Annual Report the Surgeon General United States Army Fiscal Year 1959
RESEARCH AND DEVELOPMENT
Changes in Organization and Emphasis
Major changes were made during fiscal year 1959 in the Army Medical Service organization for research and development and in the emphasis placed on certain types of research studies. In order to achieve more effective coordination and control of research and development activities, the U.S. Army Medical Research and Development Command was authorized and established, on 23 August 1958, as a class II activity under The Surgeon General. Brig. Gen. Joseph H. McNinch, MC, was assigned as its first commanding general and was also designated as Special Assistant to The Surgeon General for Research and Development Affairs. Following the establishment of the new organization, all of the seven medical research units in CONUS and the two overseas were transferred to the Command. In addition, two new medical research units were established-one at Landstuhl, Germany, and the other in Panama. In order to provide the proper means for conducting
104
the entire Army medical research program, the Research Contracting Office, previously a part of the Supply Division, OTSG, was transferred to and incorporated into the headquarters of the new Command in the Office of The Surgeon General. Experience during the last 9 months of the fiscal year proved the validity of the reorganization.
The objective of the AMEDS Research and Development Program continued to be that of providing new or improved means for the prevention and treatment of disease and injury. A basic budget of $12,478,000 supported research and development efforts in 32 major projects covering priority military medical problems. Decreased emphasis was placed on X-ray and photographic techniques, physical standards research, and research on biomedical effects of blast. Work was initiated on the biomedical aspects of missile transport, and there was a marked increase in activities in the field of ionizing radiation. Productive results were obtained with the promise of major improvements in the prevention of radiation injury and in the treatment of nerve injury, major fractures, and acute renal failure.
Bioastronautics Research
During the year, the Army Medical Service for the first time entered the field of bioastronautics. A project entitled 'Biomedical Aspects of Missile Transport' was established, and a research program was instituted in coordination with the Surgeon General of the Navy. Even in the infancy of this effort, a major first was achieved-successful flight into space by living primates.
Utilizing space available in the nose cone of the Army Jupiter missile, two bioflights were conducted. The first, in close coordination with the Naval School of Aviation in Pensacola, Fla., was made by a 1-pound squirrel monkey on 13 December 1958. Although the launching and the flight were entirely successful, the nose cone was not recovered. Physiological data telemetered from the capsule in flight did provide valuable information concerning the bodily reactions of the small monkey while traveling into space. Even before the first launching, preparation had been initiated for a more extensive medical experiment, using both a squirrel monkey and a larger rhesus. On 28 May 1959, the historical flight took place. Two monkeys, both female-one, the Army monkey (Able), a 7-pound rhesus, and the other, a Navy monkey (Baker), a 1-pound squirrel monkey-were successfully transported to an altitude of 300 miles and to a distance of 1,500 miles. A maximum speed of 10,000 miles per hour was attained. In this flight, the nose cone was quickly retrieved, and the primates were recovered in excellent physical
105
condition. The preliminary analysis of the data telemetered during the flight and obtained from the animals after the flight indicated that they sustained no adverse effects from the experience.
The most important result of the test was that ordnance engineers, with the advice and assistance of AMEDS personnel, proved that they were capable of predicting the requirements for sustaining life during rocket travel and of constructing capsules which would completely protect the occupants. Four days after the flight, during the administration of an anesthetic prior to removal of an electrode placed in her body for the space flight, the monkey Able went into cardiac fibrillation and expired. Autopsy findings indicated complete absence of injury resulting from the missile flight. The bioflights were carried out under the auspices of the National Aeronautics and Space Administration in support of the national space program.
Biophysics Research
One of the most promising research advances of the year was made in the field of ionizing radiation. It was determined that large animals
106
could be given significant protection against radiation through preexposure administration of a combination of chemicals. This was the first time that large animals had been successfully protected against lethal doses of ionizing radiation. Sufficient promise was shown by this work that the Department of Defense provided emergency funds in the amount of $1.6 million to expand efforts to develop a safe, practical, long-lasting oral medication. Action was taken to modify existing chemicals in order to decrease toxicity and to increase length of action.
107
The objective is to provide a practical drug or combination of drugs which will increase threefold to fourfold man's resistance to radiation. Concurrently, studies were conducted on the mechanisms of
radiation injury; on the effects of radiation on immunity, infection, and wound healing; and on the results of low-level chronic exposure to radiation. Progress was also made on improving radiation treatment.
Methods have been developed for assessing medical impact to be expected from nuclear warfare. These studies will continue in order to provide planning data on personnel and on the logistic support that would be required in the event of nuclear hostilities.
Research continued on the biomedical effects of microwave radiation. Some evidence has been obtained showing that microwave radiation may have other than thermal effects on living tissue. Research directed toward development of a lightweight, battery-powered pulsed X-ray machine neared completion. Trial radiographs indicate that the pulsed X-ray may provide the solution to the requirement for X-ray support in forward field medical units.
Medical Research
A major advance in treatment of fungus infections of the skin was the development of a new antibiotic, griseofulvin. The new treatment agent was found to be extremely effective against a number of fungus infections.
Techniques have been developed to measure accurately the total amount of water in the body at one time. Through the use of these techniques, the amount of water absorbed from the air has been measured. It was shown that humidity has an important bearing on the amount of water needed by the soldier.
