A Historical Look at the Department of Veterans Affairs 

Research and Development Program 
 

 

 

 

 

 

 

Acknowledgement to Author 

This book was compiled and written by Marguerite T. Hays, M.D., for the VA Office of 

Research & Development (ORD). ORD is grateful to the author, Dr. Hays, for her 

relentless work and dedication to make this publication possible. Her outstanding efforts 

as a physician, researcher, and writer have produced a lifetime of invaluable information 

about the inception of VA research. We are proud to present this book to the VA and 

non-VA community alike. 

Copyright 

Marguerite T. Hays, M.D. authored this book, at first in the course of her duties as a 

federal government employee, then as a contractor for the federal government. This book 

is hereby irrevocably dedicated to the public domain by the Department of Veterans 

Affairs and Marguerite T. Hays, M.D. This dedication is intended to be an overt act of 

relinquishment in perpetuity of all present and future rights under copyright law, whether 

vested or contingent. It is understood that relinquishment of all rights includes the 

relinquishment of all rights to enforce (by lawsuit or otherwise) those copyrights in this 

book. It is recognized that, once placed in the public domain, its works may be freely 

reproduced, distributed, transmitted, used, modified, built upon, or otherwise exploited by 

anyone for any purpose, commercial or non-commercial, and in any way, including by 

methods that have not yet been invented or conceived. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table of Contents 

Table of Contents i
 

Preface iii 

Introduction iv 

Commonly Used Acronyms vi 

Part I, Ancestral roots, 1925-1945	 1

 1. Origins 	 3 
 

2. The VA Research Program Before 1946 25 

Part II, Beginnings of the modern program, 1946-1953 87
 

3. Postwar Progress: Modern VA research begins 89
 

4. Research Cooperation between NAS and VA	 123 

5. The Tuberculosis Treatment Trials 143 

6. The Atomic Medicine Program and 

the Birth of Nuclear Medicine 167 

Part III, The VA Research Program Takes Off, 1954-1959	 181 

7. The Intramural Research Program, 1954-1959	 183 

8.	 VA Psychopharmacology Trials lead revolution in 

 Psychiatric Practice 209 

9. The Hypertension Studies 227 

10. Smoking and Lung Cancer 241 

11. Radioimmunoassay – a revolutionary advance in medicine 249 

Part IV, The roaring sixties, 1960-1967 263 

12. The Intramural Research Program, 1960-1967 265 

13. The Cooperative Studies Program of the 1960s 299 

14. The Research Career Development Program 317 

Part V, Maturation, 1968-1981 327 

 15. Transition years, 1968-1973 329 

16. VA Medical Research comes of age, 1974-1980 349 

17. Meeting funding challenges: “Project Scissors” 379 

18. The Cooperative Studies Program of the 1970’s 391 

19. Beginnings of Health Services Research and Development 

 in VA 405 

 20. VA Research in Rehabilitation 419 

Epilogue	 437 

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Appendices 439 

Appendix I. Middleton Awards 1960-1995 I 

Appendix II. Review groups 

a. Committee on Hospitalization (White Committee) VII 

b. The Medical Council XI 

c. Committee on Veterans Medical Problems (1946-59) XXIX 

d. Central Advisory Committee on Radioisotopes XXXI 

e. Advisory Committee on Research, 1955-1960 XXXIII 

f. Advisory Committee on Research, 1961-1968 XXXV 

g. Research Program Committees active in FY 1964 XXXVII 

h. Program Evaluation Committees, 1967-8 XLI 

i. Cooperative Studies Evaluation Committee (CSEC) XLV 

j. Career Development Committee XLIX 

k. Institutional Research Program Evaluation Committees LIII 

l. Merit Review Boards, members appointed 1972-1980 LV 

m. NAS committees evaluating prosthetic and sensory aids rsch XCIII 

Appendix III. Medical Bulletins, 1946-1955 XCV 

Appendix IV. Contracts evaluated by National Academy of Sciences 

a. VA research contracts, 1947-1953 XCIX 

b. VA Prosthetics and Sensory Aids contracts begun before 1950 CIX 

Appendix V. Radioisotope programs 

a. 1962 radioisotope units CXI 

b. Clinical uses of radioisotopes in VA hospitals, 1962 CXIII 

Appendix VI. Special laboratories active during the 1950s and 60s CXV 

Appendix VII. Publications by VACO Research Service, 

1950s and 1960s CXVII 

Appendix VIII. Research Career Scientists appointed before 1980 CXIX 

Appendix IX. Alcoholism scholars, 1979-1983 CXXXI 

Appendix X. Persons interviewed CXXXV 

Appendix XI. Organization of research within the VA CXLI 

Index 583 

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Preface 

In 1988, I was having lunch with Ralph Peterson, M.D., a prominent endocrinologist who was then 

the Director of the VA’s Medical Research Service, a position I had held during the 1970s. As I 

told him about events from before he joined the VA, he was struck how little information had been 

written about earlier times in the VA research program. A few days later, he called to ask me to 

give a talk on the history of the VA research program. 

Challenged by this opportunity, I began to interview some of the earlier participants in the program 

and found their stories fascinating. I explored the VA Central Office library in Washington, DC 

and discovered another side to the dark memories of the early Veterans’ Bureau, evidence that the 

early veterans’ doctors strived for excellence and looked for ways to improve their care of sick 

veterans. 

As opportunities arose, I interviewed people associated with the VA research program. I collected 

the materials they gave me, some of it lovingly stored in their garages for years. Many in the VA, 

in Central Office and in the medical centers, participated in this effort – there is no way I can thank 

them individually here, but I am grateful to each of them. 

This work continued to be encouraged and supported by those who came after Ralph Peterson in 

leading the VA research program. In particular, I should mention Martin Albert, M.D., Ph.D., who, 

as Director, Medical Research Service, 1992-1996, was especially helpful. John Feussner, M.D., 

Chief Research and Development Officer, 1996-2002, supported this effort with his usual 

enthusiasm. He contracted with me to bring the work to fruition after I retired from my VA clinical 

position. Philip Lavori, Ph.D., Chief of the Palo Alto VA Cooperative Studies Program 

Coordinating Center, provided space and facilities for the project and has been of great personal 

support. 

Anne Knight, Barbara Klein and Robert Putnam, editors, have improved the quality of the text in 

many ways, and Dorothy Shoemaker has provided important bibliographic assistance. Many 

colleagues were kind enough to review individual chapters. Joel Braslow, M.D., Ph.D., made 

important contributions to the chapter describing VA psychopharmacology trials. I owe particular 

thanks to the late Clark Sawin, M.D., for a careful and helpful review of the entire manuscript. Of 

course, the responsibility for the final product rests with me. 

Marguerite T. Hays, M.D. 

Palo Alto, CA 

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Introduction 

Tracing the path of progress in VA medical research does not involve drawing a straight line. It 

requires, rather, sketching a jagged streak forward—the many high points marked by significant 

findings and the development of medical advances, the few downticks indicating an occasional 

disappointment—the trend always upward toward promise and hope for improved health care and a 

better quality of life. 

The focus of this history is the innovation produced in this remarkable program; a few examples of 

what VA research has accomplished include the: 

 First decisive trials of effective treatments for tuberculosis; 

 Demonstration of the lifesaving value of treating hypertension; 

 Development of the concept of CT scanning; 

 Discovery and development of radioimmunoassay, facilitating measurements of previously 

impossible precision; 

 Cooperative studies proving the efficacy of psychoactive drugs in stabilizing psychiatric 

disorders; 

 Demonstration of the relationship between smoking and lung cancer, leading to initial 

warnings in the Report of the Surgeon General; and 

 Development of a practical, implantable cardiac pacemaker. 

Although this research program produced more than enough accomplishments to completely occupy 

its text, this history also attempts to depict the pioneers who carved that path of progress. In large 

measure, the history of VA medical research is their story. 

In several instances, personal comments are included from the men and women—investigators, 

managers and administrators—who brought VA research alive. Some of their accounts are truly 

fascinating, sounding more like adventure stories than what might appear in scientific journals. For 

example, Ludwig Gross, M.D., a war refugee who escaped Poland just ahead of the Nazis, came to 

America and became a U.S. Army doctor. Even while in the Army, he carried out research, keeping 

his special mice in cages in the trunk of his car. In 1944, the Army assigned him to the clinical staff 

of the Bronx (NY) VA Hospital, and he remained there for a long productive career. At first, he did 

his research in an old bathroom after hours, breeding his own mice for his experiments. His work 

led to the proof of the viral cause of mammalian leukemia. 

And, when Dr. William Oldendorf was working as a VA neurologist at the Los Angeles VA 

Hospital, he was looking for a way to avoid suffering by his patients who needed brain 

imaging, rather than doing painful pneumoencephalography. He reasoned that composite 

pictures of the brain area from x-ray images taken at many angles would serve the purpose. 

Using simple equipment—including an old model-railroad track—he personally built the 

prototype for CT scanning—which has since benefited millions of patients worldwide. 

Some few of these researchers achieved a degree of celebrity, gaining eminence in their field, and 

perhaps even becoming perceived in the general medical community as having extraordinary genius 

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and exceptional vision. There are many more stories of researchers whose careers reflect little of 

celebrity, but much of imagination, competence, and intense excitement about their work. 

The personal stories reveal another important characteristic of these investigators: the patience with 

which they approached the mundane tasks along the way to achieving results. Records clearly 

indicate that “payoffs” in scientific knowledge often emerged only after extensive, long-term 

follow-through study. The keys to success were determination to proceed, to persist, to prevail. As 

one VA research leader said, “there were more ‘wear-throughs’ than breakthroughs.” 

A word about the scope of this book is in order: the recording of history is a never-ending process, 

but preparation for publication must have an organized, terminal point. In covering the more distant 

history of VA medical research—extending back to the era of the Veterans’ Bureau in the late 

1920s—through the year 1980, it was the intention of this work to record and, in some sense, 

safeguard that period of history most at risk of being lost to posterity. 

Unlike this text, VA research did not conclude in 1980. Together with Health Services Research 

and Development, and Rehabilitation Research and Development, the VA Medical Research 

Service continues to evolve and to engage in vitally important studies. Investigation of primary 

clinical issues continued, and new special studies were launched in areas of special interest to the 

veteran patient, such as post-traumatic stress disorder, “Gulf War Syndrome,” prostate cancer and 

AIDS. Between records developed since 1980, the personal knowledge of the current VA staff, and 

the recollections of those who have departed in recent years, the story of this continued history 

exists in rich detail. It can only be hoped that this next chapter of the story of VA research will be 

recorded and told. 

That, however, is a matter for future exploration. For now, the story of the beginnings of VA 

medical research, and its truly remarkable accomplishments over the span of its first half-century, 

should be adventure enough. 

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Commonly used acronyms 

The organization responsible for veterans’ health care 

VA (1930-1989) Veterans Administration 

VA (1989 to present) Department of Veterans Affairs 

VACO VA Central Office 

The Office in VACO specifically responsible for the veterans’ medical care program 

DM&S (1946-1989) Department of Medicine and Surgery 

VHA (1989 to present) Veterans’ Health Administration 

Head of the VACO office responsible for veterans’ medical care 

CMD (1946-1989) Chief Medical Director 

USH (1989 to present) Under Secretary for Health 

Head of the VACO office overseeing the VA research program 

ACMD/R&E (1945 to 1972) Assistant Chief Medical Director for Research and 

Education 

ACMD/R&D (1972 to 1989) Assistant Chief Medical Director for Research and 

Development 

AsCMD/R&D (1989 to 1996) Associate Chief Medical Director for Research and 

Development 

CRADO (1996 to present) Chief Research and Development Officer 

Person at a VA medical facility responsible for the research program 

ADPSR (1947 to1961) Assistant Director of Professional Services for Research 

ACOS/R&E (1961 to1972) Associate Chief of Staff for Research and Education 

ACOS/R&D (1972 to present) Associate Chief of Staff for Research and Development 

Services within Research and Development in VACO (after 1972) 

MRS Medical Research Service 

HSR&D Health Services Research and Development Service 

RER&D, later RR&D Rehabilitation (Engineering) Res. and Dev. Service 

Advisory and review groups 

Local: 

R&E Committee (1948 to 1972) Research and Education Committee 

R&D Committee (1972 to present) Research and Development Committee 

Central 

CVMP Committee on Veterans’ Medical Problems (NAS/NRC) 

RAC Research Advisory Committee 

RRAG, later RAG (Regional) Research Advisory Group 

CSEC Cooperative Studies Evaluation Committee 

MRB Merit Review Board 

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Other VA acronyms 

R&D Research and Development 

CRIP Central Research Instrumentation Pool 

CSP Cooperative Studies Program 

CSPCC Cooperative Studies Program Coordinating Center 

CNPRL Central Neuropsychiatry Research Laboratory 

Other Washington area groups influencing the VA research program 

CMR Committee on Medical Research (WWII) 

NAS National Academy of Sciences 

NRC National Research Council of the NAS 

OMB Office of Management and Budget 

NIH National Institutes of Health 

NCI National Cancer Institute 

Not abbreviated: Veterans’ Bureau (1922-1930), Medical Service (1922-1946), Medical Director 

(1922-1946), Chief, Research Subdivision (1925-1938), Chief, Postdoctoral Training and 

Research Division (1938-1945). 

vii 

Section I. Ancestral Roots
 

1925-1945
 

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(Intentionally Blank) 

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Chapter 1. Origins of the VA Research Program, 1917-1925 

America’s tradition of providing medical care to the nation’s servicemembers and Veterans is a welldocumented subject, with origins reaching back to Colonial times. The federal government has 

frequently modified and clarified its role in this area during the course of over two centuries of our 

democracy, acting through legislation and executive orders to form the institutions and programs that 

identified the recipients and established the mechanisms to provide medical service. History also 

records the way in which distinctions have been established between systems of care for active-duty 

personnel and those whose service is completed—our Veterans. 

While the evolution of federal programs for the delivery of post-service care to Veterans is well 

charted, the point at which medical research became an important consideration is less defined. No 

direct act of the legislative or executive branches of government dictated that Veterans’ health care 

could be enhanced with a research component. The association of research and clinical care grew 

mainly from the wisdom and foresight of medical practitioners themselves. Records from the earliest 

meetings of advisors and consultants charged with addressing large-scale medical needs among 

Veterans after World War I reveal gathering convictions that research could and should be integrated 

into Veterans’ health care. Beyond the positive benefit of relating that research to the unique medical 

circumstances of Veterans, the move was seen as key to reinforcing an evolving system of care. 

Many of these advisors felt that making the system attractive to physicians with research interests 

and cultivating relationships with medical education institutions would ensure the highest quality of 

care to Veterans. 

In the era well before 1946 when the Veterans Administration (VA) established formal partnerships 

with medical schools, the Veterans’ Bureau and its successor, the Veterans Administration, 

sponsored a modest program of intramural research by their own clinical staff. This early VA 

research program almost completely disappeared during the Second World War. After World War 

II, a rejuvenated VA medical care system emerged as a result of post-war reforms that included 

affiliation of VA hospitals with medical schools. Relatively few links between the research program 

of the 1920s and 1930s and the later emergence of medical research in the VA after World War II 

survived the enormous societal upheavals that affected not only VA but medicine in general. 

Nonetheless, these early efforts did provide a valuable and noteworthy prologue for what would 

come later. 

The foremost goal of early Veterans’ Bureau advisors forming an intramural agency research 

program was to “mine” rich clinical data to gain knowledge through follow-up studies and 

population statistics of a large system with many patients of similar backgrounds. The 

administrators were especially interested in problems caused directly by wartime service, such as 

long-term effects of poison gases encountered on the battlefield. And clinicians in the Veterans’ 

hospitals were deeply concerned about helping these patients by studying their most prevalent 

medical problems regardless of whether they were the direct result of military service. 

The early research program of the veterans’ hospital system emerged from the combined influence 

of a reform-minded lay bureau Director, a Chief Medical Officer considered to be ambitious and 

politically knowledgeable, an influential group of advisors with strong bonds to academia, and a 

cadre of medical officers in the veterans’ hospitals who used the means at their disposal to seek 

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better ways to treat their patients. These people are at the heart of events that identified the need for 

reform, and the academically-oriented advisors they consulted shaped that reform. 

Beginnings of systematic health care for disabled Veterans 

In 1917, upon America’s entry into World War I, more than 5 million men were in military service, 

but no hospitals existed specifically for Veterans. .1

 By the end of 1925, amazingly, 51 hospitals for 

Veterans had been established and some 30,000 Veterans were hospitalized at government expense.2 

Before World War I, Congress did not appear inclined to create a hospital system specifically for 

veterans, much less to launch a program of medical research for their special needs. Indeed, 

although some Veterans had been treated under government auspices in the past, the very concept 

that the federal government should handle the medical needs of all war-disabled Veterans was a new 

one in 1917.3 

In 1923, a committee of consultants appointed by the Secretary of the Treasury described the 1917 

provision for hospitalization of World War Veterans as “a task which had never been attempted by 

any government prior to that time, and there had been no experience in all history which could serve 

as a guide.”4 While the United States had long provided pensions for its disabled war Veterans, 

until after World War I there were no systematic arrangements for their later medical care. Sick 

merchant seamen had been cared for in Marine Hospitals since 1799.5 A few thousand indigent 

Civil War and Spanish-American War Veterans lived in national or state-supported domiciliaries or 

Soldiers’ Homes.3 Otherwise, before 1917, disabled Veterans did not receive medical care from 

their government. Those injured or ill from military service received monetary compensation in the 

form of pensions. Their families, aided by the medical and hospital systems available to all citizens, 

were expected to meet their needs for medical care and rehabilitation. 

The pension system for Civil War Veterans had been very costly and was subject to intense and 

continuing political pressures.6 In 1917, Secretary of the Treasury William McAdoo, President 

Wilson’s son-in-law,7

 appointed a Council on National Defense, which had a subcommittee charged 

with drafting a plan to meet the needs of the men about to go to war. Judge Julian W. Mack, a 

distinguished jurist and advocate for the disadvantaged, chaired this subcommittee. Other members 

included Dr. Leo S. Rowe, Assistant Secretary of the Treasury; Captain H.S. Wolfe, a prominent 

accountant and actuary; Julia C. Lathrop, of the Children’s Bureau; V. Everit Macy, President of the 

National Civic Federation; Professors Henry R. Seager and Thomas Parkinson of Columbia 

University; and the staff of the Legislative Drafting Research Fund of Columbia University. 

Under Judge Mack’s leadership, this group recommended a radically new concept of government 

responsibility and sent a draft for review to interested persons, including President Wilson and 

former President Theodore Roosevelt, who both enthusiastically endorsed it.8

 The concept entailed 

government aid to former soldiers and sailors based on their needs and the impact of military service 

on their lives; unlike the Civil War pensions, this aid was not seen as a dole provided simply because 

of military service. This plan was introduced as a Treasury Department bill and passed into law 

October 6, 1917. While completely omitting pensions for World War Veterans and their families, 

the new law provided for: 

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 Allotments to dependents while their breadwinner was on military duty, paid partly from pay 

deductions. 

 A voluntary death and disability insurance program, with premiums set at peacetime rates, 

funded by pay deductions. (This deduction and the previously mentioned one often took up 

most of the soldier’s pay, and could leave the veteran less than $10 a month.9

) 

 Compensation for injuries sustained while on active service and compensation to the families 

of those who died. 

 Vocational rehabilitation for those injured. 

Perhaps most importantly, for the first time, the law provided for the medical and surgical treatment 

and prosthetic devices for all service men and women who were injured or became ill in the line of 

duty. 8, 10 

This massive new program became the responsibility of the Bureau of War Risk Insurance, an 

agency separate from the old Pension Bureau, which continued to handle pension claims of Veterans 

of earlier wars and their dependents. In October 1917, the Bureau of War Risk Insurance, which had 

been established in 1914 to insure merchant ships against wartime aggression, was a modest 

operation with only 20 employees occupying four rooms.8

 Despite wartime shortages of personnel 

and space, the Bureau expanded rapidly to meet its new challenges. Until the armistice of November 

11, 1918, most of the Bureau’s new work involved selling insurance policies to servicemen, 

processing insurance claims and paying allotments to families and compensation payments for injury 

and death. Until the end of the war, medical care and rehabilitation were handled by military 

hospitals,11, 12 but discharged Veterans still needing care were dependent on the Bureau. 

It seems unlikely that the members of Congress who voted for this sweeping restructuring of 

Veterans’ benefits fully realized that a separate veterans’ hospital system was being created. In fact, 

Congress did not appropriate any money to build new hospitals for Veterans until 1921. 

Nevertheless, this bill was the seed for today’s comprehensive system of Veterans’ health care. 

World War I was the first U.S. war in the modern era of hospital care. In the 19th century, hospitals 

were considered charitable institutions for the impoverished. Other sick and injured persons were 

treated in their own homes. Military hospitals during the Civil War treated huge numbers of the sick 

and injured, but after discharge Veterans did not expect or receive hospitalization. Early in the 20th 

century, with the introduction of improved surgical techniques, increased medical specialization, and 

the use of clinical laboratories and radiology, hospitals became places for all the sick, the rich as 

well as the poor.13 So it was that a nation that in the past expected families and communities to care 

for the war-disabled, as long as pensions spared them from penury, suddenly expected Veterans’ 

care to be provided in government hospitals. 

At the end of the war, many patients being treated in military hospitals demanded to be released 

from active duty. Of those discharged, about 2,500 had tuberculosis and 50,000 were classified with 

nervous and mental disorders.14 Suddenly, the many sick and injured became the medical 

responsibility of, and expected medical care from, the Bureau of War Risk Insurance, which was not 

prepared to handle them. Since the Bureau had no hospitals or doctors of its own, it turned to the 

Public Health Service for use of its Marine Hospitals. In 1919, the Marine Hospital system had a 

capacity of only 1,548 beds but was expected to handle 20,000 applications for hospitalization.14 

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A disabled Veteran applying to the Bureau of War Risk Insurance for medical care would first be 

subject to a determination of eligibility that would place him in the hands of the Public Health 

Service. If there was room at a Marine Hospital, care would be provided there. But in the early 

stages of this program, many Marine Hospitals were full, so the patient might end up at a Soldiers’ 

Home infirmary or in a private or state hospital. Often these were also full, and some were not 

considered suitable to provide an acceptable level of care for deserving Veterans. 

In 1919, Congress tried to correct the shortage of Veterans’ hospital beds by authorizing transfer of a 

group of military hospitals to the Public Health Service and the purchase or construction of 

additional military hospitals. But transferred hospitals were mostly of temporary construction, and 

many were unusable. Still, some members of Congress believed that the huge Army hospitals built 

during the war, even though intended to be temporary, should be used to serve Veterans’ needs and 

did not appropriate the funds needed to carry out the authorized construction.15 By 1921, no new 

veterans’ hospitals had yet been constructed.16 Even with the hospitals that had been transferred to 

the Public Health Service, there wasn’t enough room for the disabled Veterans. Public attention to 

the problem was growing as newspapers carried pictures of sick Veterans lying on the floors of jails 

and almshouses.17 

Finally, in 1921, Congress acted. On March 4, 1921, on his last day in office, President Wilson 

signed Public Law 384, later referred to as the first Langley bill. It provided $18.6 million for 

constructing new veterans’ hospitals and remodeling and extending existing plants.16 This 

construction program was one of the first responsibilities of President Harding’s new Secretary of 

the Treasury, A.W. Mellon, whose department included both the Public Health Service and the 

Bureau of War Risk Insurance. To assist in this task, Mellon appointed a Committee of Consultants, 

generally known as the White Committee after its chairman, William C. White, M.D. (Appendix 

IIa). 

The Consultants, together with their advisory committee, traveled widely, visiting the institutions 

caring for ex-servicemen. They gathered an extensive body of data, including the distributions of 

general and Veteran population, existing government and nongovernment hospitals, access to 

transportation and predictions of future needs. They also corresponded extensively with and held 

hearings of, “interested groups.” As noted in their report: 

“In addition to the task of assembling available data, there were requests for hearings from over 

100 groups—Senators, Representatives, State and municipal committees, chambers of 

commerce, etc.—representing those interested in the location of hospitals in their particular 

districts. These scarcely provided the data on which to build a rational Federal program, but all 

were heard.”18 

Members of the White Committee were from academic settings, suggesting that the Committee 

would favor placing new veterans’ hospitals near medical schools. But this did not happen, and the 

final report sheds light on how committee members came to a critical turning point in their work: 

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“What would secure for the beneficiaries of the Government the best type of medical service? 

Should they be confined solely to isolated Government institutions, or should they have 

available such consultant and expert advice as surrounds the best type of teaching institutions? 

Which would secure the most rapid recovery and return to active participation in the duty of 

life? Here again, the tendency was all for centralization in Government institutions, in spite of 

the fact that there had been gathered from all over the United States the willingness and desire 

on the part of those institutions which had devoted themselves to the care of the public to assist 

in this work. This tendency to centralize had grown so rapidly and the change in administration 

had come about so quickly that it was impossible to wield any influence in securing special care 

by physicians who had become highly expert in special technique for the benefit of these men, 

and, although in the location of these hospitals the consultants had constantly in mind that they 

should be as near as possible to centers of medical education and assistance of this character, it 

was felt that the effort was largely wasted. 

“There was an opinion frequently expressed that our soldiers were not to be submitted to 

experiment and student teaching, and yet the very best type of medical care given is in those 

institutions that come under the critical eye of students and in which teaching is carried on—to 

wit, Johns Hopkins, Harvard, Columbia, Chicago, and elsewhere—and it is a duty of our 

Government, where possible, to accept its share in opening the doors of these institutions for 

instruction of oncoming doctors and nurses who will in the future have to deal with those who 

are sick. 

“In an attempt to solve these questions the consultants found great difficulty, because of the 

variation of expert opinion. Men of equal prominence and success in life at times presented 

diametrically opposite views, and the only conclusion that could be drawn was that in fields 

involving human activity, where positive knowledge was not available, no standards could be 

set, and any attempt to standardize human organization could only be met with failure. Each 

institution in its administration is a separate institution, modified by the locality in which it 

exists, the views of the Chief Officer of Administration, and the task which it has to perform, 

and it is impossible to lay down standards that will universally apply. To overcome this 

difficulty a request was made that the medical director for each institution be chosen during the 

process of construction, so that the Supervising Architect’s Office should have his advice 

continuously in securing an institution which would fill his administrative point of view.”19 

While in some cases Committee members undoubtedly succumbed to pressures for their decisions, 

the White Committee also actively sought out suitable locations for Veterans’ hospitals. In May 

1921, the month after the Committee originally received its charge, member Frank Billings sent the 

following telegram to Ray Lyman Wilbur, M.D., who was then president of Stanford University: 

“Will local people buy and present to government 100 or more acres to afford additional ground 

space to existing federal owned property to insure location of permanent government hospital at 

Palo Alto? Letter follows. Wire or write reply to Dr. W.C. White, C/O Bureau of War Risk 

Insurance, Arlington Building, Washington.”20 

One week later, Dr. Wilbur answered: 

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“Very appreciative of telegram and letter of Dr. Billings regarding Federal Hospital Palo Alto. 

Have consulted with Palo Alto Chamber of Commerce and feel that if your committee decides 

upon this as a permanent site Palo Alto Chamber of Commerce will raise sufficient subscription 

to pay differences so that fifty to one hundred acres adjoining present site can be purchased at 

cost to Government of $600 per acre. Community small but fully sympathetic with hospital and 

will do their best. Would appreciate opportunity to do anything further if I can.”21 

In due time, one of the White Committee’s new hospitals was placed in Palo Alto, a hospital that 

continued to be of great interest to Dr. Wilbur. 

Figure 1.1. Ray Lyman Wilbur, M.D., President of Stanford University 

and chairman of the Veteran’s Bureau Medical Council 

Among the first issues facing the White Committee was the poor service received by Veterans. 

Three separate agencies—the Bureau of War Risk Insurance, the Public Health Service and the 

Rehabilitation Division of the Federal Board for Vocational Education—were involved, and often a 

single Veteran needed service from all of them. To address this problem, as the Committee’s first 

task, members prepared and proposed an organizational chart that would put the three agencies 

under a single Bureau of Soldier Rehabilitation.22 

Meanwhile, the American Legion, distressed with the problems faced by its members, had been 

campaigning for unification of the three separate Veterans’ agencies. The lobbying effort seemingly 

had its effect on newly elected President Warren G. Harding who, shortly after taking office, 

appointed a committee of prominent citizens chaired by Gen. Charles E. Dawes to formulate a 

unification proposal. Members included Theodore Roosevelt, Jr., and representatives of the 

American Legion, the Red Cross, and labor, women’s and government groups.23 This committee 

accepted the White Committee’s proposal almost without change. Its recommendations to President 

Harding became law in August 1921 with establishment of the Veterans’ Bureau.24, 25 

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The Veterans’ Bureau 

While the new agency assumed all the responsibilities of the Bureau of War Risk Insurance and the 

Rehabilitation Division, at first it did not have responsibility for sick and injured Veterans. This was 

resolved about 8 months later, in April 1922, when President Harding issued an executive order that 

turned over to the Veterans’ Bureau all 57 Public Health Service hospitals, which by then were 

primarily serving Veterans. Later, new Public Health Service hospitals funded under the first 

Langley Act were also transferred to the Veterans’ Bureau.26 

The high hopes for these reforms were quickly steered off course as the new Veterans’ Bureau 

became plagued with problems. Waste, fraud and mismanagement during its first two years were 

brought to light in extensive 1923 Congressional hearings27 that raised charges against the Bureau’s 

first director, Charles R. Forbes, a personal friend of President Harding. 

Figure 1.2. Charles R. Forbes, first Veterans’ Bureau Director (1921-1923) 

In September 1921, Forbes had “summarily dismissed” the Bureau’s first Medical Director, Haven 

Emerson, M.D., a distinguished physician detailed from the Public Health Service to the Veterans’ 

Bureau, which had no doctors on its staff. 

Figure 1.3. Haven Emerson, M.D., first Veterans’ Bureau Medical Director (1921) 

Emerson publicly stated that the Bureau was “being made the football of politics” and that 

“plumbers and policemen” were “being substituted for scientific medical men.”28 In a talk in 

Columbus, Ohio, Emerson charged that $500,000 was being used for political patronage. Forbes 

maintained that this charge was false. He told Emerson that “his services were no longer desired,” 

and replaced him with Col. R.U. Patterson.29 

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Figure 1.4. Robert U. Patterson, M.D., Veterans’ Bureau Medical Director (1921-1923), 

later a member of the Medical Council 

In February 1923, at the request of President Harding, Forbes was forced to resign after he was 

found to be selling government property to a business associate.30 Congressional hearings in October 

and November of that year brought out evidence against Forbes so serious that the Justice 

Department later took up the case, resulting in prison terms for Forbes and one of his business 

associates. 

With this tumultuous beginning, the new agency sorely needed a leader who was above reproach. 

Harding’s choice was Gen. Frank T. Hines, a Veteran of the Spanish-American War and World War 

I. Hines, whose first job was to investigate the scandals and clean up operations, worked rapidly to 

improve service and lessen political control over the Bureau.31 He set in place systems of controls 

and supervision that, in some cases, persist today. 

Figure 1.5. General Frank T. Hines, Veterans’ Bureau Director (1923-1930) 

and Administrator, Veterans Administration (1930-1945) 

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Compensation vs. Care 

Of the benefits to Veterans provided by the 1917 law, the two that fell to the new medical 

department of the Veterans’ Bureau were establishing ratings for monetary compensation for 

disability and death, and providing medical care. Both compensation and care were complex new 

assignments and, in the immediate post-war years, compensation received the most attention. 

Compensation was most familiar to the Congressional overseers of the new Bureau because, like the 

old pension system, compensation decisions could be sensitive to political influence. Under Forbes, 

such influence had been a major problem. Although the 1923 Congressional hearings sought ways to 

improve Bureau performance in all regards,32 more attention was paid to issues of compensation 

than to quality of medical care. While hospitals and dispensaries were finally in place, testimony at 

the hearings made clear that determining a Veteran’s degree of compensable disability was their 

primary focus. 

Lester Rogers, M.D., who had become the Bureau’s Medical Director in May 1923 when Patterson 

was recalled to the Army, expressed concern in his testimony about medical care in the veterans’ 

hospitals. Nevertheless, the Senators and their staff interrogated Rogers at length, and with 

considerable criticism, about his compensation decisions. There was little apparent interest in his 

complaints that he had insufficient authority to inspect the hospitals, or that many of their beds could 

not be used because of some hospitals’ location or poor condition.33 In January 1924, soon after the 

hearings concluded, the frustrated Rogers requested, and received, transfer to the New Haven 

(Conn.) Veterans’ Hospital. 

Figure 1.6. Lester B. Rogers, M.D., Veterans’ Bureau Medical Director 1923-1924 

Other testimony during the hearings cited instances of hospitals crowded with patients who could 

have been discharged except for their disability status. Because hospitalization itself was considered 

evidence of disability, a Veteran’s compensation payment often decreased upon discharge, so the 

motivation to recover was lessened.34 Yet despite pressures on physicians and staff at the hospitals 

to place emphasis on administrative efficiency, good medical care was also expected. 

Advisors to the medical department 

Even with the emphasis on compensation issues, one of Gen. Hines’s main interests, once he had 

cleaned up the scandals and increased efficiency, was to improve the quality of medical care in the 

hospital system inherited from the Public Health Service. One of his first needs was for a new 

Medical Director to replace Rogers. In seeking a new permanent Medical Director for the Bureau, 

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Hines sought advice from prominent physicians, including Dr. Wilbur, who in addition to being 

President of Stanford University, was also President of the American Medical Association.35 In April 

1924, as a result of his search, Hines chose Edgar O. Crossman, M.D., a New Hampshire psychiatrist 

and Professor of Psychiatry at the University of Vermont, who had also been active in politics. Dr. 

Crossman had served in both houses of the New Hampshire legislature and as Federal Collector of 

Internal Revenue for northern New England. He had been President of the New Hampshire Medical 

Society and, more recently, New England District Manager for the Veterans’ Bureau.36 It is likely, 

judging by rapid progress in upgrading medical care after his appointment, that his recruitment 

included agreements about increased authority for the medical department and measures to increase 

quality. 

Figure 1.7. Edgar O. Crossman, M.D., Medical Director, 1924-1926, 1928-1929 

Hines had laid the groundwork for Crossman’s mission in earlier contacts with Wilbur that included 

requests to nominate appropriate physicians to serve as “Special Consultants” to the Veterans’ 

Bureau37 and asking Wilbur himself to “act in an advisory capacity to the Veterans’ Bureau when 

called upon on medical matters pertaining to your specialty.” Hines’s targets were specific: 

“It will be desired from time to time to obtain from you and from other members of the 

Consultant Board in General Medicine and Surgery, recommendations and advice concerning 

plans for construction and operation of general medical and surgical hospitals; the application of 

clinical methods of examination and treatment in hospitals, dispensaries and out-patient 

services; the question of medical follow-up care; and the questions of rating, for compensation 

and insurance purposes and for vocational training, of disabilities arising from general medical 

and surgical disabilities.” 

Hines further explained that the government was restricted in its ability to compensate adequately for 

expert advice, but that “it is confidently hoped that your deep and scientific interest in the problems 

of Veterans’ relief, will prevail upon you to accept this request of the Bureau.” Payment of railroad 

and Pullman fares and incidental travel expenses, plus a $20 daily fee, were offered.37 

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The Medical Council 

Other advisors were also recruited, and, on July 22-24, 1924, 18 of the 22 members appointed to the 

“Council on Medical and Hospital Affairs” assembled for their first meeting in the Veterans’ Bureau 

Central Office in Washington, D.C.38 (originally built to house the Bureau of War Risk Insurance, 

this building has been continuously occupied by federal Veterans’ agencies and today is the 

headquarters of the Department of Veterans Affairs). At its first meeting, the group modified its 

name to the “Medical Council of the Veterans’ Bureau,” and asked that its members be called 

“Councillors.” The Council suggested additional members with needed expertise and formed 

committees for Tuberculosis, Neuro-psychiatry, General Medicine and Surgery and for “Hospitals, 

Dispensaries and General Medical Welfare.” On the second day of their meeting, they met with 

President Coolidge.39 

The Medical Council members were distinguished in their spheres of professional activity and 

leaders in academic, public and private medicine (Appendix IIb). Most of them were listed in Who’s 

Who in America and held prominent positions in important medical organizations, including the 

American Medical Association, American Hospital Association, American Public Health 

Association, American College of Surgeons, American Psychiatric Association, National 

Tuberculosis Association and the American Heart Association. They held prominent university and 

government appointments and edited important journals. While no record exists describing how the 

original members were selected, a number of them had previously been advisors to the Veterans’ 

Bureau or the Public Health Service. Appointments were permanent and subsequent Council 

members were recommended by the Council itself to add balance or replace those who had resigned 

or become inactive. 

Although not present for the first meeting, Dr. Wilbur was elected to be Permanent Chairman. 

Wilbur had been one of the first Professors of Medicine and later Dean of the Cooper Medical 

College of Stanford University. In 1929, Wilbur became Secretary of the Interior in the Hoover 

administration, but he continued on the Medical Council while Lewellys F. Barker, M.D., from 

Johns Hopkins University became the Chair. Barker was William Osler’s successor as Chairman of 

Medicine at Johns Hopkins, a position he held from 1905 to 1913. He established research 

laboratories as integral parts of the university’s Department of Medicine, an unprecedented marrying 

of research and clinical practice.40 Barker later played an active role in the Washington, D.C., 

Diagnostic Center (Chapter 2). 

Figure 1.8. Lewellys F. Barker, M.D. 

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At the first meeting of the Medical Council,41 a major concern expressed by the Bureau’s Central 

Office medical staff and Council members was placed on the agenda, labeled “Medical Personnel - 

Status as to Rank and Pay.” The subject was summarized for the record as follows: 

“As the Bureau’s medical activities will last for 60 to 75 years for world war Veterans alone, 

should the medical officers have a permanent status offering continuous service, automatic and 

regular promotion which will assure young men a future, in which independent professional 

opinion and action can be exercised, or have a Civil Service status with lower pay, fewer 

allowances, and be subject to alterations of pay and the exclusive control of political superiors 

with each change of administration or oftener; average age of applicants for Civil Service jobs, 

54 years.”42 

At the time, Bureau physicians in fact received less pay and had lower status than their colleagues in 

the Public Health Service or the armed services. At its first meeting, the Medical Council 

recommended the legal establishment of a Medical Corps for the Veterans’ Bureau, that would be 

comparable to those in the other federal medical services. In the years following this first discussion, 

the Council spent considerable effort trying to get such a law passed,43 but to no avail. Only after 

World War II was a VA Medical Corps created when Public Law 293 of 1946 established the 

Department of Medicine and Surgery.44 

Other ways of improving the Veterans’ Bureau hospitals as places for doctors to practice were 

suggested by staff and endorsed by the Council, including the establishment of systematic programs 

of instruction, such as the neuropsychiatric and tuberculosis schools already started on a pilot basis, 

and creating medical reference libraries in all hospitals and clinics. The Medical Council endorsed 

these concepts at its first meeting and came up with its own, more ambitious ideas to improve the 

quality of the professional staff and medical services. These included: 

 Establishing a system of diagnostic beds for the evaluation of problem cases. 

 Publishing a journal.
 

 Initiating a research program.
 

Hines and Crossman quickly accepted these innovative concepts in principle. And by the time the 

Council met for the second time four months later, planning for their implementation was well under 

way. 

At its November 1924 second meeting, which became known as the “Cure-better-thanCompensation Conference,” the Medical Council addressed a major philosophical question that had 

been problematic in providing federal Veterans programs. Wilbur addressed the group with this 

challenge: 

“If there is anything in this Medical Council, it seems to me it should come from the direction 

of the application of modern medicine to the problems of these men considered from a 

standpoint of curative medicine.... It seems to me that we must shift from compensation, and 

think in terms of repair and cure instead of in terms of how much damage has been done ... Let 

us see what we can do from the medical standpoint of harmonizing the out-patient with the 

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hospital service to get the whole thing going as a medical concern, which will have the point of 

view of cure and attention instead of compensation and disability.”45 

The Council’s Committee on Investigation and Research expressed the same concept, stating that a 

research program is “all the more called for by the recent shift in emphasis from administration to 

treatment as the primary objective of the Bureau.” 

Making the transition from a hospital system that primarily “warehoused” the disabled to one that 

focused on “cure” was to be a gradual and incomplete process. But along the way there were signs 

that the movement had taken hold. For example, Wilbur wrote in a 1924 site visit report that the Palo 

Alto Veterans Hospital appeared to be a well-run neuropsychiatric hospital with the latest 

equipment, advanced clinical laboratory and radiology facilities. Wilbur described the wards as 

“cheerful” and said that “The whole aspect of the hospital is one of cheer and hopefulness as 

compared with the ordinary institution of the sort.” He also commented that the Chief of the 

laboratory “has an instinct for research.”46 On the other hand, there undoubtedly existed less favored 

veterans’ hospitals that never reached excellence during this early period. Nevertheless, the most 

important contribution of the Medical Council was to help the Veterans’ Bureau leaders focus on 

curative medicine as an important and laudable goal. 

Michael Davis, M.D., a Medical Council member who was an authority on outpatient care, described 

the transition from “compensation” to “cure” after his 1926 inspection of some Veterans’ Bureau 

outpatient facilities: 

“The work of the bureau physician for ambulatory cases was originally conceived chiefly as an 

aid in determining the compensation to be allowed the Veteran. The importance of thorough 

medical treatment has come forward more recently as the important element in bureau policy.”47 

Also in 1926, Winthrop Adams, M.D., of the Bureau’s Central Office Medical Service described this 

change of focus to readers of the Medical Bulletin: 

“Regardless of the fact that all of us who have been connected with this work...have realized 

that more could be done in the way of applying medical knowledge to the cure or relief of 

Veterans’ disabilities, it has, nevertheless, been apparent to all of us that the compensation 

feature was the paramount issue.... However, it is extremely gratifying to note that a decided 

change has taken place in this respect during the past year or two ....” 

Adams credited the Medical Council for this change, saying: 

“The Bureau has had for the past two years recourse to the advice of a body of eminent 

physicians, which is known as the Medical Council... The Council has at each of its conferences 

insisted that the Bureau must accomplish more than it has in the past from the curative or 

therapeutic side.”48 

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Introduction of a research concept for the Veterans’ Bureau 

At its first meeting in July 1924, the Medical Council appointed ad hoc committees to review 

member-proposed resolutions. One such resolution was presented by H. Kennon Dunham, M.D., a 

tuberculosis expert from Cincinnati who recommended that the Veterans’ Bureau establish a medical 

research effort. The Chair of the ad hoc committee appointed to review and formulate this resolution 

was Louis Dublin, Ph.D., Vice President of the Metropolitan Life Insurance Company and a pioneer 

in the development of population statistics, who commented that the “statistical equipment of this 

Bureau, excepting that of the Census Bureau, is probably the largest in the Government.” 

Figure 1.9. Louis I. Dublin, Ph.D. 

Dublin’s committee proposed an ambitious resolution, which the Council discussed at length. 

Members were divided about whether they should add a new formal “Group on Investigation and 

Research” to their committee structure. Some were uncertain about the proposed research mission of 

the Bureau. The Group on Tuberculosis recommended “adequate research should be planned in 

connection with tuberculosis.” All members saw the need for “statistical investigation,” but some 

members questioned what could be done in clinical research. Eventually, the Council established a 

permanent Group on Investigation and Research and passed the following resolution to be forwarded 

to Gen. Hines: 

“The Committee unanimously agrees that the Veterans’ Bureau should emphasize at every point 

the opportunity for investigation and research. This, because of the magnitude and importance 

of the work of the Bureau, and especially because of the field in which the work of the Bureau 

lies. Medical science is preeminently one in which investigation and research are called for. It 

therefore recommends: 

“1. That an office for investigation and research be established around the existent Division of 

Costs and Statistics. 

2. That a permanent committee of the Council be appointed to formulate lines of investigation 

and research and which shall act as liaison for such work between the Bureau on the one hand 

and the medical profession on the other. 

3. That problems of investigation and research shall cover: 

a. Those that arise directly from the administrative needs of the Bureau 

b. Those that arise through the clinical and laboratory care of patients 

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c. Those that will add definite contributions to medical knowledge 

4. The Committee further recommends that it should be the policy of the Bureau, with the 

guidance of the Council Committee, to develop active relations and exchanges of material with 

various accredited research agencies throughout the country. 

5. It further recommends that the results of such investigations as the Bureau may undertake, 

either under its own auspices or through the cooperation of outside agencies, be published in a 

bulletin of the Bureau, which may be issued either monthly or quarterly. 

6. It recommends that the medical staff of the Bureau should be encouraged in every way to 

participate in the field of investigation insofar as immediate duties will permit such 

participation. 

7. The Committee urges that the Bureau make every effort to obtain autopsy records through 

cooperating with local hospitals in order to improve its record of deceased cases in its files. 

8. The Committee will further examine the work of the Division of Costs and Statistics, and 

will make, later, a report specifying the most pressing investigations which should be 

undertaken at once. 

“The Committee recognizes the enormous scope of the field of investigation and research which 

the Bureau might properly undertake. On the other hand, it is felt that many difficulties will be 

encountered of a legal and financial character which might put great difficulties in the path of 

the entire program unless the field of investigation were narrowed somewhat to include, at the 

beginning, only those items of investigation which directly bear on the welfare of the men for 

whom the Bureau is responsible.”49 

A second resolution put forward by the Medical Council at this first meeting recommended 

establishing “regional diagnostic groups, consisting of the best available Bureau and local medical 

personnel, utilizing so far as possible, as consultants, members of this Council...” The Council 

recommended that patients with doubtful diagnoses be referred to these groups and that the 

consultants be adequately compensated.50 This resolution led to the establishment of several 

Diagnostic Centers (discussed below) that contributed to the research program through the 1920s 

and 1930s. 

The resolution about Diagnostic Centers also obliquely recommended affiliation with medical 

schools: “It is further suggested that where teaching institutions are available their use for this 

purpose will furnish excellent opportunity for the development of the attached Bureau officers as 

expert diagnosticians.” Another committee of the Council, the Neuropsychiatric Committee, also 

favored affiliation with teaching institutions: “It is recommended that in the planning of future 

neuropsychiatric hospitals of the Veterans’ Bureau, that are to be located in or near medical teaching 

centers or areas of large population, that certain of these be constructed and operated so that they 

may serve as teaching centers or schools for the medical personnel of the Veterans’ Bureau.”51 

Despite these recommendations, no formal affiliations between veterans’ hospitals and medical 

schools occurred until after World War II.52 The early VA research program had little or no formal 

input from academia except through the members of the Medical Council. 

Before the second meeting of the Medical Council in November 1924, its membership was expanded 

by nine new members, four of whom, Albert E. Cohn, M.D., Allen K. Krause, M.D., Horatio M. 

Pollack, M.D. and Joseph W. Schereschewsky, M.D., joined Drs. Louis Dublin and Michael Davis 

17
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to form the Group on Investigation and Research. Davis left the Council in 1927, but the other five 

men continued as active advisors to the research program through the life of the Council. This 

enrichment of the Council’s research expertise by adding four new members with research interests 

was consistent with Dublin’s professed enthusiasm and the support of research attributed to Dr. 

Crossman and his staff.53 

At this second meeting, the newly formed Group on Investigation and Research met and prepared an 

extensive report in which they referred to “enthusiasm for scientific work... from the Medical 

Director down....” They made the following recommendations: 

“1. The establishment of a Section on Investigation and Research in the Medical Service.

 2. The appointment of a Director of Research ... This Committee shall act as advisor to the 

Research Director.

 3. The Director of Research shall survey the present condition of the records kept both in the 

Bureau and in the field to determine their adequacy for the purposes of investigation.... 

 4. The Director of Research shall investigate the standards and definitions for the clinical 

routine in hospitals, clinics and laboratories, and shall investigate the standards of diagnosis and 

treatment in the various establishments. 

5. He shall have authority to study the work of all hospitals and other establishments of the 

Bureau.

 6. He shall make plans for revision of the rating schedule. 

 7. He shall institute a study of the future hospital needs of the Bureau in cooperation with the 

Federal Board of Hospitalization. 

8. He shall be responsible for the study of the clinical material available in the hospitals, 

clinics and out-patient departments of the Bureau, and emphasis shall be placed on the results of 

various methods of treatment. 

9. ... The Research Director shall hold conferences with the medical officers at regular 

intervals to discuss medical problems and the results of the investigations conducted at the 

several hospitals. The staffs shall be encouraged to engage in research work in so far as their 

duties will permit, and favorable notation shall be made on the record of such medical officers 

as produce useful research work. 

10. The Bureau shall arrange for the publication of a Monthly Bulletin, which shall be the 

medium for the publication of the studies made by the medical staff and the Research 

Director.”54 

The duties described for the Research Director represented an ambitious agenda for a single 

individual. The committee appears to have included functions they were sure the Bureau leadership 

wanted in order to persuade them that they needed a Director of Research. Nevertheless, it spells out 

what the committee, influenced by its two statistician members, thought of when they referred to 

research. Statistical studies of Bureau activities, systematically performed so that useful conclusions 

could be drawn, were related directly to Dublin’s positions and expertise at Metropolitan Life. 

Adequate patient records were seen as essential to such studies, as well as to clinical research. 

Furthermore, standardized procedures were important not only to assuring quality control in patient 

care but also to acquiring usable data for clinical outcome studies. 

18
 
 

 

 

 

 

 

 

 

 

The provision for research by clinical staff contained in the recommendations suggests that not much 

was expected of them. There was no provision for freeing clinicians’ time to allow them to conduct 

the suggested research, and this limitation undoubtedly limited the growth of such endeavors.55 

Nevertheless, research projects in the hospitals and dispensaries did materialize. 

By the time of the third meeting of the Medical Council on February 27-28, 1925, a section on 

Medical Research in the Bureau’s central office had been formally established and recruitment for a 

Director of Research was under way. The Group on Investigation and Research advised the 

following qualifications for this Director: 

“1. He should be a physician familiar with Bureau procedure, and preferably one of the medical 

officers of the Veterans’ Bureau.

 2. He should have a good general and medical education.

 3.	 He should have shown unusual interest in study and research and given some evidence of 

this interest in published work. 

 4. He should be a man in vigorous health and preferably under 45.

 5. He should have unquestioned administrative ability.

 6.	 He should be a man of personality, having the respect of the medical personnel of the 

Bureau.”56 

Other related progress was also under way in early 1925. A Diagnostic Center had been established 

in Cincinnati and one was in preparation for Washington, D.C. The first issue of the Veterans’ 

Bureau Medical Bulletin was published in July 1925. Considering the many impediments to change, 

the speed of these events testify to the energetic efforts by Dr. Crossman and his staff, as well as 

Gen. Hines’ decisiveness. 

19
 
 

 

 

 

 

 

 

 

 

 

References 

1. Jones, R.S., The History of the American Legion. Indianapolis and New York: The BobbsMerrill Company, 1946, 123. 

2.	 Crossman, E.O., "U.S. Veterans' Bureau Hospitals." Mod Hosp, 1926. 26: 30-32. 

3.	 Griffith, C.M., "The Medical and Hospital Service of the Veterans’ Administration." Military 

Surgeon, 1936. 79: 251-267. 

4.	 White, W.C., Billings, F., Bowman, J.G. and Kirby, G.H., Report of the Consultants on 

Hospitalization Appointed by the Secretary of the Treasury to Provide Additional Hospital 

Facilities under Public Act 384 (Approved March 4, 1921). Washington, DC: 

U.S.Government Printing Office, 1923, 1. 

5. Furman, B., A Profile of the United States Public Health Service, DHEW Publication No. 

(NIH) 73-369. Washington, DC: U.S. Government Printing Office, 1973, 20. 

6. Skocpol, T., Protecting Soldiers and Mothers. Cambridge, MA and London, England: The 

Belknap Press of the Harvard University Press, 1992, 107-130. 

7. Leigh, R.D., Federal Health Administration in the United States. New York and London: 

Harper & Brothers Publishers, 1927, 314. 

8. Adkins, R.E., Medical Care of Veterans. Washington, DC: U.S. Government Printing Office, 

1967, 92-93. 

9. Jones, History of American Legion. 1946, 125-126. 

10. Leigh, Federal Health Administration. 1927, 168-169. 

11. Adkins, Medical Care of Veterans. 1967, 102-103. 

12. Leigh, Federal Health Administration. 1927, 172-174. 

13. Rosen, G., The Structure of American Medical Practice, 1875-1941, Philadephia: University 

of Pennsylvania Press, 1983, 43-48. 

14. Lewis, B.J., VA Medical Program in Relation to Medical Schools. Washington, DC: U.S. 

Government Printing Office, 1970, 65. 

15. Leigh, Federal Health Administration. 1927, 181-191. 

16. White, Report of Consultants on Hospitalization. 1923, iii, 1-2, and 63-64. 

17. Adkins, Medical Care of Veterans. 1967, 65. 

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18. White, Report of Consultants on Hospitalization. 1923, 7. 

19. White, Report of Consultants on Hospitalization. 1923, 15-16. 

20. Telegram from Frank Billings, M.D. to Ray Lyman Wilbur, M.D., written at Chicago, IL, 

May 27, 1921. 

21.	 Telegram from Ray Lyman Wilbur, M.D. to William C. White, M.D., written at Palo Alto, 

CA, June 3, 1921. 

22. White, Report of Consultants on Hospitalization. 1923, 9. 

23. Jones, History of American Legion. 1946, 132. 

24. Adkins, Medical Care of Veterans. 1967, 110-112. 

25. Leigh, Federal Health Administration. 1927, 200-203. 

26. White, Report of Consultants on Hospitalization. 1923, 61. 

27. Investigation of the Veterans' Bureau: Hearings before the Select Committee on Investigation 

of the Veterans' Bureau, United States Senate, Sixty-Seventh Congress, October 22 to 

November 7, 1923. Washington, DC: Government Printing Office, 1923 

28. Leigh, Federal Health Administration. 1927, 207. 

29. New York Times, New York, September 14, 1921, 19. 

30.	 Smith, F.C., M.D., witness. "Testimony of Doctor Frederick Charles Smith." Hearings 

Before the Select Committee on Investigation of Veterans' Bureau, United States Senate. 

Washington, D.C.: Government Printing Office, 1923, 1: 651-664. 

31. Investigation of the Veterans' Bureau. 1923, 755. 

32. Investigation of the Veterans' Bureau. 1923, 10-150. 

33. Investigation of the Veterans' Bureau. 1923, 790-791. 

34. "Minutes of the Second Conference of the Medical Council with the Director and the 

Medical Director of the United States Veterans' Bureau." Washington, DC: U.S. Veterans' 

Bureau, 1924, 8. 

35.	 Letter from Ray Lyman Wilbur, M.D. to Frank T. Hines, written at Palo Alto, CA, February 

12, 1924. 

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36. Anonymous obituary, "Doctor Crossman." US Veterans' Bureau Medical Bulletin, 1929. 5: 

647-648. 

37. Letter from General Frank T. Hines to Ray Lyman Wilbur, M.D., written at Washington, DC, 

February 19, 1924. 

38. "Minutes of First Conference, Medical Council, U.S. Veterans' Bureau, 22-24 July, 1924." 

Washington, DC: U.S. Veterans' Bureau, 1924, 16. 

39. "Minutes of First Medical Council Meeting, 22-24 July, 1924." 1924, 34. 

40. Harvey, A.M., Science at the Bedside: Clinical Research in American Medicine, 1905-1945. 

Baltimore and London: John Hopkins University Press, 1981, 64-70. 

41. "Agenda of First Conference, Medical Council , U.S. Veterans' Bureau." Washington, DC: 

U.S. Veterans' Bureau, 1924, 14. 

42. "Agenda of First Medical Council Meeting." 1924, 5. 

43. Adkins, Medical Care of Veterans. 1967, 138-139. 

44. Adkins, Medical Care of Veterans. 1967, 180 and pp. 209-211. 

45. "Minutes of Second Medical Council Meeting, 10-11 November, 1924." 1924, 12. 

46.	 Letter from Ray Lyman Wilbur, M.D. to E.O. Crossman, M.D., written at Palo Alto, CA, 

October 7, 1924. 

47. Davis, M.M., "Improvement in out-patient service, with special reference to medical 

records." US Veterans' Bureau Medical Bulletin, 1926. 2: 108-112. 

48. Adams, W., "The organization and administration of the medical divisions of regional 

offices." US Veterans' Bureau Medical Bulletin, 1926. 2: 113-117. 

49. "Minutes of First Medical Council Meeting, 22-24 July, 1924." 1924, 23. 

50. "Minutes of First Medical Council Meeting, 22-24 July, 1924." 1924, 14-15. 

51. "Minutes of First Medical Council Meeting, 22-24 July, 1924." 1924, 21. 

52. Adkins, Medical Care of Veterans. 1967, 215-218. 

53. "Minutes of Second Medical Council Meeting, 10-11 November, 1924." 1924, 28. 

54. "Minutes of Second Medical Council Meeting, 10-11 November, 1924." 1924, 29-30. 

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55. Ziegler, E.E., "Some properties of pneumocholin, a biochemical analysis." J Lab Clin Med, 

 1933. 18: 695-704. 

56. "Minutes of the Third Conference of the Medical Council with the Director and the Medical 

Director of the United States Veterans' Bureau at Washington, D.C., 27-28 February, 1925." 

Washington, DC: U.S. Veterans' Bureau, 1925, 28. 

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(Intentionally Blank) 

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Chapter 2. The VA Research Program Before 1946 

The year 1925 marked the effective transition from recommendation to action. The Veterans' Bureau 

leadership quickly grasped key initiatives that the Medical Council viewed as vital to strengthening 

this federal agency that had been thrust into the role of delivering health care services. A system of 

diagnostic clinics with links to outside consultants was established, and the U.S. Veterans' Bureau 

Medical Bulletin began publication as an important medium for sharing information. The formal 

establishment of a research component within the Veterans' Bureau that year was also a major 

milestone. 

The advent of clearly identified medical research activity meant the marriage of projects and 

practitioners that had been informally at work with the type of hospital-based clinical research 

envisioned by the Medical Council. The Bureau's first Research Chief, Philip B. Matz, M.D., was an 

advocate of that philosophy and steered the agency's efforts primarily toward hospital-based inquiry 

directly related to the clinical conditions of a Veteran patient population. 

In 1930, the most significant reorganization of federal Veterans programs to date occurred when 

President Hoover ordered a merger of three agencies to create the Veterans Administration (VA). 

The Veterans’ Bureau, the Treasury Department’s Bureau of Pensions, and the domiciliary system of 

National Homes were now under one umbrella that would endure as the government’s largest 

independent agency for the next half-century. 

By 1932, as the Nation's economy worsened, pressures were brought to bear on many government 

programs, including those serving Veterans. Provisions within the Economy Act of 1933 limited 

access to Veterans’ hospitals for a time with revised eligibility criteria. Even though many 

restrictions were lifted as a result of public pressure, the VA still was burdened by the need to 

conserve funds. Some of Matz's initiatives toward centrally directed research were bogged down. 

With mounting demands for medical care, the Depression also forced some research-related 

programs such as the diagnostic clinics to provide direct forms of treatment. The monthly Medical 

Bulletin was reduced to a quarterly. Even the influential and highly regarded Medical Council was 

placed on an eight-year hiatus from 1931 to 1939. 

The medical research climate of the 1920s and 1930s 

What did the Medical Council members have in mind when they urged the Veterans’ Bureau to 

launch a hospital-based clinical research program? Clearly, they were not thinking of what we now 

call “basic” medical research. Research facilities as we know them today did not exist in Veterans’ 

Bureau hospitals, nor, for that matter, in most hospitals, even most of those affiliated with medical 

schools.1 Erwin Chargaff later described the general climate of medical research in the United States 

in 1928 as “dominated by an unhurried, good-natured, second-rateness.”2 

Alfred E. Cohn, M.D., a member of the Research Group of the Medical Council, was the first editor 

of the Journal of Clinical Investigation. In its 1924 first issue, he wrote an introductory editorial on 

the purposes of medical research. He urged the mastery of the methodologies of physics, 

physiology, nosology and chemistry and asserted that the business of medical research “involves a 

legitimate interest in learning as well as a means for furthering the methods which lead to the cure of 

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disease.”3

 While many authors in his journal focused primarily on the first aim, the basic 

understanding of medical problems, most of the early Veterans’ Bureau authors, whether they 

published in the Medical Bulletin or in other journals, focused primarily on the second aim, seeking 

methods to cure disease. 

As late as 1941, Alan Gregg, M.D., Rockefeller Foundation Director for the Medical Sciences, 

discussed his view of what constituted medical research.4

 He defined “research” as having “a flavor 

of dissatisfaction with the search made hereto, or with the hereto accepted explanations,” and stated 

that “scientific research attains in its successful moments a constantly closer approximation to the 

truth.” Like Dr. Cohn, Dr. Gregg divided research into two forms, observational and experimental. 

In his view, observational research (which covers most of the early VA research to be discussed in 

this chapter) requires that the investigator “bring so fresh and sensitive a mind to reexploration that 

the discoveries of exploration are possible.” He admitted, however, that medical research is “often 

shot through with irregularities (and) intuitive guesses.” 

Support of medical research in the 1920s and 1930s came from researchers themselves and from 

foundations, universities, industry and, lastly, the government. Each of these sectors was 

represented on the Medical Council’s Group on Research. 

Foundations were the most important funders. From 1937 to 1940, American foundations’ annual 

support of medicine and public health was estimated to be in the range of $12.2 to $13.5 million.5 

Foremost among the foundations was the Rockefeller Institute, founded in 1902. The Institute was 

the site of basic and clinical research in infectious diseases, cardiology and other prevalent medical 

problems. 

The most prominent industrial support of medical research came from the life insurance industry, 

which was represented on the Medical Council and the Group on Research by Louis Dublin of 

Metropolitan Life Insurance Company, a major player in the public health movement. Dublin 

undoubtedly influenced the direction of the early Veterans’ Bureau research toward demographic 

studies of a type that might be hard to reconcile with Dr. Gregg’s definition of “true” research. 

Probably the foremost medical school in support of research at the time was Johns Hopkins. Allen 

Krause, M.D., who directed a privately endowed laboratory there to study tuberculosis, was active in 

the Medical Council and its Group on Research. 

A prominent player in governmental psychiatric research was St. Elizabeth’s Hospital, the large 

federal psychiatric hospital in Washington, D.C., led by William Alanson White, M.D., also an 

active member of the Medical Council. The Public Health Service, which had long had 

responsibility for research on controlling infectious diseases, continued a program of intramural 

research in its Hygienic Laboratory.6

 The former Assistant Surgeon General for Research, Joseph 

W. Schereschewsky, M.D., was an active member of the Medical Council and its Group on 

Research. 

With regard to governmental support, Dr. Gregg warned that: “The usual reservation regarding 

research under governmental control is that political preferment or unenlightened parsimony may 

26
 

5 
 

 

 

 

 

 

 

 

 

 

 

 

 

spoil the quality of the work.”7 And while these factors may have kept the VA research program 

small before 1946, the VA was not alone in receiving little governmental funding. As late as 1945, 

the National Institute of Health (as it was then known) spent only $3 million on medical research, 

while foundations contributed some $16 million.8 

Before World War II, VA hospitals were not affiliated with medical schools, but this probably was 

not the key factor keeping the research program small. Only a few of the most prominent medical 

schools, especially those with full-time clinical faculty, had significant clinical research programs. 

The dilemma of most medical school faculty, likely shared by VA physicians, is described by 

Professor Harry M. Marks in his book, “The Progress of Experiment: Science and Therapeutic 

Reform in the United States 1900-1990”: 

 “Clinical investigators working in medical schools had to meet the demands of department 

chairmen to place service obligations before their research. As physicians, they faced 

competition from their medical colleagues for income, for patients to study, and for the allegiance 

of their students.” In addition, “Outside of a few isolated research centers, few clinical specialists 

controlled the resources called for by their research programs.”9 

Important basic research, funded mostly by foundations, was being done at a few places, such as the 

Rockefeller Institute, the Mayo Clinic and a few medical schools,10 but such studies were not 

expected of the Veterans’ Bureau. Rather, the clinical research the Medical Council urged was 

closely associated with the patient. It endeavored to bring systematic observation and scientific 

method to bedside treatment.11 

What did the VA mean by “Research”? 

The Medical Council’s view of research appropriate to the Veterans’ Bureau emphasized 

standardization of practice and records and statistical studies. Members also emphasized the 

importance to the Veterans’ Bureau of clinical research, particularly studies of outcomes. As 

Chairman Wilbur said in a 1926 address: 

“If we can get the best medical brains of this country concerned with the neuropsychiatric 

Veteran, not only to study him but to get him back ‘on the job,’ and also trace through over a 

period of years just what actually does happen, keeping alive a constant scientific interest in the 

problem, we will have done a real service in the advance of medicine.”12 

In 1926, Dr. Matz, Chief of Research at Bureau headquarters, described his view of that component 

of the agency’s mission: 

“It must be clearly understood at the outset that research work in our service must show that 

upon consummation it will result in the betterment of the treatment of the beneficiary. It is not 

within the province of the Veterans’ Bureau to carry on research work of a purely academic 

character; there are other governmental agencies for this line of endeavor; ours must be research 

based on practicability—something akin to the research work carried on by the large commercial 

corporations of the country. Our research work must eventually result in larger percentages of 

recoveries and reduced mortality rates of the beneficiaries of the United States Veterans’ Bureau. 

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One of the functions of the research subdivision of central office is to guide and advise those 

research workers who are in need of help. The research group of the Medical Council has kindly 

volunteered to cooperate with the bureau in this important work and it is strongly urged that the 

personnel in the field avail themselves of this privilege and ask for advice when in need of it.”13 

Review of clinical research in 1926 

An idea of the state of American clinical research in 1926 can be drawn from the published medical 

literature for that year. An examination of such journals as the American Journal of Psychiatry, the 

American Review of Tuberculosis and the American Journal of Syphilis, as well as the general 

medical journals Journal of the American Medical Association, the Journal of Clinical Investigation, 

the American Journal of the Medical Sciences and the Veterans’ Bureau’s own Medical Bulletin, 

reveals the types of studies that were attracting attention. 

Most authors publishing in these journals were practicing physicians. There were many papers from 

the more prestigious medical schools and private hospitals, especially in the Journal of Clinical 

Investigation. Nevertheless, a substantial number of authors reported research conducted in their 

private practices or in hospitals and public institutions without academic affiliations. 

Table 2.1 displays the types of reports published in these journals in 1926. These varied 

considerably among the journals. Of the journals reviewed, only the Journal of Clinical 

Investigation, then a quarterly journal in its second year, published a substantial amount of work on 

the pathophysiology of human disease—on topics such as the effect of hypothyroidism on plasma 

volume in patients, with repeat studies as the patients improved serving as the controls.14 

“Preclinical” studies, experimental studies on normal animals or human subjects, appeared in most 

of the journals reviewed but made up a substantial proportion of studies only in the Journal of 

Clinical Investigation and the American Review of Tuberculosis. All of the journals reviewed, 

except the Journal of Clinical Investigation, published “interpretation and synthesis” papers 

presenting generalizations from personal experience or from review of the literature, with little or no 

new objective data. 

Table 2.1. Comparison of articles published in medical journals, July-December, 1926

 Subject matter covered Percent of pages in original articles

 Med Bull JAMA AJMS JCI AJSyph AJPsy AmRevTbc 

Diagnostic methods 7 6 10 9 14 0 14 

Population statistics 7 1 2 0 0 0 30 

Descriptive studies 39 30 57 12 39 31 10
 

Therapeutic interventions 15 19 6 8 7 44 4 

Interpretation and synthesis 32 37 18 0 33 25 18
 

Preclinical and pathophysiology 0 7 6 71 7 0 25
 

Total 100 100 100 100 100 100 100 

While some coverage of therapeutic interventions was given in all of these journals, such 

interventions were emphasized in the American Journal of Psychiatry more than in the others. There 

were no reports of the prospective, randomized, placebo-controlled studies commonly seen today. 

Any studies that employed untreated controls were sequential, either comparing the patient’s 

condition before and after treatment or showing the outcome in a series of untreated patients from 

previous years compared with the treated series. Randomized studies with untreated controls were 

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rare at the time. Even the later work of the prestigious Cooperative Clinical Group15 did not meet 

this standard. In searching for the best treatment for syphilis, the Group presented standardized 

clinical statistics rather than controlled comparisons, despite a commitment to rigorous therapeutic 

investigation. 

Population statistics were prominent in the American Review of Tuberculosis and the Medical 

Bulletin. 

Most prominent in the journals reviewed were careful descriptions of the authors’ clinical experience 

with their own patients. Case reports of one or a few patients presenting with unusual conditions or 

unusual manifestations of disease were frequently published, as they are today. There also were 

frequent clinical series, generally presenting one practitioner’s or one clinic’s experience with a 

certain disease condition. Such reports reflect a carryover, which still exists in some areas, of the 

situation Marks describes: “Physicians accumulated knowledge of disease over the course of a long 

career, making age synonymous with expertise.” 16 

When diagnostic methods were presented, they were generally descriptions or standardizations of 

methods, with little evidence of any attempts to objectively validate the diagnostic usefulness of 

these methods. 

This research climate supported investigations by Veterans’ Bureau practitioners. In a sense, each 

patient successfully diagnosed and treated was himself a research project. The major skills needed 

to contribute to the medical literature were careful observation of patients and systematic recording 

of findings. These were within the reach of whoever was motivated to apply them. In the early 

days, many in the Veterans’ Bureau were so motivated. 

Even before the Central Office’s formal research initiative began, doctors in the Veterans’ Bureau 

hospitals were already doing this type of research. The first survey of ongoing Bureau research in 

1926 revealed a wide variety of projects of the types that could be done in a patient care setting 

(Table 2.2).13 

Table 2.2. Problems under investigation in Veterans’ Bureau hospitals in 1926. 

1. Penetration of aniline dyes into the central nervous system of experimental animals. 

2. Study of immunity by injecting iodine and feeding thyroid extract to guinea pigs. 

3. Basal metabolic estimation in tuberculosis. 

4. Influence of nasal conditions on neuritis, chronic bronchitis and pleurisy. Use of plumbi acetatis in acute 

edematous conditions. 

5. Malingering test by radio for deafness. 

6. Relation of malaria to paresis. 

7. Use of x-ray in treating tonsils. 

8. The sputum in cases of pulmonary spirochetosis. 

9. Study of the treatment of encephalitis lethargica. 

10. Empyema and its relation to tuberculosis. 

11. Psychoneurosis as evidence of organic pathology. 

12. Production of a serum for treatment of tuberculosis. 

13. Constitutional effect of exercise on nontuberculous and tuberculous patients. 

14. Pulmonary tuberculosis and gastrointestinal symptomatology. 

15. Electrocardiographic studies of neurocirculatory asthenia, mitral stenosis and myocarditis. 

16. Electrocardiographic studies of pulmonary tuberculosis. 

17. Efficiency of stovarsol in treatment of amoebic dysentery. 

18. Gastric secretion in cases of colitis. 

19. Comparison of McLean’s kidney function test with phenolsulphonephthalien. 

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20. The bacteriology of osteomyelitis. 

21. Laboratory investigation of phenoltetrachlorphthalein test for hepatic function. 

22. Comparison of Kahn precipitation with the complement fixation test of syphilis. 

23. Statistics on patients showing positive serological findings but negative clinical histories and no manifestations of 

syphilis. 

24. X-ray abnormalities of the sella turcica and their relations to sugar tolerance and basal metabolic findings. 

25. Investigation of leukocytosis following epileptic seizures. 

26. Treatment of neurosyphilis with tryparsamide and bismuth, sulpharsphenamine and bismuth, and malarial blood 

inoculation. 

27. Therapeutic study of effect of intramuscular and intravenous inoculation of bacillus typhosus vaccine in 

encephalitis lethargica. 

28. Effect of intravenous administration of hypertonic dextrose solutions in cases of encephalitis lethargica. 

29. Method for correcting colloidal gold solutions. 

30. Study of the etiological factors in the production of inadequate behavior through neuropsychiatric symptoms. 

31. Use of mercurochrome and gentian violet in cases of encephalitis lethargica. 

32. Tuberculosis urinary antigens and the production of specific immunity. 

33. Calcium content in the blood of tuberculosis patients. 

34. The effect upon the blood sugar of potassium oxalate when used as an anti-coagulant. 

35. Index of x-ray films, showing the rate of incidence of tuberculosis in pneumonoconiosis. 

36. Study of positive Wasserman cases to determine what per cent show parenchymal infiltrations of lungs which 

simulate tuberculosis but are negative clinically. 

37. Relation of atrophy of testicle to mumps. 

38. Influence of intercurrent attacks of pneumonia on the course and prognosis of tuberculosis. 

Initiatives to implement the Medical Council’s recommendations 

Following the July 1924 Medical Council recommendations, the staff of the Central Office Medical 

Service of the Veterans’ Bureau quickly started three key initiatives: a system of diagnostic beds 

where problem cases could be evaluated, an internal journal to communicate findings and 

information and a formal research program. These three mutually important steps were 

accomplished within the next year. 

Efforts to bolster Veterans’ health care: the Diagnostic Centers 

The new Diagnostic Centers, centers of excellence within the hospital system charged with 

analyzing difficult diagnostic problems, were started in Cincinnati (Ohio) and Washington, D.C., in 

1925 and in Palo Alto (Calif.) (Figure 2.1) in 1928. Each of these units had in-house medical staff 

and a “board of consultants” that included local leaders in various fields of medical practice. Some 

members of the Medical Council also participated in these Diagnostic Centers. Roy D. Adams, M.D. 

was the chief consultant at the Washington Center, which had 250 beds,17 and Llewellys D. Barker, 

Ph.D., Allen K. Krause, M.D. and William A. White, M.D. were on the consultant staff.18 Dr. H. 

Kennon Dunham directed the Cincinnati Center.19 The Council Chairman, Ray Lyman Wilbur, 

M.D. played an active role in acquiring the Center for Palo Alto20 and supervised the recruiting of its 

consultant staff.21 

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Figure 2.1. The Diagnostic Center at the Palo Alto Veterans Hospital, 1928 

In 1929, the Palo Alto Diagnostic Center had 50 beds. In addition there were 50 beds in the same 

building for discharged Diagnostic Center patients who needed further treatment and another 50 

beds for patients with other medical and surgical problems. The hospital also had several other 

buildings containing 860 beds for neuropsychiatric patients. The Diagnostic Center was equipped 

with a surgical operating suite, Ears, Nose and Throat (ENT) department, radiology department, 

laboratory, dental clinic and pharmacy. Its physician staff consisted of four generalists, four 

internists, a general surgeon, two neuropsychiatrists, an ENT specialist, a radiologist and a 

pathologist. In addition, 17 part-time specialists and nine consultants came from Stanford University 

and the University of California medical schools’ faculties. Patients were examined by a number of 

physicians, given a spectrum of diagnostic procedures, and then had their cases reviewed in a 

conference. For example, a patient with gastrointestinal complaints would have gastric analysis, 

fluoroscopic x-ray series, barium enema, gall bladder x-ray, and multiple stool exams and blood 

tests.22 

All physicians throughout the system were urged to transfer patients with complex problems to the 

Diagnostic Centers for workup and therapy recommendations. These Centers were credited with 

upgrading medical care in the Veterans’ Bureau, and in 1929 the American Legion urged that new 

Centers be started in Boston and at the Mayo Clinic.23 A fourth Diagnostic Center was established 

in Chicago in 1930 with Charles A. Elliott, M.D., of the Medical Council as “Dean of 

Consultants.”24 

As originally conceived, the Diagnostic Centers were not intended to carry out continuing treatment 

but to limit their role to diagnosis and specialized procedures. In the 1930s, the demand for 

treatment beds eroded this distinction. By 1931, many of the beds in the Palo Alto Diagnostic 

Center were used for routine treatment,25 though there was continued demand for more diagnostic 

beds. In late 1934, the West Coast Diagnostic Center was moved from Palo Alto to the new VA 

hospital in San Francisco.26 Ten doctors, 11 nurses, 30 other employees and 81 patients moved from 

Palo Alto to the new Diagnostic Center in San Francisco.27 The Cincinnati Center, which was not 

connected to a VA hospital, closed some time after the opening of a large Diagnostic Center at the 

Hines VA Hospital in Chicago.19 

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Diagnostic Center staff were encouraged to do research, and they contributed to the general medical 

literature as well as to the Medical Bulletin. The Centers were well set up for case reports and record 

analyses as described in 1928 for the Washington, D.C., Veterans’ Bureau Hospital: 

“A final copy of the final report on each case is forwarded to the records and research section, 

where all diagnoses and other pertinent data are indexed according to the scheme outlined in the 

August, 1928, issue of the Bulletin. The monthly and annual medical statistical reports are 

compiled and written up from the data assembled in this section. This section further serves as 

an aid in furnishing valuable data for the writing of medical papers.”28 

The Medical Bulletin 

A key early recommendation of the Medical Council was that the Veterans’ Bureau establish a 

journal. This publication, called the United States Veterans’ Bureau Medical Bulletin, and later the 

United States Veterans Administration Medical Bulletin, was issued continuously from 1925 through 

1944. 

In the 1925 preface to the first issue, Dr. Edgar O. Crossman, the Medical Council’s Medical 

Director, said: 

“The United States Veterans’ Bureau Medical Bulletin is issued for the purpose of maintaining 

the high standard of medical service rendered claimants and beneficiaries of the bureau, by the 

collection and correlation of the experience of its medical officers in the diagnosis and treatment 

of their patients, and in the solution of their medical and administrative problems. It is also 

expected to promote research along practical lines and to present the results of study of the 

wealth of medical statistics contained in the records of the bureau. It is evident that the field for 

investigation is unlimited and that the opportunity to make helpful application of the conclusions 

is unprecedented.”29 

Especially as a monthly publication (until 1932), the Medical Bulletin was full of news of the 

Veterans’ medical service, articles reflecting clinical experience, review articles and statistical 

studies. It included reports of original research by staff physicians. Even controversy and divergent 

opinions were encouraged.30 It primarily published clinical papers, including many interesting case 

reports. There also were reports of carefully observed large patient populations and epidemiological 

reports using the database set up by the Research Subdivision. Every physician hired by the 

Veterans’ Bureau was asked to submit at least one article for the Bulletin each year. Initially, about 

half of them did, and the editors chose from many submitted articles. In 1926 about 75 papers were 

submitted monthly for editorial review.31 Many of the articles, particularly reports of unusual or 

difficult cases, were written by staff of the Diagnostic Centers. 

