Both The National Library of Medicine Classification and MeSH originated at the National Library of Medicine or NLM, the national medical library of the United States. The NLM traces its roots to the Library of the Surgeon General’s Office, which was established in 1836. In 1922, the Library was renamed the Army Medical Library, and in 1952 it became the Armed Forces Medical Library. In 1956 the Library was transferred from the authority of the Department of Defense to the Department of Health and Human Services and renamed the National Library of Medicine.
The NLM is currently located in Bethesda, Maryland. The library has the largest medical collection in the world, consisting of more than 9 million items. In addition to developing and maintaining both the NLM Classification and the MeSH vocabulary, the NLM is at the forefront of developing tools for the organization of medical information and bioinformatics research. These efforts include:
- The maintenance of the MEDLINE database, its PubMed search interface, and a digital repository of freely accessible biomedical literature
- The indexing of nearly 5000 journals for the MEDLINE database using MeSH terms
- The NLM leads work to develop a Unified Medical Language System, which will provide a way to translate among various medical controlled vocabulary systems including MeSH, ICD-9, ICD-10, LCSH, and many other systems used throughout the world.
- The NLM maintains several databases of genetic information, including the complete human genome and those of many other species
- They also produce and maintain a variety of powerful tools for researchers investigating genetics, the role of specific proteins in health and disease, and other bioinformatics topics
In 1944, the American Library Association sponsored a Survey Report on the Army Medical Library, which proposed that the 'Library be reclassified according to a modern scheme … combin[ing] the notation of the Library of Congress system with the basic plan of the Cunningham classification' for Medical Literature that was first developed at Vanderbilt University.*
To carry out the recommendation to create a new classification, the Library established a Classification Committee and convened a conference of medical specialists. Based largely input from these groups a Preliminary Edition of the Army Medical Library Classification was produced by Mary Louise Marshall and published in 1948. After several revisions, the 1st edition was published in 1951. When the name of the Library was changed to NLM in 1956, the NLM Classification took the name by which it has been known since.
In 1954, the Army Medical Library issued its first official list of authorized subject headings, the Subject Heading Authority List. After several years working with and refining this list, the NLM published the first edition of MeSH in 1960.
Both NLM Classification and MeSH have been enormously successful. NLM Classification is perhaps the most widely used classification scheme in North American medical libraries, and MeSH is the most common standardized subject language for cataloging and indexing medical literature. NLMC and MeSH are each updated annually, and are freely available for download from the NLM website.
NLM Classification covers both medical sciences and the so-called 'preclinical' sciences. The classification is broken down into 35 main classes, plus an additional '19th Century Schedule' that is used for items published between 1801 and 1913 and which allows these works to be arranged on the shelf near modern medical works in spite of the significant differences in their approach to health sciences and the practice of medicine. Pre-1801 works are classed simply among works on the history of medicine.
Your yellow handout shows the main NLM classes. As you can see, the classes are not all parallel categories. A number of classes focus on systems, others on types of disorder, and others on categories of patients. Still others are devoted to the health professions or health care facilities.
In terms of subject coverage, the NLM Classification is well-suited for most contemporary medical collections, both at academic institutions and in hospitals. For librarians, the schedules are simple, straightforward, and enumerative, with the result that they are fairly easy to apply. The only schedules beyond those covering the main classes are those for 19th century works and a table for noting relevant geographic aspects of a work.
Perhaps the most significant strength of the system is that it was designed to be used in conjunction with LCC. This allows collections using NLM Classification to seamlessly integrate works not covered by NLMC into their shelf arrangement. These might include works on mathematics, statistics, psychology, animal husbandry, or any number of other subjects on the margins of medical research and practice.
Although NLMC adequately covers contemporary North American medical practice, it is less well suited for classification of alternative medicine or non-Western approaches to health and medicine. As can be seen from the outline of main classes on your handout, NLMC is firmly rooted in Western notions about the body and the nature of disease. This is generally appropriate, as the primary users of libraries using NLMC are practitioners or researchers of Western medicine. As interest grows in alternative and non-Western traditional medicine, however, we can expect to see more such works being acquired by NLMC collections.
