Robert S. Henry

“ Some may have considered the Armed Forces Institute of Pathology as a repository of museum specimens and tissues dusty with age; specimens deposited to satisfy the morbid curiosity of the visiting populace. Nothing could be further from the truth, for housed within the walls of this institution are the scientific keys which have and will continue to unlock the secrets of disease. ”

“ The fact that we are physicians does not imply that we look upon them from a medical or scientific stand only. Those of the combatants who survive are now better friends than ever, and the museum specimens coming as they do from the sick and wounded of both armies, and contributed by both Union and Confederate surgeons, enforce the lesson of the unity of the profession and of its interests, as well as that of our country. ”

“ I do not think that it is the only thing to be considered in the prevention of typhoid fever by any means; attention must be paid to all the usual sources of infection in addition to the use of vaccine. This is for the reason that the protection gained by vaccination is not absolute but only relative, and that if the infected material is present in sufficient quantities some people might develop typhoid in spite of previous vaccination. ”

“ These profound studies, so essential to the welfare of our people, are carried on under the fostering care of our National Medical Museum, whose library, now the first in the world, and whose not less admirable collection of military pathology are placed at the disposal of all investigators. ”

“ But to Walter Reed, James Carroll, Aristides Agramonte, and the lamented Jesse W. Lazear, and to the corps of intrepid and dedicated volunteers who offered themselves for experiment, must go the credit for demonstrating and establishing the fact that explained the mysterious behavior of yellow fever and offered a method of successfully combating it. As Dr. Agramonte wrote in his biographical sketch of Dr. Finlay, speaking of the parts played by the Cuban doctor and the U.S. Army Board, "the great credit due the one robs not the other of a particle of his glory." ”

“ For back of the announcement in Circular No. 2 was an idea—the idea that by careful collection, comparison, and study of the anatomical wreckage of the great war in which the United States and the Confederate States were then engaged, there might emerge a body of knowledge and understanding which would, in time, lead to the lessening of human suffering and the saving of human life. ”

“ How could it have been otherwise, when a department set up to care for the medical needs of an army of 16,000 men, with all its methods geared to the slow tempo and small- scale demands of peacetime, suddenly found itself called upon to care for an army rapidly growing to the million mark and engaged in an active and hard- fought war? ”

“ The unrealized dream of a new building, however, in no way diminished the drive of the Museum in expanding its activities to meet the demands of the war of 1917-18. "The present war," said Major Shufeldt, "has had the effect of waking up the old-time spirit in this erstwhile slumbering institution * * *. It is now an active medical concern, reaching out in all directions and absorbing every possible means to become a medical research and teaching center in the broadest sense of those words." ”

“ The Museum thus launched evolved into the Army Institute of Pathology which became the Armed Forces Institute of Pathology—a veritable treasure house of medical knowledge and an active center for consultation, research, and education in the effects of disease and injury upon the form and function of living cells and tissue. ”

“ After summing up the advantages favoring an institute located in the National Capital as a site for the registries of national scope, Dr. Karsner summed up the situation of the organization in 1946 in his Military Surgeon article. "This Institute," he said "is unique in the world. Nowhere else has there ever been a concentration of pathological specimens that is comparable. Nowhere else is the pathology of the entire Army of a great country so concentrated. Nowhere else have the civilian pathologists and other interested physicians taken such a great part in organization and operation. ”

“ The object of the American Registry of Pathology, which has grown to include 27 specific specialty registries, as outlined by Major Callender, 3 [3] is to "collect data and specimens from patients, especially those with tumors, with a view to accumulating a sufficient number of instances of each disease to determine its characteristic course, the criteria for diagnosis, and to evaluate methods of treatment * * *. The cases preferred are those living at the time of registration, and that can be followed so that the outcome may be ascertained. ”

“ As Colonel Ash said, the organization "suffered under the connotation museum, an institution still thought of by many as a repository for bottled monsters and medical curiosities. To be sure, we have such specimens. As is required by law, we maintain an exhibit open to the public but in war time, at least, the museum per se is the least of our functions, and we like to be thought of as the Army Institute of Pathology, a designation recently authorized by the Surgeon General." ”

