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

by Robert S. Henry

CHAPTER XVII

Life in the New Building

Occupancy of the new building made it possible, for the first time, said Brig. Gen. Elbert DeCoursey, to formulate and carry through "a comprehensive program of pathology" 1^[1]—which the Institute lost no time in undertaking.

The first step in this new program was to complete the organization and staffing of the Department of Pathology, which previously had been limited to the Pathology Division. Under the new organization, effective in March 1955, this division was joined by the Basic Laboratories Division and the Dynamic Pathology Division, to make up the new department. 2^[2]

To head the expanded department, the Institute secured Dr. Ernest W. Goodpasture (fig. 108), professor of pathology at Vanderbilt University, who joined the staff as the first Scientific Director of the Institute on 1 July 1955, and forthwith "engaged in planning the professional program so as to take full advantage of the facilities of the new laboratories." 3 ^[3]

The new Scientific Director was one of pathology's greats. A native Tennessean, he had taken his academic work at Vanderbilt, and had graduated in medicine from the Johns Hopkins University School of Medicine. He had taught at Hopkins and Harvard; had served on the faculty of the School of Medicine of the University of the Philippines; had studied in Vienna; and had returned to Vanderbilt where, for 31 years, he had been professor of pathology, and for 5 years, dean of the Medical School.

In May 1931, Dr. Goodpasture and his associate, Dr. Alice Miles Woodruff, published a report on the results of 3 years of research and experiment in the inoculation of chick embryos with a virus, inserted through a tiny window in the shell of an unhatched egg. The virus was that of fowlpox, a poultry disease commonly called "sorehead." The tiny droplet of virus grew and multiplied, producing abundantly the pure and uncontaminated virus from which a protective vaccine could be derived. Such a virus, the report suggested, should be "valuable in immunological experiments."

Figure 108.—Dr. Ernest W. Goodpasture, first Scientific Director, Armed Forces Institute of Pathology, 1955-1959.

The Goodpasture-Woodruff team had done more than to suggest further interesting experiments. They had found in the incubating egg a living tissue on which a virus would feed and from which it could not be contaminated, and had opened the way to the production of vaccines quickly, inexpensively, safely, and in quantity. The methods devised, it was thought, "might prove advantageous in the study and development" of other virus infections. 4^[4]

As further researches did indeed determine that other viruses could be produced by the impregnated egg method, Dr. Goodpasture's successful experiment with fowlpox began to be recognized for what it meant — a revolution in one vast field of immunology and preventive medicine through the production and use of pure, plentiful, and potent vaccines derived from the incubated egg.

Appointment of Dr. Goodpasture as Scientific Director of the Institute and head of its major Department of Pathology was not the only change in the organization and staffing that took place in the Institute's "shakedown cruise," as Capt. William M. Silliphant (fig. 109), in naval vernacular, termed the first few months in the new building. The captain, who had served as the Navy- nominated Deputy Director for 3½ years, succeeded General DeCoursey as Director in July 1955, when the latter left the Institute, after 5 years of service, to become Commandant of the Army Medical Service School at Brooke Army Medical Center, Fort Sam Houston, Tex.

Captain Silliphant, the new Director, a native of Prince Edward Island, Canada, was graduated with honors from Prince of Wales College at Charlotte-town, Prince Edward Island, and afterward was graduated cum laude from the University of Southern California. He obtained his medical degree from the Stanford University School of Medicine, and had 2 years' postgraduate study in pathology at the U.S. Naval Medical School in Washington. He was captured by the Japanese in the Philippines and for 37 months was interned in Bilibid Prison, where he served his fellow prisoners as ward medical officer, sanitation officer, and laboratory officer, simultaneously. For 5 years before his assignment to the Institute as Deputy Director, he was Director of Laboratories, U.S. Naval Medical School, National Naval Medical Center, Bethesda, Md.

In August, Col. Dwight M. Kuhns, MC, USA, became Deputy Director, serving to the end of the year 1955, when he retired for physical disability, and was succeeded by Col. Francis E. Council as the Army-nominated Deputy Director.

Meanwhile, Col. Ralph H. Thompson, the Air Force-nominated Deputy Director, retired at the end of August, and was succeeded by Col. Frank M. Townsend, USAF, MC.

Adjustment of personnel, space, and activities, to take full advantage of the new building and its facilities, went forward in the latter months of 1955 and in

Figure 109.—Capt. (later Rear Adm., Ret.) William M. Silliphant, MC, USN, third Director, Armed Forces Institute of Pathology, 1955-1959.

1956, the first full year in the new quarters, under the direction of this triumvirate.

In April 1957, Colonel Council retired, to be succeeded by Col. Joe M. Blumberg, MC, USA, as Deputy Director (fig. 110). Colonel Blumberg, a

Figure 110.—Col. Joe M. Blumberg, MC, USA, Deputy Director, 1957-1963, and Director, Armed Forces Institute of Pathology, 1963- ; Scientific Director, American Registry of Pathology, 1960- .

Georgian, is a medical graduate of Emory University in Atlanta, and has served as chief of pathology and commanding officer of Army laboratories, including the 406th Medical General Laboratory in Japan.

Figure 111.—Capt. Roger H. Fuller, MC, USN, Deputy Director, Armed Forces Institute of Pathology, 1959—1963.

The directorate remained unchanged for more than 2 years until, in August 1959, Captain Silliphant retired and joined the staff of the Cancer Research Institute of the University of California Medical Center in San Francisco. His successor as the representative of the Navy on the directorate was Capt. Roger H. Fuller, MC, USN (fig. 111), who had taken his academic training at Yale and his medical degree at Tufts, and who came to the Institute from the post of Chief of Laboratory Service at the Naval Hospital, Camp Pendleton, Calif.

