Annual Report the Surgeon General United States Army Fiscal Year 1960
RESEARCH AND DEVELOPMENT
The budget of nearly $16 million made available to the Army Medical Service for its research and development program in fiscal year 1960 supported 28 major projects, primarily in the fields of communicable disease, medical problems of ionizing radiation, and internal medicine, including metabolism and nutrition. Research in the field of accidental trauma, recognized as a national problem, is being transferred from the Army to the U.S. Public Health Service.
Despite the upward trend since 1951 in the funds provided annually for the research and development program, as shown in table 12, the rising costs of personnel, equipment, and maintenance have precluded any great increase in actual research during that period. About 43 percent of the money available in fiscal year 1960 was expended for inservice research and 57 percent for approximately 400 contracts with civilian institutions and firms. Over the years, the funds have been apportioned about equally between these two types of research.
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TABLE 12.-Army Medical Service research and development budget
(in million dollars)
Fiscal year | Number of projects | Number of tasks | Inservice budget | Contracts | Total net budget | |
Number | Budget | |||||
1951 | 25 | 130 | $2.6 | 238 | $4.4 | $ 7.0 |
1952 | 26 | 210 | $4.2 | 325 | $5.9 | $10.1 |
1953 | 26 | 215 | $4.3 | 373 | $6.7 | $11.0 |
1954 | 27 | 205 | $4.3 | 383 | $5.8 | $10.1 |
1955 | 28 | 210 | $4.4 | 355 | $5.8 | $10.2 |
1956 | 28 | 214 | $4.7 | 347 | $5.8 | $10.5 |
1957 | 29 | 223 | $4.9 | 360 | $6.3 | $11.2 |
1958 | 29 | 225 | $5.4 | 393 | $7.0 | $12.4 |
1959 | 30 | 252 | $6.3 | 373 | $6.6 | $12.9 |
1960 | 28 | 284 | $7.1 | 400 | $8.8 | $15.9 |
The U.S. Army Medical Research and Development Command was established in August 1958 as a class II activity under the command of a brigadier general. The objectives are to improve integration of Army medical research activities throughout the world, management of the research funds, and logistic support of component units. Table 13 shows the personnel authorizations, both military and civilian, for the command headquarters and the 11 component units-7 within CONUS and 4 in areas outside of CONUS.
The purpose of the AMEDS research and development program is to provide new and improved solutions of medical problems, to protect the health of Army troops wherever and whenever they are engaged in military operations in peace or combat, and to contribute new knowldege and advancement in the field of medical science. Following are discussions of the progress made during the fiscal year in the various research fields.
Medical Research
An amine buffer (THAM) was developed which counteracts the effects of 5 percent carbon dioxide in dogs when so exposed. Work is continuing to determine the effectiveness of this buffer to alleviate fatigue.
The physiology of nonfreezing cold injury has been more clearly defined by microcirculatory studies.
It has been demonstrated that man can be acclimatized to both heat and cold and retain acclimatization to both.
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TABLE 13.-U.S. Army Medical Research and Development Command personnel authorization
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Studies have shown that a normal healthy man can lose 500 cubic centimeters of blood weekly for 5 weeks without loss of physical performance or injury to health.
An electromagnetic flowmeter has been developed which can measure the volume of blood flowing through the intact artery. This provides an extremely important mechanism for the advancement of cardiovascular research. This devise is miniaturized so it can be sewn to the heart and measurements can be made at desired intervals.
Theoccurrence and characterization of emboli associated with the use of silicone antifoaming agent within tissues of patients subjected to extracorporeal circulation have been observed. This indicates that some component of the antifoaming agent enters the circulation from the defoaming surfaces of the bubble oxygenator used in cardiac surgery and is a possible source of vascular occlusion.
A technique has been developed to conduct experiments and incubation studies on radioactive labeled cercariae of Schistosoma mansoni. Preliminary studies indicate this will provide an additional tool to examine experimental schistosomiasis in animals.
A new nonphosphatide emulsion has been developed by the Southern Regional Laboratories of the U.S. Department of Agriculture which appearsvery promising from its use in dogs. It will soon be clinically evaluated. The U.S. Army Medical Research and Development Command is coordinating and participating in these studies through a transfer of funds to the U.S. Department of Agriculture.
The study of the body's use of water in field troops has been greatly simplified through the development of a method using heavy water dilution technique to determine the total water turnover in the body without actually measuring water intake and output.
Surgical Research
Army Medical Service supported research on surgical infections has been redirected to study basic mechanisms of antibiotic resistance of staphylococci rather than studies of incidence, carrier rates, and phage typing. The effectiveness of thorough and repeated disinfection and careful attention to many details concerned with the transmission of infective micro-organisms has been shown in a documentary movie of a study at the Surgical Research Unit, BAMC. Meanwhile, infections by gram-negative organisms are receiving renewed attention and interest. Evidence has accumulated that the endotoxin produced by these organisms may continue to exert a deleterious effect even after the organisms are not viable, and, therefore, neutralization of endotoxin with antiserum may be a valuable and indicated therapeutic measure.