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Figure 2.2. The Medical Bulletin, 1925-1944 

The Bulletin served the Veterans’ Bureau and Veterans Administration in much the same way as the 

American Medical Association was served by its Journal. Both journals allocated a large proportion 

of space to administrative matters, reviews, letters, editorials and meeting reports. Most of the 

original articles were based on authors’ clinical experiences—either case reports, case series or 

teaching articles based on extensive experience. Some epidemiological and methodological articles 

appeared in both journals. Preclinical science played a very small role. 

The scientific and medical subject matter of the Bulletin was closely aligned with Veterans’ health 

care needs. Table 2.3 shows the distribution of topics in 1926, 1927, 1931 and 1935. There were 

many articles on treatment of patients with tuberculosis, unusual forms of tuberculosis, syphilis, both 

tuberculosis and syphilis, and psychiatric disorders, as well as reports of favorable results from 

innovative psychiatric treatments. 

Table 2.3. Subjects of Articles in the Medical Bulletin, July-December, 1926, 1927, 1931 and 1935 (% of total pages) 

1926 1927 1931 1935 

Tuberculosis 23.8 16.2 16.7 13.9 

Neurosyphilis 1.9 4.1 6.8 5.6 

Nonsyphilitic psychoses 8.0 12.8 8.0 5.6 

Other psychiatric disorders 13.6 9.5 3.1 0.0 

Neurologic (nonsyphilitic) disorders 8.3 0.9 2.7 3.0 

Infectious diseases (other than neurosyphilis) 5.9 6.8 11.4 15.2 

Neoplasms 8.0 2.5 20.1 11.4 

Cardiovascular and arteriosclerotic disorders 11.5 9.7 6.3 6.1 

Gastrointestinal disorders 2.9 7.2 2.7 2.5 

Endocrine, renal, GU and arthritic disorders 8.8 5.2 9.0 11.6 

Sequelae of trauma 2.4 3.2 2.5 4.0 

Other 4.8 2.1 10.9 21.2
 

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Physicians in the Veterans’ Bureau were not the only contributors to the Bulletin. For example, 

librarians (who sometimes conducted “book therapy” for patients with mental illness), physical 

therapists, nurses and hospital managers also wrote articles. The Bulletin carried a news section, 

reporting activities of the Medical Council, items from Central Office and field hospitals, 

conferences at the hospitals, and Veterans’ Bureau physicians’ participation in other organizations’ 

medical meetings. 

The Central Office Research Subsection 

The Medical Research Subdivision, which had been recommended by the Medical Council, became 

a reality when Philip B. Matz, M.D. (Figure 2.3), a pathologist, joined the Central Office as its Chief 

in September 1925.32 He met with an enthusiastic Medical Council Group on Investigation and 

Research at the fourth Council meeting in October. They noted that Matz, who had been Chief of 

Laboratory Service at the Legion, Texas, Veterans Hospital, was selected from field hospital staff 

recommendations of people with the desired qualifications. 

Administrative details of his appointment to Central Office were incomplete, so he was temporarily 

assigned to the Washington, D.C., Veterans Hospital. He had already: 

“a. Made a survey of the pathological laboratory of U.S. Veterans’ Hospital #32, where he has 

been temporarily assigned. 

b. Installed a cross-index filing system for that hospital. 

c. Investigated apparently irregular blood findings of employees in the X-ray laboratory of the 

hospital and prepared a report on this study for publication in the Bulletin. 

d. Undertaken a survey of the facilities and personnel for investigation, and all research work 

now in progress in all Bureau hospitals. 

e. Got under way the standardization of the Wasserman test for all Bureau hospitals. 

f. Prepared and submitted to our Group a tentative working program for the Medical Research 

Division.”33 

Figure 2.3. Philip B. Matz, M.D., Chief, Research Subsection, 1925-1938. 

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The Medical Council Group recommended that the Division of Medical Research concentrate its 

first efforts on completing the survey of research facilities and on standardization of methods for 

diagnosis and treatment. Nevertheless, “in anticipation of future work,” they stated that: 

“a. While the Chief of the Research Subdivision should foster and encourage all evidences of 

originality in the pursuit of research work, as a matter of policy, all projected studies should be 

submitted to him for approval. He should also recommend, at his discretion, to qualified stations 

in the field, problems for medical research. 

b. The Group is of the opinion that the Chief of the Division of Medical Research should install 

a system of regular progress reports on research work being carried out in the field. 

c. The Group believes it advisable for the Chief of Medical Research to keep in touch with 

selected medical schools and laboratories, so as to be in a position to locate suitably qualified 

research personnel, with a view to cooperating with the Civil Service Commission in filling 

existing vacancies in this line of work, or for acquiring new personnel for such activities.”34 

Philip Matz, M.D., Chief of the Research Subdivision 

Dr. Matz was a 40-year-old pathologist from Baltimore, a 1908 graduate of the Long Island College 

of Medicine in Brooklyn. In 1909 he joined the staff of the Leavenworth (Kan.) National Military 

Home, where he was Chief of the laboratory until 1914. From 1914 to 1917, he was in private 

practice, conducting laboratories in Leavenworth and Kansas City and serving as consultant 

serologist to the Federal penitentiary at Leavenworth. 

During World War I, Matz was Chief of the Laboratory Service at the Base Hospital, Camp Travis, 

Texas. In 1919, he published an extensive paper about the bacteriology of pneumonia in influenza 

victims. He reported that, on throat culture, Pfeiffer’s bacillus (believed at the time to cause 

influenza) was present in 39 percent and pneumococcus in 10 percent of 868 patients with 

uncomplicated influenza. None of the blood cultures from patients with uncomplicated influenza 

was positive. In influenza patients with complicating pneumonia, on the other hand, pneumococcus 

was present in the sputum in 68 percent of 1,505 sputum cultures and Pfeiffer’s bacillus in none of 

them. Of 178 blood cultures from pneumonia cases, 11 percent were positive, all with 

pneumococcus. Spinal fluid cultures in 16 cases of meningitis also all revealed pneumococcus of 

various types. He found acidosis and urea retention in the pneumonia patients, with acute 

parenchymous inflammation in the kidneys at autopsy.35 

After the war, Matz joined the Public Health Service and was assigned as Chief, Laboratory Service, 

to a series of five Public Health (later Veterans’ Bureau) Hospitals. During this period, he wrote an 

extensive clinical research paper on the calcium content of the blood in normal and tuberculous 

subjects. He established the normal range of fasting serum calcium in 50 normal subjects and 

showed that it was no different in 72 patients with tuberculosis. In both normal and tuberculous 

subjects, he demonstrated a modest increase in serum calcium after a high calcium meal or ingestion 

of inorganic calcium salts, an effect that increased when cod liver oil was given. He presented a few 

studies in both normal and tuberculous subjects showing an inverse relationship between serum 

calcium and the coagulation time.36 

35
 
 

 

 

 

 

 

 

 

 

 

 

 

 

He had also taken postgraduate work at the University of Kansas, St. Louis University, Rush 

Medical School and the Rockefeller Institute for Medical Research.37 

After Matz moved to the Central Office, he and his small staff continued to follow the guidance of 

the Medical Council’s Group on Research. The staff concentrated on setting up a statistical system 

for tracking patients, which was necessary to understand the Bureau’s medical care responsibilities 

better. Early publications were primarily statistical descriptions of the Bureau’s patient population 

and used information gathered by the Evaluation Division in Central Office. 

A 1926 study by Matz of cardiovascular disease among Veterans38 currently hospitalized showed 

that 59 percent of the 537 such cases reported had valvular heart disease. Another 21 percent had 

myocarditis, a surprising finding that Matz attributed in part to the high incidence of tuberculous 

myocarditis. In a later report of 330 deaths due to cardiovascular disease during 1923-1925,39 

valvular disease was responsible in 47 percent and myocarditis in 28 percent of the fatalities. 

Average age at death was 34 years. “Angina pectoris” was listed as the cause of death in four cases, 

but “myocardial infarction” or its equivalent was not included as a cause of death. 

Similar reports by Matz described the Bureau’s patient populations with tuberculosis (6,715 

inpatients);40 degenerative diseases of the heart, blood vessels and kidney;41, 42 and neuropsychiatric 

diseases.43 The tuberculosis study reported a preponderance of moderately advanced cases (48 

percent) and far advanced cases (44 percent). It demonstrated a poorer response to treatment among 

“colored” than among white patients, even when the stage of their disease was taken into account. 

The study of 4,020 cases of “degenerative diseases” included 306 patients with arteriosclerosis 

(local, cerebral, general or unclassified), 435 with cardiac hypertrophy and 3,279 with some form of 

nephritis. The study of neuropsychiatric diseases reported that 65 percent of 12,220 such Veteran 

patients suffered from dementia praecox (schizophrenia), and 6.4 percent from general paresis 

(tertiary syphilis of the brain). Comparing 4,313 Veterans’ Bureau psychiatric admissions with 

71,676 admissions to civilian mental hospitals, Matz found similar incidences of dementia praecox 

and general paresis, but that more patients with manic-depressive psychosis were admitted to civilian 

hospitals and more patients with nonpsychotic conditions were admitted to veterans’ hospitals. A 

1927 article reports the distribution of compensable disabilities among World War I Veterans.44 

Matz also published demographic reports on the Veterans’ Bureau hospital activities monthly from 

October 1926 through March 1927.45-49 

Dr. Matz’s writings in the Medical Bulletin, as well as articles from field hospitals encouraged by 

him, were sprinkled with information about fever therapies for general paresis, a form of tertiary 

syphilis. In 1926, he reviewed recent publications about the procedure.50 There followed in 1927 a 

report of early experience with malarial treatment at the Hines, Bronx, Augusta, Ga, Gulfport, Miss. 

and North Little Rock, Ark. Veterans Hospitals. Of 112 patients treated, 65 percent showed shortterm improvement. Spinal fluid Wasserman became negative in only 28 percent, while the blood 

Wasserman became negative in 62 percent. This report concludes, “It is believed that the results 

obtained following this form of treatment justify its continuation and further development. While no 

rational explanation can be given of its mode of action . . . the effect may be attributable to certain 

indefinable alterations or reactions of the body.”51 A follow-up article reported on 179 cases, 

including 67 new cases. By that time, patients had been under observation for as long as 18 months, 

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and the results were “highly satisfactory”: 72 percent were “improved” or “greatly improved” and 

66 percent and 28 percent, respectively, had negative blood and spinal fluid Wasserman tests.52 

In 1926, Matz also published in the Medical Bulletin review summaries of articles reporting autopsy 

findings in paretics treated with malaria. There was reversion of histology toward normal, compared 

with untreated, patients, and a lack of spirochetes in the brain tissues.53 Matz included practical 

information about the procedure: a note about how to transport blood containing malaria plasmodia 

through the mail for use in patients at other hospitals.54 

In 1928, Matz published an updated report of Veterans’ Bureau experience, now reporting 346 

patients treated with “inoculation malaria.” This time, instead of the in-house Medical Bulletin, he 

published the Veterans’ Bureau results in the Journal of Nervous and Mental Diseases. This report 

included a review of the current status of the treatment, extensively quoting the experience of 

civilian authors and comparing Veterans’ Bureau experience with that of others. The Veterans’ 

Bureau hospitals reported no mortality due to treatment, in contrast to about 5 percent mortality in 

other series. This was thought to derive from exclusion of high-risk patients and the relatively 

young age of Veteran patients. Among treated patients, 24 percent were greatly improved and 23 

percent were improved, results comparable to other series. For comparison, Matz quoted the 

published incidence of spontaneous remissions from general paresis to be in the range of 3 percent to 

10 percent.55 

Other articles by Matz reported experience in treatment of paretic patients with ratbite fever (sodoku, 

due to spirochaeta morsus-muris, an organism that causes a malaria-like fever), with an early 

suggestion of improvement with less reported mortality than with malaria or relapsing fever.56 Other 

reports reviewed clinical conditions and standardization of clinical and laboratory tests.57-63 

In 1926, Dr. Matz and Dr. H.L. Gilchrist, Medical Director of the Army’s Chemical Warfare 

Service, advised by the Medical Council’s Drs. Allen K. Krause and H. Kennon Dunham, began to 

locate and study Veterans who had been victims of poison gases during World War I. In 1928, they 

presented a preliminary report,64 in which they described the study and its difficulties. While the 

group wanted to study each of the gases separately, often several types of gas had been used 

together. There were a total of 70,742 U.S. gas exposure casualties in World War I. In only 37,025 

of these was the type of gas known: chlorine, 1,843; mustard, 27,771; phosgene, 6,834; arsenicals, 

577. Frequently, men who were gassed had other injuries, which could interact with gas effects. Of 

the 70,742 total gas casualties, 200 died on the battlefield and 1,221 died in field hospitals, a 2.01% 

early-death rate. 

In 1921, the Army had reviewed the status of a sample of the casualties who had lived to be 

discharged from the field hospitals. Of the 3,431 cases reviewed, 353 (10.3 percent) were thought to 

have a gas-related disability in 1921. The long-term effects of gassing were unknown. 

In a survey of the problem, Matz and Gilchrist contacted U.S. and international physicians who had 

wide experience in treatment of gas victims, asking for their opinions about late (eight to 10 years) 

effects. The results were not helpful: “An analysis of the opinion of the civilian clinicians as well as 

the army officers of this and of foreign countries was so at variance and so conflicting that a 

summarization would result in no definite conclusions. It was felt, therefore, that this difference of 

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opinions was sufficiently great to justify the present study of the residual effects of wartime 

gassing.”65 

The Veterans’ Bureau study, carried out from 1926 to 1928, included a review of all deaths in the 

men reviewed by the Army in 1921, and a thorough clinical follow-up of those in the Army study 

believed in 1921 to have a possible gas-related disability. About 10 years after the initial gassing, 

they called the Veterans in for a thorough re-examination and review of their complete case 

histories. 

The authors acknowledged that the selection method made impossible an overall statistical analysis 

of the late effects of wartime gassing, since those who showed no evidence of effects in 1921 were 

not studied in the 1926-1928 review. Rather, the authors sought to establish as unequivocally as 

possible in a select group those conditions that might be due to gassing. They found in some of the 

men infrequent but definite anatomic and clinical residua of the gassing, apart from other 

considerations. The most frequent effect was a chronic bronchitis with asthma-like features. 

Gassing did not appear to predispose to tuberculosis, but it did aggravate existing tuberculosis.65-68 

The results of this study are summarized in Table 2.4. 

Table 2.4. Summary of results of the 1926-1928 Veterans’ Bureau-Army study of the late effects of wartime gassing 

Incidence of gas-related death or residual disability in 1926-1928 (eight to 10 years after gas exposure) among those surviving to 

leave the field hospital: 

Chlorine Mustard Phosgene Arsenicals 

Total number examined 96 89 79 43 

Death 0.24% 1.48% 0.40% 0.87% 

Residua 2.00% 4.41% 1.58% 0.73% 

Death or residua 2.24% 5.89% 1.98% 1.60% 

(Note that these incidence figures omit any casualties who had no evidence of gas-related disability in 1921 but who may have 

developed a disability after 1921.) 

Gas related clinical findings in 1926-1928 

 Chlorine Mustard Phosgene Arsenicals 

Chronic bronchitis x x x x 

Emphysema x x x 

Pulmonary tuberculosis x x 

Bronchial asthma x x 

Pulmonary fibrosis x 

Pleurisy x 

Bronchopneumonia x 

Chronic conjunctivitis x 

Corneal opacities x 

Matz also published a follow-up study of Veterans who had developed mental illnesses while in the 

military.69 This was of special importance because of the Veterans’ Bureau’s heavy psychiatric 

workload (Table 2.5). This study and its sequelae enriched the practical experience with psychiatric 

disease of VA doctors, who, by the middle 1930s, found that more than half of their patients suffered 

from neuropsychiatric diseases.70 These doctors played an active role in setting up methods for 

psychiatric screening of inductees at the beginning of World War II.71 

38
 
Table 2.5. Analysis of Veterans who were service-connected for neuropsychiatric disease 

Military discharges for neuropsychiatric disease, 1917-1919: 78,930 

Veterans hospitalized for neuropsychiatric disease 

Year Veterans’ hospitals Other hospitals Total 

1920 4,926 3,556 8,482 

1928 13,057 1,620 14,677 

Follow-up of selected patients admitted in the first half of 1922 

1922 diagnosis 1928 status (%) 

 Improved Unimproved Died Unknown 

General paresis (neurosyphilis) (n=246) 15 1 72 0 

Dementia praecox (schizophrenia) (n=843) 38 37 10 14 

Nonpsychotic (n=609) 40 56 1 5 

The Medical Research Division expanded modestly during the late 1920s. In his 1929 address to the 

Medical Council, Dr. Crossman said: 

“You will recall that the matter of research was discussed at the last meeting and we have, as a 

result of the recommendations which were made, authority to employ a cardio-vascular specialist 

to head up this part of the research department....A medical statistician has been authorized, and 

we have in view, I think, a very good candidate for that particular position. However, we do 

need your assistance in securing the type of man we are looking for to handle the cardio-vascular 

work....”72 

This expansion was transient, however. A 1934 report names only Dr. Matz and two assistants in 

the Research Subdivision.73 In 1930, Dr. Matz reported of his own work that: 

“The following studies have been conducted by the Research Subdivision and papers have been 

prepared and published in various medical journals during the fiscal year: 

1. A study of intestinal tuberculosis among ex-service men.74 

2. The future incidence of nervous and mental disease among ex-service men.75 

3. The Gerson-Sauerbruch regimen in tuberculosis.76 

“The following studies are now being conducted and will shortly be completed: 

1. A clinical and statistical study of diabetes mellitus. 

2. A study of malignancy among ex-service men. 

3. A study of manic-depressive psychosis - to be presented at the Association for Research in 

Nervous and Mental Disease, December, 1930. 

4. A study of the arthritides.” 

These studies were all later published,77-85 as were studies of habit-forming drugs,86 food 

poisoning,87, 88 the coincidence of malignancy and tuberculosis,89 the outcome of surgical treatment 

of tuberculosis90 and the incidence of bronchogenic carcinoma.91 In a 1932 report on dispensary 

care in the VA, Matz compared the outcome of VA clinics with those of other hospitals, showing 

that the VA outcome compared favorably. Of the patients discharged from VA clinics, 82 percent 

were considered to be cured or improved.92 

In 1935, Matz published in the New England Journal of Medicine a series of five articles about heart 

disease in Veterans.93-97 In 1937 and 1938, he published a series of articles about silicosis.98-101 

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Altogether, 89 publications from his time as Chief of the Research Subdivision were listed in the 

Index Medicus. 

Figure 2.4. Philip Matz, M.D. 

On June 1, 1938, Dr. Matz undertook a two-month tour of VA hospitals active in research. On June 

28, he was in Los Angeles, where he held a conference on studies of tuberculosis. After the 

meetings, he and a group of VA colleagues went to the beach in Santa Monica, where he suffered a 

fatal heart attack at the age of 53.37, 102 

Matz had been an active and creative leader. His assistant, Anne Bambery, wrote to his sister after 

his death: 

“I worked with Dr. Matz for about thirteen years and in that time I learned to know him as a very 

sincere counselor and friend. He was so kind and considerate of everyone.”103 

Horatio Pollack, Ph.D., statistician for the New York Department of Mental Hygiene, who was in the 

Group on Research of the Medical Council, wrote: 

“In connection with my work on the Medical Council of the Veterans’ Administration, Dr. Matz 

and I became intimate friends. I had the highest regard for him as a man, as a physician, and as a 

research worker.”104 

Arthur Vorwald of the Trudeau Foundation, Saranac Lake, N.Y., wrote: 

“I shall remember Dr. Matz for his keen enthusiasm and vision so well displayed at the various 

round table discussions held in connection with the National Tuberculosis Foundation.”105 

After Matz died, there were no major new VA research initiatives until after World War II. The 

independent Research Subdivision in VA Central Office was merged with a section on postdoctoral 

training to form the “Postdoctoral Training and Research Division,” headed by Hugo Mella, M.D. 

Mella was a neuropsychiatrist who, during his postdoctoral fellowship at Harvard, had published 

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basic and clinical neurological studies.106-114 He had entered the Veterans’ Bureau about 1926 and 

had held a variety of administrative positions. While he was Clinical Director at the Palo Alto VA 

Hospital and Manager of the VA hospital at St. Cloud, Minn., he had published a variety of 

clinically oriented and philosophical papers.115-123 After he became Chief of the Postdoctoral 

Training and Research Division, he published only the results of a follow-up study on neurosyphilis 

that Matz had not had time to complete,124 and a report of results of sulfapyradine treatment of 92 

cases of lobar pneumonia.125 Otherwise, his research activities were primarily supervisory, 

consisting of receiving monthly reports from the three designated research laboratories and arranging 

for their budgets and personnel. The vigorous leadership Matz had provided, reflected in 

acknowledgements in publications by VA doctors, had been lost. Pressures of funding, short 

staffing, and, later, wartime conscriptions took their toll. The small but vigorous research effort 

reflected in the Medical Bulletin dwindled. 

Research in the hospitals 

From the beginning, research was encouraged in the Veterans’ Bureau hospitals, though until 1932 

there seems to have been no organized effort to establish centrally funded laboratories specifically 

dedicated to full-time research. Earlier, the policy encouraging research led to many small 

investigations by hospital staff members. 

Most of these were studies that could be done without specific funding. For others, the source of the 

money is unknown. Most likely, in the tradition of the time, the investigators funded their own 

research or used their ingenuity to adapt existing resources to research use. 

An interesting series of studies on the effect of using bile salts to treat pneumococcal pneumonia was 

reported in the early 1930s by Edwin E. Ziegler, M.D., a graduate of the George Washington 

University School of Medicine, who entered the VA’s Associate Physician program in 1929. This 

was a program in which about 20 young doctors per month were recruited straight out of internship 

and given a six-week training course before being assigned to a VA hospital.126 Ziegler was 

assigned to the laboratory at Northport VA Hospital, where he probably worked under the guidance 

of Linneaus H. Prince, M.D., a pathologist whose name is connected with a variety of innovative 

research projects. Ziegler attended VA postdoctoral courses in pathology and later cited the VA as 

the source of his pathology training.127 

In his first paper on the subject of bile acids and the pneumococcus,128 Ziegler stated: 

“Since pneumococci are soluble in solutions of bile salts, my coworkers and I thought of using 

the bile salts themselves in the treatment of pneumonia. This paper deals with the treatment of 

pneumonia with the bile salts sodium taurocholate and sodium glycocholate, with some 

laboratory experiments on the salts and their properties.” 

Using in vitro studies, he showed that concentrations of bile salts that lyse pneumococci did not 

damage erythrocytes. He reported results in three patients, including one with meningitis, whose 

pneumococcal pneumonia improved after intravenous bile salts. However, the injections led to a 

sclerosing phlebitis. 

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Ziegler went on to study sodium dehydrocholate, which was less toxic to the veins and “can be given 

intravenously in quite large doses and in convenient concentrations without injury.”129, 130 He 

extended these studies when he was visiting the Army Medical School Department of Bacteriology, 

while taking a postgraduate course in pathology and bacteriology given by the Veterans’ Bureau in 

affiliation with the Army Medical School.129 His findings demonstrated an antipneumococcal action 

of the dehydrocholate, both in vitro and in animals, with minimal toxicity. He extended these 

studies to demonstrate immunity to pneumococcus in rabbits injected with a mixture of sodium 

dehydrocholate and pneumococci. 

As seems to have been frequent in the early VA, Ziegler was reassigned several times during his 

tenure. He continued to study the sodium dehydrocholate-pneumococcus mixture, “pneumocholin”, 

while working as a pathologist at the Coatesville, Pa., and Boise, Idaho, VA hospitals over the next 

few years. In 1933, he reported that pneumocholin caused no deleterious effects when injected 

intravenously and that it “induces a very effective immunity for between three and four days,”131, 132 

an effect that he felt would be useful in clinical practice because of the extended clinical time course 

in pneumococcal pneumonia. 

 Ziegler also devised a method for measuring the “oxygen absorbing power” from the ratio of 

oxygen consumption to respired volume, as measured with a basal metabolism device.133, 134 

Another young physician, Justin J. Stein, M.D., from Texas via the Mayo Clinic, joined the tumor 

clinic at the Hines VA Hospital in 1935 as a member of the “X-ray, Radium Therapy and Surgery 

“section. He became certified in radiology in 1937. Publishing a series of clinical papers on the 

importance of early diagnosis and treatment of cancer135 and on unusual tumors of the intestine,136­

138 Stein reported extensively on aspects of lung carcinoma, particularly cancers of the apex of the 

lung.139-144 He later joined the Navy, but continued to report in the Medical Bulletin about his 

combat experiences.145, 146 After the war, Stein moved to Los Angeles, where he became a faculty 

member at UCLA, a consultant at the West Los Angeles VA Hospital and Chief of radiation therapy 

at the Long Beach (Calif.) VA Hospital.147 

A series of intriguing reports in early issues of the Medical Bulletin deal with the use of 

Mercurochrome intravenously in the treatment of bacterial infections. This approach had been 

started at the Brady Urological Institute at Johns Hopkins in 1922, when it was used to cure a man 

believed to be moribund from septicemia. In July 1925, C. D.Allen, M.D., from the Memphis 

Veterans’ Bureau Hospital, published his experience with 100 cases in the first issue of the Medical 

Bulletin,

148 and added another 51 cases the following year.149 He found the best results to be in 

infections of the genitourinary tract and in arthritis. Albert Martin, M.D.,from the San Fernando 

Veterans’ Hospital (a southern California hospital later important in the VA tuberculosis trials) 

reported a case of hemolytic streptococcus bacteremia following empyema cured by intravenous 

Mercurochrome,150 and R.L. Harris, M.D., from the Augusta (Ga.) VA Hospital reported similar 

success in a case of bacteremia due to streptococcus viridans.151 H.E. Foster, M.D., from the 

Sheridan (Wyo.) VA Hospital reviewed the literature on this treatment in the Medical Bulletin, 

concluding that “In from 50 to 75 per cent of the cases treated it has been highly efficacious in single 

or repeated doses.”152 Mercurochrome was perhaps the most successful of the external disinfectants 

used internally, but its use was eventually abandoned.153 

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A major follow-up study of fractures of the long bones in World War I by J.B. Walker, M.D., a 

consultant to the Veterans’ Bureau Regional Office in New York City, appeared in the Medical 

Bulletin in 1929.154-157 Of 16,339 soldiers with one or more battle fractures of a long bone, 2019 

(16.6 percent) died. Of 39,569 soldiers with nonbattle fractures, 1,346 (3.4 percent) died. Of the 

soldiers with long bone fractures, 4,178 (7.5 percent) had amputations, and 187 of those soldiers 

died. Osteomyelitis was a major cause of death and disability. The report details various types of 

fractures, treatments and outcomes. 

While a large part of VA research during this pre-World War II period was carried out in 

coordination with the Central Office research unit or by the three designated Research Laboratories 

(below), VA professional staff continued to publish in the Medical Bulletin from its inception in 

1925 until the beginning of the war. Table 2.7 presents a sampling of titles from the Medical 

Bulletin through these years, reflecting areas of interest of VA staff whose primary responsibility 

was patient care rather than research. 

Table 2.6. Sampling of titles from the Medical Bulletin of articles written by clinicians in the hospitals, not in designated 

research units 

1925: 

Resume of treatment of 25 cases of diabetes mellitus with insulin.158 

Residuals of encephalitis lethargica.159 

The blood vessels in tuberculosis: some aspects of the part played by the blood vessels in the dissemination of tuberculosis.160 

Treatment of Raynaud’s Disease by negative pressure.161 

1926: 

A study of Larson’s ring test applied to 315 cases of tuberculosis.162 

Adenocarcinoma-primary in the renal tubules.163 

A preliminary report on attempts at active immunization of guinea pigs by urinary antigens from cases of tuberculosis.164 

Correlation of clinical and laboratory procedures in tuberculosis: 1. The complement fixation test.165 

1927: 

Studies on the bacteriocidal properties in vitro of certain fatty acids irradiated with the quartz-mercury-vapor spectrum.166 

Report of cases of leprosy with unusual manifestations.167 

Notes on amnesia.168 

1928: 

Thoracotomy for empyema complicating pneumonia - analysis of end results in 100 consecutive cases.169 

Multiple sclerosis.170 

Ancient Greek, Etruscan and Roman dentistry.171 

A study of the emotions in psychotic patients (a report of the examination of 100 psychotic patients with the Pressey test).172 

A comparative study of the Kahn and complement fixation tests of spinal fluid.173 

1929: 

Tetany from overbreathing.174
 

The Gregerson test.175
 

Julius Caesar, epileptic.176
 

1930: 

Preliminary report of fifteen cases of Sodoku treatment of general paresis.177
 

Typhoid vaccine in the treatment of general paralysis of the insane.178
 

Narcolepsy.179
 

Value of media containing certain iron compounds in differentiating the typhoid-colon group of organisms.180
 

An improved method for staining tubercle bacilli in tissues cut by the frozen-section technique.181
 

Carbon dioxide-oxygen inhalations in catatonic dementia praecox.182
 

1931: 

Experiments on bacteriophage adsorption by vulnerable bacteria.183
 

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Medical science in the thirteenth century.184
 

The use of subarachnoid lavage and ethylhydrocupeine in meningitis.185
 

Stramonium in encephalitis.186
 

1932: 

Bronchial spirochetosis, with report of a case.187
 

A world’s record for the transportation of entamoeba histolytica.188
 

Elliptical human erythrocytes: report of two cases.189, 190
 

Observations of heart action under vagus stimulation.191
 

The incidence of syphilis in 5,000 Negro ex-service men.192
 

1933: 

Intravenous administration of sodium amytal in acute psychotic episodes.120
 

Psychosis with alcoholic pellagra.193
 

1934: 

An unusual case of hysteria with a retrocursive gait.194
 

1935: 

Super-diathermy in the treatment of dementia paralytica.195
 

Nineteen cases of pneumonia in members of the Civilian Conservation Corps with no deaths.196
 

Brain abscess consequent to latent head trauma.197
 

Sulphur (colloidal) therapy in the treatment of arthritis.198
 

1936: 

Effects of long hospitalization on psychotic patients.199
 

1937: 

Use of benzedrine sulphate in catatonic stupors.200
 

Molokai and its leper colony.201
 

1938: 

Hypoglycemic shock therapy in schizophrenia: results of treatment of six cases.202
 

1939: 

Experience with the insulin shock therapy of schizophrenia.203
 

Bacteriological examination of eating utensils.204
 

1940: 

Herpes zoster in early syphilis.205
 

1941: 

The treatment of schizophrenia with desoxycorticosterone acetate.206
 

The status of thyroid ablation for intractable heart disease.207
 

Physicians in Veterans’ Bureau hospitals received some recognition outside the agency and its 

Medical Bulletin. In 1927, seven Veterans’ Bureau scientific and medical exhibits were included in 

the national meeting of the American Medical Association, in Washington, D.C. Included were 

exhibits on treatment of neurosyphilis with malaria or rat-bite fever, on laboratory findings in 

various psychoses and in syphilis, and on the effects of bran on gastrointestinal X-rays. 

In 1930, progress reports from the Bronx (N.Y.) and Perry Point (Md.) VA hospitals were reported 

in the Medical Bulletin. 

“From the Bronx Veterans Administration Hospital: 

1. “Sodoku treatment” for general paralysis given 19 patients between April 1929 and April 

1930. Results: Some improvement, no deaths. 

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2. 12 paretics inoculated with tertian malaria blood. The malarial paroxysms were terminated 

by quinine. This treatment was followed by sulpharsphenamine. The patients were gaining 

weight and strength, and there had been no deaths. 

3. During March, seven patients with chronic encephalitis lethargica were given Rosenow 

serum subcutaneously. It was planned to treat another seven with the same dose by nasal spray. 

Five others have received 500 milliamperes current by diathermy for 20 minutes to the brain, 

and have reported subjective improvement. 

4. Experiments on use of autocondensation current in multiple sclerosis. 

“From Perry Point: 

1. One hundred paretics have been given malaria treatment. 

2. Two paretics were treated with sulfosin. The reaction was so severe that the study was 

stopped. 

3. Twenty–nine epileptics were treated with a meat-free diet. They had no weight loss, and 

appear to be well. The severity but not the number of their convulsions has improved. 

4. In accordance with instructions from the Research Subdivision, Central Office, the results of 

liver feeding in patients with neurological symptoms are being studied.”208 

Later in 1930, in a more complete report of research activities in field hospitals coordinated by his 

office, Dr. Matz listed four projects “recently assigned” to field hospitals and 19 projects from field 

hospitals for which final reports had been received (Table 2.8).209 

Table 2.7. Research problems at Veterans Administration hospitals (Medical Bulletin, 1930). 

Recently assigned 

1.	 The use of the Gerson-Sauerbruch regimen in the treatment of pulmonary as well as surgical tuberculosis. 

2.	 A study of 1001 autopsy protocols for the purpose of correlating clinical and anatomic findings. 

3.	 The application of the Shaw-MacKensie test for malignancy, for the purpose of ascertaining whether or not this precipitation 

test will yield information in the diagnosis of malignant disease. 

4. Therapeutic use of liver in the degenerative diseases of the spinal cord. 

Recently completed 

1.	 The use of typhoid vaccine in the treatment of general paresis of the insane. 

2.	 Study of 100 cases of dementia praecox and manic-depressive psychosis. 

3.	 Two modifications of the Benedict quantitative determination of dextrose in the urine. 

4. Standardization of cholesterinized alcoholic beef heart antigen for use in complement fixation procedures. 

5.	 Evaluation of results obtained by the use of liver, liver extract, and insulin in the reduction of blood sugar in diabetes mellitus. 

6.	 Comparison of results with Meinicke and Kline tests. 

7.	 Improved method of staining tubercle bacilli in tissue cut by frozen section method. 

8.	 A study of the Gregerson test for the detection of occult blood. 

9. The ketogenic diet in the treatment of epilepsy. 

10. A resume of 250 electrocardiographs. 

11. The use of lipiodol in the treatment of bronchiectesis. 

12. The use of sodium ricinoleate in the treatment of intestinal tuberculosis. 

13. A study of intestinal tuberculosis. 

14. Pernicious anemia in the Negro. 

15. Liver feeding in organic neurological conditions. 

16. Rapid precipitation test for syphilis. 

17. The ‘Zoning’ phenomenon in complement fixation with cholesterinized alcohol beef heart extract. 

18. Studies in venous pressure - its clinical application. 

19. Buffered diluent as preservative for diphtheria toxin for the Schick test. 

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A new approach in the 1930s: Centrally funded research laboratories 

When the Veterans Administration was formed in 1930, the Medical Department found itself two 

layers down in the bureaucracy. Despite this, the Research Subdivision remained active through the 

mid-1930s. In 1931, Mr. George E. Ijams, Director of the Veterans’ Bureau (now part of the 

Department of Veterans Affairs) said in his address to the Medical Council: 

“I am very glad to advise you gentlemen of a little meeting held here in Washington just a few 

weeks ago, and attended by some members of your body who were good enough to come over 

here and assist us. At that meeting was brought up a matter that has been close to my heart for 

some time, the matter of research. I do not claim any authorship for this, as this was sold to me 

many years ago by a former medical director. He impressed upon me the fact that we have a vast 

reservoir of material that we were not using for the advancement of medical science. Dr. Griffith 

and I talked this over and we decided to do what we could towards securing funds for the 

employment of men who were qualified to do this work. We wanted these men to do research 

work only, and not be called upon every five minutes to make a physical examination or to 

consider Mary Jones’s efficiency report, etc. Following the conference with members of this 

council, the recommendation was made to General Hines that this work be started in the bureau. 

We appreciated the fact that we could not hope to secure a great deal of money for this purpose. 

We felt it would be much better to start in a modest sort of way and sell the idea by producing 

results. I am quite confident that if we can show results in the start of this work we will then 

have no difficulty in the future in securing whatever funds may be needed to carry on. 

“General Hines has approved this idea in principle, and I think that funds will be made available 

during the next fiscal year, beginning July 1, to enable us to start this most important work.”210 

Figure 2.5. Col. George E. Ijams 

Despite this promising start, the outcome of that decision seems to have been limited to the 

establishment of a single funded cancer research laboratory in 1933, at the Hines VA Hospital in 

Chicago. This laboratory was primarily responsible for research, but it was also closely integrated 

with the patient care program of the hospital. 

In 1935, the VA’s Medical Director, Dr. Charles Griffith, called a second meeting about research. 

The meeting also involved members of the Medical Council, Drs. Barker, Adams, Thomas F. 

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Barrett, Cohn, William F. Lorenz and White, and other experts.211 Apparently feeling that their 

efforts at the Hines hospital took care of the cancer problem, the Medical Department decided that 

the VA’s major research needs were in neuropsychiatry and cardiac disease and had set aside 

$15,000 in their annual budget for each of these new initiatives, the same sum already being allotted 

to the Hines laboratory. Some of the conferees felt that this amount of money was so ridiculously 

small that there was no point in even planning a program. Dr. Lorenz told the group that New York 

State was spending $50,000 on research in neuropsychiatry alone. After considerable general 

discussion, the conferees split into two groups, one for neuropsychiatry and one for cardiology. 

Each group recommended that a laboratory in its field be established, and that the available monies 

be used for hiring two professional leaders. The review of this meeting published in the Medical 

Bulletin placed the cardiovascular research unit at the Washington, D.C., VA Hospital and the 

neuropsychiatric research unit at the North Chicago VA facility.212 However, on the same page in 

the Medical Bulletin is the announcement of a new neuropsychiatric research unit at the Northport, 

N.Y., VA facility.213 It appears that the unit proposed for North Chicago was cancelled in favor of 

Northport; but the cardiovascular research unit at the Washington, D.C., hospital did indeed open, in 

late 1935. 

The Tumor Research Unit at the Hines VA Hospital 

In 1932, the Tumor Research Laboratory at the Hines VA Hospital, the first research laboratory to 

receive funds from VA Central Office specifically for research work, was established to collaborate 

with the Hines Cancer Treatment Center. This special cancer treatment unit, a referral center 

modeled after Memorial Hospital in New York, had been established at Hines in 1930 in association 

with the new Diagnostic Center there. Surgeons, radiologists and organ-systems specialists worked 

together. A Tumor Board met daily to examine and discuss patients. There was an active teaching 

program with local and national conferences and an arrangement for training visiting physicians. It 

had the latest cancer therapy equipment, most notably a gram of radium and all necessary machinery 

for preparation and implantation of radon beads into cancer patients.214 The research laboratory 

complemented this effort. 

Seward E. Owen, Ph.D., a biochemist, initially led the Hines Tumor Research Laboratory. His early 

work was directed to assays of “prolans.” (The term “prolan” was used at that time to define the 

substances excreted in the urine that cause positive pregnancy tests in animals; the effect is that of 

chorionic gonadotropin.) These substances were interesting to the Hines Tumor Clinic researchers 

because they observed that prolans were increased in most malignant testicular tumors, particularly 

the less well-differentiated tumors. The term “teratoma testis” was used to include a spectrum of 

testicular tumors, including chorionepithelioma; embryonal adenocarcinoma, without and with 

lymphoid stroma; seminoma; and mixed or adult-type testicular cancer. Prolan concentration in the 

urine varied by type of teratoma testis, with the highest concentration seen in chorionepithelioma 

and the least in the adult type. Owen developed a quantitative bioassay for prolans,215 first in the 

rabbit and then in the mouse, for which he reported an innovative, inexpensive metabolic cage.216 

Collaborating with Max Cutler, M.D., Chief of the Tumor Clinic, he did extensive clinical 

correlations of this method in patients with testicular tumors.217, 218 The method was used for followup of treated patients who lived at a distance from the hospital; they sent in their urine specimens by 

mail and were recalled for further treatment only when the results suggested recurrence. The method 

was applied to diagnose and follow two cases of chorionepithelioma219 and five cases of malignant 

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tumors in undescended testes.220 In 1936, Owen reported results of prolan assays in 71 patients who 

were later proven to have “teratoma testis,” compared with 29 in whom it was suspected who later 

proved to have other diagnoses. From this study, he defined the diagnostic level of urinary prolans. 

Follow-up studies showed reduction in prolans after surgery and radiation with increase on 

recurrence of the tumor. False positives were found in three patients who had received orchiectomy 

for other conditions.221 Owen and Cutler studied patients with prostatic hypertrophy and prostate 

cancer, measuring prolans and estrogenic substances by mouse bioassay. They found no 

abnormalities in those patients.222 

This method of bioassay was very laborious and used many animals. Owen searched for a more 

economical method. He studied bitterling fish, into whose water the assay substances were 

placed.223 The male bitterling fish develops a typical mating coloration when sexually stimulated; 

the female develops an extension of the ovipostor. After the responses of the fish to urine from 

pregnant women had been confirmed, urine extracts from patients with testicular tumors were tested. 

Female fish responded only to extremely high concentrations. The male fish generally responded to 

the concentrations of clinical interest, but their response was too erratic to make fish a practical 

substitute for rabbits and mice in this bioassay. Owen also tested these fish for a testosterone 

bioassay but concluded that a better understanding of their color responses was needed before a 

practical test was possible.224 He also developed a chemical assay for the prolans,225 which 

correlated fairly well with the bioassay and which he concluded would be a useful “qualitative” tool. 

Owen also searched for agents that might cause malignant growth. In a series of articles in the 

journal Growth, he explored the role of the sulphydryl amino acids cystine and cysteine on wound 

healing in mice226 and on extracts of insect larvae,227 and he studied the release of sulphydryl groups 

from protein substances when they were exposed to carcinogens.228 He published review articles 

about carcinogenesis.229, 230 Collaborating with H.A. Weiss, M.D., and L.H. Prince, M.D., he 

reported in Science and the American Journal of Cancer that various carcinogens stimulate 

regeneration and reproduction in the planarian, an aquatic worm that regenerates both head and tail 

segments when cut in half.231, 232 He also studied radiation effects in a high-breast cancer strain of 

mice. Irradiation reduced the incidence of later spontaneous breast cancer compared with similarly 

bred control mice, but not to the low incidence seen in randomly bred mice. He speculated that the 

irradiation may have reduced ovarian function and estrogen secretion, but noted that even 

nonsterilizing doses of radiation had a protective effect.233 Following up on the likelihood that 

estrogens increase susceptibility to breast cancer, he and G. R. Allaben, M.D. of the Tumor Clinic 

published a case report of a woman with breast cancer that they believed was caused by prolonged 

estrogen therapy.234 

When Owen left to join the military in 1938, Dr. Cutler, though still a consultant, became nominal 

head of the Tumor Research Laboratory. In fact, the laboratory seems to have lain dormant. Robert 

Schrek, M.D., was recruited from the St. Cloud (Minn.) VA Hospital to Hines. 

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Figure 2.6. Robert Schrek, M.D. 

Schrek was a pathologist who had done basic oncologic research at Vanderbilt University. 236-244 

When his Vanderbilt fellowship ended, Schrek went to work as a pathologist at the Pondville 

Hospital in Wrentham, Mass. While there, he did clinical research studies on cutaneous carcinoma 

that eventually led to three publications.245-247 He entered VA at St. Cloud and immediately began 

looking for an opportunity to do research. Though his transfer orders to Hines instructed him “to 

work in the Tumor Research Laboratory,” Dr. Schrek arrived to find that he was needed full-time in 

clinical service, and he was not able to start working in the research laboratory until 1940 or 1941.235 

Schrek’s earliest publications from Hines presented statistical methodology.248-250 These 

publications seem to have resulted from work done on his own, before the research laboratory 

reopened. He also wrote a descriptive and statistical review of the Hines Tumor Clinic’s 1941 

activities.251 Early in his days at Hines, Schrek formed a club with members from all Chicago area 

medical schools interested in cancer. During the war, Dr. Schrek became a Major in the U.S. Army, 

but his assignment was to continue work in the Tumor Research Laboratory.235 

At first, the laboratory consisted of Schrek and two technical people. They set up a method that he 

had devised while at Vanderbilt to distinguish viable white blood cells from dead cells using the fact 

that only dead cells take up eosin in solution.243 They used this method to assess factors affecting 

leukocyte life span. These studies were very laborious, as cell counts were done by hand-counting 

cells in a hemacytometer. Schrek obtained reasonably pure preparations of lymphocytes from rabbit 

thymus and spleen, and of polymorphonuclear leukocytes from rabbit bone marrow and from 

peritoneal exudate after intraperitoneal injection of an albumin-lecithin mixture. In short-term (twoto four-hour) experiments, he found that lymphocytes are much more sensitive to the toxic effects of 

heat and of moccasin venom than are polymorphonuclear leukocytes.252 He found that oxygen was 

not necessary for cell survival, and that polymorphonuclear leukocytes survived equally well with or 

without glucose in the medium. Glycolysis occurred under both aerobic and anaerobic conditions. 

The major factor affecting cell survival was the type of cell. In studies of human leukocytes, he 

found that those from patients with lymphatic and myelogenous leukemias had the same metabolic 

characteristics as normal leukocytes.253 In other studies, he showed that leukocytes are quite 

resistant to osmotic challenge,254 and that the response of other tissues varies.255 

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Schrek’s most noteworthy studies from the pre-1946 period were of the effects of radiation on 

leukocytes. Using his in vitro leukocyte preparation and a statistical method he devised to estimate 

50 percent and 10 percent survival times, he clearly demonstrated marked radiosensitivity of 

lymphocytes, with considerable radioresistance of the polymorphonuclear leukocytes. This was 

equally true of preparations from the rabbit, from normal human blood, and from the blood of 

patients with lymphocytic and myelogenous leukemia. The cytocidal effect of radiation on 

lymphocytes was seen only in the presence of oxygen. Schrek recalled that when the paper reporting 

these findings was in press in Radiology, one of the editors visited him and suggested that he contact 

Austen Brues of the metallurgy department at the University of Chicago (predecessor of Argonne 

National Laboratory). Schrek did not follow up on this suggestion, which he later realized would 

have resulted in his being reassigned to atomic bomb research in the Manhattan Project.256 

Meanwhile, Schrek continued to study patients in the Hines Tumor Clinic and to develop new 

methods.257 He published a summary of 1,943 admissions in Cancer Research, pointing out that 

relatively more patients from the South presented with cancers of the exposed skin and relatively 

fewer with cancers of the stomach and testis.258 He reported on a series of 20 black patients with 

skin cancers.259 Five of these occurred at the site of a previous injury. While the incidence of 

carcinomas in sun-exposed areas of the skin was dramatically decreased in blacks, the incidence in 

covered areas of the body was similar in blacks and whites. He also studied the racial distribution of 

other cancers, using data from Hines and also from a U.S. Public Health Service survey and from 

national mortality statistics. He reported that carcinoma of the male breast was much higher in 

blacks than in whites, while the incidence of breast cancer in black women was only slightly greater 

than in whites.260 Cancer of the penis and scrotum was increased in blacks.261 

In the early post-war period, in collaboration with clinicians of the Tumor Clinic, Schrek reviewed 

the smoking histories of patients with cancers of the lung, larynx and pharynx, compared with those 

of the total population of cancer patients at Hines. He concluded that: “There is strong 

circumstantial evidence that cigarette smoking was an etiological factor in cancer of the respiratory 

tract.”262 This paper was later cited in the Surgeon General’s report on the dangers of cigarette 

smoking.263 

Figure 2.7. Robert Schrek, M.D., 1952 

In his later work, Schrek continued to develop new techniques, one of the most useful of which was 

a time-lapse photography method using an inverted phase microscope.264 Using this method, he 

showed that the in vitro radiosensitivity of the lymphocytes of a patient with lymphocytic leukemia 

was predictive of the patient’s prognosis. In 61 patients with radiosensitive lymphocytes, median 

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survival was 22 months, while it was only four months in the 19 patients with radioresistant 

lymphocytes. This was not due to a change with time in radiosensitivity, as the patients with 

radiosensitivity continued to have radiosensitive lymphocytes throughout their clinical course.265 He 

also described and characterized the “hairy cell,” a previously unrecognized form of malignant white 

blood cell, and the course of hairy cell leukemia.266 

Schrek seems to be unique among the pre-WWII VA research investigators in that he made a smooth 

transition to the very different post-war VA. At the end of the war, the Tumor Research Laboratory 

at Hines was transferred to local administration. The Hines hospital, as a referral center, already had 

many consultants from nearby medical schools. The atmosphere in the Tumor Clinic was academic, 

so the introduction of a formal medical school affiliation made less difference than it might have 

otherwise. Schrek remained at the Hines VA Hospital, in charge of the Tumor Research Laboratory, 

until he retired in 1977. He continued to analyze data and publish long after his retirement. After 

the war, he became a member of the pathology department of the Schools of Medicine of 

Northwestern University and later Loyola University, as they became affiliated with Hines. He 

collaborated widely, presented at national and international meetings and published 144 papers. 

The Neuropsychiatric Research Units at the Northport VA Hospital 

The neuropsychiatric research laboratory recommended by the 1935 conference was located at the 

Northport VA Hospital on Long Island in New York. In fact, two officially designated 

Neuropsychiatric Research Units were based at Northport, with a three-year lapse between them and 

apparently little or no overlap in staff. The first of these units, called the “Neuro-Psychiatric 

Research Unit for the Study of the Influence of Heterophile Antigen in Nervous and Mental 

Disease,” was established in October 1935, and closed in October 1938. The announcement of its 

opening was published in the Medical Bulletin: 

“Upon authority received from the Administrator, a research unit was established in October at 

Veterans’ Administration Facility, Northport, Long Island, N.Y., of which Dr. E.W. Lazell of the 

staff was placed in charge. The purpose of this unit is to investigate the nature of heterophile 

antigens and their significance in the diagnosis and treatment of certain diseases, particularly 

epilepsy. The personnel of this unit consists of Dr. E.W. Lazell, physician in charge; James E. 

Stanley, laboratorian in bacteriology; Mabel M. Blomberg, assistant laboratorian in bacteriology; 

Margaret Hickey, research clerk.”213 

In 1919 and 1920, Edward W. Lazell, M.D., had been a psychotherapist working for William A. 

White, M.D. at St. Elizabeth’s Hospital in Washington, D.C., where attempts were being made to 

treat psychotic patients by psychoanalytic methods. In 1930, he wrote about an innovative method 

of applying psychoanalytic concepts to group treatment of psychotic patients.267 He developed a 

concept of the unity of the mind and the body,268, 269 which led him to try to identify a physical cause 

for neuropsychiatric disease. In 1929, he and Linnaeus H. Prince, M.D. (a pathologist whose name 

appears on research papers from a variety of VA locations) reported a search for a transmissible 

substance in the serum of patients with dementia praecox (schizophrenia).270 This study was done 

while both Lazell and Prince had full-time clinical duties, but Prince, as a pathologist, had a 

laboratory at his disposal. They exposed bullfrog tadpoles to serum from normal and schizophrenic 

subjects and found that a 1:1000 dilution of normal serum was compatible with normal development 

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of the tadpoles. On the other hand, a 1:1000 dilution of serum of schizophrenic subjects uniformly 

killed the tadpoles within three days. They seem not to have pursued this fascinating finding, but 

Lazell quoted it in later work as seminal in his studies: 

“While trying to explain the phenomena shown in the pollywog experiment, our attention was 

casually directed to the existence of heterophile antigen. In this manner the toxic or lethal factor 

in the blood of epileptics and heterophile antigen became associated in our minds.”271 

Lazell then undertook a study of the general field of immunology, searching for an immune cause 

for neuropsychiatric disease. In 1932, he published a general review272 focusing on the Forssman 

heterophile antibody, a type of antibody which has an affinity for the receptors of a species other 

than those in response to which it developed. Extrapolating from the observations that heterophile 

antibodies can be induced by feeding products from certain animals and could lead to allergic 

reactions, Lazell speculated that such a reaction might also cause such conditions as epilepsy and 

dementia praecox. 

In the spring of 1935, Lazell studied a group of 14 Veterans, all committed as insane to Northport, 

who also were epileptic. He found that certain patients had convulsions after eating certain foods. 

By injecting rabbits with the suspect foods, he found that they developed a heterophile antibody, 

thus identifying the foods as heterophile antigens. He confirmed the food allergies by scratch and 

intracutaneous skin tests. Sera from 29 epileptic patients at a different hospital confirmed the 

presence of the heterophile antibody in those with idiopathic epilepsy, but not in those whose 

convulsions were due to syphilis or encephalitis. He concluded that the patients with idiopathic 

epilepsy and dementia praecox were sensitized to heterophile antigen, that these diseases are allergic 

in nature, and that the pathology followed ingestion of excessive amounts of heterophile antigencontaining foods. 

Lazell presented these findings to the American Psychiatric Society on May 13, 1935.273 From 

October 1935 to the end of 1936, the laboratory pursued this lead. On a research ward, the 

researchers intensively studied 36 patients with idiopathic epilepsy, four of whom also had dementia 

praecox. Finding that skin tests were unreliable and also sometimes triggered convulsions, they 

sought better ways to identify the allergens responsible for a patient’s problem. They made 

extensive use of an observed leukopenic response to suspect foods. They tried elimination diets to 

prevent convulsions but concluded that so many foods had to be eliminated that such diets were 

impractical—the patients would starve. They concluded, “The greatest hope is offered by the search 

for a general desensitizer.”274 

One interesting finding from this research was the “epileptic cycle.” Lazell and his colleagues 

observed that, after a seizure, the evidence of allergy (response to allergens in skin tests, circulating 

precipitins and leukocyte reduction) was reduced. It was a logical association, given the assumption 

that “there is a close connection between dementia praecox and idiopathic epilepsy,” to hypothesize 

that induction of seizures might alleviate the symptoms of dementia praecox. This hypothesis 

directed their attention to insulin shock therapy, which was just coming into use in the United 

States.274 

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In early 1937, Dr. Lazell attended a training course at the Harlem Valley State Hospital in New York 

State on the treatment of schizophrenia with insulin coma. The course was directed by Manfred 

Sokol of Vienna, Austria, the originator of this treatment.275 On his return to Northport, Lazell 

began to treat patients with insulin. Soon, Northport was set up as a training site, and between 

March 1937 and August 1938, 17 physicians from other VA hospitals were trained in this technique. 

As Lazell stated: “The work entailed by this training fell to the research personnel; and the 

laboratory studies necessary for the treatment and for these courses were done by them.”274 

The patients referred for insulin therapy were studied by the same methods used with epileptic 

patients. Lazell found that skin sensitization in dementia praecox patients was less marked in 

general and directed to different substances than was the case with patients with epilepsy. On the 

other hand, the leukopenic response to ingestion of certain foods was as marked in dementia praecox 

as in epilepsy, though the more frequent food allergens were different. Patients with dementia 

praecox and with epilepsy showed similar heterophile antibodies. 

Following up on their observation that dementia praecox patients seemed to improve when seizures 

occurred during their insulin treatments, Lazell and his colleagues began adding metrazol to the 

treatment regimen. The logic of the combined treatment seems to have been that metrazol was more 

effective than insulin alone in inducing seizures, but that patients already in insulin coma developed 

seizures after a much smaller dose of metrazol than was otherwise needed. 

Lazell and his colleagues attempted to desensitize patients with epilepsy and dementia praecox 

against the heterophile antigen. One substance they found promising was intravenous sodium oleate. 

While studies of this substance had not been completed when the laboratory was closed,274 Lazell’s 

team did demonstrate that sodium oleate, when applied directly to tissues, counteracted the effects of 

allergic dermatitis and hay fever.276 In the report of this treatment, Lazell commented that, 

“One of the author’s sons, overhearing the discussion about sodium oleate as a cure for ivy 

poisoning, went into the woods and deliberately squeezed a mass of poison ivy in both hands and 

rubbed it on his face, arms and legs. When seen the next day, they were very red; but the 

immediate use of sodium oleate as a wet dressing justified this youngster’s confidence.” 

In 1937, Lazell was joined at Northport by Emanuel Messinger, M.D., a psychiatrist277 who had been 

at the St. Cloud (Minn.) VA Hospital and earlier at the VA in Lyons (N.J.). Despite being a 

psychiatrist, Messinger had published about cardiac function.278 After moving to Northport, he 

began studying the cardiovascular changes associated with insulin shock treatment, which he 

reported in the Annals of Internal Medicine. He showed that, during insulin coma, the heart, aorta 

and pulmonary artery dilate markedly.279 Collaborating with Nathan Moros, M.D., Messinger 

published an article on the cardiovascular effects of metrazol, written in early 1938 and published in 

1940, that reported transient tachycardia and cardiac arrhythmias.280 

This laboratory was officially closed in October 1938, a few months after Dr. Matz died. Lazell 

published his final report of the laboratory’s work in 1940.274 All told, some 45 reports were issued 

from this laboratory. 

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A new Neuropsychiatric Research Unit of a different character was set up at Northport in 1941. 

James A. Huddleston, M.D., was the director and William J. Turner, M.D., was in charge of 

laboratory activities. Other staff included a biochemist, a statistician, a laboratorian, a laboratory 

assistant and a secretary-stenographer. This new laboratory was under the immediate supervision of 

Hugo Mella, M.D., the Central Office Research Chief. It had multiple responsibilities: In addition 

to “conduct of clinical and laboratory research in neuropsychiatric disorders,” it was responsible for 

“standardization of diagnostic and treatment methods in neuropsychiatry” and for “teaching modern 

concepts and methods in neurology, psychiatry and neuropathology to physicians of the VA detailed 

for courses of instruction.”281 

An early product of this new laboratory was a review by its statistician, Charles S. Roberts, M.D., of 

the long-term results of the pharmacologic (insulin and metrazol) shock therapies that Drs. Lazell 

and Messinger and their trainees conducted in 1937 and 1938. They matched cases with untreated 

hospitalized control patients of like time of admission, age, sex (all males), race, diagnosis and prior 

length of psychiatric illness. They followed 74 treated-control pairs for at least two years after the 

shock therapy, 60 pairs for at least three years. Using a standardized scale of clinical status, they 

rated the pairs of patients at 30 to 90 days after completion of the treated patient’s series of 

treatments and after one year, two years and three years. Two of the treated patients died during the 

treatment. Twenty-one (28 percent) of the treated patients and 10 (14 percent) of the controls 

showed some improvement at some time. No treated patients, and only one control, were considered 

“cured” at follow-up. At evaluation 30 to 90 days after completion of the treatment series, 21 

percent of the treated patients were “improved” or “much improved,” while only 8 percent of the 

controls were so classified. This difference gradually eroded with longer follow-up: Early in the 

second year, improvement was 19 percent and 7 percent, respectively; in the third year, 8 percent 

and 8 percent; and in the fourth year, also 8 percent and 8 percent. Roberts concluded that the main 

effect of pharmacologic shock therapy “appears to be that of facilitating improvement of a transient 

nature.”282 

A series of papers reporting systematic clinical observations of important neuropsychiatric 

conditions emerged from the staff of this new laboratory: “The alcoholic personality: a statistical 

study”; 283 “Some dynamic aspects of alcoholic psychoses”;284 “Factors in the development of 

general paralysis”;285 and “Note on psychoses and psychoneuroses with malaria.”286 The 

researchers also reported on their early work on electroencephalography.287, 288 

This group also carried out biochemical tests. They studied trioses in the blood and devised an 

improved method for measuring blood hydroxyacetone, publishing their findings in the Journal of 

289 Biological Chemistry. Results of clinical application of this method were negative. Blood glucose 

and diastase were studied in a group of depressed patients with manic-depressive psychosis, 

comparing results with a standardized-scaled psychiatric examination. They found that “voice 

loudness,” “speech rate” and “facial expression of sadness” were all positively correlated with 

glucose levels, while “voice loudness” correlated negatively and “apathy” positively with diastase 

levels. The report of this study, of which Roberts was first author, reflects a sophisticated approach 

to probability and statistics.290 

This group’s publications about electric shock therapy, which appeared in 1945 and 1946, included 

articles about prediction of outcome,291 method292 and complications.293-295 

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No post-1946 record of this laboratory has been found. 

The Cardiovascular Research Unit at the Washington, D.C., VA Hospital 

The third pre-war official VA research laboratory was the Cardiovascular Research Unit at the 

Washington, D.C., VA Hospital. Like the Northport laboratory, it was established shortly after the 

1935 Central Office conference about research.211 The earliest of its published reports is a 1937 

review in Annals of Internal Medicine by John Reisinger, M.D., the unit’s Chief, presenting 

observations about the hospital’s hypertensive patients from October 1, 1935, to April 1, 1936.296 

In 1938, statistician Blanche Wilcox, Ph.D., and Reisinger collaborated on a study of the prediction 

of heart weight (confirmed at autopsy) from the x-ray.297 Dr. Wilcox remained with the unit until it 

closed in 1949. 

Publications from this laboratory were primarily statistical analyses and reports of advances in 

clinical cardiology and systematic observation of cardiology patients. The statistical analyses 

followed incidence of heart disease at the Washington VA hospital and also presented comparative 

data from Midwestern and Western VA hospitals.298-300 

Reisinger wrote on the uses of the Masters exercise test301 and the cold-pressor test.302 An article in 

the Archives of Internal Medicine reported four cases of dissecting aneurysm proved at autopsy, 

including two observed for three and 14 months before death.303, 304 

Reisinger also reported a case of primary tumor of the inferior vena cava.305 He and Basil 

Blumenthal, M.D., who was probably a consultant to the Unit rather than a staff member, published 

their observations about the pain of coronary artery disease and myocardial infarction.306-309 

In 1943, Reisinger published on “neurocirculatory asthenia,” with data from a review of 50 World 

War I Veterans with this diagnosis. Neurocirculatory asthenia was the term used for a condition 

known in the Civil War as “irritable heart of soldiers” and by the British in World War I as 

“soldier’s heart”310 or “effort syndrome.” Patients “manifested physical unfitness which could not 

be accounted for by auscultation of the heart or by any other methods of examination.” He recorded 

good experience of others with gradually increasing physical training for these patients and 

recommended that such a program be established for the large number of such patients expected to 

emerge from service in World War II.311 

Milton Mazer, M.D., joined the Unit around 1941 and remained for a year or two after Reisinger 

joined the Navy in 1942. He and Reisinger published a review of thiocyanate treatment of 

hypertension, with a report of nine cases.312 Mazer published technical papers on the heart X-ray 

and electrocardiogram,313-316 and he wrote an article on “Palindromic rheumatism.”317 He and Albert 

Kistin, M.D., who was active in the Unit after the war, wrote a pair of articles for the Medical 

Bulletin on “Current practice in cardiovascular diseases.”318, 319 

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Aaron H. Traum, M.D., was the Chief of the Unit at the end of World War II. He and Blanche 

Wilcox reviewed extensive records from the experience of the Unit. They also reviewed thousands 

of records of service members being discharged from the military. They published in the New 

England Journal of Medicine a survey of 19,870 cases of cardiovascular disease from the pension 

rolls of World War II Veterans.320 Of these cases, 44 percent had valvular or rheumatic heart 

disease; 15 percent were hypertensive; 9 percent were arteriosclerotic; 13 percent had peripheral 

vascular disease; 6 percent had neurocirculatory asthenia; and 13 percent had other conditions. 

Seeking better ways to screen out persons with heart disease before induction into the military, 

Traum and statistician Wilcox performed a complete record review of 150 of these Veterans, whose 

heart conditions had the same distribution as found in the larger series. They reviewed the Selective 

Service questionnaires and examination records, as well as all subsequent records, and found that in 

many cases the Veteran had known of his condition before induction and that some of them had 

mentioned it on the questionnaire. In a number of cases ultimately discharged for hypertension, no 

blood pressure had been recorded at induction.321 

Traum reviewed the 10,500 patients who had received electrocardiograms at the Washington, D.C., 

VA Hospital between 1936 and 1944 and found 259 with right axis deviation. From these, he 

identified 26 patients with definite diagnoses of arteriosclerotic (22 patients) or hypertensive (four 

patients) heart disease. Comparing them with the much larger numbers of patients without right axis 

deviation, he found that only 9 percent of the arteriosclerotics with right axis deviation had died, 

compared with 20 percent of 573 other patients with arteriosclerosis. On the other hand, three of the 

four hypertensives had died compared with a 32 percent death rate among 737 other hypertensives, 

suggesting that right axis deviation might be a poor prognostic sign in hypertensives but a good one 

in arteriosclerotic heart disease.322 He also published a case history uncovered in his record review 

of a 47-year-old World War I Veteran with Lutembacher’s Syndrome, a congenital condition which 

usually caused death before age 40. This condition had not been detected during military service or, 

indeed, until the patient was about 40 years old.323 

In terms of its wide recognition and lasting significance, the most important product of the 

Washington VA Hospital Cardiovascular Research Unit was a 1948 study of coronary artery disease 

in men under age 40, in which Traum and Wilcox collaborated with members of the Armed Forces 

Institute of Pathology.324 This study reviewed 450 Army men under age 40 who had died of 

coronary disease and were studied at autopsy, as well as 416 Army men under age 40 who had 

survived well-documented episodes of myocardial infarction. From an extensive review of the 

literature, they found previous reports of a total of 744 deaths from coronary artery disease in 

persons under age 40, with a 27:1 male: female ratio. In their study, they collected demographic 

information and medical histories from interviews of survivors and questionnaires sent to relatives of 

those who had died. They used a variety of control groups: amputees, those with gunshot wounds 

and, where appropriate, the Army as a whole. They found increasing incidence of coronary disease 

with age within the age groups studied. Compared with controls, the men with coronary artery 

disease were more likely to be hypertensive and to have a family history of heart conditions. The 

authors could not demonstrate a relationship with smoking, alcohol intake or obesity. Incidence in 

blacks was about two-thirds that in whites. The clinical and pathological features of the heart attacks 

and subsequent course in these young men were similar to those observed in coronary artery disease 

in older persons. 

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In September 1948, Milton Landowne, M.D., arrived at the Washington, D.C., VA Cardiovascular 

Research Unit as its new Chief. He had trained extensively in cardiology and had joined the faculty 

of the University of Chicago. During the War, he had studied the pneumoconioses while assigned to 

the Public Health Service. 

When he arrived, Dr. Albert Kistin and Blanche Wilcox, the statistician, were on the staff of the 

Unit. The Unit’s physical plant, Landowne recalled, was quite large, occupying most of a wing of 

the hospital. The Cardiovascular Research Unit performed the electrocardiograms and angiograms 

for the hospital. It had a chemistry laboratory and facilities for housing and studying dogs. Office 

space was plentiful. Support staff included two electrocardiograph technicians, an animal technician 

and secretaries, and recruitment of a chemist was authorized. 

The research under way was centered on angiography and electrocardiography. Kistin was very 

much interested in angiography and had invented an improved cassette changer.325 George Robb, 

M.D., a cardiologist from Johns Hopkins who was interested in angiography, had influenced the VA 

to do advanced angiography in its Cardiovascular Research Unit, and he had arranged for a 

prototype fluorescent image amplifier from General Electric to be placed there. This had not yet 

arrived when the Unit was closed in late 1949, but meanwhile, Robb collaborated with Kistin in 

electrocardiology. They published an analysis of the normal esophageal and gastric 

electrocardiogram 326 and a case report of the effects of Wolff-Parkinson-White Syndrome on the 

electrocardiogram in myocardial infarction.327 

Kistin published on the anatomy of the bundle of His328 and on optimal placement of 

electrocardiography electrodes.329 With other clinicians, he published on two cases of paralysis of 

the recurrent laryngeal nerve in rheumatic heart disease330 and a case of an anomalous pulmonary 

vein proven by angiography.331 

After Landowne arrived, he and Kistin worked together trying to understand the cause of premature 

ventricular contraction (PVC) of the heart. They recorded esophageal electrocardiograms on 33 

patients whose traditional electrocardiogram showed frequent PVCs. Fifteen of them, including six 

with normal hearts, showed evidence of retrograde conduction from the ventricle to the auricle.332, 333 

The researchers also reported on the diagnostic signs of ventricular aneurysm, based on eight cases 

they had demonstrated angiographically.334 They did a comparative study of electrocardiography 

machines with Solomon Gilford, B.S.E.E., an engineer at the National Bureau of Standards. 

In July 1949, just 10 months after he arrived, Landowne received sudden word that the Unit was to 

be closed. He and Dr. Kistin were offered the opportunity to continue their research at a different 

VA hospital, but both preferred to leave the organization. Kistin went into private practice and later 

worked with miners in West Virginia suffering from pneumoconioses. Landowne joined the NIH 

Aging Study Unit (under Nathan Shock, Ph.D.) in Baltimore. The Cardiovascular Research Unit 

officially closed in November 1949. 335 

Decline in the research program 

There seems to be little question that the enthusiasm for excellence in the veterans’ hospital system 

of the 1920s had waned by the middle of the 1930s. This happened despite the fact that medical 

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1916 1918 1920 1922 1924 1926 1928 1930 1932 

1934 

1936 

1938 1940 

progress was occurring in the VA, as reflected in the Medical Bulletin. Much of this decline can be 

attributed to aging: of the agency leadership, the patients being served, and the physicians serving 

them. 

General Hines continued as Administrator of the Veterans Administration until after World War II. 

The tight controls he had established in 1923, when he came in to reform a corrupt and wasteful 

agency, were now stifling.. Dr. Griffith, his Medical Director from 1931 through the war, is 

described as an amiable person who subordinated himself to Hines’s direction. 

The patient population changed as the World War I Veteran aged (Figure 2.8). Many of the 

tuberculous patients who filled the hospitals in the early 1920s had either died or improved. The 

acute illnesses and injuries of the young had mostly resolved or no longer required hospital care. 

Now, more VA patients suffered from the diseases of middle age, especially heart disease and 

cancer. The syphilitics left in the hospitals were the hopeless cases with tertiary disease, especially 

neurosyphilis. The population of patients with psychoses continued to increase, as there was no 

effective way to control these dread diseases even though the patients generally lived a near-normal 

life span. By 1941, nearly 60 percent of VA patients suffered from neuropsychiatric diseases. These 

were patients who did not appeal to many physicians, as the rewards of caring for them were small. 

Figure 2.8 Patient care load in the VA before the end of WWII 

0 

5000 

1 0000 

1 5000 

2 0000 

2 5000 

3 0000 

3 5000 

4 0000 

4 5000 

5 0000 

Number of inpatients

Tb c 

NP 

GM & S 

At the same time, the mechanics of recruiting and retaining quality physicians for the veterans’ 

hospitals under the Civil Service system was a constant problem. The attempts to set up a medical 

corps for the VA had been unsuccessful, and the energy behind such attempts waned over time. 

Veteran preference under Civil Service laws generally meant that only physicians who were World 

War I Veterans were hired,126 and they, too, were aging. 

58
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Final meeting of the Medical Council 

After 1931, the Medical Council did not meet for eight years, a constraint attributed to tightened 

federal spending during and after the Depression. When they were called together once more in 

1939, the members were not pleased with what had been happening in their absence. They noted 

that the character of the Diagnostic Clinics had changed. These Centers no longer confined their 

activities to diagnosis. Now their efforts were diluted with treatment activities.336 

The Research Group was particularly unhappy with the way things were going, as indicated by a 

report read by Dr. Louis Dublin: 

“Your Research Committee has, from the very beginning of the Council, repeatedly stressed the 

importance of research as an essential activity in the Medical Service of the Veterans 

Administration. It has been our opinion that a research unit would pay for itself many times over 

in the better administration of the Medical Service, as well as in an advancement of medical 

knowledge. Yet, in spite of such recommendations, often reiterated, the Administration has not 

developed such a research organization.... 

“To be sure, Dr. Matz did organize a very simple but effective unit of statistical investigation. 

Some research activities have also been conducted in individual hospitals, with commendable 

results. Here and there, individual physicians have taken advantage of their opportunity to record 

their experiences; but all these efforts, in our judgment, do not constitute an adequate approach to 

the research problem of the Veterans Administration.” 

“... Any organization which is concerned with the hospitalization of tens of thousands of patients 

annually, and which spends many millions of dollars, must in the very nature of the case, organize 

itself for effective self-criticism, and for the analysis and solution of problems which arise out of 

its varied operations. To do that, the first consideration is a leader, who by training and aptitude 

would be competent to carry on the work in a manner equal to the opportunity. At no time in the 

past has there been available this essential of a research organization. We believe that little 

progress will be made in this direction until this first step is taken. With such a step there would 

be a possibility of a development commensurate with the richness of the material which is 

available.” 

“... Finally, the Research Committee believes that the development of a research organization, 

with the Medical Service, should not be carried on without consultation with it. It is impossible to 

advise the Administration with any effectiveness if appointments of heads of divisions are made 

without consultation, and the Research Committee finds itself confronted with accomplished 

facts, which in its judgment stand in the way of a development such as it has in mind.” 

They presented a plan for a research organization with a Central Office staff that would work with 

all major divisions of the Medical Service, addressing the most pressing problems of each. Research 

“would not be limited to statistical investigations alone. The statistical method lends itself, of 

course, to the conduct of research in administration, therapeutics, the natural history of disease and 

analysis of disease processes. All of these fields should be the subject of investigation.”337 

59
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The group also recommended establishing separate research units in some of the larger hospitals, 

citing the Tumor Research Unit at Hines, attached to the Tumor Clinic at Hines, and the 

Cardiovascular Research Unit, attached to the cardiac clinic at the Washington, D.C. hospital as a 

beginning in this direction. 

The Council as a whole showed their displeasure that their advice was not being sought as much as 

in the past. They urged that they be called together annually.338 As Dr. Barker commented, “I think 

this meeting has shown that the Councillors have a deep interest in the welfare of the Veterans 

Administration and that they have many suggestions that will be helpful.”339 

Although there were occasional later meetings of the Executive Committee and individual members 

were called on to inspect hospitals, there were no further meetings of the full Medical Council after 

this October 1939 meeting. The advice about research and other activities proffered in October 1939, 

unlike the advice of the 1924 Medical Council, went unheeded. 

In 1944, Hines appointed a new advisory group, with George M. Piersol, M.D. and Dr. Roy Adams 

as Chairman and Secretary and including William F. Lorenz and Malcolm MacEachern, M.D. 

Joining these members of the old Medical Council were 12 other physicians, each representing a 

medical specialty. This Special Medical Advisory Group was short-lived. It met three times during 

early 1945, appears to have effected no changes, and disbanded when Hines left in August 1945.340 

It was replaced by a new Special Medical Advisory Group mandated in the 1946 law that established 

the Department of Medicine and Surgery (Chapter 3). 

Wartime changes 

No recorded changes in the VA research program occurred as a result of the concern of the Medical 

Council advice, and soon wartime stresses took their toll. During World War II, many of the younger 

VA physicians left for the military. Not until 1943 was the VA declared a national priority. In a 

move to preserve a coherent medical staff, Administrator Hines arranged for VA’s remaining 

physicians to be commissioned military officers, with the same salaries, benefits and recognition as 

their colleagues in the camps and war fronts. But by this time, the physician ranks in the VA were 

so depleted that supervision of patient care became very difficult. 

As Paul Magnuson, M.D., described in his autobiography, during his 1946 visit to the Palo Alto VA 

Hospital he found a facility in chaos:: 

“I didn’t expect much, but the place gave me a shock. They had five doctors there, taking care— 

question mark in a very large way—of one thousand patients. The outside of the facility was 

very nice, with well tended shrubs and flowerbeds, but what went on inside was just beyond 

description.”341 

His account contrasts sharply with the upbeat institution described by Dr. Ray Wilbur in 1924, when 

he wrote of the Palo Alto Veterans Hospital that “the whole aspect of the hospital is one of cheer and 

hopefulness as compared with the ordinary institution of the sort.”342 

60
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

There were, of course, exceptions. An occasional clinician still conducted research, as seen in the 

discussion in Chapter 3 of the work of Ludwig Gross,M.D. However, judging by the papers 

published in the Medical Bulletin during its last 10 years of publication, 1935 through 1944, original 

research seems to have almost disappeared in the hospitals except in the formal centralized research 

laboratories. 

In November 1944, in response to an inquiry from Albert Q. Maisel, a reporter who later wrote a 

scathing article in Reader’s Digest343 about the VA, Ray Lyman Wilbur wrote: 

“... In my judgment the principal difficulty has been that the whole problem of medical service 

was gauged on too low a financial level and that priorities were given to Veterans throughout the 

whole organization sometimes regardless of their skills and training. 

“The Medical Council was desirous of developing research and putting in superior men in the 

hospitals to carry it on, so that the work of the hospitals would not become largely custodial but 

would provide a series of research studies on a gradually aging group with the ailments that 

come with the years. . . . If some diagnostic and research centers could be established under the 

complete control of some of the best medical men developed by the war I believe that it would 

be worth while financially and in every other way.”344 

Wilbur went on to urge salary increases for VA professional staff, pointing out that “in the Indian 

Health Service and in the Veterans Hospital service, generally speaking, the salaries paid and the 

conditions of service have not attracted the best trained and the best qualified doctors and nurses.” 

Wilbur sent a copy of this letter to General Hines, whose response did not acknowledge these 

problems. With regard to research, Hines wrote: 

“I know that you will be glad to know that there are three research units now being operated by 

the Veterans Administration. The unit at Hines, Illinois, conducts extensive research on tumors 

and enjoys an enviable reputation with research workers throughout the country interested in this 

field. The unit at Washington, D.C. is utilized for research covering the field of cardiology, 

while the more recently established unit at Northport, Long Island, devotes its time to research 

problems in the neuropsychiatric field. 

“The established research units are not only working on basic projects in medicine but are 

concentrating on problems concerned with disabled Veterans. The units are staffed by 

outstanding medical officers and superior auxiliary personnel who have been carefully selected 

for the specific type of work to which they are assigned. Each unit has made contributions to 

scientific literature. In addition, many medical officers throughout the Service are also working 

on research problems.”345 

Despite what Hines portrayed, there is very little evidence of research being done during the war in 

the VA hospitals, except in the research units. 

By the time a new VA medical research effort started up in 1946, it was indeed a new beginning. 

Eventually, today’s strongly academic VA research program grew in conjunction with the agency’s 

61
 
 

 

 

 

post-war collaboration with medical schools. However, this was a gradual and incomplete 

transition; some research continued in hospitals with weak affiliations or even without medical 

school affiliations. This post-World War II research retained some of the post-World War I tradition 

of clinical research on the health problems of Veterans, carried out by individual physicians looking 

for better ways to treat their patients. 

62
 
 

 

 

 

 

 

 

 

 

 

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16. Marks, The Progress of Experiment. 1997, 43. 

