Armed Forces Institute of Pathology

“ One can be sure that the record of the past will serve as an inspiration to those individuals responsible in the future for the destiny of the Armed Forces Institute of Pathology and its important role in advancing military medicine. ”

“ A succession of epidemics, both at home and in the AEF, and the care of the wounded in the AEF overtaxed the laboratory forces and left "neither time nor force to collect suitable pathological specimens and preserve them according to modern methods." Furthermore, Dr. Ewing said, the "number of men in the American medical profession trained in the methods of the pathological laboratory, and especially in the methods of museum preparation, proved to be extremely small, and few of these were available to the army." ”

“ In arriving at this broader concept of pathology and the place of the pathologist in the scheme of things medical, the Institute has played a major part. During the first half-century of its life, while it still was the Army Medical Museum, it contributed to medical research and education through compiling and publishing the massive "Medical and Surgical History of the War of the Rebellion," and through the introduction and development of such techniques as photomicrography and the use of aniline dyes in staining slides for microscopic study. ”

“ 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. ”

“ At the center of this worldwide network of channels, through which pathological materials and records flowed in and diagnostic information flowed out, was the Museum (fig. 77) . "The U.S. Army is the only armed force in the world that had this centralization of pathology," said Colonel Ash, "and it has resulted in the largest single accumulation of material in the history of
Figure 77.—Schematic representation of the flow of pathological materials during World War II. A. Continental network, to and through Histopathologic Centers on the way to the Institute. ”

“ Institute set up an extensive service, making study sets available to all Army laboratories, to keep medical officers throughout the Army informed about the pathology of the diseases prevalent during the war. ”

“ Besides giving attention to consultation sought in about 250 cases per month, the Division carried on an active program in research and education. The use of loan materials in the form of microscope study sets and lantern slides was virtually doubled in 1961, as compared with i960, while response to the Division's postgraduate short course on the pathology of the oral regions was such that 60 civilians who applied for the course had to be turned down because of lack of space. ”

“ In man, and in animals with natural or experimentally induced disorders, the final identification of disease, indispensable in investigation, depends on pathologic anatomy. Through the medium of autopsies and surgical specimens, pathologic anatomy serves the Army in its usual unpretentious manner. The organization now operating in the Army is such that careful examinations can be made in the field; central facilities provide for skilled controls and permanent files. ”

“ 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 Institute Idea
"At no time during the war was there a sufficient number of trained pathologists in the service," said Surgeon General Merritte W. Ireland in his annual report for the fiscal year ending 30 June 1919. "The same condition seems to exist in civil life," he added, "for it proved impossible to find a sufficient number of trained men." ”

“ Making Pathologists in a Hurry
The shortage of pathologists led to a certain amount of shortcut improvisation, such as the way in which Maj. C. Judson Herrick of Grand Rapids, Mich., found himself in charge of the pathology department of the Army Medical Museum. As Dr. Herrick tells the story, he was commissioned as a major on 18 January 1918, and charged with the business of assembling personnel for assignment to Army hospitals to collect neuropathological materials for delivery, with their accompanying records, to the Museum. ”

“ Such a center, the Committee reported, was an "urgent and immediate" need, due to the "comprehensive and global nature of modern military medicine" if the Medical Department was "to fulfill its mission of protection and care of troops, to keep pace with worldwide developments of significance to military medicine and to maintain a productive relationship with the medical profession at large * * *. The Army Institute of Pathology and medical museum are presently housed in an antiquated building which seriously limits the important functions of this institution. ”

“ 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. ”

“ The Institute has continued this interest in global medicine, with members of its staff collecting material from all corners of the world. Contributions of cases by pathologists of other countries have added significantly to the collection of disease entities, which now exceeds one million cases. From this vast storehouse of cases, much teaching material is prepared and made available for loan to governmental and nongovernmental pathologists. ”

“ 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." ”

