Armed Forces Institute of Pathology: Its First Century 1862-1962/Chapter XVI

by Robert S. Henry

CHAPTER XVI

Carrying On in the "Old Red Brick"

During the decade of determined effort to procure and occupy the new building, there had been no cessation or slackening of the work which went on in the cramped and crowded corridors and rooms of the building, which for nearly 70 years had been the home of the Museum and its offspring, the Institute (fig. 99). On the contrary, sharp increases in the output of the staff were necessary to meet the rising demand for the fundamental services of consultation, education, and research in pathology.

In 1947— the first year in which the change of emphasis from "Museum" to "Institute" became fully effective— newly accessioned cases numbered 21,764. Two years later, after the field to be covered had been broadened from the Army to the Armed Forces, the number of new cases rose to 36,029— and the real rise in the flow of materials into the Institute had just begun. 1^[1] Already, however, the "heavy and unrelenting pressure of the daily routine" was imposing a "serious hardship on all members of the professional staff." As the Director of the Institute said, in his report for 1949, it was "barely possible to keep up with the incoming material during the working day when ancillary personnel is available, study and scientific research must be relegated to nights and week ends."

In the year 1950, the first full year of operation as the Armed Forces Institute, the number of cases received went up to 49,518, despite the fact that 13 histopathology centers had been established for the dual purpose of facilitating diagnosis and consultative services by providing them "in closer geographic relationship to Armed Forces Hospitals" and reducing the pressure upon the Institute by screening out commonplace specimens before submittal. Under the new regulation, materials from all completed autopsies were still to be sent in, but surgical specimens sent in were to be limited to those which had "future administrative, scientific, or follow-up value." 2^[2]

Instructions were made more specific in a special regulation issued on 8 June 1950, which required that all specimens derived from surgery on tumors

Figure 99.—Close quarters. A. Personnel of the Histopathology Laboratory worked under great difficulties in the old red brick building in the 1940's. B. File cases were not only stacked 11 high, but were frequently located in halls or corridors.

or tumor-like conditions and other surgical specimens as to which final or confirmatory diagnoses were called for, be sent in to the Institute. Other surgical specimens did not need to be forwarded to the Institute unless they contained noteworthy lesions. As a guide to the kind of materials which were not required to be forwarded, the special regulation listed n classes of such specimens, including such commonplace items as appendices, tonsils, and adenoids, and such comparatively rare items as arms and legs amputated for injury or infection. Even as to these excepted groups, specimens were to be forwarded if there was any doubt as to their importance. 3^[3]

For a time, it seemed that despite the effort to apply restrictions, nothing would diminish the flow of materials into the central laboratory of the three armed services and the Veterans' Administration. In 1951, the year after the new regulations went into effect, the cases accessioned numbered 52,378. In 1952, the flow reached its high water mark with 118,704 cases, of which 29,008 came from deactivated naval hospitals and 89,099 from current operations (fig. 100). Accessioning was completed that year for only 67,909 cases, the remainder of nearly 50,000 cases going to swell the massive backlog of work. "Lack of adequate laboratory and office space continues to be a most distressing situation," the Director reported. "Relief must await movement into the new building in 1954." 4^[4] Slight relief was found in 1953, when 79,212 cases were received — nearly 10,000 fewer than those from current operations in the previous year. There was a further reduction to 64,836 cases in 1954, and it appeared that efforts to bring about a more manageable flow of materials into the Institute were showing results.5^[5]

Even so, the daily inflow of pathological materials requiring attention averaged some 200 cases a day — a situation which made necessary some system for sorting out the incoming cases which required expedited handling. Since no one could be quite so well acquainted with the requirements of each case as the doctor submitting the specimen, contributors were asked to indicate the handling desired under the proper one of four classifications. The code word "Telegraph" called for immediate attention and the fastest service which could be given, with reports made to the contributor by cable, radio, telegram, or telephone. The code word "Rush" called for handling as speedily as possible, second in priority only to requests under "Telegraph," with answers sent out by airmail. "Comment" requests were answered with staff findings

Figure 100.—Mary Frances Gridley, compiler of a manual of Histologic and Special Staining Technics issued in 1952. After her death in December 1954, her fellow workers had the manual reissued in a memorial edition.

concerning autopsies, surgical materials, or a questionable change in the tissues submitted, with reports going out by ordinary mail. Material submitted under the code word "Routine" was acknowledged with any comment which was warranted by the material, but handling was not expedited.^[6] Such increases in the work of the Pathology Department were matched in greater or lesser degree by rising workloads in the other departments— the American Registry of Pathology; the Medical Illustration Service; the Medical Museum; and the Administrative Service, set up in 1947 to perform those functions which were essential to the operation of the four basic departments but were not exclusively related to any of them.

With such increases in the work to be done, there had to be increases in the staff which had the work to do. The staff, including commissioned and enlisted military personnel and civilian employees, numbered 172 at the end of 1946; 230 a year later; 251 in 1949; and 282 in 1950. In 1951, the staff numbered 338, including 15 officers attached for training in pathology as one step toward meeting the general shortage of pathologists, to which was ascribed the Institute's inability to fill all its authorized positions for medical officers and the failure to secure applicants for all the Institute's openings for residencies. By the end of 1952, the staff had increased to 338, and a year later had gone up to 365. The figure rose again to 438 by the end of 1954, the last year in the old building. 7^[7]

The Cooney Committee

In anticipation of the removal of the Institute from its old quarters to the new building which was beginning to rise on the grounds of the Walter Reed Army Medical Center, Surgeon General George E. Armstrong recommended that "studies be made of the missions and operational procedures of the Armed Forces Institute of Pathology." This recommendation was supported by the Armed Forces Medical Policy Council of the Department of Defense and, on 12 December 1952, Dr. Melvin A. Casberg, chairman of the policy council, sent to General Armstrong a memorandum requesting the establishment of an ad hoc committee to study the "scope and effectiveness" of the program of the Institute.

