"We Know What Causes Bad Breath, Do You?": The History of Meadville Public Library's Tel-Med Service

In Spring 2001, when I was working in the Business, Science, and Technology Department of Enoch Pratt Free Library, I had one of the most memorable reference interactions my career. I was wrapping up a telephone call when a wild-eyed man strode up to the desk, hoofed his right foot onto the desktop, and pulled up the leg of his jeans. A large patch of skin on his ankle was badly inflamed. Seepage from several blisters had crystalized into a sticky, amber-colored goo on his sock.

"What's this rash?!?," he barked at me.

By the grace of God, Kate Niemcyzk, Pratt's health librarian, was my partner on-desk. She had decades of experience answering -- and not answering -- all kinds of questions. 

Kate leaned in and explained patiently, "Sir, we know you're in pain and we want to help you as best we can. But we aren't allowed to diagnose medical troubles. Now, we can find you some information on skin conditions and skin care. Or we can get you addresses for walk-in clinics in town. Would that help?" 

After she led the customer and his ooze away, I scrubbed our workspace with Lysol wipes and continued to cover the phones. In between calls, I surfed the Web for some kind of community service that could meet rashy needs. However, I soon got preoccupied by other questions and I let the matter drop.

I don't think of my Baltimore years very often, but they came to mind this week as I was doing research at the Meadville Public Library (MPL). I was skimming Board of Trustees minutes from the late 1970s when I learned that MPL provided an innovative service that was tailor-made to help queasy librarians like me handle consumer health questions. 

It was called Tel-Med.

Founded in 1972 by the San Bernardino County (California) Medical Society, Tel-Med started as a regional service to provide preventative and point-of-need health information for everyday people who might not seek appointments. The society conducted surveys of physicians, health educators, and the public, and used that input to select several dozen consumer medical concerns that were of greatest interest. The doctors wrote 3-5 minute scripts for each topic; the scripts were then revised to be understood by someone with an 8th grade education. The doctors reviewed the edits to ensure accuracy, and, following their approval, the information was professionally recorded on tape. The society set up a phone line and staffed it about 60 hours per week with an operator who responded to callers by playing the cassettes. The pilot project was successful, and two years later, the society received a $150,000 federal grant to develop a self-sustaining service that could be implemented in communities across the country. By the late 1970s, Tel-Med offered a library of more than 300 tapes in English, 200 in Spanish, and procedures for customizing the content for use in other cities. It was available in 180 localities nationwide. 

Before sending its installers from California, Tel-Med required the hosting agency to obtain endorsement and cooperation from the local medical association to ensure that the recordings were appropriate for the region to be served. Hosts were also responsible for setting up any additional phone lines/numbers/services that were needed and supplying operators to handle calls. Technologically, the system included a phone linked to a special audio playback machine that could handle up to 5 cassettes simultaneously -- a cassette deck similar in design to ones then used in radio stations. When someone phoned the dedicated hotline, the operator picked up the receiver, asked the customer which tape they'd like to hear, and inserted the desired cassette. When playback was finished, the tape turned itself off and the deck signaled. The operator removed the cassette, thus reopening the line for another caller.  

MPL's records don't indicate how staff first learned about Tel-Med or who initiated the service. Alice Gertzog, the library's director, was very progressive for the time -- an advocate for outreach to Meadville's most vulnerable residents. However, Laurie Tynan, the library's Assistant Director, was MPL's first Tel-Med coordinator, and judging from records that I encountered at the Montgomery County-Norristown Public Library, where Tynan later served as director, I would say she was a strong proponent of technology. But anyone who read the Pittsburgh Post-Gazette may have seen a June 29, 1976 article (cited below) and subsequent news coverage which described Tel-Med service that was provided by the city's Health Education Center. Just 4 weeks after it opened, it had handled more than 27,000 calls. It's also possible that Gertzog, Tynan, or another MPL employee saw articles about Tel-Med in American Libraries and/or Library Journal (cited below) which were published in Fall 1978. The American Libraries article detailed a successful installation by the Public Library of Columbus and Franklin County which was funded through an LSCA grant and was serving 11,000-12,000 customers per month. The Library Journal piece described a similar library-based service in Prince George's County, Maryland. 