Succeeding Captain Silliphant as the Director of the Institute was Col. Frank M. Townsend, USAF, MC (fig. 112). The new Director had been, since 1954, the Consultant in Pathology to the Surgeon General of the Air Force, and a Deputy Director of the Institute for 4 years. A Texan by birth and rearing, he had done his premedical work at San Antonio College and the Univer

Figure 112.—Col. Frank M. Townsend, USAF, MC, fourth Director, Armed Forces Institute of Pathology, 1959-1963.

sity of Texas, and had taken his M.D. degree at Tulane University. He has served on the medical faculties of three universities—Washington University, St. Louis, Mo.; Nebraska University, Omaha; Texas University, Austin—and has been especially active in the newly developing field of aviation pathology, and the even newer field of bioastronautics.

Two months earlier, in June 1959, Dr. Goodpasture had resigned as Scientific Director of the Institute, and returned to Tennessee. His successor was Dr. Robert E. Stowell (fig. 113), one of the Nation's leaders in pathology, who came to the Institute from the University of Kansas Medical Center, Kansas City, Kans., where he had been, for n years, professor and chairman of the Department of Pathology and Oncology, and director of Cancer Research.

Through all changes in the directorate and professional staff, in the new building, as in the old, there was no change in the fundamental mission of the Institute to serve the needs of pathology through consultation, education, and research. Within the first year of occupancy of the building, space problems arose, and it became "apparent that the cut made in the original plans was a doubtful economy." In other respects, however, the new building and its equipment proved to be satisfactory, and the Institute staff expressed appreciation "to all those responsible for its planning and equipment." Special appreciation was expressed to those who had secured congressional approval of the new plant, and also the commanding general at Walter Reed Army Medical Center and his staff. "Everything possible has been done to welcome the AFIP as a part of the Center and to extend to the AFIP all the services available," the Director said, in his 1955 annual report. 5^[5]

Shortage of Space

Not even the most cordial cooperation from Walter Reed Army Medical Center, however, could relieve a space problem that became apparent as the Institute settled into its new quarters. The problem that "engrossed the attention of the Directorate" was to find room for essential facilities for expanding professional studies, storage space for the ever-increasing flood of specimens, and space to store exhibits between the times when they were shown in public. To meet such needs, plans for a wing of some 103,000 square feet were prepared for inclusion in the Army Medical Services budget for fiscal year 1958, but such plans did not meet with favor in the processes of budget making and approval. 6 ^[6]

One consequence of the space shortage at the main building of the Institute is the maintenance of warehouse space at Franconia, Va., where a large part of the more than one million specimens in the Institute's collection is stored.

Figure 113.—Dr. Robert E. Stowell, second Scientific Director, Armed Forces Institute of Pathology, 1959- .

Storage of wet-tissue specimens in 20-gallon crock jars has been largely superseded by storage in sealed plastic bags, containing a small amount of formalin (fig. 114). The plastic bags offer many advantages in saving of space, ease of handling, and freedom from formalin fumes. By April 1959, storage of speci

Figure 114.—Specimens in storage and on display. A. Large crock jars for storage of specimens are being replaced by plastic bags.

mens in the main building had been converted to plastic bags, and work was well started on conversion of the storage at Franconia. The difficulties inherent in the 25 miles between the place of storage and the place of use were such that in the spring of 1960 a study was started looking to the possibility of finding space at or near Walter Reed Army Medical Center. Maj. Charles B. Broadway, Chief of the Professional Records Division, who played a large part in the development of the plastic bag technique, represented the Institute in a careful but fruitless search, and the 50-mile round trip continues to handicap the work of the Institute, and particularly that of the Department of Pathology.^[7]

Expanded Facilities and Services

The expansion of professional services with consequent changes in the organizational structure of the Institute emphasized the fact that through all

Figure 114.—Continued. B. Sealed plastic bags for storage of specimens require less space and preservative fluid and are handled more conveniently. C. Wet specimens on display embedded or enclosed in unbreakable plastic (compare fig. 28, p. 64). changes it continued to be primarily an Institute of Pathology, with the heart and core of its operation in the Department of Pathology, which numbered on its staff some two-thirds of the entire professional staff of the Institute, and accounted for a like proportion of expenditures. To head the pathology services within the Department, Dr. Elson B. Helwig (fig. 115) was named as Chief, Division of Pathology, a post in which he was to serve under Scientific Directors Goodpasture and Stowell. The new division chief is an academic and medical graduate of Indiana University, with experience in pathology services at Western Reserve University, the New England Deaconess Hospital, the Washington University School of Medicine, and the Army of the United States.

The expanded and improved research facilities of the Institute were found to be of use not only in projects of immediate interest to the Institute itself, but also in projects of value to other agencies of government and to voluntary health organizations. One of the earliest of the numerous projects which the Institute has undertaken for other organizations on a cooperative or cosponsorship basis had to do with the sterilization of foods by irradiation. As part of this project of the Research and Development Command of the Department of the Army, the Institute undertook to furnish guidance to the study of the effects of feeding animals with irradiated foods, in an extensive program carried out in several laboratories. The Institute's services included receipt and review of all microscopic material and pathological reports, providing a central repository for all such materials, and preparing and analyzing statistical data as to pathological lesions found in animals that had been on irradiated diets for 2 years or more. 8^[8]

In addition to the evaluation of pathological findings in animals fed on food sterilized by irradiation, and other projects receiving special support from such military organizations as the Research and Development Command of the Office of The Surgeon General of the Army, the Institute received financial support outside its regular budget for carrying on studies and investigations from nonmilitary organizations, such as the American Cancer Society, the Alfred P. Sloan Foundation, the Squibb Laboratory, and the National Institutes of Health. By

i960, additional supplements to the Institute budget, derived from direct contracts and subcontracts with other Federal agencies and from grants from voluntary health organizations, totaled $351,930. Of this sum, approximately 60 percent went for basic research, with the balance of 40 percent approximately equally divided between investigations of direct military interest and applied studies in human and veterinary pathology. By the end of i960, the developing research program of Dr. Stowell, the Scientific Director of the Institute, had

