The Medical Library

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WHO Regional office for the Eastern Mediterranean

CHAPTER 1

THE MEDICAL LIBRARY

1.1 Historical Background

Medical libraries are not a recent trend. Large collections of medical

books existed in ancient Egypt, Assyria and China. The chief Egyptian

medical papyri range in date from 1900-1200 B.C. The library of Ashur-

banipal King of Assyria (668-626 B.C.) provided 30,000 fragments of

cuneiform clay tablets of which 800 were medical. The two libraries of

Alexandria - the Brucheum and the Serapeum - were the most famous of

ancient world.

The Romans in general despised medicine. But the libraries of Byzan-

tium were well equipped with medical works. During the long period of

Islamic supremacy in science (9th-11th centuries), great medical libraries

were built up in the East and Spain. Avicenna left a description of the

Royal Library at Bokhara. The earliest found-ers of monastic libraries in

the 3rd century made provision for the custody and control of books.

As soon as medical teaching began in the newly founded universities,

medical libraries in a special sense were created, but grew slowly. But

the outstanding examples were the libraries of medical corporations and

societies of which many are still existent, an example of which is the pre-

sent Royal Society of Medicine which has the leading British medical li-

brary.

In U.S.A, the National Library of Medicine (NLM) was established in1836 to become the most important medical library in the world

(1).

1.2 Definition

Libraries fall traditionally into one of the following types :

a. National libraries

b. Public libraries

c. Academic libraries

d. Special libraries

e. School libraries

(1)Encyclopaedia of librarianship / edited by Thomas Landau, p. 239-241.

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Medical Library Handbook

One is inclined here to consider medical libraries as special libraries as

their clientele and services are directed towards specific community and

subject respectively. But actually they are more than this, as they may be

national, public or academic libraries as well. Moreover, the literaturethat medical libraries cater for is doubling at least every fifteen years, the

number of medical students increases every year, the fields themselves

are changing as medical activities now take into account the complex in-

terplay of personal, emotional and environmental factors that affect an

individuals health and well being, as well as evidencing new interests in

such disciplines as psychology, anthropology, economics, sociology,

biophysics, ecology, mathematics, electronics, communication science

and operations research(2)

as well as chemistry and physics.

Saying this we may derive the following all-embracing definition of the

medical library - better called health sciences library :

The library that is exclusively or predominately concerned with materi-

als and information whether acquired or accessible in the fields of health

sciences, and exclusively or largely serves all the needs of members of

health, allied and related professions and services .

1.3 Objectives of the Medical Library

The overall aim of the medical library, regardless of its location, size or

parent organization is to provide organized library services to meet the

information needs of its clientele in their activities relating to patient

care, education, research, management and any other specialized ser-

vices.

To enable the medical library to meet this aim, and fulfill its mission, in

harmony with the objectives and goals of its parent organization, the fol-

lowing objectives may be listed(3)

:

1. Acquire, organize, provide access to, and process information so that

a user has immediate access to all facts, concepts, ideas, or other

items of information relevant to his particular needs ;

2. Handle wide variety of inputs, including formal publications of all

formats, informal notes and comments, and items derived

from more than one source ;

3. Reduce the difficulties now caused by the diversity of symbols, lan-

guages, jargons, and terminologies ;

4. Essentially eliminate the publication lag ;

(2) Miller, James G. Design of a university health science center, p. 101-121.(3)

ibid, p. 103.

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5. Make possible the retrieval of all, or nearly all, existing information

relevant to a search ;

6. Respond immediately to a users request, interact with him, and ad-just to his level of sophistication ;

7. Facilitate interaction of groups of coworkers with each other and

with the library ;

8. Provide the user, on demand, with either the flexibility, legibility,

portability, and convenience of the printed page, or the dynamic

quality and immediate responsiveness enabled by information tech-

nology ;

9. Store information on the users interests and needs for the purpose of

formulating policies about acquisitions and retention, taking the ini-

tiative to keep each user informed about new information which is inhis field of interest ;

10. Develop flexible working relationships with other systems ;

11. Standardize cataloguing, indexing and abstracting activities to make

them most efficient and most valuable to the users ;

12. Record and process all bookkeeping, billing, receipt and dis-

bursement ;

13. Handle guidelines, strategies, tactics and rules of thumb intended to

expedite solution of the problems of information processing ;

14. Provide for continuing efforts to improve the organization of and

easy access to the existing body of knowledge, including resources

sharing, and continuous education of both staff and users.