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A new antibiotic, colistin or colimycin, obtained from foreign sources, promises to be effective in controlling antibiotic-resistance infections by pseudomonas and similar gram-negative bacteria.
Studies on the mechanisms and aftermath of near drowning in dogs indicates that, after successful initial resuscitative efforts, treatment with intermittent positive pressure breathing and intravenous plasma may be essential to survival from near drowning in salt water. Dogs near drowned in fresh water are prone to die of ventricular fibrillation during or after initial resuscitation, and defibrillation may be essential to survival. Clinics treating human victims of near drowning are being urged to measure and record blood hematocrit, volume, and electrolyte studies, and to attempt to confirm in humans the phenomena observed in dogs.
Recent studies have shown that male rats raised in a continuos radiation chamber in which they received 10 roentgens per day have shown significantly less weight gain than female rats under the same conditions. The females gained weight as rapidly as nonirradiated control animals. Continuous radiation at 2, 5, and 10 roentgens per day appeared to accelerate healing of fractures in these animals. First- generation rats raised from conception to adulthood in a low-level continuous ionizing radiation chamber showed no definite pathological condition attributable to radiation, but the incidence of abnormalities in third-generation rats raised in this chamber appear somewhat increase.
The treatment of massive soft-tissue blast injuries in goats by the simple expedient of penicillin spray will prolong the mean survival time of these animals from 19 to 42 hours. The wound is 100 percent lethal if untreated, but some animals have survived permanently when treated only by penicillin spray and deferred surgical debridement. These studies are being directed toward finding better regimens for applying the penicillin, finding more effective drugs, and transposing these data to man. It is hoped that some expedient definitive surgical treatment may be provided for prolonging the lives of victims in the event there should be an overwhelming number of casualties which cannot be promptly treated according to current classical concepts.
Electronic goniometers for measuring and recording graphically the motions of various joints of the human body were developed through AMEDS supported research. The original instrument was constructed to measure, record, and calibrate the foot and ankle motion during walking. These measurements were made in connection with tests of with new boots and shoes. Subsequent instruments were developed for other joints which will facilitate the study of joint functions after injury and during during rehabilitation, as well as in limb prosthetic work and in certain diseases.
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Field evaluation of Army types of combat boots by a joint Army-Marine Corps test team has begun at Fort Bragg and Camp LeJeune, N.C. Army Medical Service support in the form of foot examinations is being furnished during these tests.
Dental Research
Excellent progress has been made in research on periodontal disease. Dental calculus is the most important local factor as a cause for periodontal disease. Calculus has been produced for the first time in experimental animals by alteration of diet. This was accomplished byincreasing both the protein content and the calcium-phosphorous ratio, and by adding sodium bicarbonate to the diet. The significance of this work lies in the fact that since it is now possible to produce calculus, methods for its control can be investigated.
Studies have been continuing in an effort to produce a vaccine for immunization against dental caries, and results have been varied.
Excellent progress has been made in the study of the abnormal keratinizing processes. From the results obtained to date, it would appear that the presence or absence of glycogen in oral epithelium may be related to the malignant potential of that tissue.
Significant progress has been made in the field of dental materials. In the casting of partial denture frames, the technique called for the use of all new metal for each casting. The scrap alloy remaining from each castingwas returned to the manufacturer for a small percentage of the original cost. A technique has been developed whereby the scrap alloy can be recast, using equal parts of new and scrap alloy. This procedure was instituted at all Army dental laboratories in October 1959, and the resultant savings are estimated at approximately $50,000 per year.
Research data obtained during the past year on the effect of hearting, storage,and impurities on the physical properties of agar base duplicating compound have resulted in the determination that 150 cases can be duplicated with one batch of material. In the past, duplicating compounds were either used too long, resulting in inaccurate duplications, or were discarded too soon, thus wasting material.
Preventive Medicine Research
Basic andapplied research studies have continued throughout the year. Based upon laboratory and volunteer studies, a field trial of a combination of primaquine and chloroquine for the suppression and prevention of malaria has been formulated and will go into effect in the summer of 1960. Tests will be conducted on the basis of laboratory data which indicate that the weekly administration of one tablet of a
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combination of these two drugs may be used in the prevention and suppression of malaria. If successful, this combination will eliminate the need for the 14-day primaquine treatment of returnees from malarial areas.
Laboratory research studies in the field of viral vaccines have resulted in a technique for better concentration and purification of vaccines in order to enhance their protective capacity and at the same time reduce their capability to produce untoward reactions.
Studies from an epidemiological approach of Army aircraft accidents are providing data on ways to provide more safety features in the cockpit, the cabin structure, and the interior of small aircraft. These studies have been conducted toward eliminating factors which cause injury or death of the occupants when these types of aircraft are involved in crashes.
Laboratory investigations have shown the fluorescent antibody technique to be accurate and rapid. Methods are being studied for rapid laboratory identification of causes of disease so that immediate steps can be taken to prevent and treat epidemics or to provide protection against biological warfare.