“ If research problems in pathology are to be properly correlated with medical problems as a whole, laboratory investigation and animal experimentation are indispensable. These phases of investigation are not available to members of the staff on the present premises of the Army Institute of Pathology This deficiency is keenly felt by members of the professional staff who are trained to think and work in broader terms, but who cannot exercise their abilities and tendencies in this direction under the present circumstances. ”

“ The heart of the building is in the central block of research laboratories, located on both sides of a 3-foot-wide "mechanical core," extending lengthwise of the building, through which each laboratory is supplied with such essentials as
electricity, water, gas, and compressed air. Surrounding this rectangular block of laboratories is a passageway, separating the laboratories from the offices which are ranged against the windowless outer walls. At the ends of the building up
Figure 96.—Typical floor plan of new Armed Forces Institute of Pathology building. ”

“ 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. ”

“ 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. ”

“ The building in which somehow the work of the war years had been done, the Committee said, "was built in 1887, fifty-eight years ago, and is no longer adequate * * * It is antiquated, overcrowded, obviously cannot be modernized, and there is no provision for experimental research." The Committee recommended, therefore, that "the Surgeon General proceed at once to secure authorization and funds for the construction of a building adequate in size and arrangement for the expanding activities of a modern army institute of pathology." ”

“ The new system deployed the limited number of trained pathologists at the points where they would be able to serve most effectively. It was recognized that there simply were not enough pathologists to go around among all the medical installations, but there were enough to staff regional centers for his topathology. ”

“ As American Forces spread to theaters of active operations, the system of channeling pathological materials and information spread with them, with the chief surgeon of each oversea theater designating a medical general laboratory, usually at the principal general hospital in the area, to serve as its histopathologic center. ”

“ In search for broader knowledge and deeper insight into the nature of these "ultimate particles," the century-old Institute is one of the forward observation posts— an organization rarely equipped for the pursuit of the elusive bits of information which can, in time, lead to a better understanding of the causes and course, and the prevention and cure, of disease. ”

“ The Registry was fortunate both in its professional sponsorship and in the Army personnel with which it had to deal. Surgeon General Ireland and Curator Callender were of one mind in feeling that the Medical Museum should, as Major Callender put it, "become a live activity in pathology in addition to its function of collecting, studying and reporting on the injuries and diseases of armed conflict." ”

“ 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." ”

“ 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." ”

“ Major Callender also pointed out that the Medical Department of the Army was in far better position to conduct a medical museum than was any other government service or an independent organization. "This is true," he said, "for preventive medicine and hygiene, as well as for pathology. Army officers have, since the advent of modern means of disease control, led the field in preventive medicine and hygiene. ”

“ In the course of the debate, Representative Lyman, of Massachusetts, expressed the views of an informed layman on the state of the medical art and the contributions of the Museum to medical progress. "Most of the progress" in medicine and surgery, he said, "has been made during the last half century, and the next fifty years promise a great advance * * *. There is no subject more baffling, and yet it is yielding to study. Already the studies of disease have rendered it highly probable that these plagues are caused by the fertilization of microscopic germs within the body ”

“ The specific disease of leprosy is the field of a registry, formed in 1950, under the sponsorship of the Leonard Wood Memorial. Most recent in the roster of registries are the ones on Forensic Pathology, formed in 1958, with the College of American Pathologists as sponsor and two formed in the centennial year of 1962 — one on Radiation Pathology, under the sponsorship of the U.S. Public Health Service, and another on Geographic Pathology, sponsored by the International Academy of Pathology. ”

“ Meeting the need for more and better-trained pathologists became, in the period following the First World War, a prime purpose of the Museum. Col. Charles F. Craig, the first postwar Curator (fig. 61) , was not primarily a pathologist but was distinguished for his studies of dengue fever, filariasis, the dysenteries, and, most particularly, malaria and its control. The incidence of the last-named disease in the Army was reduced in the first quarter of the 20th century from more than 700 to less than 10 per 1,000. ”