Figure 115.—Dr. Elson B. Helwig, Chief, Department of Pathology, Armed Forces Institute of Pathology.

resulted in research support from outside sources, nongovernmental as well as governmental, amounting to more than $700,000, or double the amount of outside support the year before.9^[9]

The Institute's program of research covered not only the descriptive morphological and statistical investigations to which research had been largely confined in the old building, but also included projects that were made possible for the first time by the facilities afforded by the new building. In the more than 200 investigations carried out in the first 5 years of occupancy of the new building, there were studies of the biological and biochemical effects of microwaves; the response of cells to acute radiation; the neuropathology of nuclear and cosmic radiation; the structure and functions of various tissues; the effects of toxic agents upon various organs; the performance of motor end-plates where motor nerves join muscle fibers; and studies in leprosy and a variety of tumors.

Much of the enlarged scope of the Institute's program was made possible by advances in the instruments available and their application to research programs. The use of the electron microscope (fig. 116) with its magnifying power on the order of 250,000 diameters enabled the observer to "see" into the interior cellular structure farther than man had seen before with the optical microscope. With such instrumentation and methodology, the pathology of diseases could be "traced beyond the cell to the intracellular and molecular level," as the Director of the Institute put it. 10 ^[10]

One of the vital areas of research which the new building opened up was in experimental pathology, using laboratory animals. In the first year of occupancy of the new building, the Laboratory Animals Branch of the Department of Pathology was set up, with the dual mission of looking after the housing, diet, and health of the animal population maintained within the Institute, and of providing facilities, assistance, and consultation to the staff on matters pertaining to experimental surgery. The population of the animal quarters at the end of 1955 exceeded 3,000. Of these, 1,900 were mice, nearly 400 were rats, more than 600 were guinea pigs, and nearly 300 were rabbits. Dogs numbered 8, swine 16, and cats 24. The average number of animals maintained in the 12 months of 1961 was 2,800 per month. The total number of animals issued during the entire year was over 14,000, of which more than 13,000 were mice, hamsters, and rats, and more than 600 were rabbits and guinea pigs. 11^[11] The Veterinary Pathology Division, responsible for these functions, as well as for studies in

Figure 116.—Optical and electron microscopes. A. How they work.

comparative anatomy and physiology, included in 1960 eleven doctors of veterinary medicine, perhaps the largest aggregation of veterinary pathologists in the United States. This section of the Institute has for many years performed autopsies in the National Zoological Park of the Smithsonian Institution, in the course of which Institute veterinarians have performed or attended necropsies on a variety of animals ranging from an elephant to a 20-foot python.^[12]

Program of Education

Closely related to the research function of the Institute is its program of education, both within and without the confines of the Institute itself (fig. 117).

Figure 116.—Continued. B. Electron microscope in use.

The effort is restricted only by the limitations on the physical space and staff time that can be devoted to it. The program includes postgraduate short courses, individual training on a residency or fellowship basis, lectures to and by members of the staff, seminars for the consideration and discussion of pathology topics, active-duty training for Reserve officers, and related intramural activities. Extramural activities include publication of professional scientific papers in biological and medical journals, attendance at and participation in meetings of scientific societies, and the preparation and distribution of study sets on a loan basis.

These services are in no manner restricted to the medical profession in the United States but include nationals of foreign countries who are welcomed to the Institute. The extent to which these foreign nationals seek the educational opportunities offered by the Institute may be gaged by the fact that in the first

Figure 117.—Educational sessions. A. Lectures are conducted for and by members of the Institute staff. B. Opportunity is afforded for more intensive study by smaller groups.

6 years in the new building, nearly 1,000 foreign nationals from over 40 countries attended courses or received training at the Institute. 13^[13]

So great is the interest in the Institute's intramural educational program that the number of "student days" — a method of measurement that reflects both the number of students attending and the length of time attended — increased from 6,000 in 1958, to more than 27,000 in 1961.

"Because of the demands upon the professional time of the staff, space and support personnel," the i960 annual report said, "the educational program appears to have reached the saturation point within the present Institute capabilities." 14^[14]

A major feature of the extramural educational effort of the Institute continues to be lending study sets for the use of physicians both within and without the ranks of the Armed Forces. The growing demand for these loan sets for study purposes called for making up new sets, increasing the number and variety of those offered, and repairing old and wornout sets, even though this meant that an "inordinate amount of time and effort" had to be spent in this activity. The demands for the sets was so great, however, and their use was so much appreciated, that it was deemed impossible to reduce their circulation of approximately 5,000 sets a year. 15^[15]

The outreach of the Institute is further strengthened by its active program of encouraging the utilization of its research riches in the preparation and publication of articles for publication in the scientific press. There are few fields of scientific investigation so prolific in publication as are the medical, dental, and veterinary disciplines, and few institutions of scientific investigation have been so active in the dissemination of research findings as the Armed Forces Institute of Pathology. This applies both to work done by members of the staff and also by others who have been associated directly or indirectly with the Institute.

