of the sections of Excerpta Mediea. The other six have from 
four to eleven sections covering their fields of specialization and 
general interest. This would seem to be a fairly important tool for 
the class II hospitals. The cost is high, but there is a lack of 
foreign journals in all these hospitals, and with the inability or 
reluctance of the professional staff to read foreign languages, this 
journal supplies an excellent means for keeping abreast of world- 
wide developments in specific fields. 
D. Book selection, including journals. 
kith the advent of the system for purchasing professional medi- 
cal books and journals locally in place of the automatic distribution 
system, the Surgeon General, in Code Letter IX-506, also set the re- 
sponsibility for book selection. The Surgeon General's Board for 
Review of Medical Books and Journals was established and the recom- 
mendation was made that similar boards be appointed at the local 
level. Included was the recommendation that the local board include 
the chiefs of the major services, the library officer, and a repre- 
sentative of the supply service. 
The theories behind this recommendation of board composition are 
several. One is that by having the chiefs of all services, none of 
the fields of medicine will be neglected. Another is that only pro- 
fessional personnel have the requisite knowledge of medical litera- 
ture for making selections. And a third is that because of their 
experience and training the chiefs of services have better knowledge 
than anyorib else of their particular fields and therefore have the 
best knowledge of what is needed in the way of literature. 
VJhile these are excellent as theories, there are several falla- 
cies to be found in the actual operation of such a board as a selec- 
tion agency. In the first place the chiefs of services are among the 
51 busiest men in any hospital and it is difficult to get them together 
to consider purchases for the medical library. In the class II hos- 
pitals where there are from ten to fourteen or so chiefs of services, 
the board is very unwieldy and it is impossible to get them all to 
meet at one time. It has already been shown that the tendency is for 
the board or committee in such cases to degenerate to a one-man opera- 
tion, thus defeating the intent of the recommendation. It has been 
found in some instances that the chief of a service is not interested 
in the literature of his field and unable to see that it should be 
provided for his subordinate workers. At the opposite extreme, it 
has been found in other instances that the members of such a board 
are so. interested in their own particular fields that they neglect 
items- of overall interest to the work of the hospital. 
Practically all the hospitals have a board of this type. Its 
present composition and general functions have been discussed above 
in the broader sense of a governing committee for the library, and 
recommendations have been made for a change in its. composition. Only 
its role in selecting books and journals for the library will enter 
into the discussion at this point. 
Unless and until the class I hospital libraries are provided 
with professional library personnel, the entire job of book selec- 
tion must be borne by the library committee under the supervision 
of the commander. 
In the class II hospital the library committee has, or should 
have, an expert in library work and medical literature at hand, 
hhere the library committee actually holds meetings for the purpose 
of book selection, the .librarian does the ground work of collecting 
recommendations for purchase from various members of the staff, add- 
ing bibliographical data and information from reviews when obtainable. 
Whore the committee does not meet, she must secure lists from individ- 
•_uals, including the chiefs of services, and then present these to 
the'designated authority for approval. 
As a general rule, the librarian has no voice in the meetings. 
She is consulted simply for information as to whether the library has 
or does not have the book under discussion. Where the committee does 
not meet, she has some control over selection in a negative manner, 
through eliminating from her lists the titles she does not think are 
needed. The librarian at one of the class II hospitals has the power 
.to buy or not buy books recommended by the chiefs of services, depend- 
ing on the overall needs of the .library. She may also decide on the 
number of copies to bo bought in case several are requested. It is 
hardly coincidental that this library has one of the best rounded 
collections of any of the hospitals visited and has the best pros- 
pects for becoming a good medical library adapted to the needs of 
the installation. 
52 The library committees of eight of the class II hospitals have 
adopted a purchasing policy that has major significance in making the 
most of the funds available. This policy concerns the purchasing of 
duplicate copies, and although stated in various forms the gist of 
all is that duplicates will be purchased only when there is a demon- 
strated need for them, aid even then in the minimum quantity. The 
objective of this policy, that of obtaining the widest possible cover- 
age of medical literature from the funds available, is entirely 
admirable • 
It is regrettable that there are no book selection aids designed 
specifically to call attention to all publications in medicine and 
allied fields. Medical journals that review books are of some help 
for this purpose, particularly in the class II hospital where the 
librarian makes it her business to know these journals and to examine 
them regularly. In recognition of this deficiency of the medical 
literature field, the Surgeon General has undertaken to publish lists 
of approved books and journals under the sponsorship of his Board for 
Review. These lists are issued twice annually, July and January, and 
according to librarians and library officers have proved very helpful. 
They are of particular value in calling attention to new editions of 
standard works. The main difficulty with these lists is that fre- 
quently they do not reach the persons for whom they are intended, 
the librarian and the library committee. Distribution is nade through 
the supply depots to the supply services of the hospitals. It was 
discovered on the visits that in four of the class II hospitals and 
seven of the class I, those lists had not come to the attention of the 
librarian or library committee but had been retained in supply. In 
one or two instances the lists could be borrowed from supply, but 
had to be returned. The reason given for retention of these lists 
in supply was that they had to be there to chock prices on them 
against those on the purchase requests from the library. Obviously, 
lists issued two times a year cannot be accurate for vary long, as 
far as prices go, and furthermore Code Letter IX-506 gays that these 
lists will include approximate prices. It should be apparent without 
argument that the purpose of these lists is defeated if they do not 
come to the attention of the persons responsible for selecting books 
and journals for the medical library. 
E. Procurement of medical professional books and journals. 
Since the establishment of allotments for books and journals for 
each hospital} their procurement has become a local matter as non- 
standard. The established procedure is for the items selected by the 
library committee to be listed on purchase requests and forwarded to 
the Purchasing and Contracting Clerk of the Supply Division in a 
class II hospital, or through supply to the central purchasing and 
contracting office of the post for the class I. Procurement of books 
and journals is taken over at this point by these agencies. It was 
found during the visits that the purchasing officials more often than 
not do not have any understanding of the problems involved in pur- 
chasing these items. 
53 To make the local job of purchasing easier and to secure the 
most books for the money, the Armed Services Medical Procurement 
Agency annually awards a contract'- for medical books to the lowest 
bidding dealer. The contract is' awarded not on a blanket discount 
rate for the supplying of all medical bookss but on the basis of a 
listing of the more important medical publishers with individual dis- 
count rates on the publications of each of them. For the Fiscal Year 
19^2 there are 2u publishers listed on the contract. It is mandatory 
that all medical installations procuring medical books buy from the 
contractor all those issued by the publishers listed on this con- 
tract, except those items that may be obtained under the Federal 
Supply Schedules. 
•Whan a-book is not obtainable from cither of these sources, the 
local purchasing agent may procure it from the publisher, another 
dealer, or a local bookstore. To adhere strictly to the general reg- 
ulations governing purchasing, however, and most of the purchasing 
agents do so, he is required to get two price quotations before pur- 
chasing a book or any other item that is not obtainable under a con- 
tract. It has been found in the course of the visits that the usual 
source for the purchase of these items is the publishers, with occa- 
sionally a local- bookstore supplying them, and in two instances a 
dealer. No matter who the final supplier may be, correspondence is 
involved, resulting in delays and the expenditure of much more money 
in the form of personnel time than is saved by getting quotations. 
During the course of the visits it has been found that the book 
procurement process is a slow one. This is partially due to internal 
workings of the supply organization of each hospital and in part to 
the dealers that have been selected so far by the' Armed Services Med- 
ical Procurement Agency. According to reports of librarians and 
library officers, anywhere from six weeks at a minimum to three months 
and longer is consune d between, the time of forwarding a purchase re- 
quest to a purchasing section -and receipt of the books in the medical 
libraiy. Much of the local share of this lapsed time is consumed in 
the details of writing purchase orders, checking prices to make cer- 
tain that those put on the purchase order are current and exact so 
that there will be no difficulties in payment by the disbursing office. 