Whatever the case, MPL had to do some wheeling and dealing to offer Tel-Med to its patrons. Judging from the articles in American Libraries and LJ, Tel-Med may have cost as much as $30,000 to set up, plus $8,000 to operate annually -- roughly $170,000 and $45,000 in 2026 dollars. If that were the case for Meadville, getting Tel-Med up and running would have sucked up more than 1/6 of the library's total annual budget. Perhaps for that reason, MPL collaborated with an entity that the minutes often refer to as "MH/MR" or "Mental Health/Mental Retardation" -- possibly a predecessor of CHAPS. Both MH/MR and the local United Way provided initial funding, and as far as I can tell, MH/MR continued to provide most of the program's financing for the next few years. Besides cost, though, there were a few other hurdles. Even though MPL obtained the support of the Crawford County Medical Society as the national Tel-Med program required, the library's board of directors remained concerned about liability. They checked on insurance coverage, and they insisted that MH/MR, rather than MPL, sign the contract with Tel-Med. In other words, MPL would administer the service on MH/MR's behalf, but MH/MR would "own" both the equipment and the legal responsibility. A third issue, staffing, was addressed with volunteers rather than paid employees. A fourth concern, offering a free hotline to everyone in Crawford County, including residents who weren't in Meadville's calling district, was resolved by instructing out-of-towners to dial 0 and ask the phone company's operator for a special connection, "Enterprise 6780."

Laurie Tynan, then Assistant Director of MPL, demonstrating the library's new Tel-Med system. From the Meadville Tribune, October 14, 1979. Copy available in MPL's 1980 scrapbook.

A clearer photo of MPL's Tel-Med equipment, early 1980s.
Image courtesy of Meadville Public Library.

Opening day on October 15, 1979 was quite an affair, with the first call being made by County Commissioner Oakley Lamb, and answered by Donald Leberman, the President of the library's Board of Directors. I haven't yet found a photographic record of that momentous occasion. But two days later, the Meadville Tribune reported that MPL's Tel-Med handled more than 150 calls on day one. The top 3 most-requested cassettes on opening day were "I'm Just Tired, Doctor," "Fears of the After-40 Man," and "We Know What Causes Bad Breath, Do You?" By the following July, when Gertzog compiled her annual report for 1979/1980, MPL had handled more than 10,800 Tel-Med calls. In October 1981, she proudly relayed the news that Tel-Med would receive a two-page spread in the upcoming telephone book. The detailed listing would help callers identify the cassettes they wanted to hear before they contacted the library. 

One side of a pamphlet that promoted MPL's Tel-Med service, while also conveying its proper, non-emergency uses. Copy available in MPL board minute book, 1979-1980.

The reverse of the same pamphlet. In the beginning, it appears that MPL's tape collection consisted of a mix of general health topics, as well as some addiction, mental health, and reproductive subjects that customers may have been reluctant to discuss face-to-face with their doctors. 

MPL's scrapbooks do not cover every year of the 1980s, and unfortunately, the Meadville Tribune isn't accessible online for that decade. But the articles I was able to find provide some interesting details. For example, a piece in the August 28, 1982 edition of the Tribune notes that cassettes on "Female Sexual Response," "Where Did I Come from, Mama," and "So You Love an Alcoholic" were among the most popular at that point. Another article published in the February 24, 1983 issue of the Erie Times includes comments from Judy Fryling, a volunteer operator and possibly a volunteer coordinator. Perhaps prompted by a question about the popularity of so-called controversial tapes, she admitted that "some kids call out of childish curiosity," but that complainers usually calmed down after they actually listen to the content. An anniversary piece in the October 15, 1984 Tribune pictures most of the steadfast volunteers who had been with the service from its beginning: William Johnston (seated), Gerry Johnston, Betty Keifer, and Frances Harrington. Rita Henderson, not pictured, was another 5-year volunteer. The same article mentions that Pat Baussman, the technical librarian, Jean Marsh, bookkeeper, Lorraine Leech, film librarian, O. Grove, the building's custodian, and more than 70 other people sometimes filled in. 

Some of Tel-Med's most steadfast volunteers. From the October 15, 1984 edition of the Meadville Tribune Copy available in MPL's 1984 scrapbook. 

Even with such dedicated volunteers, the cost of Tel-Med always ran high, as did other technological initiatives of the late 1970s/early 1980s. As early as 1983, it seems that MH/MR faced difficulty scraping up the necessary funds, as there is mention in MPL's board minutes that "MH/MR is now looking very carefully at all of their projects. We think they will finance Tel-Med again this year; if not, we will return the system to them." Again, in 1985, the board learned from Marjorie Hopkins, who had replaced Alice Gertzog as MPL's Director, that MH/MR "wanted funds to continue the operation of Tel-Med and 'would like to have some help' from the Library." The board's point of view was that MPL was already providing "in-kind" support and that the library wasn't "in a position to contribute any money." In the next contract, MPL only received an administrative fee of $2,600, plus some money for additional tapes and telephone service. The next year, MH/MR indicated that it wanted to "discontinue" Tel-Med, prompting Hopkins put out feelers out to Meadville Medical Center. Fortunately, in 1986 MMC agreed to fund MPL's service. In 1987 and 1988 there were several months when usage reached more than 2,000 calls.

Tel-Med's double-page listing in Meadville's 1989 telephone book, showing the range of MPL's cassette collection in the final year that the library operated the service.
Image courtesy of Crawford County Historical Society.

