Supporting the Medical Enterprise: DeBakey and National Library of Medicine

Early in his career, DeBakey recognized that progress and excellence in medicine don't happen in a vacuum--health care delivery and medical innovation need support, not only in the form of funding, but in institutional structure and information resources. He was a tireless advocate of such support for his own institution and for American medicine generally, beginning after World War II, when he helped initiate the legislation to establish a National Library of Medicine. During the next twenty years his medical statesmanship would become almost as legendary as his surgical virtuosity.

DeBakey's association with the NLM began during the war. His duties with the Surgical Consultants Division of the Army Surgeon General's Office required him to prepare position papers, memoranda, and technical bulletins constituting policy regulations authorized by the Surgeon General. He also acted as co-editor of a classified medical publication distributed to military officials. Background research for these assignments led him to the Army Medical Library (AML), housed in an aging, overcrowded building on the Washington, DC Mall. Originating as the library of the Army Surgeon General in 1836, the institution had expanded enormously between 1865 and 1895 under the supervision of John Shaw Billings. Besides enlarging the collection of medical books and journals, Billings organized and cataloged it, and developed the Index Medicus, a bibliography of the medical journal literature. By the time he retired, the library was the largest medical library in the world, and its patron base extended far beyond armed forces medical personnel. It continued to grow, but plans for larger quarters were repeatedly put off during the next 50 years, as two world wars and the Great Depression rendered library funding a low priority in military budgets. By the time DeBakey started visiting the library, the overstuffed stacks and the building's decrepit condition threatened the collections and rendered staff and patron areas hazardous as well. Deteriorating window frames let in freezing drafts during the winter; during heavy rains, water poured in, peeling the paint off the walls and forming puddles on the floor. Rain also leaked through the skylights, forcing the staff to place wastebaskets and buckets around the floor and on tables, and to throw tarpaulins over bookshelves, desks, and card files. Corroded downspouts leaked into interior walls. Birds, insects, and even bats came in through unscreened windows, flying around the reading room; rats and mice infested the stacks. The lighting was poor, especially in the stacks, where the staff sometimes worked with flashlights. The library did not even have indoor restrooms--it was the only Federal building in Washington with an outhouse.(Toilets were installed on the third floor in 1950, but the outhouse stayed in use too.)

DeBakey loved working with collections at the AML, but became increasingly concerned about its future as he watched conditions worsen. In 1946 he joined the Association of Honorary Consultants to the AML, one of several groups engaged in discussions about how to fund a new building and where it should be located. Most of the groups agreed that a site in Bethesda on or near the National Naval Medical Center would be best. Many also believed that the library should be separated from the Army and made a component of another federal agency, where it wouldn't need to compete for military funding. But which agency? For the next nine years, the Honorary Consultants, and a number of committees, government agencies, and individuals discussed the question, proposing the Federal Security Agency, the Department of Health, Education, and Security (later Health, Education, and Welfare), the Library of Congress, and others as alternatives. As DeBakey noted later, these discussions accomplished little beyond emphasizing the need for a new library building. In his own analysis, presented in 1950, he argued that the central problem was that the AML had outgrown its original mandate; it had "been developed by a military agency into a national institution primarily for civilian purposes and was expected to fulfill this function without proper authorization." The Surgeons General therefore had difficulty in justifying operating funds on either a military or a legislative basis. The library's problem could not be resolved until the purpose and function of a National Library of Medicine was defined and a legislative authorization for its activities was obtained. DeBakey also recommended that it should be closely associated with a medical agency and operated as a medical, not a general library, and should be sensitive to the demands of the medical profession and medical scientists.

DeBakey's recommendations were not taken up immediately, but he continued to push them. Fortunately, he was recruited to the Medical Task Force of the second Hoover Commission by Tracy Voorhees, with whom he'd served on the first Hoover Commission. He was able to get his suggestions included in the commission's recommendations. When the commission's report went out in 1955, DeBakey and others encouraged Senators Lister Hill and John F. Kennedy to draft legislation for a National Library of Medicine, within the Public Health Service. They introduced the bill in March 1956. While the legislation was evolving, controversy developed over the location of the new library, as some supporters lobbied to locate it near the American Medical Association in Chicago, and others wanted it on the NIH campus. The bill was held up by Sam Rayburn (D-Texas), the Speaker of the House, because with the Democratic National Convention approaching, he didn't wish to encourage hostilities within the Democratic National Committee. Senator Hill believed the bill would pass if Rayburn could be persuaded to release it for a vote, and asked DeBakey if he knew anyone who could help. DeBakey wasn't yet well-established in Texas, but he did know the secretary of the Democratic National Committee, Dorothy Vredenburgh--he had operated on her husband. He asked her to talk to Rayburn, and a few days later Mrs. Vredenburgh reported that the bill would be released. On August 3, 1956, President Eisenhower signed the National Library of Medicine Act into law. DeBakey was appointed to the NLM Board of Regents, and successfully campaigned for locating the new building on the south end of the NIH campus, where it opened in 1962. He served on the board for many years and continued to be an enthusiastic advocate for the NLM.