The result has been a program of publications noteworthy in quality and volume. In 1949, the year the Institute became representative of the three armed services, publications numbered 29. In 1955, the year the new building was occupied, the number of articles published was 35. Forty-one articles appeared in 1956, and 43 in 1957. In 1958, publication reached a new high of 77 items, with 76 in the next year, 82 in i960, and 91 in 1961. The sharp increase, it will be noted, did not come about until the third year in the new building, reflecting the time lapse involved in the process of research, writing, and edi torial processing of scientific articles for publication in the numerous learned journals that make up the medical press. 16^[16]

The noteworthy increases in the research and educational output of the Institute following the move into the new building were not achieved at the expense of the Institute's functions of diagnosis and consultation. True, the number of cases received did not materially increase between 1954, when 75,000 cases came into the old building, and 1958, when the number received in the new quarters reached its high point of 76,000, and actually it declined to 54,000 in 1959; 60,000 in i960; and 57,000 in 1961. The declines were largely due to the effect of budgetary limitations on the Veterans' Administration, which caused a reduction in the number of cases from that source, and also to a trend to refer to the Institute, for consultative services, only the more difficult cases, thereby requiring that more time be spent by the pathologist on the average case. "The corresponding supportive help and reports were becoming still more specialized than in the previous years," said the annual report for 1960. "Numerous instances were recorded during the year whereby the findings of our staff influenced an alteration in the course of therapy." 17^[17]

Cases received by the Radiation Injury Branch, more familiarly known as the A-Bomb Unit, constitute a special category. The number of these cases sent from Japan by the Atomic Bomb Casualty Commission laboratories at Hiroshima and Nagasaki in the years 1955-1961 exceeded 27,000, virtually the same number that had been received in the preceding 7 years since 1948. The Institute in Washington thus has become the repository for surgical and post mortem specimens of materials from more than 54,000 persons who were exposed to the blast of the first atomic bombs. The function of storage alone, however, does not give a proper picture of the Institute's participation in the scientific analysis and utilization of these materials (fig. 118).

In furtherance of its functions of education, research, and consultation, whether for immediate application or for future study and evaluation, the resources of the Institute are available for study by qualified investigators. These resources, in addition to the 54,000 specimens, include the largest collection in this country of early Japanese reporting of the overall effects of nuclear explosions, along with more than 200 translations of Japanese scientific reports dealing with radioactive injury, hematology, and pathology.

From years of experience in the management of large collections of the raw materials of pathology, the Institute has developed methods for their

Figure 118.—Handling radioactive materials.

utilization in study and investigation. In keeping with these concepts, the collection of materials from Japan has supplied much of the fundamental facts for studies of the effects of radiation, some of which have been published with Japanese and American text in parallel columns.^[18]

The American Registry of Pathology

Closely related to the Department of Pathology in the structure of the Institute is the American Registry of Pathology. The association of the two departments is all the more intimate by reason of the fact that the registrars of the individual registries that make up the American Registry of Pathology are senior pathologists who also head up the specific branches and sections of the Department of Pathology. At the time of the occupancy of the new building in 1955, there were 22 individual registries, with a total of 119,000 cases in their files. By 1962, the number of registries had grown to 27 and the number of cases in the files to more than 200,000.

The American Registry is an important arm of the Institute in its research and education functions. Several of the sponsoring medical specialty societies provide fellowships at the Institute for study in such fields as radiology, urology, dermatology, ophthalmology, otolaryngology, and veterinary pathology, while other fellowships are supported by private funds, foundations, or institutions. In addition to these sponsored fellowships, physicians of the military services, including those of the Reserve components and civilian doctors, avail themselves of the facilities of the Registry, particularly in lines of investigation requiring followup activity.

The Registry continues to act as sales agent for the fascicles of the "Atlas of Tumor Pathology," with sales running up to as many as 40,000 copies in a year. Of these sales, approximately one-fourth are made outside the United States, going directly to physicians in 55 countries.

Dr. Hugh G. Grady, who had served as Scientific Director of the American Registry of Pathology since 1949, resigned in mid-1957 to become the first professor and organizer of the Department of Pathology in the newly founded Seton Hall College of Medicine and Dentistry at Jersey City, N.J. He was succeeded by Dr. Fathollah K. Mostofi. After 2 years of service, Dr. Mostofi resigned this administrative post but continued to serve as registrar of the Genitourinary Pathology Registry.

He was succeeded as Scientific Director for the Registry by Colonel Blumberg, who combined the duties of this post with those of Deputy Director of the Institute. As Scientific Director of the Registry, he turned his particular attention to the increase in financial support from sources outside the Institute, so that the educational and research potentialities of the Registry, with its intimate association with civilian medicine, might be more fully realized. 19^[19]

The Medical Illustration Service

The aim of the Medical Illustration Service is, as its name implies, to serve the medical departments of the Armed Forces through the application of the graphic arts of pencil and brush, of photography and print, and of three-dimensional modeling. The field of service is, therefore, broader than that of pathology, and involves an exchange of information and an area of cooperation with the education and training divisions of the offices of the several surgeons general. In the earlier years of occupancy of the new building, the illustrative materials produced by the Service were not greatly used by the Navy and the Air Force, except as they participated in the materials used by the three-service Institute itself. As time went on, however, the direct use of Illustration Service materials by Navy and Air Force increased, although the Army, as might have been expected, continued to be by far the largest user of these products other than the Institute itself.

The breadth of the contacts of the Illustration Service is indicated by the fact that in i960, by no means an unusual year, it collaborated with more than 165 U.S. Government, civilian, and foreign agencies in matters pertaining to exhibits, the loan of films, lantern slide teaching sets, training aids, and illustrations. In another year, 1957, it cooperated with 19 Federal agencies in exchanging information and services in the field of medical illustration, and its personnel participated in the activities of a dozen civilian societies and associations that have like interests. 20^[20] In recognition of this breadth of contact, Mr. Herman Van Cott (fig. 119), Chief of the Service, was appointed to represent the Institute on the Interdepartmental Committee, now known as the Advisory Council on Medical Training Aids. The Council is composed of officially appointed representatives of the Army, Navy, and Air Force, the Veterans' Administration, the Public Health Service, and the Bureau of Indian Affairs. Its object is to review critically all training projects of the governmental agencies that are represented on the Committee.