The Committee, set up on 14 January 1953 by Maj. Gen. Silas B. Hays, Acting The Surgeon General, consisted of Brig. Gen. James P. Cooney, representing the Surgeon General of the Army; Capt. John H. Ward, representing the Surgeon General of the Navy; Brig. Gen. Earl Maxwell, representing the Surgeon General of the Air Force; Brig. Gen. Elbert DeCoursey, representing the Institute; and Robert A. Moore, M.D., dean of the Washington University Medical School at St. Louis, and chairman of the Scientific Advisory Board of the Institute. General Cooney was chairman of the ad hoc committee, which accordingly was known informally as the Cooney Committee.

The Committee's conclusions and recommendations were asked for as to the services of the Institute to the Armed Forces, other Government agencies, the civil professions, and foreign governments, and also as to its educational program. Special attention was directed to possible changes in the missions of the Institute, in the next few years, with consequent expansion or curtailment of activities.

In a report submitted on 9 March 1953, the Cooney Committee recommended that the services of the Institute to the three Armed Forces be continued under the terms of the charter embodied in Army Regulations No. 40-410, Navy Bureau of Medicine and Surgery Circular Letter No. 50-8, and Air Force Regulation No. 160-38, issued jointly by the three services on 15 February 1950, and enlarged upon in detail in a descriptive circular "Central Facilities Provided for Department of Defense by Armed Forces Institute of Pathology," issued on 8 June 1950, as Special Regulations No. 40-410, Bureau of Medicine and Surgery Circular Letter No. 50-50, and Air Force Regulation No. 160-55.

In addition to the services of the Institute to the Armed Forces, the Committee approved the arrangement with the Veterans' Administration as "an essential part of a vast plan of collective research whereby former military personnel may be followed through the various medical vicissitudes of their lives to old age and death," to the end that medical services for the military might be improved. The Committee likewise approved the cooperative arrangements between the Institute and the U.S. Public Health Service, the Atomic Energy Commission, and the medical, dental, and veterinary professions.

The Committee further approved the Institute's instruction in advanced pathology as part of a general program of residencies, postresidency on-the-job training, special pathology seminars, and review studies in pathology for medical officers preparing for examinations by the specialty boards in pathology or other medical or surgical specialties. The practice of the Institute in sending out loan sets to those unable to come to the Institute for study, was approved by the Committee. These sets consisted of microslides with related data, clinico- pathological materials, duplicate gross specimens from the museum collections, lantern slides, photographs, filmstrips, and motion pictures when available.

In general, the Committee gave its approval to the organization and operations of the Institute, including plans for a broader scope of work in the eagerly awaited new building. It was the opinion of the Committee, however, that the production of original motion pictures should be discontinued as soon as each of the Armed Forces had opportunity to provide for such services on its own account. The Committee felt, also, that "no useful end is served by requiring all pictures and films be sent to the AFIP" but did believe that "a central file of pictures and films of general educational value should be maintained at the AFIP." Accordingly, it recommended that the requirement of sending in all pictures and films should be limited to those of "general educational value." In its closing remarks, the Cooney Committee recognized the Institute as a "unique institution" for consultation in pathology and for the investigation of disease, filling a "need both of military and civilian medicine." Because of the "better approach to medical care" inherent in its educational facilities and methods, the Committee said, "the Armed Forces Institute of Pathology has been called 'the Postgraduate School of Pathology' for the United States and even for the world." 8^[8]

Maj. Gen. Silas B. Hays, the Deputy Surgeon General, concurred in the recommendations of the Cooney Committee, and agreed that the functions and level of operations set forth in the report were desirable. In the light of recent trends toward curtailment rather than expansion, however, he asked the advice of the Committee on the "functions to be performed and the level of operation" which should be sought under each of four assumptions— a continuation of support at the current level, and reductions of 10, 20, or 30 percent under that level.

The Committee accordingly reconvened and, on 26 March 1953, answered the general's inquiry. The "practice of pathology," it said, constituted more than 70 percent of the activities of the Institute and curtailment of this service would interfere with the development of the Institute as the central laboratory for the military services. Furthermore, the Committee said such portions of this work as were not done by the Institute would of necessity have to be done elsewhere by each of the Armed Forces, "or else the patient would suffer."

In the light of these considerations, and the further fact that the Institute was organized "to provide at the least cost possible a maximum of pathology," the Committee felt that this service "must be kept intact" and that whatever cuts might have to be made should be in the activities of the Institute which "might be considered as ancillary." Even if available funds should remain at the current 1953 level, the Committee said to "keep up with the normal increase of the pathology workload, there would have to be substantial curtailment of other activities," while a cut of as much as 30 percent in funds and personnel would mean the abolishment of all services other than that of pathology consultation, and serious curtailment of even this remaining central feature of the work of the Institute. 9^[9]

Fortunately, no such drastic cuts proved to be necessary, and the demands for consulting service in pathology did not go up to the extent anticipated. This was due, in part at least, to the more selective screening of cases in the histopathological centers, resulting in a reduced flow of pathological materials to the Institute. In 1952, the year before the Cooney Committee made its report, nearly 119,000 new cases were received, including the 29,000 cases from deactivated naval hospitals. With these figures before them, the Committee estimated a workload of 101,000 new cases in 1955, and 106,800 in i960. Actual requirements in those years, as it turned out, were fewer than 63,000 new cases in 1955 and only slightly more than that figure in i960. 10^[10]