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64
 
 

 

 

 

 

 

 

 

32. "Notes and discussion." United States Veterans' Bureau Medical Bulletin, 1925. 1: 63-64. 

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36. Matz, P.B., "Studies on the calcium content of blood of normal and tuberculous subjects." 

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37.	 Griffith, C.M., "Dr. Philip B. Matz." Ann Int Med, 1938. 12: 280-282. 

38. Matz, P.B., "Statistical studies on cardiovascular diseases in the United States Veterans' 

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39.	 Matz, P.B., "Statistical studies of the mortality of heart diseases in the United States 

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40.	 Matz, P.B., "Statistical studies on tuberculosis in the United States Veterans' Bureau." US 

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41.	 Matz, P.B., "Statistical studies on degenerative diseases in the United States Veterans' 

Bureau." US Veterans Bureau Medical Bulletin, 1926. 2: 1182-1189. 

42.	 Matz, P.B., "Statistical studies on degenerative diseases in the United States Veterans' 

Bureau." US Veterans Bureau Medical Bulletin, 1927. 3: 72-77. 

43.	 Matz, P.B., "Statistical studies on neuropsychiatric disabilities in the United States Veterans' 

Bureau." US Veterans Bureau Medical Bulletin, 1927. 3: 156-160, 253-259. 

44.	 Matz, P.B., "Statistical studies on compensation in the United States Veterans' Bureau." US 

Veterans Bureau Medical Bulletin, 1927. 3: 376-389. 

45. Matz, P.B., "Hospital statistics for November, 1926." US Veterans Bureau Medical Bulletin, 

1927. 3: 611-617. 

46. Matz, P.B., "Analysis of United States Veterans' Bureau Hospital statistics for December, 

1926." US Veterans Bureau Medical Bulletin, 1927. 3: 728-736. 

47.	 Matz, P.B., "Analysis of United States Veterans' Bureau Hospital statistics for January, 

1927." US Veterans Bureau Medical Bulletin, 1927. 3: 818-824. 

65
 
 

 

 

 

 

48.	 Matz, P.B., "Analysis of United States Veterans' Bureau Hospital statistics for February, 

1927." US Veterans Bureau Medical Bulletin, 1927. 3: 931-944. 

49. Matz, P.B., "Analysis of United States Veterans' Bureau Hospital statistics for March, 1927." 

US Veterans Bureau Medical Bulletin, 1927. 3: 1051-1060. 

50. Matz, P.B., "Malaria treatment of general paralysis of the insane." US Veterans Bureau 

Medical Bulletin, 1926. 2: 712. 

51. Matz, P.B., "The treatment of neurosyphilis by means of 'inoculation malaria'." US Veterans 

Bureau Medical Bulletin, 1927. 3: 42-46. 

52.	 Matz, P.B., "Report on the treatment of 179 cases of neurosyphilis by means of 'inoculation 

malaria'." US Veterans Bureau Medical Bulletin, 1927. 3: 387-389. 

53.	 Matz, P.B., "Histopathology of the brain in paresis following malaria treatment." US 

Veterans Bureau Medical Bulletin, 1927. 3: 619-621. 

54. Matz, P.B., "The preparation for transmission through the mail of malarial blood suitable for 

the treatment of paresis." US Veterans Bureau Medical Bulletin, 1927. 3: 944. 

55. Matz, P.B., "The treatment of neurosyphilis by 'inoculation malaria' in the United States 

Veterans Bureau." J Nerv and Ment Dis, 1928. 68: 113 - 133. 

56. Teitelbaum, A.D., "Preliminary Report of Fifteen Cases of Sodoku Treatment of General 

Paralysis." US Veterans' Bureau Medical Bulletin, 1930. 6: 263-270. 

57.	 Matz, P.B., "Standardization of clinical laboratory work in hospitals and regional offices: 

examination of sputum." US Veterans Bureau Medical Bulletin, 1928. 4: 46-55. 

58.	 Matz, P.B., "Standardization of clinical laboratory work in hospitals and regional offices: the 

spinal fluid." US Veterans Bureau Medical Bulletin, 1928. 4: 149-158, 265-277, 365-383, 

463-474. 

59.	 Matz, P.B., "Standardization of clinical laboratory work in hospitals and regional offices: 

examination of gastric contents." US Veterans Bureau Medical Bulletin, 1928. 4: 551-561. 

60.	 Matz, P.B., "Standardization of clinical laboratory work in hospitals and regional offices: 

examination of feces (Clinical Bulletin #23)." US Veterans Bureau Medical Bulletin, 1928. 4: 

711-716, 802-810. 

61.	 Matz, P.B., "Standardization of clinical laboratory work in hospitals and regional offices: 

blood chemistry." US Veterans Bureau Medical Bulletin, 1928. 4: 871-880, 958-971, 1050­

1060. 

66
 
 

 

 

 

62.	 Matz, P.B., "Standardization of clinical laboratory work in hospitals and regional offices: 

blood chemistry - the dietetic management of various diseases." US Veterans Bureau 

Medical Bulletin, 1929. 5: 61-67. 

63.	 Matz, P.B., "Standardization of clinical laboratory work in hospitals and regional offices: 

examination of transudates and exudates." US Veterans Bureau Medical Bulletin, 1929. 5: 

136-141. 

64. Matz, P.B., "Preliminary report of board of medical officers on residual effects of warfare 

gassing." US Veterans' Bureau Medical Bulletin, 1928. 4: 681-683. 

65.	 Gilchrist, H.L. and Matz, P.B., "The residual effects of warfare gases: the use of chlorine gas, 

with report of cases." US Veterans Administration Medical Bulletin, 1933. 9: 229-270. 

66. Gilchrist, H.L. and Matz, P.B., "The residual effects of warfare gases: the use of phosgene 

gas, with report of cases." US Veterans Administration Medical Bulletin, 1933. 10: 1-36. 

67.	 Gilchrist, H.L. and Matz, P.B., "The residual effects of warfare gases: the use of arsenical 

compounds, with report of cases." US Veterans Administration Medical Bulletin, 1933. 10: 

79-98. 

68.	 Gilchrist, H.L. and Matz, P.B., "The residual effects of warfare gases: the use of mustard gas, 

with report of cases." US Veterans Administration Medical Bulletin, 1933. 9: 339-390. 

69. Matz, P.B., "Outcome of hospital treatment of ex-service patients with nervous and mental 

diseases in the U.S. Veterans Bureau." Psy Quar, 1929. 3: 550 -568. 

70. "Increase of 6,264 in Veterans' Hospitals." JAMA, 1935: 1348. 

71. Adkins, R.E., Medical Care of Veterans. 1967, 161. 

72. Crossman, E.O., "Address to the Medical Council." United States Veterans' Bureau Medical 

Bulletin, 1929. 5: 569-570. 

73. Weber, G.A. and Schmeckebier, L.F., The Veterans' Administration: its history, activities 

and organization. Washington: The Brookings Institution, 1934, 319. 

74.	 Matz, P.B., "A study of intestinal tuberculosis among exservice men." Am J Med Sci, 1930. 

179: 532-546. 

75. Matz, P.B., "Future incidence of nervous and mental disease among ex-service men." Am J 

Psychiatry, 1930. 9: 1043-1060. 

76. Matz, P.B., "The Gerson-Sauerbruch dietetic regimen in tuberculosis." US Veterans' Bureau 

Medical Bulletin, 1930. 6: 27-32. 

67
 
 

 

 

77. Matz, P.B., "Study of diabetes mellitus among ex-service men." Military Surgeon, 1931. 68: 

591-635. 

78.	 Matz, P.B., "The treatment of diabetes mellitus." US Veterans Administration Medical 

Bulletin, 1932. 8: 331-350. 

79. Matz, P.H., "A study of diabetes mellitus among ex-service men." JAMA, 1936. 106: 2214 - 

2221. 

80. Matz, P.H., "A study of diabetes mellitus among ex-service men." Military Surgeon, 1937. 

80: 122 - 131. 

81.	 Matz, P.B., "A study of diabetes mellitus in ex-service men." US Veterans Administration 

Medical Bulletin, 1931. 7: 533-549, 625-642. 

82. Matz, P.B., "A study of cancer in ex-service men." US Veterans Administration Medical 

Bulletin, 1931. 7: 1010-1031, 1128-1149. 

83. Matz, P.B., "The coincidence of malignancy and tuberculosis." US Veterans' Bureau Medical 

Bulletin, 1930. 6: 939-942. 

84. Matz, P.B., "A study of manic depressive psychosis in ex-service men." US Veterans 

Administration Medical Bulletin, 1932. 8: 1-19. 

85. Matz, P.B., "Clinical and economic features of arthritis in ex-members of the military 

service." N Eng J Med, 1933. 209: 639. 

86.	 Matz, P.B., "Habit-forming drugs." US Veterans Administration Medical Bulletin, 1934. 11: 

198-209. 

87. Matz, P.H., "Food poisoning--its cause and its control." Mod Hosp, 1935. 45: 90 - 94. 

88. Matz, P.B., "Food poisoning in hospitals and domiciliary institutions." US Veterans 

Administration Medical Bulletin, 1935. 11: 159-165. 

89. Matz, P.B., "Malignancy and tuberculosis." Mil Surg, 1935. 77: 207. 

90. Matz, P.H., "The end-results of the surgical treatment of pulmonary tuberculosis." Am Rev 

Tuberc, 1936. 33: 533 - 548. 

91. Matz, P., "The incidence of primary bronchiogenic carcinoma." JAMA, 1938. 111: 2086­

2092. 

92. Matz, P.B., "The dispensary care of disabled ex-service men." US Veterans Administration 

Medical Bulletin, 1932. 8: 186-194. 

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93. Matz, P.B., "A study of heart disease among veterans: I. Clinical classification of five 

hundred cases." N Eng J Med, 1935. 212: 868 - 874. 

94. Matz, P.H., "A study of heart disease among veterans: II. Analysis of a group of cases as to 

age at onset and duration of heart disability." N Eng J Med, 1935. 212: 929-932. 

95. Matz, P.H., "A study of heart disease among veterans: III. Hereditary and famillial factors in 

the causation of cardiovascular disease." N Eng J Med, 1935. 212: 977-978. 

96. Matz, P.H., "A study of heart disease among veterans: IV. An analysis of the more frequent 

types of anatomic heart disease." N Eng J Med, 1935. 212: 1042-1048. 

97. Matz, P.H., "A study of heart disease among veterans: V. Syphilitic heart disease." N Eng J 

Med, 1935. 212: 1087 - 1089. 

98. Matz, P.B., "Pathology of the lungs and other organs in silicosis." Military Surgeon, 1937. 

81: 88. 

99. Matz, P., "Roentgenologic classification and diagnosis of silicosis." Am J Roentgenol, 1938. 

40: 848-858. 

100. Matz, P.B., "A study of silicosis." Am J Med Sci, 1938. 196: 548-559. 

101. Matz, P.B., "Pathology of the lungs and other organs in silicosis." Am J Clin Path, 1938. 8: 

345-365. 

102. "Dr. P.B. Matz, Research Unit Chief, expires: famed pathologist was on tour inspecting 

Veterans' Hospitals." Unknown (provided by Oscar Schabb, nephew). 

103. Letter from Anne Bambery to Mrs. Joseph Rudolph, Baltimore, MD (letter provided by 

Oscar Schabb), written at Washington, DC, November 1, 1938. 

104. Letter from Horatio M. Pollack to Medical and Hospital Service, VACO, written at Albany, 

NY, 1938. 

105. Letter from Arthur J. Vorwald to Medical and Hospital Service, VACO, written at Saranac 

Lake, NY, 1938. 

106. Mella, H., "The circulation of phenol sulphothalein in the cerebrospinal fluid." J Nerv Ment 

Dis, 1922. 56: 599-601. 

107. Mella, H., "Thrombotic cortical amaurosis: report of a case of bilateral calcarine softening." J 

Nerv Ment Dis, 1922. 56: 563-566. 

108. Mella, H., "The cerebrospinal fluid in jaundice." Arch Neur Psychiatr, 1922. 8: 329-330. 

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109. Mella, H., "Irradiation of the thymus in myasthenia gravis." Med Clin N America, 1923. 7: 

939-949. 

110. Mella, H., "The diencephalic centers controlling associated locomotor movements." Arch 

Neur Psychiatr, 1923. 10: 141-153. 

111. Mella, H., "Neurosyphilis as an etiological factor in the Parkinsonian syndrome." J Nerv 

Ment Dis, 1924. 59: 225-230. 

112. Mella, H., "The experimental production of basal ganglion sympathectomy in Macacus 

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113. Mella, H., "Bulbocapnin: its use in the treatment of tremor and in experimental production of 

basal ganglion symptomatology." Arch Neur Psychiatr, 1926. 15: 325-329. 

114. Ebaugh, F.G. and Mella, H., "The use of Lipiodol in the localization of spinal lesions." Am J 

Med Sci, 1926. 172: 117-123. 

115. Mella, H., "Improving our contact with relatives of patients." US Veterans' Bureau Medical 

Bulletin, 1927. 3: 801-802. 

116. Mella, H., "Panniculitis." US Veterans' Bureau Medical Bulletin, 1930. 6: 697-698. 

117. Mella, H., "The use of subarachnoid lavage and ethylhydrocupreine in meningitis." US 

Veterans' Bureau Medical Bulletin, 1931. 7: 77-78. 

118. Mella, H., "Loss of associated locomotor movements in diencephalic lesions." US Veterans 

Administration Medical Bulletin, 1931. 7: 762-763. 

119. Mella, H. and O'Neill, R.T., "Ultraviolet irradiation in general paresis." US Veterans 

Administration Medical Bulletin, 1932. 9: 29-32. 

120. Mella, H. and O'Neill, R.T., "Intravenous administration of sodium amytal in acute psychotic 

episodes." US Veterans Administration Medical Bulletin, 1933. 9: 271-275. 

121. Mella, H. and Blomberg, M.M., "A study of the absorption spectra of cerebrospinal fluid in 

the visible part of the spectrum." J Nerv Ment Dis, 1936. 83: 685-688. 

122. Mella, H., "Treatment of 43 cases of lobar pneumonia." US Veterans Administration Medical 

Bulletin, 1937. 13: 247-250. 

123. Mella, H., "Senescence and rejuvenation." US Veterans Administration Medical Bulletin, 

1938. 14: 322-328. 

124. Mella, H., "A study of results of the treatment of neurosyphilis." US Veterans Administration 

Medical Bulletin, 1939. 16: 106-119. 

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125. Mella, H., "Report of 92 cases of pneumonia treated with sulfapyridine." US Veterans 

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126. Interview with Abraham Gottlieb, M.D., December 18, 1991 at Palo Alto, CA. VAMC 

127. Directory of Medical Specialists holding certification by American Boards, Volume VI, 

published for the Advisory Board for Medical Specialties. Chicago: A.N. Marquis Company, 

1953, 1022. 

128. Ziegler, E.E., "The specific effect of bile salts on pneumococci and on pneumococcus 

pneumonia." Ach Int Med, 1930. 46: 644-656. 

129. Ziegler, E.E., "The effects on pneumococci of sodium dehydrocholate, a bile salt derivative 

III." J Lab Clin Med, 1931. 17: 317-324. 

130. Ziegler, E.E., "The effects on pneumococci of sodium dehydrocholate, a bile salt derivative." 

US Veterans Administration Medical Bulletin, 1932. 8: 105-112. 

131. Ziegler, E.E., "Pneumocholin; a new biochemical antigen." US Veterans Administration 

Medical Bulletin, 1933. 9: 276-286. 

132. Ziegler, E.E., "Some properties of pneumocholin, a biochemical antigen." J Lab Clin Med, 

1933. 18: 695-704. 

133. Ziegler, E.E., "A new measurement of oxygen absorbing power." Med Ann District of 

Columbia, 1933. 2: 225-230. 

134. Ziegler, E.E., "A new measurement of oxygen absorbing power (preliminary report)." J 

Aviation Medicine, 1933. 4: 119-129. 

135. Stein, J.J., "The early diagnosis and treatment of cancer." US Veterans Administration 

Medical Bulletin, 1936. 12: 412-421. 

136. Stein, J.J. and Hantsch, F.K., "Adenocarcinoma of the rectum with unusual sites of 

metastases." JAMA, 1937. 108: 1776-1779. 

137. Stein, J.J., "Tumors of the small intestine: a review of the literature and report of eight 

additional cases." Am J Digestive Diseases and Nutrition, 1938. 4: 517-522. 

138. Stein, J.J., "Metastases to bone from carcinoma of the gastro-intestinal tract." Radiology, 

1940. 35: 486-488. 

139. Stein, J.J., "The clinical and pathological features of tumors occurring in the region of the 

apex of the lung." Texas State J Med, 1937. 33: 293-299. 

71
 
 

 

140. Stein, J.J., "Apical lung tumors: further observations with report of seven additional cases." 

JAMA, 1938. 111: 1612-1617. 

141. Stein, J.J. and Joslin, H.L., "Carcinoma of the bronchus: a clinical and pathological study of 

164 cases." Surg Gyn and Obst, 1938. 66: 902-911. 

142. Stein, J.J., "Bone metastases from primary carcinoma of the lung. Report of an unusual 

case." J Bone and Joint Surg, 1939. 21: 992-996. 

143. Stein, J.J., "Carcinoma of the lung: a clinical study." US Naval Med Bull, 1940. 38: 329-334. 

144. Stein, J.J., "Tumors occurring in the region of the pulmonary apex: further observations with 

report of twelve additional cases." Illinois Med J, 1942. 81: 21-29. 

145. Stein, J.J., "Sudden compression injuries of the abdomen." US Veterans Administration 

Medical Bulletin, 1943. 20: 6-7. 

146. Stein, J.J., "Combat experiences in the Pacific areas." US Veterans Administration Medical 

Bulletin, 1944. 21: 177-187. 

147. "Justin John Stein", in Who's Who in America. 1980, Marquis Who's Who: Chicago. 2 3160. 

148. Allen, C.D., "Report of results obtained in 100 cases by intravenous injection of 

Mercurochrome." US Veterans' Bureau Medical Bulletin, 1925. 1: 27-33. 

149. Allen, C.D., "A further report on the use of Mercurochrome intravenously, with a review of 

its action in 151 cases." US Veterans' Bureau Medical Bulletin, 1926. 2: 443-446. 

150. Martin, A., "Hemolytic streptococcus bacteremia following empyema, with recovery." US 

Veterans' Bureau Medical Bulletin, 1929. 5: 541-543. 

151. Harris, R.L., "Mercurochrome treatment of a case of streptococcus viridans septicemia with 

recovery." US Veterans' Bureau Medical Bulletin, 1930. 6: 413-415. 

152. Foster, H.E., "Facts and fancies regarding Mercurochrome-220 Soluble." US Veterans' 

Bureau Medical Bulletin, 1930. 6: 300-308. 

153. Dowling, H.F., Fighting infection: conquests of the Twentieth Century. Cambridge, MA and 

London: Harvard University Press, 1977, 106. 

154. Walker, J.B., "Late results of fractures of the long bones - a statistical study of World War 

cases - I." US Veterans' Bureau Medical Bulletin, 1927. 3: 293-314. 

155. Walker, J.B., "Late results of fractures of the long bones - a statistical study of World War 

cases - II." US Veterans' Bureau Medical Bulletin, 1927. 3: 409-427. 

72
 
 

 

 

 

 

156. Walker, J.B., "Late results of fractures of the long bones - a statistical study of World War 

cases - III." US Veterans' Bureau Medical Bulletin, 1927. 3: 525-543. 

157. Walker, J.B., "Late results of fractures of the long bones - a statistical study of World War 

cases - IV." US Veterans' Bureau Medical Bulletin, 1927. 3: 651-657. 

158. Caldwell, H., "Resume of treatment of 25 cases of diabetes mellitus with insulin." US 

Veterans' Bureau Medical Bulletin, 1925. 1: 1-6. 

159. Rogers, J.C., "Residuals of encephalitis lethargica." US Veterans' Bureau Medical Bulletin, 

1925. 1: 20-23. 

160. Prince, L.H., "The blood vessels in tuberculosis: some aspects of the part played by the blood 

vessels in the dissemination of tuberculosis." US Veterans' Bureau Medical Bulletin, 1925. 1: 

11-18. 

161. Crichlow, R.S., "Treatment of Raynaud's Disease by negative pressure." US Veterans' 

Bureau Medical Bulletin, 1925. 1: 14-17. 

162. Bacon, H.P., "A study of Larson's Ring Test applied to 315 cases of pulmonary tuberculosis." 

US Veterans' Bureau Medical Bulletin, 1926. 2: 56-60. 

163. Prince, L.H. and Wight, T.H.T., "Adenocarcinoma - primary in the renal tubule." US 

Veterans' Bureau Medical Bulletin, 1926. 2: 987-991, 1095-? 

164. Enright, J.J., "A preliminary report on attempts at active immunization of guinea pigs by 

urinary antigens from cases of tuberculosis." US Veterans' Bureau Medical Bulletin, 1926. 2: 

357-361. 

165. Josewich, A. and Grave, F., "Correlation of clinical and laboratory procedures in 

tuberculosis. I. The complement fixation test." US Veterans' Bureau Medical Bulletin, 1926. 

2: 346-356. 

166. Wrenn, H.T., "Studies on the bactericidal properties in vitro of certain fatty oils irradiated 

with the quartz-mercury-vapor spectrum." US Veterans' Bureau Medical Bulletin, 1927. 3: 

898-910. 

167. Armstrong, C.L., "Report of cases of leprosy with unusual manifestations." US Veterans 

Bureau Medical Bulletin, 1927. 3: 1248-1254. 

168. Covey, C.B., "Notes on amnesia." United States Veterans' Bureau Medical Bulletin, 1927. 3: 

356-362. 

169. Freed, H., Haley, S.W. and Stephenson, W.O., "Thoracotomy for empyema complicating 

pneumonia - analysis of end results in 100 consecutive cases." US Veterans' Bureau Medical 

Bulletin, 1928. 4: 22-26. 

73
 
 

 

170. Crouch, E.L., "Multiple sclerosis." US Veterans' Bureau Medical Bulletin, 1928. 4: 839-845. 

171. Denson, R.L., "Ancient Grecian, Etruscan and Roman dentistry." US Veterans' Bureau 

Medical Bulletin, 1928. 4: 251-258. 

172. Flowers, H.L., "A study of the emotions in psychotic patients (a report of the examination of 

100 psychotic patients with the Pressey test)." US Veterans' Bureau Medical Bulletin, 1928. 

4: 309-321. 

173. Rabinovitch, A. and Roberts, C.G., "A comparative study of the Kahn and complement 

fixation tests of spinal fluid." US Veterans' Bureau Medical Bulletin, 1928. 4: 692-696. 

174. Read, J.M., "Tetany from overbreathing." US Veterans' Bureau Medical Bulletin, 1929. 5: 

491-493. 

175. Alvarez, R.S. and Wight, T.H.T., "The Gregerson Test." US Veterans' Bureau Medical 

Bulletin, 1929. 5: 888-890. 

176. Seymour, W.Y., "Julius Caesar, epileptic." US Veterans' Bureau Medical Bulletin, 1929. 5: 

266-272. 

177. Teitelbaum, A.D., "Preliminary Report of Fifteen Cases of Sodoku Treatment of General 

Paralysis." US Veterans' Bureau Medical Bulletin, 1930a. 6: 263-270. 

178. Schelm, G.W., "Typhoid vaccine in the treatment of general paralysis of the insane." US 

Veterans' Bureau Medical Bulletin, 1930. 6: 544-548. 

179. Crouch, E.L., "Narcolepsy." US Veterans' Bureau Medical Bulletin, 1930. 6: 371-377. 

180. Wight, T.H.T. and Meehan, W., "Value of media containing certain iron compounds in 

differentiating the typhoid-colon group of organisms." United States Veterans' Bureau 

Medical Bulletin, 1930. 6: 493-495. 

181. Moss, E.S., "An improved method for staining tubercle bacilli in tissues cut by the frozen 

section method." US Veterans' Bureau Medical Bulletin, 1930. 6: 590-595. 

182. Lasche, P.G. and Rubin, H., "Carbon dioxide-oxygen inhalations in catatonic dementia 

praecox." US Veterans' Bureau Medical Bulletin, 1930. 6: 1037-1041. 

183. Brown, C.P. and Gemar, F., "Experiments on bacteriophage adsorption by vulnerable 

bacteria." US Veterans Administration Medical Bulletin, 1931. 7: 224-229. 

184. Rothrock, A.M., "Medical science in the thirteenth century." US Veterans Administration 

Medical Bulletin, 1931. 7: 1005-1009. 

74
 
 

 

 

 

 

 

 

 

 

185. Mella, H., "The Use of Subarachnoid Lavage and Ethylhydrocupreine in Meningitis." United 

States Veterans' Bureau Medical Bulletin, 1931a. 7: 77-78. 

186. Fisher, S.G., "Stramonium in encephalitis." US Veterans Administration Medical Bulletin, 

1931. 7: 379-382. 

187. Burkett, J.A., "Bronchial spirochetosis, with report of a case." US Veterans Administration 

Medical Bulletin, 1932. 8: 26-37. 

188. Wight, T.W.T., "A world's record for the transportation of Entamoeba Histolytica." US 

Veterans Administration Medical Bulletin, 1932. 8: 306-307. 

189. Terry, M.C. and Hollingsworth, E.W., "Elliptical human erythrocytes: report of two cases." 

US Veterans Administration Medical Bulletin, 1932. 9: 7-17. 

190. Terry, M.C., Hollingsworth, E.W. and Eugenio, V., "Elliptical human erythrocytes: report of 

two cases." Arch Path, 1932. 13: 193-206. 

191. Sanders, A.O., "Observations of heart action under vagus stimulation." US Veterans 

Administration Medical Bulletin, 1931. 7: 212-217. 

192. Garrett, G.H., "Pulmonary tuberculosis complicated by syphilis." US Veterans' Bureau 

Medical Journal, 1925. 1: 1-9. 

193. Kennedy, J.A., "Psychosis with alcoholic pellagra." US Veterans Administration Medical 

Bulletin, 1933. 10: 155-158. 

194. Monat, H.A., "An unusual case of hysteria with a retrocursive gait." US Veterans 

Administration Medical Bulletin, 1934. 11: 167-168. 

195. Cullins, J.G., Morgan, H.P. and Seymour, W., "Super-diathermy in the treatment of dementia 

paralytica." US Veterans Administration Medical Bulletin, 1935. 11: 217-222. 

196. Broglum, F.L., "Nineteen cases of pneumonia in members of the Civilian Conservation 

Corps with no deaths." US Veterans Administration Medical Bulletin, 1935. 11: 258-261. 

197. Smith, A.P., "Brain abscess consequent to latent head trauma." US Veterans Administration 

Medical Bulletin, 1935. 11: 337-339. 

198. Woldenberg, S.C., "Sulphur (colloidal) therapy in the treatment of arthritis." US Veterans 

Administration Medical Bulletin, 1935. 12: 10-26. 

199. Bogen, E.F., "Effects of long hospitalization on psychotic patients." US Veterans 

Administration Medical Bulletin, 1936. 12: 345-353. 

75
 
 

 

 

 

 

200. Carlisle, C.L. and Hecjer, C.H., "Use of benzedrine sulphate in catatonic stupors: case 

reports." US Veterans Administration Medical Bulletin, 1937. 13: 224-227. 

201. Woodward, F.A., "Molokai and its leper colony." US Veterans Administration Medical 

Bulletin, 1937. 14: 60-61. 

202. Baganz, C.N. and Laxson, G.O., "Hypoglycemic shock therapy in schizophrenia: results of 

treatment of six patients." US Veterans Administration Medical Bulletin, 1938. 14: 301-305. 

203. McClintock, H.A., "Experience with the insulin therapy of schizophrenia." US Veterans 

Administration Medical Bulletin, 1939. 16: 97-105. 

204. Carlisle, C.L., "Bacteriological examination of eating utensils." US Veterans Administration 

Medical Bulletin, 1939. 15: 294-296. 

205. Lasche, P.G., "Herpes zoster in early syphilis." US Veterans Administration Medical 

Bulletin, 1940. 16: 253-256. 

206. Haynes, H.J., "The treatment of schizophrenia with desoxycorticosterone acetate." US 

Veteran Administration Medical Bulletin, 1941. 18: 141-147. 

207. Bernard, L.J., "The status of thyroid ablation for intractable heart disease." US Veterans 

Administration Medical Bulletin, 1941. 17: 336-342. 

208. Matz, P.B., "Research projects." US Veterans' Bureau Medical Bulletin, 1930. 6: 622-623. 

209. Matz, P.B., "Research." US Veterans' Bureau Medical Bulletin, 1930. 6: 1005-1007. 

210. Ijams, G.E., "Address of the director to the 12th conference of the Medical Council." US 

Veterans' Bureau Medical Bulletin, 1931. 7: 701-703. 

211. "Report of Conference on Establishment of Research Units in Cardiovascular and 

Neuropsychiatric Disease." Typewritten, 1935. 

212. "Conference on Medical Research." US Veterans Administration Medical Bulletin, 1936. 13: 

326-327. 

213. "Medical Research Unit at Northport." US Veterans Administration Medical Bulletin, 1936. 

13: 327. 

214. Scott, H., "Treatment of cancer at Edward Hines, Jr., Facility, Hines, Ill." US Veterans 

Administration Medical Bulletin, 1935. 12: 1-9. 

215. Owen, S.E., "The biologic diagnosis of teratoma testis." J Lab Clin Med, 1934. 20: 296-301. 

216. Owen, S.E., "Small animal metabolism cage." J Lab Clin Med, 1934. 19: 1135-1137. 

76
 
 

 

 

 

 

 

 

 

217. Cutler, M. and Owen, S.E., "Clinical value of Prolan A determinations in teratoma testis." 

Am J Cancer, 1935. 24: 318-325. 

218. Owen, S.E. and Cutler, M., "Diagnosis of teratoma testis by biologic assay of prolans." US 

Veterans Administration Medical Bulletin, 1937. 14: 1-5. 

219. Fortner, H.C. and Owen, S.E., "Chorionepithelioma in the male." Am J Cancer, 1935. 25: 

89-97. 

220. Christoffersen, W.G. and Owen, S.E., "Neoplasms in cryptorchids." Am J Cancer, 1936. 26: 

259-268. 

221. Owen, S.E. and Cutler, M., "Comparison of prolan bioassays in teratoma and other 

conditions." Am J Med Sci, 1936. 192: 61-67. 

222. Owen, S.E. and Cutler, M., "Sex hormones and prostatic pathology." Am J Cancer, 1936. 27: 

308-315. 

223. Owen, S.E., "The reaction of fish to sex hormones." Endocrinol, 1936. 20: 214-218. 

224. Owen, S.E., "The Bitterling fish response to male sex hormones." Endocrinol, 1937. 21: 

689-690. 

225. Owen, S.E., Polanco, Q.G. and Prince, L.H., "Urine chemistry in the diagnosis of embryonal 

tumors." Am J Cancer, 1937. 31: 613-617. 

226. Owen, S.E., "Sulphydryl and radon induced necrosis." Growth, 1937. 1: 130-134. 

227. Owen, S.E., "Sulphur and growth stimulation (a consideration of larval preparations)." 

Growth, 1938. 2: 355-361. 

228. Owen, S.E., "The action of growth stimulants on proteins." Growth, 1940. 4: 135-137. 

229. Owen, S.E., "Sex hormones, carcinogenics and sterols." Quarterly Rev Biology, 1937. 12: 

340-347. 

230. Owen, S.E., "The genesis of cancer." Mil Surg, 1938. 82: 218-225. 

231. Owen, S.E., Weiss, H.A. and Prince, L.H., "Carcinogens and growth stimulation." Science, 

1938. 87: 261-262. 

232. Owen, S.E., Weiss, H.A. and Prince, L.H., "Carcinogens and planarian tissue regeneration." 

Am J Cancer, 1939. 35: 424-426. 

77
 
 

 

 

 

 

 

 

 

233. Owen, S.E. and Williams, A.E., "Irradiation and hereditary mammary cancer." Radiology, 

1940. 34: 541-544. 

234. Allaben, G.R. and Owen, S.E., "Adenocarcinoma of the breast coincidental with strenuous 

endocrine therapy." JAMA, 1939. 112: 1933-1934. 

235. Telephone interview with Robert Schrek, M.D., May 8, 1988. 

236. Schrek, R., "Effect of pH on heat inactivation of tetanolysin." J Immun, 1933. 25: 183-197. 

237. Schrek, R., "A quantitative study of the growth of the Walker rat tumor and the FlexnerJobling rat carcinoma." Am J Cancer, 1935. 24: 807-822. 

238. Schrek, R., "A comparison of the growth curves of malignant and normal (embryonic and 

post-embryonic) tissues of the rat." Am J Path, 1936. 12: 515-530. 

239. Schrek, R., "A biological method for sterilizing contaminated transplantable tumors." Am J 

Path, 1936. 12: 531-543. 

240. Schrek, R., "Further quantitative methods for the study of transplantable tumors. The growth 

of R39 sarcoma and Brown-Pearce carcinoma." Am J Cancer, 1936. 28: 345-363. 

241. Schrek, R., "The effect of the size of inoculum on the growth of transplantable rat tumors." 

Am J Cancer, 1936. 28: 364-371. 

242. Schrek, R., "Permanent and transient (fortuitous) variations of the growth components of 

transplantable rat tumors." Am J Cancer, 1936. 28: 372-388. 

243. Schrek, R., "A method for counting the viable cells in normal and in malignant cell 

suspensions." Am J Cancer, 1936. 28: 389-392. 

244. Schrek, R. and Avery, R.C., "Histologic observations on transplantable rat and rabbit tumors 

cultivated in the chorio-allantoic membrane of chick embryos, with special reference to the 

Walker rat tumor 256." Am J Path, 1937. 13: 45-55. 

245. Schrek, R. and Gates, O., "Cutaneous carcinoma I. A statistical analysis with respect to the 

duration and site of the tumors and the age of the patients at onset and at biopsy of tumor." 

Arch Pathology, 1941. 31: 411-421. 

246. Schrek, R., "Cutaneous carcinoma II. A statistical analysis with respect to measures of 

innate and clinical malignancy." Arch Pathology, 1941. 31: 422-433. 

247. Schrek, R., "Cutaneous carcinoma III. A statistical analysis with respect to site, sex and 

preexisting scars." Arch Pathology, 1941. 31: 434-448. 

78
 
 

 

 

 

 

 

 

 

 

 

 

248. Schrek, R., "A nomogram for determining the statistical significance and the probable error 

of differences of percentages." J Lab Clin Med, 1939. 25: 180-184. 

249. Schrek, R., "Logarithmic frequency distributions." Human Biology, 1941. 13: 1-22. 

250. Schrek, R., "Logarithmic correlation coefficients and regression equations." Human Biology, 

1942. 14: 95-103. 

251. Schrek, R., "Operation of the Tumor Clinic at Hines, Ill., during the calendar year 1941." US 

Veterans Administration Medical Bulletin, 1943. 20: 181-186. 

252. Schrek, R., "Studies in vitro on the physiology of normal and cancerous cells I. The effect of 

high temperature and of moccasin venom on the viability of rabbit lymphocytes and 

polymorphonuclear leukocytes as determined by the method of unstained cell counts." Arch 

Path, 1943. 35: 857-868. 

253. Schrek, R., "Studies in vitro on the physiology of normal and cancerous cells II. The 

survival and the glycolysis of cells under aerobic and under anaerobic conditions." Arch 

Path, 1944. 37: 319-327. 

254. Schrek, R., "Studies in vitro on physiology of cells: effect of anisotonic solutions." Proc Soc 

Exp Biol Med, 1944. 57: 348-351. 

255. Schrek, R., "Studies in vitro on physiology of cells: histologic reactions of living tissues to 

hypotonic solutions." Am J Path, 1945. 21: 1101-1119. 

256. Schrek, R., "Radiosensitivity of lymphocytes and granulocytes in vitro according to the 

method of unstained cell counts." Proc Soc Exp Biol Med, 1945. 58: 285-286. 

257. Schrek, R., "A method for mounting gross pathologic specimens in Petri dishes." J Lab Clin 

Med, 1944. 29: 91-96. 

258. Schrek, R. and Allaben, G.R., "Statistical analysis of 2407 admissions to the Tumor Clinic of 

Veterans Hospital, Hines, Illinois, during 1943." Cancer Res, 1945. 5: 539-546. 

259. Schrek, R., "Cutaneous carcinoma IV. Analysis of 20 cases in Negroes." Cancer Research, 

1944. 4: 119-127. 

260. Schrek, R., "The racial distribution of cancer I. Epithelial tumors of the skin, lip and breast." 

Cancer Research, 1944. 4: 433-437. 

261. Schrek, R., "The racial distribution of cancer II. Tumors of the kidney, bladder and male 

genital organs." Ann Surg, 1944. 120: 809-812. 

262. Schrek, R., Baker, L.A., Ballard, G.P. and Dolgoff, S., "Tobacco smoking as an etiologic 

factor in disease. I. Cancer." Cancer Research, 1950. 10: 49-58. 

79
 
 

 

 

 

 

263. Advisory Committee to the Surgeon General, Smoking and Health. Washington, DC: Public 

Health Service, 1964, 152 and p. 252. 

264. Schrek, R., "Studies in vitro on physiology of cells: histologic reactions of living tissues to 

hypotonic solutions." Am J Path, 1945a. 21: 1101-1119. 

265. Schrek, R., "Studies in vitro on cellular physiology: the effect of X-rays on the survival of 

cells." Radiology, 1946. 46: 395-410. 

266. Schrek, R. and Donnelly, W.J., ""Hairy" cells in blood in lymphoreticular neoplastic disease 

and "flagellated" cells of normal lymph nodes." Blood, 1966. 27: 199-211. 

267. Lazell, E.W., "The group psychic treatment of dementia praecox by lectures in mental 

reeducation." US Veterans Bureau Medical Bulletin, 1930. 6: 733-747. 

268. Lazell, E.W., "The mechanism of psychic regression." US Veterans Bureau Medical Bulletin, 

1927. 3: 1089-1104. 

269. Lazell, E.W., The anatomy of emotion: man's two natures. Vol. 3. New York and London: 

The Century Co., 1929, 267. 

270. Lazell, E.W., "A study of the causative factors of dementia praecox: the influence of the 

blood and serum on embryological cells, a preliminary report." United States Veterans' 

Bureau Medical Bulletin, 1929. 5: 40-41. 

271. Lazell, E.W., "Sensitization in the convulsive states with special reference to heterophile 

antigen: I. Heterophile hemolysis." J Lab Clin Med, 1938. 23: 1160-1184. 

272. Lazell, E.W., "The Forssman or heterophile antigen." US Veterans Bureau Medical Bulletin, 

1932. 8: 477-485. 

273. Lazell, E.W., "Sensitization in the convulsive states with special reference to heterophile 

antigen: I. Heterophile hemolysis." J Lab Clin Med, 1938. 23: 1161. 

274. Lazell, E.W., "The influence of heterophile antigen in nervous and mental disease." US 

Veterans Bureau Medical Bulletin, 1940. 16: 235-252, 353-370. 

275. "Hypoglycemic treatment of schizophrenia." US Veterans Bureau Medical Bulletin, 1937. 

14: 94-96. 

276. Lazell, E.W., "The treatment of hay fever and ivy poisoning by local desensitization with 

sodium oleate and salts of other unsaturated fatty acids." US Veterans Bureau Medical 

Bulletin, 1938. 14: 216-219. 

80
 
 

 

 

 

 

277. "Messinger, Emanuel", in Directory of Medical Specialists, Volume 12, Marquis - Who's 

Who: Chicago 1535. 

278. Messinger, E., "The estimation of cardiac function by simple clinical methods." Ann Int Med, 

1937. 10: 986-999. 

279. Messinger, E., "Cardiovascular changes associated with the insulin shock treatment." Ann Int 

Med, 1938. 12: 853-865. 

280. Messinger, E. and Moros, N., "Cardiovascular effects of large doses of metrazol as employed 

in the treatment of schizophrenia." Ann Int Med, 1940. 13: 1184-1204. 

281. "New Neuropsychiatric Research Unit at Northport." US Veterans Administration Medical 

Bulletin, 1941. 18: 225. 

282. Roberts, C.S., "Follow-up report of 74 patients treated by pharmacologic shock compared 

with matched controls." US Veterans Administration Medical Bulletin, 1942. 19: 49-59. 

283. Moros, N., "The Alcoholic personality: a statistical study." Quarterly Journal of Studies on 

Alcohol, 1942. 3: 45-49. 

284. Turner, W.J., "Some dynamic aspects of alcoholic psychoses." Am J Psychiatr, 1942. 99: 

252-254. 

285. Moros, N., "Factors in the development of general paralysis." US Veterans Administration 

Medical Bulletin, 1943. 20: 196-201. 

286. Huddleson, J.H., "Note on psychoses and psychoneuroses with malaria." US Veterans 

Administration Medical Bulletin, 1944. 21: 1-4. 

287. Turner, W.J., "A year's experience with electroencephalography." US Veterans 

Administration Medical Bulletin, 1944. 20: 239-245. 

288. Turner, W.J. and Roberts, C.S., "An adhesive nondrying electrode paste." J Lab Clin Med, 

1944. 29: 81. 

289. Turner, W.J., Kress, B.H. and Harrison, N.B., "Determination of dihydroxyacetone in blood." 

J Biol Chem, 1943. 148: 581-584. 

290. Roberts, C.S., Turner, W.J. and Huddleson, J.H., "Variations of blood diastase and glucose in 

depression." J Nerv Ment dis, 1944. 99: 250-255. 

291. Turner, W.J., Lowinger, L. and Huddleson, J.H., "The correlation of pre-electroshock 

electroencephalogram and therapeutic result in schizophrenia." Am J Psychiatr, 1945. 102: 

299-300. 

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292. Huddleson, J.H. and Lowinger, L., "Note on initial and succeeding voltages to obtain grand 

mal in electroshock therapy." J Nerv Ment Dis, 1945. 102: 191-193. 

293. Turner, W.J., "A note on a mechanism of arterial rupture in cerebral arteriosclerosis." J 

Neuropath and Exp Neurol, 1946. 5: 168. 

294. Huddleson, J.H. and Gordon, H.L., "Fractures in electroshock therapy as related to 

roentgenographic spinal findings." Military Surgeon, 1946. 98: 38-39. 

295. Lowinger, L. and Huddleson, J.H., "Complications in electric shock therapy." Am J 

Psychiatr, 1946. 102: 594-598. 

296. Reisinger, J.A., "Study of hypertension in veterans." Ann Int Med, 1937. 10: 1371 - 1389. 

297. Reisinger, J.A. and Wilcox, B.B., "Heart weight and the measurement of the cardiac 

silhouette." US Veterans Administration Medical Bulletin, 1938. 15: 108-117. 

298. Reisinger, J.A., "Statistical study of heart diseases." US Veterans Administration Medical 

Bulletin, 1939. 16: 33-44. 

299. Reisinger, J.A. and Wilcox, B.B., "Statistical study of heart diseases." US Veterans 

Administration Medical Bulletin, 1942. 18: 351-362. 

300. Traum, A.H., "An etiologic study of 1036 cases of organic heart disease." US Veterans 

Administration Medical Bulletin, 1944. 20: 377-388. 

301. Reisinger, J.A., "The determination of exercise tolerance by the two-step test." Am Heart J, 

1938. 15: 341-353. 

302. Reisinger, J.A., "The cold-pressor test." Med Ann District of Columbia, 1941. 10: 381-386. 

303. Reisinger, J.A., "Dissecting aneurysm of the aorta." Arch Int Med, 1940. 65: 1097-1115. 

304. "Article by John A. Reisinger." US Veterans Administration Medical Bulletin, 1940. 17: 

195. 

305. Reisinger, J.A., Pekin, T.J. and Blumenthal, B., "Primary tumor of the inferior vena cava and 

heart with hemopericardium and alternation of the ventricular complexes in the 

electrocardiogram." Ann Int Med, 1942. 17: 995-1004. 

306. Blumenthal, B., "Nonclinical features of coronary arteriosclerotic heart disease." US 

Veterans Administration Medical Bulletin, 1939. 16: 45-52. 

307. Blumenthal, B. and Reisinger, J.A., "Prodromal pain in coronary occlusion." Am Heart J, 

1940. 20: 141-159. 

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308. Blumenthal, B. and Reisinger, J.A., "Pain in coronary arteriosclerotic disease of the heart." 

US Veterans Administation Medical Bulletin, 1941. 18: 166-172. 

309. Reisinger, J.A., "Coronary arteriosclerosis and heart pain." US Veterans Administration 

Medical Bulletin, 1942. 19: 127-133. 

310. Howell, J.D., ""Soldier's heart": the redefinition of heart disease and specialty formation in 

early twentieth century Great Britain." Medical History, 1985. Supplement No. 5: 34-52. 

311. Reisinger, J.A., "Neurocirculatory asthenia." US Veterans Administration Medical Bulletin, 

1943. 20: 8-20. 

312. Mazer, M. and Reisinger, J.A., "The thiocyanates in the treatment of hypertension." US 

Veterans Administration Medical Bulletin, 1942. 19: 42-48. 

313. Mazer, M., "A simple method for measuring cardiac area from the orthodiagram." Am Heart 

J, 1942. 24: 511-513. 

314. Mazer, M. and Reisinger, J.A., "An electrocardiographic study of cardiac aging based on 

records at rest and after exercise." Ann Int Med, 1944. 21: 645-652. 

315. Mazer, M. and Reisinger, J.A., "Criteria for differentiating deep Q3 electrocardiograms from 

normal and cardiac subjects." Am J Med Sci, 1943. 206: 48-53. 

316. Mazer, M. and Wilcox, B.B., "A simple graphic method for measuring the area of the 

orthodiagram." Am J Roentgenol, 1944. 51: 444-446. 

317. Mazer, M., "Palindromic rheumatism." JAMA, 1942. 120: 364-365. 

318. Kistin, A.D. and Mazer, M., "Current practice in cardiovascular diseases: I. The treatment of 

acute myocardial infarction." US Veterans Administration Medical Bulletin, 1943. 19: 369­

384. 

319. Mazer, M. and Kistin, A.D., "Current practice in cardiovascular diseases: I. The use of 

digitalis." US Veterans Administration Medical Bulletin, 1943. 19: 247-264. 

320. Traum, A.H. and Wilcox, B.B., "Cardiovascular disease among veterans of World War II: a 

survey of 19,870 cases." N Eng J Med, 1946. 234: 82-86. 

321. Traum, A.H. and Wilcox, B.B., "An analysis of one hundred and fifty cases of cardiovascular 

disease in World War II veterans." Mil Surgeon, 1945. 95: 5-10. 

322. Traum, A.H., "Arteriosclerotic and hypertensive heart disease with right axis deviation." Am 

J Med Sci, 1944. 208: 355-360. 

83
 
 

 

 

 

 

 

 

323. Traum, A.H., "Interauricular septal defect with mitral stenosis - Lutembacher's syndrome." 

US Veterans Administration Medical Bulletin, 1944. 20: 274-276. 

324. Yater, W.M., Traum, A.H., Brown, W.G., Fitzgerald, R.P., Geisler, M.A. and Wilcox, B.B., 

"Coronary artery disease in men eighteen to thirty-nine years of age." Am Heart J, 1948. 36: 

334-372; 481-526; 683-722. 

325. Kistin, A.D., "Simple manual cassette changer for multiple exposures in angiocardiography." 

Am J Roentgen, 1951. 65: 615-618. 

326. Kistin, A.D., Brill, W.D. and Robb, G.P., "Normal esophageal and gastric 

electrocardiograms: description, statistical analysis and bearing on theories of 

"electrocardiographic position"." Circulation, 1950. 2: 578-597. 

327. Kistin, A.D. and Robb, G.P., "Modification of the electrocardiogram of myocardial infarction 

by anomalous atrioventricular excitation (Wolff-Parkinson-White syndrome)." Am Heart J, 

1949. 37: 249-257. 

328. Kistin, A.D., "Observations on the anatomy of the atrioventricular bundle (Bundle of His) 

and the question of other muscular atrioventricular connections in normal human hearts." Am 

Heart J, 1949. 37: 849-867. 

329. Kistin, A.D. and Brill, W.D., "Clinically significant differences between precordial 

electrocardiograms derived from V and CF leads." Ann Int Med, 1950. 33: 636-647. 

330. Thompson, J.L. and Kistin, A.D., "Hoarseness in heart disease." Ann Int Med, 1948. 29: 

259-273. 

331. Cooke, F.N., Evans, J.M., Kistin, A.D. and Blades, B., "An anomaly of the pulmonary 

veins." J Thor Surg, 1951. 21: 452-459. 

332. Kistin, A.D. and Landowne, M., "Analysis of retrograde conduction to the aorta from 

premature ventricular contractions, a common occurrence in the human heart." Fed Proc, 

1950. 9: 71-72. 

333. Kistin, A.D. and Landowne, M., "Retrograde conduction from premature ventricular 

contractions, a common occurrence in the human heart." Circulation, 1951. 3: 738-751. 

334. Landowne, M. and Kistin, A.D., "The diagnosis of ventricular aneurysm. A study of certain 

clinical and dynamic features." J Lab Clin Med, 1950. 36: 847-848. 

335. Telephone interview with Milton Landowne, M.D., June 25, 1997. 

336. "Proceedings of the Thirteenth Conference of the Medical Council, Veterans 

Administration." October 12-13, 1939. Washington, DC, 1939, 37. 

84
 
 

337. "Proceedings of the Thirteenth Conference of the Medical Council." October 12-13, 1939, 

1939, 27-29. 

338. "Proceedings of the Thirteenth Conference of the Medical Council." October 12-13, 1939, 

1939, 43-44. 

339. "Proceedings of the Thirteenth Conference of the Medical Council." October 12-13, 1939, 

1939, 40. 

340. Adkins, R.E., Medical Care of Veterans. 1967, 170-171. 

341. Magnuson, P.B., Ring the Night Bell. Birmingham, AL: Little, Brown&Company, reprinted 

by University of Alabama Press, 1986, 1960, 303. 

342. Letter from Ray Lyman Wilbur, M.D. to E.O. Crossman, M.D., written at Palo Alto, CA, 

October 7, 1924. 

343. Maisel, A.Q., "The veteran betrayed: how long will the Veterans' Administration continue to 

give third-rate medical care to first-rate men?" The Reader's Digest, April, 1945, 45-50. 

344. Letter from Ray Lyman Wilbur, M.D. to Albert Q. Maisel, written at Palo Alto, CA, 

November 21, 1944. 

345. Letter from Frank T. Hines to Ray Lyman Wilbur, M.D., written at Washington, DC, 

December 21, 1944. 

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86
 
Section II. Beginnings of the Modern Program
 

1946-1953
 

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Chapter 3. Post-War Progress: Modern VA Research Begins 

From 1946 to 1953, the effects of World War II on medicine in general and VA in particular were 

notable. The war's impact on literally millions of people, and the concerted response of the world 

medical community to unprecedented new challenges, brought sweeping changes to the health care 

landscape. In America, huge numbers of returning Veterans already had pushed VA to its limits 

and beyond. The era would mark the transformation of the entire VA system, including the rebirth 

of a near-dormant medical research program. 

From the pre-war, hospital-based research efforts—scattered randomly at sites where local interest 

and initiative provided the impetus—emerged a modest new intramural VA research program. As it 

gradually took form, initial efforts were made to establish an infrastructure from which coordinated 

initiatives could be directed. These formative years were marked by limited funding, demands upon 

hospital space for clinical needs, and creation of a new culture among practitioners striving to 

establish research as a formal part of the VA mission. 

A key figure in the overall conversion of the agency was General Omar N. Bradley, who had been 

appointed by President Truman in 1945 as Administrator of Veterans Affairs. Bradley's enormous 

public persona had been earned largely on the battlefield. He was viewed, especially among the 

rank-and-file, as a soldier's soldier—someone who, despite his four stars, understood the basic 

needs of his troops. Given the enormous task at hand, Bradley's great credibility would be 

indispensable in earning the political support needed to push through legislation that would enable 

VA to measure up to public expectations. 

Bradley immediately named Paul Hawley, M.D., to head the VA's Medical Department. Dr. 

Hawley had been Chief Surgeon of the European Theater of Operations, adding another dimension 

of direct familiarity with the medical needs of wounded and returning service personnel. Bradley 

and Hawley recruited more high-profile leadership with the naming of Paul Magnuson, M.D., as 

Assistant Chief Medical Director for Research and Education. A dynamic academic surgeon from 

Chicago, Magnuson was widely known among the leaders of the nation's medical schools, and 

became instrumental in associating VA medicine with these institutions. 

The post-war restructuring of VA medicine 

Between the two World Wars, VA medicine was a vigorous, ingrown, semi-military system, which 

published its own journal and had a modest in-house research program. However, budget cuts 

during the Great Depression and shortages during World War II took their toll in terms of staffing. 

During the first year of the war alone, VA lost 7,000 employees.1 

Until the 1930s, most VA physicians were Veterans of World War I.2 Most of the younger doctors 

hired after 1933 were drafted into World War II. As a result, VA’s small, aging physician staff was 

severely overworked. For these and other reasons, VA had acquired a reputation for inferior 

medical care. During the war, Dr. Paul Magnuson, who later became the first Assistant Chief 

Medical Director for Research and Education, worried about the care of servicemen when the 

fighting was over: 

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 “As every doctor knew, and as we from Chicago could see for ourselves at the Veterans 

Administration’s big Hines General Hospital west of town with its 3,253 beds, the Veterans 

Administration Medical Department was in a sad state of decay. Medical treatment was so far 

below standard that the newspapers were beginning to notice the smell. I didn’t know it then, 

but before the war was over this thing was going to blow up into a first-class nationwide scandal 

of bad treatment, costly blunders and administrative incompetence.”3 

At war’s end, VA was unable to cope with the huge numbers of returning ill and injured soldiers 

and sailors. Through 1945, some doctors assigned to VA by the Army and Navy helped, but in 

January 1946, VA had fewer than a thousand doctors to care for 100,000 patients.4, 5 As Michael 

DeBakey, M.D., described the situation: “the VA, at the end of the War, was simply unable to take 

care of the wounded.”6 The same was true of those with illnesses resulting from their service in the 

war. 

Establishment of the Department of Medicine and Surgery 

In 1945, serious delays in appointing medical staff held back the rebuilding of the VA medical 

system. Young, qualified physicians being discharged from the military wanted to join VA; at the 

same time VA desperately needed them. As Magnuson said, “Doctors without patients, patients 

without doctors!”7

 A means was needed to free the hiring of doctors, dentists and nurses from Civil 

Service restrictions and delays. 

From the beginning, VA staff and advisors had tried to establish a VA medical corps. Early on, 

Administrator Hines supported these efforts, but later he opposed them despite the many difficulties 

of using the Civil Service procedures to recruit physicians. Slow recruitment and laborious 

promotion procedures (in which Hines personally signed off on all promotion actions)8

 saved 

money, an important goal to him. Nevertheless, these delays prevented VA from responding 

rapidly to new demands for medical care. Also, the Medical Department didn’t report directly to 

the Administrator. In Hines’s opinion, the Medical Department was better at a lower level in the 

organization, where doctors could concentrate on professional work and not worry about nonmedical aspects of running the hospitals. 

Magnuson, Hawley and Bradley worked together to push the medical corps concept through the 

Congress. With Public Law 293, the Department of Medicine and Surgery (DM&S) was born. In 

supporting this action, Hawley told the Senate: 

 “Unless (Public Law 293) is enacted into law at once, before the recess of Congress, the 

Medical Service of the Veterans Administration will suffer further grave consequences, which 

may be irreparable. In the interests of the thousands of disabled Veterans who have by their 

sacrifices earned better medical care than they are now receiving, I urge immediate action on 

this bill.”9 

Not surprisingly, the Civil Service leaders opposed the bill and urged the President not to sign, 

which would amount to a “pocket veto.” In his autobiography, Ring the Night Bell, Magnuson 

gives a dramatic portrayal of the last-minute reprieve of Public Law 293, 79th Congress. According 

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to Magnuson, Truman signed the bill only after the Washington Post reported that the Civil Service 

Commission and Bureau of the Budget urged a Presidential veto.10 

Figure 3.1. Magnuson, Bradley and Hawley, the architects of Public Law 293 

Armed with freedom to hire physicians, improved salaries, and partnership with the nation’s 

medical schools, the new Department of Medicine and Surgery prospered. Within six months, VA’s 

full-time physician staff increased from 600 to 4,000,11 not including the resident physicians 

assigned to VA after medical school affiliations had begun. 

Affiliation with medical schools—the concept 

The nation’s medical schools helped to remedy the crisis in VA medicine. Affiliations with medical 

schools grew rapidly under Magnuson’s leadership, and he is generally credited for having the 

vision to establish these partnerships. Two years before he joined VA, Magnuson had made just 

such a proposal to Administrator Hines: 

 “[W]hen the Veterans Administration built or leased or otherwise created new hospitals to 

meet the tremendous need that was coming, it ought to put them near the established medical 

schools and make them teaching hospitals like Presbyterian and Belleview.... I suggested that 

the Veterans Administration arrange to have the deans of the medical schools staff the 

hospitals, putting in chiefs of service, residents and interns.”12 

But the concept of VA-medical school partnership was not unique to Magnuson. Renowned heart 

surgeon Michael DeBakey recalled in a recent interview that others shared the concept: 

 “[O]ne of the ideas cropped up—I can’t tell whose original idea it was because, you know, 

these things were talked back and forth, and I was participating in it—was to have the medical 

schools affiliated with VA. One of the reasons we talked about this was because we had various 

general hospital units in the Army that were sponsored by medical schools. In fact, my own 

school had a unit, Tulane, but you had the Harvard Unit, you had the Hopkins Unit, and so on.”6 

Others had similar ideas. In 1944, Dr. Roy Kracke, Dean of the Medical College of Alabama, wrote 

General Hines suggesting that a VA hospital be built in Birmingham and serve as a teaching 

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hospital for the medical college. Hines rejected this proposal as well as the concept of medical 

school affiliation.13 

Medical school affiliations begin 

Medical school affiliations began as soon as the legislation establishing DM&S came into effect. 

Under the new law, well-trained physicians leaving the military could now be hired as staff 

physicians in VA hospitals without delay. Dr. Magnuson, strongly supported by Generals Bradley 

and Dr. Hawley, who was a retired Major General, worked feverishly to invigorate the VA medical 

program with the help of medical schools. By early 1947, VA hospitals, which had no resident 

physicians in training before 1946, now boasted some 1,000 residents.14 

VA physicians hired as a part of a medical school affiliation expected to do research as an integral 

part of their academic roles. This required that research be carried out in VA hospitals. However, 

most VA hospitals had no laboratories suitable for basic research.15 The original concept of 

Magnuson, Hawley and their co-workers was that VA research would be primarily clinical. The 

new VA doctors, however, wanted to be first-class academic physicians; for many, that meant doing 

bench research. 

The barriers to research were many: Hospitals had no research space, no research equipment and no 

technical staff. Existing regulations forbade accepting research support from any person or agency 

other than VA, which didn’t even have a research budget.8, 16 Hospital management was 

inexperienced in supporting research and didn’t understand research and its benefits for their 

hospitals. There was little research tradition in many medical schools and none in most VA 

hospitals. On the other hand, the new Deans Committees were very active in fostering research 

programs. 

Keeping all VA doctors well informed: the Technical Bulletins 

After VA’s Medical Bulletin stopped publication in 1944, VA was without an official journal. 

However, the new leadership wanted to keep the medical staff up-to-date about medicine, science 

and administration. Toward this end, between 1946 and 1955, the new DM&S published a series of 

Technical Bulletins intended to inform VA physicians about the latest research and clinical care. 

Arthur Walker, M.D. the talented Tuberculosis Service Research Chief, became the editor. While 

some Technical Bulletins were administrative, others contained a great deal of new medical 

information. Many were written by highly respected authorities (Appendix III). For example, Jay 

Shurley, M.D., who later became a Senior Medical Investigator, wrote a Technical Bulletin on 

insulin shock therapy. At that time, he was running a unit that was a leader in this kind of therapy. 

Louis Welt, M.D., and Donald Seldin, M.D. wrote on edema, and Welt also wrote about 

dehydration. J. H. Means, M.D. wrote a Technical Bulletin advocating radioiodine therapy for 

hyperthyroidism in 1946, when peaceful use of atomic energy was just beginning (Chapter 6). 

Exciting results of the first streptomycin trial (Chapter 5) were shared with VA staff in the Bulletin 

before being published elsewhere. Richard Ebert, M.D., wrote about measurement of cardiac 

output. Peter Florsheim, M.D., and George Thorn , M.D. wrote about adrenal cortical insufficiency 

in 1950, just when cortisone became available for treatment. Willem Kolff, M.D. wrote about 

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dialysis for renal failure, well before this was common practice. Also ahead of its time was a 1950 

Bulletin on cardiac massage after operating room cardiac arrest. 

American medical research in 1946 

During World War II, the war effort stimulated medical research. At a national level, the 

Committee on Medical Research (CMR), an arm of the powerful Office of Science and Technology, 

the same governmental office that supervised atomic bomb development, coordinated wartime 

medical research. The CMR arranged for the National Research Council (NRC) of the National 

Academy of Sciences to manage peer review committees to help decide who should receive 

contracts for medical research. Military medicine made great strides, thanks to both CMRcoordinated research and a modern system of medical records.6, 17 As Richard H. Shryock, M.D. 

wrote in 1947, “The American people have been slow in realizing the significance of basic research. 

It has taken time to build up the interest prerequisite to public support in a democracy.”18 

At the end of World War II, American medical research was still limited to a few institutions and a 

few dedicated investigators, frequently working with their own resources or private support.19 It was 

only in 1946 that the National Institute for Health (NIH) (soon to be expanded to the National 

Institutes of Health) began a grants program and established its Division of Research Grants. 

Previously, all NIH research support, except for a small National Cancer Institute grants program, 

was intramural or contractual.20 The entire 1945 NIH budget was only $180,000, but by 1947 it had 

shot up to $8 million.21 Only a few medical schools had large research programs. Most medical 

research, in medical schools and elsewhere, was clinical in nature.22 

Research leaders in the early post-war VA 

As VA’s first Assistant Chief Medical Director for Research and Education (ACMD/R&E), 

Magnuson headed up establishment of the Research and Education Service. Robert Kevan, a young 

officer who had planned to study hospital administration, became his executive officer in December 

1945.23, 24 In 1946, he recruited Edward Harvey Cushing, M.D., to be Chief of the Education 

Section25 and in 1947, Louis Welt to be Chief of the Research Section. When Magnuson was 

promoted to Chief Medical Director in 1948, Cushing became ACMD/R&E. Cushing resigned in 

1951 and was replaced by George Lyon, M.D., who continued as ACMD/R&E until 1956. 

Figure 3.2. Paul Magnuson, M.D. 

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Paul Magnuson, M.D., the first ACMD/R&E (1945-1948)
 

Dr. Magnuson has been described by those who knew him as a “stormy petrel,”8

 a “whirling 

dervish,”26 a “pistol” and a brilliant man who did a tremendous amount of work.27 Robert Kevan,
 

who was Magnuson’s Administrative Officer, described him as a great man who was very blunt, 

forceful and driving. Magnuson knew what he wanted and would do almost anything to get it. 

Figure 3.3. Robert Kevan 

Kevan recalled that he was a wonderful man to work with. If you made the “right” decision, he 

would back you up. If you made the “wrong” decision, he would give you a hard time.23, 24 Ralph 

Casteel, who succeeded Kevan in 1948, agreed. He recalled that Magnuson “preached that the best 

medicine was practiced by those who also taught and who explored new therapeutic modalities.” 

Figure 3.4. Ralph Casteel 

Magnuson believed that “the fight against bureaucracy and bureaucratic thinking is never won.” By 

his own admission, he was insubordinate: “I have never in my life worked for anybody but a 

patient.”28 As ACMD/R&E and later as Chief Medical Director, he worked tirelessly to set up and 

protect VA-medical school partnerships. Even after leaving VA in early 1951, he remained active. 

He was known to have contacted the White House when a new hospital was planned at a site other 

than the promised location.29 Martin Cummings, M.D., recalled that it was actually Magnuson who 

94
 
 

 

 

 

 

 

 

 

 

 

recruited him to come to Central Office as Director, Research Service, in 1953. Cummings’s new 

boss, Dr. George Lyon, was taken by surprise.30 

Magnuson was interested in all aspects of academic medicine, but most of his attention went to 

upgrading patient care and teaching programs. Cummings recalled that, when Magnuson and John 

Barnwell, M.D., visited his laboratory near the Atlanta VA Hospital in 1950, Barnwell stayed to 

discuss science while Magnuson went off to the hospital to see the clinical service.30 

Edward Harvey (Pat) Cushing, M.D., the second ACMD/R&E (1948-1951) 

Figure 3.5. E.H. (Pat) Cushing, M.D. 

Cushing (Figure 3.5) was energetic, intelligent and well-educated.31 An internist from Harvard 

Medical School, he had been in private practice in Cleveland before the War. He was a nephew of 

Harvey Cushing, the famous neurosurgeon, and was the fifth physician in his family line. 

According to Alfred H. Lawton, M.D., who was Research Chief under him, he was a delightful 

person who “ran the office as a committee.”16 

Cushing was a disciple of Magnuson. He stayed on about a year after Administrator Carl Gray fired 

Magnuson. When Cushing resigned in February 1952, his departure was abrupt and without 

warning.8 Why he left is unclear, but his obituary says it was in protest.32 

George Lyon, M.D., the third ACMD/R&E (1951-1956) 

Cushing’s successor as ACMD/R&E was George M. Lyon, M.D., who had been Special Assistant 

to the Chief Medical Director for Atomic Medicine and Chief of the Radioisotope Section of the 

Research and Education Service. 

Dr. Lyon has been described as difficult to work with by some of his colleagues. Instead of pushing 

for budget increases, he would ask for three budgets: Plan A/reduction, Plan B/hold-even and Plan 

C/slight increase. He supported the entire research program, but paid special attention to the 

Radioisotope program he also headed. 

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Early Chiefs of the Research Section 

Research program leadership fell first to Dr. Louis Welt,, a young Instructor of Medicine at Yale 

who was Chief of the Research Section from 1947 to 1948.33 Welt was replaced by Alfred Lawton, 

dean of a two-year medical school in North Dakota.16 After Lawton left in 1951, the position 

remained vacant for two years. During that time, John Nunemaker, M.D., who was later Director, 

Education Service, was Acting Chief for a few months, and he was followed by Arthur Abt, M.D.34 

Then the position was vacant until 1953, when Martin Cummings came to VA Central Office 

(VACO) (Chapter 7). 

Louis Welt, M.D. (1947-1948) 

As the first Chief of the Research Section (1947-1948), Welt was active in starting collaborative 

programs with the National Academy of Sciences (NAS). He also arranged contracts with medical 

school faculty to carry out clinical research of importance to the Veteran patient. Welt worked with 

the VA Construction Service to try to alter plans for new VA hospitals to include research 

laboratory space. He is remembered as bright, young and energetic. Magnuson hired him without 

concern for VA’s usual recruitment processes.23, 24, 35 After staying only about a year, Welt returned 

to Yale as an NIH fellow and later Assistant Professor. He subsequently moved to the University of 

North Carolina, where he rose to the position of Chairman of Medicine, and then he returned to 

Yale as Chairman of Medicine.33 During the 1950s, he wrote two VA Technical Bulletins on fluid 

metabolism.36, 37 At the time of his death in 1973, he was assisting NAS in beginning a review of 

the VA patient care program (Chapter 16).38 

Alfred Lawton, M.D. (1948-1951) 

Lawton had been Dean of the two-year medical school at the University of North Dakota. He 

recalled that he spent a large fraction of his Central Office time traveling about the country trying to 

start research laboratories. Two major problems were finding staff capable of doing research and 

finding appropriate space. As he recalled, money was not a problem; research funds were available 

for justifiable programs. He left VA in 1951 to start a medical research program for the Air Force.39 

Figure 3.7. Alfred Lawton, M.D. (right), with Roger Egeberg, M.D., 

Chief of Medicine, West Los Angeles VA Hospital, 1949 

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Struggle for research space 

Dr. Welt and his successor VACO Chiefs of Research made a major effort to insert research space 

into plans for the new VA hospitals being rapidly built to correct the national shortage of beds for 

Veterans. Most new hospital plans didn’t include space for research or radioisotope laboratories. 

Sometimes plans could be changed before construction, but research space was generally 

inadequate. For years, hospitals had to be retrofitted for research. Given the limits of the VA 

construction system, research space was squeezed into places like renovated closets, garages, 

laundries and bathrooms. Since construction monies were hard to get, these laboratories were 

primarily built with operational monies, each project costing less than the $15,000 limit.16 Despite 

these obstacles, Welt, Lawton and their successors and counterparts at hospitals succeeded in 

making the intramural program flourish. By 1952, VA had medical research programs at 66 

hospitals, with 373 employees paid from money set aside for support of research.40 In 1952, Harold 

F. Weiler joined the Central Office team, as Chief of the Research Laboratories Section, to 

spearhead the construction and furnishing of the needed laboratories. 

Figure 3.8. Harold F. Weiler 

A “Research Hospital” is built 

An important exception to the neglect of research space construction was the opening in 1953 of the 

new Chicago VA Research Hospital, later called the Chicago Lakeside VA Medical Center. A 

Chicago consulting group considered the best hospital architects in the business designed it.41 

Unlike other new VA hospitals, it had an all-marble exterior. Magnuson worked on every aspect of 

design and construction and watched each step carefully. According to his Executive Assistant 

Ralph Casteel, Magnuson “knew every crack in the rails between Washington and Chicago” from 

his frequent overnight trips to see how the construction was going.8

 This hospital was designed for 

the most advanced patient care available, and an entire floor was devoted to research laboratories. 

Francis Haddy, M.D., one of the first three physicians to work there in 1953, recalled that while the 

hospital construction had been finished when he arrived, the hospital was empty. For the first few 

months, the three physicians who were there, together with a helpful supply officer, went through 

catalogs and ordered everything “from bedpans to the most sophisticated research equipment.” 

Haddy remembers no budget restrictions; they could buy the best.42 

Half of the research floor was devoted to the radioisotope laboratory. John A.D. Cooper, M.D., of 

the Northwestern University faculty, who had trained under Magnuson, worked with the architects 

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to design this laboratory and later became its Chief. Thus, cutting-edge radioisotope research and 

clinical care was available at Lakeside from the moment the hospital opened.43 

Gifts for research get the green light 

When the VA research program was reborn after World War II, VA scientists were not allowed to 

accept gifts for research. Dr. Cushing pushed a policy, announced January 18, 1952, that 

nongovernmental gifts could be received and placed in the General Post Fund if approved by the 

Chief Medical Director. Expenditures, however, must honor donor stipulations.44 

When Dr. Lyon described the new policy to the Committee on Veterans Medical Problems, he 

noted that interagency transfer of funds at the Central Office was possible, but the U.S. Public 

Health Service did not transfer funds appropriated for research grants to VA. He also stated, “It is 

not the policy of VA to encourage VA personnel to seek funds from agencies other than VA for 

research.”45 The result was that there was no way that a VA person could get an NIH grant until 

that policy was changed in 1954 (Chapter 7). 

Cortisone research initiative 

In 1950, Lawton negotiated with pharmaceutical company Merck and Co. to make more than 2,000 

grams—said to be their entire supply—of the newly synthesized hormone cortisone available to VA 

for research. Twelve VA hospitals, including the Bronx; Chamblee, Ga; Cleveland, Ft. Hamilton, 

N.Y.; Ft. Logan (Denver), Colo.; Framingham, Mass.; Hines, Il.; Los Angeles, Minneapolis, Mt. 

Alto (Washington, DC), New Orleans and San Francisco, participated in cortisone studies. Their 

preliminary results were reported at a conference at Central Office in August 1950. Many leaders in 

VA research—among them, Solomon Papper, M.D., Marcus Krupp, M.D., Norman Shumway, 

M.D., Martin Cummings, M.D., Thaddeus Sears, M.D., William Adams, M.D., Ralph Goldman, 

M.D., James Halsted, M.D., Thomas Sternberg, M.D., William Merchant, M.D., Samuel Bassett, 

M.D., Louis Alpert, M.D., Hyman Zimmerman, M.D., Bernard Straus, M.D., Max Michael, M.D., 

James Hammarsten, M.D., and Maurice Strauss, M.D.46— presented basic and clinical papers. 

This conference stimulated further cortisone-related research, and two more conferences followed. 

This special program ended when the FDA approved cortisone for general clinical use.16 

VA research funding, 1946-1952 

During this formative period from 1946 to 1952, the overall research budget grew only modestly 

(Figure 3.9). 

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Figure 3.9 Research budget, 1947-1953 

0 

0.5 

1 

1.5 

2 

2.5 

3 

3.5 

4 

4.5 

5 

Millions of dollars

Current dollars 

Deflated to 1947 dollars 

1947 1948 1949 1950 1951 1952 1953 

Early on, the contract program grew, but later it declined as the intramural program began to solve 

its early problems and to reach “critical mass” (Figure 3.10). 

Figure 3.10 R&D funds by program type, 1947-1953 

7 

6 

5 

Millions of dollars 4 

3 

2 

1 

0 

1947 1948 1949 1950 1951 1952 1953 

Medical research contracts 

Prosthetics research contracts 

Intramural research 

Total R&D 

Research sponsored by other units in DM&S 

In addition to research leadership in the Research and Education Service, several other services 

identified research chiefs within their disciplines. Dr. K.R. Pfeiffer was Chief, Dental Research 

from 1949 until 1952. The Tuberculosis Service also had its Research Chief, Arthur Walker, who 

coordinated the early tuberculosis cooperative studies (Chapter 5). 

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Neuropsychiatry Service Research Chiefs for both Psychiatry and Psychology played key roles in 

launching the mental health research programs of the 1950s and 1960s. VA developed an active 

internship program early on for clinical psychology Ph.D. students, who were expected to produce 

research dissertations. Psychology leadership in Central Office actively encouraged research, and 

the Chief of Psychology Research, Maurice Lorr, M.D., reviewed all the resulting dissertations.47 

While informal interaction occurred between these programs and people in the Research Service, 

there seems to have been no effort at that time to centralize the various research programs. Each 

Service operated independently and found the money to pay for the research it sponsored. 

Six important research programs began during this early period, in addition to VA’s formal 

intramural research program. Medical research contracts, the prosthetics research contracts and the 

Follow-up Agency—all undertaken in collaboration with the National Academy of Sciences—are 

discussed in Chapter 4. Chapters 5 and 6 describe the research sponsored by the Tuberculosis 

Service and the Atomic Medicine Section of the Research and Education Service. Important 

research begun within the Neuropsychiatry Service during this early period led to vigorous 

psychopharmacology studies of the late 1950s and 1960s, as discussed in Chapter 8. 

Figure 3.11. Attendees at the 1952 VA Research and Education Conference 

VA research conferences 

In January 1951, Cushing and Lawton held a Medical Research Conference in Chamblee, Georgia. 

This began a series of conferences for VA research investigators that continued to be an important 

part of the research program until the late 1960s. Figure 3.11 shows the attendees gathered for the 

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second annual meeting in January 1952. In later years, these meetings became large and complex, 

with associated meetings of the radioisotope, tuberculosis and psychopharmacology groups. 

Research in the hospitals 

By 1948, a formal structure of local governance of the research programs in VA hospitals was in 

place.48 Each hospital had a Research and Education Committee, consisting of Service Chiefs and 

two Deans Committee representatives. In a 1952 presentation to the Committee on Veterans 

Medical Problems, Dr. Lyon described the role of the Executive Secretary of the hospital Research 

Committee and announced that he was attempting to formalize that position at the hospital level as 

the Chief, Investigational Service.40 By the late 1950s, this position was called the Associate 

Director of Professional Services for Research (ADPSR).49 By 1961, the title of this research chief 

had been changed to Associate Chief of Staff for Research and Education (ACOS/R&E), and in 

1972, it was once again changed, to Associate Chief of Staff for Research and Development 

(ACOS/R&D). 

Even in 1946, many more small clinical studies were probably under way than those known to 

Central Office. The average VA intramural researcher was entrepreneurial and resourceful. Except 

for reporting their publications, which had to be approved by Central Office, they were more 

accountable to their local superiors than to Central Office. A few examples follow: 

Salt Lake City VA Hospital 

When Dr. John Nunemaker began as Chief, Medical Service, at the Salt Lake City VA Hospital in 

1946, he used every means possible to start his research program. Most of the equipment he used 

belonged to the clinical laboratory. He established an animal facility in an old warehouse and raised 

rabbits on his farm and brought them in for experiments. For his bacteriological studies, he needed 

enriched serum and found that horse serum made a good medium. To obtain it, he would visit a 

slaughterhouse that prepared animal feed from horse meat. He would hold a bucket to collect the 

blood, which he anticoagulated to remove the red cells. He then let the serum clot and put it 

through a sausage grinder and then through a bacterial filter. The organisms grew well.50 In the 

early 1950s, Nunemaker moved to VA Central Office, where he became Director, Education 

Service (Chapter 7). 

Halloran VA Hospital and East Orange VA Hospital 

Pathologist Oscar Auerbach, M.D., who worked at the Halloran VA Hospital in Staten Island New 

York from 1947 to 1952, used clinical facilities for his research studies. Auerbach recalled that he 

worked full time as a routine hospital pathologist and did his research between 4 and 6 a.m. and 

during evenings and weekends.51 He moved to the new VA hospital in East Orange, N.J., in 1952. 