These objectives, to be achieved whether comprehensively or selectively,

depending on the resources provided and clientele served, require the

provision of various types of services and functions which will be cov-

ered later in the handbook.

1.4 Types of Medical Libraries

Medical libraries may be categorized by the subject they cover, the form

of materials they collect, or by the type of users they serve. For instance

there may be a nursing library covering the subject of nursing, and ser-

vicing the community of nurses, or a library that collects journals, his-

torical materials or archives for researchers, while another library caters

for clinicians, physiotherapists, or consumers.

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But the more common categorization is based upon the parent organiza-

tions, bearing in mind that such organizations belong either to the private

or public sector. This holds true for both the overall and individual cate-

gories, as in the case of hospitals, for instance, where there exist bothgovernment and private hospitals.

Consequently, the types are stated here under the following headings :

1.4.1 National Medical Libraries

National libraries are those concerned with collecting and preserving the

cultural heritage published in and/or on the respective country of the na-

tional library. But, in medicine and health sciences, there is a much big-

ger responsibility for a national medical library represented in providing

information on the subject as a whole regardless where it was originated

in the world, and the format in which it is available whether virtual or

physical.

On top of such libraries is the U.S. National Library of Medicine (NLM),

which is actually an international medical library servicing any user any-

where in the world. As this library is also leading in cooperation and

networking, it will be described more fully in the relevant chapter of this

handbook.

For other countries, there are national libraries that cater for all fields of

knowledge without restricting its services to any specific discipline. But

few of them do have, in addition, a national medical library concerned

with servicing users rather than collecting the heritage. Of those coun-

tries, one may mention the National Medical Library of UAE University(Al-Ein, Abu Dhabi).

1.4.2 Medical Centre and Medical School Libraries

These libraries normally belong to the academic institution that teaches

medicine, nursing and pharmacy. They may be departmental libraries of

their university library, autonomous, or independent of them. In some

university libraries such libraries are just subject sections without being

physically separate. They vary in their size, space, staff, automation and

the services they provide.

1.4.3 Hospital Libraries

There is a real confusion about the definition of the term Hospital Li-

brary . But, in all cases, whether public or private, it should be the one

invested with responsibilities and authority to assure the hospitals

educational, clinical, administrative and research personnel of access to

information which enables them to give the best patient care within the

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formation which enables them to give the best patient care within the

limitations of funds at hand(4)

.

When we talk about hospitals themselves, we talk about a very big busi-ness as the largest proportion of money is spent there whether in the form

of hospitalization, insurance or in cash outlay. When talking about classi-

fication of hospitals, it may be reasonable to consider that a large number

of hospitals operates under some kind of private control : religious insti-

tution, proprietary, or voluntary. Other elements for classification are :

size, average length of stay per patient, whether or not the hospital car-

ries out a formal teaching programme, and whether or not the hospital

serves one segment of the population like women, children or mentally

ill(5)

. Some hospital libraries are not more than a service provided by

public libraries to hospitals.

Moreover, MLA (Medical Library Association), in its standards for hos-

pitals, divided hospitals according to size, staffing and programmes into

six categories giving the characteristics that pertain to each category.

MLA also enlisted there qualitative standards for hospital libraries and

quantitative minimum standards for health sciences libraries in hospi-

tals(6)

.

However, there are peculiar phenomena related to hospital libraries, par-

ticularly in developing countries, namely that they are mostly very small

libraries with one staff member, if any. Contrast this with the hospitals

they serve which are mostly technologically advanced even in informa-

tion technology without involving the library. The other point is that the

hospital library should be available to its users at all times, and at the

point of need.

1.4.4 Libraries of Other Health Care Entities

These entities may be private or public too. They tend to have small li-

braries, if any. They may be better served if they have access to other re-

sources in the locality or remotely through Internet, other networks, or

some cooperation programmes.

1.4.5 Government Agency Libraries

Normally the Ministry of Health is considered the major agency which

may be responsible for different health institutions such as hospitals,

laboratories, and research centres. It may be centrally or decentrally or-ganized. Other agencies include the Ministry of Agriculture (veterinary

medicine) and environment agencies. Such libraries have a significant

role, particularly in developed countries.