A major activity of the Service is the preparation and showing of exhibits featuring medical information. In the years 1955-1961, 543 such exhibits were constructed, and 2,102, including those constructed in earlier years, were shown at local, State, and national meetings of medical associations and at other scientific gatherings. Seventy-nine, or more than one-sixth of those constructed in the years covered, won awards and official commendations (fig. 120).

From 20 prototyped wound moulage kits, developed by the Training Aids Division of the Illustration Service, the Office of the Surgeon General of the Army had 525 individual moulages depicting a variety of wounds made up, and

tried them out in several maneuvers and field exercises. The moulages were so graphic in effect and so accurate in reproducing the appearance of wounds that they were standardized for Army use and, as a step toward uniformity in nomenclature of wounds among the Allies in the North Atlantic Treaty Organization, copies of the kit were sent to Great Britain, France, and Canada. In the light of the possible interdependence of the NATO nations for medical care of their

Figure 119.—The evolution of an emblem. A. Sketches showing steps in the development of the idea for the Institute seal by Herman Van Cott, Chief of the Medical Illustration Service.

respective personnel in time of emergency, the Medical Illustration Service proposed that a graphic training aid, based on the 1958 Emergency War Surgery, NATO Handbook, be prepared and circulated (fig. 121). This proposal was approved, and the Illustration Service was asked to develop the necessary 300 overhead projector transparencies, designed to reinforce the Handbook in the instruction of Allied doctors and ancillary medical personnel. In the development of these visual aids, Lt. Col. Kathleen Phillips, ANC, USA, assigned to the Medical Illustration Service, had an important part. Preliminary sets were distributed to major medical installations in the United States and oversea commands by October 1960. After field testing and minor revisions, the set of 304 transparencies was standardized by the Army as an official graphic training aid.^[21]

Figure 119.—Continued. B. Mr. Van Cott at work.

In addition to this vivid depiction of war wounds, the Illustration Service continues its pictorial part in the war against disease. In this, it is greatly aided by the new equipment which came with the new building (fig. 122). This includes a new offset press, a hand proving press, a 24-inch processing camera, and other new items to speed up and improve the quality of reproduction of the plates in the "Atlas of Tumor Pathology." Its publication is further aided by a new collating rack in the bindery, which makes it possible for one person to collate the pages of an entire volume without lost motion. Such a rack, designed by those who were to use it in "picking up" some 5- or 6-million pages a year, is a far cry from the pigeonholes on the stairway of the old building, in which the pages of early publications of the Medical Museum were placed to be collated, a few at a time, by members of the staff en route to and from the rest rooms in the old building.

Another segment of the Illustration Service which was enabled to increase and improve its output upon removal from cramped quarters on the topmost floor of the old building is the Photography Division, which normally turns

Figure 120.—Award-winning exhibits of the Medical Illustration Service. A. Full-size exhibit which is shipped to the place of showing.

out a quarter of a million pieces of its work in a year and has, upon occasion, turned out more than 350,000 items (fig. 123). This output includes photo-micrography and color reproduction, as well as what might be called normal black-and-white representations of pathology subjects.^[22]

Television

Another interesting installation in the Institute of Pathology building is the main studio and control center for the television facilities of the Walter Reed Army Medical Center. These facilities include also studios in Walter Reed General Hospital, and the Walter Reed Army Institute of Research, and are hooked up in the hospital network of the Washington area. Programs of scientific interest, broadcast by closed-circuit transmission, are seen and heard at the National Institutes of Health, the National Naval Medical Center, the hospital at Andrews Air Force Base, the James C. Kimbrough Hospital at Fort Meade, Md., and the Wallace DeWitt Hospital at Fort Belvoir, Va., as well as on some 170 receiving sets in the Walter Reed area.

The broadcasting range is further extended by the ability to transmit programs on commercial facilities for closed-circuit showing at a distance from

Figure 120.—Continued. B. Light, portable type exhibit which can be carried by one man.

Washington. It is feasible, indeed, to have programs originating in the Walter Reed studios distributed over the facilities of nationwide broadcasting networks, as has been done upon occasion.

The assignment of space in the Institute of Pathology building for the installation of television facilities for the Medical Center was planned from the beginning, and contracts with the Radio Corporation of America for the installation were made in June 1955, within weeks after occupation of the new building. The installation, completed in late 1956, includes facilities for producing both black-and-white and color programs. One unusual feature of the equipment is a color-television camera, mounted in the ceiling of the hospital operating room, arranged for 360-degree viewing from any part of the

Figure 121.—For uniformity in war surgery, this material, based on the NATO Handbook, is designed to lessen the language barrier among the medical officers of the NATO nations by telling its story largely in pictures.

room, with remote control so that the cameraman need not be in the operating room itself (fig. 124). A similar overhead camera is mounted in the McNabb Autopsy Suite in the Institute building. With such equipment, an audience of any desired number may view the details of a surgical or autopsy procedure, without the necessity of straining and craning of necks in trying to see what goes on from the limited seating area of an operating theater.

The use of television to facilitate consultation between the surgeon in the operating room and the pathologist in the laboratory, while theoretically feasible, has not been used as widely as was anticipated, presumably because of the practical difficulty in sending and receiving meaningful specimens and slides suitable for simultaneous viewing and diagnostic discussion at a distance.

As a means of broadening and sharpening the teaching of medicine, however, the television camera and receiving sets are finding more and more uses. This is due, in part, to the presentation of televised operations to medical student audiences, but in larger part, to the possibilities for recording and rebroad

Figure 122.—Printing the fascicles of the Atlas of Tumor Pathology.

casting significant segments of medical subjects through the medium of motion-picture films or kinescopes of operations and techniques (fig. 125).