A second potential problem area for NLMC is that it is concentrated on the patient as an individual. Public health and social medicine receive relatively brief treatment. While this is not a significant concern for hospital and other exclusively medical collections, it is a potential weakness when NLMC is used by various governmental public health agencies or by academic libraries serving public health, social medicine, or medical anthropology schools or departments.
As I mentioned, the NLMC schedules are highly enumerative. This can be viewed as a weakness when one considers that there is no analytico-synthetic potential built into the system. As a result, the system does not typically describe the item’s subject content as deeply as is possible in other systems.
The notational structure of the NLM Classification is quite simple. The 35 main classes are each indicated by a two-letter combination (or, in one case, by a single letter). Subordinate classes in each category are indicated by integers, in some cases followed by a decimal element. The next element in a typical NLMC call number is a Cutter number for main entry, often paired with a work mark, followed up with a publication year. Some materials are also given a geographic code from Table G, the only supplementary table used in NLMC. These Table G codes function like Cutter numbers and are placed between the class number and the main entry Cutter. They are used most often for arranging serials published by governments, hospitals, or other organizations. In the example on the screen, the Table G code is used to arrange the records of the Boston Lying-in Hospital near those of other Massachusetts institutions.
The NLMC schedule is arranged into two main divisions. QS through QZ represent a range of 'preclinical' sciences, that is, subjects like anatomy and physiology, biochemistry, or pathology, the study of which is not directly tied to patient care. These are also the subjects first studied by students pursuing a medical education. The subjects classed in W through WZ relate more directly to the practice of medicine (although topics like hospital administration and the history of medicine are also covered here).
The ordering of the classes is based on that of the Cunningham classification developed at the Vanderbilt University medical library. According to Eileen Cunningham, the arrangement was intended to 'conform to the curriculum and subject sequence of medical teaching' and further to arrange the 'anatomical regions and systems of the body … in logical sequence.' To be quite honest, the logic of this arrangement somewhat escapes me, both in NLMC and Cunningham’s classification. Part of the reason for this is that many of the main classes are not exactly parallel to one another (for instance, Public Health, the Digestive System, and Surgery). Even what might seem to be an obvious natural order is not always observed. While Obstetrics follows Gynecology, it is itself immediately followed by Dermatology rather than Pediatrics.
In comparing NLM Classification to the two most common general classifications used in North America, it is most like the Library of Congress Classification. This is primarily due to the fact that the notation of NLMC was designed to be an expansion of LCC into notational areas excluded from the LC schedules. This choice allows for non-medical books to be classed using LCC and easily shelved into NLM collections with minimal disruption or confusion for the user.
The schedules are very highly enumerative, with almost no number building possible. The only schedule occasionally applied is the Table G of geographic codes. There is an additional '19th Century Schedule,' but it is nothing more than a guide for appropriately classing works published between 1801 and 1913 within the 35 main classes (this is necessary because of the numerous discoveries and the exponential development of medical sciences since the early modern period).
The overall structure of the system is quite loose, especially when compared to DDC. Although there was an attempt to describe structural relationships among and within the classes, NLMC numbers come nowhere near to the expressiveness of Dewey numbers. The classification is much more like LCC in this way, and is largely a 'mark it and park it' system.
Having said this, NLM classification deliberately uses repetition of numbers within the classes as a mnemonic device. Just as --092 indicates biography in DDC, in NLMC --4 or --100 usually indicates general works and textbooks, --39 handbooks, --17 atlases or pictorial works, and (as the example on the screen shows) --18.2 always indicates educational materials.
All in all, while NLM Classification is a sufficiently functional system for locating documents relative to one another, it is a fairly basic tool for describing the content of an item. Luckily, it is not the only system used by medical libraries and their users. Complementing the NLM Classification is subject description using MeSH, or Medical Subject Headings, a robust, medically-focused controlled vocabulary that is also maintained by the National Library of Medicine.
MeSH is a controlled vocabulary for describing the subject content of biomedical literature. Designed as a specialized vocabulary, it is obviously optimally suited for biomedical items, and is a less effective tool for describing non-medical materials. Although MeSH will no longer be published in print after the 2007 edition, I’ve included material from both print and electronic versions in the handouts.
