Electronic Library Puts a World of Information at Doctors’ Fingertips

When lightning struck a little boy on a St. Louis baseball field a few years ago, doctors scrambled to save his life but realized they knew very little about treating this injury in such a young child.

With the boy in critical condition and his fate uncertain, a call was placed to a computer in Bethesda, Md.

Although little had been written about treating severe lightning injuries in young children, the information that did exist was made available within 15 minutes to the computer at St. Louis University Medical Center. The cost, less than $10, proved to be a wise investment. The boy was saved with a treatment prescribed in the articles.

Instant Access Worldwide

That was not an unusual occurrence for the National Library of Medicine, where a computer system gives doctors around the world instant access to 6 million articles from 20,000 medical journals.

The library processes 3 million such requests a year, sometimes while the patient is on an operating table thousands of miles away.

Celebrating its 150th anniversary, the National Library of Medicine--part of the National Institutes of Health--is the world’s largest research library in a single scientific or professional field, with 3.5 million books, technical reports, theses and journals spanning 70 languages, as well as many pieces of medical art.

The information spans every imaginable medical topic from psychology to dentistry to zoology, from an Arabic manuscript on gastrointestinal disease, written in 1094, to the latest audiovisual and computer data on such modern maladies as AIDS and toxic disasters.

To library director Dr. Donald A. B. Lindberg, it is not a library but a “national treasure.”

The library’s birth was not a momentous affair; in 1836 there were just a few shelves of books in an office near the White House for the use of the Army surgeon general, concentrating on war wounds.

The man who started the library’s phenomenal growth was Civil War surgeon John Shaw Billings, who became as fanatical about collecting and organizing medical material as he had been about repairing war-torn limbs.

The ever-growing collection has moved at various times, to Ford’s Theatre in 1866 (theatrical performances having ceased after Abraham Lincoln’s assassination), to a building on the Washington mall and even, for a while, to Cleveland.

The latter occurred during World War II, when librarians feared Washington would be bombed and the collection lost. In 1942, off it went in 952 boxes to the Dudley Allen Memorial Library in Cleveland, where it stayed for 20 years.

The library returned to a new building in Bethesda in 1962, traveling in four vans guarded by detectives and insured by Lloyd’s of London for $6 million during the journey.

Special Windows

Now it is housed in two buildings--one four stories, the other 10. The main building is constructed so that the windows blow out, instead of in, in case of an outside explosion.

The library now finds itself at something of a crossroads in determining the course of its survival.

“Some people think it should just collect books and preserve them,” said Albert E. Gunn, chairman of the board of regents and a Texas physician and lawyer. “Others,” he said, “want it to be the center of medical informatics,” the use of highly sophisticated computer technology in up-to-the-minute medicine.

At a time of federal budget constraints, Gunn hopes the library can manage to do both.

It is used by all kinds of people:

--Producers have delved into the historical photo and print collection for the Woody Allen movie “Zelig” and the public television series “Nova” and “The Brain.”

--American scientists heading to Bhopal, India, first checked the library’s computer for information that would help them in treating victims of the Union Carbide disaster.

--Students use it for research and ordinary browsers can see Florence Nightingale’s handwritten notes, or a replica of the world’s oldest known prescription, carved on a tablet in 2100 BC. In cuneiform script, it dictated, “Purify and pulverize the skin of a water snake. . . . Pulverize bark of pear tree and moon plant.”

Not quite “Take two aspirins and call me in the morning.”