Atomic Bomb Research Unit

These figures do not include the cases received by the Atomic Bomb Research Unit set up in 1948 under an arrangement with the Atomic Energy Commission by which the Army Institute of Pathology made its facilities available "for the filing and custodial care of pathologic material and related records of interest to the Atomic Energy Commission." 11^[11]

The group assigned to this special work, known as the "A-Bomb Unit," was charged with processing "all pathologic material and case histories collected by the Atomic Bomb Casualty Commission in Japan in a fifty-year follow-up study of the victims of the atomic bomb and descendants of irradiated victims." The unit had received, by the end of 1954, specimens and case histories for 26,735 cases originating in Hiroshima and Nagasaki, in furtherance of its mission of assembling in one place in the United States the information pertaining to the effects of radiation on human beings. Included in this information are the early Japanese reportings of the overall effects of nuclear explosions, and over 200 translations of the Japanese scientific reports dealing with radioactivity, injury, hematology, and pathology. In addition to information from Japan, the Radiation Unit of the Institute collects data, from the atomic and nuclear tests conducted in this country, for the Atomic Energy Commission.

The materials received from Japan have been found of use in a score of special researches, including studies by General DeCoursey and statistical analyses by Francis X. Lynch, supervisor of the unit, and Mardelle L. Clark, Chief of the Statistics Branch of the Institute.12^[12]

Before the studies could be undertaken, it was necessary to correlate the specimens and case histories with the named individuals from whom the specimens had been taken and to whom the histories applied— a painstaking procedure made more complicated by language differences and especially by unfamiliarity with the sound and the spelling of Japanese names which had to be transliterated into some sort of American equivalent for filing purposes.

Studies of radiation effects were not the only medical problem plagued by differences in language and medical nomenclature. Difficulties in diagnosis, made more difficult by the growing confusion in the naming of neoplastic diseases, led to the publication by the Institute of its "Atlas of Tumor Pathology," as a contribution to the broadly based efforts of health organizations to combat cancer. This project had its genesis in discussions at the Fourth International Congress for Cancer Research, meeting in St. Louis, Mo., in 1947, out of which there grew the suggestion that "renewed attempts be made to simplify and standardize the nomenclature of neoplastic diseases and to devise means toward aiding graduate and undergraduate teaching of oncology" — the medical term for the body of knowledge pertaining to tumors.

This suggestion led to the calling of a conference of specialists held in Washington under the joint auspices of the National Research Council and the Scientific Advisory Board of the Army Institute of Pathology, at which it was recommended that a subcommittee on oncology be set up by the National Research Council's Committee on Pathology, as part of the Committee's overall program. In November 1947, the subcommittee was formed with Dr. Shields Warren of Boston, Mass., as chairman; and Doctors Balduin Lucke of Philadelphia, Pa., Arthur Purdy Stout and Fred W. Stewart of New York, N.Y., Milton Winternitz of New Haven, Conn., and Harold Stewart of Bethesda, Md., as members; and Dr. Howard T. Karsner, Chairman of the Research Council's Committee on Pathology, as a member ex officio.

Atlas of Tumor Pathology

This Subcommittee on Oncology was the moving force in the launching of a new "Atlas of Tumor Pathology" to be issued at the Institute of Pathology with the support and sponsorship of the American Cancer Society; the Anna Fuller Fund; the Jane Coffin Childs Memorial Fund for Medical Research; the Veterans' Administration; the National Cancer Institute of the Public Health Service; and the Armed Forces Institute of Pathology.

The first unit of the Atlas to be published recites, on the title page, that the publication was "prepared at" the Institute of Pathology under the auspices of the Subcommittee on Oncology. Subsequent units recite, on the title page, that they are "published by" the Institute, under the same auspices, and that they are for sale by the American Registry of Pathology of the Institute.

The Atlas, it was decided, was to give "preeminently a pictorial representation of the many structural variants which characterize the many kinds of neoplasms." Along with the illustrations, which were to be its outstanding feature, there were to be "adequate explanatory legends," as Dr. Lucké put it, in his introduction to the first of the 39 units or fascicles into which the proposed Atlas was to be divided.

Thirty-two distinguished pathologists accepted the invitation of the Sub-committee on Oncology to prepare the illustrative and text material on tumors of the various organs or anatomical regions which were to be dealt with in the several fascicles. In the preparation of these studies, the authors could draw not only from cases encountered in their own practice but also from cases on file in the American Registry of the Institute. Indeed, the great facilities and resources of the Armed Forces Institute of Pathology were placed at the disposal of the Subcommittee and of the collaborators, authors of the fascicles, who served without recompense other than the satisfaction of having a part in the massive marshaling of the forces of light and understanding directed against the darkness and mystery surrounding the topic of tumors.

The spirit in which the task of publishing the Atlas was undertaken is well stated in a signed foreword printed with the first fascicle. "Only through a continuing coordinated effort of all doctors, civilian and government," the statement said, "can the available specialized knowledge be welded into an

Figure 101.—Samples of the fascicles.

effective resource for all pathologists and medical personnel. The Subcommittee on Oncology has brought together the experience of eminent doctors and the resources of the Armed Forces Institute of Pathology to produce this Atlas to aid in the definition and diagnosis of those diseases grouped together under the term 'cancer'."^[13]

The method of publication in separate units, or fascicles, has many advantages for such a project as the Atlas. The first of the fascicles appeared in 1949 (fig. 101). Twelve years later, in December 1961, seven units were still in various degrees of readiness for the press; 31½ fascicles have been issued and made available to the medical profession as they were readied for publication. The earliest chapters were edited by Dr. Isabella Perry, Executive Secretary of the Subcommittee on Oncology, who was succeeded in 1950 by Dr. Mary Ruth Oldt. Since 1958, Dr. Catherine W. Blumberg, professional associate of the National Academy of Sciences, National Research Council, has been editor of the "Atlas of Tumor Pathology."