“ The solution of medical problems is rarely, if ever, achieved by methods employed in morbid anatomy alone, helpful though they may be in pointing toward the right approach. The importance or the Army Institute of Pathology as the national center of pathology would make it mandatory for this Institute to take the lead in pathologic research. This, however, can only be achieved by proving the necessary facilities for all phases of pathologic study and investigation to members of a qualified staff. ”

“ It happens that the experiment was brilliantly successful, and that the only life lost was that of one of the experimenters, but it is easy to imagine, if things had turned out differently, the outcry that would have assailed those responsible. Fortunately, the United States was represented in Cuba in 1900 by a governor general who, being a medical officer himself, had the understanding of the problem and the courage to face it in his own responsibility — and Walter Reed got the necessary authority and backing. ”

“ Disclaiming any intent to recite the progress of the Institute through its "four-score and nine years" of life, General Armstrong contented himself with a brief account of General Hammond and his "far reaching, and, I am sure, at that time considered visionary, recommendations" and invited attention "to the steps which took us from the Museum stage, which, in the minds of the public both lay and professional, tended to emphasize the dead and the dead past" to the newer and broader institute whose "primary concern is the living, and not the dead." ”

“ While the Army Medical School occupied a large part of the present building, the energies of the Museum staff in practically all the laboratory work were expended in teaching the class and in making original investigations, principally bacteriological, into questions of great importance for the Army at large and the Medical Corps in particular. The results have been so brilliant * * * that no excuse is needed for having temporarily ceased to develop the Museum feature proper — to wit, the collection, preparation and exhibition of specimens illustrating medicine in all its branches. ”

“ There was no doubt in Reed's mind of his illness and death from the bite of a mosquito, and there is persuasive evidence that he believed that the mosquito was actually one of the purebred laboratory strain which Lazear had deliberately applied to himself, and not the stray insect which Lazear hail mentioned during his illness to Carroll and Gorgas. The reason for the discrepancy, it is surmised, was possibly an apprehension on the part of the sick man that his life insurance might be forfeited if he deliberately infected himself with a possibly fatal disease. ”

“ Institute review of diagnosis is important, also, in preventing possible imposition on the Government or injustice to the serviceman in cases involving line-of-duty questions as to responsibility for death or disablement. Thus, Institute review has forestalled the collection of compensation for nonexistent disease and, on the other hand, has altered erroneous diagnoses of the causes of deaths which, if allowed to stand, would have denied benefits due the serviceman's family. ”

“ At present there are about two hundred thousand visitors a year to the Museum, and while it is true that many of these come out of curiosity, the possibilities to the medical department of acquainting such a large group of civilians of all walks of life with its activities cannot be taken lightly."
Just as he felt that much of the Museum was more closely related to the new Library, Colonel Ash felt that the Institute of Pathology was more "logically concerned with the teaching and research programs of the medical department than it is with the activities of a hospital." ”

“ 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. ”

“ The Secretary of War is now free, within the limits of that sum, to have a new edifice built for the library and museum whenever and if ever he gets the money. He has not got it yet. The new War Department budget, however, does contain, among the Surgeon General's estimates, a special item of $600,000 for the acquisition of a site. But with Congress in its present temper, and with the estimates for national defense tremendously swollen, the fate of this item appears precarious. ”

“ Reminiscent of the pioneering of the Medical Museum in the combination of the camera and the microscope is the work of the Biophysics Branch with the electron microscope and a photometer in determining the mass of biological particles so small that it can be expressed only in terms of a negative fraction of a gram raised to the 12th or even the 18th power — if such words as "mass" and "raised" can be meaningfully applied to anything so infinitesimally small. ”

“ While continuing his experiments with mosquito bites, Dr. Reed was carrying on a rigorous test of the theory that infected clothing and bedding was the transmitting agent of the fever — a theory unquestioningly accepted by the medical profession and acted upon in framing and enforcing quarantine regulations. The very name given to these infected articles, supposed to be capable of passing on the flame of infection— "fomites," a word derived from the Latin term for "tinder" — indicates how seriously they were regarded as a means of spreading the flames of the fever. ”

“ 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 ." ”

“ At these hearings, General Dart forcefully depicted the plight of the Institute, with its broad new responsibilities but its old limited and insufficient space. "The greatest handicaps to the further development of the institute," he said, "are the lack of space and the complete absence of experimental facilities in the existing obsolete building. Researches are, therefore, confined to pathologic anatomy and statistical analysis, which sharply limits full utilization of the collection of pathologic material." ”