Continuing advances were made in the development of a completely satisfactory intravenous fat emulsion, urgently required for providing nutrition to burned or severely injured personnel unable to take nourishment through the mouth. It was determined that coconut oil emulsions were superior to those previously used.
A new method for determining the optimum dosage schedule of isoniacid for the treatment of tuberculosis has been developed. This new technique is dependent upon the degree of acetylation of the drug. Use of this method of dosage determination has resulted in a significant improvement in the therapeutic effectiveness of the drug and has led to a great reduction in the incidence of treatment failures.
Research on the wholesomeness of radiated foods was continued in support of the Quartermaster program.
108
Several major advances have been achieved in the surgical research program. It has been shown that storage of liquid pooled plasma for 6 months at 32? C. makes the material incapable of transmitting viral hepatitis to patients who receive it. Use of this process makes safe the employment of plasma for patient care.
Adoption of the mouth-to-mouth method of artificial respiration as the superior and preferred method has been achieved. Public results have shown the unquestionable value of this procedure.
With the development of a new type of artificial kidney, under an AMEDS research contract, and with the use of new techniques, a marked reduction in the mortality of patients with acute renal failure has been obtained. Early prophylactic daily dialysis using the new McNeill-Collins artificial kidney has reduced to zero the mortality of acute renal failure among patients treated at the Surgical Research Unit, Fort Sam Houston, Tex. Progress has been made in the development of a practical field resuscitator.
Work has continued on the use of a porous cellulose acetate preparation known as millipore in the treatment of severed nerves and tendons. The use of this material provides greatly improved treatment results by preventing formation of painful and troublesome neuromas or scar tissue.
Dental Research
Studies continued to be made in the etiology and prevention of dental caries, peridontal disease, and other diseases. Added information has been gained on filling materials through the use of radioisotope tracer techniques. Efforts have been made to develop a vaccine for immunization against dental caries. Protection is being attempted against lactobacilli and enterococci.
Studies were continued in the field of high-speed cutting to determine optimum cutting speeds and to obtain data on the effect of higher speeds on the pulp. Studies were also conducted on the toxic mechanisms of local anesthetics. Preliminary studies of the relationship of stress to caries formation showed that the caries rate increased under stress.
Preventive Medicine Research
Major progress has been made in the development of techniques for producing virus disease vaccines. Attenuated strains of measles virus have been cultivated, indicating a possible solution to the problem of preparing an effective measles vaccine as well as serving as a model for the possible development of other virus disease vaccines.
109
Advances made in the rapid identification of micro-organisms by means of fluorescent antibody techniques are outstanding. These techniques are being used also in studies of the pathogenesis of disease or the origin and development of the damage produced by disease-causing organisms.
Research in Human Resources
Studies in the fields of neuropsychiatry, psychophysiology, and environmental physiology have provided new and useful medical information. Recent studies of the inner ear muscles have revealed that the activation of these muscles reflexly just prior to gun firing will reduce the resulting temporary hearing loss. This finding may open the way to improved preventive measures against hearing loss.
The first definitive study providing measurement of impulse-type noises of various U.S. Army weapons was initiated. Data on impulse-type noises were gathered preliminary to relating them to the measurement of the hearing acuity of Army personnel exposed to such noises.
Research on cold acclimation has shown that man can be adapted to cold and further that this adaptation can exist coincidentally with heat acclimation, Further tests of cold adaptation will be conducted in the field to prove the practicality of preconditioning troops for operation anywhere in the world. During the cold studies, it was determined that in the adapted man there was a decreased heat loss, a change in the methods of heat production, and an increased resistance to cold injury.
Oversea Research
Medical research was continued overseas, both in research units of the Command and by special teams. Studies of diseases prevalent in South East Asia were conducted by the research unit at Kuala Lumpur, Malaya.
In coordination with the Middle America Research Unit, directed by the National Institutes of Health, Army personnel studied histoplasmosis and other problems of medical importance in the Panama area.
Facilities of the Tropical Medical Research Laboratory at San Juan, Puerto Rico, were enlarged with the addition of a metabolic laboratory and ward at the Rodriguez Army Hospital.
A new research unit was established at Landstuhl, Germany, with the initial mission of investigating radioactivity in man in that area. A low-level, whole-body counter was obtained from the U.S. Atomic Energy Commission and by the end of the year was placed in operation in the Landstuhl Research Unit.
110
A research team was sent to Thailand to assist the Thai medical profession in controlling a major cholera epidemic and to carry out studies on that important disease. Improved treatment methods were developed, and a better understanding of the cholera process was obtained.
Late in the year, a small medical team departed for Pakistan and Iran with the primary objective of studying sandfly fever, a disease of potential military importance in that area.
Development of Materiel
Continued emphasis was directed toward the improvement of medical equipment for field medical units. The changing concepts of modern warfare dictate that the weight and cube of field equipment be reduced as much as possible. In addition, vital considerations are maintenance, simplicity of operation, reliability, and minimum logistic support requirements. Representative of the items toward which developmental efforts were directed are projects relating to a scrub sink, a field hospital bed, a field sterilizer, a field operating table, and a field X-ray apparatus. A development feasibility study was initiated concerning a medical-surgical pod for air vehicles.
The automatic jet injector was carried through user tests and is being processed for standardization. The jet injector in field use made it possible to process 1,200 immunizations per hour.