Many of the purchasing agents are so cautious in this matter that 
they even write to the contractor for quotation of exact prices be- 
fore writing purchase orders; this despite.the fact that the supply 
bulletins and memoranda state that the contractor is hot to be con- 
tacted unnecessarily for price verification and that he will bill at 
the correct price whether higher or lower than the one shown on the 
order. ' TJhen ordering from the contractor, one of 'the hospitals avoids 
the delay involved in correspondence on prices by using DD Contract 
Form 19, War Department Delivery' Order. On this instrument changes 
in price can be made without affecting payment of the bill. 
54 Another internal delay comes in receipt of the books and the 
making of receiving reports. In all but one of the hospitals visited 
books are addressed by the shipper to the supply officer. At the 
single one in which they are addressed to the medical library} avail- 
ability of new medical books to the staff is speeded up greatly. 
The librarian at this hospital makes an informal report of receipt 
to supply and the formal receiving report is made up in that office. 
This procedure eliminates lengthy delays due to partial shipments. 
Supply divisions are reluctant and usually refuse to release partial 
shipments of books ordered on any given purchasing document. Yet 
frequently the dealer sends part of the order while he secures from 
publishers the remaining books on the order. The result is that 
needed.books are present in the hospital but must await the process- 
ing of red tape before they can be used by the prefessional staff. 
The other major delay may be charged to the dealers that have 
been selected by the ASMPA, different ones for the two fiscal years, 
1951 and 1952. The poor deliveries and service of the two used so 
far point up the fallacies of selecting contractors solely on the 
basis of low bid and of authorizing an agency that knows nothing 
about the book trade to award the contract without advice from ex- 
perts in the field. It must be admitted, however, that from all 
reports the services of the 1952 contractor arc a considerable im- 
provement over those of the 1951 agent, but the 1952 dealer still 
does not measure up to the standards of a regular book jobber 'who 
carries quantities of books by all publishers in stock. It is this 
lack of a book stock that makes so many partial shipments necessary. 
Because of the poor services of the 1951 supplier, funds were lost 
to many of the hospital libraries through his failure to deliver or 
cancel before the end of the fiscal year. Cases have been reported 
in which this dealer did not supply currently published books vitally 
needed by medical staffs and gave no reason for not doing so. 
In addition to the delays in delivery and generally poor service 
of these contractors, it is further submitted that a contract of the 
type awarded by the ASMPA is neither economical nor efficient. The 
contract for 1952 covers only 21 publishers. Of these there are a 
few that arc strictly publishers of medical books, while others are 
university, technical, and general presses that have more or Hess 
strong medical lists. A rough grouping of the discounts offered on 
the contract rcteals that there are two publishers at less than 20%, 
thirteen between 21 and 31%3 two at 35%3 two at 50%3 ^nd one at 70%. 
Considering only the strictly medical publishers on the contract, 
the discount offer is less than 20% on two of the publishers, 20% 
on four, 25 to 29% on three, and over 30% on two. 
It is conceded without argument that the 21 publishers on this 
contract would cover the bulk of American books in the field of medi- 
cine and a considerable portion of those in allied subject fields. 
It has been noted on the field visits, however, that books of pub- 
lishers not on the contract are bought, and while those may bo few 
55 in number, the added costs and difficulties that result from their 
procurement from non-contract sources are out of all proportion. 
The usual sd urce for them is the publisher who offers no more than a 
10^ discount. then local bookstores or jobbers are used, as is some- 
times the case, the discount is from 0 to 10^. In addition to the 
low discount rates, administrative costs are high because of the 
necessity for correspondence to secure quotations, end the writing 
and.processing of separate, often individual purchase orders, for 
such books; and with this procedure variously estimated at a cost of 
from.six to twelve dollars the routine becomes ridiculous. 
In contrast to the type of contract established by the ASMPA is 
the one recently awarded by the Federal Supply Service, and which is 
in effect from December 1951 through November 1952. In a new section 
of the Federal Supply Schedule, Class 35 5 Part I, Section B, the FSS 
has awarded an all-inclusive contract for the supply of medical books. 
By the terms of this contract, the Chicago Medical Book Company is 
the authorized supplier of medical books, defined as ''books in the 
medical field that are ordinarily used by a trained physician or 
medical technician in the practice of his profession; included in 
this category aro books relating to Veterinary Medicine, Surgery, 
Dentistry, Dietetics, Nursing and allied fields..." The discount 
rate of this contract is 20^ for one or more copies and time of de- 
livery is two days. Wile no brief is made for this particular 
dealer, it is worthy of mention at this point that his establishment 
has been visited by the Head of the Order Section, Army Medical Li- 
brary, who reports that he is a true jobber with a large warehouse of 
books in which are represented the publications of a great majority 
of the publishers in medical and allied fields. The suggestion is 
made,that this or a similar contract would, despite the fact that the 
average discount rate is sometimes lower than that obtained by the 
ASMPA, be more economical in the long run. It would reduce the time 
and effort required at the local level to purchase books and obtain 
a higher discount rate for those publishers not covered by the present 
ASMPA contract. Because of a large stock and extensive knov/ledge of 
the medical field, such a jobber would give much better service than 
has been offered in the past. It should be noted that the two-day 
delivery time, even if it only means that the order will be shipped 
within two days, contrasts enormously with the thirty-day normal,and 
twenty-day special, delivery time of the ASMPA contractor as recorded 
in the 1952 contract. 
VJhile the picture concerning local procurement of medical books 
is confusing, slow, uneconomical, and inefficient, it is clear and' 
concise as compared with the current practices for obtaining journals 
for the medical library. The following methods for selecting sup- 
pliers ' of journals w^cro found to be in use at various hospitals: 
1. Purchase from the dealers listed in the Federal Supply 
Schedule, Class 35} Part II, "Periodicals and Law Books." 
56 2. Purchase from dealers selected on the basis of competitive 
bid. 
3. Combination of 1 and 2. 
4. Awarding a contract to a supplier without competitive bidding 
by other periodical agents. 
Use of the fourth method is obviously improper because it does 
not follow prescribed procurement procedures. It was found only at 
three of the class I hospitals. In each case no discount was given 
by the agent and in two of them it was noted that the agent was the 
same who had given a substantial discount to other hospitals that had 
issued their subscription lists on a competitive bid basis. 
The first method and the third take advantage of sources already 
established by the Federal Supply Service. There are de out ten deal- 
ers listed in the named portion of the Federal Supply Schedule who 
supply journals in medical and allied fields. They are scattered all 
over the United States} predominantly in the eastern portion, however, 
and offer varying discount rates on the journals they have contracted 
to supply. while there is the advantage of established sources, there 
are two disadvantages to use of the FSS agents.. One is that up to 
ten purchases orders must be made to cover a hospital's journal sub- 
scription list; and since the FSS listings would not cover all those 
needed by a class II hospital, in most instances, there is still the 
necessity for securing bids for the remainder. The other is that the 
discounts offered by these dealers are usually simply for payment with- 
in a specified time, such as 2^ for ten days, etc. A check of 22 of 
the medical titles listed against the prices of a dealer's catalog 
reveals that in 19 cases the prices of the FSS list are identical 
with his list price; in two cases the FSS price was one dollar less ' 
and in one, twenty cents less. 
At one hospital the third method had been carried to such an 
extreme as to be absurd. Purchase orders had been made to the FSS 
dealers for all of the hospital's journals listed in the schedule. 
Bids had been asked on the remaining journals by title. The end 
result was that the purchasing clerk had written a total of thirteen 
purchase orders to cover the 129 journals that the hospital buys. 
The second method seems to ccnflict with the mandatory use 
clause of the above named supply schedule. It is to be noted, how- 
ever, that the Federal Supply Service is cognizant of the possibility 
that a better price can be obtained by awarding the entire subscrip- 
tion list to a single dealer. The mandatory use clause says the 
schedule will be used except "when these items (including medical 
journals) are purchased at a price advantage on a combination plan 
known in the trade as 'Club,' 'Premium,' or 'Special.'" V/here this 
practice of asking for competitive bids on the entire medical journal 
subscription list was used it was found that the hospital had secured 
a discount on the total bill of approximately 8%. In addition 
57 to this price advantage there are the obvious administrative advan- 
tages of writing a single purchase order and paying a single bill, 
whether it cover 2£ journals or 200. 