The first chairman of the Subcommittee, Dr. Shields Warren, resigned in 1951, to be succeeded by Dr. Lucké who, as chairman, performed the last of his many services to the Institute until his death in 1954, when Dr. Arthur Purdy Stout of the Institute of Cancer Research of Columbia University became chairman. Dr. Paul Steiner of the University of Pennsylvania and Dr. Lauren Ackerman of Washington University, a member of the International Committee on Oncological Nomenclature, were added to the membership of the committee before the move into the new building.

Acceptance of the Atlas has been worldwide, with from 12 to 25 percent of the distribution in foreign lands. The fascicles have met with hearty acclaim abroad as well as at home, although there was some feeling abroad that "perhaps not enough attention has been paid to the nomenclature and opinions of non-American pathologists," as Dr. Stout put it in an editorial article in the American Journal of Clinical Pathology. 14^[14]

The degree of acceptance of the Atlas by the medical profession is indicated by the growing demand for the fascicles as they have appeared. The original print orders were for 5,000 copies of each, a figure which has been increased to 7,500 copies, then to 10,000, and now to 15,000 copies.

In 1949, the year in which the first fascicles appeared, the American Registry of Pathology was designated as the department of the Institute through which sales of the fascicles would be handled. Four years later, in October 1953, Dr. Hugh G. Grady (fig. 102), who had succeeded Col. James E. Ash as Scientific Director of the Registry in 1949, reported that the first four fascicles had been "completely sold out." This "tremendous sale," he added, has been done with nothing resembling a sales organization or any worth- while advertising." 15^[15] In 1954, the last year in the old building, 17,623 copies of fascicles were sold, still without a sales organization in the usual sense, and still without advertising other than word-of-mouth reporting of the merits of the publications. 16^[16]

The fascicles which were sold out have been reprinted, whenever it has been possible to do so without holding up the printing of those as yet unissued, and others which are now out of print will doubtless be reproduced as opportunity offers.

Another arm of the Institute which has a part in the enterprise of publishing the "Atlas of Tumor Pathology" is the Medical Illustration Service, which

Figure 102.—This group is carrying out one of the three prime responsibilities of the Institute, diagnostic consultation, under the direction of Dr. Hugh G. Grady (upper right), Scientific Director, American Registry of Pathology, 1949-1957.

is responsible for the physical production of the fascicles. Because of the highly specialized character of the illustrations which are the distinguishing feature of the Atlas, the negatives used in offset printing are prepared in the Medical Illustration Service's plant, where the closest cooperation between the pathologist and the printer can be assured. Presswork, in the ticklish business of reproducing accurately the photomicrographs which are the heart of the fascicles, likewise can best be done in the Institute's own plant. For these and other reasons, the printing division of the Institute qualifies as an "approved field printing agency" under the standards and rulings of the congressional Joint Committee on Printing. When it came to setting type for the text of the fascicles, however, the situation was different. The type-setting equipment in the Institute's plant was antiquated and inadequate, "necessitating hours of hand setting" which delayed all other operations. Rather than attempting to set type with the equipment it had, arrangements were made to have this done by the U.S. Government Printing Office—an arrangement which is still in effect.^[17]

The American Registry

While both the American Registry and the Medical Illustration Service are integral parts of the Institute of Pathology, both have responsibilities that extend beyond the primary purposes of their parent organization. Thus, the several registries are so many links between the medical services of the Armed Forces and the civilian medical, dental, and veterinary professions. At the beginning of the last decade of the Institute's occupancy of the old building, there were 12 such links; at the time of the move into the new building, the number had grown to 22, each one with a registrar chosen from the Institute's staff of senior pathologists. The separate registries, each working with its own sponsoring organization in medical, dental, or veterinary specialties, are bound together in the American Registry of Pathology.

An important service of the American Registry to the medical profession, civil as well as military, is the circulation of histopathological study sets (fig. 103). These sets are especially appreciated by those who are preparing for examination by the certifying boards of the various organized medical, dental, and veterinary specialties. Before 1949, distribution of these study sets had been on a rental basis, with the fees paid to the National Research Council. This was changed, effective 1 January 1949, to a loan basis, with no charge other than paying the transportation both ways. When the Army Chief of Finance was approached with an inquiry as to the method of property accountability to be adopted under the new system, its legality was questioned. The Logistical Division of the Army General Staff, to whom the question was referred, ruled that the plan was "both authorized and desirable," and directed that the language of the pertinent Army Regulations No. 40-410 be amended so as to make it clear that "the Army Institute of Pathology may supply teaching material, such as sets of prepared microscopic slides to Army installations and qualified professional persons as approved by the Director." 18^[18]

Approximately 50 different study sets, each one containing from 25 to 100 slides, accompanied by a syllabus and other materials, were kept in circulation, with no more than one set at a time loaned to a borrower. More than 10 sets a day were loaned in the last year of occupancy of the old building. 19^[19]

The value of the work of the American Registry was further recognized by the action of the American College of Surgeons which, in July 1953, donated

Figure 103.—A sample study kit.