In the late 1950s, he carried out the work for which he is best known, showing smoking to be an 

important cause of lung cancer (Chapter 10). During the early post-war years, Auerbach’s studies 

were primarily on the pathology of tuberculosis, although he also wrote on the germinal epithelium 

in male paraplegics,52 hepatocellular carcinoma53 and osteogenic sarcoma.54 He collaborated with 

Gladys Hobby, Ph.D., then at Pfizer, Inc. but later at the East Orange VA Hospital, on animal 

studies aimed at developing an immunization method better than BCG for protection against 

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tuberculosis.55 He reported a huge series of observations from autopsies at Seaview Hospital, a 

tuberculosis hospital on Long Island where he had worked before the war. He brought the material 

with him when he joined VA. From these records and slides, he extracted clinical information 

about rare complications of tuberculosis: 311 cases of tuberculous empyema,56 421 cases of 

tracheobronchial tuberculosis,57 108 cases of tuberculous meningitis58, 59 and about 200 cases of 

serosal (pleural, peritoneal or pericardial) tuberculosis.60 After streptomycin became available, he 

published on the ways that treatment with the antibiotic affects the pathology of tuberculosis.61-63 

Oakland VA Hospital 

Bruno Gerstl, M.D., also a pathologist, went to the Oakland VA Hospital in California (later moved 

to Martinez) in 1946 or 1947. The hospital, located in a renovated hotel, was loosely affiliated with 

the University of California at San Francisco. Gerstl collaborated with members of the Medical 

Service on clinical studies of mitral insufficiency,64 erythrocyte fragility65 and cryptococcosis.66 In 

1953, he and other pathologists reported on water, sodium and potassium contents of the human, 

guinea pig and rabbit lung.67 Gerstl became interested in studying the immunology of cancer, for 

which needed, and eventually obtained, an animal room to house his guinea pigs. Gerstl also 

studied the immunology of tuberculosis, especially methods to measure tuberculosis antibodies.68-70 

Figure 3.12. Bruno Gerstl, M.D., and Hospital Manager at the Oakland VA Hospital 

Bronx VA Hospital 

Bernard Roswit, M.D., Rosalyn Yalow, Ph. D., and Solomon Berson, M.D., were active in setting 

up a radioisotope unit and doing research using radioisotopes at the Bronx VA Hospital during this 

period. Their work is described in Chapter 11. 

Ludwig Gross, M.D., was also active in research at this hospital, where he had transferred while still 

in uniform. During the time he could spare from his clinical duties, Gross was working in an old 

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bathroom. There, he bred leukemia-prone mice and tried to prove his theory of the viral cause of 

mammalian leukemia by transmitting this tendency to develop leukemia to normal mice. He finally 

succeeded in proving the theory in 1949. 

Figure 3.13. Ludwig Gross, M.D. (in 1975) 

Gross was a war refugee from Poland. In 1939, he had given a lecture at NIH in which he 

speculated that leukemia was caused by a virus and that some day we would have a vaccine for it. 

He was introduced at that time to the Surgeon General and to the nucleus of the NIH staff. He then 

returned to Europe and was in Poland when the Nazis invaded. He escaped just in front of the Nazi 

line. 

When, after many difficulties, he managed to return to the United States, he applied for a 

commission in the U. S. Army. At first he was turned down because he was not a citizen. He went 

to the Polish Ambassador, who wrote a letter that supported his entry into the U.S. Army Reserve in 

Cincinnati. 

While in Cincinnati, Gross studied neuroblastoma, a condition that may skip a generation in its 

transmission. Gross considered that this might be due to vertical transmission of disease from 

generation to generation through the genome. This led to the concept that the virus responsible for 

the cancer transmission became associated with the genome. Not everyone carrying the genome 

developed cancer, since there was some mutual benefit between the genome and the virus. 

Gross wanted to continue his research even after he entered active Army service. He wrote to John 

Joseph Bittner, Ph.D., the discoverer of a genetic line of mice that were very prone to breast cancer. 

He asked Bittner for a breeding pair of his mice and Bittner sent them. He had no laboratory, so he 

kept his mice in coffee cans covered with screens, in the trunk of his car and sometimes in his 

apartment. 

In 1944, the Army transferred him to a station in North Carolina near Durham. While on leave, he 

went to Philadelphia, where he visited Baldwin Lucke, M.D.,who was working on transmission of 

kidney cancer in frogs. They discussed the problem of viral transmission. When Lucke went with 

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him to his car, Gross opened the trunk and showed him his mice. Lucke was a consultant to the 

Surgeon General, and one week after this meeting, Gross received transfer orders to the Bronx VA 

Hospital. 

When he arrived at the Bronx, they told him to look for a room where he could set up a lab. He 

found a room that was being used for storage of oxygen tanks, which contained two toilets. The 

hospital staff cleared it out, and the carpenters covered the toilets. There, he studied the hemolytic 

action of mouse mammary carcinoma filtrates and extracts on mouse erythrocytes71, 72 and a similar 

effect of human cancer extracts on human erythrocytes.73 He later continued his study of breast 

cancer transmission, examining possibly oncogenic particles in mouse and human breast milk.74 

But Gross’s main interest was leukemia, and all he had when he arrived at the Bronx were his mice 

with a 90 percent chance of developing breast cancer. Jacob Furth, M.D., at Cornell had a strain of 

leukemia-prone mice, the AK strain. When Gross asked Furth for a breeding pair, he gave him 11 of 

his AK mice. Gross bred the mice himself. While there was no specific money for research, the 

hospital allowed him to spend some of his time conducting his studies. He spent five years, 1944 to 

1949, trying to transmit the tendency to leukemia to non-leukemia-prone mice by injection of 

filtrates. The hospital was considering taking away his research time and space, as he seemed to be 

nonproductive. 

In 1949, Gilbert Dalldorf, M.D., gave a lecture at the hospital about the Coxsakie virus. He 

explained that it could be transmitted only in newborns. Before Dalldorf even finished the lecture, 

Gross ran out to his laboratory where he had some newborn normal mice. He injected them with 

cells from AK mice, and they developed leukemia.75, 76 Later he found that he could also transmit 

leukemia with just a filtrate,77 and that the effect extended into the next generation.78 He 

characterized transmission of other viruses as well during this early period79-82 and evolved a theory 

about the viral transmission of malignancies.83, 84 

Figure 3.14. Laboratory in which Ludwig Gross carried out 

his original work on mouse leukemia 

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After Gross’s success in transmitting leukemia through the newborn mice, the Hospital Director, 

Ralph G. Devoe, a retired general, became very supportive and gave him substantial space to 

support his research. 

Gross had trained as a surgeon and had to learn experimental techniques from scratch. C.P. Rhodes, 

M.D., at Memorial Hospital adopted him as a friend and taught him a great deal about research. 

The man who made the filters that Gross was using also helped him to develop his techniques.85 

While extreme, Gross’s early experience at the Bronx VA Hospital exemplifies the determination 

and independence shown by many early VA researchers. They had little guidance and often were 

not well understood. Little or no research infrastructure was available. But a venturesome spirit 

that encouraged original thinking and inventiveness permeated the newly “academic” organization. 

Washington, D.C., VA Hospital 

Hyman Zimmerman, M.D., joined VA in 1949 at the old Mt. Alto (Washington, D.C.) Hospital and 

started a research laboratory there. He carried out the research himself, using clinical equipment 

and supplies, as well as some of his own funds. The question of getting money for research was not 

even raised; neither he nor anyone else even thought about asking for money to support his 

research. However, in 1951 he was recruited to the Omaha (Neb.) VA Hospital to be Chief of the 

Medical Service. Although he made the availability of a laboratory a condition of his recruitment, 

no research laboratory awaited him in Omaha. The Hospital Director contacted the Regional 

Director, and the Regional Director contacted Dr. Lawton. The princely sum of $25,000 was 

allocated to set up the new laboratory. There was no review of his research and, as he recalled, later 

support for his research came from the local hospital budget.86 

West Los Angeles Wadsworth VA Hospital 

Shortly after DM&S was established, the huge Wadsworth VA Hospital in Los Angeles formed a 

Dean’s Committee that included leaders from both the University of Southern California (USC) and 

the College of Medical Evangelists, now Loma Linda School of Medicine. After faculty for the 

planned University of California at Los Angeles (UCLA) School of Medicine began to arrive, 

UCLA also sat on the Dean’s Committee. B.O. Ralston, M.D., Dean of the School of Medicine at 

USC, was the Chairman. Ralston met Roger Egeberg, M.D., who had been General McArthur’s 

personal physician during the war, in Washington, and recruited him to be Chief of Medicine at 

Wadsworth. Egeberg (Figure 3.7) arrived in July 1946 and began working with the “old guard” to 

try to upgrade the facility. Planning for the new UCLA School of Medicine was under way, and 

key faculty were being recruited. Until 1955, UCLA had no hospital, and many of the new faculty 

worked at Wadsworth.87 

William Adams, M.D., arrived in Los Angeles in 1948 and joined the Wadsworth staff. Shortly 

thereafter, Adams and Ralph Goldman, M.D., began a multidisciplinary research effort. Once they 

had acquired laboratory space, they still lacked staff and funds to hire staff. Adams made two trips 

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to Washington, where he talked with Alfred Lawton. He presented Lawton with a proposed Table 

of Organization, and Lawton gave him funds to hire 14 or 15 technical staff in response to Adams’s 

argument was that a staff of this size was needed to attract senior people. After that, it still took 

more than a year to get the lab set up. 

Figure 3.15. Samuel Bassett, M.D. 

Samuel Bassett, M.D., came to Wadsworth about 1950. Bassett was seen as instrumental in the 

discovery of potassium deficiency syndrome in corrected severe diabetic acidosis. Adams 

remembered a patient who had become paralyzed after treatment for diabetic acidosis. Bassett 

suggested that she might have a low blood potassium level. Adams ran the potassium measurement 

himself by a colorimetric method (flame photometry was not yet available). No one believed the 

results because they were so low. After the patient was given potassium, they were able to take her 

out of the respirator and she improved. The resident who wrote the paper received the credit for this 

important discovery.88 

John Lawrence, M.D., the newly appointed Chairman of Medicine at UCLA, used money from 

Parke Davis Company to renovate four Quonset huts on the VA campus behind Building 114 for 

the use of the new UCLA faculty. These Quonset huts were empty, requiring that everything be 

installed including a heating system. The laboratory work benches were obtained free from the old 

chemistry building at the University, when a new chemistry building was built. A walk-in cold 

room was put in at a cost of $2,500. A weighing room had to be specially constructed, because the 

Quonset hut shook. To stabilize the balances, a concrete slab was laid through the floor.89 

Egeberg’s effort as Chief of Medicine was primarily to build the Medical Service and, incidentally, 

to protect his staff during the McCarthy era.87 He wrote clinical papers even before there was a 

research laboratory at Wadsworth.90, 91 His personal research interest was coccidioidomycosis. In 

addition to clinical treatment trials,92, 93 he worked to find out where the coccidioidomycosis 

organism was when it was not in the human body. Dr. Ann Leconnen, who was in charge of the 

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Outpatient Department at the LA County General Hospital, collaborated on this project with 

Egeberg and his wife. They had collected just about everything they could find around the Lost 

Hills area, which is in a coccidioidomycosis endemic area. They were unable to culture the 

organism from any of the plants or soil or warm-blooded animals. 

Thinking that a cold-blooded animal was a possible vector, the team decided to try to infect 

rattlesnakes with coccidioidomycosis organisms by having the snakes inhale the organisms. To 

obtain the snakes, Leconnen contracted with the owner of a small general store in the San Joaquin 

Valley. One evening after her children had gone to bed, the store owner came to her house carrying 

a gunny sack. He opened the gunny sack and dumped a dozen rattlesnakes on the floor. 

To make the rattlesnakes inhale the suspension of coccidioidomycosis organisms, they found a 

resident who had been in the desert during his military service and had learned how to handle 

rattlesnakes. He would grasp the snake behind its head, causing it to expose its fangs. Venom 

would drop from the fangs. The snake would then hold its breath, often as long as five minutes. 

Holding a syringe full of the suspension of coccidioidomycosis organisms, Egeberg would wait in 

front of the snake, watching to see when it would take its first breath. When the snake finally 

breathed, he would empty the syringe into the snake’s mouth, forcing it to inhale the organisms. 

Ultimately, the snakes failed to develop cocci, and the project was dropped.94 

Ralph Goldman, M.D., who later entered the field of gerontology and headed VA’s nationwide 

Extended Care program, was a nephrologist. In addition to clinical reports on hereditary 

hemorrhagic telangiectasis,95 unsuccessful attempts to treat Hodgkin’s Disease with aureomycin,96 

and acute renal failure due to phenylbutazone,97 he took advantage of the metabolic unit he had 

helped to establish. There, he studied the diurnal variation in excretion of water, and electrolytes 

and steroids in congestive heart failure and hepatic cirrhosis.98, 99 He also studied renal function in 

multiple myeloma, showing that reduction in glomerular, vascular and tubular function is parallel, 

consistent with destruction of entire nephron units.100 With Bassett, he studied calcium and 

phosphorus excretion after calcium administration in patients with hypoparathyroidism and found a 

disproportionate increase in calcium excretion when serum calcium had normalized.101 He also 

studied the mode of creatinine excretion in renal failure, excluding fecal excretion and increased 

creatine formation as alternative routes.102 

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Figure 3.16. Ralph Goldman, M.D. 

Bassett collaborated widely, working in a metabolic unit at Wadsworth that Adams and Goldman 

established. Among his fellows was William Blahd, who later became a leader in nuclear medicine 

(Chapter 6). While working with Bassett, Blahd published an attempt to treat Hand-SchullerChristian Syndrome with cortisone, apparently one of the cortisone studies begun by Dr. Alfred 

Lawton.103 He demonstrated that prolonged epinephrine administration did not impair adrenal 

cortical function.104 Blahd also carried out a study of potassium deficiency that was probably the 

trigger for his later extensive work on potassium metabolism.105 

Seeking an alternative pathway for iron loss, William Adams performed an early study measuring 

iron excretion in sweat. He and his colleagues found that sweat itself contained no measurable iron, 

though the skin cells desquamated with the sweat were iron-rich.106 He had a special interest in 

multiple myeloma patients, in whom he studied fibrin formation and the effects of 

plasmapheresis.107, 108 With Bassett, he studied metabolic balance of calcium, phosphorus, 

electrolyes and nitrogen in multiple myeloma patients treated with ACTH, establishing the negative 

balances now recognized,109 and the effect of cortisone and ACTH in leukemias of various types.110 

With Melvin Levin, M.D., and others, Bassett also studied metabolism in gout, showing little effect 

of an acute gouty attack on adrenal function and equivocal therapeutic benefit from ACTH, 

cortisone and testosterone. The team found that therapeutic doses of colchicine were followed by 

sodium and chloride retention.111, 112 

Atlanta VA Hospital 

In Atlanta, internist Max Michael, M.D., studied the inflammatory response, with a special interest 

in sarcoidosis. His follow-up epidemiological study of 350 cases of sarcoidosis showed a 

predominance in persons who reside in the South and in rural areas.113 He demonstrated delay in 

response to an inflammatory stimulus in rabbits treated with cortisone.114 

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In 1949, Martin Cummings, M.D., who had been Chief of the Tuberculosis Research Laboratory at 

the Communicable Disease Center in Atlanta, moved to the Atlanta VA Hospital as Chief of a new 

tuberculosis laboratory. He, Michael and Walter L. Bloom, M.D., collaborated on studies 

comparing macrophage response in peritoneal exudates in rats and rabbits in an attempt to explain 

the greater resistance of rats to tuberculosis115 and the influence of cortisone in reducing the rat’s 

natural resistance to experimental tuberculosis.116 In other collaborations, Cummings expanded on 

the latter finding, showing that cortisone-enhanced tuberculosis in rats responded to 

streptomycin,117 and that induction of diabetes with alloxan also made rats susceptible to virulent 

tuberculosis.118 He and his collaborators also showed that ACTH and cortisone do not suppress the 

tuberculin reaction in guinea pigs,119 that centrifugation is not an effective way to concentrate 

tubercle bacilli in sputum,120 and that certain amino acids may enhance resistance to tuberculosis in 

a variety of animals.121 Cummings and his coworkers also published clinical articles on the 

hemagglutinen test for tuberculosis,122 methods of culture for the tubercle bacillus123 and treatment 

of tuberculous meningitis.124 After he moved to Central Office, Cummings collaborated with 

statistician Dorothy Livings on a report of the incidence of streptomycin-resistant tubercle bacilli in 

VA patients.125 

Minneapolis VA Hospital 

Dr. Richard Ebert had been stationed in Europe during World War II as part of a Harvard Medical 

School medical unit. There he met General Bradley. After the war, Ebert, who was looking for a 

job, was approached by Cecil Watson, M.D., Ph.D., Chairman of Medicine at the University of 

Minnesota. In February 1946, Ebert joined the Minneapolis VA Hospital as Chief of Medicine. At 

that time, the Dean’s Committee was just beginning to be active. The hospital was generally very 

slow moving. The large Tuberculosis Service had many patients with long stays. In addition, 

demobilized service people demanded VA care. 

With the backing of the Dean’s Committee and of Central Office, Ebert rapidly built up the Medical 

Service. Within six months, a program of resident and medical student training was thriving. 

Not long after that, Ebert and others began a research program. Watson and Morris Visscher, M.D., 

the Chairman of Physiology, were interested in VA. Visscher arranged for Herbert Wells, who was 

in the Department of Physiology but who had an M.D. degree, to join VA’s patient care staff. They 

also recruited an equipment specialist to help them equip the research laboratories. The Minneapolis 

research program was becoming active, and they began to look for money. They contacted Central 

Office and were told to contact NIH, but then they learned that NIH policy was not to give grants to 

VA researchers. In about 1947, they were among the first to receive research money from VA.126 

In 1947, Dr. Craig Borden, who later became Chief of Medicine at the Chicago Lakeside VA 

Hospital, and Ebert set up the first cardiac catheterization laboratory west of the Mississippi. It was 

an opportunity for both advanced patient care and clinical research. With this laboratory, they made 

some of the first circulatory measurements, such as measurements of pressures in the pulmonary 

circulation.127, 128 They studied pulmonary hypertension,129, 130 the anoxia of myocardial 

infarction,131 and ventilation132, 133 and lung elasticity in various clinical conditions.134 In 1949, 

Ebert and Abraham Falk, M.D., reported in the Journal of the American Medical Association on 17 

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cases of tuberculous pericarditis treated with streptomycin in a cooperative clinical trial (Chapter 5) 

and found that circulatory failure was cured or much improved in eight of them.135 With others, 

Ebert published an article in Science about erythrocyte disappearance kinetics in normal persons 

and in persons with hemolytic diseases.136 

In late 1946, Ebert recruited William Tucker, M.D., from the University of Chicago to head the 

200-bed Tuberculosis Service. Other key recruits were James Hammarsten, M.D., Benjamin Heller, 

M.D and Leslie Zieve, M.D. These physicians collaborated among themselves and with Ebert and 

others. Among their publications were studies of blood volume,137, 138 reports on acceleration of 

liver disease in tuberculous patients treated with amithiozone,139 the effects of cortisone in 

nephropathies140 and adrenaline on renal function and electrolyte excretion.141 Clinical reports 

included a 1949 compilation of the studies of streptomycin treatment methods up to that time142 and 

case reports on acute myocarditis143 and on transfusion reactions.144 

Figure 3.17 Number of VA publications 

900 

800 

700 

600 

500 

400 

300 

200 

100 

0 

1943 1944 1945 1946 1947 1948 1949 1950 1951 

Year 

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VA research in the early 1950s 

The intramural program quickly bore fruit. VA publications increased from fewer than 100 per year 

in 1945 and 1946 to more than 800 in 1951. Even without a mandate from the Congress (Chapter 

7), more and more money was being spent on intramural research. VA was on its way to leadership 

in medical research. 

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References 

1. Adkins, R.E., Medical Care of Veterans. Washington, D.C.: U.S. Government Printing 

Office, 1967, 166. 

2. Interview with Abraham Gottlieb, M.D., December 18, 1991 at Palo Alto, CA VA Medical 

Center. 

3. Magnuson, P.B., M.D., Ring the Night Bell. Birmingham, Ala: Little Brown and Company, 

1960, 268. 

4. Magnuson, Ring the Night Bell. 1960, 278. 

5. Adkins, Medical Care of Veterans. 1967 

6. Interview with Michael DeBakey, M.D., January 28,1994 at Dr. DeBakey’s office at Baylor 

Medical Center, Houston, TX. 

7. Magnuson, Ring the Night Bell. 1960, 276. 

8. Interview with Ralph Casteel, May 3, 1988 at a restaurant in Bethesda, MD. 

9. Adkins, Medical Care of Veterans. 1967, 211. 

10. Magnuson, Ring the Night Bell. 1960, 289-298. 

11. Adkins, Medical Care of Veterans. 1967, 214. 

12. Magnuson, Ring the Night Bell. 1960, 269. 

13. Adkins, Medical Care of Veterans. 1967, 181. 

14. National Academy of Sciences - National Research Council. "Minutes of First Meeting, 

Committee on Veterans Medical Problems." September 20, 1946. Washington, D.C.: 

National Research Council, 1946, 2. 

15. NAS-NRC. "Minutes, First Meeting of the CVMP." September 20, 1946, 1946, 2-3. 

16. Telephone interview with Alfred H. Lawton, M.D., April 26, 1988. 

17. Shryock, R.H., American Medical Research, Past and Present. New York: The 

Commonwealth Fund, 1947 

18. Shryock, American Medical Research. 1947, 321. 

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19. Harvey, A.M., Science at the Bedside. Clinical Research in American Medicine, 1905-1945. 

Baltimore and London: Johns Hopkins University Press, 1981, 554. 

20. Telephone interview with Ernest Allen, Ph.D., April 11, 1988. 

21. McCarthy, C.R. "Testimony before the U.S. House of Representatives Committee on 

Veterans' Affairs." Hearing on Government Sponsored Research involving Radioactive 

Materials Conducted in VA Medical Centers. February 8, 1994. Washington, D.C., 1994, 4. 

22. Harvey, Science at the Bedside. 1981 

23. Magnuson, Ring the Night Bell. 1960, 285-286. 

24. Telephone interview with Robert Kevan, January 11, 1992. 

25. Magnuson, Ring the Night Bell. 1960, 306. 

26. Magnuson, Ring the Night Bell. 1960, 320. 

27.	 Interview with Dorothy Bluestein, May 5, 1992 at Ms. Bluestein's home in Silver Spring, 

MD. 

28. Magnuson, Ring the Night Bell. 1960, 344. 

29. Magnuson, Ring the Night Bell. 1960, 349-350. 

30. Interview with Martin M. Cummings, M.D., February 7, 1994 at Dr. Cummings’s home in 

Florida. 

31. Interview with Marjorie T. Wilson, M.D., April 29, 1988 at Dr. Wilson's office at ECFMG, 

in Washington, D.C. 

32. "Edward Cushing, District Physician." The Washington Post, Washington, D.C., November 

16, 1969. 

33. Louis Welt, M.D. Curriculum Vitae, provided by Yale University 

34. National Academy of Sciences - National Research Council. "Minutes, Twenty fifth 

Meeting of the CVMP." December 5, 1952. Washington, D.C.: National Research Council, 

1952, 17. 

35. Interview with Gilbert W. Beebe, Ph.D., June 1, 1994 at a hotel lobby in Washington, DC. 

36. Welt, L. and Seldin, D., "The pathologic physiology and treatment of edema." Veterans 

Administration Technical Bulletin, 1951. 10-69. 

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37. Welt, L., "The pathogenesis and management of dehydration." Veterans Administration 

Technical Bulletin, 1955. 10-105. 

38. Interview with Richard Greene, M.D., Ph.D, April 7, 1993 at Dr. Greene’s home in 

Washington, D.C. 

39. National Academy of Sciences - National Research Council. "Minutes, Twenty first Meeting 

of the CVMP." May 25, 1951. Washington, D.C.: National Research Council, 1951, 10. 

40. NRC. "Minutes, Twenty fifth Meeting of the CVMP." 1952, Appendix 2, p. 546. 

41. Magnuson, Ring the Night Bell. 1960, 315-316. 

42. Telephone interview with Francis Haddy, M.D., Ph.D., April 6, 1988. 

43. Telephone interview with John A.D. Cooper, M.D., March 24, 1988. 

44. NAS-NRC. "Minutes, Twenty fifth Meeting of the CVMP." December 5, 1952. Washington, 

D.C.: National Research Council, 1952, Appendix 2, 547. 

45. NAS-NRC. "Minutes, Twenty fifth Meeting of the CVMP." December 5, 1952. Washington, 

D.C.: National Research Council, 1952, 548. 

46. Lawton, A.H. "Veterans Administration Conference on Cortisone Research." 1950. 

47.	 Interview with Maurice Lorr, Ph.D., April 28, 1994 at Dr. Lorr’s office in Washington, D.C. 

48. "Veterans Administration Technical Bulletin 10A-152: Medical research program." 

49. Chapple, C., "Newsletter." R and E Newsletter, May, 1960, 2. 

50. Telephone interview with John C. Nunemaker, M.D., January 14, 1992. 

51. Interview with Oscar Auerbach, M.D., October 30, 1992 at Dr. Auerbach's office at the East 

Orange, NJ VA Medical Center. 

52. Stemmerman, G., Weiss, L., Auerbach, O. and Friedman, "A study of the germinal 

epithelium in male paraplegics." Am J Clin Path, 1950. 20: 24-34. 

53.	 Auerbach, O. and Trubowitz, S., "Primary carcinoma of the liver with extensive skeletal 

metastasis and panmyelophthisis." Cancer, 1950. 3: 837-843. 

54. Auerbach, O., Friedman, M., Weiss, L. and Amory, H., "Extraskeletal osteogenic sarcoma 

arising in irradiated tissue." Cancer, 1951. 4: 1095-1106. 

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55. Hobby, G., Lenert, T. and Auerbach, O., "The immunizing properties of an isoniazidresistant mutant of the Vallee strain of M. Tuberculosis as compared with BCG." Am Rev 

Tuberc, 1954. 70: 527-530. 

56. Auerbach, O., "Empyema as a complication of chronic pulmonary tuberculosis." Am Rev 

Tuberc, 1949. 59: 601-618. 

57. Auerbach, O., "Tuberculosis of the trachea and major bronchi." Am Rev Tuberc, 1949. 60: 

604-620. 

58.	 Auerbach, O., "Tuberculous meningitis: Correlation of therapeutic results with the 

pathogenesis and pathologic changes. I. General considerations and pathogenesis." Am Rev 

Tuberc, 1951. 64: 408-418. 

59.	 Auerbach, O., "Tuberculous meningitis: Correlation of therapeutic results with the 

pathogenesis and pathologic changes. II. Pathologic changes in treated and untreated cases." 

Am Rev Tuberc, 1951. 64: 419-429. 

60. Auerbach, O., "Pleural, peritoneal and pericardial tuberculosis." Am Rev Tuberc, 1950. 61: 

845-861. 

61. Auerbach, O. and Stemmermann, G., "Anatomic change in tuberculosis following 

streptomycin therapy." Am Rev Tuberc, 1948. 58: 449-462. 

62. Stemmermann, G. and Auerbach, O., "Massive pulmonary hemorrhage in tuberculosis. A 

report of two unusual cases." Am Rev Tuberc, 1950. 62: 324-330. 

63. Auerbach, O., Katz, H. and Small, M., "The effect of streptomycin therapy on the bronchocavitary junction and its relation to cavitary healing." Am Rev Tuberc, 1953. 67: 173-200. 

64.	 Movitt, E. and Gerstl, B., "Pure mitral insufficiency of rheumatic origin in adults." Ann Int 

Med, 1953. 38: 981-1001. 

65. Movitt, E., Gerstl, B. and McKinlay, E., "Osmotic erythrocyte fragility in patients with 

jaundice." Am J Med Sci, 1951. 222: 535-537. 

66. Berk, M. and Gerstl, B., "Torulosis (cryptococcosis) producing a solitary pulmonary lesion. 

Report of a four year cure with lobectomy." J Am Med Assn, 1952. 149: 1310-1312. 

67. Mendenhall, R.M., Ramorino, P.M. and Gerstl, B., "Water, sodium, and potassium content 

of human, guinea pig, and rabbit lung." Proc Soc Exper Biol and Med, 1953. 82: 318-322. 

68.	 Gerstl, B., Kirsh, D., Andros, E., Winter, J. and Kidder, L., "Evaluation of hemolytic 

modification of Middlebrook-Dubos test for tuberculosis antibodies." Am J Clin Path, 1952. 

22: 337-344. 

115
 
 

 

 

 

 

 

 

 

 

69.	 Gerstl, B., Kirsh, D., Davis, W. and Barbieri, M., "Absence of circulating antibodies in 

patients with pulmonary tuberculosis." Science, 1954. 120: 853-854. 

70.	 Gerstl, B., Kirsh, D., Winter, J., Weinstein, S., Hollander, A., Cova, P. and Barbieri, M., 

"Nonspecific reactions with the Middlebrook-Dubos Test for tuberculosis antibodies." J Lab 

Clin Med, 1954. 44: 443-448. 

71. Gross, L., "Hemolytic action of mouse mammary carcinoma filtrate on mouse erythrocytes 

in vitro." Proc Soc Exper Biol and Med, 1947. 65: 292-293. 

72. Gross, L., "Increased hemolytic potency of mouse mammary carcinoma extracts following 

incubation with tumor cells." Proc Soc Exper Biol and Med, 1948. 67: 341-343. 

73. Gross, L., "Destructive action of human cancer extracts on red cells in vitro." Proc Soc 

Exper Biol and Med, 1949. 70: 656-662. 

74. Gross, L., Gessler, A. and McCarthy, K., "Electron-microscopic examination of human milk 

particularly from women having family record of breast cancer." Proc Soc Exper Biol and 

Med, 1950. 75: 270-276. 

75. Gross, L., "Suseptibility of suckling-infant, and resistance of adult, mice of the C3H and of 

the C57 lines to inoculation with AK leukemia." Cancer, 1950. 3: 1073-1087. 

76. Gross, L., "Susceptibility of newborn mice of an otherwise apparently "resistant" strain to 

inoculation with leukemia." Proc Soc Exper Biol and Med, 1950. 73: 246-249. 

77. Gross, L., "'Spontaneous' leukemia developing in C3H mice following inoculation, in 

infancy, with AK-leukemic extracts, or AK-embryos." Proc Soc Exper Biol and Med, 1951. 

76: 27-32. 

78. Gross, L., "Pathogenic properties, and 'vertical' transmission of the mouse leukemia agent." 

Proc Soc Exper Biol and Med, 1951. 78: 342-348. 

79. Gross, L., "Presence of leukemic agent in normal testes and ovaries of young mice of AK 

line." Acta Haemat, 1953. 10: 18-26. 

80. Gross, L., "Neck tumors, or leukemia, developing in adult C3H mice following inoculation, 

in early infancy, with filtered (Berkefeld N), or centrifuged (144,000Xg), AK-leukemic 

extracts." Cancer, 1953. 6: 948-957. 

81. Gross, L., "Biological properties of the mouse leukemia agent." Cancer, 1953. 6: 153-158. 

82. Gross, L., "A filterable agent, recovered from AK leukemic extracts, causing salivary gland 

carcinomas in C3H mice." Proc Soc Exper Biol and Med, 1953. 83: 414-421. 

116
 
 

 

 

 

 

 

 

83. Gross, L., "The "vertical" transmission of mouse mammary carcinoma and chicken 

leukemia. Its possible implications for human pathology." Cancer, 1951. 4: 626-633. 

84. Gross, L., "Delayed effects of inoculation of AK-leukemic cells in mice of the C3H line. A 

working hypothesis on the etiology of mouse leukemia." Cancer, 1952. 5: 620-624. 

85. Interview with Ludwig Gross, M.D., October 28, 1992 at Dr. Gross's office at the Bronx 

VAMC. 

86. Interview with Hyman Zimmerman, M.D., April 6, 1988 at Washington, DC VAMC. 

87. Interview with Roger Egeberg, M.D., February 25 and 26, 1992 at Dr. Egeberg's home in 

Washington, DC. 

88. Telephone interview with William Adams, M.D., February 17, 1992. 

89. Telephone interview with William Valentine, M.D., February 14, 1992. 

90. Coodley, E., Weiss, B. and Egeberg, R., "Reiter's Syndrome: Report of six cases." Ann West 

Med Surg, 1948. 2: 500-505. 

91. Egeberg, R., "Treatment of chest emergencies: medical aspects." Ann West Med Surg, 1951. 

5: 133-137. 

92. Weir, R., Egeberg, R., Lack, A. and Leiby, G., "A clinical trial of prodigiosin in 

disseminated coccidioidomycosis." Am J Med Sci, 1952. 224: 70-76. 

93. Egeberg, R., "Coccidioidomycosis: its clinical and climatological aspects with remarks on 

treatment." Am J Med Sci, 1954. 227: 268-271. 

94. Telephone interview with Roger Egeberg, M.D., April 11, 1994. 

95. Goldman, R., Asher, L. and Ware, E., "Hereditary hemorrhagic telangiectasis." 

Gastroenterol, 1949. 12: 495-501. 

96. Goldman, R., "The effect of aureomycin upon Hodgkin's Disease." Am J Med Sci, 1951. 

221: 195-198. 

97. Lipsett, M. and Goldman, R., "Phenylbutazone toxicity: Report of a case of acute renal 

failure." Ann Int Med, 1954. 41: 1075-1079. 

98. Goldman, R., "Studies in diurnal variation of water and electrolyte excretion: Nocturnal 

diuresis of water and sodium in congestive cardiac failure and cirrhosis of the liver." J Clin 

Invest, 1951. 30: 1191-1199. 

117
 
 

 

 

 

 

 

99. Goldman, R. and Bassett, S., "Diurnal variation in the urinary excretion of neutral lipidsoluble reducing steroids in congestive heart failure and cirrhosis of the liver with ascites." J 

Clin Invest, 1952. 31: 253-258. 

100. Goldman, R., Adams, W. and Luchsinger, E., "Renal function in multiple myeloma." J Lab 

Clin Med, 1952. 40: 519-522. 

101. Goldman, R. and Bassett, S., "Effect of intravenous calcium gluconate upon the excretion of 

calcium and phosphorus in patients with idiopathic hypoparathyroidism." J Clin Endocrinol 

Metab, 1954. 14: 278-286. 

102. Goldman, R., "Creatinine excretion in renal failure." Proc Soc Exper Biol and Med, 1954. 

85: 446-448. 

103. Blahd, W., Levy, M. and Bassett, S., "A case of Hand-Schuller-Christian Syndrome treated 

with cortisone." Ann Int Med, 1951. 35: 927-937. 

104. Leslie, A., Blahd, W. and Adams, W., "The effect of prolonged administration of 

epinephrine on adrenal cortical function and epinephrine tolerance in chronic asthmatics." J 

Lab Clin Med, 1953. 41: 865-870. 

105. Blahd, W. and Bassett, S., "Potassium deficiency in man." Metabolism, 1953. 2: 218-224. 

106. Adams, W., Leslie, A. and Levin, M., "The dermal loss of iron." Proc Soc Exper Biol and 

Med, 1950. 74: 46-48. 

107. Craddock, C., Adams, W. and Figueroa, W., "Interference with fibrin formation in multiple 

myeloma by an unusual protein found in blood and urine." J Lab Clin Med, 1953. 42: 847­

859. 

108. Adams, W., Blahd, W. and Bassett, S., "A method of human plasmaphoresis." Proc Soc 

Exper Biol and Med, 1952. 80: 377-379. 

109. Adams, W., Mason, E. and Bassett, S., "Metabolic balance investigation of three cases of 

multiple myeloma during ACTH administration; Exchanges of calcium, phosphorus, 

nitrogen and electrolytes." J Clin Invest, 1954. 33: 103-121. 

110. Adams, W., Valentine, W., Bassett, S. and Lawrence, J., "The effect of cortisone and ACTH 

in leukemia." J Lab Clin Med, 1952. 39: 570-581. 

111. Levin, M., Fred, L. and Bassett, S., "Metabolic studies in gout." J Clin Endocrinol Metab, 

1952. 12: 506-518. 

112. Levin, M., Rivo, J. and Bassett, S., "Metabolic studies in gout with emphasis on the role of 

electrolytes in acute gouty arthritis." Am J Med, 1953. 15: 525-534. 

118
 
 

 

 

 

 

 

113. Michael, M., Jr., Cole, R., Beeson, P. and Olson, B., "Sarcoidosis: Preliminary report on 

study of 350 cases with special reference to epidemiology." Natl Tuberc Assoc, 1950. 46: 

208-212. 

114. Michael, M. and Whorton, C., "Delay of the early inflammatory response by cortisone." 

Proc Soc Exper Biol and Med, 1951. 76: 754-756. 

115. Bloom, W., Cummings, M. and Michael, M., "Macrophage content of oil-induced peritoneal 

exudate in rats and rabbits." Proc Soc Exper Biol and Med, 1950. 75: 171-172. 

116. Michael, M., Cummings, M. and Bloom, W., "Course of experimental tuberculosis in the 

albino rat as influenced by cortisone." Proc Soc Exper Biol and Med, 1950. 75: 613-616. 

117. Cummings, M., Hudgens, P., Whorton, M. and Sheldon, W., "The influence of cortisone and 

streptomycin on experimental tuberculosis in the albino rat." Am Rev Tuberc, 1952. 65: 

596-602. 

118. Roche, P., Cummings, M. and Hudgens, P., "Comparison of experimental tuberculosis in 

cortisone-treated and alloxan-diabetic albino rats." Am Rev Tuberc, 1952. 65: 603-611. 

119. Sheldon, W., Cummings, M. and Evans, L., "Failure of ACTH or cortisone to suppress 

tuberculin skin reactions in tuberculous guinea pigs." Proc Soc Exper Biol and Med, 1950. 

75: 616-618. 

120. Klein, G., Maltz, M., Cummings, M. and Fish, C., "Efficacy of centrifugation as a method of 

concentrating tubercle bacilli." Am J Clin Path, 1952. 22: 581-585. 

121. Lewis, G., Hankey, L., Adair, F. and Cummings, M., "A study of certain amino acids as they 

may relate to the problem of host resistance to tuberculosis." Am Rev Tuberc, 1952. 66: 

378-380. 

122. Fleming, J., Runyon, E. and Cummings, M., "An evaluation of the hemagglutination test for 

tuberculosis." Am J Med, 1951. 10: 704-710. 

123. Cummings, M., "Diagnostic methods in tuberculosis. II. Demonstration of M. tuberculosis 

by culture." Am J Clin Path, 1951. 21: 684-690. 

124. Atkins, E. and Cummings, M., "Tuberculous meningitis: Treatment of spinal block with 

intrathecal administration of tuberculin." New England J Med, 1952. 247: 715-717. 

125. Cummings, M. and Livings, D., "The prevalence of streptomycin resistant tubercle bacilli 

among 5,526 patients admitted consecutively to hospitals." Am Rev Tuberc, 1954. 70: 637­

640. 

126. Telephone interview with Richard Ebert, M.D., December 22, 1993. 

119
 
 

 

 

127. Ebert, R., Borden, C., Wells, H. and Wilson, R., "Studies of the pulmonary circulation. I. 

The circulation time from the pulmonary artery to the femoral artery and the quantity of 

blood in the lungs in normal individuals." J Clin Invest, 1949. 28: 1134-1137. 

128. Borden, C., Ebert, R., Wilson, R. and Wells, H., "Studies of the pulmonary circulation. II. 

The circulation time from the pulmonary artery to the femoral artery and the quantity of 

blood in the lungs in patients with left ventricular failure." J Clin Invest, 1949. 28: 1138­

1143. 

129. Borden, C., Ebert, R., Wilson, R. and Wells, H., "Pulmonary hypertension in heart disease." 

New England J Med, 1950. 242: 529-534. 

130. Borden, C., Wilson, R., Ebert, R. and Wells, H., "Pulmonary hypertension in chronic 

pulmonary emphysema." Am J Med, 1950. 8: 701-709. 

131. Borden, C., Ebert, R. and Wilson, R., "Anoxia in myocardial infarction and indications for 

oxygen therapy." J Am Med Assn, 1952. 148: 1370-1371. 

132. Wilson, R., Borden, C., Ebert, R. and Wells, H., "A comparison of the effect of voluntary 

hyperventilation in normal persons, patients with pulmonary emphysema, and patients with 

cardiac disease." J Lab Clin Med, 1950. 36: 119-126. 

133. Brown, C., Fry, D. and Ebert, R., "The mechanics of pulmonary ventilation in patients with 

heart disease." Am J Med, 1954. 17: 438-446. 

134. Stead, W., Fry, D. and Ebert, R., "The elastic properties of the lung in normal men and in 

patients with chronic pulmonary emphysema." J Lab Clin Med, 1952. 40: 674-681. 

135. Falk, A. and Ebert, R., "Tuberculous pericarditis treated with streptomycin." J Am Med 

Assn, 1951. 145: 310-314. 

136. Evans, R., Amatuzio, D. and Ebert, R., "Red blood cell studies: Ashby curves." Science, 

1952. 115: 572-573. 

137. Schultz, A., Hammarsten, J., Heller, B. and Ebert, R., "A critical comparison of the T-1824 

dye and iodinated albumin methods for plasma volume measurement." J Clin Invest, 1953. 

32: 107-112. 

138. Hammarsten, J., Heller, B. and Ebert, R., "The effects of dextran in normovolemic and 

oligemic subjects." J Clin Invest, 1953. 32: 340-344. 

139. Falk, A., Zieve, L., Tucker, W. and Hanson, M., "The hepatic toxicity of amithiozone." Am 

Rev Tuberc, 1951. 64: 159-169. 

120
 
140. Heller, B., Jacobson, W. and Hammarsten, J., "The effect of cortisone in glomerulonephritis 

and the nephropathy of disseminated lupus erythematosis." J Lab Clin Med, 1951. 37: 133­

142. 

141. Jacobson, W., Hammarsten, J. and Heller, B., "The effects of adrenaline upon renal function 

and electrolyte excretion." J Clin Invest, 1951. 30: 1503-1506. 

142. Tucker, W., "Evaluation of streptomycin regimens in the treatment of tuberculosis." Am Rev 

Tuberc, 1949. 60: 715-754. 

143. Borden, C., "Acute myocarditis. Report of a case with observations on the etiologic factor." 

Am Heart J, 1950. 39: 131-135. 

144. Borden, C. and Hall, W., "Fatal transfusion reactions from massive bacterial contamination 

of blood." New England J Med, 1951. 245: 760-765. 

121
 
(Intentionally Blank) 

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Chapter 4. Research Cooperation Between the NAS and VA 

In 1945, as World War II drew to an end, Michael E. DeBakey, M.D., was a Colonel, the Chief of 

the Surgical Consultants Division of the Army’s Surgeon General’s Office. He recalled 

neurosurgeon Harvey Cushing’s frustration at the lost opportunity to benefit from World War I 

medical experience with follow-up studies. DeBakey realized the important information to be 

gained from follow-up studies to learn the long-term outcome of war injuries and he worried that 

postwar interest in war-related medical research would wane.1 

Figure 4.1: Michael DeBakey, M.D. 

DeBakey wrote a memorandum to Surgeon General Kirk, recommending an NRC-coordinated joint 

effort of VA and the military services to mine military records and use follow-up studies to learn 

about medical outcomes.2 At Kirk’s request,3 the NRC called a meeting of the Surgeons General of 

the Army, Navy and Public Health Service, the Medical Director of the Veterans Administration 

and the NRC. To outline a program, they formed an ad hoc committee that held two meetings in 

May and June of 1946 (Appendix IIc). 

The group recommended that the Academy, through the National Resources Council (NRC) of the 

National Academy of Sciences, establish a standing Committee on Veterans Medical Problems. 

The NRC assigned Dr. DeBakey and Gilbert Beebe, Ph.D., a statistician who later became Chief of 

the Follow-up Agency, to write an action plan. Approved by the ad hoc committee, its 

recommendations included formation of a standing Committee on Veterans Medical Problems to 

advise the NRC and VA, and a Medical Follow-up Agency in the NRC to carry out studies of longterm outcomes of wartime injuries and illnesses.4 

Committee on Veterans Medical Problems (CVMP) 

The standing Committee on Veterans Medical Problems (Appendix IIc) first met on Sept. 20, 1946.5 

It became apparent that the originally proposed clinical follow-up research had to expand and 

include research by VA physicians. Chief Medical Director Hawley informed the CVMP that for a 

number of years the Veterans Administration would not be sufficiently staffed or equipped to 

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undertake research in major clinical and biological problems and could support only small clinical 

studies. Nevertheless, as early as the June 13, 1946, meeting of the planning committee, 

“Dr. (Perrin H.) Long called attention to the fact that investigative projects had already been 

planned or even set up, and that unless such work, costing a considerable amount of money, 

were supported, the younger men would not remain in the Veterans Administration.”6 

In fact, the intramural research program, research initiated by staff in VA hospitals (Chapter 3), 

took root simultaneously with the programs sponsored by the NAS through the CVMP. 

The contractual relations between VA and the NRC that the CVMP reviewed fell into three 

categories: 

1. VA contracts to non-VA institutions, primarily medical schools, for medical research. This 

program flourished through 1953, when it was almost entirely replaced by the VA intramural 

research program. 

2. Prosthetics research contracts with academic and other non-VA institutions. The contract 

prosthetics research program continued until the late 1970s, when it was partially replaced by 

intramural VA rehabilitation research. Early on, the CVMP oversaw this program. Then, NRC 

advice began to come directly to VA from the NRC’s Advisory Committee on Artificial Limbs 

(Chapter 20). The NRC role in reviewing prosthetics research contracts continued until 1976. 

3. The Medical Follow-up Agency. In the early CVMP active period, the Follow-up Agency 

was funded entirely by VA. This Agency remained in the NRC until 1988 and then moved 

organizationally to the Institute of Medicine. With funding from multiple sources, the Followup Agency continues to play an active role in medical research. 

The CVMP originally oversaw the entire VA research program, though this oversight role later 

decreased as the intramural program expanded. To complete the necessary scientific reviews, 

especially of contract requests, the NRC reestablished a system of advisory committees similar to 

the wartime NRC medical advisory committees.7 

Those committees had begun to form in 1940, when the Surgeon General’s Office of the Army 

asked the NAS for advice on chemotherapy and transfusions. At that time, the NRC formed two 

advisory committees of civilian specialists. Additional requests led to the creation of more 

committees, so that by June 1941, eight major medical committees and 33 subcommittees were 

active. With the onset of the war, the President’s Office of Science and Technology (that 

sponsored, among other projects, work on the atomic bomb) became active and well funded. Its 

sponsorship of the medical research needed for the war effort was carried out by its Committee on 

Medical Research (CMR), which requested advice from these NRC committees. By 1943, 52 NRC 

committees and subcommittees, with 221 members, were advising the CMR, and most research 

contracts funded by the CMR were funded in response to an NRC committee’s recommendation. 

To finance this committee structure, the Office of Science and Technology provided contractual 

support to NAS. The Chairman of the NAS Division of Medical Sciences became Vice Chairman 

of the CMR. 

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At the war’s end, the CMR closed its contracts program. It, and the NRC committee structure 

supporting it, were abolished in 1946.8 A postwar effort required a new start by the NRC, with new 

oversight and subject matter advisory groups. 

By December 1946, the NRC had established advisory committees on medicine (with 

subcommittees on venereal diseases, cardiovascular diseases and tuberculosis), and on surgery, 

neuropsychiatry, chemotherapy, sanitary engineering, growth, prosthetic devices and sensory 

devices. The latter two committees and their successor committees were important to VA’s early 

research in rehabilitation (Chapter 20). 

CVMP’s activity was funded by a separate VA contract to the National Academy of Sciences. It 

actively advised the VA research program, meeting 30 times from 1946 through 1953. 

VA’s extramural contracts program 

Until the end of 1953, the CVMP reviewed all VA general research contracts, as well as follow-up 

studies. The Committee depended on reviews by NRC’s subject matter committees, but the CVMP 

itself also reviewed all contract applications. In addition, it established a roster of consultant 

statisticians,9 a concept unusual for the time. 

During the first year, many contracts (Appendix IV) were for follow-up studies that required access 

to VA records or examination of VA patients. Prominent in those begun in 1947 was the follow-up 

study on peripheral nerve injuries, led by Barnes Woodhall, M.D., of Duke University. This study 

became part of the Follow-up Agency work and eventually resulted in a monograph.10

 In 1948, VA-supported contracts included a spectrum of Veterans’ medical care problems. One 

contract studied treatment of coccidioidomycosis, a problem among Veterans stationed in endemic 

areas. Even though new cases of syphilis were well treated with penicillin, tertiary syphilis 

continued to be a problem for VA patients, and in 1948 contracts were awarded for study of paresis 

and of cardiovascular syphilis. A contract with a Yale scientist explored the physiology of frontal 

lobotomy. 

While many contract-supported investigators applied through their VA affiliates, most were medical 

school faculty members, and the medical schools administered the contracts. It is likely that some 

of this contract research was performed in the affiliated VA hospital. Contract recipients included 

such luminaries as Norman Brill, M.D., Barnes Woodhall, George Burch, M.D., Michael DeBakey, 

Harold G. Wolff, M.D., Thomas Sternberg, M.D., Paul Beeson, M.D., Milton Winternitz, M.D., 

George Taplin, M.D., I.L. Chaikoff, M.D., Ph.D., Brian Blades, M.D., Harold Beecher, M.D., Cyril 

N.H. Long, M.D., Franz Ingelfinger, M.D., Leslie Zieve, M.D., Ph. D, and Marshall Urist, M.D. 

University charges for overhead costs became a problem that Dr. Cushing discussed in a September 

1951 report to VA’s Special Medical Advisory Group: 

“One university . . . which proposed a contractual research project with the VA that was 

approved by the National Research Council has raised an issue on the overhead allowance 

proposed in the contract. The contract submitted by the VA to this university provided for 

twelve per cent of the total amount of the contract as overhead. The university came back and 

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said that they could not accept the contract as the overhead was entirely too low. The overhead 

which this school desired was either 44 per cent of the salaries and wages mentioned in the 

contract, or 31 per cent of the total amount of the contract. VA thanked them very much and 

said that the contract was not sufficiently important to it to proceed on that basis. . . . How far is 

‘Uncle Sugar’ going to go in supporting, by overhead, some of these grants?”11 

Administering these contracts burdened the very small VA Central Office research staff, and 

contracts were loosely supervised until Marjorie Wilson, M.D., joined the staff. Wilson recalled 

that she came to Washington, D.C., in 1951 and found a job in VA’s Research and Education 

Service. When she arrived, she found three filing cabinets filled with 150-200 contracts that had 

not been organized in any way. She read all the contracts and systematized the files, establishing 

expense and result records and sending the progress reports to the NRC committees to help them in 

their annual reviews of renewal requests. VA contracts for prosthetics research (Chapter 18) were 

handled by the Prosthetics and Sensory Aids Service at that time. 

Figure 4.2 VA expenditures for research contracts, 1947-1953 

1.8 

1.6 

1.4 

1.2 

1
 

Medical research
 

Prosthetics research 

0.8 

0.6 

0.4 

0.2 

0 

Dr. Wilson remembered the contract holders as the “giants” in academic medicine. Virtually all 

contracts were for clinical investigations.12 

The Medical Follow-up Agency 

The plan for follow-up studies devised by DeBakey and Beebe and debated by the 1946 ad hoc 

Committee on Veterans Medical Programs included a three-pronged approach: 

1. A separate agency to be established to work with VA and armed services to perform followup studies on World War II Veterans; 

2. A program of clinical follow-up research to be initiated by faculty of the affiliated schools 

on contract, and later included in an intramural research program; and 

3. Large-scale epidemiologic studies. 

Millions of dollars (not deflated)

1947 1948 1949 1950 1951 1952 1953 

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At its first meeting in September 1946, the CVMP accepted the DeBakey-Beebe report and 

recommended that the NRC establish an independent Follow-up Agency, to be funded by a VA 

contract but administratively responsible to the NRC. The Medical Follow-up Agency was started, 

with Beebe as its statistical leader and John Ransmeier, M.D., as the medical leader. Over the next 

two years, Follow-up Agency staff worked closely with VA to put the follow-up program in motion. 

Figure 4.3: Gilbert Beebe, Ph.D. 

The Follow-up Agency’s initial task was records identification. Some dedicated military physicians 

had developed personal rosters of Service personnel with conditions that especially interested them, 

and these were collected.13 However, these records, by and large, were not usable for large-scale 

studies. It soon became apparent that it was necessary to find a way to work with the existing 

records systems. In March 1948, the Follow-up Agency reported to its organizational superior in 

the NAS that: 

“In December 1947 the Veterans Administration published Technical Bulletin 3-30, its 

‘Procedure for Following National Research Council Access to Information from Files of the 

Veterans Administration and Army Medical Records of World War II Veterans,’ which made it 

possible to determine the present addresses of Veterans and to assemble their Army records in 

either Washington or an appropriate study center. In order to locate subjects for the various 

study centers, approximately 22,000 National Research Council Locator Requests have been 

processed through the Veterans Administration. Providing service medical records to the 

centers has necessitated calling in approximately 700 medical records from the Veterans 

Administration, exclusive of those obtained from the Army and Navy directly. This phase of 

the work is only beginning, the effort thus far having been confined to giving each study center 

an initial group of cases with which to test its procedures and make a start in its work. 

Cooperation from all portions of the far-flung Veterans Administration organization has been 

complete, but an endeavor of this scope inevitably proceeds slowly until there is wide 

understanding of just what is required.” 

“The truly cooperative nature of the follow-up program is well illustrated by the full 

participation of both Army and Navy in the process of creating rosters and securing both 

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personnel and medical records. Many tabulations have been made by the medical statistics 

divisions of both Army and Navy according to specifications established by the Committee, 

and listings and duplicate punch-cards have been furnished covering tens of thousands of 

admissions for many different conditions. Army personnel and medical records of World War 

II are housed in St. Louis, and it has been necessary to establish there a branch record office for 

the Committee in order to arrange necessary access to those records and to abstract or 

reproduce them as required by responsible investigators. Navy and Marine Corps records have 

been made available in similar fashion except that, until recently, they were concentrated in 

Washington, D.C. where personnel from the Committee's main record office could have access 

to them. The removal of non-current Navy records to Garden City will necessitate a small unit 

there unless the Navy can continue to call records back to Washington on request.”14 

Having Follow-up Agency staff work at the Armed Services’ centralized records depots was 

successful, and good relations were maintained with the medical records departments of the Army 

and the Navy, as well as VA.15 

An early problem in conducting follow-up studies was the VA General Counsel’s decision that 

follow-up examinations performed for research purposes could not be combined with required 

medical examinations when a Veteran was applying for compensation. In those cases, the Veteran 

needed to make a separate trip, generally to a university clinic, for the follow-up examination, thus 

removing the financial motivation that encouraged the Veteran to cooperate in the compensation 

exam. To improve compliance in difficult cases, the Follow-up Agency worked with the Red 

Cross, which sent staff to intercede with the Veterans and help them get to the centers for 

examination.15 This is described in the report of the study of peripheral nerve injuries: 

“At that point (when the man had not replied to repeated letters, including a certified letter) the 

center was considered to have exhausted its power of appeal and the man was referred to the 

American Red Cross, through its national headquarters, to help under a cooperative agreement 

worked out with the Follow-up Agency. Red Cross representatives were provided with a 

statement about the project and visited each center to learn something of the nature of the 

examination and of the essential medical interests of the investigators . . . . An immediate 

benefit of the Red Cross participation in the follow-up work was the information it provided 

about the apparent motivation of men who refused to participate and about the interaction 

between subjects and personnel of the follow-up center.”16 

Even before the Follow-up Agency became functional, proposals for studies poured in to the CVMP 

for review. As of December 1947, these included follow-ups of liver function following hepatitis, 

tuberculosis, schistosomiasis, peripheral nerve injuries, spinal cord injuries, aneurysms and fistulae, 

arterial injuries, psychoneuroses and epilepsy.17 Some of these fell by the wayside, but a number 

became a part of the Follow-up Agency’s long-term program. 

By early 1949, the Follow-up Agency had planned a number of projects and pilot feasibility studies 

were under way.18 At the same time, members of its statistical staff were increasingly called on for 

advice about other contracts under review by the CVMP. The Agency also assisted in planning and 

coordinating other VA contract follow-up studies at 30 centers, primarily universities. Most of 

these required actual reexamination of patients, rather than just records review. Seymour Jablon, a 

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mathematical statistician who joined the Agency in 1948, worked closely with Dr. Beebe and 

eventually replaced him as Chief when Beebe retired in 1977.19 

Figure 4.4: Seymour Jablon 

By late 1949, costs and the slow and uncertain return of results from follow-up studies were 

beginning to arouse the concern of the CMVP and the VA Research staff responsible for their 

funding. None of the studies had yet been published. Some of the contract follow-up studies were 

experiencing problems because they had been set up hastily. Faults in statistical design were 

surfacing. The CVMP ruled that any future proposals must be approved twice—once in concept 

and later, after input from the Follow-up Agency staff on the designs—before they were actually 

funded.20 

In early 1951, VA and the CVMP jointly appointed a subcommittee to review the Follow-up 

Agency's activities. The Agency’s cumulative cost through FY 1951 was $1.752 million. The 

subcommittee reported enthusiastically about the following projects under way, with comments on 

the status of results as of 1951: 

“Infectious Hepatitis. A follow-up of approximately 1,000 survivors of the original infection 

has revealed no residual of severe liver damage or evidence of progressive liver disease 

(Projects #22, #31, #49). 

Psychoneurosis. It is expected that the complete analysis will produce information of value to 

the Armed Forces in setting policies for induction, assignment to combat duty, and the 

disposition of men who break down in service (Project #7). 

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Peripheral Nerve Injuries. Emphasis is placed on the value of specialized neurologic treatment, 

use of special neuropsychological techniques as an adjunct to surgery, and improvement in the 

management of peripheral nerve injuries (Project #13). 

Arterial Injuries. The study has developed methods for objective study and information 

concerning improved handling of vascular injuries (Projects #14-17). 

Schizophrenia. The average length of service prior to breakdown was two and a half years. The 

majority could have been detected by adequate study at time of induction (Project #18). 

Tuberculosis. The incidence of more than 25% of positive tuberculin reactors among Veterans 

is almost double that of non-Veterans. The incidence of positive reactors increases with the 

length of service (Project #20). The final analysis should develop data on which constructive 

recommendations may be made to the Armed Forces for improved screening procedures for 

tuberculosis at admission and discharge (Project #89). 

Tumors of the Testis. The result of this study of the largest known series of testicular tumors 

(approximately 1,000) indicates significant differences in the prognosis for certain types. Pure 

seminomas (comprising about 40% of this total) had a five-year mortality rate of 1%; other 

types and combinations had 5-year mortalities ranging from 40 to 75%. 

Rheumatic Fever. The conclusions resulting from the final analysis should reveal significant 

information concerning future induction of men with history of rheumatic fever and the 

disposition of men having this disease while in service (Project #65). 

Million-volt Irradiation. Among the late effects of million-volt irradiation are fibrosis of the 

lung, and severe damage to the gastrointestinal tract including ulceration, perforation and 

obstruction. Any dose above 2,000r may produce severe tissue damage; however some patients 

are able to withstand 4,000r. ” 

All of these were studies of World War II Veterans, aimed at discovering the long-term effects of 

diseases and injuries incident to their service. By their very nature, these studies required time to 

accumulate data, but by this time the reviewers wanted to see at least intermediate results. Most of 

the studies in this list did have outcomes published shortly after this report. Results of the hepatitis 

studies have stood the test of time.21 The psychoneurosis studies formed the basis for adjusting 

psychiatric standards for mobilization.22 The irradiation studies led to methods of evaluating 

tolerance levels for the gastrointestinal tract.23 

After reviewing this report, the CVMP enthusiastically endorsed the Follow-up Agency's 

activities.24 

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Figure 4.5. Meeting, about 1950, of the group working on the follow-up study of WWII 

vascular injuries. Dr. Beebe is second from left, second row, and Dr. DeBakey is at the far 

right, front row. 

A year later, however, some concern remained about the effectiveness of the Follow-up Agency. 

Dr. Milton Winternitz, Chairman of the NAS Division of Medical Sciences, commented to the 

CVMP that the total cost over five years, including all follow-up activities, had been $2.4 million, 

with “relatively little harvest to date.” None of the major projects had yet been completed. The 

CVMP again appointed an ad hoc committee to review the status of the follow-up studies.25 This 

led to an in-depth review by Donald Mainland, Ph.D., Professor of Medical Statistics at New York 

University. In his report of March 22, 1953, Mainland praised the statistical excellence of the 

Follow-up Agency staff but pointed to problems caused by early enthusiasm, large numbers of 

hastily planned studies, and more recent lagging because of clinician investigators’ competing 

responsibilities. He advised NRC to phase down the program and use its statistical staff to improve 

the quality of NRC-sponsored research.26 

By 1953, of 26 follow-up studies, eight were completed, 14 were targeted for completion over the 

next 18 months, two had been abandoned, and two long-term studies had no projected completion 

date. The NRC and VA placed a moratorium on starting new follow-up studies.27 

Until 1954, VA provided all support for the Follow-up Agency. During late 1953, VA found it 

necessary to reduce the Follow-up Agency annual budget abruptly from $228,000 to $163,000. The 

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Agency had to drop 10 staff members. Dr. R. Keith Cannan, Sc.D. described the situation to a 

meeting of the Executive Committee of the NRC Division of Medical Sciences: 

“The future of the Follow-up Agency of the Division is in jeopardy. The Veterans 

Administration’s 1954 budget request has been cut from 6.5 to 5.5 million dollars, while the 

number of their research laboratories has approximately tripled in three years. At the same time, 

there has been a shift in emphasis from extra-mural to intra-mural research. The question now 

before the Division is whether or not an effort should be made to maintain the Follow-up 

Agency.” 

After extensive discussion, the committee resolved that: 

“The medical experience of the Armed Forces and of the Veteran population provide a unique 

opportunity for medical follow-up studies of importance to clinical medicine and to the Armed 

Forces and the Veterans Administration. The Division of Medical Sciences provides a logical 

focus of leadership and organization for the many interests in such studies, and steps should be 

taken to re-establish, as a broad inter-agency program, a significant program of follow-up 

studies.”20 

The Follow-up Agency prepared a new plan, eventually adopted, in which they would seek support 

from VA and other agencies as well. They would keep a small “core” staff, which would be 

temporarily enlarged when new projects were funded. VA support would come as a contribution to 

“core” and also to specific contracts.28 

By the end of 1954, the Follow-up Agency was still on shaky ground and continued to seek a stable 

funding base. By this time, only four of its original 26 projects were still current. Owing to the 

moratorium, no new projects had been added.29 

Within a few months the situation improved: three projects continued under VA sponsorship, but 

now the Army and the U.S. Public Health Service were each sponsoring two new projects.30 

Multiple-agency funding continued thereafter. 

Studies in Several Key Areas 

In 1954, the Follow-up Agency, working with VA neurologist John Kurtzke, M.D., undertook its 

first controlled clinical trial. This study resulted from the observation that isoniazid, given to a 

patient with both tuberculosis and multiple sclerosis, appeared to lead to improvement in his 

multiple sclerosis. After the initial serendipitous observation, 30 patients with multiple sclerosis 

were treated with isoniazid and “ninety percent . . . showed striking improvement over a period of 

two years in comparison with controls from an earlier period.”31 With the encouragement of the 

CVMP, the Follow-up Agency coordinated a study of 186 multiple sclerosis patients in 11 VA 

hospitals, comparing 100 mg isoniazid thrice daily with placebo. The results were negative: “By 

all criteria, including laboratory findings and over-all clinical impressions, the differences between 

the isoniazid and placebo groups were insignificant. No beneficial effects that could be ascribed to 

isoniazid in multiple sclerosis were observed in nine months or more of follow-up.”32 In this, one 

of the earliest placebo-controlled clinical trials, this particular treatment was laid to rest. However, 

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the collaborating group built on this study to conduct a five-year follow-up of the clinical course of 

these well-studied patients with this puzzling disease.33 There were 52 deaths during the five-year 

period. Eight patients improved, 35 were unchanged, and in the others, the disease worsened. 

Mortality was directly related to severity of the disease at the time of the original study. There was 

no long-term difference between patients treated with isoniazid during the controlled trial and those 

given placebo. 

When, in 1957, VA began collaborative studies with the National Cancer Institute on the value of 

adjunctive chemotherapy in surgical oncology (Chapter 13), the Follow-up Agency broadened its 

support of the VA research program by providing ongoing statistical support. 

The leaders of the Follow-up Agency recognized early on the value of follow-up studies in pairs of 

twins. From the mid-1950s, they explored the possibility of establishing a twin registry. In 1958, 

partially funded by VA, the Agency staff began the long, complex process of assembling a roster of 

Veteran twin pairs from World War II. They started with lists of male twins born between 1917 and 

1927 in 29 states. Of the 45,000 male twin pairs identified, there were 8,000 where both were 

Veterans. To determine zygosity (whether identical or fraternal) of these twin pairs, the Follow-up 

Agency asked the FBI for copies of their fingerprints that were made at induction into the military. 

The FBI found this to be difficult and provided only some of the fingerprints. In addition, all 

subjects answered a questionnaire that included the question “As children, were you and your twin 

as alike as two peas in a pod?” The answer to this question correlated 95 percent with the results of 

fingerprint matching, and it was used to classify zygosity when fingerprints were not available. 

A special committee reviewed all requests to use the twin registry and used strict criteria in their 

review, turning down two of the first three requests. The concern was to avoid unduly troubling the 

subjects while maintaining the registry by contacting them periodically. Some studies conducted in 

subsequent years required the twins to appear for examination, but most depended on records. 

Altogether, some 200 articles have been published that used this twin registry as a resource. 

The Follow-up Agency later assisted VA in setting up a registry of Vietnam-era Veteran twins; this 

is now managed as a part of VA’s intramural epidemiologic program.34 

Results of Follow-up Agency studies 

All told, between 1949 and 1996, the Follow-up Agency played a key role in studies leading to 

some 500 publications.35 Its bibliography has been described as “a chronicle of the history of 

epidemiology in military and Veteran populations.”36 

Among the results of the early VA-sponsored Follow-up Agency studies were: 

Infectious hepatitis. A group of 367 men living in the Minneapolis area who had documented 

hepatitis during World War II, including 69 with multiple attacks, received thorough workups four 

to six years later. They were compared with 137 men who had been heavily exposed to hepatitis 

without a clinical episode and to 212 controls. There were no significant differences among the 

21

groups. A separate study from Philadelphia showed similar results in 271 men who had suffered 

clinical hepatitis, 138 “heavily exposed” men and 242 controls.37 A third study was a 10-year 

follow-up of 460 men with acute hepatitis who were subjects of controlled treatment trials during 

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the Korean War. At follow-up, there was no difference between groups treated in different ways 

(bed rest, forced diet).38 

Psychoneurosis. The psychiatric status of 955 former enlisted personnel diagnosed with 

psychoneurosis during their service was studied about five years after the original episode. Only 11 

percent of these Veterans had sought psychiatric care from VA. Of the total, 62 percent came in for 

examination by a psychiatrist and information about all but 1.5 percent was available from some 

source such as VA records. The mortality pattern in the sample matched that of the general 

population except for an increase in suicides (six compared with an expected two). Only 1.8 

percent were judged to be psychotic at follow-up, but 72 percent were judged to have some 

psychiatric disease. In general, the trend was judged to be toward improvement over time.39, 40 

Peripheral nerve injury. In this study, one of the first approved by the CVMP, late results in 3,656 

World War II peripheral nerve injuries were assessed in five clinical centers. The study supported 

use of radical surgery for complete loss of nerve function but conservative treatment when nerve 

continuity has not been interrupted. It also demonstrated the value of physical therapy in recovery 

of function. The study showed an inverse relation between functional recovery and the distance 

from the lesion to its area of principal innervation.41 

Tuberculosis. This study compared induction and discharge chest x-rays of about 3,000 men 

discharged from the military for tuberculosis and 3,000 matched controls. In about half of those 

discharged for tuberculosis, evidence of tuberculosis was present in the induction film. New 

tuberculosis was more frequent in non-whites; in tall, thin men; and in former prisoners of war.42 

Rheumatic fever. 135 randomly selected men with confirming records of diagnosis were examined 

three to eight years after Army hospitalization for acute rheumatic fever. At the follow-up 

examination, 32 of these men (23.7 percent) had rheumatic heart disease, a lower incidence than 

seen after rheumatic fever in children. Even in those with physical evidence of rheumatic heart 

disease, most were living normal lives with 95 percent employed or in school.43 

Sarcoidosis. This was an epidemiological study of the 350 cases of sarcoidosis recognized among 

Armed Forces personnel during World War II. Residence in rural areas of the Southeast within 

regions of fine sandy soil appeared to favor development of sarcoidosis, and it was seen more 

frequently in blacks.44, 45 

Hand injury. Follow-up of 104 patients with severe war wounds to the hand showed that adequate 

physical therapy is of great importance to functional recovery, and more important than 

reconstructive surgery that might require immobilization of the hand. All but four of the men 

studied were employed at follow-up.46 

Combat-related schizophrenia. Two physicians who had treated 341 patients with acute 

schizophrenia in New Guinea during World War II were able to make personal contact with 156 of 

them five to eight years after the initial episode. They followed the remainder through VA records. 

Thirty control subjects, selected by the Follow-up Agency, were also examined. Although there 

was a trend toward improvement with time, 186 of the patients were still considered moderately or 

severely impaired five or more years after the initial episode. Neither the military nor the domestic 

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experiences of the schizophrenic patients differed from controls. The authors concluded that there 

is little profit to be gained in attempting to screen out those who may have schizophrenia at 

induction.47, 48 

Prisoners of War. The Follow-up Agency has carried out a series of studies of long-term morbidity 

and mortality of former prisoners of war (POWs). The first, published in 1955, showed that overall 

mortality was increased in World War II POWs from the Pacific, but not the European, theater. 

This excess mortality was almost entirely due to tuberculosis and accidents.49 In the second study, 

which included Korean War Veterans, POWs also had excess mortality.50 However, by 1975 this 

excess in mortality rate had waned in both World War II and Korean War ex-POWs.51 A 1975 

study of morbidity in former POWs showed the most frequent illnesses to be psychiatric, with 

higher rates of hospitalization and VA disability. Excess morbidity correlated well with 

retrospective accounts of captivity weight loss, nutritional deficiencies and other associated 

symptoms.52 

Head injuries. This was a follow-up of 739 World War II Veterans who had suffered penetrating 

wounds of the brain. Four centers examined their status extensively some 10 years after their 

injuries. Epilepsy, found in 28 percent, was worse and more frequent when the wounds were larger 

and deeper. Impaired judgment and altered personality were also related to the size of the wound, 

but not to its location.53, 54 

Buerger’s disease. Epidemiology and 10-year prognosis were studied in 936 Army males with 

Buerger’s Disease documented from 1942 to 1948. Compared with Army men in general, those 

with the disease were older, more likely to be officers and more likely to be Jews. Incidence was 

estimated at about 3.5 per 100,000 Army men aged 20-44. Mortality was increased and related to 

severity of the disease. Amputations and sympathectomies also were related to disease severity at 

onset, and neither decreased in frequency with time.55 

Hodgkin’s disease. Epidemiology of, and survival over 17 years from, Hodgkin’s Disease were 

studied in 388 documented cases, diagnosed during World War II. Patients with Hodgkin’s Disease 

were better educated, of higher economic class and less likely to be married than Army men in 

general. The number of signs and symptoms of the disease at onset correlated with the histologic 

type and with survival. After 17 years, 8.4 percent of the men with granuloma and 28.6 percent of 

those with paragranuloma were alive. All five men with Hodgkin’s sarcoma died within one year.56 

Ulcerative colitis. In a study of the epidemiology of ulcerative colitis among Army men in 1944, 

525 patients were compared with matched controls. The incidence was seen to rise with age, and 

Jews were affected more than twice as frequently as non-Jews.57 In a follow-up study of mortality 

from these samples, 10.7 percent of the patients with ulcerative colitis died in the first 17 years after 

the index hospitalization, compared to 5 percent in the controls. Half of this excess mortality was 

due to ulcerative colitis, generally within the early years after diagnosis. The other half was due to 

cancer of the colon, most frequently in later years. A bad prognosis correlated strongly with the 

extent of colon involvement in X-rays made in 1944.58 

Missiles in the heart. Forty men who survived missiles in the heart which had not been removed 

were studied 17 to 20 years after their injuries. Most had normal electrocardiograms and chest X135
 
 

 

 

 

 

 

 

 

 

 

 

 

rays at follow-up. Pericarditis had occurred in 25 percent. Only one patient had had serious 

migration of the missile. However, all of those examined suffered a “formidable strain of living 

with a missile in the heart,” and five were totally incapacitated by an anxiety neurosis.59 

Lumbar disk disease. The epidemiology of herniated nucleus pulposis (HNP) was studied in 1,095 

first Army admissions, matched on age and period of World War II service with holders of Army 

National Life Insurance policies. HNP was found to be associated with mechanical factors related to 

body build (excess height, excess weight, good posture) and occupation (enlisted, ground combat, 

craftsman, rural residence). There was no difference from controls in prior service hospitalizations, 

including those for trauma.60 

There has been speculation that it might have been better if the Follow-up Agency had originally 

been made a part of VA.19 Among the reasons cited was that such an arrangement would have 

given needed stability, though it might have reduced the Agency’s freedom of action. Also, 

participation in a strong in-house VA biostatistics and epidemiology program in the early days 

could have enriched the VA program and provided guidance and consistency. Feedback from VA 

could have improved the early follow-up studies. 

On the other hand, as an independent agency, the Follow-up Agency was able to branch out to other 

sources of funding when VA’s attention turned toward other priorities. It could meet urgent nonVA needs, such as those of the Atomic Bomb Casualties Commission. And though the Agency 

grew away from its VA roots, relations between the Follow-up Agency and VA Research remained 

good through the years and continue to be mutually beneficial. 

Closing of the Committee on Veterans Medical Problems 

By 1954, CVMP activity was winding down. The Follow-up Agency was well established. As the 

VA intramural program reached firmer ground, the research program had turned away from 

supporting research contracts.61 Review of the contracts program, a key role of the CVMP, was no 

longer necessary. The CVMP no longer oversaw the prosthetics research program. From 1954 to 

1959, the CVMP met only about once a year to review the overall VA research program and 

oversee the Follow-up Agency. It formally disbanded at the end of 1962.62 

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References 

1. Letter from Gilbert W. Beebe, P.D. to author, written at Bethesda, MD, July 5, 2002. 

2. Letter from Michael DeBakey, M.D. to Norman T. Kirk, Surgeon General of the Army, 

written at the Pentagon, March 5, 1946. 

3. Letter from Norman T. Kirk to Frank B. Jewitt, President of the National Academy of 

Sciences, written at Washington, D.C., 

4. National Research Council, Report on the Value and Feasibility of a Long-Term Program of 

Follow-up Study and Clinical Research. Washington, D.C.: National Academy of Sciences, 

1946. 

5. National Academy of Sciences - National Research Council. "Minutes of First Meeting, 

Committee on Veterans Medical Problems." September 20, 1946. Washington, D.C.: 

National Research Council, 

6. National Research Council, Report on Follow-up Study and Clinical Research. 

7. National Academy of Sciences - National Research Council. "Minutes, Second Meeting of 

the CVMP." December 9, 1946. Washington, D.C.: National Research Council. 

8. Richards, A.N., "Foreword," in Advances in Military Medicine Made by American 

Investigators Working under the Sponsorship of the Committee on Medical Research, 

Andrus, E.C., Bronk, D.W., Carden, G.A., Keefer, C.S., Lockwood, J.S., Wearn, J.T., and 

Winternitz, M.C., Editors. 1948, Little, Brown and Company: Boston. 

9. NAS-NRC. "Minutes, First Meeting of the CVMP." September 20, 1946, 29. 

10. Peripheral Nerve Regeneration: A Follow-up Study of 3,656 World War II Injuries. 

Woodhall, B. and Beebe, G.W., eds.; Washington, D.C.: U.S. Government Printing Office, 

1957. 

11. Cushing, E.H. "Minutes, Special Medical Advisory Group." Washington, D.C., 9. 

12. Interview with Marjorie T. Wilson, M.D., April 29, 1988 at Dr. Wilson's office at ECFMG, 

in Washington, D.C. 

13. National Academy of Sciences - National Research Council. "Minutes, Third Meeting of the 

CVMP." March 14, 1947. Washington, D.C.: National Research Council, Appendix C. 

14. Medical Follow-up Agency "Report to Chairman, Division of Medical Sciences, National 

Academy of Sciences." 1948. 3-4. 

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15.	 Interview with Gilbert W. Beebe, Ph.D. and Seymour Jablon, May 3, 1988 at Mr. Jablon's 

office at NIH. 

16. Peripheral Nerve Regeneration. Woodhall and Beebe, eds.; 1957, 18-19. 

17. National Academy of Sciences - National Research Council. "Minutes, Fifth Meeting of the 

CVMP." December 11, 1947. Washington, D.C.: National Research Council. 

18. Medical Follow-up Agency "Report to Chairman, Division of Medical Sciences, National 

Academy of Sciences." 1949. 5. 

19. Interview with Gilbert W. Beebe, Ph.D., June 1, 1994 at a hotel lobby in Washington, DC. 

20. National Academy of Sciences - National Research Council. "Minutes, Fourteenth Meeting 

of the CVMP." November 18-19, 1949. Washington, D.C.: National Research Council. 

21.	 Zieve, L., Hill, E., Nesbitt, S. and Zieve, B., "The Incidence of Residuals of Viral Hepatitis." 

Gastroenterology, 1953. 25: 495-531. 

22. Brill, N.Q. and Beebe, G., "Some Applications of a Follow-up Study to Psychiatric 

Standards for Mobilization." Am J Psychiatry, 1952. 109: 401-420. 

23. Amory, H. and Brick, I., "Irradiation Damage of the Intestines Following 1000-Kv Roentgen 

Therapy." Radiology, 1951. 56: 49-57. 

24. Medical Follow-up Agency "Report to Chairman, Division of Medical Sciences, National 

Academy of Sciences." 1951. 5. 

25. National Academy of Sciences - National Research Council. "Minutes, Twenty Fifth 

Meeting of the CVMP." December 5, 1952. Washington, D.C.: National Research Council. 

26. Mainland, D. "The VA-NRC Program of Follow-up Studies: Evaluation and Suggestions." 

1953. 

27. Follow-up Agency "Report, Division of Medical Sciences, NRC." 1953. 

28. National Academy of Sciences - National Research Council. "Minutes, Twenty Eighth 

Meeting of the CVMP." December 7, 1953. Washington, D.C.: National Research Council. 

29. National Academy of Sciences - National Research Council. "Minutes, Thirtieth Meeting of 

the CVMP." Washington, D.C.: National Research Council. 

30. National Academy of Sciences - National Research Council. "Minutes, Thirty First Meeting 

of the CVMP." April 15, 1955. Washington, D.C.: National Research Council. 

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31. NAS-NRC. "Minutes, Thirtieth Meeting of the CVMP." November 2, 1954. Washington, 

D.C.: National Research Council. 