All but two of the class II hospitals visited and three of the 
class I follow the practice of having the agent supplying journals 
address them directly to the medical library. This is a sensible ar- 
rangement because only the first issue of the year of a journal must 
be put on a receiving report. By this system the journals are avail- 
able immediately to the professional staff members. Under the system 
of having journals mailed to supply, there are inevitable delays, 
for despite the good intentions to make daily deliveries, other busi- 
ness sometimes prevents this. In the two class II hospitals where 
this practice is followed, supply was needlessly duplicating the work 
of the library in maintaining a record to check in each issue as it 
arrived. Such a record is essential in the library itself to insure 
that all issues have been received so volumes will be complete for 
binding. 
F. Disposition of Excess Books and Journals. 
SR tO-UO£-£, "Medical Service - Permanent File of Medical Litera- 
ture /' 1£ August 19k9, establishes the Army Medical Library as the 
agency to receive books and journals excess to the needs of medical 
installations of the Arny and Air Force. This regulation is further 
implemented insofar as the Army is concerned by SGO Code Letter IX-J>06. 
This letter instructs} as do the regulations, that excess jour- 
nals will be shipped on government bill of lading, or by other method 
if the quantity is not sufficient for this, to the Director of the 
Army Medical Library, and will bo accompanied by a general descrip- 
tion of the contents. In only one installation during the field visits 
was it found that there vias any difficulty concerning the disposition 
of excess journals under these instructions. In this particular 
class II hospital, the supply officer had refused to use local funds 
to pay the cost of shipping. 
For books, the general instructions of the regulations are specif- 
ically defined in Code Letter IX-£06, which says that with certain 
exceptions serviceable medical books excess to the needs of an instal- 
lation will be listed and the list submitted through the distribution 
depot to the Acquisition Division of the Army Medical Library. The 
Army Medical Library will indicate desired books, and advise the sta- 
tion through the distribution depot concerned. It is up to the dis- 
tribution depot to authorize disposal of excess books as surplus 
through salvage when shipping instructions are not received from the 
Army Medical Library within thirty working days after the submission 
of the original list. 
58 These instructions are entirely adequate and would dr a good job 
of getting rid of obsolete books in Arny hospitals except the conti- 
nental armies are somehow' entering the picture. Exactly how this 
is being done, whether through the Army Surgeon or through the Army 
Librarian (Special Services) is not known, but the results are. Dur- 
ing its lifetime, one class II hospital, an activity, had received 
from various hospitals in its region that had been closed after World 
War II numerous copies of many old editions and superseded texts. 
Much of its shelf space is consumed by handicraft books once thought 
to belong in the medical library because they were assigned reading 
for the patients "undergoing occupational therapy. In an effort to 
clear its shelves, the librarian and library committee thoroughly 
surveyed the collection, marked obsolete and out of scope material 
for disposition, prepared the proper lists, and submitted them as 
required. The list amounted to more than ^00 books. Three months 
later the distribution depot sent a listing of Army hospitals to 
which 200 of the books were to be shipped and identified the books 
to be sent uo each. Six months later no further word had come on 
the remaining 300, which were still on the shelves although marked 
with a disposition symbol. 
Apparently, much the same sort of thing is being done in another 
continental army area. At one of the class I hospitals visited, the 
library officer exhibited a box of about 2> books that had been dis- 
carded from the medical library of another class I hospital in the 
same area. There were copies of every one of these books already in 
his library and, in fact, he had planned on disposing of the copies 
already on hand. Evidently a list had been circulated among the 
hospitals in the area asking if any of the books were wanted and 
someone had checked these 23 without consulting the library officer 
or his files. This is a local problem and is not the issue here. 
The point is that someone had consumed a good deal of time and effort 
in both these Army areas in listing and circulating lists of super- 
seded editions when it is probable that every hospital library has 
copies of them that are of no value. 
At two of the class II hospitals that were closed in 1950 and 
then reactivated, the disposition, or rather lack of disposition, of 
excess books has caused a tremendous amount of work. Both of them 
received on reactivation great quantities of old medical works. One 
even inherited eight and ten copies of old editions of texts that had 
been used in ASTP courses during World War II. 'Unfortunately, in 
both instances all this mass of valueless material was integrated 
into the collections, along with cataloging, classifying, and shelf- 
listing of them, more to make an impression with the size of the 
collection than anything else, it is presumed. Currently, the 
librarians at both of these hospitals are hard at work removing 99^ 
of these from the records and the collections, doubling the wasted 
effort• 
59 RECOWENDATIONS 
(Chapter III) 
1. The Collection. 
a. It is recommended that each of the hospitals, class I 
and class: II, establish and enforce a policy of keeping indefinite 
loans to an absolute minimum and possibly discontinuing them alto- 
gether in favor of extended loans of one month's duration. This would 
insure that return of a particular book would at least be considered 
occasionally rather than letting it remain forever on an office shelf. 
It is recognized that there are certain tools, particularly for phar- 
macies and laboratories, that must be on hand in the work area at all 
times. But many of these are also required in the library for con- 
sultation by medical officers. Therefore, it is recommended that con- 
sideration be given to the establishment of a separate fund outside 
the library budget with which to provide separate offices with books 
that are needed constantly. 
b. In order to maintain the medical libraries of the Army 
Medical Service in an efficient working condition, it is recommended 
that all of them be thoroughly weeded of obsolete end'superseded 
books. To insure that disposition is not made of any older material 
that is still valuable, the professional staff of the hospital should 
participate in this project. They should also be expected to par- 
ticipate on a continuing basis in the future to maintain a useful 
collection in the medical library. Not only will the collection it- 
self be better for such a program, but efficiency 'will be promoted 
through the elimination of record keeping on deadwood. 
2. Journals. 
a. It is recommended that the minimum number of current 
journal titles received in the medical library should be not less 
than 100 in any class II hospital, and not less than 60 in any 
class I hospital. 
b. Careful consideration should be given annually to the 
library's subscription list to make sure that the major needs of the 
hospital are represented. This is a job for the library committee, 
but if there is a librarian she should be heard and heeded, for her 
advice will be valuable in this immediate objective and also in pre- 
venting the occurrence of gaps in the future files. 
c. It is recommended that certain policies in relation 
to the binding and keeping of journals and the extent of the files 
be established. This should be done by the library committee, again 
with the advice of the librarian. 
60 1) Determine which of the journals received are 
important enough to be bound aid kept. In the class I hospital the 
number should be somewhere between ten and twenty, with progression 
toward the larger number dependent on the presence and extent of 
specialized treatment responsibilities. No figure can be given 
for the class II hospital, for the number and variety of interests 
of the staff, the specialties it represents, and training program, 
and the availability of literature in other medical libraries 
should all be taken into account in making this decision. 
2) Determine how long the journals that are not 
included in the binding program will be kept - one or two, but no 
more than three years. (If they are worth keeping in an unbound 
state for more than three years, they are worth binding.) 
3) Determine goals of completion and of limitation. 
In the class II hospitals this may mean complete files from volume 
one for those journals that arc essential to the specialties and 
research work of the hospital. The number of these should be kept 
to a minimum. For the remaining basic journals and those essential 
to the specialties, there should be a goal of ten years and a limi- 
tation of five years for the remainder. For the libraries of class 
I hospitals, a limit of five years might be set on all journals 
that are retained. 
d. The policies recommended for establishment in 3 above 
should be reviewed annually in the light of changing goals and mis- 
sions of the hospital. 