Structurally, MeSH is a poly-hierarchical system. That is to say, any term may have multiple parent terms as well as multiple daughter terms. For a visual example of how this works, take a look at your green and blue handouts illustrating the tree structure for the terms Alzheimer Disease and Sjögren’s Syndrome. In the green Sjögren’s example, the syndrome is hierarchically related to five different categories of disease through six different paths. The advantage of such a structure is that it permits the user to adopt various approaches to arrive at the material sought. For example, in the case of Alzheimer’s (blue), it allows one to view the condition both as a disease and a psychological disorder, distinct first-level categories in the MeSH system.
The syndetic structure of cross references includes several relationships that we have seen in other systems. Looking at your green, blue, and beige handouts, you can see examples of the system of cross references in both the electronic and print versions of MeSH. These are indicated using slightly different terms in the print and electronic versions, and include:
- See Also (electronic)/See related (print) references point the cataloger, indexer, or searcher to related terms. The print version also includes an XR reference (see the Neoplasms example) that provides a backward reference to a See related reference from another descriptor (this is handled behind-the-scenes in the electronic version).
- Entry Term (electronic)/X (print) references are straightforward Used For references
- Broader and narrower term relationships are indicated through reference to the MeSH tree structure. These are expressed through the Tree number, the alphanumeric code given immediately under the heading. These can be looked up in print, but are most effectively browsed visually online.
- MeSH also includes Consider Also references which point to other terms that, while perhaps not as strongly related as See Also references might be relevant to catalogers, indexers, or searchers.
One of MeSH’s greatest strengths for searchers is that it is designed to show complex relationships among terms. Researchers can come at their problem through various paths through the poly-hierarchical structure. Similarly, one can work backward from a problem in multiple directions. With the use of a well-designed tool, such as NLM’s PubMed interface to the MEDLINE database, very sophisticated explorations of the literature are possible.
For catalogers and indexers, an important strength of MeSH is that it provides scope notes and annotations for every term and qualifier. For those of you who have struggled to understand what is intended by a particular heading or subheading, the value of even minimal scope notes is immediately obvious.
Yet another strength of MeSH is tied to its use. MeSH is used to describe both monographic literature as well as to index papers published in journals. This provides for a consistency of subject description in biomedical fields that may be lacking in other disciplines.
The MeSH vocabulary provides for extremely specific and exhaustive description of biomedical topics. For dealing with the more general works that may be included in medical collections, MeSH may not always be sufficient. As was the case with the NLM Classification, MeSH is strongly oriented toward Western medical science and practice, although it does provide terms for a variety of concepts and therapies drawn from both traditional and alternative medicine.
The vocabulary attempts to treat each descriptor consistently with respect to parallel terms. One way that this goal is achieved is through the use of scope notes and explicit instructions relating to the use of subheadings (or 'qualifiers' ias they are called in MeSH).
The fact that MeSH is a specialized vocabulary makes it a bit easier maintain internal consistency within the system. Systems which attempt to classify the universe of knowledge like Dewey, LCSH, or Colon Classification are forced to struggle to consistently treat concepts that are not parallel or easily comparable. The limited scope of MeSH allows for a much more closely regulated approach.
The full potential of the MeSH vocabulary becomes apparent when one constructs a subject search using NLM’s PubMed interface to MEDLINE. Your pink handout illustrates and example of this. If you’ve never explored PubMed before, I strongly encourage you to do so. It is a fantastic example of a well-designed database search tool combined with an equally robust and well-designed controlled vocabulary system.
Terms in the MeSH vocabulary can be coordinated in a number of ways to describe an item. Although an attempt is made to precoordinate concepts in creating specific descriptors, there is usually a need to postcoordinate terms as well to provide an adequate description for the subject content of an item.
There are a couple of ways that this can be done:
The first is through the use of subheadings, or qualifiers as they are known in the MeSH terminology. In the 2007 edition of MeSH there are 83 possible qualifiers. Of course, not every qualifier is suitable for combination with every MeSH designator. For this reason, the documentation for each qualifier includes both a note describing its use as well as general guidelines as to what terms are appropriate for combination with the term. This is done through the use of notations referring to the MeSH tree structure (in the parasitology example on the screen, A represents anatomy, B1-3 various sorts of organisms, C diseases, and so on). Looking back to your blue, green, and beige handouts, you can also see that the full description for each MeSH term provides a list of qualifiers that are valid for combination with the term.