The possibilities inherent in such additional uses of the television camera have been enormously enlarged by the development of video magnetic tape. This development, which is compatible with the equipment at Walter Reed, records the living program, both picture and sound, on magnetic tape, from which it can be transferred to motion-picture film, available for showing on any 16-mm. projector, or can be reproduced directly from the tape wherever compatible equipment is available. Thus, a program recorded on video tape is multiplied many times over as an educational medium, reaching by sight and sound many audiences besides the original viewers of the program. Indeed, the potential audience is as vast as that afforded by the nationwide network of television cables, microwaves, broadcasting stations, and receiving sets that make up the great system of visual and sound intercommunication, included in the one word—television.

Of more immediate application, however, is the practice of exhibiting programs, through closed-circuit facilities, to audiences assembled in Dart Audi

Figure 123.—Modern photomicrography apparatus.

torium of the Armed Forces Institute of Pathology; Sternberg Auditorium in the Walter Reed Army Institute of Research; or the post theater of Walter Reed Army Medical Center. To such audiences, it is possible to transmit by sight and sound, in black and white or in color, significant operations, "live" or by delayed broadcast; microscopic studies for simultaneous viewing, rather than having the viewers wait their turns at the microscope; lectures and discussions, with accompanying illustrative materials; or other demonstrations of educational interest—all viewed on a picture screen of 6 by 8 feet, if in color, or 9 by 12 feet, if in black and white.

As part of the educational aspect of its threefold mission, the Armed Forces Institute of Pathology, particularly through the efforts of Dr. Robert E. Stowell, its Scientific Director, contributes to the Medical Center's television programming, with discussions, demonstrations, and illustrations of pathology material by members of the Institute staff and consultants.^[23]

Figure 124.—Television camera mounted in ceiling of Armed Forces Institute of Pathology autopsy room.

The Museum's Movements

The department of the Institute least affected by the move into the new building in 1955 was the Museum, the ancestor organization which had, in 1947, already vacated its quarters in the old building. When the Institute moved, it took with it those sections with which the Museum shared Chase Hall, leaving to the Museum the entire building. In addition, the Cornell Museum, open only to the medical profession, was taken out of Chase Hall and removed to the new building. Col. Hugh R. Gilmore, Jr., MC, USA, who had been Curator of the Museum since 1953, continued to head the entire Museum, dividing his attention between the professional museum quartered in the new building, and the two branches that continued in Chase Hall—the Lay or Public Museum and the Museum Laboratory.

Figure 125.—Lectures, with and without the use of visual aids, are an important part of the Institute's educational mission. In this instance, Col. Joseph L. Bernier (later Maj. Gen. and Chief of the Dental Corps, U.S. Army), is backed up by television images on four receiving sets.

With the increased room available in Chase Hall, it became possible to take many specimens out of the footlocker storage to which they had been consigned when the wanderings of the Museum had begun, 15 years before. Funds were found, moreover, for the purchase of 36 new-type exhibit cases for the display of specimens under more advantageous conditions.^[24]

This slight easing of space pressures, however, and the improvement of display materials, did not end the vicissitudes and wanderings of the Museum. Chase Hall was squarely within the area of the Southwest Washington Urban Renewal Project, and was known to be doomed at an early date. The question was, therefore, one of finding new quarters before the present ones were taken over by the wreckers as part of the rebuilding of a section of the city.

Nevertheless, doomed to destruction as the building was, the curators and staff of the Museum attempted, with quite a remarkable degree of success, the task of refurbishing and enlivening the quarters in which the Museum was located. Colonel Gilmore retired from active service in June 1955, and was succeeded by Dr. Alfred Plaut, of the Institute staff, as Curator, with Lt. Col. Harvey W. Coddington, MSC, USA, as Assistant Curator. In the few months during which this arrangement was in effect, Dr. Plaut devoted most of his attention to the Cornell Museum, which was housed in the AFIP building, and Colonel Coddington attended mostly to the affairs of the rest of the Museum.

In March 1957, Colonel Coddington became Curator of the Museum, the first Medical Service Corps officer to do so. His task was described as "maintaining two unique collections, both devoted to the * * * preservation and display of selected medical material of historical and scientific worth." Among the new exhibits shown were those of "Space Biology," "Psychiatry in Operation Deepfreeze," "Medical Aspects of Aircraft Investigations," and "Women in Medicine." During the year, 15 guest exhibits were shown.

In 1957 also, the task of cataloging the Museum's collection of nearly 500 microscopes (fig. 34, pp. 86-87)— probably the world's largest and most representative collection of the basic tool of the pathologist — was completed. In 1957, also, the number of visitors to the Museum exceeded 200,000 persons for the first time, reaching 221,000.

Early in 1958, Colonel Coddington returned to his duty in the Office of The Surgeon General, and was succeeded at the Museum by Col. Albert E. Minns, also of the Medical Service Corps of the Army. The new Curator was a graduate of the School of Pharmacy of the University of Buffalo, and the University College of the University of Maryland. In a service of 3^ years as Curator, he sought to give the Museum a "living atmosphere" by the rotation and refurbishing of 218 out of a total of 715 exhibits shown in that period.

In April 1959, the Cornell Museum was moved out of the Institute building and installed intact in a suitable room, access to which was limited to the medical profession, in the Chase Hall quarters of the Museum. In this year, also, the number of visitors to the Museum rose to 363,000 — by far the highest number in any previous year.

Even this record, averaging 1,000 visitors daily— the Museum being open to the public 365 days a year — was broken in the next year, i960, when the number of visitors reported went up to 587,000. For the first 11 months of the year, visitors came to the temporary quarters in Chase Hall which had been home to the Museum for 13 years, but which was scheduled for demolition early in 1961.

In November and December i960, therefore, the Museum moved into quarters shared with other Government agencies in another temporary building designated as "Tempo S" and located only a block away, at Jefferson Drive between Sixth and Seventh Streets, SW. The move was well planned and smoothly performed, with the laboratory and exhibit materials moved out of the old quarters and into the new in such fashion that the Museum was never closed down and remained open to visitors throughout the move.