to it the Codman Bone Sarcoma Registry—the first to be formed in the United States. The collection included 2,374 cases, with specimens and medical histories, on the basis of which much of what was known of the behavior and classification of bone tumors had been developed. The collection became part of the Registry of Musculo-Skeletal Pathology, but retained its name so as "to preserve the identity of the first such Registry created, and to honor Dr. Codman who first conceived the idea of a Registry and follow-ups as an essential feature of medical investigation." General DeCoursey, the Director, expressed the happiness of the Armed Forces Institute of Pathology at receiving "this historical and valuable collection."^[20]

The Medical Illustration Service

In much the same way as the activities of the American Registry extended beyond the strictly military aspects of the Institute into fields of civilian medicine, so the Medical Illustration Service had responsibilities which were broader than the limits of the Institute. These responsibilities were placed on the Illustration Service by the Surgeon General's Office in August 1947, when "certain functions of The Surgeon General's Office pertaining to the preparation and coordination of all Medical Department exhibits were transferred to the Army Institute of Pathology," and all "Medical Department installations and individuals invited to prepare or desiring to prepare an exhibit for a medical meeting, convention or other similar gathering" were called upon to "coordinate the matter with the Director, Army Institute of Pathology, prior to taking any action on a given project." The purpose and effect of the order was to "improve the appearance of all exhibits [of Medical Department functions and activities], eliminate duplication and prevent the presentation of activities and materials not approved by The Surgeon General." 21 ^[21]

In 1947, the first year in which this broader concept of the Institute's Medical Illustration Service was in effect, 25 exhibits were constructed and shown at a like number of meetings. In 1948, the number of exhibits built was 47, for showing at the same number of meetings. The number of exhibits built increased to 81 in 1954, the last year in the old building. In the same year, there were 267 showings of Medical Department exhibits at 121 meetings. In the 8 years ending with 1954, the Illustration Service of the Institute constructed 457 exhibits; attended 393 meetings at which exhibits were displayed; and showed its exhibits 1,217 times. Medals, awards, and official commendations received numbered 52. 22^[22]

The first exhibit which expressed the triservice character of the Institute was one representing all United States hospital services (fig.104)——Army, Navy, Air Force, Veteran's Administration, Public Health Service, and Bureau of Indian Affairs— shown at the 1951 annual meeting of the American Hospital Association in St. Louis, Mo. 23^[23]

Illustrative of the way in which "mileage" was made by multiple showings of the exhibits, as well as the way in which the various departments of the

Figure 104.—President Harry S. Truman inspects an Institute exhibit on U.S. Government hospital services, shown at a meeting of the American Hospital Association.

Institute worked together, was the exhibit on malaria prepared by the staff of the Medical Museum in conjunction with Dr. Ernest Carroll Faust of New Orleans, La., consultant on tropical diseases, and constructed by the Illustration Service. This exhibit was shown at the 1952 annual meeting of the American Medical Association, where it received the Billings Silver Medal, and afterward was set up and shown at the American Public Health Association meeting in Cleveland, Ohio; at Tulane University in New Orleans, La., at the meeting of the American Society of Tropical Diseases at Galveston, Tex.; and was finally placed at Brooke General Hospital at Fort Sam Houston, Tex.^[24]

Building and showing of medical exhibits, however, was but one phase of the activities of the Medical Illustration Service (fig. 105). Its "primary object" as stated by Maj. Carroll F. Naidorf, Chief of the Service for the greater

Figure 105.—Antonio Cortizas, Cuban-born medical sculptor, at work on a heart-lung model. Sergeant Cortizas, a master specialist, died in 1956.

part of the year 1946, was "to make documented medical pictures available for study, research, teaching and publication"—an assignment which, he added, "requires more than a passive acceptance and filing of inadequately documented pictures."^[25]

Major Naidorf's successor as Chief of the Service was Dr. Edward M. Gunn, who had served in the Pacific in World War II, and was at the time of the reorganization of the department a civil service administrative employee of the Surgeon General's Office. Two years later, in 1949, Dr. Gunn described the reorganized Service as the "most complete and well balanced organization of its kind."

The organization thus described included Roy M. Reeve (fig. 106) as Deputy Chief of the Service and Herman Van Cott as Chief of the Scientific

Figure 106.—Roy M. Reeve, who went to work for the Museum in 1917, and for 37 years was its official—and sometimes only—photographer.

Illustration Division. Joseph Carter was Chief of the Photography Division; Don Carlos Ellis, of the Audiovisual Aids Division; and Herbert C. Kluge, of the Illustration Library. In 1950, the Technical Duplication Branch and Photo stat Division was headed by Maj. Floyd C. Egger, and in 1951, a new General Service Division was formed with Lt. Cdr. G. T. Moss as Chief. In the spring of 1952, after 5 years of service, Dr. Gunn resigned to enter private industry, to be succeeded by Mr. Reeve as Acting Chief of the Department, with Mr. Van Cott as Deputy Chief. William E. Macy became Chief of Scientific Illustration. Later in the year, Commander Moss was relieved, due to a change of station, and was replaced by Joseph Q. Conroy. Joseph Carter retired and was succeeded by Julius Halsman as Chief of the Photography Division. The recently renamed Printing Division was headed by Walter Harders, in place of Major Egger, who was transferred. 26^[26]

In March 1953, Don Carlos Ellis, Chief of the Training Aids Division, died from injuries received in an automobile accident and was succeeded by Morris Goldberg.