The second approach to postcoordination is to apply several terms to the item in order to describe the material. This approach is illustrated in the second example on the screen. This is a fairly typical monographic example, but descriptions of journal articles in the MEDLINE database often include as many as fifteen descriptors. These may include terms such as 'Human' or 'Female' allowing searchers to narrow their results as necessary, for example when seeking information for very specific clinical applications. To cut out some of the noise this creates in situations where it is overly descriptive, indexers identify some headings as major topics for a paper. These major headings can be searched independently by the researcher if desired, with or without combination with one or more secondary terms.
I’ve included two monographic records in MARC format and a MEDLINE record on the lavender and rose pages of your packet so that you can look at examples.
MeSH offers an advantage over LCSH for describing medical literature in that it is able to provide more detailed descriptions by virtue of its greater specificity for biomedical topics. This is to be expected for a vocabulary specifically designed for a limited field. Of course, medical collections often include items that cover non-medical topics, so LCSH may be used as a complement to MeSH description.
Structurally, MeSH tends to be more compact than LCSH. While LCSH headings may often be followed by two or three subheadings, individual MeSH descriptions generally consist of a heading alone or a heading plus a single qualifier. In order to achieve a well-rounded description of the entire item, however, several MeSH headings are generally required.
Yet another major difference from the point of view of the cataloger or indexer is that the documentation for MeSH is more thorough than that provided for LCSH. While there are a number of sources for information about LCSH, many of them are poorly organized or difficult to use. When seeking guidance for appropriate usage, LCSH suffers from inadequate or nonexistent scope notes for the clarification of potentially ambiguous terms. The NLMC documentation provides clear and definite instruction concerning the use of designators and the application of qualifiers.
While MeSH and LCSH show differences with respect to scope, structure, and documentation, it is important to remember that they both have their strengths. MeSH provides very detailed and specific treatment of medical topics, while LCSH had a broader scope and permits more extensive use of heading/subheading combinations. Ultimately, the power of either system relies upon the diligence of the cataloger, the design of the retrieval tool, and the skill of the searcher.
The cream-colored page of your packet shows some examples of MeSH and LCSH terms side-by-side.
LIS417: NLM Classification and MeSH - Presentation Transcript
National Library of Medicine Classification
and Medical Subject Headings (MeSH)
Joshua A. Parker
4 December 2007
LIS417: Subject Cataloging & Classification (Joudrey)
Graduate School of Library & Information Science
Simmons College • Boston, MA
NLM Classification & Medical Subject Headings (MeSH)
The National Library of Medicine
National medical library of the United States
1836: Library of the Surgeon General's Office
1922: Army Medical Library
1956: National Library of Medicine
Largest medical collection in the world
Developed and maintains the NLM Classification
and Medical Subject Headings (MeSH)
MEDLINE, PubMed, and PubMed Central
UMLS (Unified Medical Language System)
Maintains several databases of genetic information
Produces advanced bioinformatics research tools
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
Development & History of NLMC & MeSH
1944: Need for a new specialized medical
classification system recognized
1948: Preliminary edition of the Army Medical
Library Classification published
1951: First edition of Army Medical Library
Classification published
1954: Subject Heading Authority List published
1960: First edition of MeSH published
Present: NLMC & MeSH updated annually and are
freely available for download at www.nlm.nih.gov
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
NLMC: Basic Structure, Strengths, & Weaknesses
Basic Structure
Covers preclinical as well as medical sciences
35 main classes
Supplemental 19th Century Schedule
Strengths
Well-suited for most contemporary medical collections
Simple, highly enumerative structure; easy to apply
Accommodates the use of LCC for non-medical works
Problem Areas
Alternative and non-Western medicine
Public Health/Social Medicine
Not analytico-synthetic; limited descriptive potential
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
NLM Classification: Main Classes
QS Human Anatomy WI Digestive System
QT Physiology WJ Urogenital System
QU Biochemistry WK Endocrine System
QV Pharmacology WL Nervous System
QW Microbiology and Immunology WM Psychiatry
QX Parasitology WN Radiology. Diagnostic Imaging
QY Clinical Pathology WO Surgery
QZ Pathology WP Gynecology
WQ Obstetrics
W Health Professions WR Dermatology
WA Public Health WS Pediatrics
WB Practice of Medicine WT Geriatrics. Chronic Disease
WC Communicable Diseases WU Dentistry. Oral Surgery
WD Disorders of Systemic, Metabolic or WV Otolaryngology
Environmental Origin, etc. WW Ophthalmology
WE Musculoskeletal System WX Hospitals and Other Health Facilities
WF Respiratory System WY Nursing
WG Cardiovascular System WZ History of Medicine
WH Hemic and Lymphatic Systems 19th Century Schedule
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
NMLC: Notation
Structure:
Main Class indicated by letters
Subordinate classes by ordinal numbers
Cutters; special geographic codes (Table G)
The annual report of the Boston Lying-in Hospital for 1947
WX 2 Hospitals, etc. + Serial Hospital Reports
.AM4 Massachusetts (from Table G)
B7L6a Cutter for author + work mark
1947 Year of publication
Arrangement
Division between preclinical & clinical topics
Rough attempt to express structural relationships
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
NMLC: Comparison to DDC & LCC
Notation modeled on LCC
Schedules very highly enumerative, the only
supplementary schedule (sometimes) applied
is Table G.