3. Indexes and Abstracts. 
a. All class I and class II hospitals should have the 
basic indexes mentioned as essential for them in the boc^y of this 
report. One copy of the Current List should always be available 
in the medical library. 
b. In addition to the basic indexes, it is recommended 
that the class II hospital medical libraries obtain or complete files 
of abstract journals essential to research programs, and obtain, 
whenever they exist, such special indexes or abstract journals 
that pertain to the local fields of specialization. 
c. The four class II hospitals that do not already re- 
ceive sections of Excerpta Medica should obtain back files and enter 
current subscriptions to the sections particularly related to their 
work. i , 
U. Book Selection. 
a. It is recommended that the board for review be recon- 
stituted in line with the recommendations above on government of the 
61 medical library; that it be a library committee with broader powers 
than simply the selection of books for the library; and that it hold 
meetings quarterly at an absolute minimum, for the purpose of select- 
ing books. 
b. It is recommended that in the class II hospitals where 
there is a librarian, the committee function in an advisory fashion 
in the selection of books, with final decision for purchase remaining 
the responsibility of the librarian. A similar system should be 
established in the class I hospitals if it is decided to follow the 
recommendation here of having the hospital commander responsible for 
the total library program in the hospital. 
c. The library should establish formally policies that 
will assist in obtaining wider coverage of the medical field by plac- 
ing restrictions on the number of copies of any one title to be pur- 
chased, and to insure that the needs of the medical staff as a whole 
are met. 
d. It is recommended that whatever steps are necessary 
be taken to assure that the lists of books and journals published by 
the SGO Board for Review of Books and Periodicals reach the persons 
for whom they are intended; namely, the librarian and the medical 
library committee. 
£. Pro curement . 
a. In the interests of making books and journals avail- 
able to the professional staff of a hospital with the least delay 
possible, it is recommended that the purchasing agent include the 
specification that they be addressed by the shipper to the medical 
library. 
b. If the procurement of medical professional books is 
to remain at the local level, the following recommendations arc made: 
1) For the purpose of cconony, service end speed 
in delivery, either the FSS contract should be used or one similar 
to it should be entered into by the ASMPA. 
2) In the event it is felt that a separate contract 
is needed by the Armed Services, it is suggested that specialists in 
the field of procuring medical literature be consulted in awarding 
the contract. 
c. If the procurement of medical professional journals 
is to remain at the local level, it is recommended that all hospitals 
be instructed to put their entire subscription lists out for competi- 
tive bid. 
62 d. The major recommendation of this Chapter is that the 
procurement of medical professional books and journals be removed 
from the local, level and done by a staff of specialists at a central 
agency. Based on the experience of the Veterans Administration 
Library Service, where all purchasing of books and journals for the 
hospitals is done in the Central Office, it is known that better dis- 
counts can be obtained and that there is supervision of the service 
of the dealers under central purchasing where there is none under the 
present arrangements. 
6. Disposition of Excess Books. 
SR UO-hO5-5 should be revised to include the more specific 
instructions of SGO Code Letter IX-£06. To prevent the wasted effort 
noted in the above instances, the list sent to the Army Medical 
Library should be returned to the station in every case, marked in 
two ways: 1) those books wanted by the Army Medical Library, if any; 
and 2) those books that are to be disposed of as surplus through 
salvage. If any remain they may be listed and circulated among 
other Army hospitals for an indication of their wishes. 
63 CHAPTER IV 
TECHNICAL PROCESSES 
The words ''technical processes" are used as a heading for this 
chapter as a sort of shorthand^ for the purposes of this survey these 
words are taken to mean all the work that is done behind the scenes 
to organize the collection of a library, provide a key to it so that 
individual items may be readily found, and integrate newly added 
books and journals into the total collection. In the terminology of 
the librarian, the major components of these processes are classifi- 
cation, cataloging, preparations, and binding. 
For all practical purposes, the medical libraries of the eleven 
class I installations visited may be eliminated from this discussion 
except in the matter of recommendations. It has been pointed out 
elsewhere that these libraries have not had the benefit of profes- 
sional library personnel. The work of classifying and cataloging a 
collection to bring out author, title, and the various subjects of 
a particular piece of literature requires technical knowledge of 
processes, and proficiency in them. In the medical library this 
work demands an even higher level of capability because of the dif- 
ficult terminology of the subject matter. It is therefore hardly 
to be expected that enlisted personnel assigned to the library or 
officers assigned the duty of library officer would possess this 
knowledge, and the conditions found in the libraries visited bear 
out this assumption. 
Generally the arrangement of material on the shelves is by ac- 
cession number. Obviously, this is no order at all and no aid to 
locating a particular book. In four of the medical libraries in 
class I hospitals, an attempt had been made by the library officer 
to group books and journals on the shelves according to broad sub- 
jects. This is a very rough attempt at classification, and at one 
hospital the library officer had gone one step further by consult- 
ing a copy of the Dewey Decimal Classification in determining the 
subject groups. The great difficulty of such rough classifying is 
that the library officer, usually administrative, does not have li- 
brary or medical qualifications, and in undertaking the knotty prob- 
lem of deciding the subject relationship of one book to another may 
place it under a subject where a professional man would never expect 
to find it. Under the circumstances, the best arrangement for books 
in these libraries is alphabetically, by author. Then the indivi- 
dual book can be found without the necessity of reading someone 
else's mind to decide where it may have been placed, and it is sim- 
plicity itself to replace properly a book taken from the shelves. 
This shelving system does not meet the requirements of the new 
regulation (SR 735-80-1) which says (paragraph 6c) that there shall 
be shelflist cards showing the class number for books of non-fiction. 
64 But until such time as class I hospitals are furnished with personnel 
capable of classifying their collections, a shelflist by author which 
follows the arrangement of the books on the shelves must suffice. 
The catalog of a library is a tool which is designed to give 
several approaches to an individual book, by author or title, or by 
the various subjects treated in case the user is looking not for a 
specific book but for one that will give the needed information with- 
out regard to a particular author or title. In respect to these 
approaches to the books in their collections, the medical libraries 
in class I hospitals are almost entirely remiss. Efforts have been 
made in some of them to provide complete catalogs to the collections. 
But it is immediately obvious that these efforts are amateurish and 
incomplete. The lack of personnel with the technical knowledge and 
ability has been a handicap. But so has the impermanence of military 
personnel assigned to library work. In several instances it was 
observed that good starts toward elementary catalogs had been made, 
only to be abandoned and all the effort lost when the individual 
who had the initiative to begin it was moved on elsewhere. Because 
these collections arc small, ranging from 600 to 2,000 books, with 
most of those visited concentrated in the range of 1,000 to l,l;00, 
an elaborate catalog is not needed. Nor should it bs needed in the 
future, because these libraries ought to be kept as small working 
collections supplying essentials only. 
The situation regarding technical processes in the medical 
library of the class II hospital is considerably different. In the 
first place, the collections are larger and have more subject variety. 
In the second, they are used for reference by practicing professional 
personnel. But they also are used for the additional purposes of 
professional training and research, and consequently a more refined 
approach must be made. In the third place, these libraries have 
personnel who in some cases have training for this technical work 
and in all cases have some background of experience in it. Further- 
more, however inadequate in some instances, there is clerical 
assistance available for labeling the call numbers on books, 
typing,and filing catalog cards. 
In regard to the medical libraries in class II hospitals, there 
are so many variations in the technical processes that it is almost 
impossible to make any general statements. It may be said, however, 
that only two of these libraries are neither classified nor cataloged. 
One of these two is in a hospital that was closed and reopened^ its 
collection is very small. In this case, and in the case of the 
other which has been in uninterrupted existence over a long period, 
the librarian is not trained professionally, nor has either of them 
had previous experience in other medical libraries. For the second 
hospital the statement that the collection is not classified should 
be modified by saying that it does not follow any regular library 
classification scheme. The books here are grouped into subjects 
65 according to a selection of subject headings from the Quarterly- 
Cumulative Index Lfedicus ♦ Under this system each shelf is labeled 
with a broad subject; e.g., Medicine. Such a system without an 
accompanying catalog does not bring out the various subjects that 
may be included in a single book, and it is inflexible in that it 
does not provide readily for expansion. 
Surprisingly, the largest medical library in any of the class II 
hospitals has not been cataloged, L'ith the hiring of a new librarian, 
a. professional who had no medical library experience, classification 
and author and title listing of the books were undertaken and com- 
pleted. The librarian recognized that an approach by subject is 
essential for the extensive research and training programs of this 
.installation, and expressed the intention of beginning this project. 