International Efforts

Colonel Minns, the Curator under whom this successful move was made, reached the statutory age of retirement in June 1961, and after some delay, was succeeded as Curator by Col. John W. Sheridan. The new Curator was also of the Medical Service Corps of the Army, the third Curator in succession to be chosen from this source. As had been the case of his predecessor, he was to be called upon to move the Museum — this time from Tempo S to the "old red brick" that had been its home for 60 years prior to 1947.25^[25]

While the Museum had from its early years attracted a degree of international attention — winning the praise of Virchow himself for the contributions of the "Medical and Surgical History of the War of the Rebellion" — its lack of facilities for advanced experimentation had severely limited its participation in international study efforts. Occupancy of the new building by the Institute opened up new avenues for such participation in the worldwide war against disease which knows no national boundaries. Such a war calls for a common medical language for international communication of the results of research in both the clinic and laboratory.

The Museum and its successor, the Institute, had participated in this international effort, notably through the publication of the fascicles of the "Atlas of Tumor Pathology," devoted to developing a nomenclature of tumors in the communication of the results of medical research which could surmount the barriers of ordinary language differences.

A further step in this direction was taken on 2 December 1958, when the World Health Organization, the National Research Council, and the Armed Forces Institute of Pathology signed a three-way agreement for the establishment of the International Reference Center for Soft Tissue Tumors. Pursuant to the agreement, the Institute selected from its collection a general histologic reference set of tumors of the soft tissues, with an accompanying syllabus and classification of tumors of these tissues.

This material was sent to the headquarters of the World Health Organization at Geneva, Switzerland, where a meeting of an Expert Committee on Cancer was held in the last week of June 1959. This meeting, attended by pathologists from various parts of the world, agreed upon a tentative classification of soft tissue tumors, and plans for future operation of the Reference Center. The latter half of 1959 was given over to the collection of soft tissue tumors of various types from the Institute files and their classification in accordance with the tentative classification agreed upon at Geneva. Microscope slides, paraffin blocks, tissues, and records were collected, and the first histological reference set of fibrous tissue tumors, with an accompanying syllabus, was prepared. This material was widely circulated for review and comment. The revisions indicated were made and, in the spring of i960, 50 sets of material on tumors of fibrous tissues were made up. Each set consisted of 25 representative sections of tumors of fibrous tissues, with a syllabus which contained a general discussion of the diagnostic difficulties involved, and with a description and discussion of each type of tumor and a clinical history and comment on each case. In addition to the 50 sets sent to the World Health Organization at Geneva, for distribution to the health centers of cooperating nations, 30 sets were turned over to the American Registry of Pathology to be loaned to individual pathologists.

A second international reference set of 25 cases each, dealing with tumors of adipose tissue was prepared early in 1961, in an "edition" of 100 sets, and received a similar distribution. 26^[26]

An earlier instance of international cooperation is the Joint Committee on Aviation Pathology — a group which is "joint" in a double sense in that it is jointly representative of the three armed services of the United States, as well as being representative of the medical departments of the armed forces of Canada and the United Kingdom. The Committee dates from 1955, when it was established by a directive of the Department of Defense, amplified by jointly issued regulations of the Armed Forces.

The Committee grew out of discussions, in 1954 and 1955, among pathologists interested in the application of pathology to aviation accidents. The group included Wing Commander (later Air Commodore) Bruce Harvey, Medical Service, RAF; Capt. S. I. Brody, MC, USN; Dr. Howard T. Karsner,' Medical Research Adviser, U.S. Navy, Bureau of Medicine and Surgery ; Col. Frank M. Townsend, then Deputy Director and later Director, Armed Forces Institute of Pathology; and Dr. F. K. Mostofi, of the Institute. As a result of several meetings of this group, the Department of Defense issued, on 14 November 1955, a directive setting up the Joint Committee on Aviation Pathology, with headquarters at the Institute, where permanent files of the findings and other records of the Committee are maintained.

The Committee is charged with the duty of collecting information on the correlation between pathological evidence and the factors which cause aircraft accidents, making detailed pathological studies to help determine the cause of unexplained aircraft accidents, improving flight safety by taking into account pathological conditions, and investigating factors which may result in pathological changes in flight personnel.

A prime purpose of the Committee is to insure, insofar as it may be possible to do so, that medical officers shall have full opportunity to participate in the investigations of aircraft accidents. From examinations made on the scene and pursued further in the laboratory, the pathologist may determine what part was played by human or environmental factors in causing the accident. He can weigh the evidence pointing to some medical condition, such as shortage of oxygen, presence of carbon monoxide, explosive decompression or pre-existent disease in the pilot, or he may note a pattern and sequence of injuries that point to some failure or improper design of the aircraft itself. For example, it was medical investigation of a commercial airliner crash near Bolivia, N.C., on 6 January i960, by representatives of the Joint Committee, that led other investigators to find that the accident was due to the explosion of a bomb smuggled aboard by a passenger.