Less structured than DDC; does not strongly
express relationships among classes
Some mnemonic use of numbers as in DDC
QX 18.2 Parasitology. Educational materials
WI 18.2 Digestive System. Educational materials
WN 18.2 Radiology. Educational materials
WZ 18.2 History of Medicine. Educational materials
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
MeSH: Basic Structure & Strengths
Structure
Poly-hierarchical
• The entry for each term fully describes the location of
the term using both visual trees and notation
Syndetic Structure
• See Also/See Related, XR references
• Entry Term/X (Used For references)
• Consider Also references
Strengths
Allows for several approaches to any single term
Scope notes and annotations for every term and
qualifier (subheading)
Used for both monographic literature and indexing
papers published in journals
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
MeSH Structure Example: Alzheimer Disease
DISEASES PSYCHIATRY & PSYCHOLOGY
Nervous System
Diseases Mental Disorders
Central Nervous
System Diseases Delirium, Dementia,
Neurodegenerative Amnestic, Cognitive
Diseases Disorders
Brain Diseases
Tauopathies Dementia
Alzheimer Disease
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
MeSH: Characteristics of the Vocabulary
Extremely specific and exhaustive for medical and
medically-related topics
Vocabulary designed to treat each term consistently
in comparison to other parallel terms
Limited subject field helps maintain internal
coherence
Particularly powerful when used with NLM's
MEDLINE/PubMed, allowing for the construction of
very focused searches
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
MeSH: Facilities for Coordination
Use of Qualifiers
Each qualifier has a note detailing its use
parasitology (A, B1, B2, B6, C, E7, F3, J2) PS, parasitol
Used with animals, higher plants, organs, and diseases for parasitic factors. In
diseases, it is not used if the parasitic involvement is implicit in the diagnosis.
The description of each MeSH term includes a list of
allowable qualifiers
Application of multiple terms
245 00 ‡a Salivary electrostimulation in Sjogren's syndrome.
650 _2 ‡a Xerostomia ‡x therapy.
650 _2 ‡a Xerostomia ‡x etiology.
650 _2 ‡a Sjogren's Syndrome ‡x complications.
650 _2 ‡a Salivary Glands ‡x secretion.
650 _2 ‡a Electric Stimulation Therapy.
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
MeSH: Comparison to LCSH
MeSH designed for a specific set of
disciplines (medical sciences; associated
basic and social sciences; health
administration, etc.)
Permits much more specific description for these
fields
LCSH may also be required to adequately
describe non-medical works
MeSH documentation much more clear and
exhaustive than that provided for LCSH
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
Current Use of NLM Classification & MeSH
National Library of Medicine
Maintains NLMC and MeSH
Other Medical Libraries
Academic
Hospital
MEDLINE/PubMed
http://www.pubmed.gov/
Powerful tool for using MeSH to search
biomedical literature
Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
NLM Classification & Medical Subject Headings (MeSH)
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Joshua A. Parker • LIS417: Subject Cataloging & Classification (Joudrey) • Simmons College GSLIS • 4 December 2007
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