Still another of these libraries had not been cataloged up to 
19^0. Here again a new librarian considered subject-cataloging of 
the collection to be the number one job. In this instance the 
approach was different, in that the librarian checked the collection 
and ordered catalog cards for 1,^00 titles from the Library of Con- 
gress. Added entries for titles and subjects were typed in simpli- 
fied form bjr clerical assistants, but the librarian saved an inesti- 
mable amount of her time by taking advantage of professional catalog- 
ing already done by the staff of the Library of Congress. She might 
have gone one step further and saved a lot of clerical time by order- 
ing complete sets of the cards instead of single copies. 
There is a practically even division of the medical libraries 
in class II hospitals on whether or not to take advantage of the 
printed catalog cards offered for sale by the Library of Congress. 
Four of the libraries buy them whenever available; one does not buy 
the cards but is subscribing to the proof sheets and catalog cards 
will be typed from this previously-done cataloging; and five of the 
libraries do not buy any Library of Congress cards. Of the latter 
five, two of the librarians had suggested to the library committee 
that it would be worthwhile to buy these cards, but in both instances 
the committee had not considered their purchase from the book and 
journal fund to be legitimate, and had refused authorization. Other 
committees have not taken this view, and two of the hospitals have 
no difficulties of this sort because the medical and patients' 
libraiy operations are combined and Library of Congress cards arc 
ordered for both. Cataloging and classification are time consuming 
jobs, and when it must be done in its entirety by the librarian 
require as much as one-third to one-half of her time. This detracts 
from the time she has available for devotion to services to users of 
the library. Anything that can be done to increase the amount of 
time that the medical librarian can spend serving the professional 
staff is worthwhile. 
66 There is great variety in the classification systems in use 
among the medical libraries of the class II hospitals• Six are in 
use if the bread subject grouping based on tho QCIM may be counted 
a system. Three of the hospitals use the Cunningham classification, 
three the Boston Medical Library system, one the Library of Congress; 
one proposes to use Dewey and one uses the Army Medical Library Clas- 
sification. In all but the instance where the Army Medical Library 
Classification is used, decision on a particular classification 
scheme was made on the basis of what was considered best at the time 
of establishment and on the personal preference and knowledge of the 
librarian. For libraries of tho size found in these class II hospi- 
tals any one of the systems seems to be adequate. It may seem more 
logical that Army Medical Service libraries should use the Army 
Medical Library Classification, but this scheme was developed in 
its final published form only in 1951* At the one library where it 
is in use the hospital has been closed and reopened. With books con- 
ing in bearing the markings of at least three other classification 
systems, the librarian decided to unify them under this one. She 
is much pleased with the system ai d feels it meets all the needs 
of this hospital library. 
One of the major difficulties of cataloging medical books at the 
local level is that adequate subject-heading authority lists to assist 
the librarian have not been developed for the field of medicine. In 
deciding on subjects to be used, the librarian must use the relative- 
ly brief sections of more general subject-heading guides or the sub- 
ject listings issued by the Quarterly Cumulative Index Medicus. The 
one tool that would give considerable assistance in cataloging medi- 
cal works, the printed annual Catalog of the Army Medical Library, 
was found in only one of the hospitals visited. 
In contrast to local cataloging and classifying in the Army Med- 
ical Service is the centralized system of the Veterans Administration 
Library Service, which may be described briefly at this point. In 
this agency all cataloging, classifying, and duplication of catalog 
cards, book cards, and book pockets is done in the Central Office in 
Washington, and no cataloging at all is done by the station librarian 
The medical libraries of upwards of 125 hospitals are served by this 
method. Since the Veterans Administration has in its Central Office 
librarians who are specialists in this work, there is nothing amateur- 
ish about the finished product and each book is cataloged in con- 
siderably less time than it would be by a local librarian fitting 
these tasks in between others. It is also the experience of this 
agency that while not all the stations buy the same titles, a high 
proportion' of them are the same. • Cataloging and classification work 
done in the Central Office is thus done once to answer the needs of 
many, instead of 125 or more times. Since the work is done at the 
Central Office from such tools as Library of Congress proof slips 
and Arny Medical Library catalog cards, the cataloging is done ahead 
of time, and books on arrival at the station do not have to be held 
67 while the librarian gets around to cataloging them* By a combinaticn 
of specialists and machine methods, the Veterans Administration is 
able to keep costs at a minimum. Its cost for a set of cards (the 
cards to be filed in the catalog, book card and book pocket) is 
fifteen cents, including all costs of cataloging, classifying, and 
printing. In addition to the cost saving feature, it is important 
that by having this work done centrally from one-third to one-half 
more of the librarian's time is made available to the professional 
staff of the station. 
Recent figures from the Veterans Administration Library Service 
give concrete support to the assumption that centralizing technical 
processes is economical. The figures cover cataloging and classify- 
ing 206,878 bocks and the production of 1,03k,390 cards for them. 
The actual cost of the work performed by experts in the Central Of- 
fice is compared with estimates, derived from experimentation and 
experience, of what it would take to do the same job at each station: 
Man Hours Cost 
Central Office 30,328 $ 59,1611 
Local Station - 88,532 2^3,395 
These figures reveal two important facts. One is that the ex- 
pert staff that does this kind of work on a full time basis can pro- 
duce the same amount of work in less time thaa the local librarian 
who performs a variety of tasks• The second is that while central 
man hours are one-third the local, the central cost is one-fourth, 
a difference that is accounted for by the fact that clerical opera- 
tions are performed by lower paid clerical workers at the Central 
Office, whereas much of this work must be done by thp higher paid 
professional at the local station. RECOMMENDATIONS 
(Chapter IV) 
1. Recommendations on technical processes for the medical 
libraries of class I hospitals depend on whether or not library per- 
sonnel is provided .for them. 
a. If professional library personnel is provided, the 
first steps should be organization of the collections in these hos- 
pitals along libraiy lines. Since these collections are largely 
unclassified, it is further recommended that the Army Medical Library 
Classification be the system used to organize them. 
b. If professional library personnel cannot be provided, 
then the advice and assistance of the post librarian should be sought. 
Depending on the amount of time she or one of her staff can offer 
gratuitiously, the medical library should be organized either along 
regular library lines or as proposed in the pamphlet on this subject 
published by the Army Medical Library. 
c. In either case a considerable amount of work can be 
saved if the collections are first carefully weeded of material no 
longer needed. 
2. To keep these libraries, both class I and class II, in a 
well organized condition in the future, and to eliminate duplication 
and poor quality of work at the station level, it is suggested that 
a central office similar to that of the Veterans Administration be 
organized to perform this work for Army Medical Service libraries. 
69 CHAPTER V 
SERVICES AI'© USE 
The services offered by a library Qf any type and the amount of 
use made of them serve to measure the adequacy of the library. Unfor- 
tunately, little can be said in this respect about libraries of the 
Arny Medical Service, because they either do not keep statistical 
records of use at all or else these records are very incomplete. 
Six of the class II hospital medical libraries were able to report 
the number of loans made; one of these could also supply the number 
of reference and research questions the librarian had worked on. 
But only one could give a complete statistical summary of the work 
of the medical library, and this record had only been started at the 
beginning of the year. Because the statistics arc differently kept 
in those hospitals that have them, there is no basis for comparison 
and no point to reproducing them here. 
Being without librarians and usually also without attendant, 
it was not expected that much in the way of statistics on use could 
be obtained from the medical libraries of the class I hospitals 
visited. Qnljr a record of loans might be present in any event for 
nothing else in the way of services is offered in these libraries. 
Even these statistics were not to be had. 
All of the libraries offer books and journals for use outside 
the library, with varying restrictions. As a general rule, material 
may be borrowed from the medical library only by commissioned pro- 
fessional personnel. Enlisted technicians who arc required to do 
reading in connection with courses or their work are given access to 
use of medical library materials within the library only after pres- 
entation of a note from the officer for whom they work. Loans to 
technicians are made only through officers. At three of the hospi- 
tals where there are no other medical libraries in the vicinity, the 
hospital's medical library is open to the use of civilian doctors. 
Because they must have information readily available for clear- 
ance of personnel when they leave the post, the medical libraries of 
Army Medical Service hospitals must keep a dual charging record. 
