Annual Report of the Surgeon General United States Army Fiscal Year 1958
RESEARCH AND DEVELOPMENT
The budget of $12,150,000 made available for the Research and Development Program during the fiscal year supported 34 major research and development projects, covering multiple problems of military medical priority. Productive results were obtained in preventing disease and injury and in improving medical therapy and the medical screening methods of selecting personnel.
Progress in Research
Dental research.-The most notable advance in dental research has been the development of a new method of local anesthetizing that represents the first basic change in injection technique in the history of dentistry. Called jet injection, it is a method of injecting fluids into skin and mucous membrane by forcing liquid substances through very small openings or jets at very high pressure. Preliminary study now completed has shown that this technique provides dental local anesthesia of sufficient depth and duration to complete successfully operative and surgical procedures.
Satisfactory progress was made in determining the effect of irradiation on oral tissues and in the etiology and prevention of dental caries,
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periodontal disease, and other oral disease. Excellent progress has also been made in evaluating the many types of high-speed cutting devices and the effect of high-speed cutting on the pulp.
Preventive medicine research.-Experience showed, as had been anticipated a year ago, that previously prepared influenza vaccine did not give any demonstrable protection from infection with the 1957 Far East strains of virus. It was found, however, that vaccination with vaccine prepared from these 'new' strains can protect against the epidemic disease. Consequently, it was possible to initiate a program that resulted in the general vaccination of Army personnel and in the prevention of a significant number of influenza cases.
Continuation of the studies of adenovirus vaccine has demonstrated its effectiveness in the prevention of adenovirus disease in recruits.
The development of a cholesterol adsorption column technique appears to be most significant. Passage of fluid containing live or killed viruses through such a column resulted in the adsorption to the cholesterol of more than 90 percent of the virus activity, while less than 10 percent of the foreign protein material was retained. This indicates a greater than tenfold increase in the specific activity of virus per milligram of protein. The antigenic activity of the adsorbed virus appears not to be altered. This seems to be a practical method of concentrating and purifying viral antigens for vaccine production.
Also significant have been the results of studies on diethyltoluamide, which promises to be an excellent repellent for numerous arthropods of medical importance.
Basic sciences research.-In the field of basic sciences, increased emphasis was placed not only on research into the toxic effects and health hazards of military chemicals, particularly in view of the development of new forms of fuel for use in satellites and ballistic missiles, but also on the rapid identity of micro-organisms by means of fluorescent antibody techniques.
Medical research.-Army medical research during the year developed a safe and effective intravenous fat emulsion to provide food for those unable to take nourishment through the mouth. Experience demonstrated that when the emulsion is given over a reasonable period of time (2 units a day for 14 days) the incidence of untoward reactions is somewhat less than that in the administration of whole blood.
The wholesomeness of irradiated pork stored from 6 to 12 months at room temperatures has been studied extensively. Volunteer troops were fed this pork in a regulation Army mess without any harmful
effects. Acceptance in general seemed to be good despite some flavor changes brought about by irradiation.
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Because of renewed interest of the Army in environmental factors which affect the performance of soldiers, an Advisory Committee in Environmental Medicine has been established by The Surgeon General.
The main function of this committee is to serve as a consultant group to The Surgeon General on the technical and professional aspects of environmental medicine with emphasis on the military implications.
During the fiscal year, 107 medical research contracts were monitored with civilian institutions and other governmental agencies at a cost of approximately $2,250,000, and in-service projects in the amount of more than $1,000,000.
Surgical research .-A technique for administering mouth-to-mouth artificial respiration has been developed by researchers working under Army Medical Service contracts. The superiority of this new method over other conventional methods of resuscitation is demonstrated in a recently completed research documentary color movie. The mouth-to-mouth method can be quickly learned and easily applied for prolonged periods without tiring the operator, and is particularly applicable to asphyxiated patients with crushed-chest injuries, to infants and children, and to overweight or heavy-set individuals. The development of this new technique resulted from efforts by the Army to devise methods for providing adequate first aid to paralyzed, nerve-gas casualties. In using this new method, the operator wears a mask connected by a hose to that worn by the victim, with a filtering device between the two masks to prevent him from being poisoned by air from the gassed patient's lungs. Field tests showed that mask-to-mask artificial respiration can be administered to a litter patient by the normal respiration of one of the litter bearers even while the patient is being removed from a contaminated area.
Significant discoveries have been made in the use of millipore, a porous plastic with a pore diameter of 0.45 micron (.000018 inch), which is large enough to permit the passage of nutrient body fluids but too
small for the growth of scar-tissue cells through a membrane of this material. Millipore tubes wrapped around repaired tendons and peripheral nerves improve the results of recovery from these injuries because they keep scar tissues from growing into the healing nerve or tendon. Millipore is also being used for repairing experimental wounds of spinal cords and optic nerves. While it is still too early to predict the outcome, it is hoped that millipore will permit healing of these injuries. Teflon seems to be the most satisfactory synthetic material available for repair of arterial and body wall defects.