32.	 Veterans Administration Multiple Sclerosis Study Group, "Isoniazid in treatment of multiple 

sclerosis: Report on Veterans Administration Cooperative Study." JAMA, 1957. 163: 168­

172. 

33.	 Veterans Administration Multiple Sclerosis Study Group, "Five year follow-up on multiple 

sclerosis: Report on Veterans Administration Cooperative Study." Archives of Neurology, 

1964. 11: 583-592. 

34. Berkowitz, E.D. and Santangelo, M.J., The Medical Follow-up Agency: The First Fifty 

Years, 1946-1996. Washington, D.C.: National Academy Press, 1999, 27-28, 31, 45, 65, 67. 

35. Berkowitz and Santangelo, Medical Follow-up Agency. 87-124. 

36. Remington, R. "Remarks by Chairman, Committee on Epidemiology and Veteran Follow-up 

Studies, Commission on Life Sciences, National Research Council." Conference on 

Epidemiology in Military and Veteran Populations, quoted in Report of an Ad Hoc 

Executive Committee charged to review the Medical Follow-up Agency, July 27, 1987. 

37. Neefe, J., Gambescia, J., Kurtz, C., Smith, H., Beebe, G., Jablon, S., Reinhold, J. and 

Williams, S., "Prevalence and nature of hepatic disturbance following acute viral hepatitis 

with jaundice." Ann Intern Med, 1955. 43: 1-32. 

38. Nefzger, M. and Chalmers, T., "The treatment of acute infectious hepatitis." Am J Med, 

1963. 35: 299-309. 

39. Brill, N.Q. and Beebe, G., "Follow-up study of psychoneuroses." Am J Psychiatry, 1951. 

108: 417-425. 

40. Brill, N.Q. and Beebe, G.W., A Follow-up Study of War Neuroses. VA Medical Monograph. 

Washington, D.C.: U.S. Government Printing Office, 1955. 

41. Peripheral Nerve Regeneration. Woodhall and Beebe, eds.; 1957. 

42. Long, E.R. and Jablon, S., Tuberculosis in the Army of the United States in World War II. 

VA Medical Monograph. Washington, D.C.: U.S. Government Printing Office, 1955. 

43. Engleman, E.P., Hollister, L.E. and Kolb, F.O., "Sequelae of rheumatic fever in men. Four 

to eight year follow-up study." JAMA, 1954. 155: 1134-1140. 

44.	 Michael, M., Jr., Cole, R., Beeson, P. and Olson, B., "Sarcoidosis: Preliminary report on 

study of 350 cases with special reference to epidemiology." Natl Tuberc Assoc, 1950. 46: 

208-212. 

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45. Gentry, J.T., Notowsky, H.M. and Michael, M., "Studies on the epidemiology of sarcoidosis 

in the United States: The relationship to soil areas and to urban-rural residence." J Clin 

Invest, 1955. 34: 1839-1856. 

46. Freni, D.R. and Warren, R., "End-results of rehabilitation of war wounds of the hand." Arch 

Surg, 1951. 63: 774-782. 

47. Ripley, H. and Wolf, S., "Long-term study of combat area schizophrenic reactions." Am J 

Psychiatry, 1951. 108: 409-416. 

48. Ripley, H. and Wolf, S., "The course of wartime schizophrenia compared with a control 

group." J Nerv Ment Dis, 1954. 120: 184-195. 

49. Cohen, M.B. and Cooper, M.Z., A Follow-up Study of World War II Prisoners of War. VA 

Medical Monograph. Washington, D.C.: U.S. Government Printing Office, 1955. 

50. Nefzger, M., "Follow-up studies of World War II and Korean War prisoners." Am J 

Epidemiology, 1970. 91: 123-138. 

51. Keehn, R.J., "Follow-up studies of World War II and Korean Conflict prisoners: III. 

Mortality to January 1, 1976." Am J Epidemiology, 1980. 111: 194-211. 

52. Beebe, G.W., "Follow-up studies of World War II and Korean War prisoners. II. Morbidity, 

disability, and maladjustments." Am J Epidemiology, 1975. 101: 400-422. 

53. Walker, A. and Jablon, S., "A Follow-up of head-injured men of World War II." J 

Neurosurg, 1959. 16: 600-610. 

54. Walker, A.E. and Jablon, S., A Follow-up Study of Head Wounds in World War II. VA 

Medical Monograph. Vol. 16. Washington, D.C.: U.S. Government Printing Office, 1961, 

600-610. 

55. De Bakey, M.E. and Cohen, B.M., Buerger's Disease: A Follow-up Study of World War II 

Army Cases. Springfield, IL: Charles C. Thomas, 1963 

56. Cohen, B.M., Smetana, H.F. and Miller, R.W., "Hodgkin's Disease: Long survival in a study 

of 388 World War II Army Cases." Cancer, 1964. 17: 856-866. 

57.	 Acheson, E.D. and Nefzger, M.D., "Ulcerative colitis in the United States Army in 1944. 

Epidemiology: Comparisons between patients and controls." Gastroenterology, 1963. 44: 7­

19. 

58. Nefzger, M. and Acheson, E., "Ulcerative colitis in the United States Army in 1944. 

Follow-up with particular reference to mortality in cases and controls." Gut, 1963. 4: 183­

192. 

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59. Bland, E. and Beebe, G., "Missiles in the heart. A twenty-year follow-up report of World 

War II cases." New Eng J Med, 1966. 274: 1039-1046. 

60.	 Hrubek, Z. and Nashold, B.S., "Epidemiology of lumber disk lesions in the military in 

World War II." Am J Epidemiology, 1975. 102: 366-376. 

61. National Academy of Sciences - National Research Council. "Minutes, Twenty Ninth 

Meeting of the CVMP." Washington, D.C.: National Research Council, 5. 

62. Letter from R. Keith Cannon to members of the Committee on Veterans' Medical Problems, 

written at Washington, D.C., September 19, 1962. 

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Chapter 5. The Tuberculosis Treatment Trials 

Tuberculosis was a major public health problem in the 19th century and first half of the 20th 

century. Thanks in part to public health action, especially isolation of active cases and the 

campaign against public spitting, the incidence of the disease generally decreased in the United 

States. Deaths from tuberculosis declined from 195 per year per 100,000 population in 1900, to 113 

in 1920 and 46 in 1940.1

 However, military personnel during wartime were exposed to crowding, 

disease and poor nutrition. Many who served in the two World Wars contracted tuberculosis. 

Tuberculosis in the World War I Veteran 

In 1917, when the United States was on the brink of World War I, a new law defining the nation’s 

responsibility to provide for the health of those who served in its wars replaced the previously 

politically driven pensions system (Chapter 1). Under this new law, injured and ill former 

servicemen had the right to care in government hospitals.2 

Patients with tuberculosis were prominent among those needing care in Veterans’ hospitals, and 

accounted for 12 percent of the 178,000 World War I service disability discharges.3 During the 

early and mid-1920s, a network of Veterans’ hospitals devoted entirely to the care of the 

tuberculous grew up in the United States. 

Before the Veterans’ Bureau was established, World War I Veterans stricken with tuberculosis were 

treated in U. S. Public Health Service hospitals, but the number of beds was inadequate and allowed 

care of only a small minority. Many World War I Veterans stricken with tuberculosis were 

hospitalized in private hospitals under government contract. Many others stayed home, where they 

often infected their families and friends. New VA tuberculosis beds were filled as soon as they 

became available. The number of hospitalized Veterans with tuberculosis skyrocketed from 12,000 

in 1920 to a 1922 peak of 44,951.3 After that, the number of Veterans’ tuberculosis admissions 

decreased and stabilized at about 11,000 per year from 1929 through 1945.4 

In this pre-antibiotic era, VA care for tuberculosis was considered to be the best in the nation. 

Following the advice of the American Tuberculosis Association,5

 hospitals were placed in locations 

considered best for controlling the disease. These were in areas away from cities, often in the 

mountains, where the clear air was thought to be beneficial. Even though a 1927 Veterans’ Bureau 

study showed that climate had no effect on outcome of tuberculosis,6 the generally held medical 

opinion was that it did. Patients were kept in bed because bed rest was the mainstay of treatment. 

Increasingly, pneumothorax and thoracoplasty, operations to rest the diseased area of lung, became 

accepted treatment for tuberculosis and were added to bed rest.7, 8 

The Medical Council, VA’s advisory council in the 1920s and 1930s (Chapter 1), included a special 

group to consider treatment of tuberculosis. They advised on such matters as frequency of refills of 

pneumothorax, evaluation of “arrested” cases needing readmission and frequency of bacteriological 

studies.9 

In 1926, VA’s new Research Subdivision’s published its first report: a statistical analysis of 

Veterans hospitalized with tuberculosis who also had a second disability. Nearly 39,000 such 

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Veterans had been hospitalized since 1919.10 Significantly more Veterans with far advanced 

tuberculosis and a second disability were “colored” (62 percent) than white (42 percent). The 

following year, a systematic study of Veterans examined the prevalent view that climate influences 

the outcome of tuberculosis treatment.6

 Treatment results at the 19 Veterans’ tuberculosis hospitals 

scattered throughout the country in a variety of climates and settings were correlated with their 

climatic conditions. The study concluded that “climate is not an important factor, and does not 

influence the end results.” 

During the period between the two World Wars, tuberculosis remained one of the most important 

problems of Veterans’ medical care, though the fraction of tuberculous patients in Veterans’ 

hospitals declined from 40 percent in 1922 to 8 percent in 1941.11, 12 VA’s own medical journal, the 

Medical Bulletin, published articles by VA staff that generally reflected their thoughts about their 

attempts to improve patients’ care. In the year 1927 alone, the Medical Bulletin published 10 

clinical research articles about tuberculosis. Topics included treatment of bone tuberculosis by 

actinotherapy,13 heliotherapy in laryngeal tuberculosis,14 statistical analysis of tuberculosis in 

mental hospitals,15 interaction between tuberculosis and intercurrent diseases,16 an outcomes study 

of 500 cases of pulmonary tuberculosis,17 a systematic (negative) study of the effect of climate on 

outcome of tuberculosis treatment6 and an essay on the history of tuberculosis.18 There were case 

reports of lupus vulgaris,19 generalized tuberculous adenitis,20 tuberculous pericarditis21 and 

tuberculous duodenal ulcer.22 Also published were various essays on the importance of early 

diagnosis of tuberculosis,23 proper history taking24 and advice about care of the tuberculous 

patient.25 

Tuberculosis patient load 1940 - 1957 

0 

2000 

4000 

6000 

8000 

10000 

12000 

14000 

16000 

Year 

Tbc 

Figure 5.1. Number of patients with tuberculosis in VA hospitals, 1940-1957 

Tuberculosis in the World War II Veteran 

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As the United States mobilized for the Second World War, the Veterans Administration staff 

dwindled.26 Doctors and nurses were needed in the military. When they left VA, there were no 

replacements. Facilities deteriorated because of shortage of staff and materials for upkeep. At the 

end of the war, the sudden influx of demobilized soldiers, many with tuberculosis, created 

overcrowding and short staffing. In some cases, patient care was not good and the patriotic public 

was alerted through newspapers and magazines.27 Eleanor Roosevelt learned of the situation and 

informed President Truman.28 It was at that point that Truman called on General Omar Bradley to 

head VA., with Bradley, in turn, naming General Paul Hawley to head VA’s medical department. 

One of the first problems Hawley tackled was the needs of the new Veterans who had tuberculosis. 

At that time, some 12,000 Veterans were hospitalized in VA hospitals for tuberculosis, and their 

number was growing steadily. 

Hawley persuaded John Barnwell, M.D., a professor at the University of Michigan, to come to 

Washington to lead the VA fight against tuberculosis. Barnwell was a well-known authority on the 

disease, who himself had been treated for tuberculosis. Equally important, he was active in the 

American Trudeau Society (a non-government organization advocating tuberculosis research) and a 

personal friend of leaders in the field. His goal was to use every resource available to him to 

improve the care of the tuberculous Veteran. 

Figure 5.2. John Barnwell, M.D. 

In 1946, the best medical centers and sanitoria continued to treat tuberculosis with rest therapy. 

Patients were confined to special hospitals or to special units in general hospitals. Complete bed 

rest was enforced, with patients not even getting up to use the bathroom. Pneumothorax and 

thoracoplasty, to “rest” the diseased area or to reduce the size of tuberculous cavities, were 

common. Typically, a tubercular patient would be hospitalized for a year or more. Given the danger 

of infection, sufferers were isolated from their normal worlds. Even if their disease was eventually 

arrested, the personal and social impact of the disease was significant. The possibility of death was 

very real; sometimes entire families were wiped out by tuberculosis. 

Streptomycin comes on the scene 

For half a century after Robert Koch’s discovery of the tubercle bacillus in 1882 as the cause of 

tuberculosis, attempts at systemic treatment were made. These treatment approaches began with 

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Koch’s own enthusiastic, but eventually disappointing, use of tuberculin, an inactivated product of 

the tubercle bacillus, and ranged through the use of sanocrysin, a gold compound, in the 1920s and 

1930s. A study that may have been the first placebo-controlled clinical trial in the world proved 

sanocrysin to be disappointingly ineffective in curing tuberculosis.29 Transient enthusiasm occurred 

for proposed cures, which ultimately proved ineffective. An example is the use of turtle serum, 

thought to be effective because the turtle has antibodies to a type of mycobacterial disease.30 One 

disappointment after another led to a pervading skepticism about any proposed new treatment for 

this persistent and resistant disease. When streptomycin appeared in the wake of penicillin’s 

spectacular wartime success and showed promise in treatment of tuberculosis, it was greeted with 

suspicion by the older, more experienced phthisiologists.30 

Very little streptomycin was available at the beginning of 1946. Its distribution to civilians in the 

United States and England was controlled by central governmental agencies. In early 1946, the 

entire VA hospital system received only 2 kg per month. General Hawley appointed a 

“Streptomycin Committee,” chaired by Dr. Barnwell, to distribute this scant supply to VA hospitals. 

Barnwell recruited Dr. Arthur Walker, who had worked on the clinical development of penicillin 

during the war, to serve as Secretary to the committee and coordinate the streptomycin treatment 

program. At first, all of the streptomycin was used for nontuberculous conditions such as tularemia. 

Gradually, the manufacturers succeeded in increasing production. By April 1946, some 

streptomycin was available to explore treating selected tuberculosis patients. 

Figure 5.3 Arthur Walker, M.D. 

In preliminary clinical trials,31 streptomycin, which had been discovered in 1944,32 showed promise 

against tuberculosis. It was known to inhibit the tubercle bacillus in culture. But despite a few 

isolated cases successfully treated with streptomycin, no one really knew if clinical tuberculosis 

would be helped by the drug. 

Tuberculosis is a very complex disease. The tubercle bacillus grows slowly and often attacks sites 

that are not very vascular, so the antibiotic might not reach the bacillus through the blood stream. It 

walls itself off in “tubercles,” surrounded by fibrous tissue with little blood supply. It invades many 

parts of the body and shows itself in various ways. 

The body fights tuberculosis through its immune system. The treatments that had been successful 

up to that time, such as bed rest, depended on the immune defensive resources of the patient’s body. 

146
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patients frequently would improve without specific treatment. Permanent arrests of the disease 

often occurred, though it was generally felt that people were never completely “cured.” Whether 

streptomycin would alter the course of this complex clinical picture and bring about true cures was 

doubtful. Barnwell and Walker set out to try to answer that question.33 

Design of the VA-Armed Forces streptomycin trial 

Walker had been part of the central group coordinating wartime studies of penicillin treatment of 

syphilis. Those studies depended on systematic study of the patient before and during treatment, 

standardization of a prescribed regimen of treatment and adequate follow-up. Comparison with an 

untreated control series of patients, or with patients treated with the then-standard arsenical and 

bismuth regimens, was not a part of these studies. Instead, the investigators drew on their 

significant personal clinical knowledge about the natural history of syphilis, knowledge believed 

sufficient to predict the course of the disease without penicillin.34 

The design for the first VA-Armed Forces study of streptomycin in tuberculosis, begun in 1946, 

followed the same pattern as that used for the study of penicillin in syphilis: carefully defined study 

of the patient before treatment, prediction of what the patient’s clinical course would be without 

treatment, standardization of treatment to a single dosage schedule, observation for the effect of 

treatment on signs and symptoms of tuberculosis, repeated cultures to isolate the tubercle bacillus, 

observation for treatment complications, and post-treatment follow-up. 

In their first report to the American Medical Association Council on Pharmacy and Therapeutics, 

Barnwell and Walker cited the preliminary reports about streptomycin, especially those already 

published from the Mayo Clinic. The reports made clear that the widespread VA-Armed Forces 

clinical study was founded on good evidence that streptomycin was effective in at least some 

instances: 

“There was thus available to the federal agencies, at the time their investigation was designed, 

considerable information as to the effectiveness and dangers of streptomycin in the treatment of 

human tuberculosis. Without this information the investigation would not have been 

undertaken.”35 

This statement describes the prevailing attitude at the time in the United States. It was the 

physician’s responsibility to do the best thing for the patient. The patient’s responsibility was to 

adhere to the prescribed treatment, generally without participating actively in the therapeutic 

decision. “Informed consent” for an unestablished treatment was not the norm. 

Barnwell and Walker chose seven VA and two military hospitals for their study of streptomycin in 

tuberculosis. These included VA hospitals at Bronx (N.Y.), Hines (Ill.), Livermore (Calif.), Oteen 

(Asheville) (N.C.), and three hospitals that have since been closed: Rutland Heights (N.J.), San 

Fernando (Calif.), and Sunmount (N.Y.). Also included were Fitzsimons General Army Hospital in 

Denver and the Sampson, N.Y,, Navy Hospital. Only patients selected for the study in these 

hospitals received the drug. Hospital selection for the first study was based on having doctors 

knowledgeable about tuberculosis who were eager to cooperate in a study to see what effect 

streptomycin had on moderately advanced tuberculous disease. 

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These hospitals were given an allotment of the precious streptomycin that was adequate to treat 

those patients who qualified for the protocol. Barnwell and Walker worked with representatives of 

the Army and Navy to establish and follow a common protocol. Requirements of the protocol were: 

“a. That all cases would have been observed for a period of at least sixty days prior 

to initiation of treatment and that during this period the pulmonary lesion would
 

have become more extensive or, at best, remained stationary; 

 b. That tubercle bacilli would have been recently recovered from the sputum or 

gastric contents and that confirmation of their identity by inoculation into guinea 

pigs, or by culture, would have been started;
 

c. That moderately advanced disease would be preferred but that far advanced
 

disease would be acceptable, provided the patient had an estimated life expectancy
 

of at least twelve months without streptomycin therapy;
 

d. That the X-rays would disclose some exudative component, the more the better, in 

the pulmonary lesion;
 

e. That all patients would preferably have been on complete bed rest prior to therapy
 

but, if this was not the case, that they would observe the same degree of physical 

 activity during therapy as was in effect before treatment was started;
 

f. That pneumothorax would not be present on the side toward which the treatment 

was primarily directed; 

g. That no collapse procedures would be initiated during treatment but, if 

pneumoperitoneum, phrenic paralysis, or contralateral pneumothorax was present 

prior to treatment, they would be maintained at the preexisting level.”35
 

Since the first question to be answered was whether streptomycin really had any effect on the 

course of tuberculosis, Barnwell and Walker and their colleagues first decided to use a dosage 

schedule that could be expected to maintain blood streptomycin levels over the course of 24 hours. 

Based on previous experience with penicillin, patients in the first study received a daily dose of 1.8 

grams of streptomycin, 0.3 grams intramuscularly every four hours. As they state in their early 

paper describing the study: 

“These decisions concerning dosage and duration of treatment were admittedly 

 arbitrary for there were no data on which to base an informed judgment but, in order 

that the study have any statistical significance, it was considered essential that this first 

group of patients be treated in accordance with a single regimen.”33
 

Barnwell and Walker visited the study hospitals to review the patients chosen for the study and to 

assist in meeting the criteria. They soon found that the majority of patients in VA tuberculosis 

wards had far-advanced disease, so a larger fraction than planned of these patients were included in 

the study. 

The question of controls 

From the beginning of this study, discussion and worry centered around the use of controls. Some 

felt that concurrent untreated controls were essential. However, withholding the drug raised ethical 

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concerns, once clinicians became convinced that it worked, even though that hadn’t been proven. 

Finding it impractical to include prospectively randomized controls in their study, Barnwell and 

Walker and their advisors then substituted two other types of controls: 

a. Use of the patient as his own control, and 

b. Use of untreated patients, similar clinically, from a time before streptomycin was available. 

Not everyone was satisfied, however, with the decision to omit the use of concurrent randomized 

controls. Gilbert Beebe, Ph.D., a statistician who headed the National Research Council’s Followup Agency (Chapter 4), met with Barnwell and urged the use of untreated controls.36 Heated 

discussion of the issue of controls occurred at the third Streptomycin Conference in 1947, but the 

issue was not resolved. The following exchange between Dr. Walker and Paul Densen, D.Sc., a 

distinguished statistician who had joined VA Central Office, is recorded in the minutes: 

“Dr. Densen: From the statistical research end, it would be better to work only five 

cases in many different ways rather than to enlarge such a study to 50 cases. If you 

do five cases intensively, and do five cases without streptomycin, on which you get 

the same kind of laboratory observations, you will have a better series statistically 

than if you do all 10 cases on streptomycin.” 

“Dr. Walker: You and I have been arguing on opposite sides of the control question 

for the last few days.”37 

After this discussion with the statisticians, the clinicians met in executive session, without the 

statisticians, and decided not to include untreated controls. 

The streptomycin conferences begin 

In December 1946, those involved in conducting the streptomycin trial met in Chicago for the first 

of what proved to be a 25-year series of conferences. In addition to the VA, Army and Navy 

participants and Corwin Hinshaw, M.D., of the Mayo Clinic, the first physician to use streptomycin 

in patients, attended. Other participants included Esmond Long, M.D., of the Phipps Institute in 

Philadelphia, who later led an important U.S. Public Health Service study (discussed below), and 

C.J. Van Slyke, M.D., Medical Director of the National Institute of Health. 

At this first meeting, participants brought the records and biweekly chest x-ray films of the patients 

they had treated. As Dr. Walker described it, “34 individuals sat in a tight semicircle for three days 

gazing devotedly at x-ray view-boxes.” The assembled group read the series of x-rays from each of 

135 patients, and wrote down their opinions about changes in the tuberculous lesions. A statistician 

from VA Central Office statistics group then tabulated the opinions. 

The proceedings of this conference and of all of the later conferences were published by VA and 

distributed widely.38 

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Figure 5.4. Cover of the published minutes 

of the First Streptomycin Conference 

Results of the first VA-Armed Forces streptomycin study 

Since the organizers of the study had little idea about the expected outcome, the first patients were 

studied very thoroughly. They received chest x-rays, many of them stereoscopic, every two weeks 

during treatment. Auditory and vestibular function and screens for renal or hepatic toxicity were 

frequently assessed. Bacteriologic response was monitored, and blood streptomycin measured. 

Careful clinical records were kept.33 

Clinically, the initial improvement in the first group of 223 patients was impressive. The 

investigators were enthusiastic about their patients’ increased sense of well-being. Most patients 

(85 percent) had improved appetites and gained weight. Most (73 percent) who had fever became 

afebrile. Sputum production, cough and the number of tubercle bacilli in the sputum decreased. Of 

this first group of patients, 43 percent became bacteriologically negative during the 120 days of 

streptomycin treatment. 

But there were also adverse effects. Most frequent and disturbing (92 percent) was vestibular (inner 

ear) damage, which disturbed the patient’s balance, and this persisted after treatment, though many 

patients adapted to it. The caloric test for vestibular function was affected in 77 percent, but only 

0.5 percent had objective hearing loss; 67 percent developed casts in their urine and 70 percent 

developed eosinophilia. 

Encouraged by the results but suspicious of chest-film readings by those clinicians participating in 

the study, Barnwell and Walker sought a more objective assessment. For this, they recruited a jury 

of seven tuberculosis experts chosen by the President of the American Trudeau Society, the premier 

society for the study of tuberculosis. These seven men met for six days in May 1947 to read and 

compare films. They were presented with blinded film sets from patients with and without 

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streptomycin treatment, each set containing three films. The first two films in each set were taken 

at a two-month interval, the third after a four-month interval. In the case of treated patients, the 

first two-month interval was the pretreatment observation period. The first x-ray reviewed was 

taken two months before treatment began and the second immediately before treatment. The 

second, four-month interval was the period of streptomycin treatment in the treated group. The jury 

of experts evaluated interval changes in 222 lesions in 131 patients during the two months just prior 

to streptomycin treatment and during the four months of streptomycin administration. 

The corresponding interval changes were also judged in 142 lesions in 88 “historical control” 

patients, patients at the same hospitals who met the criteria of the study but who had been treated 

before streptomycin became available. 

Table 5.1. Chest film review by panel of experts. Review of 222 lesions in 131 patients 

treated with streptomycin and of 142 lesions in 88 historical control patients. 

Percent of exudative lesions 

Interval Treated Untreated 

 (n=222) (n=142) 

2 mo. before “treatment” 

Worse 36.9 7.0 

No Change 34.2 57.1 

Better 28.9 35.9 

4 mo. during “treatment” 

Worse 0.5 4.2 

No Change 14.5 65.6 

Better 85.0 30.2 

The results of their review were dramatic (Table 5.1). Firstly, it looked as if the historical controls 

chosen from the participating hospitals were, on average, less ill than the treated patients. Fewer of 

their exudative lesions worsened over a two-month period than did those in the study patients 

during the two-month pretreatment observation period. Among the untreated patients, the natural 

history of the illness was predictably stable, with about as many lesions worsening or improving 

over the next four months as during the first two months. On the other hand, in the treated patients, 

exudative lesions were much more likely to improve during the four months of streptomycin than 

during the pretreatment period. Only one of the 222 lesions evaluated in the treated patients 

worsened during treatment. 

A more extensive, but less objective, analysis included all of the biweekly films of all 223 patients 

(Table 5.2). In this study, physicians at the various participating hospitals read the films. Again, a 

dramatic improvement occurred during the period of streptomycin treatment. 

Resistance to streptomycin 

Eight percent of the patients in Table 5.2, after an initial improvement, began to do worse while still 

receiving streptomycin. This pattern would not have shown up on the “expert panel” readings, as 

that panel didn’t review films taken during the treatment course. The pattern of improvement 

followed by worsening suggested that resistance of the organisms to streptomycin was developing. 

Bacteriological analysis confirmed that 44 percent of the patients’ organisms had become 

Table 5.2. Chest x-ray readings by physicians at the patients’ hospitals (223 Patients) 

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Percent of Patients

 Before Rx During Rx After Rx 

Progression 75.3 0.5 16.4 

Stationary 17.1 6.5 44.1 

Regression 7.6 84.7 39.5 

Regression, then progression NA 8.3 NA 

moderately or markedly resistant to streptomycin by the end of two to three months’ treatment at 

1.8 grams/day and 65 percent were resistant at four months.33 This finding, that the tubercle bacillus 

became resistant to streptomycin as treatment progressed, and that resistance was associated with a 

reduced clinical response to the drug, was a uniform finding in all three streptomycin studies 

described in this chapter. 

Conclusion: Streptomycin is effective in treating pulmonary tuberculosis 

In May 1947, the VA-Armed Forces group had completed treatment of 543 cases, all having 

received 1.8 or 2 grams of streptomycin per day, and were convinced that streptomycin does, in 

fact, have a beneficial effect in treatment of tuberculosis. Expert panels confirmed this conclusion in 

1947. 

Results in other types of tuberculosis 

In addition to the study of pulmonary tuberculosis, by far the most prevalent type of the disease, the 

group studied other forms, following a variety of protocols tailored to each condition. By the time 

of their first publication in November 1947, the group could clearly recommend streptomycin in 

tuberculous cutaneous sinuses, tuberculous lymphadenitis, tracheobroncial and laryngeal 

tuberculosis, and tuberculosis of the tongue, tonsils, intestine and peritoneum. In fact, the results 

were so favorable that they never were able to complete the protocols planned for those 

conditions—there were no longer enough patients. Other extrapulmonary tuberculosis, of the 

urinary system, bone, joints and pericardium, showed less clear-cut benefit. Even miliary or 

meningeal tuberculosis, previously a death sentence, sometimes yielded to streptomycin. 

Informing practitioners of study’s results 

At the third VA-Armed Forces Streptomycin Conference, held in May 1947, participants discussed 

the best way to let others know about their early results. Dr. Walker felt strongly that participants 

from each hospital should publish their own results. Barnwell suggested a summary article, 

followed by articles from individual hospitals. This was the plan eventually followed. There was 

concern, however, that information dissemination shouldn’t wait for the formal publication process. 

As Barnwell said: 

“There is one thing that we have been warned about repeatedly in all matters of this 

sort, and that is that we should get this thing to the profession before it gets to the
 

layman. We have already put the profession in a position of having to keep strict 

silence on this program. Items have been appearing in lay magazines and the daily
 

press. It is high time we got it to the profession through their own journals, instead of 

putting the profession in the position of having patients read about streptomycin in the 

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newspapers.”39 

W. Van Winkle, M.D., who represented the American Medical Association, suggested that there be 

a brief statement in JAMA: 

“It seems to me that we have a twofold problem, one of acquainting the general 

 profession, and the second of acquainting those who are treating tuberculosis patients, 

 with the details of the results. The first thing is most important at the present time; that 

 is, to acquaint the general profession with streptomycin. I would urge that some sort of 

 statement be published .... The A.M.A. is receiving from 10 to 12 letters a week 

asking about streptomycin in tuberculosis, and we have no good reference to give them.”40 

The first of a series of such statements to the profession, officially authored by the Chief Medical 

Officers of the VA, Army and Navy but presumably written by Walker and Barnwell, was 

published as a report to the AMA Council on Pharmacy and Chemistry in the November 8, 1947, 

issue of JAMA. It concluded that: 

 “The findings of Hinshaw and his several collaborators have been confirmed. 

 Streptomycin is a useful adjunct in the treatment of tuberculosis.”35 

The primary publication of this first VA-Armed Forces study of streptomycin in tuberculosis 

presenting results in the first 223 patients was published that same month in the American Review of 

Tuberculosis.

33 

Later studies by the VA-Armed Forces group 

By the May 1947 meeting, it was clear that the side effects of streptomycin, especially the damage it 

caused to the vestibular system, were troubling. Also, a large fraction of the treated patients now 

harbored tubercle bacilli that were resistant to streptomycin. These patients and those who caught 

the disease from them could no longer benefit from streptomycin. The VA-Armed Forces 

collaborative group decided to branch out, to try different treatment schedules in a search for one 

that would have a therapeutic effect, but with less toxicity and drug resistance. 

They compared the 2-gram-per-day dose they had been using with 1 gram per day. Again, they did 

not use true randomization. Instead, the group divided itself for comparison, with some hospitals 

continuing the 2 gram/day regimen, others changing to 1 gram/day. They found the results 

comparable, but with less toxicity when 1 gram/day was administered. They provided this 

information in an addendum to their primary November 1947 publication.33 

153
 
streptomycin or to one where they would not. As is commonly done today in cooperative clinical 

trials, randomization was by a “statistical series based on random sampling numbers drawn up for

each sex at each centre by Professor Bradford Hill.”42 Unlike present-day practice, however, none

of the patients were told they were participating in a research protocol.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 5.5. Executive Committee Meeting, VA-Armed Forces Cooperative Study on the
 

Chemotherapy of Tuberculosis, VA Hospital, Sunmount, N.Y., September 10, 1959.
 

Clockwise: Dr. William Harris, VA Hospital, Salt Lake City; Dr. William Hentel, VA
 

Hospital, Albuquerque, N.M.; Dr. H.E. Walkup, VA Hospital, Oteen, N.C.; Dr. Patrick
 

Storey, VA Hospital, Baltimore; Dr. B. Ramin, Regional Office, Boston; Dr. W. Spencer 

Schwartz, VA Hospital, Oteen, N.C.; Dr. R.H. Schmidt Jr., VACO; Dr. Edward Dunner,
 

VACO; Mrs. Dorothy Livings, VACO; Dr. N. D’Esopo, VA Hospital, West Haven, Conn.; Dr.
 

A. Falk, Consultant, St. Paul, Minn.; Capt R.G. Streeter (MC) U.S. Navy; Dr. Maurice Small, 

VA Hospital, East Orange, N.J.; Dr. Williamm. Feldman, VACO. 

The many subsequent VA-Armed Forces trials of treatment regimens for tuberculosis used 

comparison groups but always compared the current “best” treatment with the proposed new 

treatment. At first, the comparison was among hospitals that adopted different “arms” of the study. 

But in 1948, they introduced comparison groups within the hospitals, randomizing by the patient’s 

hospital number. Later, they adopted true randomization. The consortium of investigators 

continued to work together, examining new opportunities for the treatment of tuberculosis and 

meeting annually until 1972. The group of investigators and their particular interests and areas of 

expertise expanded. Specialty committees met, and an Executive Committee determined the overall 

course of the studies. 

The MRC streptomycin study 

In 1946, the British National Health Service met an even more difficult challenge than did VA. 

Streptomycin was in such short supply that in all of Great Britain there was only enough to treat 50 

patients with pulmonary tuberculosis.41 Taking this problem as an opportunity, A. Bradford Hill, an 

eminent statistician, and Phillip D’Arcy Hart, the Director of the Tuberculosis Research Unit of the 

Medical Research Council (MRC), persuaded the MRC to sponsor a truly randomized clinical trial 

of tuberculosis. 

Study design 

In the MRC study, patients who met very narrow criteria, as judged by a central committee, were 

referred to cooperating hospitals. They were randomized either to a ward where they would receive 

154
 
155

In the MRC study, patients who met very narrow criteria, as judged by a central committee, were

referred to cooperating hospitals. They were randomized either to a ward where they would receive 

In the MRC study, patients who met very narrow criteria, as judged by a central committee, were

referred to cooperating hospitals. They were randomized either to a ward where they would receive 

streptomycin or to one where they would not. As is commonly done today in cooperative clinical 

trials, randomization was by a “statistical series based on random sampling numbers drawn up for

each sex at each centre by Professor Bradford Hill.”42 Unlike present-day practice, however, none

of the patients were told they were participating in a research protocol.

Patients in the streptomycin group received 2 grams/day, 0.5 gram intramuscularly every six hours,

for four months—essentially the same dosage schedule used in the first VA-Armed Forces study.

In all respects except administration of streptomycin, the care of the streptomycin group and the

control group was the same. All patients in both groups were kept on bed rest for the six-month 

study period.

As in the VA-Armed Forces study, a panel of experts read the sequential x-ray films of the patients,

blinded to their treatment group. The design of this review was somewhat simpler than in the VAArmed Forces study, but the outcome was very similar. 

Results

Just as in the larger and “looser” VA study, the MRC group found that the early response to

streptomycin was dramatic: at six months, only 7 percent of the streptomycin-treated patients had

died, compared with 27 percent of the controls. Of those still living, only 18 percent of the

streptomycin-treated patients had deteriorated clinically, compared with 46 percent of the controls.

Radiological improvement had occurred in 69 percent of the streptomycin patients, but in only 33

percent of the controls. Of the streptomycin patients, 15 percent had no tubercle bacilli in their 

sputum or gastric washings; in only 4 percent of the control series was that the case. Notably,

however, of those in the streptomycin-treated group who still harbored tubercle bacilli, 85 percent 

of those bacilli were resistant to streptomycin.42

The USPHS streptomycin study

In 1947, the U.S. Public Health Service (USPHS) began planning its own study of streptomycin in

pulmonary tuberculosis. Heading this study was Carroll Palmer, M.D., a statistician who had

argued unsuccessfully for the use of untreated controls in the original VA study.43 Its senior 

physician was Esmond R. Long, M.D., who was also involved in the VA studies. Participants 

included Dr. Emil Bogen of Olive View Sanatorium in Southern California, who, as a consultant at 

the San Fernando VA Hospital, was also an active participant in the VA study. Other “crossover”

participants included John Barnwell, M.D., Corwin Hinshaw, M.D., Ph.D., Walsh McDermott, 

M.D., Paul Bunn, M.D., Nicholas D’Esopo, M.D., and William Tucker, M.D..44

Study design

At the fifth VA-Armed Forces Streptomycin Conference, held in April 1948, Shirley H. Ferebee, 

the USPHS statistician who coordinated the study, presented the protocol to the VA group.

The USPHS group planned five studies, the first of which asked: “How useful is streptomycin in the

treatment of tuberculosis?” The plan for that study was to enroll 1,000 patients with pulmonary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

streptomycin or to one where they would not. As is commonly done today in cooperative clinical 

trials, randomization was by a “statistical series based on random sampling numbers drawn up for 

each sex at each centre by Professor Bradford Hill.”42 Unlike present-day practice, however, none 

of the patients were told they were participating in a research protocol. 

Patients in the streptomycin group received 2 grams/day, 0.5 gram intramuscularly every six hours, 

for four months—essentially the same dosage schedule used in the first VA-Armed Forces study. 

In all respects except administration of streptomycin, the care of the streptomycin group and the 

control group was the same. All patients in both groups were kept on bed rest for the six-month 

study period. 

As in the VA-Armed Forces study, a panel of experts read the sequential x-ray films of the patients, 

blinded to their treatment group. The design of this review was somewhat simpler than in the VAArmed Forces study, but the outcome was very similar. 

Results 

Just as in the larger and “looser” VA study, the MRC group found that the early response to 

streptomycin was dramatic: at six months, only 7 percent of the streptomycin-treated patients had 

died, compared with 27 percent of the controls. Of those still living, only 18 percent of the 

streptomycin-treated patients had deteriorated clinically, compared with 46 percent of the controls. 

Radiological improvement had occurred in 69 percent of the streptomycin patients, but in only 33 

percent of the controls. Of the streptomycin patients, 15 percent had no tubercle bacilli in their 

sputum or gastric washings; in only 4 percent of the control series was that the case. Notably, 

however, of those in the streptomycin-treated group who still harbored tubercle bacilli, 85 percent 

of those bacilli were resistant to streptomycin.42 

The USPHS streptomycin study 

In 1947, the U.S. Public Health Service (USPHS) began planning its own study of streptomycin in 

pulmonary tuberculosis. Heading this study was Carroll Palmer, M.D., a statistician who had 

argued unsuccessfully for the use of untreated controls in the original VA study.43 Its senior 

physician was Esmond R. Long, M.D., who was also involved in the VA studies. Participants 

included Dr. Emil Bogen of Olive View Sanatorium in Southern California, who, as a consultant at 

the San Fernando VA Hospital, was also an active participant in the VA study. Other “crossover” 

participants included John Barnwell, M.D., Corwin Hinshaw, M.D., Ph.D., Walsh McDermott, 

M.D., Paul Bunn, M.D., Nicholas D’Esopo, M.D., and William Tucker, M.D..44 

Study design 

At the fifth VA-Armed Forces Streptomycin Conference, held in April 1948, Shirley H. Ferebee, 

the USPHS statistician who coordinated the study, presented the protocol to the VA group. 

The USPHS group planned five studies, the first of which asked: “How useful is streptomycin in the 

treatment of tuberculosis?” The plan for that study was to enroll 1,000 patients with pulmonary 

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tuberculosis, half of whom would receive streptomycin in addition to other indicated treatment. 

The controls would “receive any therapy indicated other than streptomycin.” In her presentation, 

Ferebee emphasized the following conditions: All cooperating investigators must agree to adhere to 

the protocol and make and record observations in the prescribed manner; a panel of experts would 

judge the suitability of patients for the study; the central study office would make assignment to 

treatment group by chance and would evaluate the results using “quantitative” observations.45 

Patients with all types of tuberculosis and treatments were included. Even prior treatment with 

streptomycin was permitted, but accounted for only a small number of patients. Streptomycin 

dosage (about 1.4 grams/day) was somewhat smaller than used in the original VA-Armed Forces 

and MRC studies but more than the 1 gram/day dose reported by the VA-Armed Forces group to 

reduce complications, compared with 2 grams/day, without affecting outcome. Unlike the original 

VA-Armed Forces and MRC studies, in which streptomycin was given for four months, it was 

given for three months in the USPHS study. 

The idea behind this trial design was to conduct a field study, assessing streptomycin effects under 

all sorts of tuberculous conditions, in contrast to the VA-Armed Forces and MRC studies, in which 

patients had been selected for suitability. The inclusion of randomly selected control patients who 

did not receive streptomycin was key to this study. This was by no means uncontroversial. Even 

the establishment of a central “Appeals Board” to approve deviations from the protocol didn’t 

reassure those who questioned the use of untreated controls. J. Burns Amberson, M.D., who, 

ironically, had been leader of a placebo-controlled study of tuberculosis treatment in the 1920s 

(which proved sanocrystin to be useless in treatment of tuberculosis) opposed the use of a central 

group to supplant the physician’s clinical judgment: 

“As a matter of fact I do not believe it is possible to give a definition (of life threatening disease) 

which would cover all the possibilities. Fundamentally, it rests on the judgment of the physician 

who is treating the case and who knows the patient best. He is in a far better position than 

anyone else to make the decision. If he is capable of undertaking a clinical investigation of 

therapy, he is certainly capable of assuming the responsibility for such judgment.”46 

In the end, a total of 23 of the 271 control patients received streptomycin, 12 of them with approval 

of the Appeals Board and 11 of them without such clearance. These were partly balanced by seven 

of the 270 patients who were randomized to streptomycin but who refused the drug. The 

statisticians were able to deal with these small numbers of deviations from the protocol and to 

present a definitive result, assessing each patient at the end of a one-year observation period. 

Results 

Like the VA-Armed Forces and MRC study investigators, the USPHS investigators found that 

improvement occurred more frequently in the streptomycin group than in the control group by all of 

the criteria they examined: mortality, temperature, body weight, conversion of sputum culture and 

x-ray appearance of the thorax. These results were statistically significant, and, it was believed, 

would convince the doubters about streptomycin’s efficacy when they were published in 1950.44 

Table 5.3. Characteristics of the three major trials of streptomycin efficacy in pulmonary tuberculosis 

156
 
 VA-DOD MRC USPHS 

Date planning begun May 1946 Sept. 1946 July 1947 

Date first patients entered July 1946 Jan. 1947 Nov 1947 

Date series completed May 1947 April 1948 May 1950 

Date of primary publication Nov. 1947 Oct. 1948 Nov. 1950 

Study design: 

 Number of study sites 7 6 14 

 Type of institutions VA&military public variable 

 Controls Pre-rx obs of pt, Prospective, Prospective, 

 historical conts randomized randomized 

 Screening of patients Local Central Central 

 Chest x-ray evaluation Impartial jury Impartial jury Impartial jury 

 Dataanalysis Central Central Central 

Patient characteristics: 

 Number given streptomycin 223 55 270 

 Number of concurrent controls None 52 271 

 Ages 97.3% < 46y Under 30 81% <45y

 Gender 98.2% male 40% male 53% male 

 Race 74.8% white not stated 61% white 

 Restrictions on clinical type Exudative lesions New disease Not minimal 

 No collapse Rx No collapse Any assoc Rx 

 Life expect.>1yr Progressive Not terminal 

 % with positive cultures on entry 100 100 100 

 % with fever on entry 72 70 66 

 % with elevated ESR on entry 83 95 not stated 

Treatment protocol:

 Pre SM observation 60 days 1 week Variable 

 Days on streptomycin 120 days 4 months 91 days

 Minimum post-Rx observ. 120 days 2 months 9 months 

 Dailystreptomycin dose 1.8 grams 2 grams 20mg/kg 

 Dosage schedule 0.3gq4h 0.5gq6h 3 daily doses 

Surveillance: 

 For complications 

 Auditory Yes Not stated Not stated 

 Vestibular Yes Variable Not stated 

 Renal Yes No Yes 

 Hepatic Yes No No 

 Hematologic Yes No Yes 

 For clinical response 

 Chest xray q2wk Monthly (?) q3mo(?) 

 TPR q4h yes qd 

 ESR, wt q2wk Yes Yes 

 Physical exam q2wk Yes q3mo

 Nudephotos Rx beg and end No No 

 For bacteriological response 

 Culture q2wk variable 7 in 1 year 

 Sensitivity to SM variable variable all positives 

 Blood SM concentration variable not done not done 

 

 

 

The use of untreated control patients in these studies 

The original VA-Armed Forces streptomycin study has been criticized for its lack of suitable 

controls. The planners of the study were aware that simultaneous, untreated controls were 

desirable, but they decided against using them. In their primary report of their study, the VA-Armed 

Forces investigators explained: 

“It was the original decision of the Committee to have the Units select suitable cases 

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and then divide them at random into two groups, the one to be treated with streptomycin, the 

other to provide controls. It seemed a feasible procedure at the time. The very scanty supplies 

of streptomycin, and the real ignorance of its effectiveness, made it reasonable to leave half the 

patients without treatment or, rather, to treat them by other methods than streptomycin. In 

retrospect, it would have been highly desirable to do this ....”33 

But by the time the study had been launched, there was enough streptomycin to treat all eligible 

patients. The authors then went on to rationalize the approach they had taken: 

 “The purpose of controls, in such a situation as this, is to compare the results of one
 

form of therapy with another. In so far as a comparison of the effects of bed-rest upon 

pulmonary tuberculosis is concerned, these cases may reasonably be said to serve as 

their own controls.”33
 

When the MRC group decided to include untreated control patients, they faced a simpler ethical 

situation: At that time, there really was a shortage of streptomycin, and only a few patients could be 

treated, whatever study design was adopted: 

 “The selection of this type of disease constituted full justification for having a parallel 

series of patients treated only by bed-rest, since up to the present this would be
 

considered the only form of suitable treatment in such cases. Additional justification lay 

in the fact that all the streptomycin available in the country was in any case being used,
 

the rest of the supply being taken up for two rapidly fatal forms of the disease, miliary
 

and meningeal tuberculosis.”42
 

In addition, in the austere medical climate of post-war Britain, even the patient selected for the 

study and randomized to the control group benefited: 

 “When a patient had been accepted as suitable, request was made through the local 

authority for admission to one of the streptomycin centers; in spite of long waiting-lists 

these patients were given complete priority, and the majority were admitted within a 

 week of approval.”42
 

The rationale was different for using untreated controls in the USPHS study. Its planners and the 

Study Section that reviewed this very expensive project felt that a large, controlled study was 

necessary to establish once and for all whether streptomycin had a real effect: 

“Previous investigations had indicated a distinct and often dramatic improvement in 

many cases treated with streptomycin. However, further evidence was essential to 

distinguish the effect of the drug from the vagaries of the disease and the effect of other 

treatment. The Study Section agreed that the major portion of the funds specifically
 

appropriated by the Congress for streptomycin research could best be employed in a
 

rigorously planned investigation designed to determine, through the use of concurrent
 

controls, the effect of adding streptomycin to other therapeutic measures.”44
 

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A central question about the USPHS study was the ethical justification for leaving a group of 

patients untreated with an antibiotic that was readily available and that might have helped them. 

The VA and MRC studies, each in its own way, had already shown that addition of streptomycin to 

standard treatment in pulmonary tuberculosis was superior to standard treatment alone. But the 

VA-Armed Forces study was statistically “loose,” and the MRC study had a relatively small number 

of patients. Both of the earlier studies had been limited to patients with particular forms of a most 

variable disease. Perhaps the results of the VA-Armed Forces and MRC studies had not been widely 

accepted at the time the USPHS study began. In the past, there had been so many disappointments, 

so many “turtle serum”-type enthusiasms, that academic leaders and responsible public officials 

may have felt the need to be sure of their ground before advocating the use of a treatment that was 

also toxic to many patients. 

On the other hand, streptomycin was becoming widely used before the results of the USPHS study 

were published in 1950 and investigators were moving on to other treatments (Table 5.4). By the 

time the USPHS study had completed patient intake, combined therapy with streptomycin and 

paraaminosalycilate (PAS) was already under study by the VA-Armed Forces and MRC groups and 

was proving to be superior to streptomycin alone. Both groups published those results before 

publication of the USPHS study (which did not use the combined therapy). The USPHS study may 

have suffered the fate of other studies for which planning, funding and preparation take a long time: 

it may have become obsolete by the time its results were published. 

Table 5.4. Reports involving antituberculosis chemotherapeutic agents cited under “Tuberculosis - therapy” in Index Medicus. 

Entries are the number of citations mentioning the agent in their titles. 

 1947 1948 1949 1950 

Streptomycin 44 120 102 86 

PAS 4 10 32 45 

Combined agents 3 3 8 12 

Thiosemicarbazones 0 2 8 42 

Other antibiotics 2 13 12 10 

One must assume that the investigators in the USPHS study, some of the leaders of academic 

phthisiology, still had sufficient doubt about the question of streptomycin’s efficacy to justify 

staying with the study to its completion. 

The use of untreated, or placebo-treated, controls continues to be controversial in some situations; 

debate continues on this issue.47 

“Informed consent” by patients in these studies 

Even though the concept of informed consent by experimental subjects has its roots in the reaction 

to Nazi atrocities that claimed to be carried out in the name of science, it was not a widespread 

concept in the late 1940s. The organizers of the USPHS study faced the dilemma of withholding 

streptomycin from randomly assigned patients by making access to the study, and its funding, 

available only to investigators who were willing to study untreated control patients. They also 

provided an appeals mechanism for desperate cases. They dealt with the problem of pressure for 

treatment from patients in the control group by simply not informing the patients that they might 

benefit from streptomycin treatment. 

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The untreated patients in the MRC randomized controlled study also didn’t know that 

they were a part of a randomized study: “Patients were not told before admission that they were to 

get special treatment.”42 They were placed on different wards from treated patients and were 

probably unaware of the possibility of streptomycin treatment. In the MRC study, it was easier to 

justify randomization of patients to the arms of the study, because the shortage of streptomycin in 

Britain at that time was so severe that patients who were not in the study did not have access to 

streptomycin treatment. Nevertheless, the planners of the study apparently did not feel obligated to 

inform patients about the goals and procedures of the study or to obtain their permission. As stated 

in the study report: 

“It was important for the success of the trial that the details of the control scheme should remain 

confidential. It is a matter of great credit to the many doctors concerned that this information 

was not made public throughout the 15 months of the trial, and the Committee is much indebted 

to them for their cooperation.”42 

The VA group was dealing with a patient population that was more aware of their options. Patients 

needed to be told about the drug and its risks as well as its benefits, though no formal consent 

process was required. At the January 1947 meeting of participants in the VA-Armed Forces study, 

Dr. Walker told the group:

 “ It has seemed wise to have each patient who has received streptomycin, sign some
 

general statement. A copy of something you might use for that purpose is enclosed in 

your folder.”48
 

S.T. Allison, M.D., Chief of the Medical Service at the Rutland Heights (N.J.) VA Tuberculosis 

Hospital, commented at the VA-Armed Forces study participants’ meeting in May 1947: “This 

primarily is a research problem, but we in the field have to more or less sell this experiment to the 

patient.” Allison went on to comment, in response to the suggestion that very small doses of 

streptomycin be tried: 

“If we are going to get patients to subject themselves to streptomycin treatment, we 

have to show some results or we won’t get the patients. I know that in my hospital, 

where we have 500 patients under treatment for tuberculosis, it is one big family, and 

they are interested in results. If they see a group of patients putting on weight and 

getting better, they will be for streptomycin. On the other hand, if it is purely 

experimental, if we don’t get results, one patient will say, ‘So-and-so didn’t get any 

benefit, so I won’t take it. I won’t subject myself to this treatment.’ We have got to 

think not only of the research problem but of the clinical problem as well.”39 

Nevertheless, the use of a formal consent form appears to have been optional, and it is uncertain 

whether VA patients realized that they were part of a research protocol. 

This issue of patient autonomy and its associated transfer of responsibility from the physician to the 

patient is one that still confronts clinical researchers and those who oversee their work. 

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Later studies of tuberculosis treatment 

A major difference between the original VA-Armed Forces study and those of the MRC and 

USPHS was that the original VA-Armed Forces investigation was planned by the investigators 

themselves, with little input from statisticians. As time went on and they gained more experience, 

the VA-Armed Forces group gradually came to accept statistical guidance, although they never 

carried out a placebo-controlled study. 

Gradually, VA studies and those of the MRC and USPHS grew more alike. In April 1948, VA 

investigators began testing paraaminosalicylic acid (PAS) in combination with streptomycin, using 

the streptomycin-alone regimen for the control series. As soon as the streptomycin-PAS regimen 

was shown to be superior, it was taken as the control against which new treatments were tested. 

The MRC and USPHS groups used similar strategies, once the original question of efficacy of 

streptomycin was established. They no longer studied untreated control patients, but instead 

compared patients receiving the new treatment with those receiving an established one. 

After feeling their way along in the early days, learning as they gained experience with their studies, 

negotiating with the statisticians, and coping with the realities of human behavior, in 1960 VA 

investigators established their concept of the essential principles of a clinical trial: 

1. The design of the trial is of critical importance. 

2. Ethical considerations are essential, particularly in the selection of regimens to be 

investigated. 

3. The “experimental” regimen to be studied should be compared with a “control” series, 

usually the best known available form of therapy. 

4. Such comparisons preferably should be concurrent, not retrospective. 

5. Assignment to treatment should be by a method of random selection, as free from possible 

bias as the circumstances permit. 

6. The number of patients studied should be sufficiently large to permit valid deductions to be 

drawn. 

7. Every effort should be made to ensure that observations of results are as objective and 

uniform as possible. 

8. Statistical guidance should be provided at all stages of the study, from design to rigid 

statistical evaluation of results.49 

These principles form the basis for today’s extensive and productive VA Cooperative Studies 

Program. 

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References 

1. Daniel, T.M., "An immunochemist's view of the epidemiology of tuberculosis." in 

Prehistoric Tuberculosis in the Americas, Buikstra, J.E., Editor. 1976, Department of 

Anthropology, Northwestern University: Evanston, IL 40-41. 

2. Jones, R.S., The History of the American Legion. Indianapolis and New York: The BobbsMerrill Company, 1946, 125-126. 

3. Hawley, P.R., "The tuberculosis problem of the Veterans' Administration." Am Rev Tuberc, 

1947. 55: 1-7. 

4. Tuberculosis Service. Washington, D.C.: Veterans Administration, 1945 

5. Edwards, H.R., "The National Tuberculosis Association and its interest in the tuberculous 

veteran." Am Rev Tuberculosis, 1947. 55: 8-16. 

6. Matz, P.B., "The effect of climate upon the treatment of pulmonary tuberculosis." US 

Veterans' Bureau Medical Bulletin, 1927. 3: 1150-1159. 

7. Matz, P.B., "The surgical treatment of pulmonary tuberculosis in the United States Veterans' 

Bureau." Am Rev Tuberculosis, 1929. 20: 809-832. 

8. Matz, P.B., "The end-results of The surgical treatment of pulmonary tuberculosis." Am Rev 

Tubercul, 1936. 33: 533-548. 

9. Veterans' Bureau Medical Council, "Report of Group of Tuberculosis." US Veterans' Bureau 

Medical Bulletin, 1927. 3: 840-841. 

10.	 Matz, P.B., "Statistical studies on tuberculosis in the United States Veterans' Bureau." 

Medical Bulletin of the Veterans' Bureau, 1926. 2: 793-794. 

11. Forbes, C.F., Annual Report of the Director, United States Veterans' Bureau. Washington, 

DC: Veterans Bureau, 1922, 31. 

12. Hines, F.T., Annual Report of the Administrator of Veterans' Affairs. Veterans 

Administration, 1941, 7-8. 

13. Carr, B.W., "Bone tuberculosis treated by actinotherapy." US Veterans' Bureau Medical 

Bulletin, 1927. 3: 1003-1004. 

14.	 Fisher, E., "Heliotherapy in the treatment of laryngeal tuberculosis." US Veterans' Bureau 

Medical Bulletin, 1927. 3: 1066-1068. 

15. Matz, P.B., "Tuberculosis in mental hospitals." US Veterans' Bureau Medical Bulletin, 1927. 

3: 490-491. 

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16. Matz, P.B., "The effect of intercurrent diseases on the clinical course and the hospitalization 

period of cases of pulmonary tuberculosis." US Veterans' Bureau Medical Bulletin, 1927. 3: 

998-1002. 

17. Marcley, W.J., "End results of pulmonary tuberculosis-A study of 500 cases." US Veterans' 

Bureau Medical Bulletin, 1927. 3: 128-133. 

18. Park, W.E., "History of tuberculosis." US Veterans' Bureau Medical Bulletin, 1927. 3: 692­

699. 

19. Carman, W.L., "Use of actiniotherapy with results of treatment in a case of lupus vulgaris." 

US Veterans' Bureau Medical Bulletin, 1927. 3: 815-817. 

20. McKnight, J.L., "Generalized tuberculous adenitis, with report of case." US Veterans' 

Bureau Medical Bulletin, 1927. 3: 725-727. 

21. Benedict, C.C., "Pericarditis complicating pulmonary tuberculosis with report of case." US 

Veterans' Bureau Medical Bulletin, 1927. 3: 789-797. 

22. Buckley, R.C., "Tuberculous ulcer of duodenum-Case report with postmortem findings." US 

Veterans' Bureau Medical Bulletin, 1927. 3: 228-230. 

23. Smith, R.W., "Paramount importance of early diagnosis in treatment of tuberculosis of 

spine." US Veterans' Bureau Medical Bulletin, 1927. 3: 1226-1230. 

24. Starns, C.E., "The importance of proper history taking in tuberculosis hospital." US 

Veterans' Bureau Medical Bulletin, 1927. 3: 450-452. 

25. "The tuberculous patient." US Veterans' Bureau Medical Bulletin, 1927. 3: 505-507. 

26. Hines, F.T., Annual Report of VA Administrator. 1941, 1-3. 

27. Maisel, A.Q., "The veteran betrayed: How long will the Veterans' Administration continue 

to give third-rate medical care to first-rate men?" The Reader's Digest, April, 1945, 45-50. 

28. Adkins, R.E., Medical Care of Veterans. Washington, DC: Government Printing Office, 

1967, 174. 

29. Amberson, J.B., McMahon, B.T. and Pinner, M., "A clinical trial of sanocrysin in 

pulmonary tuberculosis." Am Rev Tuberculosis, 1931. 24: 401-435. 

30. Interview with Nicholas D'Esopo, M.D., December 6, 1995 at American Lung Association 

offices in Hamden, CT. 

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31. Hinshaw, H.C. and Feldman, W.H., "Evaluation of chemotherapeutic agents in clinical 

tuberculosis." Am Rev Tuberculosis, 1944. 50: 202-213. 

32. Schatz, A., Bugie, E. and Waksman, S.A., "Streptomycin, a substance exhibiting antibiotic 

activity against gram-positive and gram-negative bacteria." Proc Soc Exp Biol Med, 1944. 

55: 66-69. 

33. Barnwell, J.B., Bunn, P.A. and Walker, A.M., "The effect of streptomycin upon pulmonary 

tuberculosis." Am Rev Tuberc, 1947. 56: 485-507. 

34. Hobby, G.L., Penicillin: Meeting the Challenge. New Haven and London: Yale University 

Press, 1985, 156-157. 

35. Streptomycin Committee, "The effects of streptomycin on tuberculosis in man, report to the 

Council on Pharmacy and chemistry." JAMA, 1947. 135: 634-641. 

36.	 Interview with Gilbert Beebe, P.D., June 1, 1994 at a hotel lobby in Washington, DC. 

37. "Minutes." Third Streptomycin Conference. May 1-3, 1947. St. Louis, Mo.: VA Branch 

Office, St. Louis. Mo, 1947, 125. 

38. "Minutes." First Streptomycin Conference. December 12 -14, 1946. Chicago, IL: VA 

Branch Office #7, Chicago, IL, 1946, 

39. "Minutes." Third Streptomycin Conference. 5/1-3/47, 1947, 128. 

40. "Minutes." Third Streptomycin Conference. 5/1-3/47, 1947, 130-131. 

41. Hill, A.B., "Suspended Judgement: Memories of the British streptomycin trial in 

tuberculosis." Controlled Clinical Trials, 1990. 11: 77-79. 

42. Marshall, G., Blacklock, J.W.S., Cameron, C., Capon, N.B., Cruickshank, R., Gaddum, J.H., 

Heaf, F.R.G., Hill, A.B., Houghton, L.E., Hoyle, J.C., Raistrick, H., Scadding, J.G., Tyler, 

W.H., Wilson, G.S. and D'Arcy, P., "Streptomycin treatment of pulmonary tuberculosis." 

Brit Med J, 1948. 2: 769-782. 

43. Marks, H.M., The Progress of Experiment: Science and Therapeutic Reform in the United 

States, 1900-1990. Cambridge: Cambridge University Press, 1997, 122. 

44. Long, E.R. and Ferebee, S., "Controlled Investigation of Streptomycin Treatment in 

Pulmonary Tuberculosis." Pub Health Reports, 1950. 65: 1421-1451. 

45. Ferebee, S.H. "Report on the USPHS Streptomycin Study Program." Fifth Streptomycin 

Conference. April 15-18, 1948. Chicago, IL: Veterans Administration Branch Office, 

Chicago, IL, 1948, 49. 

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46. Letter from J.B. Amberson to E.R. Long, cited in Reference 43, page 124, 

47. Rothman, K.J. and Michels, K.B., "The continuing unethical use of placebo controls." New 

Eng J Med, 1994. 331: 394-398. 

48. "Minutes." Second Streptomycin Conference. January 23-24, 1947. Chicago, IL: VA Branch 

Office #7, Chicago, IL, 1947b, 88. 

49. Tucker, W.B., "The evolution of the cooperative studies on the chemotherapy of 

tuberculosis of the Veterans Administration and Armed Forces of the U.S.A." Adv Tuberc 

Res, 1960. 10: 1-68. 

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Chapter 6. The Atomic Medicine Program and the Birth of Nuclear Medicine 

One VA research area that took off quickly after World War II was research in the use of 

radioisotopes. During the autumn of 1946, Major General Paul R. Hawley, M.D., the Chief 

Medical Director, became deeply concerned about the problems that atomic energy might create for 

VA because of the possibility of nuclear warfare. He held a conference in his office on August 7, 

1947, attended by key VA and military health officials, including officers who had worked on the 

Manhattan Engineering Project.1 Attendees included Lt. Gen. Leslie R. Groves, Commander, and 

Col. James Cooney, Chief Medical Officer, of the Manhattan Engineering District, the organization 

that developed the atomic bomb. Also attending were Maj. Gen. Raymond Bliss, Surgeon General, 

U.S. Army; Rear Admiral W.L. Wilcutts, Deputy Surgeon General, U.S. Navy; Maj. Gen. Malcolm 

Grow, Air surgeon, U.S. Air Force; Leonard Scheele, M.D., Surgeon General, U.S. Public Health 

Service; and George Marshall Lyon, M.D., who was the medical officer for much of the early 

atomic bomb testing that took place on Bikini Island in the Pacific. 

George Lyon and the Atomic Medicine Program 

Dr. George Lyon (Figure 3.6), a pediatrician from West Virginia, had been assigned to the 

Manhattan Project as a naval officer and was the ranking medical officer at the Bikini tests in the 

Pacific. Soon after Bikini, Lyon became VA’s expert on atomic energy. When he left the Navy, he 

retained the records of the military personnel who had been exposed in the various atomic tests. 

These were stored in a locked file in his office; when he left Central Office in 1956, they went with 

him.2 

Lyon was recruited in 1947 as “Special Assistant to the Chief Medical Director for Atomic 

Medicine.” His charge was to prepare VA to handle claims for injuries associated with the atomic 

bomb tests. As it turned out, few if any such claims were received, but the Atomic Medicine unit 

kept up with the literature on radiation effects. Soon, under Lyon’s leadership, VA set up a 

Radioisotope Section of the Research and Education Service, with Lyon as its Chief. Lyon 

characterized the existence of the “Atomic Medicine” program as a secret, with emphasis on 

radioisotope research applications in VA serving to divert interest from the nuclear warfare theme.3 

VA became the lead agency for civil preparedness against an atomic attack, and staff of the 

radioisotope units in the hospitals were responsible for civil preparedness at the local level.4 

Lyon, who knew key people with the Manhattan Project and the Navy atomic warfare program, 

used his personal contacts extensively in establishing the new VA radioisotope program. He 

quickly proceeded to set up radioisotope departments in as many VA hospitals as possible. At each 

of them, there was a physician chief and a radiation safety officer, generally a physicist with 

training in nuclear physics. These VA radiation physicists held courses for their communities on 

atomic preparedness and taught local police and fire departments how to handle Geiger counters. In 

1949, the Atomic Medicine program published a Training Guide for a Course in Radiological 

Defense. By the summer of 1950, most VA staff physicians, nurses and dentists, as well as some 

400 others, had received this training.1 

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The physicians and scientists in these new VA radioisotope departments began to explore the uses 

of radioisotopes for diagnosis and treatment. In 1947, the Chief Medical Director established a 

Central Advisory Committee on Radiobiology and Radioisotopes. 

Members of this Committee (Appendix IId and Figure 6.1), who were leaders in the use of 

radioisotopes in medicine and medical research, advised on all use of radioisotopes by the agency. 

But the Committee also assisted in establishing the medical research program in general. Three of 

its members, who were especially close to Dr. Lyon, worked at a practical level to help establish 

VA radioisotope laboratories in different geographic areas. This Committee was active from 1947 

to 1961. It was not until 1955 that a similar advisory committee was appointed with responsibility 

for other aspects of the VA medical research program. 

Figure 6.1. Meeting of the Central Advisory Committee on Radioisotopes 

Left to right: Hugh Morgan, M.D.; Perrin H. Long, M.D.; George M. Lyon, M.D.; Admiral 

Joel Boone, M.D. (CMD), H.L.Friedell, M.D., Ph. D.; Shields Warren, M.D.; A.G.Moseley, Jr,
 

M.D.,. Missing: Stafford Warren, M.D.
 

The Radioisotope Laboratories 

By the end of 1946, sites for six radioisotope laboratories had been identified, primarily based on 

the presence of staff and consultants who had been involved in the Manhattan Project.5 The first of 

these to conduct routine clinical work with radioisotopes (as distinct from research studies) opened 

at Van Nuys, Calif, in February 1948 with Mortimer E. Morton, M.D., as Chief.1 Others followed 

rapidly. By 1949, 12 radioisotope laboratories were functioning; by 1951, there were 14, 

employing 98 persons; and by the end of 1953, there were 33, with 202 employees. By 1960, 60 

such laboratories had been established. In 1965, 86 VA hospitals were licensed under the Atomic 

168
 
In 1948, Dr. Lyon convened the first meeting of his Chiefs of Radioisotopes in VA Central Office. 

These meetings continued twice a year, and later annually, until in the late 1950s they were 

subsumed in the more general annual VA research meetings (Chapter 3). 

 

 

 

 

 

 

 

 

 

 

 

Energy Commission to use radioisotopes; of them, 55 maintained separate Radioisotope Services. 

In time, these numbers grew so that every VA medical center with an acute-care responsibility 

provided nuclear medicine services. 

Figures 6.2–6.4. 1949 Radioisotope conference in Washington, D.C. 

Figure 6.2. Edward D. Hudack, M.D.; Henry Lanz, Raymond Libby, 

Ph.D.; Bernard Roswit, M.D.; Benedict Cassen, Ph. D.; William W. Saunders, M.D.; 

Herbert C. Allen, Jr., M.D.; George Meneely, M.D. 

Figure 6.3.: Raymond Libby, Ph.D.; Benedict Cassen, Ph.D., Mortimer Morton, M.D., Ph.D;
 

Wallace Armstrong, M.D.; Hymer Friedell, M.D., Ph. D.;George Meneely, M.D., George
 

Lyon, M.D. 

Figure 6.4. Benedict Cassen, Ph.D.; Raymond Libby, Ph.D; Joe Meyer, Ph.D. 

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Figure 6.4. Benedict Cassen, Ph.D.; Raymond Libby, Ph.D; Joe Meyer, Ph.D. 

 

 

 

 

 

 

 

 

In 1948, Dr. Lyon convened the first meeting of his Chiefs of Radioisotopes in VA Central Office. 

These meetings continued twice a year, and later annually, until in the late 1950s they were 

subsumed in the more general annual VA research meetings (Chapter 3). 

Figure 6.5. Harold Weiler, M.D.; George Lyon, M.D. and Graham Moseley, M.D. 

lead the 1950 Radioisotope Conference 

Figure 6.6. Attendees, Fifth Semiannual VA Radioisotope Conference, VAH Framingham, 1950 

Dr. Lyon was so eager to set up new radioisotope laboratories that he actively sought out experts in 

a variety of fields to start them. As a pediatrician, he did not hesitate to recruit fellow pediatricians. 

The majority of the early VA Chiefs were specialists in internal medicine, however, and this 

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relatively heavy balance of internists continued in VA nuclear medicine for many years. In VA, the 

Radioisotope Service in the field hospitals was an independent unit; this encouraged variety and 

individualism in its Chiefs. 

In 1950, Joseph Ross, M.D., at the Framingham (Mass.) VA Hospital, with Herbert Allen, M.D., 

from Houston, Reginald A. Shipley, M.D., from Cleveland and Leslie Zieve, M.D., from 

Minneapolis, formed a group to plan a Cooperative Study of Radioiodine Therapy of 

Hyperthyroidism. Dr. Ross chaired the group and reported its early work at a meeting of VA Chiefs 

of Radioisotopes held in Central Office in June 1951. A case study protocol was developed for use 

by all participating radioisotope laboratories. At the next meeting, in Los Angeles in January 1952, 

the protocol was agreed upon by the participants and the study was launched. Its goals were to 

determine the relation between dose (in microcuries per gram concentrated by the thyroid) and the 

outcome of treatment, and to search for characteristics that might predict a patient’s response to 

treatment. The group also proposed to follow patients over the long term to identify any adverse 

effects of the treatment, especially the development of thyroid cancer.6

 This study, performed on a 

purely voluntary basis with little urging from Central Office, succeeded in collecting an early body 

of data, but it failed to reach a definitive conclusion. Some of the Chiefs objected to the degree of 

standardization required. Even more importantly, Dr. Ross became the founding Associate Dean at 

the new UCLA School of Medicine in 1954, and after that he lacked time to pursue the study.7 

Nevertheless, this study led to research within VA to improve the thyroid dose estimate for 

radioiodine.8, 9 It also set the pace for a more definitive NIH-funded study to address open 

questions.10 

While the radioisotope laboratories increasingly concentrated on providing the latest in patient care, 

they remained at the forefront of nuclear medicine research. At the Wadsworth VA Hospital in Los 

Angeles in the late 1940s, Dr. Herbert Allen developed a method to map the radioactivity in the 

thyroid gland by using a directional probe at many points along a grid over the neck.11 

Figure 6.7. Herbert Allen, M.D., manually scans 

 the radioactivity in a patient’s thyroid gland 

This technique gave crude imaging information and took several hours to complete a study. Allen 

challenged Benedict Cassen, Ph.D., a physicist at UCLA, to develop an electrically driven scanner. 

The result was the first nuclear medicine scanner, developed in 1950 by Drs. Cassen, Allen and 

Goodwin and used to study the thyroids of patients at Wadsworth.12, 13 At a January 1952 meeting 

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in Los Angeles, Franz Bauer, M.D.; William E. Goodwin, M.D., and Raymond L. Libby, Ph. D. 

demonstrated this new device to “mechanically scan” radioiodine in the thyroid gland. This was the 

beginning of the imaging of radioisotope distribution in intact persons, a technique that has 

revolutionized the diagnostic and therapeutic approaches to many diseases of various organs. 

Figure 6.8. Benedict Cassen and the first radionuclide scanner 

Later in the 1950s, Manuel Tubis, Ph.D., a radiochemist at Wadsworth, developed a variety of 131Ilabeled compounds, of which the most important was iodohippurate (hippuran), a compound that 

proved very useful in the study of kidney disorders and is still in use.14, 15 

Figure 6.9. Manual Tubis, Ph.D. 

In the late 1950s, Drs. Berson and Yalow at the Bronx VA Hospital announced their 

radioimmunoassay method (Chapter 11), a discovery that later won a Nobel Prize for Yalow. This 

technique has revolutionized the measurement of hormones, drugs and body chemicals in tiny 

samples of blood or tissue. 

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Local governance 

A hospital Radioisotope Committee regulated the activities of the radioisotope laboratories at the 

local level. Research in these laboratories did not come under the control of the hospital Research 

and Education Committee until the separate Radioisotope Service in Central Office was dissolved in 

1960, making the radioisotope research program a part of Research Service. After that, the 

hospital’s Radioisotope Committee became a subcommittee of the Research and Education 

Committee, and approval of both of the local committees (Radioisotope and Research and 

Education) was needed before a research project involving radioisotopes could start. At first, the 

members of the Radioisotope Committee were exclusively non-VA consultants. Later, the 

committee also included VA staff experienced in radioisotope use. 

By 1962, radioisotope use was widespread in VA (Appendix Va), and patients could be examined 

through a wide variety of clinical radioisotope studies (Appendix Vb). 

Graham Moseley 

Shortly after he arrived in VA Central Office, Dr. Lyon recruited A. Graham Moseley, M.D. to join 

him. Moseley had been on the chemistry faculty at Marshall University before World War II. 

During the war, he was in the Navy and was present with Lyon at the Bikini tests. At Bikini, he is 

24

reported to have detected high levels of Na in a ship’s onboard distiller, used to prepare drinking 

water from sea water. 

When Lyon became ACMD/R&E in 1952, he appointed Moseley to be Chief of the Radioisotope 

Program, which became a separate service when Research and Education became a recognized 

independent Office in 1953. Moseley continued to administer the program until he retired in 1967. 

He had an intimate knowledge of all of the radioisotope laboratories, and he used his considerable 

talents and knowledge of the “system” to expand the radioisotope program. He is remembered as “a 

delightful guy who ran the program and tried to give everyone what he needed to do a good job.”16 

Figure 6.10. A. Graham Moseley Figure 6.11. Moseley and Harold Weiler 

at a planning meeting 

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When Ralph Casteel left Research and Education to become Special Assistant to the Chief Medical 

Director in 1956, Dr. Lyon assigned Moseley the additional duties of his “Special Assistant.” 

Moseley continued as both Special Assistant to the ACMD/R&E and head of the Radioisotope 

Program until 1965, when Benjamin Wells, then the ACMD/R&E, arranged to have Moseley and 

the radioisotope program transferred out of the Research and Education Office and into the 

Professional Services Office.18 Moseley’s duties as Special Assistant to the ACMD/R&E were 

turned over to a new Deputy ACMD, James A. Halsted, M.D. This was the official beginning of 

the Nuclear Medicine Service in VA Central Office as a clinical entity, with Moseley as its 

Director. 

At that time, Moseley wrote to all of the Radioisotope Services asking for material to include in a 

brochure he intended to write about the radioisotope research program. The brochure itself seems 

to have disappeared, if it was ever completed, but many of the responses are still available. They 

paint a picture of a group of contented, productive, hospital-based clinicians and scientists, spending 

much of their effort on patient-oriented research but also conducting many types of bench research 

and establishing a rapidly increasing number of patient-care procedures. Their research contributed 

to many disciplinary areas that use the tracer principle, which was invented in 1912 and is based on 

the principle that radioactive elements have identical chemical properties to their nonradioactive 

form and therefore can be used to trace chemical behavior in solutions or in the body.19 

Richard Ogburn, Belton Burrows and Gerald Hine 

When Graham Moseley retired in 1967, his position as Director of the Central Office Radioisotope 

Service was filled by Richard Ogburn, M.D., who had been Chief, Radioisotopes, at the Omaha VA 

Hospital and had set up the first hospital-based nuclear reactor in addition to running an active 

clinical and research program. But Ogburn died shortly after he was appointed. 

Figure 6.12. Richard Ogburn, M.D. Figure 6.13. The TRIGA reactor at the Omaha VAMC 

After Ogburn’s death, the Director position remained vacant. Concerned about this lack of 

leadership, four Nuclear Medicine Chiefs, William Blahd, M.D. from Los Angeles, Ervin Kaplan, 

M.D. from Hines (Ill.), Richard Peterson, M.D. from Iowa City and Belton Burrows, M.D. from 

Boston, met with Lyndon Lee, M.D. the Associate Chief Medical Director for Professional 

Services. They offered to take over the program on an interim basis in rotation. Burrows (Figure 

6.6) received the first month’s assignment. At the end of that month, the others persuaded him to 

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continue. However, Burrows did not want to move to Washington or to give up his program in 

Boston. So for the next five years, he commuted between Boston and Washington, managing the 

national clinical nuclear medicine program as well as the nuclear medicine programs at his hospital 

and at Boston University.16, 20, 21 However, he was responsible only for the clinical Nuclear 

Medicine Service and not for leading research in the field, still the purview of Research Service. In 

1969, Gerald Hine, Ph.D., a physicist who had worked with Burrows at Boston and then for the 

International Atomic Energy Commission, came to the Central Office Research Service as Program 

Chief for Radioisotope Research.22 

Figure 6.14 Gerald Hine, Ph.D. 

The place of nuclear medicine within VA 

Over the years, nuclear medicine in VA has experienced a number of organizational changes. 

Although it started as a Section of the Atomic Medicine Division within the Research and 

Education Service, it also originally enjoyed a direct line to the Chief Medical Director. In 1953, 

when the Research and Education Service was elevated to a freestanding Office, it contained three 

Services: Atomic Medicine, Research and Education. In 1960, the Atomic Medicine Service 

(which was active only through its Radioisotope Section) was abolished, and the radioisotope 

research program was incorporated within Research Service. 

Increasingly, with maturation of the field, more and more of the radioisotope work at VA hospitals 

became established patient care procedures rather than pure research. Some clinical funding of the 

hospital-based program began in 1955. In 1965, as previously mentioned, a clinical Nuclear 

Medicine Service was officially founded within Professional Services in VACO, though the hospital 

Radioisotope Services were still considered to be primarily research. Finally, in about 1971, when 

Mark J. Musser, M.D., was Chief Medical Director, Nuclear Medicine became a clinical service at 

VA hospitals, with support of patient-care activities coming from clinical funds rather than research 

funds. By 1972, when James J. Smith, M.D., became Director of Nuclear Medicine in Central 

Office, the clinical Nuclear Medicine Service had become entirely independent of the Research 

Service. 

Basic scientists in the Radioisotope Services 

The physicists and other basic scientists recruited into the early radioisotope program served as a 

nucleus for later development of a corps of basic scientists for the VA research program as a whole. 