In December of the same year, Mr. Reeve retired, after 36 years of service, in which he had done much to enhance the position of the Museum-Institute as a leader in the field of medical photography, particularly in photomicrography. He was succeeded as head of the Medical Illustration Service by Herman Van Cott, a graduate in fine arts of Yale University and an artist of distinction in his own right. 27 ^[27]

Rebirth of the Medical Museum

During the last decade of the occupancy of the old brick building by the Institute, the Medical Museum— the mother which "had been overshadowed by its offspring" 28^[28] — began a comeback from the low estate into which it had drifted during and just after World War II. Wartime demands for space had all but squeezed the Museum out of the main building. Museum materials, for which no room was available, had been stored and, as it turned out, not well and safely stored. Rehabilitation started when on 9 August 1946, Chase Hall, a temporary building put up during the war to house the SPARS— the Women's Reserve Corps of the U.S. Coast Guard— was assigned to the Museum, which began to gather itself together again.

The small part of its collections which had remained in the main building were moved across the street, Independence Avenue, into the newly available space. Thither, also, the vans brought materials from storage space on Maine Avenue in Washington, and from a warehouse on Columbia Pike in nearby Virginia.

A year after the occupation of Chase Hall, the Director reported that "the initial post-war stage of chaos with hundreds of boxes of items of unknown type, number, location or condition has given way to a stage of concentrated storage of items of generally known type, condition and location." For the Museum to get "started on its return to its rightful place as an unparalleled working body of scientific and historical medical data in the Western Hemisphere," he added, would require "time, patience, and persistent attention to innumerable details * * * coupled with an adequate staff ." 29^[29]

At the end of another year, it was possible to report that reorganization of the Museum was completed for practical purposes with "transporting, cleaning, repairing, sorting, preliminary cataloguing, temporary storage, final cataloguing, cross referencing, indexing, filing, accessioning, wrapping, packing and final storing of over 126,000 museum items and the salvage or discard of damaged medical items and a great bulk of unrelated or distantly related material." 30^[30]

Three years after the move into Chase Hall, the Director's report for 1950 noted that "the Museum proper has changed from a large vacant recreation hall and assorted smaller rooms to an organized exhibit area with over 300 displays which reflect broad medical interests of value to the public, junior medical officers and specialists."

Back of the transformation, there was devoted and intensive work by the Museum staff, headed by Dr. Ruell A. Sloan, whose outstanding service to the Museum-Institute was soon to end with his untimely death on 17 June 1951. Between 21 March 1947, when Dr. Sloan became Curator, and the submittal of the Annual Report for 1950, the staff had grown from "one physician and a few inexperienced enlisted men to a staff of 21," forming the nucleus of the professional, technical, and administrative personnel necessary to the basic operation of a comprehensive medical museum. 31^[31]

The Pathology, Anatomy, and Embryology Division was headed by Dr. Henry W. Edmonds. A new Information Section was formed with Mrs. Evelyn Drayton as its Chief. The General Service Division, of which Miss Helen R. Purtle was Chief, had reviewed, physically inventoried, partially indexed, and filed over 250,000 museum items of widely assorted types. After storage of some and disposal of other items seriously damaged by hasty war storage and "items useless to current and future development of the Museum" there remained nearly 80,000 items in the working collection. 32^[32]

Upon the death of Dr. Sloan, Dr. Henry W. Edmonds served as Acting Curator until October 1952, when he resigned and was succeeded by Miss Purtle, also as Acting Curator, until the end of the year. At that time, Col. Hugh R. Gilmore, Jr., former Curator, returned to the Museum in the same capacity. 33^[33]

He continued in that position until after the main body of the Institute had moved away, leaving the Museum in the renovated temporary quarters in which it was to be housed for more than a decade.

With all the attention paid to the auxiliary departments of the Institute, the fact remained that it was primarily an Institute of Pathology and that its primary purposes were consultation, education, and research in pathology. In line with this purpose, the members of the staff were active in the preparation and publication of scientific papers on medical topics — the term "medical" as used here and elsewhere in this work being broad enough to cover dental and veterinary subjects as well. In furtherance of such publication, an Editorial Branch was set up in 1951, with a membership which included the Director of the Institute, the Chief of the Pathology Division, five senior pathologists, the Chief of the Medical Illustration Service, and an editor, who acted as recorder for the Board. The Board was to review manuscripts prepared for publication by staff members of the Institute, and to edit the Institute's own publications. 34^[34]

Research Programs

With somewhat the same objective of seeing that limited facilities were put to the best use, a screening committee was set up to evaluate applications for research projects to be carried on at the Institute. Although the nature of the facilities in the old building limited the range of research to "morphologic and statistical aspects of disease" the committee processed 36 applications in 1952, the first year of its existence, and added 42 in the following year. With projects previously initiated and new projects approved, the total number underway in 1954, the last year in the old building, came to 150. 35^[35] One project of direct and personal interest to the combat soldier and the medical officer had to do with the development of practical and effective body armor— a medicomilitary goal long sought. Much basic information about the behavior of bullets in wounds had been accumulated, particularly in the series of experiments conducted in 1935 by Col. George R. Callender and Maj. R. W. French of the Army Medical Museum staff. 36^[36] More recent studies, made at the Naval Medical Field Research Laboratory at Camp Lejeune, N.C., led to the development of a sleeveless vest of laminated layers of synthetic fibers, covering the thorax and abdomen.