“ Diagnosis in the early stages of disease "offers the best chance of cure," Major Callender said, but early and accurate diagnosis is not possible in the absence of opportunity to observe enough cases to form a basis for reasonable judgments. Except at large medical centers, there were too few cases of any one kind to afford such opportunity for study. By combining cases from the country as a whole, Major Callender observed, "It will be possible to obtain considerable numbers of cases and specimens in a much shorter time." ”

“ In its aims and purposes, the Institute represents the hard core of our attack on disease and war injuries which ordinarily take such a terrific toll of military effectiveness * * *. In these days of increasingly devastating conflicts, this institution will become of even greater importance than during the past. New types of warfare, including atomic weapons, make additional pathological facilities mandatory for the prevention and treatment of casualties. ”

“ There was ignorance of the epidemiology of typhoid, that it was conveyed in other ways than by polluted water, ignorance of sanitation in general and of camp sanitation in particular, ignorance of proper precautions to be taken in the preparation and handling of food, ignorance of the danger of having sick men in kitchens, ignorance of the accurate methods of diagnosis which are now employed as routine in camps and hospitals, ignorance of the existence of typhoid carriers. ”

“ To carry out the contemplated experiments, however, there had to be more than a theory and a breeding stock of mosquitoes. There had to be money, for one thing — precious little money by comparison with modern expenditures or in relation to the results accomplished, but money just the same. And there had to be experimental "animals" — and so far as anyone then knew, the only animal subject to yellow fever was the genus Man, himself. ”

“ Hepatitis, while it is exceedingly debilitating and distressing to its victims, is not a disease of high mortality, the death rate being less than three-tenths of 1 percent of hospitalized cases. In disablement and deadliness, hepatitis was not to be compared with yellow fever, but there was enough plausibility in the rumor that "yellow jack" had returned to the Army through the hypodermic syringe of the surgeon to make it damaging to morale. ”

“ The Registry Movement
"The evolution of the pathology registries stands out as the most important organizational development in American pathology," declared Brig. Gen. Elbert DeCoursey, addressing the annual meeting of the American Academy of Ophthalmology and Otolaryngology in 1952. ”

“ This disturbing fact led to another problem — not where to get the men necessary for the experiments, for that problem was to be solved by ready volunteers, but whether to authorize experiments on human subjects. In the light of the results accomplished, that question does not seem as thorny now as it must have seemed to Dr. Reed, who had the responsibility for proposing such a course to Surgeon General Sternberg, and to Maj. Gen. Leonard Wood, Governor General of Cuba, who had the final responsibility for authorizing human experimentation. ”

“ The movement for consolidation of all governmental scientific activity does not appear to have developed any great popular strength, but coming as it did, just as the Army Medical Museum was changing its direction so as to expand its services to medicine in general, as well as military medicine in particular, such public discussion of the plan led Major Callender to give serious and concentrated thought to the position and the future course of the Museum. ”

“ Calling "the attention of the profession in a general way to the advisability of more frequently resorting to this store- house of pathology," one Washington doctor declared that instead of the specimens being looked upon "as so much 'embalmed beef,' they should be regarded as treasures of great value," to be consulted by the "earnest student of disease." ”

“ The Museum, he said, had "only a beginning of such an anatomical collection as I have indicated is desirable * * *. We are accustomed to think that human anatomy is exhausted as a field for original research," a view to which the speaker did not subscribe. "There is ample material and scope for original work for half a dozen skilled anatomists for many years to come to supply the demands of this museum for illustrations of human morphology * * *," he added. ”

“ Broad as it is, the definition is not broad enough to cover all the activities and contributions of the Institute. Being limited to man, it does not cover the work of the Institute in veterinary science, a field in which what is probably the largest staff of veterinary scientists in the country is engaged. Nor does it cover much of the work of the Medical Illustration Service, one of the four departments which make up the Institute, and one which is called upon for many services outside the perimeter of pathology. ”

“ Sophie Spitz, a brilliant young woman pathologist serving as a contract surgeon, "prepared comprehensive study sets from the large collection of material that had come to the Institute from wide-spread tropical installations, which were distributed particularly to the Army pathologists. In order to reach a wider circle, she prepared other collections of tissues from tropical diseases which went out to nearly all medical schools in the United States and Canada, as a means of alerting students to the possibilities in this special field." ”