Stemming from their importance to the “atomic medicine” program, the nuclear medicine scientists 

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commanded high salary grades, and this soon led to upgrading of all basic scientist positions in VA 

research.4 Among the nonclinician scientists who started their VA work in the radioisotope 

program of the 1940s, 1950s and 1960s were Rosalyn Yalow, Ph.D. at the Bronx, who won the 

Nobel Prize; Joe Meyer, Ph.D., later VACO Program Chief in Basic Sciences; David Cohn, Ph.D. 

later ACOS for Research and Development at Kansas City; Gerald Hine, Ph.D. at Boston; Joseph 

Rabinowitz, Ph. D. at Philadelphia; Helmut Gutman, M.D. at Minneapolis; Charles C. Irving at 

Memphis; Raymond Lindsay at Birmingham; and Manuel Tubis, Ph. D, Nome Baker, Ph. D., and 

Michael Shatz at Wadsworth. 

Nuclear medicine as a physician specialty 

In 1955, the Society of Nuclear Medicine was founded by a small group of physicians and 

scientists, including Rex Huff, M.D., Chief of Radioisotopes at the Seattle VA Hospital. Huff gave 

the first paper in the scientific session of the Society’s first meeting, “Estimates of Cardiac Output 

by In Vivo Counting of I131 Labeled HSA.” VA nuclear medicine physicians and scientists have 

been prominent in the Society of Nuclear Medicine ever since. 

Figure 6.15. Rex Huff, M.D. 

In 1969, nuclear medicine was one of the subject areas in which VA’s new Research and Education 

Training Program (Chapter 14) was established, with a distinguished selection committee.22 Six of 

these formal training programs were in place in 1970, and their numbers grew over the next two 

years. These programs, funded by research money but administered by the Education Service, were 

designed to train physician trainees with at least two years of prior residency training in a related 

field in both the patient care and the research aspects of nuclear medicine. The intent was to 

provide an entry opportunity for physicians who wanted to enter academic nuclear medicine. This 

program arrived at an opportune moment for the field of nuclear medicine, which at that time had 

no specialty board and no formal residency programs. In the Nuclear Medicine Training Programs, 

young physicians learned both clinical and research skills. Many remained in VA, enriching the 

program’s research and clinical components. In 1972, this program was folded into VA’s regular 

residency program, and residency slots were added to hospitals’ allocations to replace the lost 

trainee slots. In this way, VA developed nuclear medicine residency programs well before most 

other institutions supported them. 

176
 
 

 

 

 

 

 

 

 

 

The physicians who entered the early VA radioisotope program have been among the pioneers in 

nuclear medicine. Among the many physicians who contributed to the program in the 1950s and 

early 1960s and emerged as leaders in nuclear medicine practice and research were Drs. Solomon 

Berson, William Blahd, James Pittman, Leslie Zieve, Ervin Kaplan, Marcus Rothschild, Belton 

Burrows, Ralph Cavalieri, Robert Donati, Clayton Rich, Lindy Kumagai, Richard Spencer, Ralph 

Gorton, Gerald Denardo, David Baylink, Walter Whitcomb, Robert Meade, Francis Zacharewich, 

Leo Oliner and Robert Chodos. All of these physicians have made important contributions to 

medicine and medical science. 

In 1972, the American Board of Nuclear Medicine gave its first certifying examination for 

physician specialists. At about the same time, access to nuclear medicine services became a 

requirement for hospital certification. The specialty of nuclear medicine had matured. It was now 

in the mainstream of American medicine. Within VA, Nuclear Medicine Services took their place 

next to the other clinical services. 

Today, the primary job of a VA nuclear medicine physician is patient care. Many of them 

continue to be active in research, but their research is now under the same umbrella as that of 

other VA research investigators. Those who recall the early days take pride in VA as the 

birthplace of their specialty. 

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References 

1. Lyon, G.W. "VA radioisotope program: Historical." 25th meeting of the Committee on 

Veterans Medical Problems. Washington, DC: National Academy of Sciences, 1952, 553­

554. 

2. Interview with Clo Gooding, May 2, 1988 at VA Central Office, Washington, DC. 

3. Lyon, G.W. "VA radioisotope program: General statement of objectives and principles." 

25th meeting of the Committee on Veterans Medical Problems. Washington, DC: National 

Academy of Sciences, 1952, 554-556. 

4.	 Interview with Joe Meyer, Ph.D., May 4, 1992 at Dr. Meyer’s home in suburban Maryland. 

5. Interview with Herbert Allen, M.D., January 28, 1994 at Dr. Allen’s office in Houston, TX. 

6. Ross, J. "Cooperative study of radioiodine therapy for hyperthyroidism." 25th meeting of the 

Committee on Veterans Medical Problems. December 5, 1952. Washington, DC: National 

Academy of Sciences, 1952, 576-578. 

7. Telephone interview with Joseph Ross, M.D., February 1, 1990. 

8. Goodwin, W.E., Cassen, B. and Bauer, F.K., "Thyroid gland weight determination from 

thyroid scintigrams with postmortem verification." Radiology, 1953. 61: 88-92. 

9. Bauer, F.K. and Blahd, W.H., "Treatment of hyperthyroidism with individually calculated 

doses of 131I." Arch Intern Med, 1957. 99: 194-201. 

10. Dobyns, B.M., Sheline, G.E., Workman, J.B., Tompkins, E.A., McConahey, W.M. and 

Becker, D.V., "Malignant and benign neoplasms of the thyroid in patients treated for 

hyperthyroidism: A report of the cooperative thyrotoxicosis therapy follow-up study." J Clin 

Endocrinol Metab, 1974. 38: 976-998. 

11.	 Allen, H.C., Libby, R. and Cassen, B., "The scintillation counter in clinical studies of human 

thyroid physiology using I131." J Clin Endocrinol Metab, 1951. 11: 492-511. 

12.	 Cassen, B., Curtis, L., Reed, C. and Libby, R., "Instrumentation for I131 use in medical 

studies." Nucleonics, 1951. 9: 46-50. 

13. Bauer, F.K., Goodwin, W.E., Libby, R. and Cassen, B., "Visual delineation of thyroid 

glands in vivo." J Lab Clin Med, 1952. 39: 153-158. 

14. Tubis, M., Posnick, E. and Nordyke, R.A., "Preparation and use of I131 labeled sodium 

iodohippurate in kidney function tests." Proc Soc Exp Biol Med, 1960. 103: 497-498. 

178
 
 

 

15. Nordyke, R.A., Tubis, M. and Blahd, W.H., "Use of radioiodinated hippuran for individual 

kidney function tests." J Lab Clin Med, 1960. 56: 438-445. 

16. Interview with William Blahd, M.D., November 8, 1991 at Dr. Blahd's office in the VA 

Medical Center, Los Angeles, CA. 

17. Telephone interview with James Pittman, M.D., March 13, 1988. 

18. Interview with Ralph Casteel, May 3, 1988 at a restaurant in Bethesda, MD. 

19. Letters from Radioisotope Service Chiefs, collected by Clo Gooding., written in 1965 to A. 

Graham Moseley, Jr. 

20. Interview with Ervin Kaplan, M.D., May 1, 1994 at Dr. Kaplan’s home in Wilmette, IL. 

21. Interview with Belton Burrows, M.D., October 27, 1992 at Dr. Burrows's home in 

Brookline, MA. 

22. Medical Research in the Veterans Administration, FY 1969. Washington, DC: Government 

Printing Office, 1969, ix. 

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180
 
Section III. The VA Research Program Takes Off
 

1954-1959
 

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(Intentionally Blank) 

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Chapter 7. The Intramural Research Program, 1954-1959 

Research becomes a Service 

In 1953, the Research and Education Service in the young VA Department of Medicine and Surgery 

(DM&S) was upgraded in status, becoming the new Research and Education Office with three 

Services: Research, Education and Atomic Medicine. George M. Lyon, M.D., the Assistant Chief 

Medical Director (ACMD) for Research and Education succeeding Dr. Harvey Cushing, headed the 

new Office1 but did not give up his title of Director, Atomic Medicine Service. Although Dr. 

Graham Moseley actually ran the radioisotope program, Lyon continued his intense interest and, 

some felt, favored it over Research and Education.2 John C. Nunemaker, M.D., was a very active 

Director of the Education Service after serving as Acting Chief, Research Section, in 19523

 when 

Alfred Lawton left. 

Figure 7.1. John Nunemaker, M.D. Figure 7.2. Martin Cummings, M.D. 

Martin M. Cummings, M.D., becomes Director, Research Service 

Shortly after the new Research Service was created, Martin M. Cummings, M.D., became its 

Director. Cummings had worked at the Tuberculosis Evaluation Center in Atlanta (part of the U.S. 

Public Health Service’s Centers for Disease Control) from 1947 to 1950. Drs. Magnuson and 

Barnwell, after visiting Dr. Cummings in his laboratories, persuaded him to move to the Atlanta VA 

Hospital in 1950 to start a tuberculosis research laboratory and take over care of tuberculosis 

patients. In 1954, they recruited him to VA Central Office.4 

Research Service, 1954 

When Cummings arrived in Central Office, his professional staff consisted of only three people. 

Harold Weiler (Figure 6.11), a former high school science teacher, was “Chief, Research 

Laboratories,” and worked on plans for building and equipping general medical research 

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laboratories. Cummings recalled that, during his time at Research Service, a large fraction of the 

contract budget went for prosthetics research. Marjorie Wilson, M.D., “Chief of Contracts 

Research,” left soon after Cummings’s arrival and was succeeded by T. S. Moise, M.D. The third 

staff member, Graham Moseley, worked closely with Cummings even though he was not officially 

in the Research Service. 

Research space remained a big issue. There was little point in increasing the budget for studies 

unless intramural physicians and scientists had space to do their work. By this time, some research 

space was included in plans for new hospitals, and a great deal of effort went into preparing these 

plans. Cummings remembered this as a difficult but rewarding process, in which his initial plans 

usually ended up being significantly reduced by VA’s own construction design section, as well as 

by review staff at the Bureau of the Budget. In some instances, he recalled, space for research was 

provided through a patchwork approach: 

“I remember the VA Hospital in Durham because the faculty at Duke was real gung-ho. They 

wanted to do a lot of work in the VA. After our construction plans had been trimmed way 

back, they put up a Quonset hut adjoining the VA and made that a research facility. A lot of the 

medical schools contributed a lot of space as well. I don't claim to have had any intimate 

influence on a design but I always fought for a strategic location and I fought for an adequate 

square footage.”4 

As a result of the efforts of Weiler and Nunemaker (while Nunemaker was responsible for 

Research)5

, Research Service could soon offer generic plans for laboratory renovation and lists of 

equipment for setting up new laboratories. To save money and paperwork, Central Office bought 

some frequently needed equipment in volume for distribution to laboratories. Cummings, Weiler 

and Moseley worked together to design both medical research and radioisotope laboratories.4 

Research program reaches out 

Cummings worked hard to improve VA affiliations with medical schools. For example, he rapidly 

opened negotiations with the new UCLA medical school, which lacked research laboratories for 

arriving faculty. Renovations at Wadsworth VA Hospital provided laboratories for these faculty 

members. Admiral Boone, the CMD, and Stafford Warren, the UCLA Dean, reached an informal 

agreement that Cummings carried out.4

 VA paid for setting up the laboratories but thereafter made 

very little financial contribution to the UCLA faculty programs using the labs. However, the 

presence of faculty members, working side by side with VA investigators, enriched Wadsworth’s 

research program. Even after the UCLA Medical Center, which included faculty laboratories, 

opened in 1955, several full-time UCLA faculty members remained at Wadsworth. Meanwhile, as 

the intramural program at Wadsworth grew, it took over space developed for UCLA. A highly 

productive medical research program followed. 

NIH grants become available to VA investigators 

During a visit to Los Angeles to help implement the UCLA affiliation, Cummings talked with 

Samuel Bassett, M.D., a VA physician and investigator also on the UCLA faculty. Bassett 

complained that VA investigators were not allowed to compete for NIH funds. Shortly after that 

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visit, Cummings talked with Ernest Allen, the Associate Director of the Division of Research Grants 

at NIH. Allen told him that NIH had been receiving applications from VA investigators but had 

turned them all down administratively, owing to a lack of a funding precedent. After Cummings 

raised the issue, Allen looked into the policy history and checked the legal language. He found 

nothing in the law to forbid NIH from funding principal investigators from VA. Shortly thereafter, 

Cummings and Allen went together to Philadelphia for an NIH site visit. They discussed the matter 

further and on the return trip drafted an agreement to allow VA to compete for NIH funds through 

their affiliated universities.4 Allen proceeded to make the change in policy at NIH. The new 

availability of research funding, which Cummings later described as a major incentive for 

recruitment and retention of VA physicians and scientists, was announced within VA in January 

1954.7 

Promoting VA research 

When Dr. John Barnwell, who had spearheaded the tuberculosis trials (Chapter 5) became ACMD 

in 1956, he conceptually broadened the scope of the research program. It was natural that the 

tuberculosis studies grew more closely identified with Research Service during his period of 

Research and Education leadership. He encouraged interaction between his staff and other research 

leaders in VACO. 

Barnwell was a good critical observer of research, even though he himself was not very active in 

research except for his interest in the tuberculosis cooperative studies. Barnwell was a humanist 

and philosopher. He remained current in his field and was also personally generous.4 

Barnwell’s predecessor, Dr. George Lyon, had taken a rather conservative approach toward seeking 

VA research support from outside the agency. In contrast, Barnwell encouraged Cummings to “do 

anything honorable to improve the budget.” Barnwell, as well as Dr. William S. Middleton, who 

became Chief Medical Director in 1955, worked with members of Congress and professional 

organizations toward this goal. Cummings and Barnwell made contact with Mary Lasker and 

Florence Mahoney, two remarkable women who were well known at their time for their influential 

advocacy in Congress for health care research funding. These influential research advocates 

arranged for meetings with Senator Lister Hill, Chairman of the Appropriations Committee, and 

other members of Congress who became interested in the VA research program. 

Another strong supporter of VA research who was particularly influential with the Congress was 

prominent Houston surgeon Michael DeBakey, M.D., who had been active on the Committee for 

Veterans Medical Problems since its inception. DeBakey recalled that “in those early days, I was 

there every year testifying both in the House and the Senate for their appropriations for research and 

emphasizing... this was the way to advance the quality of care in VA—by putting in research and 

having these committee affiliations with medical schools as an integral part of that activity.”8 

William Middleton, M.D. 

William S. Middleton, M.D., the Chief Medical Director from 1955 to 1963, was a strong advocate 

for the VA research program. Middleton had been Dean of the University of Wisconsin School of 

Medicine since 1935. He had pushed the concept of VA-medical school affiliation since the 

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beginning of DM&S, and affiliations flourished during his term as Chief Medical Director. He 

viewed his role as physician leader. Each week while he was in Central Office, Middleton made 

clinical rounds at the Washington, D.C., VA Hospital. He was a taskmaster— respected by all, 

loved by many and feared by some. He furthered the research program in any way he could, and his 

support was critical to the program’s growth spurt during his years as Chief Medical Director. 

Cummings called Middleton “the most extraordinary administrator that I ever met in the VA. If you 

were ever invited to travel with him and go to the field, he would do his duty and perform the 

necessary business with the hospital director and all of the staff, but you’d never get out of a VA 

hospital without making rounds with him and seeing patients. And he taught me a lot of medicine 

while we were both in an administrative job.”4 

Figure 7.3. William S. Middleton, M.D. 

While he was in Central Office, Cummings ran a personal research laboratory and saw patients at 

Mt. Alto (Washington, DC) VA Hospital. He was also on the faculty of George Washington 

University Medical School and lectured there. But he spent more time at his Mt. Alto laboratory, 

where he was assisted by two technicians and a postdoctoral fellow in a study of sarcoidosis. Both 

Barnwell and Middleton encouraged these academic activities. 

VA medical research becomes law 

In 1955, Congress appropriated an explicit VA research budget for the first time. But, in dealings 

with Congress, Cummings discovered that a lack of legal authorization for research within VA was 

a major impediment to improving the research budget. Middleton agreed to Cummings’s efforts 

seeking legal authorization. The political dealings were successful. In September 1958, with 

passage of Title 38, USC, section 4101, the words “including medical research” were added to the 

legal definition of the mission of the DM&S.9 This helped to justify increased funding for VA 

medical research. 

Medical Research in the Veterans Administration 

As a part of their efforts to educate Congress, Drs. Barnwell, Cummings and Nunemaker, with 

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encouragement from Dr. Middleton, prepared Medical Research in the Veterans Administration, the 

first annual report to Congress on VA’s research program. This first report, presenting material 

from fiscal year 1956, was published on March 5, 1957.10 In his transmittal letter Dr. Middleton 

said, “The compelling force to accelerate medical research within the Veterans’ Administration has 

been tempered only by difficulties in engaging qualified medical staff and in achieving the 

necessary expansion of laboratory space and related physical facilities.” Medical Research in the 

Veterans Administration continued through 1975 as an annual report, describing all aspects of the 

VA medical research program, including research supported by patient care services and the 

Follow-up Agency. An annual “supplement” detailed individual research projects. 

Figure 7.4. VA’s annual report to Congress on its research program 

This report had evolved from a simple catalog inventory of research projects. When Middleton took 

Cummings on visits to hospitals, he would complain, “We don’t have anything like the NIH 

Inventory of Research Projects.” Cummings set out to create such an inventory. Marjorie Wilson, 

who returned to Central Office in 1956 as Assistant Director, Education Service, under John 

Nunemaker, worked with Cummings on this effort. They received important help from Marguerite 

Duran of Medical Records, who indexed and classified the research projects. In 1956, this catalog 

contained over 3,600 projects—a number that had increased to 5,000 by the time Cummings left 

Central Office in 1959. Cummings took this catalog with him whenever he went to Capitol Hill and 

used it as ammunition to show members of Congress that VA was conducting excellent research 

work.4 

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Beginnings of the Career Development Program 

The VA Research Career Development Program, which received high acclaim through the years as 

a source of physician leadership in VA and academia, began in 1956 with the Clinical Investigator 

Program. Drs. Cummings and Nunemaker, encouraged by Dr. Middleton, initiated the concept of 

providing young physicians with VA appointments to concentrate on research.4 

When Marjorie Wilson returned to VA Central Office, her major task was to organize the Clinical 

Investigator program. In preparation, she reviewed programs of the NIH, the American Heart 

Association and other organizations and established a formal system of applications and an 

evaluation committee. The “Selection Committee for Clinical Investigators,” forerunner of the 

long-standing Research Career Development Committee, was established in November 1956. Its 

founding members were J. Burns Amberson, M.D., from New York’s Bellevue Hospital; Stanley E. 

Dorst, M.D., Dean, University of Cincinnati School of Medicine; Maxwell Finland, M.D., from 

Harvard Medical School; Carl A. Moyer, M.D., from Washington University, St. Louis; and Harold 

G. Wolff, M.D., from Cornell. From its inception, this committee upheld high selection standards.11 

From the very first group, the selectees made major contributions to academic medicine and the VA 

medical program.12 

Wilson also started the Senior Medical Investigator program in 1959, modeled on programs for 

senior scientists such as the American Heart Association Established Investigator program. The 

Selection Committee for Clinical Investigators also reviewed the Senior Medical Investigators, but 

Central Office leadership played an active role in their selection. Oscar Auerbach, M.D., Ludwig 

Gross, M.D. and Edward D. Freis, M.D. 13-15 among the earliest appointees, all recalled in 

interviews that they first heard of the program when they received calls from Dr. Middleton or Dr. 

Cummings inviting them to accept the appointment. Senior Medical Investigators could work 

independently on research of their choosing. They were permitted to accept teaching and patient 

care responsibilities, but their primary effort was on research. As with the Clinical Investigators, 

Senior Medical Investigators were supported directly from research funds. 

New Central Office research staff 

Charles Chapple, M.D., came to the Central Office Research Service in 1956 as Chief of Clinical 

Studies (cooperative studies). Chapple, a pediatrician friend of Dr. Lyon, had previously been at 

Children’s Hospital in Philadelphia and was Professor of Pediatrics at the University of 

Pennsylvania. He had been honored by election to the “Young Turks” and held several 

consultantships. In addition, Chapple was an accomplished amateur archeologist and botanist. 

While in the Navy in the Aleutians, he had discovered three new plant species, one named after him. 

He invented the Isolette infant incubator and a humidification device, which led to the Croupette.4 

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Figure 7.5 Charles Chapple, M.D. 

Around 1958, Chapple took on special responsibility for furthering research in aging. An Advisory 

Committee on Problems of Aging was established in December 1955, with rotating membership of 

five leaders in the field. This Committee assisted Chapple in encouraging research relevant to 

aging, a problem of special interest to Chief Medical Director Middleton. Abraham Dury, Ph.D., 

who served on this Committee in the early 1960s, recalled that meetings dealt primarily with policy 

and strategic issues and did not review the science of ongoing projects.16 

W. Edward Chamberlain, M.D., came to VA Central Office in 1957 as “Special Assistant to the 

CMD for Atomic Medicine,” apparently recruited by Dr. Lyon to be his successor.17 A radiologist, 

Dr. Chamberlain had been Professor of Radiology at Temple University Medical School. He served 

on the Committee on Veterans Medical Problems from 1956 to 1958. From 1958 to 1960, 

Chamberlain’s title was “Assistant Director (Plans), Research Service.” In 1960, he received the 

Longstreth Medal from the Franklin Institute in Philadelphia for his earlier innovative contributions 

to radiology.18 

The Research Advisory Committee 

By the 1950s, the Committee on Veterans Medical Problems (Chapter 4) had become less active in 

advising the VA intramural research program. To fill this gap, in September 1955, six months after 

William S. Middleton became Chief Medical Director, VA appointed its own Advisory Committee 

on Research. This Committee (Appendix IIe) continued to be active until 1960, when it was 

reconstituted. It reviewed the research program and advised about new directions. Generally, a 

new program such as the Clinical Investigator program would be reviewed and approved by this 

Committee before implementation. At times, especially in the early years, members met at 

individual hospitals to review the local research program. However, they did not review individual 

research projects.2 

Annual Research Conference 

The annual research conferences, started by Dr. Cushing at the Atlanta meeting in January 1952 

(Chapter 3), continued to be well attended and popular. Invited were all Associate Chiefs of Staff 

for Research and Education (ACOS/R&D)’s, Chiefs of the Radioisotope Services, Clinical 

Investigators and Senior Medical Investigators, as well as other VA research scientists whose papers 

were accepted for presentation. 

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The second Annual Research Conference was held at the Houston VA Hospital, and the next seven 

at the Memphis VA Hospital. By the December 1959 10th conference, the group was too large to 

meet in a VA facility and began meeting for the next eight years at the Netherlands Hilton Hotel in 

Cincinnati. By 1959, the Annual Research Conference required two concurrent sessions for 

presentation of 108 papers chosen from 288 submitted abstracts.19 

At the 1959 conference, attendees established a Middleton Award for research accomplishment to 

recognize the importance of Dr. Middleton’s support for the research program. “The managers of 

VA installations” were to nominate recipients, and a special committee with representatives from 

both the field and Central Office was to make the selection. The Middleton Award “is considered 

the highest honor that can be given by colleagues in recognition of outstanding quality in 

research.”20 Solomon A. Berson and Rosalyn S. Yalow, who later were awarded the Nobel Prize, 

received the first Middleton award the following year at the annual research conference. The award 

is still given annually, and its recipients (Appendix I) reflect the spectrum of VA medical research. 

Growth of the Cooperative Studies Program 

More and more VA physicians began to recognize VA’s potential as a site for cooperative clinical 

trials. By 1956, the studies on chemotherapy of tuberculosis (Chapter 5) had expanded to include 

studies of other pulmonary diseases and an intensive collaborative effort to develop and standardize 

pulmonary function tests. These studies were extended to include coccidioidomycosis and 

histoplasmosis. Fifty-four VA and four military hospitals collaborated in these studies, and their 

reports were distributed to 35 foreign countries as well as throughout the United States. As a 

separate effort, eight VA hospitals collaborated in a study of possible effects of tranquilizing drugs 

on tuberculosis patients who were also psychotic.21 

A study of the new antihypertensive drugs began in eight VA hospitals.22 This study (Chapter 9), 

later brought VA wide recognition and won Dr. Freis the Lasker Award and a nomination for the 

Nobel Prize. 

A new study of therapies for esophageal varices23 compared medical methods to surgical 

procedures. This study group continued into the mid 1970s, comparing long-term results in patients 

who underwent portacaval shunts with a control group treated medically. The procedure was found 

to have no survival or lifestyle benefit,24 but the study showed that portacaval shunt did decrease the 

hematological problems of hypersplenism.25 

At the end of 1956, plans included cooperative studies on resistant staphylococcal infections, 

sarcoidosis and treatment of coronary artery disease.26 Several cooperative studies on cancer 

chemotherapy were in progress.27 The number of active studies grew rapidly; the fiscal year 1960 

annual report listed 34.28 

By 1959, the VA cooperative studies on chemotherapy of psychiatric disorders (Chapter 8) were 

well under way. The independent cooperative study of patients diagnosed with psychosis and 

tuberculosis disbanded, reporting essentially negative findings: the combination of anti-tuberculosis 

drugs and various tranquilizers was not harmful and isoniazide, even in high doses, had no adverse 

effect on psychiatric status of patients in need of mental hospital care. Electric shock therapy 

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combined with anti-tuberculosis drugs was found not to cause untoward complications, and 

management of these patients’ disease on full activity without bed rest was effective. Therapeutic 

results for the patients’ tuberculosis were very good, and the full activity program was believed 

valuable in management of the psychiatric condition. Annual chest x-rays for all patients in 

neuropsychiatric hospitals, with immediate isolation of actual or suspected tuberculosis cases, 

resulted in a marked decline in new cases. A randomized study of isoniazide administration to such 

patients was planned but not put into effect because of the small number of newly discovered cases. 

Early cooperative clinical trials (Table 7.1) tended to share some structural characteristics. One or 

more biostatisticians would be involved. Often the trials were based in Central Office, but 

university and other biostatisticians also participated. There was a board of consultants and a 

Central Office-based coordinator, most frequently a physician in one of the professional services. 

For example, Edward Dunner, M.D., who later joined Research Service but who was at that time a 

member of the Tuberculosis Service, coordinated the studies on antihypertensive agents, diabetes 

mellitus and other endocrine diseases, and the pulmonary disease studies, outgrowths of the 

tuberculosis trials. Lyndon E. Lee Jr., M.D., at that time a member of Surgery Service, coordinated 

all 10 of the VA-funded cooperative surgery studies, as well as those funded by the National Cancer 

Institute. In 1956, 11 Eastern VA hospitals and five in the West participated in two regional cancer 

chemotherapy cooperative studies. These NCI-funded studies involved both VA and university 

hospitals. In addition, several NCI-funded projects based entirely within VA continued for many 

years. These included VA study groups for cancer chemotherapy, lung cancer and surgical adjuvant 

cancer chemotherapy. 

The endocrine disorders cooperative study did not produce the clinical answers desired but 

nevertheless made an important contribution. The original plan was to study adrenal insufficiency 

and other rare diseases, taking advantage of the huge VA-wide patient population for a more robust 

number set. To prepare for the clinical study, five steroid assay laboratories were established in 

Table 7.1. VA cooperative study groups active during the 1950s 

Study Years active 

Chemotherapy of tuberculosis 1946-1974 

Prefrontal lobotomy 1950-1956 

Multiple sclerosis 1954-1963 

Sarcoidosis 1954-1956 

Pulmonary function testing 1954-1965 

Antihypertensive drugs 1956-1975 

VA cancer chemotherapy group 1956-1968 

Western cancer chemotherapy group 1956-1964 

Southwestern cancer chemotherapy group 1956-1964 

Esophageal varices 1956-1975 

Peptic ulcer surgery 1956-1972 

Ruptured intervertebral disk 1956-1967 

Surgery of Parkinsonism 1956-1968 

Hospital infections 1956-1963 

Coccidioidomycosis 1957-1961 

Histoplasmosis 1957-1965 

Blastomycosis 1957-1965 

Tuberculosis in psychotic patients 1957-1959 

Atherosclerosis 1957-1972 

Lung cancer 1957-1975 

Adjuvant Cancer Chemotherapy 1957-1975 

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Surgery of solitary pulmonary nodules 1957-1968 

Lung cancer diagnosis 1957-1962 

Surgery of coronary artery disease 1957-1975 

Evaluation of analgesics 1957-1962 

Chemotherapy in psychiatry 1957-1973 

Psychology research 1957-1962 

Diabetes mellitus 1958-1965 

Endocrine disorders 1958-1966 

University surgical adjuvant study 1958-1963 

Early diagnosis of lung cancer – pilot 1958-1963 

Outpatient psychiatry 1958-1964 

Atrophic lateral sclerosis – assisting NINDB 1958-1961 

Functional deafness 1958-1961 

Gastroenterology (gastric ulcer) 1959 -1969 

VA Prostate Cancer Chemotherapy Study Group 1959-1963 

Midwestern cancer chemotherapy group 1959-1964 

medical centers. These laboratories developed standardized chemical procedures for assay of 

plasma 17-hydroxycorticosteriods and standardized the test for ACTH stimulation.29 While the 

study never accrued enough patients to provide definitive results about Addison’s disease, the 

reference laboratories’ important work set standards for steroid hormone assays that were widely 

adopted. 

Special Laboratories 

In some cases, when a research project was judged to need centralized administration, it was 

formally established as a “Special Laboratory.” The first of these, a laboratory at the Boston VA 

Hospital charged with the study of epilepsy, started in 1952; others followed quickly. These 

laboratories were specially funded from and reported directly to Central Office, in contrast with 

other research projects, which were controlled and funded through the hospital’s Research and 

Education Committee. This seems to have been a transitional mechanism, brought into play when 

the concept of a hospital’s intramural research program as a single “laboratory” seemed 

inappropriate. As hospital-based programs diversified and formal funding mechanisms were put in 

place, the Special Laboratories were no longer necessary. A number of the most productive leaders 

of the laboratories (Appendix VI ) became medical investigators or senior medical investigators 

(Chapter 14). By 1970, almost all of the Special Laboratories had been closed or absorbed into 

other programs 

Examples of research by individual staff members at VA hospitals 

By the close of the 1950s, the VA research program was still youthful, growing and very much 

decentralized. Any VA staff member who wanted to conduct research generally could, though very 

likely on his or her own time. There was still room, in VA and elsewhere, for a physician untrained 

in research to learn how to conduct research and to carry out the work. Some of this work proved to 

be important. The atmosphere encouraged innovation, but systems were not yet in place to 

discourage mediocrity. The result was a varied program that centered on clinical issues. 

Many important VA research programs began during the 1950s. Among them: the development of 

radioimmunoassay by Berson, Yalow and their colleagues at the Bronx VA Hospital (Chapter 11); 

the studies led by Edward Freis at the Washington VA Hospital that eventually proved the 

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importance of pharmacotherapy of hypertension (Chapter 9); Oscar Auerbach’s studies at the East 

Orange (N.J.) VA Hospital proving that smoking causes lung cancer (Chapter 10); and the studies 

led from the Central Neuropsychiatric Research Laboratory at Perry Point (Md.) VA Hospital that 

proved the efficacy of antipsychotic drugs (Chapter 8). 

Following is a brief sampling of other VA intramural research programs in progress during the 

1950s: 

Dallas–Diabetes 

When Roger Unger, M.D., arrived at the Dallas VA hospital in 1956, he found that Seymour 

Eisenberg, M.D., Leonard Madison, M.D., and Willis Sensenbach, M.D. were collaborating on 

studies of cerebral blood flow, using the Kety method in a variety of clinical conditions. Among 

other findings, they showed that cerebral blood flow in confused cardiac patients is markedly 

reduced.30 Unger, who had been hired as a clinician, had little time for research, but Eisenberg 

nonetheless gave him a corner of the laboratory for research. 

Noting he had never had any specific training in doing research, Unger credited two technicians in 

the radioisotope laboratory, Mary McCall and Ann Eisentraut with getting him started. 

“They were dying to do research, but they didn’t know how to apply their skills. I had a lot of 

ideas but few skills. So we were able to work together. They were tremendously helpful.”31 

After a new Chief of Medicine freed some of Unger’s time for research, he began his long and 

distinguished career as a diabetes researcher. He collaborated with Madison on a series of studies 

on the metabolic effects of insulin and of tolbutamide32-37 and on a tolbutamide test for mild 

diabetes.38, 39 

Figure 7.6 Roger Unger, M.D. 

Unger’s most important early contribution to diabetes research was developing, with his colleagues, 

a practical assay to measure glucagon. As he described this effort: 

“I was interested in the pathophysiology of carbohydrate metabolism—diabetes. The big need 

in those days was to be able to measure peptide hormones in the plasma.... We tried to 

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reproduce (a red cell) assay for insulin and glucagons. I had the idea that glucagon was a very 

important player in carbohydrate metabolism along with insulin, and we wanted an assay for 

both. We used this red cell immunoassay, and it was very, very insensitive. It only measured 

milliunits of insulin, so it was useless. But the idea of competitive inhibition using antibodies, 

I thought, was a good one. So in 1952 Berson published his first paper on detecting insulin 

antibodies in the plasma of insulin-dependent diabetics using labeled insulin, 131I labeled 

insulin. So my idea was – well, instead of using red cells, why not use 131I?” 

Unger did not know Dr. Berson, but telephoned him anyway to discuss his idea. Unger related that 

he was invited to the Bronx VA Hospital, where Berson and Rosalyn Yalow were doing research 

that would later lead to a Nobel Prize: 

“I went up to the Bronx VA and ... she (Dr. Yalow) came in with a pile of notebooks and she 

showed me the data. She had a beautiful curve for an insulin assay. They had already had this 

idea and finished it. 

“I said, ‘Why did you not publish anything?’ He (Berson) said ‘We’re having an awful lot of 

trouble getting this article published.’ He showed me the preprint. So I said, ‘Well, look, Dr. 

Berson, since you’ve already worked out the insulin assay, why don’t I just go on ahead and 

work on the glucagon assay?’ He said ‘You’re welcome to try that. We’ve been trying it for 

two or three years, and I’ll tell you right now, you can’t get glucagon antibody since it’s not 

allergenic.’ I said, ‘We’ve already immunized a bunch of rabbits. I mean, we’ve already 

challenged a bunch of rabbits with glucagon for this RBC assay, but it is too insensitive. Why 

don’t you teach me how to iodinate glucagon, and I’ll go back and use your technique to see if 

194
 
 

 

 

 

 

 

 

Figure 7.7. Collegial letter from Solomon Berson to Roger Unger 

there are any antibodies?’ He taught me how to iodinate, and I went back to Dallas and did, in 

fact, find glucagon antibodies. 

“So we published a paper in 1959,40 which really, in terms of date, was the first RIA paper 

ever published. We knew that they (Berson and Yalow) were having publication problems 

with a prior article, so I wrote them to ask permission—could we go on ahead and publish this 

paper? There was no published record of their work that I could cite to give them the credit 

that they deserved. Their paper didn’t come out until 1960. They did have a paragraph in 

Advances in Nuclear Medicine in 1958, I think, that I was able to cite to give them the proper 

credit, and they told me to go ahead. I offered to hold the paper back until after theirs was 

published, but they said ‘No, go ahead.’”31 

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Oakland–Pathology 

At the Oakland (Calif.) VA Hospital, set in an old hotel, Bruno Gerstl, M.D. and his colleagues 

were systematically collecting increasingly sophisticated clinical data. Tuberculosis was still a 

clinical problem of great interest. Gerstl’s group found that circulating antibodies of the common 

type were absent in pulmonary tuberculosis,41 but that antibodies were detectable by a new 

method.42 They studied the electrophoretic patterns of the lipoproteins in spinal fluid and the effects 

of diet on the pattern of unsaturated fats.43, 44 They correlated X-ray findings with pathology, 

especially in pulmonary diseases.45-47 

Los Angeles–Gastroenterology 

At the Wadsworth VA Hospital in Los Angeles, James Halsted, M.D., Chief of Gastroenterology, 

was collaborating on studies of the effects of stress on the upper gastrointestinal tract.48, 49 His most 

important contributions during this period were on the absorption of vitamin B12 and its relation to 

megaloblastic anemia, especially in diseases of the upper gastrointestinal tract.50-58 In 1955, Halsted 

moved to the Syracuse VA Hospital as Director, Professional Services (later called the Chief of 

Staff), and Morton Grossman came to Wadsworth to head gastroenterology. Grossman was already 

beginning his work on gastrointestinal hormones59, 60 but his work during the 1950s reflected broad 

interests. He studied gastro-esophageal reflux,61 experimental pancreatitis,62 Laennec’s cirrhosis63, 

64 and a new nuclear medicine test for intestinal absorption.65 By the end of this period, he was 

working on his first dog model for the experimental studies of gastric secretion, for which he 

became famous.66 

Boston–Nephrology 

Among the enthusiastic staff Maurice Strauss, M.D. recruited to the Boston VA Hospital was 

Solomon Papper, M.D. With his colleagues, Papper studied renal excretion of water and solutes in 

human subjects, as influenced by various conditions. They reported on sodium excretion in 

Addison’s disease67 and after sodium administration,68 on ethanol effect on water diuresis,69 and on 

the influence of Laennec’s cirrhosis,70-72 acute hepatitis73 and myxedema74 on kidney function. 

Chicago Research Hospital – Physiology 

In 1953, Francis Haddy, M.D. joined the brand-new Chicago Research VA Hospital, where, 

together with Richard Ebert, M.D., Craig Borden, M.D., Ben Heller, Ph.D., and John A.D. Cooper, 

M.D., Chief of Nuclear Medicine (Chapter 6), he set up the clinical and research facilities. He 

returned to the Research Hospital in 1957 as one of the early Clinical Investigators. Morris Lipton, 

M.D., Ph.D., was then the associate director for research in Chicago, a position he held until 1957, 

when Haddy assumed it until leaving in 1959.75 Haddy and Lipton collaborated on studies of 

serotonin and its interaction with the catecholamines.76, 77 Haddy expanded the work he had done in 

the Army78 on factors influencing blood flow to a series of animal studies on regulation of blood 

flow.79-85 

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Thomas Starzl, M.D., was at the Research Hospital at that time and was already transplanting livers 

in dogs, though without success.86 Starzl later achieved the first successful human liver transplant 

while at the Denver VA Hospital. 

Des Moines–Surgery 

At Des Moines, Iowa, L.T. Palumbo, M.D., Chief of Surgery, published extensive follow-up 

evaluations of large series of patients treated by established and innovative surgical procedures: on 

the physiological changes caused by vagotomy, with or without gastrectomy,87-89 and on results of 

various types of hernia repair (1650 cases).90, 91 He worked extensively on methods to avoid 

Horner’s syndrome when doing upper sympathectomy,92-94 and studied the physiology of the 

sympathetic pathways to the eye.95, 96 

Birmingham–Cardiology 

At the Birmingham (Ala.) VA Hospital, E.E. Eddleman, M.D. was studying, in humans and dogs, 

the motions made by the heart as measured externally by kinetocardiography or 

ballistocardiography.97-104 

San Fernando–Mycology 

At the San Fernando (Calif.) VA Hospital, a tuberculosis hospital later destroyed in an earthquake, 

Milton Huppert, Ph.D. was beginning his research in mycology. Huppert later became known as an 

authority on coccidioidomycosis. From 1955 through 1959, he published on this condition, 111

 as 

well as on candida albicans infections,105, 106 atypical mycobacteria107, 108 and fungal infections of 

the skin.109, 110 

Chicago Westside–Hematology 

Paul Heller, M.D., later acclaimed for his clinical and basic research on the hemoglobinopathies and 

made a Senior Medical Investigator in 1969, met Hyman Zimmerman, M.D. when both were in 

Washington, D.C. Zimmerman (Chapter 3) recruited Heller to the Omaha (Neb.) VA Hospital in 

1951 and then to the Chicago Westside VA Hospital in early 1954. After joining VA, Heller 

collaborated with Zimmerman in an eclectic research program: clinical studies of hepatic 

dysfunction,112-116 studies of nucleophagocytosis,117, 118 serum enzyme patterns in disease119-121 and 

Vitamin B12 distribution in the rat.122 Encouraged by Zimmerman, Heller began to study and 

publish on the hemoglobins.123-126 Heller’s later work on abnormal hemoglobin diseases, especially 

sickle cell anemia and sickle cell trait, later won him the Middleton Award (Chapter 18). 

Buffalo–Cardiac Pacemaker 

When Andrew Gage, M.D., started work as a surgeon at the Buffalo (N.Y.) VA Hospital around 

1953, fresh out of his residency, William Chardack, M.D. was the hospital’s Assistant Chief of 

Surgery. Gage and Chardack organized a one-room animal research facility in an old laundry area. 

In that room, they housed dogs, kept apparatus, and set up the animal studies operating room. After 

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about a year, they added another room and were able to house the dogs separately. One research 

employee took care of the animals, assisted at surgery and did a wide variety of other tasks. 

Around 1954, Gage and Chardack began to work on coronary revascularization and blood flow. 

They studied mortality in dogs after coronary ligation. Gage worked out a system of putting 

thrombogenic wires into coronary arteries.127 After the dogs developed ischemia, they were used to 

study the Beck and Vineberg operations, early procedures directed to coronary artery stenosis.128 

In 1958, Chardack and Gage started the work that led to developing an artificial pacemaker. In their 

coronary studies, they assembled a lot of physiology equipment but were having problems with it. 

They hired Wilson Greatbatch, an electrical engineer who was then a private consultant, to assist 

them. He asked if there might be some use for a device to stimulate the heart and they said that they 

would be interested in seeing such a device. Greatbatch built one and brought it back; the 

researchers attached it to a dog’s heart and it worked for 20 seconds before failing. This was the 

beginning of the work that led to the clinically applicable pacemaker. The concept of pacing the 

heart had been tried in England and reported not to be feasible, but Gage and Chardack had not seen 

the paper.129 During the following year, they studied many dogs with increasing success130 in their 

tiny laboratory supported by VA general medical research funds. 

In 1959, they had a visit from John Kennedy, M.D. the Director of Surgery, and Lyndon Lee, M.D. 

the Chief of Surgery Research, in Central Office. The investigators were able to show the visitors a 

dog with complete heart block that was kept alive with the pacemaker. Very impressed, Kennedy 

and Lee arranged for additional funds to enlarge the facility. 

This successful implantable pacemaker131 was first described at the December 1959 VA annual 

research meeting held in Cincinnati.129 

First NAS-NRC survey of VA research 

In the late 1950s, at the request of the VA Administrator, the National Academy of SciencesNational Research Council (NAS-NRC) began the first of its three surveys of VA’s research 

program. Why VA requested these surveys is uncertain, but it seems likely that its leaders wanted 

to be reassured of the value of the program and also to acquire an objective source to quote in 

support of it. 

While the NAS-NRC report was not published until June 1960, the actual review occurred in 1958 

and 1959. In the process, hospitals were visited, deans and research investigators interviewed, and 

many documents reviewed. The report concluded that “There is no question but that the Veterans 

Administration has good reason to be proud of the quality of its research now.”132 

This report recommended that central coordination by Central Office Research Service and 

decentralized administration be continued for VA’s medical research program. “It has proved both 

effective and efficient to give autonomy in the use of research funds and responsibility for the 

quality and pertinency of research to the local Veterans Administration stations.”133 This report also 

encouraged expansion of the Research Service staff in Central Office by the “addition of three or 

four persons who are highly skilled in research methods and research administration.”134 

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The report compared the 1958 VA research publications in more prestigious journals with those 

from the NIH’s intramural program. In general, more NIH publications appeared in basic journals 

such as the American Journal of Physiology and the Journal of Biological Chemistry, while more 

VA publications appeared in clinically oriented journals such as the Annals of Internal Medicine, 

JAMA, the New England Journal of Medicine and the AMA Archives series. Publication in the 

Journal of Clinical Investigation was similar for the two groups: 23 NIH papers published and 27 

VA papers published that year.135 

VA research at the end of the 1950s 

The NAS-NRC report provided an encapsulated description of the VA medical research program in 

1959. There were 6,371 approved projects, with 1,780 described as general medical research, 1,761 

as studies in aging, 1,711 as investigations of mental and nervous diseases, 642 as radioisotope 

research, 381 as tuberculosis studies and 96 as dental research. Nine special dental research 

laboratories and 12 other special laboratories reported directly to Central Office. In addition, 17 

tuberculosis laboratories and 34 neuropsychiatric laboratories worked closely with their 

counterparts in Central Office. In all, 128 VA stations operated research programs. There were 28 

ongoing cooperative studies, including the study of the chemotherapy of tuberculosis, which 

involved 58 hospitals. This can be said to be the "golden age" of VA research. 

Recalling the 1950s, Dr. Andrew Gage described the enthusiasm of VA researchers: 

“Research was motivated by academic drive and intellectual curiosity. It was easier in those 

days, because there was so much to be done and little to impede a motivated researcher. 

Devices needed to be built and physiologic studies done. One could have an idea and carry it 

out, and six months later a paper might be generated.”129 

Figure 7.8 Research budget, 1954-1959 

18 

16 

14 

12 

10
 

Current dollars
 

Deflated to 1954 dollars
 

8
 

6 

4 

2 

0 

Millions of dollars

1954 1955 1956 1957 1958 1959 

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References 

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3. Lyon, G.M. "Medical research programs of the Veterans Administration." 25th meeting of 

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5. Telephone interview with John C. Nunemaker, M.D., January 14, 1992. 

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11.	 Interview with Stewart G. Wolf, M.D., 10/30/92 at Dr. Wolf's office in Tott's Gap, PA. 

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15. Interview with Edward Freis, M.D., April 8, 1993 at Dr. Freis's office at the Washington, 

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16.	 Interview with Abraham Dury, Ph.D., February 8, 1994 at Dr. Dury’s home in Florida. 

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18. "Personals." Newsletter: Research and Education in Medicine, September, 1960. 28. 

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22. Medical Research in the Veterans' Administration, FY 1956. 1957, 10. 

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29. Medical Research in the Veterans' Administration, FY 1960. 1960, 42. 

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31. Interview with Roger H. Unger, M.D., January 27, 1994 at Dr. Unger’s office at the Dallas 

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insulin administered via the portal vein and via a peripheral vein on the magnitude of 

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34. Unger, R.H. and Madison, L.L., "Comparison of response to intravenously administered 

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35. Madison, L.L., Combes, B., Strickland, W., Unger, R.H. and Adams, R., "Evidence for a 

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36. Madison, L.L., Combes, B., Unger, R.H. and Kaplan, N., "The relationship between the 

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circulation." Ann NY Acad Sci, 1959. 74: 548-556. 

37. Unger, R.H., Madison, L.L. and Carter, N.W., "Relative effectiveness of newer oral agents 

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the framework of a tentative subclassification of the disease." Ann NY Acad Sci, 1959. 82: 

570-584. 

38.	 Unger, R.H. and Madison, L.L., "A new diagnostic procedure for mild diabetes mellitus; 

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39. Unger, R.H. and Madison, L.L., "The intravenous tolbutamide response test in diagnosis of 

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121. Heller, P., Weinstein, H., West, M. and Zimmerman, H., "Enzymes in anemia: A study of 

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122. Heller, P., Henderson, W., Bowser, E., Levitsky, JM, and Zimmerman, H., "The distribution 

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J Lab Clin Med, 1960. 55: 29-37. 

123. Josephson, A.M., Singer, K., Singer, L., Heller, P. and Zimmerman, H., "Hemoglobin Sthalassemia and Hemoglobin C-thalassemia in siblings." Blood, 1957. 12: 593-602. 

124. Oliner, H. and Heller, P., "Megaloblastic erythropoiesis and acquired hemolysis in sicklecell anemia." N Eng J Med, 1959. 261: 19-22. 

125. Heller, P., Weinstein, H., West, M. and Zimmerman, H., "Glycolytic, citric acid cycle, and 

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J Lab Clin Med, 1960. 55: 425-434. 

126. Yakulis, V., Heller, P., Josephson, A. and Singer, L., "Rapid demonstration of A2 

Hemoglobin by means of agar gel electrophoresis." Am J Clin Path, 1960. 34. 

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127. Gage, A., Olsen, K. and Chardack, W., "Experimental coronary thrombosis in dog; 

Description of method." Ann Surg, 1956. 143: 289-294. 

128. Gage, A., Olsen, K. and Chardack, W., "Cardiopericardiopexy: An experimental 

evaluation." Ann Surg, 1958. 147: 289-294. 

129. Telephone interview with Andrew Gage, M.D., May 21, 1992. 

40. Unger, R.H., Eisentraut, A.M., McCall, M.S., Keller, S., Lanz, H.C. and Madison, L.L., 

"Glucagon antibodies and their use for immunoassay for glucagon." Proc Soc Exp Biol Med, 

1959. 102: 621-623. 

41. Gerstl, B., Kirsh, D., Davis, W., Jr. and Barbieri, M., "Absence of circulating antibodies in 

patients with pulmonary tuberculosis." Science, 1954. 120: 853-854. 

42. Gerstl, B. and others, "Detection of apparently absent circulating antibodies in tuberculous 

sera." Am Rev Tuberc, 1955. 72: 345-355. 

43. Gerstl, B., Davis, W., Jr, Smith, J., Athineos, E. and Herold, G., "Effects of dietary fat upon 

polyunsaturated fatty acids in patients with multiple sclerosis." Proc Soc Exp Biol Med, 

1959. 100: 534-538. 

44. Smith, J., Gerstl, B., Davis, W., Jr. and Orth, D., "Lipoprotein patterns of spinal fluid 

obtained by electrophoresis." Arch Neurol Psychiat, 1956. 76: 608-613. 

45.	 Epstein, E., Gerstl, B., Bark, M. and Belber, J., "Silica pregranuloma." Arch Dermat, 1955. 

71: 645-647. 

46. Jacobs, L. and Gerstl, B., "Effect of pulmonary tuberculosis on Roentgen shadow of heart." 

Rock Mountain MJ, 1956. 53: 363-370. 

47. Jacobs, L., Gerstl, B., Hollander, A. and Berk, M., "Intra-abdominal egg-shell calcifications 

due to silicosis." Radiology, 1956. 67. 

48. Halsted, J., "Emotional component in gastrointestinal disorders." California Med, 1954. 80: 

449-454. 

49. Bachrach, W., Smith, J. and Halsted, J., "Spasm of the choledochal sphincter accompanying 

sudden stress." Gastroenterol, 1952. 22: 604-606. 

50. Halsted, J., Gasster, M. and Drenick, E., "Absorption of radioactive vitamin B12 after total 

gastrectomy; Relation to microcytic anemia and to site of origin of Castle's intrinsic factor." 

N Eng J Med, 1954. 251: 161-168. 

51. Swendseid, M., Halsted, J. and Libby, R., "Excretion of cobalt 60-labeled vitamin B12 after 

total gastrectomy." Proc Soc Exper Biol and Med, 1953. 83: 226-228. 

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52. Swendseid, M., Gasster, M. and Halsted, J., "Limits of absorption of orally administered 

vitamin B12: Effect of intrinsic factor sources." Proc Soc Exper Biol and Med, 1954. 86: 

834-836. 

53. Halsted, J., "Megaloblastic anemia associated with surgically produced gastrointestinal 

abnormalities." California Med, 1955. 83: 212-217. 

54.	 Halsted, J., Swenseid, M., Gasster, M. and Lewis, P., "Absorption of radioactive vitamin 

B12 in patients with disease of small intestine: Relation to macrocytic anemia." Trans Amer 

Clin Climat Assn, 1955. 66: 18-36. 

55.	 Halsted, J., Swenseid, M., Lewis, P. and Gasster, M., "Mechanisms involved in development 

of vitamin B12 deficiency." Gastroenterology, 1956. 30: 21-36. 

56. Halsted, J. and others, "Evaluation of fecal recovery method for determining intestinal 

absorption of vitamin B12." J Lab Clin Med, 1956. 48: 92-101. 

57.	 Citrin, Y., DeRosa, C. and Halsted, J., "Sites of absorption of vitamin B12." J Lab Clin Med, 

1957. 50: 667-672. 

58. Halsted, J., Carroll, J. and Rubert, S., "Serum and tissue concentration of vitamin B12 in 

certain pathologic states." N Eng J Med, 1959. 260: 575-580. 

59. Grossman, M., "The physiology of secretin." Vitamins and Hormones, NY, 1958. 16: 179­

203. 

60. Grossman, M., "Some properties of trypsin inhibitor of pancreatic juice." Proc Soc Exp Biol 

Med, 1958. 99: 304-306. 

61.	 Tuttle, S. and Grossman, M., "Detection of gastro-esophageal reflux by simultaneous 

measurement of intraluminal pressure and pH." Proc Soc Exp Biol Med, 1958. 98: 225-227. 

62. Grossman, M., "Experimental pancreatitis: Recent contributions." JAMA, 1959. 169: 1567­

1570. 

63. Grossman, M., "Hepatic coma." Gastroenterology, 1958. 34: 667-674. 

64.	 Tuttle, S., Figueroa, W. and Grossman, M., "Development of hemochromotosis in a patient 

with Laennec's cirrhosis." Am J Med, 1959. 26: 655-658. 

65.	 Grossman, M. and Jordan, P., Jr, "The radio-iodinated triolein test for steatorrhea." 

Gastroenterology, 1958. 34: 892-900. 

66. Grossman, M., "Stimulation of secretion of acid by distention of denervated fundic pouches 

in dogs." Gastroenterology, 1961. 41: 385-390. 

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67. Rosenbaum, J., Papper, S. and Ashley, M., "Variations in renal excretion of sodium 

independent of change in adrenocortical hormone dosage in patients with Addison's 

disease." J Clin Endocr, 1955. 15: 1459-1474. 

68. Papper, S., Saxon, L., Rosenbaum, J. and Cohen, H., "Effects of isotonic and hypotonic salt 

solutions on renal excretion of sodium." J Lab Clin Med, 1956. 47: 776-782. 

69. Rosenbaum, J., Papper, S., Cohen, H. and McLean, R., "The influence of ethanol upon 

maintained water diuresis in man." J Clin Invest, 1957. 36: 1202-1207. 

70. Papper, S., "The role of the kidney in Laennec's cirrhosis of the liver." Medicine, Balt, 1958. 

37: 299-316. 

71. Papper, S. and Saxon, L., "The diuretic response to administered water in patients with liver 

disease. II. Laennec's cirrhosis of the liver." Arch Int Med, 1959. 103: 750-757. 

72. Papper, S., Belsky, J. and Bleifer, K., "Renal failure in Laennec's cirrhosis of the liver. I. 

Description of clinical and laboratory features." Ann Intern Med, 1959. 51: 759-773. 

73. Papper, S., Seifer, H. and Saxon, L., "The diuretic response to administered water in patients 

with liver disease. I. Acute infectious hepatitis." Arch Int Med, 1959. 103: 746-749. 

74. Bleifer, K., Belsky, J., Saxon, L. and Papper, S., "The diuretic response to administered 

water in patients with primary myxedema." J Clin Endocr, 1960. 20. 

75. Telephone interview with Francis Haddy, M.D., Ph.D., April 6, 1988. 

76. Gordon, P., Haddy, F. and Lipton, M., "Serotonin antagonism of noradrenalin in vivo." 

Science, 1958. 128: 531-532. 

77. Haddy, F., "Serotonin and the vascular system." Angiology, 1960. 11: 21-24. 

78. Emanuel, D., Scott, J. and Haddy, F., "Effect of potassium on small and large blood vessels 

of the dog forelimb." Amer J Physiol, 1959. 197: 637-642. 

79. Haddy, F., "Vasomotion in large and small blood vessels." Illinois Med J, 1958. 114: 107­

111. 

80. Haddy, F., "Effect of histamine on small and large vessel pressures in the dog foreleg." 

Amer J Physiol, 1960. 198: 161-168. 

81. Haddy, F., "Local effects of sodium, calcium and magnesium upon small and large blood 

vessels of the dog forelimb." Circ Res, 1960. 8: 57-70. 

82. Haddy, F., "Peripheral vascular resistance." Amer Heart J, 1960. 60: 1-5. 

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83. Haddy, F., "Effect of levarterenol upon venous pressure in the rabbit ear." Angiology, 1961. 

12: 486-490. 

84. Haddy, F., "Autoregulation of blood flow." Amer Heart J, 1961. 62: 565-566. 

85. Haddy, F., Molnar, J. and Campbell, R., "Effects of denervation and vasoactive agents on 

vascular pressures and weight of dog forelimb." Amer J Physiol, 1961. 201: 631-638. 

86. Starzl, T.E., The Puzzle People: Memoirs of a Transplant Surgeon. Pittsburgh and London: 

University of Pittsburgh Press, 1992, 62. 

87. Palumbo, L., "Physiological changes of upper gastrointestinal tract following combined 

partial gastrectomy and vagus resection." Mississippi Valley Med J, 1954. 76: 56-60. 

88. Palumbo, L., Mazur, T. and Doyle, B., "Combined vagus resection and partial gastrectomy 

for duodenal and marginal ulcer." Arch Surg, 1954. 69: 762-768. 

89. Palumbo, L., Mazur, T. and Doyle, B., "Partial gastectomy with or without vagus resection 

for duodenal or marginal ulcer." Surgery, 1954. 36: 1043-1050. 

90. Palumbo, L. and Mighell, S., "Primary indirect inguinal hernioplasty." Am J Surg, 1954. 88: 

293-297. 

91. Palumbo, L. and Mighell, S., "Primary direct inguinal hernioplasty; Study of 275 Cases." 

Surgery, 1954. 36: 278-282. 

92. Palumbo, L., "Upper dorsal sypmpathectomy without Horner's syndrome." Arch Surg, 1955. 

71: 743-751. 

93. Palumbo, L., "Anterior transthoracic approach for upper thoracic sympathectomy." Arch 

Surg, 1956. 72. 

94. Palumbo, L., "New surgical approach for upper thoracic sympathectomy; a method to avoid 

Horner's syndrome." Arch Surg, 1958. 76: 807-810. 

95. Palumbo, L., "A new concept of the sympathetic pathways to the eye; a new technique to 

avoid a Horner's syndrome." Surgery, 1957. 42: 740-748. 

96. Palumbo, L. and Shapiro, S., "Physiological studies before and after upper dorsal 

sympathectomy." Ann Surg, 1958. 147: 261-263. 

97. Eddleman, E.E., Jr. and Reeves, T.J., "Kinetocardiography." Meth Med Res, 1958. 7: 107­

118. 

98. Eddleman, E.E., Jr., "Kinetocardiographic changes as the result of mitral commissurotomy." 

Am J Med, 1958. 25: 733-743. 

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99. Frederick, W.H. and Eddleman, E.E., Jr., "Genesis of the force ballistocardiogram of the 

dog." J Appl Physiol, 1958. 13: 109-117. 

100. Frederick, W.H. and Eddleman, E.E., Jr., "A simple bed suspension for ultra-low frequency 

ballistocardiography on dogs." J Appl Physiol, 1958. 12: 347-348. 

101. Suh, S.K., Cooper, W.H., Frederick, W.H. and Eddleman, E.E., Jr., "Force, work, and power 

ballistocardiography." Am J Card, 1958. 1: 726-735. 

102. Eddleman, E.E., Jr. and Thomas, H.D., "The recognition and differentiation of right 

ventricular pressure and flow loads." Amer J Cardiol, 1959. 4: 652-661. 

103. Eddleman, E.E., Jr., Hughes, M.L. and Thomas, H.D., "Estimation of pulmonary artery 

pressure and pulmonary vascular resistance from ultra low frequency precordial movements 

(kinetocardiograms)." Amer J Cardiol, 1959. 4: 662-668. 

104. Suh, S.K. and Eddleman, E.E., Jr., "Kinetocardiographic findings in myocardial infarction." 

Circulation, 1959. 19: 531-542. 

105. Huppert, M. and Cazin, J., Jr., "Pathogenesis of candida albicans infection following 

antibiotic therapy; Further studies of effect of antibiotics on in vitro growth of candida 

albicans." J Bact, 1955. 70: 435-439. 

106. Huppert, M., Cazin, J., Jr. and Smithe, H., Jr., "Pathogenesis of candida albicans infection 

following antibiotic therapy; Effect of antibiotics on incidence of candida albicans in 

intestinal tract of mice." J Bact, 1955. 70: 440-447. 

107. Huppert, M., Wayne, L. and Juarez, W., "Characterization of atypical mycobacteria and of 

nocardia species isolated from clinical specimens. II. Procedure for differentiating between 

acid-fast microorganisms." Am Rev Tuberc, 1957. 76: 468-479. 

108. Wayne, L., Krasnow, I. and Huppert, M., "Characterization of atypical mycobacteria and of 

nocardia species isolated from clinical specimens. I. Characterization of atypical 

mycobacteria by means of the microcolonial test." Am Rev Tuberc, 1957. 76: 451-467. 

109. Huppert, M. and Keeney, E., "Immunization against superficial fungous infection. II. 

Studies on human volunteer subjects." J Invest Derm, 1959. 32: 15-19. 

110. Keeney, E. and Huppert, M., "Immunization against superficial fungous infection. I. Studies 

on experimental animals." J Invest Derm, 1959. 32: 7-13. 

111. Huppert, M. and Walker, L., "The selective and differential effects of cyclohexamide on 

many strains of coccidioides immetis." Am J Clin Path, 1958. 29: 291-295. 

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112. Heller, P., Korn, R. and Zimmerman, H., "Amebic hepatitis presenting as fever of unknown 

origin." N Eng J Med, 1953. 249: 596-600. 

113. Loomis, G., Heller, P., Hall, W. and Zimmerman, H., "Pattern of hepatic dysfunction in 

malaria." Am J Med Sci, 1954. 227: 408-416. 

114. Heller, P., Zimmerman, H., Rozengvaig, S. and Singer, K., "L.E. - cell phenomenon in 

chronic hepatic disease." N Eng J Med, 1956. 254: 1160-1165. 

115. Krasnow, S., Walsh, J., Zimmerman, H. and Heller, P., "Megaloblastic anemia in alcoholic 

cirrhosis." Arch Int Med, 1957. 100: 870-880. 

116. Korn, R., Kellow, W., Heller, P., Chomet, B. and Zimmerman, H., "Hepatic involvement in 

extrapulmonary tuberculosis: Histological and functional characteristics." Am J Med, 1959. 

27: 60-71. 

117. Zimmerman, H.J., Walsh, J. and Heller, P., "Production of nucleophagocytosis by rabbit 

antileukocytic serum." Blood, 1953. 8: 651-654. 

118. Heller, P. and Zimmerman, H., "Nucleophagocytosis; Studies of 336 patients." Arch Int 

Med, 1956. 97: 208-224. 

119. West, M., Heller, P. and Zimmerman, H., "Serum enzymes in disease. III. Lactic 

dehydrogenase and glutamic oxalacetic transaminase in patients with leukemia and 

lymphoma." Am J Med Sci, 1958. 235: 689-701. 

120. Zimmerman, H., West, M. and Heller, P., "Serum enzymes in disease. II. Lactic 

dehydrogenase and glutamic oxalacetic transaminase in anemia." Arch Int Med, 1958. 102: 

115-123. 

130. Chardack, W.M., "Recollections - 1958-1961." PACE, 1981. 4: 592-596. 

131. Chardack, W., Gage, A. and Greatbatch, W., "A transistorized, self-contained, implantable 

pacemaker for the long-term correction of complete heart block." Surgery, 1960. 48: 643­

654. 

132. Committee on the Survey of Medical Research in the Veterans Administration Medical 

Research in the Veterans Administration: Final Report. National Academy of Science - 

National Research Council, 1960. 45. 

133. NAS Committee on VA Research Final Report. 1960. 2. 

134. NAS Committee on VA Research Final Report. 1960. 3. 

135. NAS Committee on VA Research Final Report. 1960. 102-103. 

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Year 

1920 

1922 1924 1926 1928 

1930 

1932 

1934 

1936 

1938 

1940 

1942 

1944 

1946 

1948 

1950 

1952 

1954 

1956 

Chapter 8. VA Psychopharmacology Trials Lead 

a Revolution in Psychiatric Practice 

Post-war VA Central Office direction of psychiatric research 

New enthusiasm for research in mental health emerged after World War II, with the establishment 

of the Department of Medicine and Surgery and the affiliations with medical schools that began in 

1946 (Chapter 3). Even as hospitals retooled to care for increasing numbers of patients with 

psychiatric disorders (Figure 8.1), the Central Office leadership recognized a need to create research 

programs focused on mental health. Research Chiefs for both psychiatry and psychology were 

recruited. While they increasingly interacted with leaders of the fledgling Research Service, these 

chiefs were quite independent of Research Service and reported to their superiors in 

Neuropsychiatry Service (Chapter 3). The Chiefs were charged with designing and supervising 

research of importance to VA’s neuropsychiatric patients. 

Figure 8.1 Neuropsychiatric patients in VA hospitals 

0 

10000 

20000 

30000 

40000 

50000 

60000 

70000 

80000 

Background—the psychoactive drugs 

Since the 1950s, the explosive growth of effective psychopharmacological agents has 

revolutionized care of the seriously mentally ill. Prior to 1950, no genuinely effective psychoactive 

drugs were available to psychiatrists. There were sedatives and hypnotics, such as barbiturates, 

hyoscine, and chloral hydrate for insomniac, violent, anxious or agitated patients. However, few 

physicians seriously believed that these drug interventions actually treated psychiatric illness. At 

best, the medications relieved symptoms; at worst, they restrained patients chemically rather than 

physically and sometimes proved to be harmful.1 

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In 1950, this situation began to change when the French pharmaceutical firm Rhône-Poulenc 

synthesized chlorpromazine (Thorazine). Though originally synthesized for its antihistaminic 

properties, a number of physicians noticed its ability to create a “euphoric quietude” without undue 

sedation. Beginning in 1952, an increasing number of publications extolled chlorpromazine’s virtue 

for treating psychiatric patients and, by the mid- to late 1950s, it had become one of the most 

successful pharmaceutical agents synthesized.2 Almost simultaneously, Western physicians 

“discovered” derivatives of the alkaloid Rauwolfia serpentina, which had been used for centuries in 

India. Its Western use as an anti-hypertensive agent as well as a psychotropic agent briefly rivaled 

the perceived tranquilizing ability of chlorpromazine.3

 Also serendipitously, physicians in the early 

1950s found that monoamine oxidase inhibitors could relieve depression and, in the mid- to late 

1950s, that depressed patients responded favorably to the tricyclic imipramine. Thus, by the end of 

the 1950s, pharmaceutical companies had synthesized all major classes of what became a 

contemporary psychopharmacopoeia—including minor tranquilizers, such as the benzodiazepines.4 

New psychopharmacologic agents intensified psychiatrists’ growing recognition that they needed 

better methods for evaluating therapeutic interventions. In the 1930s, a surge of “revolutionary” 

therapies promised highly optimistic rates of cure, according to the best contemporary scientific 

evidence. For example, physicians of the 1930s and 1940s saw prefrontal lobotomy as the most 

scientifically validated therapy in their armamentarium, a belief reinforced when its inventor won 

the Nobel Prize in 1947.5 Lobotomy’s luster soon faded with the introduction of chlorpromazine 

and the realization that lobotomy may not have been as effective as originally believed.6-8 Insulin 

shock therapy, too, faced a similar fate as investigators increasingly questioned its efficacy (Chapter 

2). In short, psychiatrists, like their counterparts in general medicine, became aware of the pitfalls 

of simple clinical, albeit “expert,” observation in deciding whether an intervention worked or not. 

Bias, the lack of valid comparison groups, and difficulties in objectively measuring outcomes made 

1950s researchers increasingly wary of 1930s and 1940s studies of treatment outcome.9 

With growing disillusionment about older remedies and the proliferation of new psychotropic drugs, 

psychiatric researchers began employing methods we now commonly associate with randomized 

controlled clinical trials. However, clinical trials posed particularly thorny problems because 

psychiatric disorders proved difficult to define clearly and outcomes were often vague and difficult 

to quantify. Further, many psychiatrists believed in the unique nature of the doctor-patient 

relationship that clinical trials appeared to efface.10 However, VA investigators led the way in 

surmounting these difficulties, developing methodologies and carefully nurturing relevant studies. 

By the mid-1970s, large, multi-center clinical trials had become generally accepted as the 

unquestionable means for establishing preferred treatment of mental illness. VA researchers played 

a critical role in this process. 

Early VA research in psychiatry 

Before World War II, psychiatry research in VA, as elsewhere, was limited in scope, despite the 

large and growing number of patients hospitalized for neuropsychiatric illnesses. A centrally 

funded laboratory at the Northport (N.Y.) VA Hospital carried out work on shock therapies as well 

as more basic studies (Chapter 2). In the1920s and early 1930s, articles in the VA Medical Bulletin 

reflected a thoughtful approach to psychiatric problems in some neuropsychiatric hospitals. But by 

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the late 1930s and early 1940s there is little evidence of searches for better treatments. During 

World War II, a time when psychiatry generally received increasing recognition, VA psychiatry 

suffered from a severe shortage of psychiatrists. Many psychiatrists and other doctors joined the 

military services. VA research in general and psychiatric research in particular, seems almost to 

have ceased. 

The lobotomy study 

In this setting, in 1949, Richard L. Jenkins, M.D., Chief, Research in Psychiatry, and J. Quinter 

Holsopple, Ph.D., Chief, Research in Psychology, reviewed the records of some 1,500 VA patients 

who had received lobotomy operations. They concluded that, while there was “clear consensus that 

benefits did accrue to operated patients...such benefits were not reflected with equal clarity in 

discharge rates or in social and economic independence.”11 Evaluation of lobotomized patients as 

seen in the literature still heavily depended on case reports and small, uncontrolled series. Jenkins 

and Holsopple sought a more objective evaluation and designed a prospective study of the effects of 

prefrontal lobotomy. They recruited Maurice Lorr, Ph.D., VA Chief of Research in Outpatient 

Psychiatry, to design objective psychological scales to evaluate clinical status of study patients 

before surgery and at intervals after the operation. 

Figure 8.2. Maurice Lorr, Ph.D. 

In setting up this study and later in starting the psychopharmacology studies, they drew heavily on 

the experience of leaders of the early VA tuberculosis studies (Chapter 5). The research problems 

were similar: Most of the people carrying out the day-to-day aspects of the studies at the hospitals 

had little or no prior research experience. Psychiatric hospitals, like tuberculosis hospitals, tended 

to be isolated and generally were not affiliated with medical schools. The study outcome measures 

depended heavily on clinical observations; it was difficult to make them objective. And it was also 

difficult to conceal from evaluators which treatment a patient had received. 

Despite these obstacles, Jenkins, Holsopple and Lorr designed a study that, in the context of its time 

and subject, has been described as “model science.”12 Six VA hospitals participated and, between 

1950 and 1953, 373 patients were studied: 188 who received lobotomies and 185 controls. All 

patients were reviewed and judged appropriate for lobotomy before they were assigned to the group 

having the operation or the control group that did not undergo lobotomy. However, modern 

randomization methods were not followed strictly: Many controls were those whose families 

refused the operation. “Controls were matched as closely as possible with the patients selected for 

lobotomy.”13 The operating surgeon decided on the type of surgery, so that the data analysis 

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included four different types of operations, though 140 of the 188 operated patients received the 

“standard” lobotomy procedure. 

Patients were studied prior to the operation, with the controls studied shortly after randomization, 

and at three months and one, two, three, four and five years after surgery or entry into the study. 

The key evaluation instrument, the Multidimensional Scale for Rating Psychiatric Patients 

(MSRPP), was developed for the study by Lorr and his colleagues. Other clinical and psychometric 

observations were also recorded. 

During the years of the study follow-up, chlorpromazine and other effective drugs came into 

increasing use in the treatment of schizophrenia. As time went on, more patients in the study were 

treated with these agents. At the time of the three-year follow up, one-fifth of the patients evaluated 

were on the drugs; by five years, two-thirds. Drug treatment made interpretation of lobotomy 

effects difficult. 

On average, the lobotomy study showed some improvement in lobotomized patients compared to 

controls, as reflected in significantly higher discharge rates at three and four years. By five years, 

however, drug therapy had diluted the picture and the differences between the groups had 

diminished. 

Though its conclusions were unimpressive, this study provided a template for psychopharmacology 

studies that followed. It provided tools to evaluate results of psychiatric treatment. As Jenkins told 

the Committee on Veterans Medical Problems in December 1952, before the neuroleptic drugs were 

in widespread use: 

“The VA lobotomy research project, under Dr. Holsopple and myself of Central Office, is 

being carried on in VA hospitals at Roanoke, Bedford, Northampton, Fort Custer, North Little 

Rock and American Lake, with very little special assistance. We regard it as significant, not 

only because it is yielding fairly clean-cut results upon the effects of lobotomy, but even more 

because we believe we have devised methods for determining and recording the effects of a 

treatment measure upon psychiatric patients more satisfactorily than it has been done before. 

These methods we believe to have an importance, which extends far beyond lobotomy. 

Central among them is the Multidimensional Patient Rating Scale, devised by Dr. Maurice 

Lorr of the Psychology Section, Central Office, which we believe to be a much more reliable, 

comprehensive and useful device for recording comparable data about different patients, and 

about the same patient at different times, than any other with which we are acquainted.”11 

The Central Neuropsychiatric Research Laboratory 

In 1955, Holsopple and the lobotomy study staff moved from Central Office to the VA hospital at 

Perry Point on the Chesapeake Bay in northern Maryland. The hospital’s administration turned 

over a building for research purposes, and the Central Neuropsychiatric Research Laboratory 

(CNPRL) was started there, with Holsopple serving as its first chief. This move was a turning point 

in VA’s clinical psychiatric research program. The laboratory, though supported by Central Office, 

now became a distinct entity. It had more space than before and the staff now had access to patients 

and collaborations with physicians and psychologists at the hospital. Perry Point at that time was a 

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neuropsychiatric hospital with a moderately active research program. Twenty-eight research studies 

involving 48 investigators were ongoing there at the time of VA’s first report to Congress for FY 

1956. 

The CNPRL was the focus for VA cooperative studies in psychiatry over the next two decades. Its 

staff, with their advisors, chose and designed studies, developed methodologies, and coordinated 

data collection and analysis. Together with Central Office colleagues, CNPRL managed the annual 

VA research conferences on chemotherapy in psychiatry. They came to know the clinicians at the 

participating hospitals and worked closely with them. The annual conferences and other contacts 

were important to morale and to assuring that these difficult studies were successful. 

First VA trial of chemotherapy in psychotic disease 

Even before completion of the lobotomy study, Holsopple and Jenkins began to plan a similar study 

of the new psychotropic drugs appearing on the scene. During the 1950s, the use of drugs in major 

psychiatric illness increased rapidly. Like lobotomy, these new interventions achieved widespread 

use: A survey in January 1957 showed that 50 percent of the 57,000 patients with psychiatric 

diseases hospitalized in VA hospitals were receiving tranquilizing drugs. Of those on tranquillizers, 

61 percent received chlorpromazine and 21 percent reserpine or other Rauwolfia extracts.14 

On the other hand, in the early 1950s there was no clear evidence for the efficacy of these drugs. 

Dosage and administration schedules were empirical. It wasn’t known for sure if they did more 

than simply sedate patients. One of the early studies of these drugs, rare in that it was a randomized 

blinded study, was conducted by an internist who later played an important role in the VA 

psychopharmacology cooperative studies. In 1953, Leo Hollister, M.D., Chief of Medicine at the 

Palo Alto VA Hospital, then a psychiatric facility, noted that when he gave reserpine to treat 

hypertension in patients who were also schizophrenic, the patients’ schizophrenic symptoms 

seemed to improve. He learned that others were using reserpine to treat psychotic symptoms, and 

he decided to confirm his impressions with a double-blind study. He persuaded some of his 

psychiatrist colleagues to refer acutely ill schizophrenic patients to him. They were treated with 

Figure 8.3. Leo Hollister, M.D. 

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reserpine or placebo, following a random assignment design blinded to both the patient and 

referring physician, and sent back to the referring psychiatrist for evaluation after three weeks of 

treatment on Hollister’s ward. The reserpine-treated patients had improved dramatically. 15,16 

When Jenkins and Holsopple assembled a group to plan the new cooperative studies, Hollister was 

invited to participate. 

The group convened by Jenkins and Holsopple reflected a variety of interests and areas of expertise 

in behavioral science research. In addition to Hollister, Jenkins, Holsopple and Lorr, the original 

group included Gilbert Beebe , Ph.D., (statistician) and Jonathan Cole, M.D., (psychiatrist) from the 

National Academy of Sciences, Charles Chapple (internist) from Central Office Research Service, 

S.T. Ginsberg. M.D. and Clyde Lindley, M.A. from Central Office Psychiatry Service, Harry 

Goldsmith, M.D. from the Baltimore Regional Office and Ivan F. Bennett, M.D., Eugene Caffey, 

M.D., Ian Funk, M.D. and Amedeo Marrazzi, M.D., psychiatrists from VA hospitals at Coatesville 

(Pa.), Perry Point (Md.), Albany (N.Y.) and Pittsburgh. Their first task was to help design a study 

aimed at determining the efficacy of the new drugs. Biostatistician Gilbert Beebe of the Follow-up 

Agency (Chapter 4) advised them about study design. 

A meeting of prospective participants was held at the Downey (Ill.) VA Hospital in April 1956, and 

the first study, involving 37 hospitals, was launched. This study (Figure 8.4) compared 

chlorpromazine, promazine, phenobarbital and placebo. It clearly showed that chlorpromazine, and 

less so promazine, led to improvement. Phenobarbital was no better than placebo. This study 

proved that the antipsychotic effects of chlorpromazine were not solely the result of sedation.17 

Figure 8.4. Results of the first study of the efficacy of the 

phenothiazide drugs in schizophrenia 

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Such studies were difficult to perform. Sometimes patients who had been on drugs relapsed during 

the “washout” period before starting on study medication. Some patients refused their pills. Even 

though the drugs looked alike, ward staff often guessed what drug a patient was receiving, making it 

difficult to maintain the “blind” criterion for these studies. The planning group and CNPRL staff 

frankly discussed these problems and tried to find ways around them.18 

Further role of the CNPRL 

This first chemotherapy trial, which built on experience from the lobotomy study, created the 

template for future VA cooperative trials in psychiatry. It also institutionalized the CNPRL as the 

central organizing agency in future trials. Underscoring its role as a central organizing agency for 

cooperative trials, the CNPRL remained directly funded by VA Central Office Neuropsychiatry 

Service. In 1962, Edward Dunner, M.D., then Director, Research Service, attended the annual 

conference and enticed the group to join Research Service. After that, CNPRL was funded by 

Research Service as a Special Laboratory (Chapter 7) but retained close ties with Neuropsychiatry 

Service and its successors. The program remained much the same. 