In June 195 1, a joint Navy- Army mission, whose senior members were Cdr. John S. Cowan, MC, USN, and Lt. Col. Robert H. Holmes, MC, USA, was sent to Korea to see how effective this body armor would be under combat conditions. The vests were first issued to medical corpsmen and to troops of the 1st Marine Division and the 2d Infantry Division. Experience in 1951 and in 1952 showed that the 8-pound vests were not unduly cumbersome, and that three out of four hits by shell fragments failed to penetrate the vest and injure the soldier, while two out of three of all hits were likewise defeated by the armor. Such results "determined beyond doubt that the field soldier could wear, would wear, and desired to wear the body armor afforded him." 37^[37]

Serving the four basic departments of the Institute in such vital particulars as supply and finance was the Administrative Service. In the last years of occupancy of the old building, this Service was headed by Lt. Col. E. R. White-hurst, MSC, USA, from the time when the Institute took on its triservice character until 1950 and again from January 1952, until the new building was occupied. These chiefs of the Administrative Service were responsible to the directorate for the smooth operation of a complex organization. This organization, as described by Colonel Whitehurst, "really functions neither as a military nor a civilian installation, but endeavors to coordinate six different types of personnel, governed by the broad policies of the three Surgeons General and a civilian Scientific Advisory Board, and maintains close coordination not only with the three uniformed services, but also with the Public Health Service, the Veterans' Administration, and the National Research Council." 38^[38]

Triservice Administration

The first Director under the triservice arrangement was Brig. Gen. Raymond O. Dart, who was succeeded on i August 1950, by General DeCoursey, with Capt. Arthur W. Eaton, MC, USN, as a Deputy Director. Nearly a year later, in June 1951, the three-man directorate was completed when Col. Ralph M. Thompson, of the U.S. Air Force Medical Corps was named as the Deputy Director from the Air Force. On 15 February 1952, Capt. William M. Silliphant, MC, USN, was named Deputy Director, in the place of Captain Eaton. This triumvirate continued as the directorate of the Institute until mid-1955, after the move into the new building.

Preliminary to the move was a meeting called by Maj. Gen. Leonard D. Heaton, Commanding General of the Walter Reed Army Medical Center, for the purpose of clarifying the various logistical relationships between the Medical Center and its several components, and the newest member of the Center, the Armed Forces Institute of Pathology. The meeting, held on n August 1954, was attended by key staff personnel of the Medical Center, the Military District of Washington, the Office of The Surgeon General of the Army, and the Armed Forces Institute of Pathology.

In convening the meeting, General Heaton "made it plain at the onset that the AFIP is basically a tripartite organization — Army, Navy, and Air Force. It is a separate, distinct class 2 organization under administrative jurisdiction of The Surgeon General of the Army and under command of the Director. Although the AFIP will be physically located on the Post at Walter Reed, the only command responsibility that will be exercised by the Center will be of necessity in those areas of administration and logistical support, the responsibility for which has been laid down in SGO Administrative Letter 1-6. Insofar as those areas are concerned, the Director of AFIP will coordinate his activities with the Center Command." 39^[39]

General Heaton proposed that the various questions raised be taken up "item by item * * * to assure that the proposed solutions are mutually agreeable to all of us." His opening remarks set the tone of a friendly and

fruitful meeting which dealt with practical questions as to matters of personnel, official orders, transportation and travel, protection and surety services, cus

Figure 107.—Aerial view showing the location of the Institute building (upper left corner) in relation to the Walter Reed Army Medical Center.

todial and "housekeeping" services, supply, finance, records administration, postal service, civilian employees, commissary facilities, repairs and utilities, military training, and others of the thousand and one complications bound to arise in fitting the new member into the pattern of work and life at the Army Medical Center.

On 13 February 1955, the move from the old building to the new was started. Already, 5,000 items of new equipment had been purchased and placed in the new building. The move from the old building, carried out by General Service Administration forces, according to plans laid down by the Institute staff, was accomplished in a month, during which time 10,200 tagged items were moved to new quarters—40 vanloads, mostly specimens sealed in plastic bags going to outside storage at Franconia, Va., and 150 vanloads going to the long sought and eagerly awaited new building on the Walter Reed reservation (fig. 107).^[40]