One record is the book card which serves to locate the particular 
book and the other is a record by name of the individual, showing 
'what he has borrowed and returned. For this record the accession 
number, which has been discontinued by the new regulations on ac- 
countability, was a convenient shorthand. The recording of the 
accession number on the individual's record was much quicker and 
easier than is the writing of author, title, and copy number that 
is now necessary. For this reason two of the larger hospitals are 
continuing their accession record and numbers as well as assigning 
copy numbers. 
70 In .addition to the loan of books there are certain other serv- 
ices that may be expected in a good medical library. These services 
and the extent to which they are performed in class II hospitals will 
be discussed below. 
1. Information, reference end research. All of the medical 
libraries offer this service in varying degrees. One of the largest 
libraries, in a hospital that has an extensive research and training 
program, offers the least because it has no trained medical librarian. 
In the interest of saving the time of the professional man, reference 
service is one of the most essential services of the medical library. 
It should be freely offered and it should be of the best quality. 
2. Compilation of bibliographies by the librarian also saves 
the time of the professional man. Not only this, but the trained 
medical librarian can do a more thorough and quicker job of searching 
the literature on a particular subject, because of her familiarity 
with medical publications. This service is offered, again with vari- 
ations in quality and extensiveness, by eight of the medical libra- 
ries . Several of the librarians reported that they would like to 
offer more bibliographic work and that there is demand for it, but 
the librarian does not have the time. 
3. Checking the references listed in proposed publications of 
the professional staff is another accepted medical library service. 
It is offered in only four of the libraries in class II hospitals 
of the Army Medical Service. This service is lacking in two of the 
larger hospitals in which considerable research is conducted. One 
of them does not have a trained medical librarian and in the other 
no particular librarian is responsible for service in the medical 
library. 
A. In five of the libraries the librarian undertakes to obtain 
photostats and microfilms of articles, etc., for professional staff 
members. Of the three libraries that do not offer this service, one 
of the librarians was not even aware of the fact that photoduplica- 
tions could be obtained without charge from the Army Medical Library. 
From the point of view of the Army Medical Library it is essential 
that this service be offered by the local medical library. .Receipt 
of those requests from the medical librarian insures that the 
resources of the station library and of any other medical libraries 
in the area have been checked before a call is made on the already 
heavily engaged facilities of the Army Medical Library. Also by 
channeling all such requests through the hospital medical library 
the attention of professional staff members is called to their own 
library, in case they arc not already aware of what its collection 
and services are. 
5. All ten of the libraries in class II hospitals borrow 
material on interlibrary loan from other libraries. The amount of 
borrowing varies, of course, according to the collection on hand in 
71 the hospital and the derands of the professional staff. It also 
varies with the interest of the librarian in securing what is needed 
and her knowledge of sources outside the hospital. At two of the 
larger hospitals, heavy borrowing from other libraries in the vicin- 
ity is simply an indication of the weakness of their own journal files. 
In another where almost 700 items were borrowed, heavy interlibrary 
loan reflects the research activities of the professional staff, the 
interest of the librarian in supplying service, and the excellence of 
the collections in other nearby medical libraries. 
6. Orientation of the professional staff to the medical library 
is an essential service, but may be found in only three of the hospi- 
tals . And in only one of these three are all new staff members given 
an introduction to the medical library by the library staff. In the 
other two, orientation is restricted to summer ROTO students. A small 
investment of time by the medical librarian and new staff members for 
this service would result in much better knowledge of library facili- 
ties and better use of the collection. 
7. One of the libraries offered one other service because of 
the unusual, qualifications of the librarian. She is able to do trans- 
lations of articles in several languages for the professional staff. 
Formerly the translations were written, but because of the press of 
other work she has recently had to make them orally. 
In the above discussion of services offered by the medical 
library it has been mentioned briefly in some places and intimated 
in others that the facilities and services of the hospital medical 
library should be made known to the professional staff of the hospi- 
tal. This public relations aspect of medical library service is 
completely lacking in the radical libraries of class I hospitals 
where there are no trained personnel to offer services. And in the 
class II hospitals advertising of the collection and services has 
been neglected so much as to be almost non-existent. Since the pres- 
ence of a good medical library is requisite to the operation of a 
hospital, it is up to the librarian to encourage use of the collec- 
tion and services by whatever devices she can discover. 
One of these devices is to furnish each professional staff mem- 
ber with lists of new books received and with lists of journals to 
which the library subscribes. This is done in only two of the class 
II hospitals. 
None of the librarians in class II hospitals post information 
about the radical library on bulletin boards scattered throughout 
the hospital. It is noteworthy that the Library Service of the 
Veterans Administration has recently distributed and has posted in 
conspicuous places in its hospitals attractice small posters calling 
the attention of the professional staff to the services of their 
medical library. Similar posters would not be amiss in Army Medical 
Service hospitals of both classes. 
72 Once the medical officer is aware of the collection and the 
services offered by his medical library3 true public relations begin 
in the library itself. Poor public relations result from permanent 
arrangement of the library as a conference room or from its being 
closed frequently to library use for this purpose. 
Within the library the qualifications and service attitude of 
the librarian and her assistants have much to do with good public 
relations. Possessing the qualifications required to perform the 
services listed above is the first essential, but this alone is not 
enough. At two of the class II hospitals where the qualifications 
of the librarians were better than average, poor service attitudes 
on their part did much to discourage use of the medical library. 
In both instances the librarians were unpleasant, were either unwill- 
ing to perform services for the professional staff or performed them 
ungraciously, and one had more of a watchdog attitude toward the 
books under her control than oven the regulations on accountability 
for books require. Needless to say, maximum use of either of these 
libraries is not attained. 
Two other libraries offer sharp contrast to this picture. In 
the most heavily used of the medical libraries in the class II hos- 
pitals, the service attitude of the librarian and her assistant is 
remarkable. The staff goes to almost any lengths to find the answers 
to reference questions and, on their own initiative, suggest other 
libraries as sources for material not included in the collection. 
Active participation of the library in the training program is re- 
flected in its heavy use by trainees. Services of this librarian 
were so much in demand that the surveyor had difficulty in inter- 
viewing her. Conditions at the other hospital where a good service 
attitude in the library staff was found were not quite so ideal as 
in this instance, but still superior. Willingness as well as 
ability of the staff to perform services is essential. 
In both the class I and class II hospitals an effort was made 
by the surveyor to obtain from members of the professional medical 
staff a critical appraisal of their medical library's collection and 
services, when offered. Generally it may be said that this effort 
met with failure, either because the individuals questioned had not 
made much use of the library, or because they would not be honestly 
critical to an outsider. Exceptions to this generality were found 
in the cases noted in the preceding two paragraphs, for what is 
recorded here is a combination of opinions of local personnel and 
observations of the surveyor. At one of the larger hospitals a true 
critical appraisal of the medical library was obtained from a pro- 
fessional man who has wide experience in the use of medical litera- 
ture. Because his assessment may be applied to more than this par- 
ticular hospital, his remarks are quoted (not verbatim) here; ''The 
library staff is willing and anxious to do as much as it can to 
assist the professional hospital staff. However, it is limited in 
73 this effort by 1) lack of a librarian trained and experienced in 
medical library work; 2) incompleteness of the journal files and 
the fact that those on hand go back for only three to five years; 
and.3) a need for more medical reference books." 
RECOiWNDATIONS 
(Chapter V) 
1. In order to provide a basis for comparison, a standard 
statistical report, compiled monthly and cumulated annually, should 
be adopted for libraries of the Army Medical Service. Figures in- 
cluded in the report should cover loans (books and journals), attend- 
ance in the library, materials used in the library, reference ques- 
tions, interlibrary loans, loans to other libraries, and photodupli- 
cations obtained. 
2. The services offered by the medical libraries, their 
quality, and their use by the professional staff are dependent on 
the provision of qualified and trained library personnel, on which 
subject recommendations have been ma.de elsewhere in this report. 