As shown from by the list of cassettes in the 1989 phone book, Meadville's Tel-Med library was extensive -- and socially progressive. While Meadville was/is a college town, it is situated within a conservative area of the state and a significant portion of its funding came from the county. So I was surprised that I didn't uncover any evidence of negative responses from the public. Admittedly, library scrapbooks can be biased toward preserving the more positive news stories while not including embarrassing or distressing ones, but I didn't see any controversies mentioned in the library's board minutes, librarians' reports, or anywhere else, either. It's interesting to compare this to disputes over Internet filtering that occurred just a few years later, during the mid/late 1990s and the early 2000s. People all over the country lost their minds over the possibility of kids accessing digital information about masturbation and other sex-related topics. But in the 1970s-1980s, there wasn't much to stop youngsters from anonymously calling Tel-Med and hearing about it over the phone. What made the difference? -- that Tel-Med was developed and endorsed by medical professionals? That it was delivered via audio, rather than visually? Unfortunately, quite a few of today's cultural warriors, swarming and responding in thoughtless fashion as directed by their favorite pundits, would still try to get it banned, I'm sure, if their libraries tried to provide something as openly-available as Tel-Med was.

Ironically, the popularity of Tel-Med might have speeded its decommissioning at MPL, because it eventually became apparent that the library couldn't meet the public's demand. At the board's February 1989 meeting, Hopkins conveyed that "Tel-Med is a good service, but in its present form it is ineffective." Volunteers were only able to cover the phone about half the time MPL was open, and there were an increasing number of calls after-hours that couldn't be picked up. By then, Tel-Med offered a newer, automated system that could handle calls 24 hours a day, 7 days a week. After Hopkins and board members investigated the matter further, the decision was made to transfer Tel-Med operations to Meadville Medical Center. By mid-February 1990, the move was complete, and this chapter of MPL's history came to a close.

As I hope my brief description conveys, Tel-Med is an inspiring story from a public-services angle, and a fun story from a technological angle. But in addition, it's a reminder that forward-thinkingness can come from any corner of Pennsylvania. With just 13,000 residents, Meadville is a small town within a small county. But its employees and volunteers showed enormous creativity and energy in promoting their neighbors' mental and physical well-being. 

For more information about Tel-Med:

• Harer, W. Benson, "Tel-Med: A Public Medical Service by Phone," California Medicine, August 1972, 68-70. PubMed, https://pmc.ncbi.nlm.nih.gov/articles/PMC1518590/. 
• Harer, W. Benson, "Tel-Med: A Success Story," Western Journal of Medicine, August 1979, 162-164. PubMed, https://pmc.ncbi.nlm.nih.gov/articles/PMC1271730/.
• "Health Service Inaugurated," [The Tribune (Meadville, PA)], October 17, 1979, n.p.. Copy available in MPL 1980 scrapbook.
• "Health Tapes Popular Here," The Times (Erie, PA), February 24, 1980, n.p.. Copy available in MPL 1980 scrapbook.
• "Meadville Adds New Tapes," [The Tribune (Meadville, PA)], August 18, 1982, n.p.. Copy available in MPL 1982/1983 scrapbook.
• Meadville Public Library, Board of Directors Meeting Minutes, September 14, 1978, October 12, 1978, February 22, 1979, March 8, 1979, August 9, 1979, October 11, 1979,  February 10, 1983, March 14, 1985, October 15, 1985, November 19, 1985, June 17, 1986, February 16, 1989, July 20, 1989, September 21, 1989, and February 15, 1990. 
• "Medical Info: New Access," Library Journal, October 1, 1978, 1905-1906.
• Pierce, Henry W., "S-E-X is a Hang-up for Health Phone Callers," The Post-Gazette (Pittsburgh, PA), June 29, 1976, 9. ProQuest Historical Newspapers, https://www.proquest.com/hnppittsburghpostgazette/newspapers/june-29-1976-page-9-24/docview/1858213982/.
• Sager, Donald J., "Answering the Call for Health Information," American Libraries, September 1978, 480-482. JSTOR, https://www.jstor.org/stable/25623424. 
• Smith, Jane. "Tel-Med Marks Fifth Anniversary," [The Tribune (Meadville, PA)], October 15, 1984, n.p.. Copy available in MPL 1982/1983 scrapbook.
• "Tel-Med in Operation," [The Tribune (Meadville, PA)], October 14, 1979, n.p.. Copy available in MPL 1980 scrapbook.
• "TEL-MED Opens Fifth Year," [The Tribune (Meadville, PA}], October 15, 1983, n.p.. Copy available in MPL 1982/1983 scrapbook.
• "Telephone Health Tapes Now Offered by Library," [The Tribune (Meadville, PA)], October 13, 1979, n.p.. Copy available in MPL 1980 scrapbook.
• "Volunteers Operate Tel-Med," The Times (Erie, PA), February 24, 1983, n.p.. Copy available in MPL 1982/1983 scrapbook.