Aerospace Pathology

Closely related to the work in aviation is that of aerospace pathology which, in the AFIP organizational setup, is one of three branches of the Division of Military Environmental Pathology. Aerospace pathology deals with the pathological conditions encountered in the flights into outer space by biopack mice and monkeys, and animals of various kinds, preparatory to flights by men, and the increasingly numerous flights by men themselves. 27^[27]

Not all of the adventure in such flights, by any means, is that of those who ride the vehicles into space, or at least into the extreme heights of rarefied atmosphere. There was, for example, the flight of the Air Force balloon to investigate the risks to future travelers in the stratosphere from cosmic rays, sent up from International Falls, Minn. The balloon carried a cargo of live mice and tissue cultures that would have to be examined immediately, or with- in a very few hours, after the return of the balloon from stratosphere to earth. For this reason, it was imperatively necessary that the pathologists who were to make the examination should reach the place where the balloon came down promptly after its descent. In an engagingly humorous account of "Operation Stratomouse," published in Military Medicine in 1956, Dr. Webb Haymaker of the Neuropathology Section of the AFIP, tells of the adventures and misadventures of the reception crew as they chased an unpredictable balloon in an ancient and vibratory C-47 plane, a truck, and a taxicab across North Dakota, into Montana, and back to Minnesota — to find that 90 out of 93 precious mice were alive and well, while autopsies of the three that were dead disclosed no effects of cosmic rays. 28^[28]

The investigation as to the effects of cosmic rays upon the central nervous system of animals was continued for several years, the latest experiment having been conducted at Fort Churchill, Canada, in the summer of 1961. In this experiment, 8 monkeys and 24 mice were sent aloft nearly 24 miles, where they floated for about 10 hours.

Another area of the activities of the National Aeronautics and Space Administration in which the support of the Institute's Animal Care Branch was used, was in the animal flights into space which were an essential preliminary to the manned flights of Project Mercury. Personnel of the Institute who had received special training in handling chimpanzees were deployed in the anticipated landing areas to care for the animals after they had landed from their flights. The skeleton of one of the animals, "Able" whose death did not result from his flight, but from a subsequent operation, is an exhibit of interest in the Medical Museum.

Like everything else connected with space exploration, bioastronautics, as space medicine is beginning to be known, is growing in interest and importance. In connection with man's entry into space, the Institute has conducted studies of radiation, decompression, rapid acceleration and deceleration, and hypoxia, and the correlation of basic sciences with such specialized studies. The results are made available to Project Mercury, particularly through the membership of the Director of the Institute on the team of medical specialists that support the manned flights of the project. Thus, Colonel Townsend participated in the arrangements and conduct of the suborbital flight of Cdr. Alan B. Shephard, Jr., USN, on 1-5 May 1961 ; the like flight of Capt. Virgil I. Grissom, USAF, on 17-21 July 1961 ; the orbital flight of Lt. Col. John H. Glenn, Jr., USMC, on 12-21 February 1962; and the second orbital flight, that of Lt. Cdr. Malcolm Scott Carpenter, USN, on 23-26 May 1962. Colonel Townsend was represented in the six-orbital flight of Cdr. Walter M. Schirra, Jr., USN, by Lt. Col. David Auld, USAF, MC, who was detailed to serve on the team at Cape Canaveral, Fla., from 29 September to 5 October 1962.

1. 1 DeCoursey, Elbert: Editorial. American Journal of Clinical Pathology 25: 554-555, May 1955.
2. 2 Annual Report, Armed Forces Institute of Pathology, 1955, p. 3.
3. 3 Idem.
4. 4 Woodruff, A. M., and Goodpasture, E. W.: The Susceptibility of the Chorio-Allantoic Membrane of Chick Embryos to Infection With the Fowl-pox Virus. American Journal of Pathology 7: 209-222, May 1931.
5. 5 Annual Report, Armed Forces Institute of Pathology, 1955, pp. 3, 5, 6.
6. 6 Ibid., pp. 53, 54 .
7. Annual Reports, Armed Forces Institute of Pathology. 1955, p. 3; 1959, pp. 34, 36; 1960, p. 14.
8. 8 Annual Reports, Armed Forces Institute of Pathology, 1955, p. 15; 1956, p. 22; 1957, pp. 28, 65.
9. 9 Townsend, Frank M.: The Armed Forces Institute of Pathology. U.S. Air Force Medical Digest July 1960.
10. 10 Idem.
11. 11 Annual Reports, Armed Forces Institute of Pathology, 1955, p. 21; 1961, p. 168.
12. (1) Annual Report, Armed Forces Institute of Pathology, 1961, p. 24. (2) Townsend, US. Air Force Medical Digest (1960).
13. 13 Annual Reports, Armed Forces Institute of Pathology, 1955-1060, passim.
14. 14 Annual Report. Armed Forces Institute of Pathology, 196o.p. 18. annex 2.
15. 15 Annual Report, Armed Forces Institute of Pathology, 1958, p. 30.
16. 16 Annual Reports. Armed Forces Institute of Pathology, 1958-1960. passim.
17. 17 Annual Report. Armed Forces Institute of Pathology, i960, p. 17.
18. Memoranda in files, Radiation Injury Section, AFIP.
19. 19 Annual Reports, Armed Forces Institute of Pathology, 1957, p. 37; 1959, p. 71.
20. 20 Annual Reports, Armed Forces Institute of Pathology, 1957, p. 44: 1960, p. 25.
21. (1) Annual Report, Armed Forces Institute of Pathology, 1959, p. 80. (2) Office Memorandum, AFIP, undated.
22. Annual Report, Armed Forces Institute of Pathology, 1961, pp. 215-225.
23. Illustrated brochure, Radio Corporation of America, Walter Reed Army Medical Center, 1 November 1957
24. Annual Report, Armed Forces Institute of Pathology, 1955, pp. 35-37.
25. 25 Annual Reports, Museum sections, Armed Forces Institute of Pathology, 1955-1961. passim.
26. 26 Annual Report, Armed Forces Institute of Pathology, 1950, p. 65.
27. 27 (1) Army Regulations No. 15-97, Bureau of Medicine and Surgery Instruction 6510.6, Air Force Regulation No. 160-127, "Joint Committee on Aviation Pathology," Departments of The Army, The Navy, and The Air Force, 3 September 1957. (2) Office Memorandum, AFIP, 28 March 1960, Summary of Activities through February 1961.
28. 28 Haymaker, Webb: Operation Stratomouse. Military Medicine 119: 151—171, September 1956.