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On January 30–31, 1978, hospital librarians from around the United States were invited to the National Library of Medicine (NLM) for the “Hospital Librarians Conference” to discuss the needs of hospital libraries and the relationship between them and NLM. As representatives were included from hospital libraries in the then eleven regions of the Regional Medical Library (RML) program, the meeting was later dubbed by participant Judith Topper the “Bethesda Eleven”  (or subsequently Bethesda 11). It resulted in ongoing dialogue between hospital librarians and NLM and modifications to NLM programs.
The hospital librarians who attended the meeting were the following. [Names with an asterisk indicate that an oral history is available or anticipated for the Medical Library Association Oral History Project.]
Region I: Jacqueline Bastille*, AHIP, FMLA, Massachusetts General Hospital, Boston, MA
Region II: Judith M. Topper, AHIP, FMLA, Lawrence Hospital, Bronxville, NY
Region III: Betsy Schreder, Veterans Hospital, Wilkes-Barre, PA
Region IV: Alice Sheridan*, Fairfax Hospital, Falls Church, VA
Region V: Barbara Coe Johnson, AHIP, FMLA, Harper Hospital, Detroit, MI
Region VI: Marilyn Gibbs [Barry]*, AHIP, DeKalb General Hospital, Decatur, GA
Region VII: Judith Messerle*, AHIP, FMLA, St. Joseph Hospital, Alton, IL
Region VIII: Sarah Hill [Memmott]*, St. Luke’s Hospital, Kansas City, MO
Region IX: Jane A. Lambremont*, FMLA, Earl K. Long Hospital, Baton Rouge, LA
Region X: M. Faye Meyn, Sacred Heart General Hospital, Eugene, OR
Region XI: Kay Kammerer, Alta Bates Hospital, Berkeley, CA 
Melvin S. Day, NLM deputy director, later observed that “attendees were selected for their knowledge of the field and their articulateness and outspokenness” and that “these individuals were representatives from hospitals, not of or for hospitals” .
In addition, others were invited as guests to represent the RML program (Michael J. Torrente*, Southeastern Regional Medical Library Program); American Hospital Association (Eloise Foster, AHIP, FMLA); Veterans Administration (James M. Hahn); and a hospital administrator (John Danielson, Capital Area Health Consortium, Newington, CT). A number of NLM staff participated, including Day, who chaired the meeting, and Peter A. Clepper, program officer, Extramural Programs, who served as executive secretary for the meeting .
In welcoming the librarians, Martin M. Cummings, director, observed that they shared the goal of improvement of information services to users in health care settings. He hoped for a better understanding of NLM’s objectives and programs, and a better appreciation by NLM staff of the realities of day-to-day library operations in health care institutions. A series of papers prepared and distributed in advance of the meeting focused the discussions for the meeting. The librarians had been sent background materials prepared by NLM staff as a common starting point and assigned to write comparable papers from their perspective on the same topics. Subjects included extending online services to hospitals, improving the relevance of databases, locator tools, realities of hospital funding, federal support for interlibrary loans, the new copyright legislation, training for librarians, grants for library consortia, and audiovisual needs . (See the agenda at the end of this summary.)
By all accounts, the eleven librarians were articulate and effective in communicating their concerns. They met informally the night before the conference at the suggestion of Messerle to discuss their approach , and they drafted and presented a position statement before the conclusion of the meeting. The NLM account of the meeting calls the discussions “frank, friendly, and informative” and says the “hospital librarians were not reticent about airing their problems,” making suggestions on how NLM might help .
The minutes include twenty recommendations from the conferees, although Day noted later that the meeting objective was an exchange of views, not an effort to reach consensus . The recommendations addressed coverage and indexing terms in publications and databases (such as strengthening coverage of nursing journals, expanding hospital titles in Abridged Index Medicus, and adding subject headings and check tags for hospital administration, marketing, nursing, and social aspects); interlibrary loan (assistance in developing subregional journal locator lists, publicity about proposed changes to delivery system, and consideration of graduated fee for national standard for charges); training (MEDLINE update review sessions by Regional Medical Libraries, simpler writing in the Technical Bulletin, expanded NLM and RML role in continuing education for hospital librarians, leadership and communication skills training, use of self-instructional media, and exchange of training materials by Regional Medical Libraries); communication with hospital administrators (publicity on NLM online services, information on contribution of hospital libraries, and inclusion of health information science in graduate curricula); and outreach (strategies for hospitals of under 200 beds, revision of Resource Improvement Grant Program to allow small hospitals to take advantage, reconsideration of funds for consortia, and more effective use of RML audiovisual consultants) .
The “Summary Statement of Hospital Librarians” presented at the conclusion of the conference pointed to two areas of concern for the future of hospital-NLM relations: the continuation of direct communication and financial and technical support for tools and mechanisms at the hospital library level. They noted the importance of awareness of and involvement in NLM planning to achieve broad-based constituent support and of input by hospital librarians in RML plans and programs .
Although the Bethesda 11 ceased to be a formal forum for communication with NLM , discussion of the conference recommendations continued. At the following Medical Library (MLA) Association Annual Meeting in Chicago in June 1978, Arthur Broering, deputy associate director, Extramural Programs, NLM, spoke at the Hospital Library Section (now called Hospital Libraries Section) meeting on the role of NLM in relation to hospital libraries and the library’s response to the recommendations. Three of the Bethesda 11 (Lambremont, Topper, and Schreder) addressed issues discussed at the conference . The MLA/NLM Liaison Committee meeting at the 1978 meeting also covered items presented by Bethesda 11 members, including the scope of Abridged Index Medicus, the local and subregional union list, and NLM commitment to hospital library development .