74 SECTION VI 
RELATIONS WITH OTHER LIBRARIES 
This subject has been touched upon briefly in other sections of 
this report, but with Army Medical Service libraries relying so heav- 
ily on civilian libraries and on the Arny Medical Library, a fuller 
discussion is indicated. Then, too, there has been no consideration 
of the services the larger libraries in class II hospitals might offer 
to nearby class I hospitals. In the interests of obtaining needed 
medical literature with the least practicable delay, it is elementary 
to try to obtain it from a nearby source rather than from one at some 
distance away. 
Because of the inadequacies of their collections in some in- 
stances, and the determination to maintain only a working collection 
in others, libraries of the Arny Medical Service are heavy users of 
the resources of other medical libraries. This is especially true 
of the class II hospitals where the medical literature needs cover 
a wide range. It is, of course, to be expected that some of the 
medical libraries are more fortunate in outside local medical 
library resources than others. 
Probably the most fortunate of all is Walter Reed ^rmy Hospital 
because immediately adjacent to it are the considerable resources of 
the Army Medical Service Graduate School. It is still more fortunate 
in being able to call for reference service on the Army Medical 
Library by telephone, and to use a messenger service borrowing from 
this library, the Library of Congress, the Library of the Department 
of Agriculture, the Library of the National Institutes of Health, 
and other specialized libraries in Washington. , 
For purposes of service and materials the medical library at 
Letterman Army Hospital is practically a branch of the Lane Medical 
Library of Stanford University. Lane is only ten minutes away from 
the hospital and messenger service twice daily makes the resources 
of that library, which claims to be the largest west of Chicago, 
practically a service unit of the hospital. For work requiring use 
of a large number of items the medical officer from Letterman may use 
the roading room at Lane and do his work there. As a general rule 
civilian libraries agree only to lend materials to Army libraries, 
because they do not have sufficient staff to give reference or other 
services.'* Such is not the case here, for the librarian at Letterman 
may call on the Lane staff for help with reference questions. 
The same is true at Fitzsimons, where the librarian may call on 
the librarians of the Veterans Administration Hospital and of the 
Library of the Medical Society of Denver City and County for assist- 
ance with reference questions. These three librarians are keeping a 
75 joint filo of reference questions and the sources from which they 
were answered. Again, there is much borrowing from these two local 
libraries and also from the medical library of the University of 
Colorado, which is located in Denver. Borrowing from this library, 
which has extensive journal files, has been so heavy that the libra- 
rian has felt her staff is overburdened and has suggested that even- 
tually a charge may have to be ma.de for this service. The librarian 
at Fitzsimons is also fortunate in having in Denver a Bibliographic 
Center which records the holdings of all libraries in the Rocky 
Mountain region. Through it any item in the area may be located, 
but since the medical library is not a member the librarian must use 
post librarian's membership to request what is wanted. 
Although Valley Forge is thirty miles from other civilian medical 
libraries which are located in Philadelphia, it is close enough for 
messenger services and is almost as fortunate as those mentioned 
above in availability of medical library resources. It borrows pri- 
marily from the medical school of the University of Pennsylvania, and 
from Temple University. Its search for items needed is simplified 
by the presence of the Union Catalog in Philadelphia, which covers 
the collections of some 200 libraries in the eastern part of the 
United States. 
Murphy Army Hospital has the smallest collection of any of the 
Class II hospitals. But it is located close to cne of the country*s 
heaviest concentrations of medical libraries, the Boston area. Hero 
for the first and only time was it found that any charge is made to 
Army libraries for loans from a civilian library. This, however, is 
not discrimination, for the Boston Medical Library requires any other 
libraries that wish to make use of its extensive resources to buy a 
membership. For a charge of per year the Murphy library may have 
twenty items out on loan at any one time. Because of staff shortage 
and financial difficulties of its own, the.Boston Medical Library is 
not able to offer reference and research assistance except on a fee 
basis. Murphy also has available to it the resources of the Harvard 
University Medical'School Library and the medical library of Tufts 
College, in addition to many specialized and hospital libraries. 
Good relations are maintained between the library of Brooke Army 
Hospital and other libraries in its vicinity, but unfortunately those 
are not able to supply too many of its needs. Inter-service library 
assistance was found hero, in that the hospital borrows from tho good 
research collection of the library of the Air Force's School of Avia- 
tion Medicine. Otherwise Brooke Army Hospital must call on university- 
medical libraries in Toxas some hundreds of miles away, or on the 
Army Medical Library. 
The most isolated class II hospital in respect to the resources 
of other medical libraries is Beaumont. This hospital is a good 
seven to eight hundred miles from cither Houston, Texas, or Denver, 
Colorado, the nearest cities with medical schools and libraries. 
76 Among tho class I hospitals, isolation from other medical library 
facilities is the rule rather than the exception; so little can be 
said about their relation with medical libraries. Two are located 
in cities that have medical libraries in universities, and one is 
located in the same city, or rather on the outskirts of the same city 
that has a class II hospital with a medical library. 
One of the questions to be answered by this survey was the extent 
to which the medical libraries of the class II hospitals might serve 
as regional libraries for class I hospitals in their vicinities. In 
some instances they might do a creditable job in this field; in 
others where the collections and library personnel arc not too good, 
the class I hospital might as well contact a good civilian medical 
library in the area or the Army Medical Library. It was found that 
some of the class II libraries do lend materials to class I hospitals 
that are nearby. One of them even lends books on an indefinite loan 
basis to small but separate medical organizations in its vicinity. 
At another, loans and reference service are offered to the personnel 
of a nearby Air Force hospital. At one of the class II hospitals 
the librarian had received a goodly number of requests from medical 
officers in other installations, but because of lack of clearance 
control over them was reluctant to make loans. Instead she had re- 
ferred such requests to a civilian medical library and expected that 
institution to make loans she would not herself make. The inter- 
ference of accountability regulations in this instance with freedom 
in circulating printed medical information to Army personnel is 
regrettable. It can be circumvented by following the usual library 
policy outside the Army of making loans only to the library and not 
to individuals. Such items may in turn be lent to the individuals 
requesting them, but the local library assumes responsibility for 
their safekeeping and return. 
All the medical libraries of the Army Medical Service are open 
for use of materials within the library by any medical personnel of 
the Armed Services, and to civilians in those instances 'where there 
are no other medical library facilities in the vicinity. 
All of the Army Medical Service hospitals have availed themselves 
of the services of the Army Medical Library in greater or lessor de- 
grees. Those class II hospital libraries that call on this organiza- 
tion the most are the ones with the most active training programs and 
also the ones with librarians,most interested in fulfilling the 
literature needs of the professional staff. This statement must bo 
qualified by noting that tho excellence of other local resources 
have tho effect of reducing the' demands made on the Army Medical 
Library for service. 
Especially heavily used is the photcduplication service supply- 
ing photostats and microfilm, and following this in tho amourt of use 
is the borrowing of the bocks and journals themselves on intorlibrary 
77 loan. Requests for bibliographies.or exhaustive surveys of the 
literature on a particular subject come less frequently and, more 
usually than not, directly from the professional man rather than 
through the medical library. Most of the librarians were not aware 
that they could call on the Army Medical Library for assistance in 
the answering of reference and information questions. 
It has been mentioned previously that photoduplication orders 
addressed to the Arny Medical Library should be routed through the 
local medical library. This applies equally to other types of re- 
quests, to insure that local resources have been checked first, and 
also to make certain that the staff of the Army Medical Library will 
not go over the same ground that has already been covered. 
Thore is no question of the willingness of the Arny Medical 
Library to undertake special work for medical personnel of the Army 
or any of the Armed Services. However, to keep the time of the Army 
Medical Library's staff free for such special projects, the more 
elementary medical library work should bo performed at the local 
level. Tn order to accomplish this the recommendations previously 
made for the improvement of collections and personnel should bo 
heeded. 
RECOMMENDATIONS 
(Chapter VI) 
1. Relations of libraries of the Army Medical Service with 
civilian libraries is a one-way street insofar as the inter-loan of 
medical literature is concerned. It is recommended that the privi- 
lege of borrowing from civilian libraries not be abused; and to 
achieve this it is reiterated here that qualified personnel are 
needed in Arny libraries} as well as requisite funds to construct 
collections to cover the daily needs of professional staff members. 