Holsopple, the founding Chief, died in 1957, not long after launch of the chlorpromazine study and 

before completion of the prefrontal lobotomy study. N. Norton (Ned) Springer, Ph.D., followed 

him as Chief for a year, and then Julian J. Lasky, Ph.D. was Chief until he joined the Peace Corps in 

1962. At that point, C. James Klett, Ph.D., assumed leadership of CNPRL. Klett continued as 

Chief for the balance of its existence as the CNPRL and thereafter as a Cooperative Studies 

Program Coordinating Center. Klett had been recruited to CNPRL shortly after Holsopple’s 

unexpected death. He was a young research and clinical psychologist from Northampton (Mass.) 

VA Hospital, who had interviewed patients for the lobotomy study during his internship at the 

American Lake (Wash.) VA Hospital. 

Figure 8.5. James Klett, Ph.D. 

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Organization of the studies and of the CNPRL

 The CNPRL quickly developed an organizational structure to design and implement cooperative 

trials. Early on, it acquired its own statistical staff, which often worked in collaboration with 

university consultants. The group of VA consultants who conceived the first study remained as an 

advisory committee, at first informal and later as a formal Executive Committee. Eugene Caffey, 

Jr., M.D., then a Staff Psychiatrist at Perry Point hospital, served on this committee from the 

beginning and remained on it after he moved to Central Office as Deputy Assistant Chief Medical 

Director for Professional Services. He and Hollister both served through the Executive 

Committee’s entire 20-year history. The current Director of Neuropsychiatry Service in Central 

Office, or its successor Services, was always on the Executive Committee and was deeply involved 

in the planning and execution of studies, even after the CNPRL and its studies officially joined the 

Research Service in 1962. Most other Executive Committee members served for shorter terms. 

They represented many interests and disciplines and made important contributions to the success of 

the program. 

Figure 8.6. The Executive Committee in 1966 

How a study was created 

Generally, the Executive Committee originated and approved the concept of a study in collaboration 

with the CNPRL staff. After concept approval, staff developed the complete protocol, which the 

Executive Committee would review. Once approved, the new study with its protocol would be 

announced in a letter sent to all VA psychiatric hospitals and others with large psychiatric patient 

populations. Participants were chosen from hospitals that expressed an interest in the study. The 

test drugs or placebos were furnished to the participants, but the only other tangible reward for 

study cooperation was attendance at the annual conference. 

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Starting with the second annual meeting, pharmaceutical firm representatives were invited to attend. 

The drug companies provided study drugs and matching placebos without cost, and sometimes they 

helped with packaging. Otherwise, they did not fund the CNPRL-sponsored studies, nor did they 

dictate or approve the study design. 

CNPRL staff designed protocols, recruited participating hospitals, received data, analyzed results, 

planned the annual meetings of participants and generally nourished the program. As new 

methodologies were needed, they saw to it that they were developed. When it was time to publish 

results, they often wrote the papers. This was a different process from the simultaneous VA 

cooperative studies in medicine and surgery, which usually were initiated and designed by the field 

investigators who carried them out, assisted by biostatisticians from Central Office. It also differed 

from the present-day Cooperative Studies Program (Chapter 18), in which planning originates with 

staff members in the medical centers but is completed collaboratively together with one of the 

Cooperative Studies Program (CSP) Coordinating Centers. 

There was active collaboration between the CNPRL and Dr. Lorr’s laboratory in developing 

psychiatric rating scales and in research directed toward defining psychiatric syndromes by factor 

analysis and clustering techniques. In addition, psychologists in the CNPRL worked on evaluation 

scales. John Overall, Ph.D., was a member of the CNPRL staff from 1959 to 1961, having joined 

after a postdoctoral fellowship in psychometrics. When he arrived, data from the third cooperative 

study, a comparison of six phenothiazine derivatives, was just coming in. He and Donald Gorham, 

Ph.D., an older psychologist with a wealth of clinical experience, worked to simplify the Lorr 

MSRPP, using factor analysis of the MSRPP data from the third study. This involved laborious 

computer work, entering all of the data onto punched cards and waiting three months while a 

commercial computer firm programmed a matrix analysis, since VA had no computers available for 

research at that time.19 Eventually, combining Overall’s knowledge of factor analysis and 

Gorham’s clinical understanding, they produced the Brief Psychiatric Rating Scale (BPRS),20 which 

is still in widespread use in psychiatric research. 

Later studies sponsored by the CNPRL 

The landmark chlorpromazine study was followed by a sequence of studies evaluating all the 

important antipsychotic drugs available at that time.17, 21, 22 The cooperative group studied effects of 

different dosage schedules and “drug holidays” or even complete discontinuation of treatment.23 

They studied psychotherapy as an adjunct to or substitute for neuroleptic medication24 and 

evaluated the long-term need for anti-Parkinson drugs by chronic patients.25 

For a number of years, Dr. Lorr and others studied the use of minor tranquilizers and psychotherapy 

in treatment of neurotic patients. These studies26 were shared with the Executive Committee of the 

CNPRL. 

The CNPRL also undertook some of the earliest investigations of antidepressant drugs. In 1954, 

Geigy Pharmaceuticals synthesized the first effective tricyclic antidepressant, imipramine. But the 

drug’s antidepressant effects became recognized only in the late 1950s. VA researchers and 

clinicians saw the need to evaluate this class of drugs as well as the phenothiazines. A study 

comparing imipramine with isocarboxazid, amobarbital-dextroamphetamine and placebo showed 

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the efficacy of imipramine but was confounded by the high rate of spontaneous improvement in all 

27 groups.

In the late 1960s and 1970s, the CNPRL began branching out beyond its earlier focus on 

phenothiazines and antidepressant medications. Around 1961, Samuel C. Kaim, M.D., came to 

Central Office Research Service as Program Chief in Psychiatry. He was especially interested in 

addictive disorders and sparked studies on alcoholism and drug abuse. Noteworthy was a doubleblind study of 537 patients undergoing alcohol withdrawal that compared chlordiazepoxide, 

chlorpromazine, hydroxyzine, thiamine and a placebo, given for a 10-day detoxification period. As 

to general symptomatic improvement, no significant differences were found among treatments, but 

chlordiazepoxide (Librium) was clearly the most effective of the drugs studied for prevention of 

delirium tremens and convulsions.28 In the late 1960s and early 1970s, VA collaborated with the 

Special Action Office for Drug Abuse Prevention (SAODAP), an interagency group under the 

White House, in a study comparing a long-acting methadone analog, L-alpha-acetyl methadol, with 

two dosage levels of methadone in the treatment of heroin addicts. The new drug, administered 

three times a week, was as safe as daily methadone and compared favorably with high-dose 

methadone in efficacy.29 The superiority of high-dose methadone over low doses in this study 

contributed to the ongoing controversy about appropriate maintenance dose. Several subsequent 

studies showed additional evidence of safety and efficacy of L-alpha-acetyl-methadol as well as 

guidance for induction and crossover schedules. 

In the late 1960s,Dr. Jonathan Cole, who by this time was head of the Psychopharmacology Center 

at the National Institute of Mental Health (NIMH), invited CNPRL to submit a grant application on 

the role of lithium in the treatment of manic-depressive disorders and schizophrenia in 12 VA 

hospitals and six public hospitals. Dr. Caffey was designated as principal investigator. This jointly 

funded VA-NIMH study was reviewed by both agencies, coordinated by CNPRL and overseen by a 

joint Executive Committee chaired by Caffey. At the suggestion of the NIMH review committee, 

additional funds were provided to support a new position for an assistant at the CNPRL. Robert F. 

Prien, Ph.D., was recruited to the CNPRL and assumed essentially all responsibility for the study in 

both VA and non-VA hospitals. The study evaluated lithium compared with other active therapies 

in the affective disorders,30 as prophylaxis against recurrence,31 and for treatment of patients with 

schizoaffective disorder in the excited state.32 Unlike other studies coordinated by the CNPRL, 

hospitals that collaborated in the lithium studies were funded. NIMH paid for the extra staffing and 

other expenses required by the study.33 

Annual Research Conference on Chemotherapy in Psychiatry 

These studies were enhanced by annual conferences that had an important effect on the morale of 

the participants. In April 1956, the Central Office Psychiatry and Neurology Service sponsored the 

first such conference at the Downey (Ill.) VA Hospital. Some 75 people attended, including 

representatives from VA neuropsychiatric hospitals and other VA hospitals with large psychiatric 

sections. CPNRL staff and key people from Central Office were also present.34 This meeting 

became an annual event for 20 years. At the second meeting, 17 representatives of 10 

pharmaceutical firms were among the more than 100 attendees.35 

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The Neuropsychiatry Service coordinated the annual meetings. They fostered cooperation between 

the hospitals and participating disciplines and catalyzed friendships among people from various 

hospitals and with Central Office and CNPRL staff. The social aspects were also important. 

Psychiatrists, psychologists, nurses, social workers and statisticians attended and participated. 

Clyde Lindley, the Administrative Officer for Neuropsychiatry Service, encouraged the studies and 

secured funding for the conference each year. He and others maintained a high standard for the 

scientific presentations that soon became the dominating feature of the conference.36 

The flavor of these meetings is reflected in a description in the May 1961 Research and Education 

Newsletter: 

“About 250 scientists attended the Sixth Annual Conference of the VA Chemotherapy 

Studies in Psychiatry and Broad Research Approaches to Mental Illness, held at the 

Netherlands Hilton Hotel, Cincinnati, Ohio, March 27-29, 1961 ... The Chief Medical 

Director, Dr. William S. Middleton, opened the conference with a brief address. Invited 

addresses were delivered by Dr. Carrol Keonig, VAH Chicago (Res), Illinois, Dr. R.G. 

Kuhlen, Syracuse University and Dr. J. T. Shurley, VAH, Oklahoma City, Oklahoma. 

“There were preliminary reports on the VA’s Cooperative Study No. 5, Chemotherapy of 

Depression, and Study No. 6, an evaluation of several drugs in treating newly admitted 

schizophrenic patients. The NIMH made a preliminary report on a 9-hospital collaborative 

study evaluating drugs in treating acute schizophrenic patients. An initial report was made on 

the VA Cooperative Study with Psychiatry Outpatients, evaluating the effectiveness of early 

treatment with a tranquilizer. Thirty research papers were presented which covered a wide 

range of topics in the field of mental illness, from the neurophysiological to the effect of 

milieu therapy. Four symposia were presented to highlight significant research approaches to 

the field of mental illness.” 

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Figure 8.7. Published Proceedings of the annual conferences 

In addition to VA attendees, representatives were present from the American Psychiatric 

Association, the Mental Health Institute at the University of Michigan, the New York Department 

of Mental Health and NIMH.37 

These annual conferences, with name changes to reflect their increasingly broader scope, continued 

through the 20th annual conference in April 1975, held shortly before Clyde Lindley retired from 

VA38 and when the CNPRL was transferring its operations to the Cooperative Studies Program. 

That meeting had nearly 600 participants, offered CME credit, and covered such diverse topics as 

biofeedback, family therapy, suicide prevention and drug abuse, as well as the cooperative studies 

39 program.

Impact of the CNPRL studies 

These studies had broad impact, even beyond proving the efficacy of drug treatment for psychiatric 

disorders, The centrally directed program brought psychiatrists and many additional physicians into 

research. The studies’ tests and scales became widely used in VA and elsewhere. For example, the 

NIMH adopted the BPRS as part of the standard assessment battery in its Early Clinical Drug 

Evaluation Unit. Spin-off research projects were begun in hospitals where staff previously had little 

motivation or opportunity to carry out research. Dr. John Barnwell, who started the tuberculosis 

trials, said when he addressed the members of the first conference of this cooperative group in 1956: 

“When you bring together a considerable number of doctors into a cooperative study, you 

obviously gather a group of individuals of varying experiences and capacities. As with many 

graduates of medicine, some have never before participated in any investigation. Some have 

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never distinguished between observed fact and the professor’s opinion. A well-conducted 

cooperative study forces all to attempt to make this distinction and it helps us all to clarify and 

identify our problems. It may make investigators out of some who never realized that the 

body of medical knowledge was a growing, living thing with its own diseases and relapses.”40 

CNPRL-coordinated studies involved many VA staff who otherwise would not have participated in 

research. Some who entered research through this program were later successful in their own 

research programs. Especially in the early days, the major motivation for hospital psychiatrists to 

take part in these trials was altruistic. They received little or no reward for participation. Some 

were invited to the annual study meetings, but few became authors of the resulting scientific papers. 

Their main reward was sharing the excitement of being part of an important venture to help patients. 

This opportunity was particularly important to those working in isolated, unaffiliated hospitals. 

In 1972, when Cooperative Studies Program Coordinating Centers (CSPCCs) were set up to 

manage the administrative and statistical aspects of the cooperative studies (Chapter 18), a new 

CSPCC was established at Perry Point with Dr. Klett as its Chief. The CNPRL continued as a 

separate entity, with Klett remaining as its chief until 1975. During this time, Dr. Prien completed 

the lithium studies and prepared several review papers. One important product is a 1975 

monograph, an annotated program bibliography of publications from the two decades of the 

CNPRL existence.26 Thereafter, new cooperative studies were handled by the Perry Point CSPCC. 

At first, this new CSPCC concentrated on neuropsychiatric protocols, but gradually it took on 

studies in other subject areas and soon entered the mainstream of the Cooperative Studies Program. 

Impact of the VA psychopharmacology studies on psychiatry 

Psychiatric science and practice have undergone enormous change since the 1950s. One of the 

most significant developments in psychiatry was the creation of VA multi-center cooperative 

studies for evaluation of psychiatric interventions described in this chapter. The basis of psychiatric 

clinical practice has moved from relying mostly on individual, expert judgment to learning from 

rigorous outcome studies. VA has continued to sponsor Cooperative Studies directed at improving 

the treatment of its patients with serious mental illnesses. In recent years, VA psychopharmacology 

cooperative studies have included the recent generations of new antipsychotic drugs. 

A major outcome of the VA studies, and of similar studies by others, was a massive exodus of 

psychiatric patients from state and federal institutions, the most dramatic change in American 

psychiatry over the last half of the 20th century. From the mid-19th century until the 1950s, the 

number of patients in psychiatric hospitals continually rose. At the 1955 peak, 559,000 individuals 

resided in state hospitals. VA institutions experienced similarly high growth in numbers of 

residential psychiatric patients (Figure 8.1). In the 1950s, psychiatric patients constituted nearly 60 

percent of the VA patient population. Some 40 years later, by 1997, the number of patients in state 

hospitals plummeted to 62,722, although the U.S. population had nearly doubled since the mid 

1950s.41 VA’s inpatient psychiatric population has declined in parallel. The savings in cost and 

suffering made possible by the proper use of psychoactive drugs is immeasurable. The studies 

described in this chapter expedited and legitimized their use. 

Acknowledgment: Joel Braslow, M.D., Ph.D., made important contributions to this chapter. 

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References 

1. Braslow, J., Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the 

Twentieth Century. Berkeley: University of California Press, 1997. 

2. Swazey, J.P., Chlorpromazine in Psychiatry: A Study of Therapeutic Innovation. 

Cambridge, MA: MIT Press, 1974. 

3. Ayd, F.J., "The Early History of Modern Psychophysiology. 29th (1990) Annual Meeting of 

the American College of Neuropsychopharmacology, San Juan, PR." 

Neuropsychopharmacology, 1991. 5: 71-84. 

4. Healy, D., The Antidepressant Era. Cambridge, MA: Harvard University Press, 1997. 

5. Valenstein, E.S., Great and Desperate Cures: The Rise and Decline of Psychosurgery and 

Other Radical Treatments for Mental Illness. New York: Basic Books, 1986. 

6. Appel, K., Myers, J.M. and Scheflen, A.E., "Prognosis in psychiatry: Results of psychiatric 

treatment." Arch Neur Psychiatry, 1953. 70: 459-468. 

7. Barahal, H.S., "1000 prefrontal lobotomies - a five-to-10-year follow-up study." Psychiat 

Quarterly, 1958. 32: 653-678. 

8. Robin, A.A., "A controlled study of the effects of leucotomy." J Neurol, Neurosurg and 

Psychiatry, 1958. 21: 262-269. 

9. Psychopharmacology: Problems in Evaluation. Cole, J.O. and Gerard, R.W., eds.; 

Washington, DC: National Academy of Sciences, 1959. 

10. Barsa, J.A., "The fallacy of the 'double blind'." Am J Psychiatry, 1963. 119: 1174-1175. 

11. Jenkins, R.L. "Intra-VA research in neurology and psychiatry." 25th meeting of the 

Committee on Veterans Medical Problems. December 5, 1952. Washington, DC: National 

Academy of Sciences-National Research Council, Appendix IV. 

12. Pressman, J.D., Last Resort: Psychosurgery and the Limits of Medicine. Cambridge, New 

York, Melbourne: Cambridge University Press, 1998, 394-397. 

13.	 Ball, J., Klett, C.J. and Gresock, C.J., "The Veterans Administration study of prefrontal 

lobotomy." J Clin Exptl Psychopathology and Quarterly Rev Psychiatr Neurol, 1959. 20: 

205-217. 

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14. Lindley, C.J. "VA hospital survey of tranquilizing drugs." Second Research Conference on 

Chemotherapy in Psychiatry. Downey, IL: Office of the Chief Medical Director, Veterans 

Administration, Washington, DC, 29-30. 

15.	 Interview with Leo E.Hollister, M.D., January 29, 1994 at his residence in Houston, TX. 

16.	 Hollister, L.E., Krieger, G.E., Kringel, A. and Roberts, R.H., "Treatment of chronic 

schizophrenic reactions with reserpine." Ann NY Acad Sci, 1955. 61: 92-100. 

17.	 Casey, J.F., Bennett, I.F., Lindley, C.J., Hollister, L.E., Gordon, M.E. and Springer, N.N., 

"Drug therapy in schizophrenia: A controlled study of the relative effectiveness of 

chlorpromazine, promazine, phenobarbital, and placebo." Arch Gen Psychiat, 1960. 2: 210­

220. 

18.	 Hollister, L.E. "Discussion, first plenary session." Second Research Conference on 

Chemotherapy in Psychiatry. May 9-10, 1957. Downey, IL: Office of the Chief Medical 

Director, Veterans Administration, Washington, DC, 25-26. 

19. Interview with John Overall, Ph.D., January 28, 1994 at Dr. Overall’s office in Houston, 

TX. 

20. Overall, J.E. and Gorham, D.R., "The Brief Psychiatric Rating Scale." Psychol Rpts, 1962. 

10: 799-812. 

21. Casey, J.F., Hollister, L.E., Klett, C.J., Lasky, J.J. and Caffey, E.M., Jr., "Combined drug 

therapy of chronic schizophrenics: A controlled evaluation of placebo, dextroamphetamine, 

imipramine, isocarboxazid, and trifluoperazine added to maintenance doses of 

chlorpromazine." Amer J Psychiat, 1961. 117: 997-1003. 

22.	 Lasky, J.J., Klett, C.J., Caffey, E.M., Jr., Bennett, J.L., Rosenblum, M.P. and Hollister, L.E., 

"Drug therapy of chronic schizophrenics: A comparative evaluation of chlorpromazine, 

chlorprothixene, fluphenazine, reserpine, thioridazine, and triflupromazine." Dis Nerv Syst, 

1962. 23: 698-706. 

23. Caffey, E.M., Jr., Diamond, L.S., Frank, T.V., Grasberger, J.C., Herman, L., Klett, C.J. and 

Rothstein, C., "Discontinuation or reduction of chemotherapy in chronic schizophrenics." J 

Chron Dis, 1964. 17: 347-358. 

24. Gorham, D.R., Pokorney, A.D. and Moseley, E.C., "Effects of phenothiazine and/or group 

psychotherapy with schizophrenics." Dis Nerv Syst, 1964. 25: 77-86. 

25. Klett, C.J. and Caffey, E.M., Jr., "Evaluating the long-term need for antiparkinson drugs for 

chronic schizophrenics." Arch Gen Psychiat, 1972. 26: 374-376. 

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26. Abrams, S. and Ciufo, S., Cooperative Studies in Mental Health and Behavioral Sciences. 

Washington, DC: Department of Medicine and Surgery, Veterans Administration, 1975, ii. 

27. Overall, J.E., Hollister, L.E., Pokorney, A.D., Casey, J.F. and Katz, G., "Drug therapy in 

depressions: Controlled evaluations of imipramine, isocarboxazid, dextroamphetamineamobarbital, and placebo." Clin Pharmacol Therapeut, 1962. 3: 16-22. 

28.	 Klett, C.J., Hollister, L.E., Caffey, E.M., Jr. and Kaim, S.C., "Evaluating changes in 

symptoms during acute alcohol withdrawal." Arch Gen Psychiat, 1971. 24: 174-178. 

29. Ling, W., Charavastra, C., Kaim, S.C. and Klett, C.J., "Methadyl acetate and methadone as 

maintenance treatments for heroin addicts." Arch Gen Psychiat, 1976. 33: 709-720. 

30.	 Prien, R.F., Caffey, E.M., Jr. and Klett, C., J, "Comparison of lithium carbonate and 

chlorpromazine in the treatment of mania." Arch Gen Psychiat, 1972. 26: 146-153. 

31. Prien, R.F., Caffey, E.M., Jr. and Klett, C., J, "Factors associated with treatment success in 

lithium carbonate prophylaxis." Arch Gen Psychiat, 1974. 31: 189-192. 

32. Prien, R.F., Caffey, E.M., Jr. and Klett, C., J, "A comparison of lithium carbonate and 

chlorpromazine in the treatment of excited schizo-affectives." Arch Gen Psychiat, 1972. 27: 

182-189. 

33.	 Interview with C. James Klett, Ph.D., January 11,1990 at a hotel lobby in Washington, D.C. 

34. First Research Conference on Chemotherapy in Psychiatry. Downey, IL: Office of the Chief 

Medical Director, Veterans Administration, Washington, DC, 1956. 

35. Second Research Conference on Chemotherapy in Psychiatry. Downey, IL: Office of the 

Chief Medical Director, Veterans Administration, Washington, DC, 1957. 

36. Telephone interview with C. James Klett, Ph.D., March 12, 2001. 

37. Kaim, S. and Lindley, C., R&E Newsletter, May, 1961, 14-15. 

38. Klett, C.J. "Preface." Highlights of the 20th Annual Conference, Veterans Administration 

Studies in Mental Health and Behavioral Sciences, i. 

39. Highlights of the 20th Annual Conference, Veterans Administration Studies in Mental 

Health and Behavioral Sciences. Klett, C.J., ed. Perry Point, MD: Veterans Administration, 

1975, 

40. Barnwell, J.B. "The value of cooperative research." First Research Conference on 

Chemotherapy in Psychiatry. Downey, IL: Office of the Chief Medical Director, Veterans 

Administration, Washington, DC, 3-5. 

224
 
41.	 Lamb, H.R., "Deinstitutionalization and public policy", in American Psychiatry after World 

War II (1944-1994), Menninger, R.W. and Nemiah, J.C., Editors. 2000, American 

Psychiatric Press: Washington, DC 259. 

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Chapter 9. The Hypertension Studies 

The relationship between hypertension, commonly referred to as high blood pressure, and adverse 

health effects has long been recognized. People with hypertension are more likely than others to 

have cardiovascular disease, heart attacks, stroke and heart failure. VA medical research over more 

than 60 years has significantly contributed to the improved treatment of hypertension. 

In their 1948 review of young service men who had heart attacks during World War II, Wallace M. 

Yater, M.D., and his colleagues at the Washington (D.C.) VA Hospital showed that enlistment 

blood pressures in men who had coronary attacks were higher compared with those of men who 

were later treated by VA for amputations.1 These authors reviewed earlier publications that also 

showed this effect. While the relationship between hypertension and vascular disease was already 

well established, it was by no means accepted that one led to the other. Many authorities thought 

that hypertension and vascular disease were simply different expressions of a common problem. 

Unless hypertension was causing obvious problems, such as the convulsions of eclampsia in 

pregnancy or the headaches and papilledema of malignant hypertension, hypertension was not 

widely believed to require treatment. 

Early treatment of hypertension 

Before effective drugs became available to lower blood pressure, other approaches were 

recommended in standard medical textbooks. The 1925 10th edition of Osler’s Principles and 

Practice of Medicine, revised by Thomas McRae, M.D., states that one should look for a 

correctable cause for hypertension. If no cause was found: 

“Any focus of infection should be removed... Mental rest and quiet, so far as can be secured, 

are important. Long hours of physical rest are useful. Exercise, short of fatigue, is helpful, 

best in the form of walking, golf, etc. A good vacation, often one spent at one of the springs, 

is an advantage. One day a week in bed on a low diet is useful in more advanced cases. 

“... Bathing in tepid or warm water usually is best. The bowels should be kept well open, for 

which a saline before breakfast is often useful. A weekly dose of blue mass or mercury and 

chalk powder at bedtime for two successive nights is often beneficial. Some patients do well 

with irrigations of the colon once or twice a week in addition.”2 

This advice had not changed much by the 1947 16th edition of the same text, revised by Henry A. 

Christian, A.M., M.D., LL. D. Dr. Christian advised, however, that: “The bowels should be kept 

normal; the oft advised free catharsis seems to the present author inadvisable.” He went on to state 

that “A sedative, such as phenobarbital, generally is helpful.”3 

Edward Freis, M.D., of the Washington VA Hospital, whose later work was prominent in solving 

the hypertension problem, described the situation in 1951. He advised treating only patients with 

such severe hypertension that they were “almost certain to develop fatal complications within a few 

years.” These were: 

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“1. Patients with hemorrhages, exudates and/or papilledema in the optic fundi. 

 2. Patients with diastolic blood pressures persistently above 120 mm. Hg. even after fortyeight hours of bed rest in the hospital.

 3. Patients with repeated attacks of acute hypertensive encephalopathy associated with 

extreme elevations of blood pressure.”4 

The reason for this conservatism was that while the available effective treatments—surgical 

sympathectomy, Walter Kempner. M.D.’s “200 mg sodium diet”—a diet of rice, fruit, sugar and 

iron supplements low in fat and in sodium--and toxic drugs—could be life-saving, they were very 

hard on the patient. Freis and others searched for effective, less toxic drugs to lower blood 

pressure, and within the next few years the search began to produce results. 

Should hypertension be treated? 

By the 1950s and 1960s, effective drugs for reducing blood pressure were becoming available. 

Mortality in patients with malignant hypertension who were treated with the new drugs was shown 

to be markedly reduced when compared to historical controls.5 Increasing numbers of cardiologists 

favored drug treatment for severe or malignant hypertension.6 But even that opinion was not 

universal, and there was no agreement about the best way to handle less severe cases, patients with 

diastolic blood pressures under 120 mm Hg. 

Even though cardiology texts started advising drug therapy for severe hypertension, standard 

medical textbooks generally hesitated to advise drug therapy. For example, a 1966 British 

textbook of medicine stated: 

“In the present status of therapy there is no justification in attempting to lower the blood 

pressure by drugs or operation in the absence of symptoms. An exception might be made in 

young subjects, especially men, with a high fixed level of blood pressure (e.g. diastolic 

exceeding 120 mm.). In such cases it may be felt that complications are likely to occur 

sooner rather than later and for this reason some reduction of the pressure with hypotensive 

drugs is justifiable. The level may be regarded as fixed when residual hypertension persists 

after 7 days' complete rest in bed with adequate sedation.”7 

The 1967 edition of the Cecil and Loeb Textbook of Medicine, contained the following “philosophy 

of treatment”: 

“Be sure that the patient really needs treatment. Those over 70 years rarely do, whatever the 

level of pressure, and certainly should not be treated unless a definite indication such as 

pulmonary edema, angina pectoris, severe headache or marked shortness of breath on effort is 

present. It is sad to see a well preserved patient of 70 years with an arterial pressure of 190 

systolic, 90 diastolic in mm. of mercury due to the presence of a rigid aorta receiving 

treatment for a headache or other symptoms that are manifestations of anxiety or depression. 

Age needs no additional therapeutic hazards.”8 

A 1966 book, Controversy in Internal Medicine, included a strongly stated criticism of those who 

treated even severe hypertension. Hypertension researchers William Goldring, M.D. and Herbert 

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Chassis, M.D. stated, “We believe that we are now in an era of empiric treatment of hypertension, 

in which a huge uncontrolled clinical-pharmacological experiment may be masquerading as a 

clinically acceptable therapy.” They commented: 

“The effect of artificially lowered blood pressure on the occurrence of cerebral vascular 

accidents and myocardial infarction or failure has been reported, but only as a statistical 

relationship between these complications and the level of blood pressure. . . . Furthermore, 

there are sufficient reports in the literature indicating that coronary disease may progress in 

spite of artificially lowered blood pressure.” 

They even questioned the value of lowering blood pressure in “accelerated hypertension” or 

“malignant hypertension,” concluding that: 

“After about 15 years of data collecting, we believe that the alleged usefulness of 

antihypertensive drugs rests on conclusions drawn from notoriously uncertain statistical 

compilations compounded by equally uncertain estimates of morbidity and mortality in the 

natural history of a disease of highly unpredictable course.”9 

Two other papers in the same book10, 11 placed more value on use of antihypertensive drugs. In his 

summarizing “Comments,” Arnold Relman, M.D., a Harvard Medical School professor who later 

on became the editor of the New England Journal of Medicine asks: “It is not difficult in most 

cases to lower blood pressure with various types of drugs, but does this prolong life or prevent 

serious cardiovascular complications?” His perspective was that: 

“We need more controlled prospective studies. I suspect, however, that few will be 

forthcoming, so that the practicing physician is faced with a familiar dilemma.” 

Relman concluded: 

“If he is prudent, I believe he will reserve drug therapy—for only those patients with 

moderate or severe hypertension whose blood pressures cannot be improved by simpler 

measures. While using drugs, the physician must be aware of the possible dangers of longrange toxic effects and of all the uncertainties implicit in the uncontrolled experiment he is 

conducting.”12 

To find answers to the questions and address skepticism about hypertension treatment, in 1956 Dr. 

Edward Freis, Chief of the Medical Service at the Washington VA Hospital, assembled a group of 

colleagues from other VA facilities to start a cooperative study on antihypertensive drugs. 

Edward D. Freis, M.D. 

Freis, interested in research since childhood, published several clinical papers during his early 

medical training. While in an Air Force pathology laboratory in Lincoln, Neb., during World War 

II, he worked with I. Arthur Mirsky, M.D., who was already famous for his diabetes research. 

Mirsky shared a tremendous enthusiasm for research and taught Freis much about how to carry out 

medical investigation.13 Together, they published a paper on shock induced by trypsin.14 

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Figure 9.1. Edward Freis, M.D. 

After the war, Freis returned to Boston University to complete his residency under Chester S. 

Keefer, M.D. Keefer introduced him to James Shannon, of later importance to the NIH, who was 

then head of the Squibb Institute for Medical Research. Shannon wanted to study the 

chemotherapy of hypertension. His previous search for antihypertensives, which had not been 

successful, included work on the red pigment in lobster shells, since the Russians had reported that 

ground-up lobster shells reduced blood pressure. 

Now, Shannon wanted to test pentaquine, an antimalarial drug used during World War II, which 

caused hypotension when given in large doses. Freis agreed to do the clinical trials. The hospital 

assigned a wing of a ward for a clinical trial of pentaquine in hypertensive patients. The drug 

produced severe side effects, but it did lower blood pressure and help some patients with the most 

severe hypertension.15 

After that, Freis and his fellow resident Joseph Stanton, M.D., learned about veratrum viride from 

a review paper by Otto Krayer, M.D., of Harvard.16 Veratrum viride had been used by American 

Indians in their initiation rites to cause vomiting and collapse as well as by 19th century physicians 

in Appalachia to treat eclampsia. Freis and Stanton studied it in their hypertensive patients. They 

found the therapeutic window was very narrow: The dose that lowered the blood pressure often 

caused bradycardia, sweating and projectile vomiting. They found the drug’s effectiveness 

improved by combining it with a low-sodium diet. They followed up with a series of other studies 

of drugs having some benefit to patients with severe hypertension. 

In 1949, Freis was recruited to Washington, D.C., to be Assistant Chief of the Medical Service at 

the Washington VA Hospital and a faculty member at Georgetown University. At first his 

laboratory was primarily at Georgetown, but he gradually moved his base of operations to VA. He 

found that VA patients were more cooperative in his clinical research than Georgetown clinic 

patients. Also, VA had a good laboratory, partly in the same facility as the old Cardiovascular 

Research Laboratory that closed in 1949 (Chapter 2). There, Freis conducted hemodynamic 

studies, primarily on cardiac patients. An important product of this period of research was the 

demonstration that cardiac output and stroke volume decreased in proportion to the severity of 

myocardial infarction. He worked with engineers from the National Bureau of Standards to 

develop the first monitoring equipment and other special equipment for cardiac patients. 

230
 
planned closely with Lawrence Shaw, A.M., the new head of research biostatistics at VA Central

Office to keep the study design simple. From their work on available drugs, they chose what they

considered to be the best regimen, a combination of hydrochlorothiazide, reserpine and 

hydralazine. They persuaded the pharmaceutical companies to provide placebo tablets. Additional

special tablets, each with its own placebo, were available when doses of one or another drug

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All along, Freis continued his clinical research on drugs to counteract hypertension. The most 

important breakthrough, in 1957, was the development of chlorothiazide, a new diuretic drug that 

quickly supplanted injection of mercurial diuretics in edematous patients. Freis had tried 

mercurials in severe hypertension and saw the potential of chlorothiazide therapy for hypertension. 

He quickly treated a series of hypertensive patients with this new drug and presented his results at 

the next meeting of the American Heart Association. 

Beginnings of the VA cooperative studies on hypertension 

Freis learned about the cooperative study approach to clinical research in the early 1950s. During a 

meeting of cardiologists in Europe, Freis joined a VA colleague, Hubert V. Pipberger, M.D., in a 

visit to Paul Martini, M.D., a well-known medical statistician in Germany. Together, they 

discussed Pipberger’s interest in cooperative studies in vectorcardiography. Returning to the 

conference, Freis defended his use of drug treatment for hypertension and encountered opposition 

to his position. He concluded that his only alternative was to use multi-clinic trials in the fashion 

he and Pipberger had discussed with Martini. 

At a VA Chiefs of Medicine meeting, Freis gained the interest of about 15 people in mapping out a 

plan to conduct such a study. His original thought was for a “very simple design—placebo versus 

treatment—the best treatment you had available at the time—and follow up for complications.” 

But, everyone wanted to add to it. Freis described what he encountered: 

“The plan was made out by the doctors. There was no help yet at that stage from any 

statisticians, and it was a lousy plan.... Pretty soon it was loaded.... We were comparing 

different drugs at the same time we were studying effectiveness and mortality. Well, we 

learned after that that you can’t have two main objectives in the same study.” 

Freis took the group’s plan to VA Central Office. In a Nov. 26, 1956, press release, the goal of the 

study was described as “determining how well newer drugs control high blood pressure and 

whether they can prevent hardening of the arteries, heart attacks, strokes and other complications of 

the disease.”17 The leaders in the cooperating VA hospitals, in addition to Freis, were Mark 

Armstrong, M.D., and Walter Kirkendall, M.D., of Iowa City, John Bakke, M.D., and Harold 

Dodge, M.D., of Seattle, Massimo Calebresi, M.D., of West Haven (Conn.), Loyal Conrad, M.D., 

of Oklahoma City, E.E. Eddelman, M.D., of Birmingham (Ala.), Rudolph Fremont, M.D., of 

Brooklyn (N.Y.), David Littman, M.D., of West Roxbury (Mass.), Clifford Pilz, M.D., of Chicago 

West Side, Eli Ramirez, M.D., of San Juan (Puerto Rico) and David Richardson, M.D., of 

Richmond (Va.). 

Results of the first series of studies by this group of investigators were reported in a series of 

papers in the Annals of Internal Medicine between 1960 and 1962.18-20 These studies helped to 

establish the most effective ways to control hypertension using then-available agents, but they did 

not answer the central question of whether this led to prevention of the disease’s complications. 

Resolving hypertension’s core question 

In 1963, Freis and a group of investigators from earlier studies planned a study specifically 

designed to resolve the essential mystery surrounding hypertension treatment. This time, they 

21 

231
 
In 1963, Freis and a group of investigators from earlier studies planned a study specifically 

designed to resolve the essential mystery surrounding hypertension treatment. This time, they

planned closely with Lawrence Shaw, A.M.,21 the new head of research biostatistics at VA Central

Office to keep the study design simple. From their work on available drugs, they chose what they

considered to be the best regimen, a combination of hydrochlorothiazide, reserpine and 

hydralazine. They persuaded the pharmaceutical companies to provide placebo tablets. Additional

special tablets, each with its own placebo, were available when doses of one or another drug

needed to be adjusted because of side effects.

Patients were very carefully selected for this study. Veterans with hypertension were hospitalized

for an initial workup before enrollment. Those whose diastolic blood pressures averaged between

90 and 129 mm Hg during days four through six of a hospital stay were considered for the study.

They selected only patients who appeared motivated and had no existing severe hypertensive

sequelae. As Freis recalled, although there was no formal consent process, the patient’s preference

to return to his usual practitioner was a formal basis for exclusion.

The investigators rigorously checked a patient’s reliability before accepting him into the study.

After hospital discharge and before randomization, patients received two placebo tablets, one

containing riboflavin. During two subsequent clinic visits, pill counts were done and urine was

checked by fluorescence for riboflavin content. Excluded from the study were patients who failed

to keep both appointments and bring their pills, had incorrect pill counts, or had no riboflavin in

their urine. With these precautions, noncompliance—probably the most important cause of

treatment failure in ordinary practice—could be minimized.

This study began in April 1964 and only the statistical staff were aware of the results until they

were “unblinded” in 1969. However, in early 1967, Shaw told Freis of his early analysis of results

from patients with severe hypertension, defined as diastolic pressures 115 through 129. By this 

time, 143 patients with severe hypertension were enrolled in the study, 70 of them on placebo

medication. Fifty-five patients with severe hypertension, 23 on placebo, had been followed for

more than two years. Analyzing this group of patients, Shaw found that the number of serious 

cardiovascular events was much greater in the placebo group, showing a convincing degree of

statistical significance. Serious cardiovascular “events” had occurred in 27 of the placebo-treated

severely hypertensive patients but in only two of those receiving active antihypertensive treatment.

There was no question that reducing a markedly elevated diastolic blood pressure helped to protect

the patient. Patients in this “severe hypertension” group were immediately dropped from the study, 

and those who had been on placebo received active treatment to reduce their blood pressures.

The Journal of the American Medical Association published the results in December 1967.22 As 

Freis recalled, this paper on treatment of severe hypertension didn’t cause much discussion. But he 

also recalls deciding against having a press release. Just as there were those who still needed to be

convinced that treatment of hypertension is efficacious, there were others, convinced that lowering

blood pressure protected patients, who criticized the group for doing a placebo-controlled study. 

And the more difficult question—whether treatment of mild and moderate hypertension is 

efficacious—still needed to be answered.

232

In 1963, Freis and a group of investigators from earlier studies planned a study specifically 

to resolve the essential m surroundin h ertension treatment. This time the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

designed ystery g yp , y 

planned closely with Lawrence Shaw, A.M.,21 the new head of research biostatistics at VA Central 

Office to keep the study design simple. From their work on available drugs, they chose what they 

considered to be the best regimen, a combination of hydrochlorothiazide, reserpine and 

hydralazine. They persuaded the pharmaceutical companies to provide placebo tablets. Additional 

special tablets, each with its own placebo, were available when doses of one or another drug 

needed to be adjusted because of side effects. 

Patients were very carefully selected for this study. Veterans with hypertension were hospitalized 

for an initial workup before enrollment. Those whose diastolic blood pressures averaged between 

90 and 129 mm Hg during days four through six of a hospital stay were considered for the study. 

They selected only patients who appeared motivated and had no existing severe hypertensive 

sequelae. As Freis recalled, although there was no formal consent process, the patient’s preference 

to return to his usual practitioner was a formal basis for exclusion. 

The investigators rigorously checked a patient’s reliability before accepting him into the study. 

After hospital discharge and before randomization, patients received two placebo tablets, one 

containing riboflavin. During two subsequent clinic visits, pill counts were done and urine was 

checked by fluorescence for riboflavin content. Excluded from the study were patients who failed 

to keep both appointments and bring their pills, had incorrect pill counts, or had no riboflavin in 

their urine. With these precautions, noncompliance—probably the most important cause of 

treatment failure in ordinary practice—could be minimized. 

This study began in April 1964 and only the statistical staff were aware of the results until they 

were “unblinded” in 1969. However, in early 1967, Shaw told Freis of his early analysis of results 

from patients with severe hypertension, defined as diastolic pressures 115 through 129. By this 

time, 143 patients with severe hypertension were enrolled in the study, 70 of them on placebo 

medication. Fifty-five patients with severe hypertension, 23 on placebo, had been followed for 

more than two years. Analyzing this group of patients, Shaw found that the number of serious 

cardiovascular events was much greater in the placebo group, showing a convincing degree of 

statistical significance. Serious cardiovascular “events” had occurred in 27 of the placebo-treated 

severely hypertensive patients but in only two of those receiving active antihypertensive treatment. 

There was no question that reducing a markedly elevated diastolic blood pressure helped to protect 

the patient. Patients in this “severe hypertension” group were immediately dropped from the study, 

and those who had been on placebo received active treatment to reduce their blood pressures. 

The Journal of the American Medical Association published the results in December 1967.22 As 

Freis recalled, this paper on treatment of severe hypertension didn’t cause much discussion. But he 

also recalls deciding against having a press release. Just as there were those who still needed to be 

convinced that treatment of hypertension is efficacious, there were others, convinced that lowering 

blood pressure protected patients, who criticized the group for doing a placebo-controlled study. 

And the more difficult question—whether treatment of mild and moderate hypertension is 

efficacious—still needed to be answered. 

232
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

So the group continued to enroll patients with diastolic pressures up to 114 for another two years, 

until September 1968. The “blind” for these patients continued until after the last observations had 

been completed in October 1969. Three hundred eighty patients had been observed for one to five 

years, on average for more than three years. 

As before, throughout the course of the study, the statistical group continued to monitor the 

“unblinded” data. They shared the results with Central Office officials. One Saturday in October 

1969, Thomas Chalmers, M.D., Assistant Chief Medical Director for Research and Education and 

an authority on controlled clinical trials, was working at his desk in Central Office. He looked at 

the latest statistical analysis of results from the hypertension study. It was clear that reducing 

blood pressure prevented stroke and congestive heart failure. Immediately, Chalmers sent out 

instructions to the study clinics to put all patients on active treatment and to break the blind. Later, 

the group found that the significance of their findings was primarily due to the patients with 

moderate hypertension, diastolic pressures 105-114. It would take a later, much larger, study to 

prove the protective effect of treating even mild hypertension. 

This VA report, by virtue of its randomized, double-blind, placebo-controlled design, presented the 

first definitive and convincing proof that treating moderate hypertension was beneficial in 

preventing or delaying many of its catastrophic health complications. 

 Figure 9.2. Results of the study of patients with moderate hypertension 

Response to the study 

The report of the study showing the efficacy of treatment of moderate hypertension appeared in 

JAMA in August 1970.23 It provoked little immediate reaction. The Associated Press circulated 

the news, but not much was published in the general press. As Freis recalled, there was little 

immediate interest among physicians. However, the results were recognized in the 1971 edition of 

the Cecil-Loeb Textbook of Medicine: “Now that controlled trials of treatment in less severe grades 

of hypertension have been carried out, it is clear that improvement in outlook is conferred by 

successful treatment.” Nevertheless, the textbook continued to advise against treating the elderly.24 

233
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In May 1971, Freis spoke at a special seminar on clinical trials held by the “Young Turks” (the 

American Society for Clinical Investigation) at its Atlantic City meeting. Freis recalled that Mary 

Lasker had heard about the study and approached Secretary of Health, Education and Welfare 

Elliot Richardson with reprints of Freis’s papers and publications. Richardson, whose physician 

father had had hypertension and died of a stroke, ordered the creation of a nationwide effort to 

publicize hypertension. This program became known as the National High Blood Pressure 

Education Program. 

In November 1972, Freis received the Lasker Award for his contributions to clinical medicine. 

The 1974 edition of Controversies in Clinical Medicine included a follow-up to the 1966 

disagreement on the treatment of hypertension: 

“There has (in the first edition) been a difference of opinion in regard to the treatment of 

benign hypertension, but both Hollander and Relman stated the need for a carefully 

controlled prospective study. Such a study has now been done. 

“The results of a clinical trial conducted in the Veterans Administration and led by Freis 

conclusively demonstrated the value of treating patients with benign hypertension of a 

moderate or severe grade.”25 

Nevertheless, skepticism about benefit from treatment of hypertension waned slowly. Even in 

1997, Moser wrote:26 

“Even as results of therapy in the 1950s and the early 1960s improved, progress was still held 

back by prevailing attitudes of therapeutic nihilism, popularized and given respectability by 

several leading medical authorities. It is hard to believe, but some experts still believed that 

arterial disease was the cause of the hypertension rather than the result. These opinions 

scoffed at the use of drug as treatment of the manometer or the ‘numbers’ rather than the 

patient. There was disbelief that benefit could be achieved by just paying attention to the 

numbers. In the mid 1950s at the New York Academy of Medicine, we presented 10 cases of 

malignant hypertension, who had experienced clearing of fundoscopic abnormalities and 

heart failure and as a result of blood pressure lowering. Two eminent authorities pronounced 

that this probably represented the ‘natural history’ of some patients. When reversal of LVH 

was demonstrated on EKG, a well-known New York City electrocardiographer sent us a note, 

‘Ain't nature grand.’ (This electrocardiographer) expressed disbelief that cardiac hypertrophy 

could be reversed by just lowering the blood pressure (paying attention to the manometer). In 

view of more recent data, this attitude seems strange indeed. 

“But some hypertension experts in the 1990's still belittle the benefits of ‘just lowering the 

blood pressure.’ It may be true that modifying other risk factors in addition to lowering blood 

pressure will result in a greater reduction in morbidity and mortality than has been noted thus 

far in the clinical trials and clinical experience.” 

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Later studies by the VA Cooperative Study Group on Antihypertensive Agents 

Important questions about hypertension remained. The VA group had proven that drug treatment 

helped the patients they studied who had moderate to severe hypertension. These patients were 

relatively young, averaging about 50 years of age. How about the elderly? How about patients 

with mild hypertension—should they also be treated? What is the significance of systolic 

hypertension when the diastolic pressure is normal? How do other drugs compare with the fixed 

combination used in the morbidity study? Can the drugs be stopped after the blood pressure is 

controlled? The group of research clinicians remained together as the “Veterans Administration 

Cooperative Study Group on Antihypertensive Agents” and carried out a series of studies, some of 

them supported by the NIH and pharmaceutical companies as well as by VA. 

Among their first efforts was a more detailed analysis of the data from the morbidity study on 

patients with mild to moderate hypertension. They found that the older the patient and the more 

cardiovascular or renal abnormalities present at entry, the greater the benefit from treatment. 

While the entry diastolic blood pressure had little effect on adverse outcomes in the treated group, 

treatment had a greater effect on the level of blood pressure in those with the greater entry blood 

27 pressures.

In later studies, the group compared new drugs with established antihypertensive drugs in a series 

of carefully controlled studies.28-35 They also studied the effectiveness of drug combinations when 

single drugs were not effective in sufficiently lowering blood pressure and found that 

combinations, especially those containing diuretics, are often effective when the same drugs given 

singly are not.36 This finding has led to the recommendation that drug combinations be used 

routinely.37 

A 1975 paper reporting an attempt to wean patients from antihypertensive drugs showed that only 

15 percent of patients with drug-controlled hypertension remained normotensive when a placebo 

was substituted. However, a later study showed that dosage could frequently be reduced safely but 

not discontinued entirely.38 

Following the VA group’s original finding that treatment of the elderly reduced adverse events, a 

finding reinforced by other groups,39-42 an NHLBI-funded study with VA participation showed that 

lowering systolic blood pressure below 160 mmHg in elderly persons with isolated systolic 

hypertension lowered the stroke rate by one-third.40 

Implications of the hypertension studies 

Proof that treatment of hypertension prevents its complications has led to widespread efforts to 

detect and control the condition. In 1972, anticipating that a large number of untreated hypertensive 

Veterans would need treatment to prevent complications, VA started the Hypertension Screening 

and Treatment Program (HSTP), which included 32 treatment clinics to detect and treat 

hypertension in Veterans. H. Mitchell Perry, M.D., of the St. Louis VA Medical Center was 

chairman of the program. A law change in late 1973 permitted outpatient treatment of 

hypertension. Treatment visits to the HSTP clinics began in January 1974 and some of these clinics 

are still active today. A 20-year review in 1998 showed that lowering blood pressure had been 

235
 
 

 

effective in 85 percent of patients and that early treatment had decreased incidence of end-stage 

renal disease by half.43 

The VA cooperative studies on hypertension have led to a revolution in the care of those with this 

condition. Countless people have been spared the ravages of stroke and other consequences of 

uncontrolled hypertension. 

236
 
 

 

 

 

 

 

References 

1. Yater, W.M., Traum, A.H., Brown, W.G., Fitzgerald, R.P., Geisler, M.A. and Wilcox, B.B., 

"Coronary artery disease in men eighteen to thirty-nine years of age." Am Heart J, 1948. 36: 

334-372. 

2. McCrae, T., The Principles and Practice of Medicine. Originally Written by William Osler. 

Tenth Edition. New York and London: D. Appleton and Company, 1925, 864. 

3. Christian, H.A., The Principles and Practice of Medicine. Originally Written by William 

Osler. Sixteenth Edition. New York and London: D. Appleton-Century Company, 

Incorporated, 1947, 1130. 

4. Freis, E.D., "An approach to the treatment of severe essential hypertension." Medicine 

Illustrated, 1951. 5: 53-58. 

5. Perry, H.M. and Schroeder, H.A., "The effect of treatment on mortality rates in severe 

hypertension." Arch Int Med, 1958. 102: 418-425. 

6. Leishman, A.W.D., "Merits of reducing high blood-pressure." Lancet, 1963. 1: 1284-1288. 

7. Scott, R.B., Price's Textbook of the Practice of Medicine. London: Oxford University Press, 

1966, 735. 

8. Beeson, P.B. and McDermott, W., Cecil-Loeb Textbook of Medicine, Twelfth Edition. 

Philadelphia, London, Toronto: W.B. Saunders Company, 1967, 665-666. 

9.	 Goldring, W. and Chasis, H., "Antihypertensive drug therapy: An appraisal", in Controversy 

in Internal Medicine, Ingelfinger, F., Relman, A., and Finland, M., Editors. 1966, W.B. 

Saunders Company: Philadelphia and London, 83-91. 

10. Page, I.H. and Dustan, H.P., "The usefulness of drugs in the treatment of hypertension", in 

Controversy in Internal Medicine. 1966, 92-95. 

11. Hollander, W., "The evaluation of antihypertensive therapy of essential hypertension", in 

Controversy in Internal Medicine. 1966, 96-100. 

12. Relman, A.S., "Comment", in Controversy in Internal Medicine. 1966, 101-102. 

13.	 Interview with Edward Freis, M.D., May 27, 1997 at Dr. Freis's office at the Washington, 

DC VAMC. 

14. Mirsky, I.A. and Fries, E.D., "Renal and hepatic injury in trypsin "shock"." Proc Soc Exp 

Biol Med, 1944. 57: 278. 

237
 
 

 

 

 

 

 

15. Freis, E.D. and Wilkins, R.W., "The effects of pentaquine in patients with hypertension,." 

Proc Soc Exp Biol Med, 1947. 64: 455-458. 

16. Krayer, O. and Acheson, G.H., "The pharmacology of the veratrum alkaloids." Physiol Rev, 

1946. 26: 282-446. 

17. Veterans Administration Central Office, Future release. 1956, Veterans Administration: 

Washington, DC. 

18. Veterans Administration Cooperative Study on Antihypertensive Agents, "A double blind 

control study of antihypertensive agents." Arch Int Med, 1960. 106: 133-148. 

19. Veterans Administration Cooperative Study on Antihypertensive Agents, "A double blind 

control study of antihypertensive agents II." Arch Int Med, 1962. 110: 222-229. 

20. Veterans Administration Cooperative Study on Antihypertensive Agents, "A double blind 

control study of antihypertensive agents III. Chlorothiazide alone and in combination with 

other agents; Preliminary results." Arch Int Med, 1962. 110: 230-236. 

21.	 Interview with Lawrence Shaw, February 3, 1994 at Mr. Shaw’s home. 

22. Veterans Administration Cooperative Study on Antihypertensive Agents, "Effects of 

treatment on morbidity in hypertension. Results in patients with diastolic blood pressures 

averaging 115 through 129 mm Hg." JAMA, 1967. 202: 116-122. 

23. Veterans Administration Cooperative Study on Antihypertensive Agents, "Effects of 

treatment on morbidity in hypertension. Results in patients with diastolic blood pressures 

averaging 90 through 114 mm Hg." JAMA, 1970. 213: 1143-1152. 

24. Beeson, P.B. and McDermott, W., Cecil-Loeb Textbook of Medicine. Philadelphia, London, 

Toronto: W.B. Saunders Company, 1971, 1058-1059. 

25. Ingelfinger, F.J., Ebert, R.V., Finland, M. and Relman, A.S., Controversy in Internal 

Medicine II. Philadelphia and London: W.B. Saunders Company, 1974 

26. Moser, M., Myths, misconception, and heroics; The story of the treatment of hypertension 

from the 1930s. Le Jacq Communications, Inc., 1997 

27. Veterans Administration Cooperative Study Group on Antihypertensive Agents, "Effects of 

treatment on morbidity in hypertension III. Influence of age, diastolic pressure, and prior 

cardiovascular disease; further analysis of side effects." Circulation, 1972. 45: 991-1004. 

28. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 

"Multiclinic controlled trial of bethanidine and guanethidine in severe hypertension." 

Circulation, 1977. 55: 519-524. 

238
 
 

 

 

 

 

 

 

 

29. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 

"Propranolol in mild HBP." JAMA, 1977. 237: 2307-2310. 

30. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 

"Comparative effects of ticrynafen and hydrochlorothiazide in the treatment of 

hypertension." New Eng J Med, 1979. 301: 293-297. 

31. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 

"Comparison of prazosin with hydralazine in patients receiving hydrochlorothiazide." 

Circulation, 1981. 64: 772-779. 

32. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 

"Comparison of propranolol and hydrochlorothiazide for the initial treatment of 

hypertension. I. Results of short-term titration with emphasis on racial differences in 

response." JAMA, 1982. 248: 1996-2003. 

33. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 

"Comparison of propranolol and hydrochlorothiazide for the initial treatment of 

hypertension. II. Results of long-term therapy." JAMA, 1982. 248: 2004-2011. 

34. Veterans Administration Cooperative Study Group on Antihypertensive Agents, "Low-dose 

captopril for the treatment of mild to moderate hypertension. I. Results of a 14-week trial." 

Arch Int Med, 1984. 144: 1947-1953. 

35. Materson, B.J., Reda, D.J., Cushman, W.C., Massie, B.M., Freis, E.D., Kochar, M.S., 

Hamburger, R.J., Fye, C., Lakshman, R., Gottdiener, J., Ramirez, E.A. and Henderson, 

W.G., "Single-drug therapy for hypertension in men. A comparison of six antihypertensive 

agents with placebo." New Eng J Med, 1993. 328: 914-921. 

36. Materson, B.J., Reda, D.J., Cushman, W.C. and Henderson, W.G., "Results of combination 

anti-hypertensive therapy after failure of each of the components." J Hum Hypertension, 

1995. 9: 791-796. 

37. Freis, E.D., "Improving treatment effectiveness in hypertension." Arch Int Med, 1999. 159: 

2517-2521. 

38. Freis, E.D., Thomas, J.R., Fisher, S.G., Hamburger, R.J., Borreson, R.E., Mezey, K.C., 

Mukherji, B., Neal, W.W., Perry, H.M. and Taguchi, J.T., "Effects of reduction in drugs or 

dosage after long-term control of systemic hypertension." Am J Card, 1989. 63: 702-708. 

39.	 Amery, A., Birkenhager, W., Brixko, P., Bulpitt, C., Clement, D., Deruyttere, M., De 

Schaipdryver, A., Dollery, C., Fagard, R., Forette, F., Forte, J., Hamdy, R., Henry, J.F., 

Joossens, J.V., Leonetti, G., Lund-Johansen, P., O'Malley, K., Petrie, J., Strasser, T., 

Tuomilehto, J. and Williams, B., "Mortality and morbidity results from the European 

Working Party on High Blood Pressure in the Elderly Trial." Lancet, 1985. 1: 1349-1354. 

239
 
 

40. S.H.E.P. Cooperative Research Group, "Prevention of stroke by antihypertensive drug 

treatment in older persons with isolated systolic hypertension." JAMA, 1991. 265: 3255­

3264. 

41. The Management Committee, Australian National Blood Pressure Study, "Treatment of mild 

hypertension in the elderly." Med J Aust, 1981. 2: 398-402. 

42. Coope, J. and Warrender, J.S., "Randomized trial of treatment of hypertension in elderly 

patients in primary care." Br Med J, 1986. 293: 1145-1151. 

43. Perry, H.M., "Hypertension research in the VA." unpublished, 1998. 

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Chapter 10. Smoking and Lung Cancer 

Arguably, the American public takes for granted the health warnings that appear on tobacco 

products’ packages and in their advertising. Smokers and non-smokers alike readily accept the 

notion that inhaling burning tobacco fumes is unhealthy. But the issue was not always as settled as 

it appears today. Scientific and legal battles about tobacco dot the landscape of both medicine and 

commerce over the past 50 years. Public and corporate acceptance of what many now consider to 

be a common-sense notion is a far cry from the days when smoking was considered a benign habit. 

A vivid picture of just how far this subject has evolved requires only a glimpse of life among the 

troops of World War II. Smoking was so widespread in the military that small packages of 

cigarettes were routinely included in field rations. War-zone photos of soldiers at rest often 

depicted men taking smoking breaks; the Bill Maudlin cartoon characters portraying typical GIs 

Willie and Joe frequently uttered their war-time wisdom past lips from which a cigarette dangled. 

Cigarette manufacturers routinely sponsored radio broadcasts; one that aimed its entertainment 

specifically to the Armed Forces announced prizes for military units in the form of hundreds of 

cartons of cigarettes. The phrase “smoke if you got ‘em” remains well-known to most Veterans. 

That the study of a connection between smoking and health first emerged from the then-obscure 

interests of a VA scientist seems more than just a coincidence. 

Oscar Auerbach, M.D., was named one of VA’s first Senior Medical Investigators in 1959. A staff 

pathologist at the Halloran VA hospital on Staten Island (N.Y.) from 1947 until 1952, when he 

moved to the new East Orange (N.J.) VA Hospital, Auerbach remained on the staff at East Orange 

until 1980, keeping an office there until his death in 1997 at age 92. 

Figure 10.1. Oscar Auerbach, M.D. 

Auerbach was a central player in VA tuberculosis trials (Chapter 5) and had been a pathologist at 

the Seaview tuberculosis hospital on Staten Island before joining VA. He published landmark 

reports on the pathology of unusual types of tuberculosis based on his Seaview experience. These 

included tuberculous empyema,1

 tracheobronchial tuberculosis,2 tuberculosis of the pleura, 

241
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 

peritoneum and pericardium3 and tuberculous meningitis.4

 After he joined VA, Auerbach studied 

the effects of the new antituberculosis drugs on the pathology of the disease.5-9 

Auerbach became a central figure in American medicine for his studies of the relationship between 

smoking and lung cancer, demonstrated by his use of “smoking dogs.” He was a participant in the 

first Surgeon General’s report on the effects of smoking and was written up in Life magazine. 

Following are excerpts from an Oct. 30,. 1992, interview that this book’s author conducted with Dr. 

Auerbach in his office at the East Orange VA Medical Center.11 

“When I was at Seaview, I published on tuberculosis. When I first went into the Veterans 

Administration, I published on the effects of antibiotic therapy (on tuberculosis). And one day, 

right here, I gave a clinico-pathological conference (CPC) on an individual who had died of 

lung cancer. As a TB pathologist, used to taking many sections of the tracheobronchial tree, I 

saw in the many sections all of the preliminary stages of the lung cancer, including carcinoma 

in situ and early invasion. This individual was exposed to chromate, so I thought it was all due 

to chromate. 

“I mused to the conference after my presentation that it would be interesting to see if we would 

find those same changes in the tracheobronchial tree that we saw here following smoking. So 

Charles Pfizer, for whom I had been a consultant, gave me money to pay four technicians 

overtime to work on that at night. 

“When I was through with the preliminary report, somehow or other Ed Murrow got wind of it 

and sent his man up and asked me if I would go on his program, See It Now. I felt it was too 

preliminary and wouldn’t do it. So I presented the preliminary changes at the American 

College of Chest Physicians in Atlantic City somewhere around 1952 or 1953. The Cancer 

Society became interested in our studies, and we had a press conference, and that was the 

beginning of the explosion as far as I’m concerned. It was really quite something. 

“Everybody was interested. The American Cancer Society called a press conference, and asked 

me if I would appear at what was the then the Pennsylvania Hotel in New York. Around that 

table were all of the big reporters. They all were around the table and quizzed me. I never 

knew the power of the press until the next week. One of the people at the press conference was 

a column writer for the New York Times. There was a whole story on me on the op-ed page of 

the New York Times. It appeared in papers throughout the country. 

“I presented my material to the American Cancer Society, and from then on all our studies 

were done with an epidemiologist at the American Cancer Society, Cuyler Hammond. 

“The original results which I showed were the presence of these precancers. I drew no 

conclusions. These were published in (the journal) Cancer.12 

“As I said, we drew no conclusions. But there were sufficient changes in the tracheobronchial 

tree to warrant our going on with the study. I saw that we needed more material. That was a 

preliminary study with no conclusions drawn. 

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“I had been in the Navy with Charles Cameron, who was the Medical Director of the Cancer 

Society. Dr. Perdy Stout, who was my consultant at that time, and I went to see him. They 

brought in Dr. Hammond and Dr. Weaver, who was then the Research Director. And Dr. 

Hammond really began a dance all over the place. He said, ‘What your slides are showing is 

what we have been saying epidemiologically, but they wouldn’t listen to us.’ And see, this was 

the proof. So he became very excited. And he said, would you let me work with you? I said 

that I would let him work with me on one condition, that he become a co-author. He said, 

‘That’s very generous. You know, I’ve been asked by the Cancer Society to help you.’ We 

made quite a team. So you notice that his name is on all the papers. 

“The Cancer Society people were very excited. They said that they would support us. And for 

all the years after that, we were supported by the American Cancer Society. 

“It was very, very, very interesting. I would go into the American Cancer Society, and I would 

sit down with Cuyler Hammond and with Lawrence Garfinkel, who took his place. E. Cuyler 

Hammond was the world’s best and best-known epidemiologist in the field of smoking. No 

question about it. This all happened in the early 50s. 

(Meanwhile, what were you doing at VA?) 

“I was a routine pathologist, carrying on with all my work. I did the research at home at night 

and on weekends. For years I did that.. . It was all day Sunday. And I’d start about 4 in the 

morning and work until about 6:30. I would go home after work and sometimes work until 

10:00 at night. And all day Saturday, all day Sunday. It was something I loved. I enjoyed 

doing it.... 

 “Well, here’s what would happen. I would go and see Cuyler Hammond at the American 

Cancer Society and we sat and we talked. And he said, ‘Oscar, what are you trying to do?’ I 

said, ‘Simple. I am trying to see, in individuals who die of lung cancer, whether they show all 

the changes preliminary to the development of invasive carcinoma.13 If I prove that, am I also 

able to see those same changes in individuals who die of causes other than lung cancer? And 

are they proportional to the amount of cigarettes they smoke?’14 

“And those were the two studies all the way through, except one, which came later: What 

happens when individuals give up the smoking habit? That became the article that was 

published in the New England Journal of Medicine15, 16 on former cigarette smokers.” 

The first, 1964 Surgeon General’s report on Smoking and Health includes a section on these 

anatomical studies.17 That report reviewed the results of attempts up to that time to induce lung 

cancer in experimental animals from smoking. They concluded that all studies up to that time 

were inconclusive.18 

(When did you decide to set up your experimental dog model?) 

“I’ll tell you what happened. There was an advertisement by one of the tobacco companies. A 

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full-page ad, which said that it is interesting that no animal model was used. That inspired me. 

And so I did one study on animals. They were all thoroughbred beagles. I did it with Cuyler. 

Ten smoking dogs versus 10 non-smoking dogs. 

(How did you get the dogs to smoke?) 

“Tracheostomy. That study set the pace. It was at that time that we saw that we could produce 

the same changes in the tracheobronchial tree as we saw in human beings right up to invasion. 

And that was published.19 Then we were beset by the tobacco industry. But that never 

bothered me and the tobacco industry never bothered me. 

(What did they do?) 

“Oh, the tobacco industry would always write articles. When I went to have articles published 

in the Archives of Environmental Health, they threatened the editor. They also went to the 

AMA and tried to have my article withdrawn. 

(What kind of pressure could they use?) 

“Oh, they would take their advertisements out of the papers. I had a story in Life magazine. A 

very pretty young woman was doing the story for them. And the tobacco industry threatened 

Life magazine, that if they wrote that story, they were going to withdraw their ads. She told me 

that the editorial board, all the editorial board, had a meeting and stated that they were 

completely behind the story that she wrote. And the article was published.... 

“When we were studying the smoking dogs, they got the antivivisectionists after us. 

(How did you decide to use dogs first of all?) 

“I sat down with Cuyler Hammond and Arthur Purdy Stout. I said that, if we were going to do 

an animal model, the tracheobronchial tree must be large enough so that we could examine it. 

It must be one in which we could see the same changes as in the human being if they really 

occur. Dr. Hammond said that we want no variables. He insisted upon one breed and one sex, 

males. 

“We found that using a tracheostomy was the best way to teach the dogs how to inhale. We 

later found out that they inhale by themselves after a while. But with the tracheostomy, we had 

complete control of how much smoke would go in . . . What happened (in the preliminary 

study) was that one died after 29 days. Another dog died after 200-some-odd days, another 

after 410 days, another after 415, and another after 420. We found that they were developing 

pulmonary infarcts. I called Cuyler Hammond, and said we’d better end this trial now while we 

still have good tracheobronchial trees to examine. So five dogs were sacrificed from 420 to 

423 days. And we found that they developed pulmonary embolisms from thrombi that would 

develop in the right atrial appendage. The control dogs didn’t have any changes.19 

“We did the larynx. We did the esophagus. We did the lung parenchyma. Our studies on 

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emphysema were equally as important as our studies on the tracheobronchial tree. All related 

to the smoking effects. Every study in the dog paralleled that of the human being. 

“And always, I want you to know, we were pursued by the tobacco industry, but that was 

nothing. That didn’t bother me. Never. They got hold of the Congressmen and Senators..... 

They wrote to Dr. Middleton and Dr. Middleton called me and said, ‘Oscar, I want you to 

know they asked why the Veterans Administration was supporting a doctor who was killing an 

important industry in the southern states?’ And his answer was, ‘I never interfere in the 

scientific pursuits of the people who are under me.’ I received the same support from Ben 

Wells, Jim Musser and Hal Engle. Bill Middleton knew everything I was doing. So did Jim 

Musser and Ben Wells.” 

Auerbach’s definitive study of smoking dogs involved a total of 97 male beagles, eight nonsmoking 

controls with tracheostomies in place and the rest smoking various numbers of cigarettes, both 

filter-tipped and unfiltered. After almost three years, all the nonsmoking dogs had normal lungs. 

Histopathological changes had occurred in the lungs of all the smoking dogs, with the greatest 

changes in the lungs of dogs smoking unfiltered cigarettes most heavily.20 Ten of the 24 dogs in the 

latter group developed invasive bronchiolo-alveolar tumors.21 They also showed pulmonary 

fibrosis with emphysema.22, 23 In another study, Auerbach demonstrated thickening of the arteriolar 

walls in the myocardia of smoking dogs and humans.24 

Auerbach later studied other environmental effects on lung cancer. He collaborated with Geno 

Saccomanno, M.D., Ph.D., of the Grand Junction (Colo.) VA Hospital, who studied the factors 

leading to lung pathology among the uranium miners of the Colorado plateau.25-32 He collaborated 

on studies of arsenic33 and asbestos34, 35 exposure and of inhalants36 to lung cancer. 

Auerbach’s landmark contributions were the result of intense and laborious observation. His 

laboratory was lined floor to ceiling with slides. A typical study involved 208 serial section slides 

on each of 117 cases, each containing more than 24,000 slides and each studied, in most cases, by 

Auerbach himself. He also had expert statistical collaboration from his first studies on the lung 

cancer problem, and randomization and “blinding” were the rule. Auerbach’s work has made a 

lasting impact on the health of millions. 

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References 

1. Auerbach, O., "Empyema as a complication of chronic pulmonary tuberculosis." Am Rev 

Tuberc, 1949. 59: 601-618. 

2. Auerbach, O., "Tuberculosis of the trachea and major bronchi." Am Rev Tuberc, 1949. 60: 

604-620. 

3. Auerbach, O., "Pleural, peritoneal and pericardial tuberculosis - a review of 209 cases 

uncomplicated by treatment or secondary infection." Am Rev Tuberc, 1950. 61: 845-861. 

4.	 Auerbach, O., "Tuberculous meningitis: Correlation of therapeutic results with the 

pathogenesis and pathologic changes." Am Rev Tuberc, 1951. 64: 408-429. 

5. Auerbach, O., Weiss, L. and Stemmerman, G., "Pathology of tuberculosis treated with 

streptomycin: A review of 34 cases." Dis Chest, 1951. 19: 145-157. 

6. Auerbach, O., Katz, H.I. and Small, M., "The effect of streptomycin therapy on the 

bronchocavitary junction and its relation to cavity healing." Am Rev Tuberc, 1953. 67: 173­

200. 

7. Auerbach, O., Hobby, G., Small, M., Lenert, T. and Vaughn, L., "Effect of degree of healing 

upon persistence of tubercle bacilli within pulmonary lesions." Am Rev Tuberc, 1955. 72: 

386-389. 

8. Auerbach, O., "Pulmonary tuberculosis after the prolonged use of chemotherapy." Am Rev 

Tuberc, 1955. 71: 165-185. 

9. Auerbach, O., Hobby, G., Small, M., Lenert, T. and Comer, J., "The clinicopathologic 

significance of the demonstration of viable tubercle bacilli in resected lesions." J Thorac 

Surg, 1955. 29: 109-132. 

10. "New cigarette-cancer link." Life Magazine, June 11, 1956, Cover and pp 129-130. 

11. Interview with Oscar Auerbach, M.D., October 30, 1992 at Dr. Auerbach's office at the East 

Orange, NJ, VA Medical Center. 

12.	 Auerbach, O., Petrick, T.G., Stout, A.P., Statsinger, A.L., Muehsam, G.E., Forman, J.B. and 

Gere, J.B., "The anatomical approach to the study of smoking and bronchogenic carcinoma." 

Cancer, 1956. 9: 76-83. 

13. Auerbach, O. and Stout, A.P., "Histopathological aspects of occult cancer of the lung." Ann 

N Y Acad Sci, 1964. 114: 803-810. 

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14. Auerbach, O., Stout, A.P., Hammond, E.C. and Garfinkel, L., "Changes in bronchial 

epithelium in relation to cigarette smoking and in relation to lung cancer." N Engl J Med, 

1961. 265: 253-267. 

15. Auerbach, O., Stout, A.P., Hammond, E.C. and Garfinkel, L., "Bronchial epithelium in 

former smokers." N Engl J Med, 1962. 267: 119-125. 

16. Auerbach, O., Stout, A.P., Hammond, E.C. and Garfinkel, L., "Smoking habits and age in 

relation to pulmonary changes: Rupture of alveolar septums, fibrosis and thickening of walls 

of small arteries and arterioles." N Engl J Med, 1963. 269: 1045-1054. 

17. Surgeon General of the United States Smoking and Health: Report of the Advisory 

Committee to the Surgeon General of the Public Health Service. U.S. Department of Health, 

Education and Welfare; Public Health Service, 1964. 167-173. 

18. Surgeon General Smoking and Health. 1964. 165. 

19. Auerbach, O., Hammond, E.C., Kirman, D., Garfinkel, L. and Stout, A.P., "Histologic 

changes in bronchial tubes of cigarette-smoking dogs." Cancer, 1967. 20: 2055-2066. 

20. Hammond, E.C., Auerbach, O., Kirman, D. and Garfinkel, L., "Effects of cigarette smoking 

on dogs: 1. Design of experiment, mortality, and findings in lung parenchyma." Arch 

Environ Health, 1970. 21: 740-753. 

21. Auerbach, O., Hammond, E.C., Kirman, D. and Garfinkel, L., "Effects of cigarette smoking 

on dogs. II. Pulmonary neoplasms." Arch Environ Health, 1970. 21: 754-768. 

22. Frasca, J.M., Auerbach, O., Parks, V.R. and Jamieson, J.D., "Electron microscopic 

observations on pulmonary fibrosis and emphysema in smoking dogs." Exp Mol Pathol, 

1971. 15: 108-125. 

23. Frasca, J.M., Auerbach, O., Parks, V.R. and Jamieson, J.D., "Alveolar cell hyperplasia in the 

lungs of smoking dogs." Exp Mol Pathol, 1974. 21: 300-312. 

24. Auerbach, O., Hammond, E.C., Garfinkel, L. and Kirman, D., "Thickness of walls of 

myocardial arterioles in relation to smoking and age. Findings in men and dogs." Arch 

Environ Health, 1971. 22: 20-27. 

25. Saccomanno, G., Archer, V.E., Saunders, R.P., James, L. and Beckler, P.A., "Lung cancer of 

uranium workers on the Colorado Plateau." Health Physics, 1964. 10: 1195-1201. 

26. Saccomanno, G., Archer, V.E., Auerbach, O., Kuschner, M., Saunders, R.P. and Klein, 

M.G., "Histologic types of lung cancer among uranium miners." Cancer, 1971. 27: 515­

523. 

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27. Saccomanno, G., Archer, V.E., Auerbach, O. and Saunders, R.P., "Susceptibility and 

resistance to environmental carcinogens in the development of carcinoma of the lung." Hum 

Pathol, 1973. 4: 487-495. 

28. Saccomanno, G., Archer, V.E., Saunders, R.P., Auerbach, O. and Klein, M.G., "Early 

indices of cancer risk among uranium miners with reference to modifying factors." Ann N Y 

Acad Sci, 1976. 271: 377-383. 

29. Auerbach, O., Saccomanno, G., Kuschner, M., Brown, R.D. and Garfinkel, L., "Histologic 

findings in the tracheobronchial tree of uranium miners and non-miners with lung cancer." 

Cancer, 1978. 42: 483-489. 

30. Saccomanno, G., Yale, C., Dixon, W., Auerbach, O. and Huth, G.C., "An epidemiological 

analysis of the relationship between exposure to Rn progeny, smoking and bronchogenic 

carcinoma in the U-mining population of the Colorado Plateau--1960-1980." Health Phys, 

1986. 50: 605-618. 

31. Saccomanno, G., Huth, G.C., Auerbach, O. and Kuschner, M., "Relationship of radioactive 

radon daughters and cigarette smoking in the genesis of lung cancer in uranium miners." 

Cancer, 1988. 62: 1402-1408. 

32. Saccomanno, G., Auerbach, O., Kuschner, M., Harley, N.H., Michels, R.Y., Anderson, 

M.W. and Bechtel, J.J., "A comparison between the localization of lung tumors in uranium 

miners and in nonminers from 1947 to 1991." Cancer, 1996. 77: 1278-1283. 

33. Wicks, M.J., Archer, V.E., Auerbach, O. and Kuschner, M., "Arsenic exposure in a copper 

smelter as related to histological type of lung cancer." Am J Ind Med, 1981. 2: 25-31. 

34. Auerbach, O., Hammond, E.C., Selikoff, I.J., Parks, V.R., Kaslow, H.D. and Garfinkel, L., 

"Asbestos bodies in lung parenchyma in relation to ingestion and inhalation of mineral 

fibers." Environ Res, 1977. 14: 286-304. 

35. Auerbach, O., Garfinkel, L., Parks, V.R., Conston, A.S., Galdi, V.A. and Joubert, L., 

"Histologic type of lung cancer and asbestos exposure." Cancer, 1984. 54: 3017-3021. 

36. Weiss, W., Moser, R.L. and Auerbach, O., "Lung cancer in chloromethyl ether workers." 

Am Rev Respir Dis, 1979. 120: 1031-1037. 

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Chapter 11. Radioimmunoassay—A Revolutionary Advance in Medicine 

If there has ever been any skepticism about the quality of medical research being done within the 

VA health care system, such doubts were forever dispelled with a signal event in 1977. A dedicated 

and relentless VA physicist and a VA scientist studying hormones each gained the world’s attention 

by being awarded the Nobel Prize in Physiology or Medicine. Rosalyn Yalow, Ph.D., of the Bronx 

VA Medical Center captured science’s crown jewel for her groundbreaking work in the field of 

radioimmunoassay (RIA), a process by which substances in the blood can be measured with 

exquisite accuracy. Andrew F. Schally, Ph.D., earned the recognition for his research at the New 

Orleans VA Medical Center on hormone activity in the hypothalamus gland. 

The breakthrough work by Yalow and her colleague Solomon Berson, M.D., was supported from its 

inception by the Radioisotope Service at the Bronx VA Hospital. The RIA achievement is a 

testimony to the skill of Drs. Yalow and Berson and to the value of VA’s policy of providing 

sustained support to talented and productive medical researchers. 