1. 1 Annual Report, Armed Forces Institute of Pathology, 1947, p. 11.
2. 2 Annual Report, Armed Forces Institute of Pathology, 1950, p. 23.
3. 3 Special Regulations No. 40-410-10; Bureau of Medicine and Surgery Circular Letter No. 50-50; Air Force Regulation No. 160-55, pp. 2-6.
4. 4 Annual Report, Armed Forces Institute of Pathology, 1952. p. 43.
5. 5 Annual Reports, Armed Forces Institute of Pathology, 1951, p. 6; 1952. p. 5: 1953, p. iii; 1954. p. I.
6. Annual Report, Armed Forces Institute of Pathology, 1950, pp. 23, 24.
7. 7 Annual Reports, Armed Forces Institute of Pathology, 1947, Exhibit A; 1948. p. 2; 1949. P. 8: 1950, PP- 2-5; I951. PP- I2,13; 1952. P. II; 1953. P. 5; 1954.P. 57.
8. 8 (1) "Study of Armed Forces Institute of Pathology." Report of the Cooney Committee to The Surgeon General, Department of the Army, 23 January 1953. (2) The characterization of the Institute as "The Postgraduate School of Pathology" was in an address by Dr. Robert A. Moore, Dean of the Washington University School of Medicine, at a Pathologists' Luncheon in Chicago, 16 October 1952.
9. 9 2d indorsement, General Cooney, dated 27 March 1953, to The Surgeon General of the Army 27 March 1953, subject: Study of the Missions and Functions of the AFIP. On file in historical records of AFIP.
10. 10 Annual Reports, Armed Forces Institute of Pathology, 1952, p. 5; 1955, p. 4; 196o, annex No 3.
11. 11 Letter, Kenneth G. Royal, Secretary of the Army, to Carroll L. Wilson, General Manager, Atomic Energy Commission, 3 February 1948, in response to letter of 23 January 1948. Copy on file in historical records of AFIP.
12. 12 (1) Clark, Mardelle L., and Lynch, Francis X.: Clinical Symptoms of Radiation Sickness, Time to Onset and Duration of Symptoms Among Hiroshima Survivors in the Lethal and Medical Lethal Ranges of Radiation. The Military Surgeon 3: 360-368, November 1952. (2) Reynolds, Mardelle L., and Lynch, Francis X.: Atomic Bomb Injuries Among Survivors in Hiroshima. Public Health Reports 70: 261-270, March 1955. (3) DeCoursey, Elbert: Pathology of Ionizing Radiation. Minnesota Medicine 34: 313-318, April 1951. (4) DeCoursey, Elbert: Injury from Atomic Bombs. Radiology 56: 645-652, May 1951. (5) Annual Report, Armed Forces Institute of Pathology, 1950, p. 28.
13. Signers of the statement were: R. W. Bliss, The Surgeon General, Department of the Army; C. A. Swanson, The Surgeon General, Department of the Navy; Malcolm C. Grow, The Surgeon General. Department of the Air Force; Charles S. Cameron, Scientific Director, American Cancer Society; Lewis H. Weed, Chairman, Division of Medical Sciences, National Research Council: Leonard A. Scheele, The Surgeon General, U.S. Public Health Service; and Paul B. Magnuson, Medical Director. Veterans' Administration.
14. 14 Stout, Arthur P.: Editorial. American Journal of Clinical Pathology 25: 175, 176, February 1955.
15. 15 Annual Report, Armed Forces Institute of Pathology, 1953, Exhibit 2, p. 7.
16. 16 Annual Report, Armed Forces Institute of Pathology, 1954, p. 20.
17. Annual Report, Armed Forces Institute of Pathology, 1948, p. 27.
18. 18 (1) Annual Report. Armed Forces Institute of Pathology. 1949.p. 10. ( 2) Army Regulations No. 40-410. (3) Department of the Army Circular Letter No. 1, 1949.
19. 19 Brochure, "AFIP: Armed Forces of Pathology," appendix III, 1952.
20. Annual Report, Armed Forces Institute of Pathology, 1951, pp. ii. 23, 40.
21. 21 (1) Circular Letter No. 127, Surgeon General's Office, U.S. Army, 8 October 1947. (2) Whitehurst, E. R.: The Evolution of the Armed Forces Institute of Pathology and Related Problems of Administration. The Military Surgeon 106: 302, April 1950.
22. 22 Compiled from Annual Reports, Armed Forces Institute of Pathology.
23. 23 Annual Report, Armed Forces Institute of Pathology, 1951, p. 57.
24. Annual Report, Armed Forces Institute of Pathology, 1953, p. 54.
25. Final Report, Maj. Carroll F. Naidorf, 26 October 1946. On file in historical records of AFIP.
26. 26 Annual Reports, Armed Forces Institute of Pathology, 1940, p. 40; 1950, pp. 33, 45; 1951, pp. 37, 45 - 1952. PP. 44. 45.
27. 27 Annual Report, Armed Forces Institute of Pathology, 1953, pp. iii, 4.
28. 28 Annual Report, Armed Forces Institute of Pathology, 1947, p. 22.
29. 29 Annual Report, Armed Forces Institute of Pathology, 1948, pp. 34. 35.
30. 30 Annual Report. Armed Forces Institute of Pathology, 1949, p. 61.
31. 31 Annual Report, Armed Forces Institute of Pathology, 1950, p. 57.
32. 32 (1) Memorandum, Ruell A. Sloan, for Col. E. DeCoursey, 9 December 1950. (2) Annual Report, Armed Forces Institute of Pathology, 1950, p. 60.
33. 33 Annual Reports, Armed Forces Institute of Pathology, 1952, p. 53; 1953, p. 36.
34. 34 (1) Annual Reports, Armed Forces Institute of Pathology, 1949, p. 35; 1951, p. 41. (2) Special Orders No. 67, 11 July 1951.
35. 35 (1) AFIP, Special Orders No. 27, 20 March 1952. (2) Annual Reports, 1952, Exhibit 28, p. 35; 1953. P. 22; 1954, P. 3.
36. 36 Callender, G. R., and French, R. W.: Wound Ballistics: Studies in the Mechanism of Wound Production by Rifle Bullets. The Military Surgeon 77: 177-201, October 1935.
37. 37 (1) An analysis of the results of the mission to Korea was given in a paper entitled. "Wound Ballistics and Body Armor," by Lt. Col. Robert H. Holmes, MC, USA, read before the Section on Military Medicine at the 101st Annual Session of the American Medical Association, Chicago, on 11 June 1952, and published in the Journal of the American Medical Association 150: 73-78, 13 September 1952. (2) Additional information is given in: Holmes, Robert H., Enos, William F., and Beyer, James C: Medical Aspects of Body Armor Used in Korea. Journal of the American Medical Association 155: 1477, 1478, 21 August 1954. The three men who prepared this article, from which the quoted sentence is taken, were all members of the AFIP. Colonel Holmes was awarded the Legion of Merit for his part in the study and analysis.
38. 38 Whitchurst. The Military Surgeon. 106 (1959). p. 309.
39. 39 Minutes of cited Meeting, 13 August 1954. On file in historical records of AFIP.
40. Annual Report, Armed Forces Institute of Pathology, 1955, p. 79.