2. It is recommended that freedom of inter-loan of materials 
and the performance of services where possible by the libraries and 
librarians of class II hospitals in respect to class I hospitals in 
their areas be offered without question. 
78 CONCLUSIONS 
In the preceding pages of this report it has been developed in 
no uncertain terms that the collections and services of the iinny 
Medical Service libraries in fixed hospitals in the United States 
are not up to standard. One or two exceptions to this statement may- 
be found in certain class II hospitals, b.ut even in those one or more 
aspects of first class medical library service, adapted to the needs 
of the professional staff and to the research and training programs, 
are missing. 
Failure of the medical libraries to measure up to what may bo 
expected of good libraries may be attributed to several causes: 
1. Professional medical personnel of the urny Medical Service 
do not question the desirability of having medical books and journals 
in each hospital, but little attention has been paid to developing 
adequate collections or providing qualified library personnel, 
2. Failure to recognize that the medical librarian should bo 
fully qualified in her professional field has resulted in poorly 
organized collections and library staffs that are unable to perform 
properly the services expected of a medical librarian. It has also 
resulted in a lack of confidence in the librarians ' ability to give 
direction to the program. Professional men, who arc prone to empha- 
size their own specialties to the neglect of literature of more 
general application, are being directly involved in this work in- 
stead of acting merely as advisors to a professional librarian. In 
the class I hospitals the question of a library staff has been com- 
pletely ignored. Corollary to this is the failure to recognize the 
value of the professional librarian's time, as indicated by the lack 
of provision of sub-professional and clerical assistance. 
3. Since the start of the present monetary allotment system 
for local purchase of books and journals, collections in the medical 
libraries have shown improvement. There is no doubt but that many 
of them are still suffering from the effects of the former automatic 
distribution system, particularly demonstrated by incomplete files 
of journals. 
U. Lack of policies, or failure to enforce them where they 
exist, on indefinite loans, has had the effect of decentralizing the 
collections and removing the most recent and useful literature from 
the library where it would be available to the entire professional 
staff. 
£. In some of the hospitals development of the medical library 
along accepted lines has been hindered by the misconception that the 
library quarters should also serve for meetings and conferences* 
79 6. Failure to provide funds for items of supply and equipment 
peculiar to library operations is handicapping both the librarian 
and the library user. 
The above are the immediate, and mainly local, reasons for the 
poor collections, facilities, and services found in Army Medical 
Service libraries in field installations. But the more far-reaching 
conclusion is that these conditions have developed for lack of a 
central agency to give general direction to the Army's medical 
library service. 
Therefore, it is the major recommendation of this report that a 
central agency to give technical supervision to medical library serv- 
ice within the Array, and perhaps eventually also in the Navy and Air 
Force, be established. The large objective of such a central office 
should be services to the local libraries rather than control, with 
final responsibility for the library service of a hospital in the 
hands of the hospital commander. 
In line with the recommendations in Chapters I and II of this 
report, to the effect that library service within a hospital should 
be unified, the central agency should be concerned with general as 
well as medical library service. The functions listed below for the 
central office deal only with the medical library because this is the 
field of greatest need. It is assumed that it will have parallel 
functions for general library service of hospitals. 
Central Library Office Functions 
1. Fers onnel. 
a. Determination of qualifications to be required of 
medical librarians, development of standards of performance, and 
determination of the Civil Service grades for professional library 
jobs of varying difficulty. 
b.' Determining and obtaining authorizations for qualified 
library personnel for hospitals of various types. 
c. Training and developing the abilities of library per- 
sonnel presently to be found in the medical libraries through insti- 
tutes, regional conferences, visits to the ^rny Medical Library, and 
courses in medical librarianship at civilian universities. 
d. Recruiting qualified personnel for libraries of the 
Array Medical Service. 
e. Advising and assisting hospital commanders in employ- 
ing professional library personnel. 
80 2. Collections. 
a. Compiling and publishing standard lists of medical 
works, with indications of basic requirements for medical libraries 
in hospitals of any type and size. 
b. Producing periodically and regularly lists of new 
publications, with evaluative annotations. 
c. Advising on selection of medical literature to provide 
information and research materials in fields of specialization. 
d. Consulting and advising on binding and retention 
policies for journals. 
e. Advising on excess and out of scope books- and methods 
for disposing of them. 
3. Budgeting. 
a. Application for test purposes and further development 
of the formulae proposed above to achieve equitable allotment of funds. 
b. Making recommendations on the adequacy of funds in 
relation to the missions of the individual hospitals. 
U. Procurement of books and journals. 
a. Establishing and operating a central procurement 
agency for books and journals in medical and allied subject fields. 
b. Preparing bid lists and selecting contractors to 
supply medical books and journals to the libraries. 
c. Evaluating the services of the contractors selected. 
d. Developing a fast and efficient order routing., begin- 
ning with selection at the station, ordering by the central office 
from contractors, and ending with delivery by the supplier direct 
to the local library. 
o. Reserving a portion of the funds of each hospital to 
purchase, without orders from the hospitals, such items as will be 
needed by all, regardless of size and mission - in other words the 
standard works and basic indexes. 
£. Cataloging, classification, and preparations. 
a. Centralizing performance by specialists of the tech- 
nical work of cataloging and classifying medical literature bought 
for the hospitals. 
81 b. Producing catalog cards, book cards, and pockets 
for each publication bought, these items to be mailed to the station 
so as to arrive before or by the time of receipt of the book. 
6. Supplies and equipment. 
a. Determining the supply and equipment needs of medical 
libraries. 
b. Taking necessary action to obtain standardization and 
placement on tables of allowa.nccs of such library items as are sus- 
ceptible to this procedure. 
c. Obtaining authorizations and funds for local purchase 
of such items as cannot be standardized. 
7. General supervision of medical libraries in field instal- 
lations of the Army Medical Service. 
a. Conducting field inspections of medical libraries to 
chock and advise on the development of collections, services, and 
personnel. - " 
b. Advising on general policies and rules in connection 
with operation of medical libraries. 
c. Advising on location of the medical library and 
space requirements for it. 
d. Preparing a field manual for operations similar to 
that published by the Veterans Administration Library Service. 
c. Performing a three-way liaison between the central 
field office, the local librarian, and the hospital commander. 
There remains the problem of assigning responsibility for per- 
formance of the recommended central office functions. This calls 
for a staff decision that is beyond the scope of this report. 
However, one or two suggestions may be made. 
One possibility is to incorporate the central agency as another 
division within the structure of the ^rmy Medical Library, the major 
activity in the field of medical librarianship within the Department 
of Defense. In favr of this is the fact that this installation 
already has a body of experts in all phases of medical library work. 
Additional personnel would be required for an office of field serv- 
ices, but a great deal of the work could be accomplished by the 
existing divisions with only minor additions in personnel. 
The possibility of a contractual arrangement, or qven a simple 
cooperative agreement, with the Veterans Administration for perform- 
ance of some of the central agency functions is attractive. This 
82 organization is already supervising tho provision of both medical and 
general library service in 170 hospitals of various sizes. The Vet- 
erans Administration Library Service has developed a great body of 
experience in methods over a period of several years. Its organiza- 
tion., methods, and equipment for ordering, cataloging, classifying, 
and reproducing cards arc impressive. And those operations are per- 
formed at a very low cost. It makes good sense, from tho point of 
view of economy, to take advantage of a ready-made organization of 
this sort rather than to duplicate it. 
The central agency functions listed above are essential if the 
medical library service of tho Army is to support professional activ- 
ities. There is the possibility of splitting responsibility for tho 
functions between a central office and the local stations. Such a 
division would work to reduce the size of the operation at the central 
office and might bo workable. But this measure is mentioned only as 
a substitute for tho better results that would be obtained through 
central office operation, as recommended. In the event this alter- 
native is found attractive, it will be necessary to request partici- 
pation of the Army Library Service to fulfill the primary need of 
medical libraries for professional library personnel to organize and 
service tho collections of class I hospitals. 
83