Neuropsychiatry and Psychophysiology
Considerable effort is being devoted to improving the flow of information between fundamental research in psychophysiology and its application to the human engineering problems of the Army. Studies are considering the relationship between certain background socioeconomic factors and military effectiveness. Methods are being developed to identify early the causes of maladjustment and military delinquency, and to prevent or minimize the consequences. The effects of psychological and social stresses with their implications are being analyzed for management and leadership, and for preventive psychiatry. Investigations concerned with the functions of the sensory systems have been expanded to include the combined effects of multiple environmental stresses upon human performance.
Biophysics Research
Research studies with the compounds, benzophenone and chloroquine, both topically and orally, as a screen against ultraviolet radiation revealed most encouraging results. Both compounds were found to be good energy absorbers for ultraviolet rays, and investigations been extended to include ionizing radiations.
Studies continue to provide planning data on personnel and the logistic support that would be required in the event of nuclear hostilities.
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Research is directed toward the development of a light weight battery-operated pulse X-ray machine. Trial radiographs indicate a requirement to vary the voltage of the machine and time of pulse to assure greater definition. It is hoped that this machine on completion may provide the solution to the requirement for X-ray support in field medical units.
Irradiated animals have been found to have decreased tolerance to a number of drugs and agents used for anesthesia. Doses of some agents which would have been used normally and routinely were found to be lethal in irradiated animals.
Anti-Radiation Drug Program
Progress in protecting animals against the lethal action of radiation has been achieved by the discovery of substances which enhance the protective action of aminomercaptans, although these substances do not have much protective action if given alone without mercaptans. The mercaptans, which are being developed primarily on a contract program with universities, research institutes, and industry, are just becoming available for large animal testing. These agents were also shown to protect against a central nervous death syndrome (or immediate incapacitation) or a gastrointestinal death syndrome. These new findings in dogs are of fundamental theoretical and practical importance and further demonstrate the utility which might be expected from a useful agent.
Oversea Research
The U.S. Army Medical Research Unit in Malaya has continued research studies on fevers of unknown origin and on arthropodborne disease. Several different viruses were recovered from patients and have been shown to be etiologically related to the disease of the patient. It has thus far proved impossible to identify these viruses, and they may be new to science. Field tests have demonstrated that the insecticide dieldrin, when applied to the ground, effectively controls the chigger vectors of scrub typhus for a minimum period of 2 years and 2 months. The new repellent, diethyltoluamide, was found to be extremely effective against a wide range of mosquitoes in Malaya and was far superior to any other compound known.
All medical research proposals submitted during the year by the U.S. Army Research and Development Liaison Group (Europe) and the U.S Army Research and Development Group (Far East) have been monitored for review and evaluation in the U.S. Army Medical Research and Development Command.
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Development of Materiel
Emphasis on improvement of medical equipment for field medical units was continued to reduce the weight and dimensions as much as possible and to increase the efficiency. Representative of some of the items in the development cycle which indicate promising results are the folding field bed, which has a weight decrease of 60 percent and a reduction in dimension of 55 percent over the current standard item, while the field pressure sterilizer for dressings-16 by 24 inches-weighs 70 percent less and has reduced the dimension by 30 percent over the current standard item. Also, a modification of the Thomas leg splint has been developed which is lighter in weight and can be folded when not in use but has a wedgelike device for locking the joint firmly into place when the splint is in an extended position.
More aggressive action is being taken to develop medical equipment which will be compatible with the concepts of future transportation. In this respect, requirements were initiated to consider highly mobile and air-transportable medical treatment and medical support facilities.
In considering the immediate, the long range, and the very long range organizational, operational, and doctrinal concepts of the field army, more control is being exercised to assure that the equipment requirements are continually monitored. As a result, recommendations have been submitted to the Armed Services Medical Materiel Coordination Committee to realine the present priority of AMEDS medical equipment development projects, to modify the purpose of others, and to delete projects for which no further requirement exists. All personnel in the OTSG concerned with these projects are kept abreast of developments by the 'In-Process Review' method. Group consideration of the development program is beneficial in that it maintains the continuity of knowledgeable personnel, provides more realistic military and essential characteristics, and enables the development project engineer to accomplish the mission in a much shorter period.
Research Grants
Public Law 85-934 (72 Stat. 1793), approved on 6 September 1958, authorized the Department of Defense to establish grants with nonprofit organizations for the accomplishment of basic scientific research. This is a major change since such work was previously accomplished only on a contractual basis. This simple expedient allows the command to pay in advance for work it desires to have accomplished, whenand if it has the funds available. AR 70-5, Research and Development (General), dated 28 December 1959, establishes specific criteria for the submission and evaluation of grant proposals and prescribed
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procedures for making grants to nonprofit institutions for the purpose of procuring basic scientific research.
Information Office
As a result of the increased emphasis on research and development activities, an information office was established in the headquarters of the U.S. Army Medical Research and Development Command on 27 September 1959.