Nearly concluded clinical tests show that clostridial enzymes are poor burn-debriding agents. Evaluation of surgical debridement of large
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burns continues. Several investigators started studies of the antibiotic potentiating properties of gamma globulin. Discovery of the causes of antibiotic resistance and sensitivity in staphylococcic organisms led to concepts of ideal antibiotic or chemotherapeutic agents.
Synthetic polypeptides and solubilized keratin have interesting possibilities as new artificial plasma volume expanders and for other purposes. Proof that storage of liquid human plasma at 31˚ C. for 6 months destroys hepatitis is sufficient to have induced several leading medical centers to adopt this method.
Recently initiated studies of the effects of chronic continuous low-level ionizing radiation may or may not alter certain current surgical concepts and methods.
Improvement of prosthetic limbs continues. With the deactivation of the Ocular Research Unit at the Walter Reed Army Institute of Research, in-service ocular research was transferred to the ophthalmology service at Walter Reed Army Hospital.
At present, 117 surgical research contracts with civilian institutions and in-service research activities in 7 military installations are being monitored.
Biophysics research.-Studies continued in the fields of X-ray and photographic techniques. A paper describing the utilization of isotopes for portable X-ray application has been selected to be read at the Atoms for Peace Conference at Geneva in the fall of 1958. Other notable work in the X-ray field has been the awarding of contracts to the Linfield Research Institute to develop a portable X-ray machine and a laboratory pulse X-ray system. The former effort is expected to yield an X-ray machine suitable for a field army and will weigh approximately 45 pounds. The latter laboratory X-ray system is expected to provide a new tool for research in radiobiology.
Various investigators have indicated that there may be harmful effects from microwave radiation. As a result of these preliminary studies, work has been inaugurated at the Army Medical Research Laboratory on behalf of the U. S. Army Chief of Research and Development.
Work continues in the biological and medical aspects of ionizing radiation. A contract has been let with the E. H. Smith Company to analyze the casualty effects of nuclear weapons. This study is expected to give a planning estimate for the number and type of casualties and for the hospital treatment effort required.
The blood enzyme system is being studied to determine if it is a practical biological indicator of radiation. If successful, this method will allow quick determination of individuals requiring immediate therapy.
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Army Medical Service School, Brooke Army Medical Center, Fort Sam Houston, Tex.
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An instrumentation system is expected to be completed at the Walter Reed Institute of Research that will give fundamental information on accumulated gamma-emitting isotopes in man.
Research in human resources.-The Experimental Psychology Department, Army Medical Research Laboratory, was reorganized during the year to permit greater emphasis on the more fundamental aspects of human sense modalities and less on the applied aspects of human engineering. A field study of two antimotion sickness drugs was completed and resulted in information concerning tests sensitive to side effects. The comparative tests of the sound attenuation properties of the T56-6 helmet and other ear-protective devices for combat crew members was completed and a final report submitted. New studies were initiated in an attempt to develop medical screening methods of aviation trainees. A field trip to the Greenland Icecap by members of the Army Medical Research Laboratory resulted in a better understanding of the visual problems associated with the 'white-out' phenomenon. Neuropsychiatric studies on sleep deprivation by investigators at Walter Reed Army Institute of Research were brought to a point where some of the problems associated with this stressful situation were better understood.
Development of Materiel
Efforts were intensified to improve existing medical equipment and to develop new field items. To make the materiel development program more effective, The Surgeon General established in his office a Development Branch in the Research and Development Division to provide guidance to the Medical Equipment Development Laboratory, a class II activity at Fort Totten, N.Y.; to coordinate user tests of field-type equipment proposed for adoption in the Army Medical Service; and to correlate The Surgeon General's development activities with the Armed Services Medical Materiel Coordination Committee.
Seventeen projects, directed toward the improvement of medical equipment of field medical units, were formulated in April 1958 under the revitalized program and were submitted to the Armed Services Medical Materiel Coordination Committee for subsequent referral to the development laboratory. This program concentrates attention on the development of field-type equipment directly related to improving battlefield performance rather than on projects that provide only marginal benefits. The objective is to develop light, compact, highly mobile, air-transportable field medical units without sacrificing the standard of medical care.
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The Army Medical Depot at Louisville, Ky., developed a 100-bed hospital unit, completely air transportable, that is now being field tested. It is intended as one element of a three-unit field hospital that would provide support to fast-moving combat units.