At the 1980 MLA Annual Meeting in Washington, DC, the section program was a panel on “NLM and Hospital Libraries: An Update,” which included Cummings. Ernest M. Allen, associate director, Extramural Programs, and Joseph Leiter, associate director, Library Operations, reported on NLM activities arising from the Bethesda 11 conference, and Messerle gave one of the hospital librarian replies . She focused on improved and expanded communication as the primary concern of respondents to a section survey : the need for basic unit (hospital library) input in decision making at the NLM and RML levels, more downward communication on issues affecting the basic unit, and sharing of resources across regional boundaries . Cummings committed to promoting increased representation for hospital librarians in network decision making . The president of the Hospital Library Section reported in 1981 her inclusion as an official observer at the RML directors’ meeting .
NLM prepared a status report on responses to the twenty recommendations for the 1978 MLA Annual Meeting and updated it for the 1980 meeting. It reported that Abridged Index Medicus had increased the number of titles of primary interest to hospitals in 1979 after collecting data from various hospital sources. Outreach to hospitals of fewer than 200 beds had increased, including 44 resource improvement grants. Policies were revised to allow single institutions and consortia to compete for grants on an equal basis and to provide higher personnel support for consortia. Responses to some of the other recommendations described existing mechanisms or the belief that responsibility lay with another organization . The hospital librarians assessed their satisfaction with the responses and did their own identification of what belonged to NLM and what belonged to MLA as part of the MLA/NLM Liaison Committee, the Legislation Committee, or the Hospital Library Section .
The Bethesda 11 meeting is also credited with new program directions, including a decision to actively encourage hospital libraries to become MEDLINE search centers , and for changes in plans for online training, serial holdings data, grant programs, and NLM and RML advisory mechanisms . The decision to approve the inclusion of hospital library holdings in SERHOLD, the database that would underpin automated routing of document delivery requests and union listing, was bolstered by the reception of the idea at the meeting .
The meeting was seminal in raising the awareness of both NLM and hospital librarians about each other’s perspective. As the librarians noted in their summary statement, “Since the environments in which we function and the places from which we come are so different, we feel that regular opportunities for direct communication are necessary if we are to achieve the genuine understanding of one another’s problems and concerns that is essential for progress” . The focus on hospital libraries and their involvement in NLM and RML planning increased after 1978, and acknowledgment must be given to the impact of the conference.
AGENDA OF HOSPITAL LIBRARIANS CONFERENCE
January 30–31, 1978
Hospitals and NLM On-Line Services: Sara Hill and Grace T. McCarn, head, MEDLARS Management Section
Expansion of Data Bases for Subject Areas Relevant to Hospitals: Alice Sheridan and Clifford A. Bachrach, head, Medical Subject Headings Section
Locator Tools, SERLINE and Others: Jacqueline Bastille and Betsy L. Humphreys, AHIP, FMLA, assistant head, Serials Records
Health Library Programs and Hospital Funding Realities: Kay Kammerer and John Danielson
Hospital Library – NLM Relationships and Communications: Judith Messerle, Jane Lambremont, John Danielson, and Carol Spencer, deputy chief, Reference Services Division
Stabilization of Federal Support for Interlibrary Loans and User “Right of Access”: Marilyn Gibbs and Arthur Broering, deputy associate director, Extramural Programs
Copyright Legislation: Faye Meyn and Albert Berkowitz, AHIP, FMLA, chief, Reference Services Division
Assistance and Training for Health Librarians: Betsy Schreder and Richard West, chief, Office of Program Planning and Evaluation
Grants for Hospital Library Consortia: Judith Topper and Doris Doran, program officer, Division of Biomedical Information Support
Audiovisual Needs and Services in Hospitals: Barbara Coe Johnson and Harold M. Schoolman, deputy director for research and education
- Messerle J. Letter to M. Cummings. 15 Feb 1978.
- Hospital medical librarians and NLM. NLM News. 1977 Dec;32(12):2.
- MLA/NLM Liaison Committee reports. MLA News. 1978 Apr;101:5–6.
- Department of Health, Education, and Welfare. National Institutes of Health. National Library of Medicine. Hospital librarians conference [minutes]. 30–31 Jan 1978.
- Hospital librarians, NLM staff discuss mutual interests. NLM News. 1978 Feb;33(2):4.
- Topper J. Letter to J. Messerle. 18 Jan 1978.
- Summary statement of hospital librarians. January 31, 1978. NLM News. 1978 Feb;33(2):5.
- Messerle J. Letter to Bethesda Eleven. 3 Oct 1978.
- Jarvis MJ. Hospital Libraries Section: the first fifty years [Internet]. Medical Library Association; Jan 1999 [cited 24 Jan 2012]. <https://www.mlanet.org/community/sections/history/hls.html>.
- Agenda, MLA/NLM Liaison Committee meeting, June 10, 1978.
- Johnson D. Letter to J. Messerle. 19 Dec 1979.
- Clevesy S. Letter to J. Messerle. 2 May 1980.
- [Messerle J.] Draft of presentation for June 18, 1980, Hospital Library Section meeting. Undated manuscript.
- Clevesy S. President’s message. Hospital Library Section Newsletter. 1980;5(1):1.
- NLM responses to recommendations of hospital librarians. (NLM-EP 6/80.)
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- Humphreys BL. Adjusting to progress: interactions between the National Library of Medicine and health sciences librarians, 1961–2001. J Med Lib Assoc. 2002 Jan;90(1):4–20.
- Humphreys BL. Personal correspondence. 21 Nov 2011.