(4) Johnson, Barbara Coe. Services an integrated hospital library can and cannot do, p. 284-

288.(5)

ibid.

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(6) MLA. Standards for hospital libraries.


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As such agencies represent their respective countries at the various re-

gional and international intergovernmental organizations, they have ac-

cess to a wide range of expertise and resources from such organizations,

particularly the World Health Organization (WHO). On the regionallevel, the Council of Arab Ministers of Health of the League of Arab

States may be mentioned. This Council established the Arab Centre for

Medical Literature (ACMEL) seated in Kuwait.

1.4.6 Libraries of Professional Societies, Voluntary Health Organiza-tions

and Foundations(7)

Professional societies are association of colleagues in an occupational

context, i.e. : societies, syndicates, academies, or associations in medi-

cine and allied health sciences. Some of these societies are responsible

for bibliographic control over a specified discipline or areas of interest to

their membership. They may be responsible for writing, editing and in-dexing reports, proceedings and digests related to the history and policies

of the societies. Needless to say that professional medical library associa-

tions do exist, though not common in the various countries. The U.S

Medical Library Association (MLA) is the most outstanding example in

the world. It was established in 1898 and has 5000 members organized in

14 regional chapters and 23 special interest groups. It publishes a quar-

terly bulletin (Bulletin of the Medical Library Association) as well as

numerous publications including Current practice in health sciences

librarianship which will consist of eight volumes ; it is, in fact, the fifth

edition of the classic handbook of medical library practice.

It has an active continuing education programme. It established in 1989

the Academy of Health Information Professionals. The other two medical

library associations that deserve to be mentioned are : the Canadian

Health Libraries Association which publishes the quarterly Bibliotheca

Medica Canadiana, and the European Association for Health Informa-

tion and Libraries.

Voluntary health organizations are composed of persons of heterogene-

ous background and orientation who organize to support special purposes

related to the health field through voluntary contributions from the gen-

eral public. Their libraries are generally small and specialized. They may

be involved in one or more of the following activities : public education,

support of services in diagnosis or treatment centres, support of research,publications for professional or general audiences.

On the other hand, foundations, institutes and other similar organizations

are supported by private benefactors or grants. These may include : fam-

ily or personal foundations, corporate foundations, community trusts and

(7) Crawford, Susan. Health sciences libraries of professional societies, voluntary health organiza-

tions, and foundations, p. 269-276.

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government foundations. Their libraries usually provide special services

for a limited set of users as they support the programme of their institu-

tion in which they are situated, although the entire programme may con-

sist of supporting a unique library collection.

On the whole, such libraries may provide services to physicians, bio-

medical research, and/or assume the role of community libraries in the

health field, serving students, teachers, pharmaceutical manufacturers, at-

torneys and the general public.

1.4.7 Pharmaceutical and other Company libraries

These firms belong to the private sector, and their libraries are not usu-

ally accessible to outsiders as their services are tailored to their staff and

customers. Except for major companies these libraries tend to be small.

In addition to the pharmaceutical companies, the following companies

are included here : health insurance companies, medical advertisers,

medical publishers, vendors of health information, and marketing de-

partments in organizations doing business in the medical fields.

1.4.8 Libraries of Regional and International Organizations

The world health organization (WHO) together with its various regional

offices and centres plays a significant role in the field of medical infor-

mation and informatics in all its member states. It will thus be covered in

more detail later in this handbook. Other organizations include the Pan-

American Health Organization (PAHO), and the Council of Arab Minis-

ters of Health, previously mentioned, which established the Arab Centre

for Medical Literature (ACMEL).

Moreover, there are many libraries that hold medical collections, small or

large, as part of providing services for their own clientele. Such libraries

include public libraries, school libraries (school health and health educa-

tion) particularly schools of the handicapped, sports centres and clubs.

From a futurist point of view, another categorization is coming up not

limited to any one type of medical libraries, but will encompass them all.

This categorization states that there will be three types of libraries :

1- Paper library, where materials collected and technical operations are

based largely on paper ;

2- Automated library, where most operations are computerized while

the collections remain largely on paper ;

3- Virtual library, which some may call electronic or digital library,

where both the operations and collections are stored and used in

electronic format.

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The Medical Library

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