RIA works by combining an unknown amount of the substance to be measured with an antibody 

that will bind to it in a reversible way, so that after a time the bound and unbound amounts of the 

substance will reach equilibrium. It is also mixed with a radioactive version of the material to be 

measured. Since the binding of the radioactive form competes with the stable form for binding on 

the antibody, the known radioactive form can be used as a “tracer” for the behavior of the unknown 

amount of the stable form and will achieve the same bound-to-unbound equilibrium as does the 

substance to be measured. When the amount of antibody present is enough to bind only part of the 

material to be measured, it will also bind only that same fraction of the radioactive tracer. The more 

substance to be measured, the more will be left after saturating the antibody binding. Since this is 

equally true for the tracer, one can measure the percent of bound tracer and thus accurately measure 

the unknown. The Nobel Prize announcement provided this example: 

“The percentage binding of labeled insulin to the antibodies is a function of the total insulin 

concentration in the solution... RIA is so sensitive that it allowed determination of insulin in 

amounts as small as 10-20 pg and ACTH in an amount less that 1 pg (or one thousandbillionth g) per ml.”1 

The discovery of RIA dates back some 30 years before it culminated with the Nobel award. In late 

1947, Bernard Roswit, M.D., set up a Radioisotope Unit at the Bronx VA Hospital, one of the 

original seven units approved by Herbert Allen, M.D.2

 (Chapter 6). Roswit’s first hire, in 

December 1947, was the young physicist Rosalyn Yalow3 who wanted to work with radioisotopes. 

Yalow’s training was in nuclear physics, with a Ph.D. degree earned in 1945 at the University of 

Illinois. Her first job was working as an electrical engineer for International Telephone and 

Telegraph, a leading worldwide telecommunications company. Yalow next moved to teaching, 

joining the physics faculty at Hunter College in the Bronx. 

Yalow very much wanted to pursue her interest in research even though Hunter possessed no such 

facilities. Her training in nuclear physics had fostered an interest in radioisotopes and a curiosity 

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that was stimulated by her husband’s use of radioiodine in the treatment of patients with thyroid 

disease. She visited Dr. Edith H. Quimby, Sc.D. at Montefiore Hospital in New York, who agreed 

to teach her about radioisotopes and introduced her to Gioacchino (Gino) Failla, Sc.D.. In addition 

to their research activities at Montefiore, Quimby and Fialla were radiology consultants at the 

Bronx VA Hospital. Through them, Yalow met Bernard Roswit, M.D., Chief of Radiation Therapy 

at VA. 

At first, Yalow performed her VA work while “moonlighting” from her teaching job, but in 1949 

she opened her own VA-based laboratory. Early papers were eclectic and reflected the interests of 

her clinician colleagues. With Roswit, she studied radioactive phosphorus (32P) in diagnosis of 

testicular cancer4

 and radioactive iodine (131I) in treatment of metastatic thyroid cancer.5 With 

others, she studied dosimetry in diagnostic radiology,6

 variability of bone marrow biopsies,7 and the 

clearance of radiosodium from skin and muscle.8-11 

Figure 11.1. Rosalyn Yalow, Ph.D., in her laboratory 

In 1950, an opportunity arose to recruit a physician colleague for the Radioisotope Unit. Yalow 

recalled: 

“It seemed to me... that the future of radioisotopes in medicine was not in radiotherapy, in 

spite of the ‘atomic cocktail’... but that the way to go would be physiology—that we needed 

somebody trained in internal medicine. So I went to the Head of Medicine at the hospital 

here, Dr. Bernard Straus, and said, ‘We'll take anybody you recommend.’ 

“And he said, ‘I have a brilliant resident. He's already accepted the position at another VA 

Hospital but I'll send him down to you.’ And so Sol came down, and we interacted very well, 

and he gave up the other job.” 

Solomon Berson, M.D., was just finishing his internal medicine residency in the Mt. Sinai-Bronx 

VA-affiliated program. He had already shown a talent for clinical research and was an author on 

papers about Hodgkin’s Disease12, 13 and rheumatoid arthritis.14 For the first year or so after he 

joined VA, he worked there only part-time and also carried on a private practice. Soon, he gave up 

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his practice and worked full time at VA, because he found the work so exciting. In 1954, when the 

radioisotope unit was separated from Radiotherapy and became a separate Radioisotope Service at 

the hospital, Berson became its Chief. 

Figure 11.2. Solomon Berson, M.D. 

The first collaborative work by Berson and Yalow were studies of 32P and 42K labeled red blood 

cells for studies of blood volume and red-cell disorders.15-17 

Soon they began to study the thyroid. Yalow developed an improved Geiger counter for detection 

of the 131I gamma ray. They worked out a method for measuring iodine clearance by the thyroid 

gland and applied it to a variety of clinical conditions. In 1954, they published what was probably 

the first comprehensive model of thyroid iodine metabolism.18-20 

Next their attention was directed to 131I labeled human serum albumin, and they began studying 

albumin metabolism and blood volume in humans, both well and ill.21-26 Two early research 

fellows in the lab, Marcus Rothschild, M.D., and Arthur Baumann, M.D.,27 worked on the albumin 

studies, which Rothschild later extended to important work on albumin production by the liver. 

Rothschild and Baumann also collaborated on the laboratory’s first studies of metabolism of insulin, 

which Yalow labeled with 131I. These studies were stimulated by Arthur Mirsky’s theory that adultonset (Type 2) diabetes was caused by an excessive rate of metabolism of insulin, as it was known 

that the pancreas of these patients contained insulin. Mirsky’s theory would predict that insulin 

would disappear faster from the blood of diabetic patients than from the blood of normal subjects. 

Instead, the opposite occurred. 

Yalow described how the process worked: 

“We labeled the insulin with (radio) iodine, gave it intravenously, and noted that there was a 

slower disappearance in the adult diabetics, rather than faster, which the theory had predicted. 

Although there was an occasional patient who was a ‘rapid disappearer’ when his diabetes was 

first discovered, he then converted to a ‘slow disappearer’ after three months of insulin 

therapy. And then we had schizophrenic patients who had had insulin shock therapy who 

were also ‘slow disappearers’. So we thought this was due to the development of antibody.” 

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But the notion of an antibody to insulin was too iconoclastic for the medical establishment, and this 

led to difficulty in publication28 of this pivotal discovery, the basis for the concept of 

radioimmunoassay: 

“We were able to demonstrate that, yes, in the plasma of insulin-treated patients, the labeled 

insulin was bound to something that had the characteristics of a gamma globulin. We 

submitted the paper to Science; they rejected it. We submitted the paper to the Journal of 

Clinical Investigation; they rejected it... We reached a compromise with the (JCI) editor. 

Instead of calling it an antibody we called it a binding globulin, because they agreed that we 

had demonstrated it had the characteristics of a gamma globulin. But in those days everybody 

knew peptides smaller than 10,000 were not antigenic. Therefore, insulin could not be 

antigenic. Therefore we couldn't call it an antibody.” 

So the key publication reporting the binding of insulin to an antibody28 used the term “binding 

globulin,” but, within a year or so, the presence of insulin antibodies was well accepted. 

Over the next three years, Berson and Yalow published elegant characterizations of these 

antibodies.29-35 As they assayed the antibodies using various amounts of insulin, they realized that 

they could turn the process around. A fixed amount of antibody would bind a certain amount of 

insulin. If the balance between antibody and insulin were optimal, the fraction of the insulin (or 

radioactive insulin) that bound to the antibody would relate to the total amount of insulin present. 

While this concept is as simple as it is elegant, carrying it forward to a usable assay required intense 

work and thought. The antibody had to be just right. The balance in the assay had to be correct. At 

first, they succeeded in measuring insulin added to human blood, but the assay was not sensitive 

enough to measure the insulin in normal serum. They were very careful, checking and crosschecking. Eventually, they were confident they could measure insulin in normal human serum. A 

preliminary report showing insulin response to glucose in two human subjects appeared in Nature in 

1959.36 The definitive report presenting the radioimmunoassay of human insulin, including glucose 

response studies in 96 patients, appeared in the Journal of Clinical Investigation in 1960.37 

Successful radioimmunoassay of insulin led to an explosion of assays. As Berson and Yalow 

continued refining their method, others were trying to apply the same concept to other hormones. 

The Radioisotope Service at the Bronx VA Hospital played an active role. Even before the 1960 

paper was published, Berson and Yalow helped Dr. Roger Unger, who used the same concept to 

measure circulating glucagon in human subjects, to get started (Chapter 7). Now many others 

sought their instruction. Yalow saw the two journal articles as the sparks that ignited more 

widespread interest in the field. She noted:: 

“[O]ver the next four or five years, we gave four training programs in which, at no charge, we 

invited endocrinologists—anybody who wanted to come. And I think we trained 140 people. And... 

those people started to produce an awful lot of papers, and that's how immunoassay took off.”3 

In 1963, Seymour Glick, M.D., and Jesse Roth, M.D., both fellows in the Berson-Yalow laboratory, 

published with Yalow and Berson a successful method to assay human growth hormone in normal 

human plasma.38 In 1963, Berson and Yalow, with Gerald Aurbach, M.D. and John Potts, M.D. of 

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the NIH, published a report on radioimmunoassay of parathyroid hormone,39 though this assay still 

required a lot of work before it could be used routinely. 

The following year Berson and Yalow published a preliminary report with Drs. Glick and Roth on 

the assay of ACTH extracted from plasma.40 This was followed by years of painstaking 

development to increase the sensitivity of the assay, necessary since ACTH is present in very small 

concentrations in normal human plasma. Eventually, in 1968, they published a method for 

radioimmunoassay of ACTH in unextracted plasma, together with its application in a variety of 

physiological and clinical states.41 

Figure 11.3. Yalow and one of the guinea pigs 

whose antibodies made radioimmunoassay possible 

Paralleling the development of assays and improvements in techniques, there was constant study of 

patients and physiological processes. As Yalow said, “We never developed assays to develop 

assays. We developed assays to deal with physiologic problems.”3 The insulin assay led to studies 

of insulin metabolism in normal people and diabetic patients.42-45 Development of the human 

growth hormone assay was followed by studies of the physiology of growth hormone, made 

possible by this new tool. Most important was their demonstration that hypoglycemia caused a 

marked rise in growth hormone levels.46, 47 In 1969 the group showed that different types of stress 

had different effects on ACTH and growth hormone response.48 

In 1968, Solomon Berson left VA to become the founding Chair of the Department of Medicine at 

the new Mount Sinai School of Medicine. However, he did not move his research to Mount Sinai, 

and Yalow remained at the Bronx VA Hospital, now as Chief, Radioisotope Service. From that 

time until his sudden death in 1972, Berson continued to work at VA laboratory when he could, 

generally late at night, but Yalow managed the day-to-day operation of the research. 

The laboratory entered a new field, gastrointestinal hormones, which Yalow and her colleagues 

studied over several years. The first of the hormones they looked at was gastrin. At the same time, 

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they produced an assay for the Australia antigen, the virus that causes hepatitis B. This assay made 

it possible for blood banks everywhere to detect the hepatitis B-causing virus in blood donations, to 

prevent the transmission of this virulent disease. 

Figure 11.4. Rosalyn Yalow, Roger Unger, Solomon Berson and Erik Jorpes at

 the Nobel Conference on Gastrointestinal Hormones in 1970 

Yalow described how the hepatitis B assay came about: 

“When we described the gastrin assay, Mort Grossman was expecting John Walsh, who had 

been at the NIH, to come to him in the Career Development Program. And so he felt it would 

be a good idea if John Walsh came here to learn the gastrin assay before he went out to Mort 

Grossman. And I was in Washington, so I thought I ought to take John out to lunch and, you 

know, get to know him a bit.” 

Walsh was studying the Australia antigen, the marker for infectious hepatitis B, and Yalow 

expressed an interest in working together to develop an assay to detect it. She said: 

“We used ourselves and our technicians as our controls. And so I labeled the Australia 

antigen, and purified it on the G200 column, and then we added it to control plasma, and its 

behavior in my plasma was different from its behavior in the plasma of two of the technicians 

here. And it turned out that those two technicians had been sent to the South Pacific, during 

the War. They had the yellow fever vaccine which was contaminated with the virus. They had 

antibody. So we had an assay going, immediately. We didn't have to immunize a guinea 

pig.”3 

After Berson’s death in 1972, Yalow continued to extend the radioimmunoassay to new uses. The 

laboratory was named the “Solomon A. Berson Research Laboratory,” and a fellowship in Berson’s 

254
 
 

 

 

 

 

 

name was established to support young researchers in the laboratory. 

Yalow and Berson had been nominated for the Nobel Prize while Berson was still alive. Now that 

he had died and was not eligible for the prize, her work alone would have to earn the recognition. 

Over the next years, she and her young colleagues developed a major body of work on hormones 

and prohormones,49-59 on the many locations of hormones previously associated with a single site,60­

62 and on hormones in malignancies.63, 64 She and Ludwig Gross, M.D., developed a 

radioimmunoassay for the mouse leukemia virus that Gross had discovered.65 Yalow continued to 

make contributions, all from a modest laboratory in which she herself could vouch for every 

finding. 

Throughout Yalow’s research career, VA consistently supported her research. She asserted that she 

had never applied for a grant from the NIH or other agencies. She in turn was most loyal to the 

institution that had nourished her career. In all her contacts, she proudly acknowledged VA as her 

home base and the source of support for her research. 

Finally, in 1977, Rosalyn Yalow received the Nobel Prize for the development of 

radioimmunoassays of peptide hormones. She was the second woman to receive the award in the 

category of “Physiology or Medicine.” 

Figure 11.5. Rosalyn Yalow receiving the Nobel Prize 

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The magnitude of her work was captured in the formal Nobel announcement: 

“RIA brought about a revolution in biological and medical research. We have today at our 

disposal a large number of RIA-like procedures, so-called ligand methods, for determination 

of almost anything we wish to measure: peptide hormones, hormones that are not peptides, 

peptides that are not hormones, enzymes, viruses, antibodies, drugs of the most different 

kinds, etc. This has brought about an enormous development in hitherto closed areas of 

research. 

“Yalow’s contributions were not limited to presenting us with RIA. In a series of classical 

articles she and her coworkers, with the aid of RIA, were able to elucidate the physiology of 

the peptide hormones insulin, ACTH, growth hormone, and also to throw light upon the 

pathogenesis of diseases caused by abnormal secretion of these hormones. Thus, they directed 

diabetes research into new tracks and gave it a new dimension. This was pioneering work at 

the highest level. It had an enormous impact. We were witnessing the birth of a new era in 

endocrinology, one that started with Yalow.”1 

The young physicist from a modest family, who as a student had been urged to use stenography as a 

back door into science, had found in VA her opportunity to thrive and to make an important 

contribution.66 

256
 
 

 

 

 

 

References 

1. Karolinska Institutet, The 1977 Nobel Prize in Physiology or Medicine. 1977: Stockholm, 

Sweden. 

2. Lyon, G., Summary of Radioisotope Labs (Handwritten Notes). 1957. 

3. Interview with Rosalyn Yalow, Ph.D., October 28, 1992 at her office at the Bronx VA 

Medical Center. 

4. Roswit, B., Sorrentino, J. and Yalow, R., "Use of radioactive phosphorus (P32) in diagnosis 

of testicular tumors; Preliminary report." J Urol, 1950. 63: 724-728. 

5.	 Sorrentino, J., Roswit, B. and Yalow, R., "Thyroid carcinoma with multiple metastases and 

pathologic fracture, successfully treated with radioiodine; Report of a case." Radiology, 

1951. 57: 729-737. 

6. Sorrentino, J. and Yalow, R., "Nomogram for dose determinations in diagnostic radiology." 

Radiology, 1950. 55: 748-753. 

7. Fadem, R.S. and Yalow, R., "Uniformity of cell counts in smears of bone marrow particles." 

Am J Clin Path, 1951. 21: 541-545. 

8. Conway, H., Roswit, B., Stark, R.B. and Yalow, R., "Radioactive sodium clearance as test 

of circulatory efficiency of tubed pedicles and flaps." Proc Soc Exp Biol Med, 1951. 77: 

348-351. 

9.	 Wisham, L.H., Yalow, R. and Freund, A.J., "Consistency of clearance of radioactive sodium 

from human muscle." Am Heart J, 1951. 41: 810-818. 

10. Wisham, L.H. and Yalow, R., "Some factors affecting clearance of Na24 from human 

muscle." Am Heart J, 1952. 43: 67-76. 

11. Freund, J., Wisham, L.H. and Yalow, R.S., "Effect of priscoline on clearance of 

radiosodium from muscle and skin of man in normal and diseased limbs." Circulation, 1953. 

8: 89-97. 

12. Straus, B., Berson, S.A., Bernstein, T.C. and Jacobson, A.S., "Guanazolo in therapy of 

Hodgkin's disease." Blood, 1950. 5: 1059-1061. 

13. Fadem, R.S., Berson, S.A., Jacobson, A.S. and Straus, B., "Effects of cortisone on bone 

marrow in Hodgkin's disease." Am J Clin Path, 1951. 21: 799-813. 

14.	 Guest, C.M., Kammerer, W.H., Cecil, R.L. and Berson, S.A., "Epinephrine, pregnenolone 

and testosterone in treatment of rheumatoid arthritis." JAMA, 1950. 143: 338-344. 

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15. Yalow, R. and Berson, S.A., "Use of K42 tagged erythrocytes in blood volume 

determinations." Science, 1951. 114: 14-15. 

16. Berson, S.A. and Yalow, R., "Use of K42 or P32 labelled erythrocytes and I131 tagged 

human serum albumin in simultaneous blood volume determinations." J Clin Invest, 1952. 

31: 572-580. 

17. Berson, S.A., Yalow, R.S., Azulay, A., Schreiber, S.S. and Roswit, B., "The biologic decay 

curve of P32 tagged erythrocytes. Application to study of acute changes in blood volume." 

J Clin Invest, 1952. 31: 581-591. 

18. Berson, S.A. and Yalow, R.S., "The effect of cortisone on the iodine accumulating function 

of the thyroid gland in euthyroid subjects." J Clin Endocrinol Metab, 1952. 12: 407-422. 

19. Berson, S.A., Yalow, R.S., Sorrentino, J. and Roswit, B., "The determination of thyroidal 

and renal plasma I131 clearance rates as a routine diagnostic test of thyroid dysfunction." J 

Clin Invest, 1952. 31: 141-158. 

20. Berson, S.A. and Yalow, R.S., "Quantitative aspects of iodine metabolism. Exchangeable 

organic iodine pool, and rates of thyroidal secretion, peripheral degradation and fecal 

excretion of endogonously synthesized organically bound iodine." J Clin Invest, 1954. 33: 

1533-1552. 

21. Berson, S.A. and Yalow, R.S., "Distribution of I131 labelled human serum albumin 

introduced into ascitic fluid: Analysis of kinetics of 3 compartment catenary transfer system 

in man and speculations on possible sites of degradation." J Clin Invest, 1954. 33: 377-387. 

22. Rothschild, M.A., Bauman, A., Yalow, R.S. and Berson, S.A., "Effect of splenomegaly on 

blood volume." J Appl Physiol, 1954. 6: 701-706. 

23. Schreiber, S.S., Bauman, A., Yalow, R. and Berson, S.A., "Blood volume alterations in 

congestive heart failure." J Clin Invest, 1954. 33: 578-586. 

24. Vazquez, O.N., Newerly, K., Yalow, R. and Berson, S.A., "Estimation of trapped plasma 

with I131 albumin; Critique of methods." J Appl Physiol, 1954. 6: 437-440. 

25.	 Bauman, A., Rothschild, M.A., Yalow, R. and Berson, S.A., "Distribution and metabolism 

of I131 labeled human serum albumin in congestive heart failure with and without 

proteinurea." J Clin Invest, 1955. 34: 1359-1368. 

26. Rothschild, M.A., Bauman, A., Yalow, R. and Berson, S.A., "Tissue distribution of I131 

labelled human serum albumin following intravenous administration." J Clin Invest, 1955. 

34: 1354-1358. 

27.	 Interview with Marcus A. Rothschild, M.D., February 8, 1994 at Dr. Rothschild's home in 

Florida. 

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28.	 Berson, S.A., Yalow, R., Bauman, A., Rothschild, M.A. and Newerly, K., "Insulin-I131 

metabolism in human subjects: Demonstration of insulin binding globulin in the circulation 

of insulin-treated subjects." J Clin Invest, 1956. 35: 170-190. 

29. Berson, S.A. and Yalow, R.S., "Ethanol fractionation of plasma and electrophoretic 

identification of insulin-binding antibody." J Clin Invest, 1957. 36: 642-647. 

30. Berson, S.A. and Yalow, R.S., "Studies with insulin-binding antibody." Diabetes, 1957. 6: 

402-405. 

31. Berson, S.A. and Yalow, R.S., "Insulin antagonists, insulin antibodies and insulin 

resistance." Am J Med, 1958. 25: 13S-18S. 

32. Berson, S.A. and Yalow, R.S., "Species-specificity of human antibeef, pork insulin serum." 

J Clin Invest, 1959. 38: 2017-2025. 

33. Berson, S.A. and Yalow, R.S., "Recent studies on insulin-binding antibodies." Ann NY Acad 

Sci, 1959. 82: 338-344. 

34.	 Berson, S.A. and Yalow, R.S., "Quantitative aspects of the reaction between insulin and 

insulin-binding antibody." J Clin Invest, 1959. 38: 1996-2016. 

35. Berson, S.A. and Yalow, R.S., "Cross reactions of human anti-beef, pork insulin with beef, 

pork, sheep, horse and human insulins." Fed Proc, 1959. 18: 11. 

36. Yalow, R.S. and Berson, S.A., "Assay of plasma insulin in human subjects by 

immunological methods." Nature, 1959. 184 (Suppl 21): 1648-1649. 

37. Yalow, R.S. and Berson, S.A., "Immunoassay of endogenous plasma insulin in man." J Clin 

Invest, 1960. 39: 1157-1175. 

38.	 Glick, S.M., Roth, J., Yalow, R.S. and Berson, S.A., "Immunoassay of human growth 

hormone in plasma." Nature, 1963. 199: 784-787. 

39. Berson, S.A., Yalow, R.S., Aurbach, G.D. and Potts, J.T., "Immunoassay of bovine and 

human parathyroid hormone." Proc Natl Acad Sci USA, 1963. 49: 613-617. 

40. Yalow, R.S., Glick, S.M., Roth, J. and Berson, S.A., "Radioimmunoassay of human plasma 

ACTH." J Clin Endocrinol Metab, 1964. 24: 1219-1225. 

41. Berson, S.A. and Yalow, R.S., "Radioimmunoassay of ACTH in plasma." J Clin Invest, 

1968. 47: 2725-2751. 

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42.	 Yalow, R.S. and Berson, S.A., "Plasma insulin concentrations in nondiabetic and early 

diabetic subjects. Determinations by a new sensitive immuno-assay technic." Diabetes, 

1960. 9: 254-260. 

43. Yalow, R.S. and Berson, S.A., "Comparison of plasma insulin levels following 

administration of tolbutamide and glucose." Diabetes, 1960. 9: 356-362. 

44.	 Berson, S.A. and Yalow, R.S., "Plasma insulin in health and disease." Amer J Med, 1961. 

31: 874-881. 

45. Berson, S.A. and Yalow, R.S., "Insulin antibodies and insulin resistance." Diabetes Dig, 

1962. 1: 4. 

46. Roth, J., Glick, S.M., Yalow, R.S. and Berson, S.A., "Secretion of human growth hormone: 

Physiologic and experimental modification." Metabolism, 1963. 12: 577-579. 

47. Roth, J., Glick, S.M., Yalow, R.S. and Berson, S.A., "Hypoglycemia: A potent stimulus to 

secretion of growth hormone." Science, 1963. 140: 987-988. 

48. Yalow, R.S., Varsano-Aharon, N., Echemendia, E. and Berson, S.A., "HGH and ACTH 

secretory responses to stress." Horm Metab Res, 1969. 1: 3-8. 

49. Silverman, R. and Yalow, R.S., "Heterogeneity of parathyroid hormone. Clinical and 

physiologic implications." J Clin Invest, 1973. 52: 1958-1971. 

50. Yalow, R.S. and Wu, N., "Additional studies on the nature of big big gastrin." 

Gastroenterology, 1973. 65: 19-27. 

51. Yalow, R.S., "Radioimmunoassay methodology: Application to problems of heterogeneity 

of peptide hormones." Pharmacol Rev, 1973. 25: 161-178. 

52. Coslovsky, R. and Yalow, R.S., "Influence of the hormonal forms of ACTH on the pattern 

of corticosteroid secretion." Biochem Biophys Res Commun, 1974. 60: 1351-1356. 

53. Gewirtz, G., Schneider, B., Krieger, D.T. and Yalow, R.S., "Big ACTH: Conversion to 

biologically active ACTH by trypsin." J Clin Endocrinol Metab, 1974. 38: 227-230. 

54. Straus, E. and Yalow, R.S., "Studies on the distribution and degradation of 

heptadecapeptide, big, and big big gastrin." Gastroenterology, 1974. 66: 936-943. 

55.	 Straus, E., Greenstein, A.J. and Yalow, R.S., "Effect of secretin on release of heterogeneous 

forms of gastrin." Gut, 1975. 16: 999-1005. 

56. Straus, E., Urbach, H.J. and Yalow, R.S., "Comparative reactivities of 125I-secretin and 

125I-minus 6-tyrosyl secretin with guinea pig and rabbit anti-secretin sera." Biochem 

Biophys Res Commun, 1975. 64: 1036-1040. 

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57. Yalow, R.S., Hall, K. and Luft, R., "Immunoreactive somatomedin B in urine." J Clin 

Endocrinol Metab, 1975. 41: 638-639. 

58. Yalow, R.S., Hall, K. and Luft, R., "Radioimmunoassay of somatomedin B." Adv Metab 

Disord, 1975. 8: 73-83. 

59. Yalow, R.S., Hall, K. and Luft, R., "Radioimmunoassay of somatomedin B. Application to 

clinical and physiologic studies." J Clin Invest, 1975. 55: 127-137. 

60. Straus, E. and Yalow, R.S., "Studies on the distribution and degradation of 

heptadecapeptide, big, and big big gastrin." Gastroenterology, 1974a. 66: 936-943. 

61. Straus, E., Yalow, R.S. and Gainer, H., "Molluscan gastrin: Concentration and molecular 

forms." Science, 1975. 190: 687-689. 

62. Straus, E., Muller, J.E., Choi, H.S., Paronetto, F. and Yalow, R.S., "Immunohistochemical 

localization in rabbit brain of a peptide resembling the COOH-terminal octapeptide of 

cholecystokinin." Proc Natl Acad Sci U S A, 1977. 74: 3033-3034. 

63. Gewirtz, G. and Yalow, R.S., "Ectopic ACTH production in carcinoma of the lung." J Clin 

Invest, 1974. 53: 1022-1032. 

64. Ayvazian, L.F., Schneider, B., Gewirtz, G. and Yalow, R.S., "Ectopic production of big 

ACTH in carcinoma of the lung. Its clinical usefulness as a biologic marker." Am Rev Respir 

Dis, 1975. 111: 279-287. 

65. Yalow, R.S. and Gross, L., "Radioimmunoassay for intact Gross mouse leukemia virus." 

Proc Natl Acad Sci U S A, 1976. 73: 2847-2851. 

66. Yalow, R.S. "Nobel Autobiography." Nobel Prize Awards, 1977. Stockholm, Sweden. 

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Section IV. The Roaring Sixties
 

1960-1967
 

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(Intentionally Blank) 

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Chapter 12. The Intramural Research Program, 1960-1967 

Most of the 1960s was characterized by the rapid growth of medical research within VA, and 

institutional recognition that VA’s research efforts deserved and had earned solid agency 

support. Congress provided increased budget allocations, dedicated space was built or 

otherwise provided, and basic science was gaining a foothold. The agency’s ties to academic 

institutions were gaining strength, as well. VA’s reputation for engaging in productive clinical 

studies was attracting additional ties for collaborative research even as less formalized joint 

efforts continued with renewed vigor. The era also brought about recognition of VA research 

achievement, and the annual research conference continued to be an important medium for the 

presentation of scholarly and clinical information. 

Growth of the VA research program 

At the decade’s start, the VA medical research program was experiencing a growth spurt. A 

$17 million budget supported over 6,000 projects, most of them in clinical research: 1,400 

were related to neuropsychiatric disorders, 300 to tuberculosis, and the rest included almost 

every field of medical research.1 

The 1960 annual report to Congress provided this definition of the agency’s medical research 

program: 

“For the purposes of the mission of the Research Service of the Department of Medicine 

and Surgery of the Veterans’ Administration, medical research is defined as any study 

undertaken to test a hypothesis related to the etiology, pathogenesis, natural history, 

prevention, amelioration, or cure of human disease or deformity.”2 

The report laid out the basis upon which a VA with a strong research program was able to 

achieve and maintain a higher standard of medical care: 

1. Attraction of top-caliber staff 

 2. Improved clinical interest of nonresearch staff 

3. Newer and better care for patients

 4. Availability of expert consultation

 5. Increase in prestige3

 “Research in the VA system is considered a privilege,” the report noted. “Any member 

of a VA hospital professional staff who is eager to do research presents his project as a 

proposal in competition for funds and space with other staff members. Because VA 

physicians participate in research only as it relates to their patient care responsibilities, it 

is evident that their research originates in the clinical problems which confront them at the 

bedside. Probably there can be no better direction of medical research than this.”4 

The report made a strong case for providing adequately equipped laboratories to support 

research programs, pointing out that, in a recent year, 80 medical schools provided over $40 

million for development of basic research laboratories, which allowed faculty members to 

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obtain an additional $65 million in federal grants. The physical plant was still the most 

pressing problem facing the VA research program.5 

By this time, there was a growing body of basic research, only indirectly influenced by patientcare needs, in the VA research program. Nevertheless, the needs of the Veteran patient 

continued to be a major motivation for VA researchers. For example, the development of the 

technique of radioimmunoassay, described in the previous chapter, required elegant, complex 

understanding and methodologies of basic science, but the impact on patient care proved to be 

enormous. 

New Central Office leadership 

The expanding budget started during Martin M. Cummings, M.D.’s time as Director, and the 

resulting opportunity for innovation, attracted well-qualified leaders to the Central Office 

Research Service. 

Marc J. (“Jim”) Musser, M.D. 

In 1959, Dr. Musser replaced Dr. Cummings as Director, Research Service. Musser had 

previously been Professor of Medicine at the University of Wisconsin, where he knew Dean 

Middleton well, and also Chairman of the Department of Medicine at Baylor University in 

Houston. He brought to the Research Service a rich network of friends in academic medicine 

and considerable political acumen and administrative talent. In 1962, he became Assistant 

Chief Medical Director/Research and Education (ACMD/R&E), but left Central Office in 

1965 to direct a Regional Medical Program in North Carolina. He returned to Central Office 

as Chief Medical Director at the end of 1969 and continued to champion the research program 

while leading the VA Department of Medicine and Surgery (DM&S). 

Figure 12.1. Marc J. Musser, M.D.
 

Benjamin B. Wells, M.D.
 

Dr. Benjamin Wells was appointed to the post of ACMD/R&E in the spring of 1960. He had
 

joined VA in 1957 at the Hines (Ill.) VA Hospital and was Chief of Staff at the New Orleans
 

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VA Hospital before coming to Central Office in July 1958 as Director of the Education 

Service. He held an M.D. from Baylor University and a Ph.D. in biochemistry and physiology 

from the University of Minnesota and was a diplomate of both the American Board of 

Pathology and the American Board of Internal Medicine. As a graduate student, Wells had 

done important research on the adrenal cortical hormones, work that was extensively cited by 

6 Edward C. Kendall, Ph.D. in his book Cortisone. Before joining VA, Wells was Chairman of 

Medicine at the University of Arkansas and at Creighton University and Dean of the School of 

Medicine at the University of Arkansas. He had also served as a journal editor and practiced 

medicine with an unaffiliated group. In addition to these accomplishments, he was reported to 

be an expert pianist. 

Figure 12.2. Benjamin B. Wells, M.D. 

Dr. Wells was described by those who knew him as small in stature and huge in intellect. A 

witty person, he got along well with people and was a skillful politician who spearheaded 

VA’s success in improving the research budget through the 1960s. 

His sense of humor pervaded even official documents. The following passage in the fiscal 

year 1961 annual report to Congress was probably his: 

“The last annual report differed from most of the earlier numbers by the omission of the 

abstracts written by each investigator describing his research. These abstracts added little 

light and much bulk, so were abandoned.”7 

In the Research and Education Newsletter, he stated: 

“The NEWSLETTER is not ‘staffed out.’ For those who may be new in the business, this 

is the process of intellectual emasculation in which a document is passed through several 

hands and several echelons until it emerges in depersonalized and inanimate form, its 

wordage increased but its stimulating force reduced to an amplitude of zero.”8 

On another occasion he wrote: 

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“Perhaps it is all wrong, but society is not willing to give money for unidentified or 

undisclosed ventures. The fact that scientists find research an entertaining and gratifying 

way of life has little persuasive value.”9 

In 1962, Dr. Wells left Central Office to become the founding Dean of the California College 

of Medicine at Los Angeles (now the School of Medicine at the University of California, 

Irvine). In a parting tribute, Dr. Musser wrote: 

“Certainly, in his quiet and gentle, yet refreshingly positive, way, Ben Wells had become 

one of the most respected and effective executives in the Department of Medicine and 

Surgery.” 

Wells returned to Central Office again as ACMD/R&E in 1965 when Musser went to North 

Carolina. A year later, Wells left once more to direct the Regional Medical Program in 

Alabama and then returned in 1969 as Deputy Chief Medical Director under Musser. 

James A. Halsted, M.D. 

Dr. James Halsted came to VA Central Office (VACO) in 1964 as Deputy ACMD/R&E. A 

graduate of Harvard Medical School, he had been in private practice before World War II. 

During the war, he served in North Africa and Italy. He began his VA career at the 

Wadsworth (Los Angeles) VA Hospital, where he was Chief of Gastroenterology from 1950 to 

1955. There, he married Anna Roosevelt, daughter of President Franklin D. Roosevelt.10,11 

Later he moved to the Syracuse VA Hospital, was a Fulbright scholar for two years in Iran and 

then Director of Postgraduate Education of the University of Kentucky Medical School. At the 

time of his recruitment to VACO, he was Associate Chief of Staff for Research and Education 

(ACOS/R&E) at the Dearborn (Mich.) VA Hospital and professor at Wayne State University. 

Figure 12.3. James A. Halsted, M.D. 

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Dr. Halsted had become interested in medical research during World War II while stationed in 

North Africa. He and his colleagues studied soldiers who developed peptic ulcers under the 

stress of battle. They demonstrated that these were exacerbations of preexisting ulcers and that 

new ulcers seldom resulted from battle stress.12 While at Wadsworth, he and his colleagues 

studied the absorption of Vitamin B12, demonstrating its complete absence after total 

gastrectomy.13, 14 He also showed that antibiotic treatment in “blind loop syndrome” reversed 

the malabsorption of Vitamin B12 seen in this condition.15, 16 While at the Syracuse VA 

Hospital, he demonstrated protein loss from the stomach in Menetriere’s disease17 with fellow 

researcher Kenneth Sterling, M.D. While in Iran, he and Ananda Prasad, M.D., later 

ACOS/R&D at the Allen Park (Mich.)VA Hospital, became interested in a group of dwarfs 

who had anemia and no sexual development. Eventually, they established zinc deficiency as 

the cause of this syndrome.18 In March 1966, after two years in Central Office, Dr. Halsted 

moved to the Washington (D.C.) VA Hospital, where he was ACOS/R&E and VA-wide 

coordinator for research in nutrition.19 

Edward Dunner, M.D. 

Dr. Edward Dunner had been in VA since 1941 as a staff physician at the Palo Alto, San 

Fernando and Livermore hospitals in California. While at Livermore, he participated in the 

original tuberculosis trials under John Barnwell, M.D. (Chapter 5). From 1950 to 1954, he was 

Area Chief for Tuberculosis in St. Louis. He came to Central Office Tuberculosis Service in 

1954 and served as Chief of Tuberculosis Research and Executive Secretary of the VA-Armed 

Forces Chemotherapy of Tuberculosis Cooperative Study from 1956 to 1958. In 1958, he 

joined the Central Office Research Service as Associate Director and Chief of the Clinical 

Studies Division. He was Director of the Research Service from 1962 to 1966, when he 

became Special Assistant to ACMD/R&E Dr. Benjamin Wells.20 

Figure 12.4. At the 1965 Annual Research Conference: Edward Dunner, M.D., center, 

with Ludwig Gross, M.D., of the Bronx VA Hospital and Lucien Guze, M.D., ACOS/R&E 

at the Los Angeles Wadsworth VA Hospital 

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Local research management 

By 1960, governance of the research program had stabilized. Each VA hospital with a 

research program had a Research and Education (R&E) Committee responsible for evaluating 

and approving staff research proposals and distributing the support money allocated by Central 

Office. Each hospital received a basic institutional research allocation to provide equipment, 

supplies, technical support, and other facilities necessary for the proper pursuit of research 

activities. When a research project was completed, R&E Committee approval was needed 

before results could be published. The Committee comprehensively reviewed the hospital’s 

research program annually for quality and productivity and reported findings to Central Office. 

The position of “Assistant Director of Professional Services for Research”(ADPSR), renamed 

the “Associate Chief of Staff for Research and Education” (ACOS/R&E) in 1961, was 

established as Secretary to the R&E Committee and as full-time coordinator of the research 

4

program.

Professional papers had required Central Office approval before submission for publication 

until 1957, when the review and approval responsibility moved to the R&E Committees. Two 

copies of published papers were sent to Central Office, a practice that continued into the 

1970s.21 

Special Laboratories 

In 1960, while the majority of the research carried out in VA laboratories was controlled by 

the R&E Committee, there continued to be Special Research Laboratories (Appendix VI), 

some of them new and others dating back to the 1950s. These laboratories were still 

controlled directly by Central Office Research Service, with budgets earmarked and activities 

supervised by Central Office staff. By 1963, 22 laboratories were directly supervised by 

Central Office staff and carried out special projects in response to Central Office direction. 

However, in most cases, these were investigator-directed laboratories that functioned very 

much like program project grants, with a central theme but a number of projects initiated by 

the laboratory staff. 

Radioisotope program 

By 1960, radioisotope research at the local level had been completely integrated into the 

overall research program, and the hospital Radioisotope Committee was now a subcommittee 

of the R&E Committee. The Central Office now considered most research projects in the 

Radioisotope Services in relation to disease state or research problem, rather than the use of 

radioisotopes. Only 185 of the 6,569 research projects listed in the 1960 annual research 

report were classified as “radioisotope, not elsewhere classified.”22 

Extra-VA research funding 

VA investigators successfully used the privilege achieved in 1954 to apply for non-VA monies 

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through affiliated medical schools. Research grant support in 1960 was listed as $4.5 million 

for 717 projects.23 VA was responsible for approximately one-third of the National Cancer 

Institute’s nationally integrated cancer chemotherapy research program.24 

Epidemiology and biostatistics 

A new division of Central Office Research Service, the Geographic Epidemiology Division, 

was activated in July 1959. Sir Donald Acheson, KBE, who later served as Chief Medical 

Officer of the United Kingdom and was knighted by Queen Elizabeth, was its first Chief. 

After Acheson left VA in January 1960, Clifford A. Bachrach, M.D., was appointed to succeed 

him. The Geographic Epidemiology Division was charged with using VA materials and 

resources to study geographic distribution of diseases. Early efforts focused on multiple 

sclerosis, regional ileitis, ulcerative colitis, and nonspecific lung diseases.25 By the mid-1970s, 

this division had become the only branch of the Central Office actually carrying out research. 

In addition, a Central Office Research Statistics Division was established in 1959, apparently 

by transferring staff from the VA Controller’s Office. Dr. Bachrach was also chief of this 

division, which included four other statisticians.26 Many but not all of the cooperative studies 

received statistical support and coordination from this division. In 1962, Dr. Bachrach 

volunteered for service in Israel, and Donald V. Brown, Ph.D., of the Systems Development 

Corporation was recruited to head this Statistical Division with special responsibility for the 

new Research Support Centers. 

The Cooperative Studies Program 

In 1960, the tuberculosis and psychopharmacology studies (Chapters 4 and 8) were very active. 

A Tuberculosis Cooperative Study Laboratory in Atlanta was by then operating as a central 

laboratory serving several new tuberculosis cooperative studies. This laboratory distributed 

standardized testing materials to all tuberculosis cooperative study units to improve 

comparability of test results. In addition, cooperative studies were started to research a variety 

of other medical problems. The hypertension study group (Chapter 9) published its first major 

report in 1960. 

During the early 1960s, individual program chiefs directed cooperative studies. However, 

Lawrence W. Shaw, who came to VA Central Office in 1963 as a senior statistician, gradually 

worked into overall leadership of cooperative studies. 27,28 In 1966, the first meeting was held 

of the Cooperative Studies Evaluation Committee (CSEC), a general advisory committee for 

all cooperative studies. This Committee is still active today (Appendix VII). The first CSEC 

chairman was William Tucker, M.D., Director of the Medical Service in VA Central Office. 

During the 1960s, CSEC reviewed most of the VA cooperative studies except the psychiatry 

studies, coordinated by the Central Neuropsychiatric Research Laboratory (CNPRL) (Chapter 

8), and those studies conducted in collaboration with the National Cancer Institute, which were 

reviewed by committees of the National Academy of Sciences (Chapter 4). 

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Publications 

In 1960, a publication titled Research and Education (R&E) Newsletter debuted and continued 

to be published two to six times a year through 1968. The Newsletter and annual reports to 

Congress required a more formal publications process. Thus, in 1960 the position of 

Publications Editor was established—a position first located in the Research Service and later 

moved to the ACMD/R&E office. The initial Publications Editor was Mrs. L. Tracy Fetta, 

who had prepared a prospectus on research in aging. She prepared the 1959 and 1960 annual 

reports to Congress and the R&E Newsletter. However, Dr. Chapple (Chapter 7) played an 

active role in establishing the Newsletter and served as its editor.29 He was officially 

designated Chief of Research Publications from 1962 to1964. In addition to the annual report 

to Congress, titled Medical Research in the Veterans Administration, Research Service 

published occasional manuals and monographs (Appendix VII). 

Budgetary management 

Budgetary decision-making was generally straightforward. The Director of the Research 

Service had the authority to distribute research funds, and his decisions were honored. There 

was no advisory committee structure influencing individual decisions and there existed few 

bureaucratic “hoops” to master. The Director was responsible for the results of those 

decisions, good or bad. 

Robert Efron, M.D., described his own experience with the way things sometimes worked, 

from the occasion when Marc J. Musser, M.D., recruited him to work for VA: 

“Efron had been working in his basement laboratory at the Medical Research Council 

(MRC) in London when Musser (then Director of the VA Research Service) was visiting 

the facility. His British hosts asked Musser if he would like to meet their young American 

scientist. 

After hearing about Efron’s research, Musser asked him whether, when he came back to 

the U.S., he would like to work for VA. He said to contact him when the time came. Not 

long afterward, Efron was recruited by Boston University Medical School to do patient 

care and research located in the Boston VA Hospital. 

“Efron’s lab equipment at MRC was specialized to his work, and it was decided that he 

could take it with him to the U.S. The delicate equipment required a huge, room-sized 

crate and very careful handling. He contacted Musser, and inquired whether VA might be 

able to pay for the crating and moving cost. 

“The VA research chief simply said it would be done. With no further action on the 

Efron’s part, no supply forms, no applications, no paper work at all... the crating and 

shipping were accomplished. When the equipment was set up in his new VA lab, not a 

single item had been damaged.”30 

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Introduction of Program Chiefs 

The 1960 National Academy of Sciences report on the VA research program (Chapter 7) 

advised expansion of the Central Office professional staff. This advice, together with Dr. 

Middleton’s support for the research program and Drs. Musser’s and Wells’s energetic 

leadership, led to a marked expansion of the Central Office research staff during the 1960s. 

The concept of the Program Chief (Table 12.1) was introduced in this staffing expansion. Dr. 

Chapple, already responsible for the Research in Aging Division, became Chief of Research in 

Aging; and Lyndon Lee, M.D., already administering surgical cooperative studies (Chapter 

13), became Chief of Research in Surgery. Graham Moseley’s position was redesignated as 

Chief of Research in Radioisotopes, and Joe Meyer, Ph.D., became Chief of the Research 

Laboratories Division, and later (in 1962) Chief of Research in the Basic Sciences. The first 

recruits specifically to the position of Program Chief were Samuel C. Kaim, M.D., who arrived 

in 1960 as Chief of Research in Psychiatry and Neurology, and Harold W. Schnaper, M.D. and 

H. Elston Hooper, Ph.D., who in 1961 became Chiefs of Research, respectively, in Internal 

Medicine and Psychology. Later in the 1960s, recruitment continued of subject matter 

specialists to administer their particular areas of research, with 19 new recruits between 1963 

and 1971. 

Table 12.1. Program Chiefs 

Lee, Lyndon E., Jr., M.D., Coordinator, Research in Surgery, 1957-1964 

Chapple, Charles C., M.D., Chief, Research-in-Aging Division, 1958-1962 

Moseley, A. Graham, Chief, Radioisotope Division, Research Service, 1958-1967
 

Kaim, Samuel C., M.D., Chief, Research in Psychiatry and Neurology, 1960-1970 

Hooper, H. Elston, Ph.D., Chief, Research in Psychology, 1961-1965 

Schnaper, Harold W., M.D., Chief, Research in Internal Medicine, 1961-1967 

Meyer, Joe, Ph.D., Chief, Research in Basic Sciences, 1962-1968
 

Cass, Jules S, D.V.M., Chief, Research in Laboratory Animal Research and Care, 1963-198?
 

Feldman, W.H., D.V.M., Chief, Laboratory Research in Pulmonary Diseases, 1963-1967 

Matthews, James H., M.D., Chief, Clinical Research in Pulmonary Diseases, 1963-1968
 

Filer, Richard N., Ph.D., Chief, Research in Psychology, 1965-1970 

Rosenberg, Charles A., M.D., Chief, Research in Endocrinology and Metabolism, 1965-1968 

Wolcott, Mark W., M.D., Chief, Research in Surgery, 1965-1970
 

Chauncey, Howard W., D.M.D., Chief, Research in Oral Diseases, 1966-1971 

Nadel, Eli M., M.D., Chief, Research in Pathology and Laboratory Medicine, 1966-1968 

Simons, David G., M.D., Chief, Research in Physical Medicine and Rehab., 1967-1971 

Dury, Abraham, Ph.D., Chief, Research in Basic Sciences, 1968-1972 

Cady, Allen B., M.D., Chief, Research in Gastroenterology, 1969-1971 

Christianson, Lawrence G., M.D., Chief, Research in Neurology, 1969-1970 

Hine, Gerald G., Ph.D., Chief, Research in Nuclear Medicine, 1969-1973 

Loudon, Robert G., M.B., Ch.B., Chief, Research in Pulmonary&Infectious Dis., 1969-1970 

Meyer, Leo M., M.D., Chief, Research in Hematology, 1969-1970 

Oliner, Leo, M.D., Chief, Research in Endocrinology and Metabolism, 1969-1971
 

Adler, Terrine K., M.D., Chief, Research in Pharmacology, 1970-1972 

O’Reilly, Sean, M.D., Chief, Research in Neurology, 1971-1972 

 Sisk, Charles W., M.D., Chief, Research in Arthritis and Rheumatism, 1971-1972
 

Program Chiefs were responsible for encouraging and coordinating research in their specific 

program areas. Each was allotted a portion of the total research budget, over which he or she 

had almost complete discretion. Typically, they traveled extensively, visiting laboratories and 

reviewing research in their program areas. They formed Research Program Committees to 

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assist them in directing their efforts, and they also coordinated special Study Groups. They 

served as coordinators of the Clinical Investigator Program within their special areas and later 

of the Research Associate, Medical Investigator and Research and Education Trainee 

programs. In their fields, they served as Executive Secretaries of the Coordinating Committees 

for Cooperative Studies and later as Executive Secretaries of the Program Evaluation 

Committees. 

Research Program Chiefs (1960-1968) 

Lyndon E. Lee, Jr., M.D. 

Dr. Lyndon Lee came to Central Office in 1957 as Coordinator for Surgical Research within 

the Surgery Service. He graduated from Duke University School of Medicine in 1938 and 

completed postdoctoral training in surgery. Before coming to Central Office, he had wide 

experience in surgery, both in clinical practice and research. In 1958, when Theodore B. 

Moise, M.D., left the post of Chief of Extra-VA Research, Lee transferred to Research Service. 

He and Dr. Barnwell negotiated with the Director of the National Cancer Institute (NCI) to 

initiate a joint program of research on cancer therapy. Lee was responsible for coordinating 

this joint VA-NCI research. He also continued to coordinate research in surgery and in 1963 

became Program Chief in Research in Surgery. In 1964, he left the Research Service to 

become Director, Surgery Service, but returned as Acting ACMD/R&E in 1970. In 1971, he 

became ACMD for Professional Services. Until he left Central Office in the late 1970s, he 

coordinated the joint VA-NCI research program, taking it with him as he went from post to 

post.31 

Figure 12.5. Lyndon Lee, M.D. Figure 12.6. Samuel Kaim, M.D., right,

 with Edward Dunner, M.D.
 

Samuel C. Kaim, M.D. 

Dr. Samuel Kaim came to Central Office Research Service in 1960 as Program Chief in 

Psychiatry and Neurology. A New Yorker, Kaim had done his undergraduate work at Western 

Reserve College (now Case Western Reserve University) and studied medicine in Zurich, 

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Switzerland. He had been in the private practice of psychiatry until 1950, when he joined the 

staff of the VA hospital at Coral Gables (Fla.), where he became Chief, Psychiatry and 

Neurology Service, in 1958.32 

H. Elston Hooper, Ph.D. 

Dr. Hooper (Figure 16.2) was appointed Chief, Psychology Research, in 1961. After obtaining 

his bachelor’s degree at UCLA in 1942, he served for more than three years in the Air Force as 

a research psychologist in the Air Crew Selection Program. He then entered the VA Clinical 

Psychology Program and received his Ph.D. from USC in 1950. He was staff psychologist at 

the Long Beach (Calif.) VA Hospital from 1950 to 1960. He then went to the Augusta (Ga.) 

VA Hospital to serve as Chief of the Central Research Laboratory for the Psychological 

Research Program for a year before going to VACO.33 Except for a brief period in the mid1960s as Chief of the Western Research Support Center at the Sepulveda (Calif.) VA Hospital, 

Hooper remained in Central Office Research Service until his retirement in 1978. 

Harold W. Schnaper, M.D. 

Dr. Schnaper was recruited to Central Office as Program Chief, Research in Internal Medicine, 

in 1961. Previously, he worked with Edward Freis, M.D., at the Washington (D.C.) VA 

Hospital, serving as his Assistant Chief and an active partner in the early hypertension studies 

(Chapter 9). In 1965, Schnaper became Assistant Director of Research Service but also 

continued to coordinate research in internal medicine until he left Central Office to become a 

professor at the University of Alabama in 1966. He was Acting Director of the Research 

Service after Dr. Dunner transferred to the ACMD office and before Lionel M. Bernstein, 

M.D., Ph.D. arrived in Central Office.34 

James H. Matthews, M.D. 

Dr. James Matthews came to the Central Office in 1961 as Secretary to the Committee on the 

Chemotherapy of Tuberculosis, which was then still a part of Professional Services. He had 

been a pulmonary specialist at the Oteen VA Hospital in Osteen, N.C., and had participated in 

the tuberculosis cooperative studies. From the time of his arrival in Central Office, he 

coordinated his activities closely with Research Service and by 1963 had transferred to 

Research Service as Program Chief for Clinical Research in Pulmonary Diseases. He 

gradually took on other responsibilities as well, becoming Chief of Research Communications 

in the ACMD office in 1965 and Assistant Director, Research Service, in 1968. In 1972, he 

left VA to head the tuberculosis control program for the State of Virginia.35, 36 

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Figure 12.7. James Matthews, M.D. 

Lewis W. Carr, D.S.W. 

Dr. Lewis Carr became Program Chief, Social Work Research, in 1963. His responsibilities 

were to develop, promote and administer the social work research program, in response to a 

recommendation by an Ad Hoc VA Social Work Research Committee. Dr. Carr, a Doctor of 

Social Work from Washington University, was Clinical Social Worker in the Mental Hygiene 

Clinic at VA Regional Office, St. Louis, from 1957 to 1959 and Research Social Worker at the 

Houston VA Hospital and Assistant Professor of Social Work in the Department of Psychiatry, 

Baylor University, from 1961 to 1963. At the time of his appointment, he was a member of the 

National Association of Social Workers, the Academy of Certified Social Workers, the 

Council on Social Work Education, and the National Conference on Social Welfare.37 

Charles A. Rosenberg, M.D. 

Dr. Charles Rosenberg came to Central Office as Chief of Research in Metabolism and 

Endocrinology in 1964 from the Batavia (N.Y.) VA Hospital, where he had been Chief of 

Medicine and had established a Radioisotope Unit. Previously he was at the Nashville VA 

Hospital as Assistant Chief of Medicine and Chief of the Radioisotope Unit. In addition to 

endocrinology, Dr. Rosenberg took on responsibility for coordinating research in 

gastroenterology and hematology, taking some of the load from Dr. Harold Schnaper.38 Dr. 

Rosenberg later became Director of Medical Service in Central Office and then Chief of Staff 

at the Miami VA Medical Center. 

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Figure 12.8. Charles Rosenberg, M.D. 

Mark W. Walcott, M.D. 

Dr. Walcott, who had been Chief of Surgery at the Coral Gables (Fla.) VA Hospital, was 

Program Chief of Research in Surgery from 1964 to 1970. He took over this assignment when 

Dr. Lyndon Lee became Director of Surgery Service in Central Office. Lee, however, 

continued to be Chief of Extra-VA Research, a position in which he coordinated the NCIfunded VA surgical adjuvant studies and cancer research ward at the Washington VA Hospital. 

Walcott was an active researcher and while in Central Office set up a hyperbaric oxygen 

chamber for mice at the Washington VA Hospital, where he carried out research on gas 

gangrene. He also practiced surgery at the hospital once a week. Such activities were 

encouraged. Hal Engle, M.D., the CMD during Walcott’s later years in Research Service and 

a strong supporter of the VA research program, envisioned the possibility of academic 

affiliations for the Central Office DM&S, with close ties to the Washington VA Hospital. 

Walcott was later Chief of Staff at the Salt Lake City VA Hospital and set up the Regional 

Medical Education Center there. He was ACMD for Professional Services during the 1980s.39 

Figure 12.9. Mark Walcott, M.D., center, with Joe Meyer, Ph.D., 

and Lyndon Lee, M.D., at the 1965 Research Conference 

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David G. Simons, M.D. 

Dr. David Simons became Program Chief of Research in Physical Medicine and Rehabilitation 

in 1965. He was a 20-year Veteran of the Air Force, and Director of the Physiometrics 

Research Laboratory at the Houston VA Hospital. In 1962, he received the Aerospace 

Medicine Honor citation from the American Medical Association. He continued to be based in 

Houston but frequently traveled to Washington.40 

Figure 12.10. David G. Simons, M.D. Figure 12.11. Margaret M. Plymore, Ph.D. 

Margaret McCrindle Plymore, Ph.D. 

Dr. Margaret Plymore became Chief, Research in Clinical Nursing, in 1965. Her office was 

located in the Boston VA Hospital, rather than Central Office. A sociologist by training, she 

had been on the faculties of Yale and Emory Universities before joining the Boston VA 

Hospital as its Chief Research Clinical Nurse.40 

Howard W. Chauncey, Ph.D., D.M.D. 

Dr. Howard Chauncey became Program Chief of Research in Oral Diseases on October 1, 

1965. His Ph.D. degree was in biochemistry from Boston University and his dental degree 

from Tufts University. He had been active in dental research at Tufts, where he was Professor 

of Oral Pathology. Dr. Chauncey remained in Central Office until 1971, when he became 

ACOS/R&E at the Boston VA Outpatient Clinic.41 

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Figure 12.12. Howard W. Chauncey, Ph.D., D.M.D. Figure 12.13. Eli M. Nadel, M.D. 

Eli M. Nadel, M.D. 

Dr. Nadel joined Research Service in 1965 as Program Chief, Research in Pathology. Before 

coming to Central Office, he had been a career physician at NIH, most recently as Chief of 

NCI’s Diagnostic Research Branch.41 He left VA in 1970. 

Abraham Dury, Ph.D. 

Dr. Dury had worked on the endocrinology of aging at the Pittsburgh VA Hospital and had 

chaired VA’s advisory committee on research in aging. He then moved to NIH, into the new 

Institute for General Medical Sciences. When Dr. Joe Meyer decided to return to the 

laboratory in 1968, he persuaded Dury to move to VA to replace him as Program Chief, Basic 

Sciences. Dury stayed in VA Central Office as an important member of Research Service 

during the changes of the following years, until he retired in 1976. 

Figure 12.14. Abraham Dury, Ph.D. 

Lawrence G. Christianson, M.D.
 

Dr. Lawrence Christianson was Director of the Automatic Data Processing Staff when he was 

279
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

recruited to be Chief of Research in Neurology in 1969. He had been at VA Hospital in Fort 

Meade, S.D., before coming to VACO in February 1961 as Assistant Director, Medical 

Services. He spent only seven months in Research Service before returning to Medical 

Service.42 

The Enhanced Career Development Program 

In June 1961, the Clinical Investigator Program, which until then had been coordinated by 

Research Service’s sister Education Service, was officially transferred to Research Service. 

Dr. Schnaper coordinated awards in internal medicine and Dr. Lee in surgery. As new 

Program Chiefs arrived, they assumed coordination in their areas. 

The Clinical Investigator program continued to be very active during the 1960s. As of 

February 1962, 47 awardees had completed their appointments. Forty of them remained in 

academic medicine, 15 in medical schools and 25 within VA. 

Shortly after they arrived, Drs. Kaim and Hooper established entry-level Research Associate 

programs in psychiatry and psychology to alleviate the shortage of psychiatrists and 

psychologists adequately trained in research. The training was one year for psychiatrists 

and two years for psychologists. The first Research Associates, three in psychiatry and four 

in psychology, entered their training in 1962. 

The Research Associate in Psychology program continued as a two-year program through 

the 1960s. The one-year Research Associate program was later extended to include oral 

diseases, podiatry and pathology, areas perceived to have major shortages of qualified 

research personnel. In these four programs, 13 Research Associates completed training 

during fiscal year 1965. In many cases, the one-year appointments were extended for a 

second year and the Research Associate appointment soon became established as a two-year 

appointment. By 1967, 38 appointees participated in the physician Research Associate 

Program and applicants from all specialties were considered. 

The early 1960s was a period of expansion of the Senior Medical Investigator (SMI) program. 

The VA research program had now matured to the point where many distinguished research 

physicians provided leadership. Appointment as an SMI conferred high honor on selected 

distinguished investigators in the VA hospital system. They worked independently on research 

of their own choosing. While they were permitted teaching and patient-care responsibilities, 

the major focus was to be on research activities, and they were supported directly from 

research funds. Their four-year appointments were usually renewed after review, so this 

program conferred an unusual amount of continuity for the recipient. 

Dr. Musser, as Director of the Research Service, actively expanded the SMI program. Drs. 

Samuel Bassett (Chapter 3) and Edward Freis (Chapter 9) were appointed in 1959; Drs. Oscar 

Auerbach (Chapter 10) and Ludwig Gross (Chapter 3) in 1960; Dr. Jay Shurley in 1961; Dr. 

Morton Grossman (Chapter 7) in 1962; and Dr. Solomon Berson (Chapter 11) in 1963. Dr. 

Bassett died in 1962, leaving six active SMIs. 

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Jay Shurley, M.D., the only psychiatrist to hold an SMI appointment, had an eclectic research 

program. He had authored a 1948 VA Medical Bulletin on insulin shock therapy43 and was 

engaged in research on sensory deprivation at the time he received the SMI appointment. 

Figure 12.15. Jay Shurley, M.D. 

Dr. Shurley’s primary research interest involved the physiological, psychological and 

behavioral effects of unusual environments. He conducted extensive studies of the effects of 

sensory isolation through water immersion and other controlled environments.44, 45 He found 

that patients with insomnia were helped by use of an air-fluidized bed originally developed for 

burn victims.46 In the late 1960s and 1970s Dr. Shurley studied the effects of the extreme 

environment at the Navy’s South Pole Station.47, 48 Much of this work focused on changes in 

sleep patterns.49-51 

External advisors to VA research 

The Committee on Veterans Medical Problems of the National Academy of Sciences 

(Appendix IIc) continued into the 1960s, but its advice was limited to negotiations with other 

agencies, industries and universities. At the start of 1960, four VA advisory committees 

advised the Research Service: the Advisory Committee on Research, begun in 1955 (Appendix 

IIe); the Advisory Committee on Radiobiology and Radioisotopes, begun in 1947 (Appendix 

IId); the Advisory Committee on Problems in Aging, begun in 1955; and the committee 

reviewing applicants for Clinical Investigator appointments, first called the Committee on 

Clinical Investigations and later the Research Career Development Committee (Appendix IIj). 

In 1960, the first three of these committees were abolished, and a new Advisory Committee on 

Research was established, with membership from the three committees and other experts from 

outside VA to advise on all aspects of the research program. This Advisory Committee on 

Research (Appendix IIf) remained active until 1968. 

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Internal advisors: the Research Program Committees 

In November 1960, Research Service began to establish Research Program Committees, whose 

members were available to advise the Director of the Research Service and Program Chiefs on 

the status of the field and to assist in broad planning and further development of the research 

program in their specialties. These Committees consisted primarily of VA field researchers, 

with some outside consultants. Each committee had an Executive Secretary from Central 

Office who was the Program Chief, or a subject matter expert from another Central Office 

Service.52 

In fiscal year 1964, Research Program Committees were in place for basic science, cancer, 

cardiovascular disease, infectious disease, oral diseases, psychiatry, neurology and psychology, 

and pulmonary disease (Appendix IIg). 

Program Evaluation Committees 

In 1964, several chairmen of the Research Program Committees were asked to develop a 

mechanism for review of individual investigators’ research programs. As a result of their 

recommendations, Research Evaluation Committees were established. Each principal 

investigator who was identified with a VA medical research laboratory or program was asked 

to document the scope, purpose, progress and achievements of his or her research, to enable a 

critical scientific evaluation by panels of experts composed of VA and non-VA members. This 

program was announced in a Chief Medical Director’s letter dated January 8, 1965, entitled 

“Evaluation of Medical Research Program.” These committees reviewed brief proposals; their 

decisions were based on the productivity of the research or the apparent promise of the 

investigator. By 1968, Program Evaluation Committees had been established in 12 subject 

areas (Appendix IIh.). 

Study Groups 

In 1961, VA established “Study Groups,” small groups of VA investigators who met about 

twice a year to discuss individual research and exchange ideas and plans for new or extended 

cooperative studies.53 In 1962, these groups were active in research on epilepsies, arthritis and 

rheumatic diseases, coccidioidomycosis, emphysema, oral diseases, physical medicine and 

rehabilitation, sarcoidosis, and social work.54 By 1964 the Study Groups on epilepsies and 

sarcoidosis had disbanded; new groups studied chronic bronchitis, multiple sclerosis, 

psychological aspects of aging, and nursing.55 By fiscal year 1967, nine study groups were 

active. The emphysema and chronic bronchitis groups had disbanded. There were now 

groups studying endocrinology and “Restoration Centers, Intermediate Care Wards, Nursing 

Care Home Unit and Domiciliaries.”56 Subsequently, interest in these study groups waned. 

The annual reports of 1968 and 1969 listed only four groups. By FY 1973, only the group 

studying coccidioidomycosis remained active.57 It continues to meet annually, now sponsored 

by the NIH. 

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Research Support Centers 

In 1962, Research Support Centers were established at the Hines (Ill.), Washington (D.C.) and 

Sepulveda (Calif.) VA Hospitals, known respectively as the Midwestern, Eastern and Western 

Research Support Centers. Their charge was to provide multidisciplinary consultation and 

assistance in: 

a. Research design, mathematical and statistical formulation 

b. Data acquisition, processing and analysis 

c. Storage, retrieval and transmission of scientific information 

d. Education and training 

As originally envisioned, the center at Hines would primarily provide statistical and 

computational services and the one in Washington would emphasize medical instrumentation 

and automatic data processing.58 

In January 1963, the Hines Center presented the first of a series of courses for research 

investigators, covering problems in experimental design and applied statistical methods.59 

In March 1964, a fourth center, the Southern Research Support Center, opened at the Little 

Rock (Ark.) VA Hospital. While this center had a broad mission— biochemistry, physical 

chemistry, biophysics, statistics and data processing, research design, psychology, 

bioengineering and instrumentation—its 20 staff members, including seven Ph.D. scientists, 

had particular expertise in instrumentation and design and construction of specialized research 

instruments. This Center offered courses in biomedical instrumentation and atomic 

medicine.60 During FY 1966, it developed procedures for a central research instrument 

program and became the site for the Central Research Instrumentation Pool (CRIP).61 

In July 1965, a new Eastern Research Support Center opened at the West Haven (Conn.) VA 

Hospital.62 The Center at the Washington, D.C. VA Hospital became the location of VA’s 

pilot Automated Hospital Information Systems (AHIS) effort, pioneering work dedicated to 

using computers to augment hospital information systems (Chapter 19). 

In time, each support center developed special interests, while still trying to serve all of the 

regional needs of its researchers. By 1969, the Western Center had acquired expertise in 

information systems and became the site of data processing for the new Medical Research 

Information System. The Eastern and Midwestern Centers became leaders in biostatistics, 

while the Southern Center expanded its expertise in instrumentation.63 

Outreach to other Federal agencies 

During the 1950s and 1960s, VA actively worked with other agencies. The medical research 

program was and remains represented on the Councils of the National Institutes of Health. 

Many NIH Study Sections include VA representatives. As of 1964, VA also was represented 

on the President’s Committee on Aging and the Committee on Scientific and Technical 

Information of the President’s Federal Council for Science and Technology.64 

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The program expands and the budget soars 

During the early 1960s, the VA research budget constantly expanded (Figure 12.16), helped by 

its good press and the favorable report from the National Academy of Sciences. Musser and 

Wells, strongly backed by Middleton, were politically very active. 

Figure 12.16 Research budget, 1960-1967 

50 

45 

40 

35 

30 

Current dollars 25 Deflated to 1960 dollars 

20 

15 

10 

5 

0 

The budgetary process then, as now, began with presentation and reviews of a budget through 

the VA hierarchy to the Bureau of the Budget, now called the Office of Management and 

Budget (OMB), before arriving at the Presidential budget. Within VA, the budget was 

reviewed by the Chief Medical Director and then the Administrator’s staff. Bureau of the 

Budget auditors then completed a thorough review with an eye to saving money. Dr. 

Middleton, as Chief Medical Director, encouraged and vigorously defended growth of the 

research budget.65 While his successor, Joseph H. McNinch, M.D., was less enthusiastic, Dr. 

H. Martin “Hal” Engle, the Chief Medical Director who followed McNinch, was also a strong 

advocate of research. William J. Driver, VA Administrator from 1965 to 1969, actively 

pushed the VA research program, even contacting the White House when necessary on its 

behalf.66 Driver and Drs. Engle and Wells attended a meeting with President Lyndon Johnson 

to discuss federal funding of medical research (Figure 12.17). Millions of dollars

1960 1961 1962 1963 1964 1965 1966 1967 

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Figure 12.17. White House meeting about federal funding of medical research 

With this degree of encouragement, the research budget was consistently favorable at VA’s 

submission stage but usually cut back by the Bureau of the Budget staff. Work at the congressional 

level was then necessary to restore the cuts. Here, Drs. Wells and Musser were the key players. 

Wells, especially, was described in interviews as a “consummate politician.” 

With increased resources, it was possible to expand the program as recommended by the 

National Academy of Sciences report. Efforts continued to build and improve the physical 

plant and equipment for research at VA hospitals. During the early 1960s, VA requested, and 

Congress appropriated, extra money for construction of badly needed VA research 

laboratories. Twice, the congressional appropriation had a special item for research laboratory 

construction. In 1961, the Research Service employed a full-time architect.67 

VA pioneers better standards for veterinary care of research animals 

Along with expanded basic science and more sophisticated clinical research programs, animal 

research facilities had been developed in most VA hospitals’ research programs. At that time, 

standards for the care and use of research animals were primarily subjective. In 1962, VA 

appointed its first Chief of Research in Laboratory Animal Medicine and Care, Jules S. Cass, 

D.V.M. His charge was to develop a training program for animal care and improve the quality 

of research with laboratory animals. 

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Figure 12.18. Jules S. Cass, D.V.M. 

Since 1951, Dr. Cass had been at the University of Cincinnati as Assistant Professor of 

Industrial Health. He received his veterinary training and M.S. degree from Ohio State 

University and served a fellowship in medical entomology at the College of Veterinary 

Medicine of the University of Minnesota, where he remained as an instructor. He also spent 

two years in the Communicable Diseases Center in Savannah, Ga., where he was responsible 

for the health of the laboratory-animal colony.68 

Under Dr. Cass’s leadership, VA developed training programs for animal technologists and set 

pioneering standards for veterinary care within animal research facilities. As accreditation 

standards developed in the general research community, VA established a policy that all 

animal facilities must be accredited. Dr. Cass worked very closely with animal activists, 

particularly groups campaigning for humane care of laboratory animals. 

VA developed a reputation as a pace-setter in improving standards. Construction of animal 

facilities became an important part of the VA research construction program, a policy that 

continues to the present day.69 

Medical research in the basic sciences 

Until about 1960, most medical research in VA was carried out by clinicians and was clinical 

in nature. As medical science progressed, however, the scientific base for medical research 

became increasingly important. Collaboration and interaction with full-time, specifically 

trained basic scientists became very desirable. 

Up to this point, most of the independent basic scientists in VA had entered through the 

Radioisotope Service. Since basic scientists were needed to handle the radiation safety 

program, from the beginning the Radioisotope Service had conferred high status on Ph.D. 

scientists and given them high grades in the Civil Service. However, elsewhere in medical 

research during the early days, the few Ph.D. scientists who entered the VA program were 

regarded and graded as “super technicians.”70 Largely as a result of Dr. Joe Meyer’s efforts, 

this situation changed in the 1960s. 

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Joe Meyer, Ph.D. 

Dr. Joe Meyer (Figure 12.9) came to VA Central Office in 1960 as Chief of the Research 

Laboratory Division, succeeding Harold P. Weiler, Meyer, an organic chemist by training, 

served as a research chemist in Chicago before World War II. During the war, he worked on 

programs sponsored by the Office of Scientific Research and Development and later the 

Manhattan Project. After the war, he worked as a chemist in the pharmaceutical industry but 

then went to Western Reserve College in 1946 as a graduate student and instructor in the new 

Biochemistry Department. He received his Ph.D. from Western Reserve in 1949 and then 

joined VA as Assistant Director and Principal Scientist of the Radioisotope Unit at the Denver 

VA Hospital, with a faculty appointment in the Department of Biophysics at the University of 

Colorado Medical School. While at Denver, he was in charge of the program to train public 

employees, such as police and firefighters, in radiation protection. In 1953, he moved to the 

New Orleans VA Hospital, where he installed the Radioisotope Unit and then served as its 

Associate Director, with an Associate Professor of Biochemistry appointment at the LSU 

Medical School. In 1959, he went to Houston as Chief of Medical Research Laboratories and 

Associate Professor of Biochemistry at Baylor University.71 

After a short time as Chief of the Research Laboratories Division, Meyer perceived greater 

opportunities. The need to encourage development of basic science in the research program 

was recognized, and he had the background to do this. He suggested to Dr. Musser that he be 

made Program Chief for Basic Science, and this soon became his major responsibility. Drs. 

Middleton, Musser, and Wells all wanted a strong basic science component in VA and gave 

Meyer the autonomy he needed to achieve this goal.70 

One of the initiatives Meyer directed was research in aging. He apparently inherited this 

initiative from Dr. Chapple and relied on the Advisory Committee to help him identify areas of 

interest. To further this work, Meyer was urged to contact the renowned scientist Linus 

Pauling, Ph.D., the only recipient of two undivided Nobel prizes. Meyer visited Pauling, who 

agreed to collaborate with a VA scientist. They recruited Arthur Chernoff, Ph.D., who had an 

interest in aging. Pauling was about to announce his macromolecular theory at the Sepulveda 

(Calif.) VA Hospital, but the arrangement collapsed under political pressure stemming from 

Pauling’s reputation as a pacifist.70 

Meyer, who had known Dr. Andrew Schally at Baylor University, worked with the New 

Orleans Hospital to recruit Schally into VA research. Meyer described his efforts to help: 

“One of the things I did was very useful to Andy. He needed all these hypothalami to 

work with, so Jim Musser said, ‘Why don’t you go up to Madison (Wis.) to the Oscar 

Meyer plant there and talk with them? Maybe they’ll make pig hypothalami available to 

Andy.’ So, I went up and talked with them and, sure enough, they made arrangements so 

we could put a technician up there. I am told... that they ended up with almost a million 

hypothalami, which is what made it possible for Schally to do his work.” 

Schally credited Meyer for making possible his Nobel Prize-winning work on the hypothalamic 

hormones. One of the first things he did after he won the Nobel Prize was to call Joe Meyer. 

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Meyer traveled extensively, pushing the importance of basic science as integral to the VA 

medical research program. He actively sought out distinguished and promising scientists, such 

as Paul Srere, Ph.D., who went to the Dallas VA Hospital, and Claude Baxter, Ph.D., who went 

to Sepulveda. Most of these new recruits were active academicians with appointments in 

affiliated universities. In addition, he encouraged promising young Ph.D.s already in the 

system to remain.70 

The VA Annual Medical Research Conference 

During the early 1960s, VA’s popular annual research conference expanded. It was now held 

at the Netherlands Hilton Hotel in Cincinnati. Concurrent sections for the scientific 

presentations became the norm. 

The Agenda Committee was bombarded with abstracts for the program. All Clinical 

Investigators and Senior Medical Investigators were invited and held their own special 

subsection meetings. The Radioisotope Chiefs continued to attend and have their own special 

meetings, as did the Associate Chiefs of Staff for R&E. A description of the 1963 Conference, 

from the January 1964 Research and Education Newsletter, follows: 

“The 14th V.A.A.M.R.C. was as successful a conference as has been held by the VA in a 

perceptibly long while. For the last several years, the format of these conferences has 

been experimental but now it seems to have settled into a proper mold. The meeting was 

divided, like last year’s, into separate quarter-day sessions but, unlike last year’s, usually 

it was only the format which remained constant during each of these periods. The subjects 

were treated with a certain continuity, although this may not have been conspicuous in any 

but the plenary sessions. 

“Tuesday evening, Clinical Investigators presented papers and Senior Medical 

Investigators led the discussions. Most Conferees, however, were not present but, instead, 

were sitting in administrative session, listening to matters discussed which touched on the 

specific and personal if it could be said that there was anything else at all during that 

evening meeting. 

“The first session, the official opening of the general scientific meeting, on Wednesday 

before the entire body, was of good omen. Its welcomes were gracious, its introductions 

remarkably informative of the speakers’ philosophies and remarkable backgrounds and the 

addresses themselves extraordinarily good and well received. These last were by the 

William S. Middleton award winner, Stanley Ulick, M.D. of the V.A.H. Bronx and by the 

Chief Medical Director, Joseph H. McNinch, M.D., who was appearing before the 

Conference for the first time. The welcomes were by L. H. Gunter, the VA Hospital 

Director of the long-time host-city whose team does most of the work of the Conference, 

and from Dr. Jackson Freidlander, the Area Medical Director. The introductions were by 

the Assistant Chief Medical Director for R&E in Medicine, Dr. M.J. Musser and by one of 

the co-winners of last year’s W. S. Middleton award, Dr. Leslie Zieve, Associate Chief of 

Staff, Chief of the Radioisotope Service and Chief, Special Laboratory for Cancer 

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Research of the V.A.H. Minneapolis, Minn. (This latter is reproduced here, in toto.) 

“The second was a specialties-session during which four separate programs were 

conducted simultaneously in separate parlors. The largest of these was a combined 

medical-surgical series. The others were in psychology, pulmonary disease and the basic 

sciences. 

“After lunch while research support (statistical and biological) was being described, about 

20 large circular discs were brought into the theater-sized hall where they were set on legs, 

and chairs were placed around them. When this process was completed a sign, 

designating the topic to be discussed around it was placed on each and the round-table 

discussions were on their way. At one, the subject was so popular that it became clear at 

once that no peace or audibility would be possible around that table, so the members were 

led off by their leader to a parlor. At the rest of the round-tables the numbers were not so 

great, although still allowing little elbow-room but the enthusiasm and intensity around 

them had nothing to do with number and the discussions were unabated until closing time. 

“Before dinner on Wednesday there was a cooperative reception. In this kind, as in the 

studies of the same name, the investigator can become involved to whatever degree he 

chooses. Nothing else was on the prescribed agenda for the evening. 

“Thursday morning until the coffee break, the conferees again gathered and heard 

discourses as an assemblage. These were piloted by the only speaker from beyond the VA 

confines, Dr. Ewald Busse, Professor of Psychiatry, Medical School, Duke University, 

who spoke on Research in Aging and they were followed by the final period which was a 

second Specialties Session. This resembled the first one in all respects except that, where 

psychology had the front on Tuesday, psychiatry led the parlor on Wednesday. By 1:30 

p.m. the 14th Veterans Administration Annual Medical Research Conference had joined 

the previous 13 in the cemetery for deceased Conferences and the 15th was being 

conceived.”72 

The Middleton Award (Chapter 7) was presented at each annual conference by the previous 

year’s winner, and the awardee addressed the conference. After the 1960 award to Berson and 

Yalow, in 1961, Hubert Pipberger at the Washington (D.C.) VA Hospital received it for his 

work on computerization of the electrocardiogram (Chapter 13). In 1962, it went to 

collaborators Leslie Zieve and William Vogel at Minneapolis for their studies of phospholipids 

and phospholipases. In 1963, Stanley Ulick from the Bronx received the award for his work in 

the chemistry and metabolism of mineralocorticoid hormones. In 1964, Ulick presented it to 

Robert Becker for his identification of electrical control systems in living organisms, including 

humans. 

289
 
 

 

Figure 12.19. Drs. Becker, Musser, Ulick and Wells while 

Dr. Becker received the Middleton Award 

In 1965, Lucien Guze, M.D., and George Kalmanson, M.D. (Figure 12.20), from the Los 

Angeles VA Hospital received the Middleton Award for discerning the host-parasite relationship 

in chronic infectious kidney disease. In 1966, Guze presented the Award to Leo Hollister, M.D. 

of Palo Alto (Chapter 8) for his numerous significant contributions in the field of therapeutic 

drugs for mental illness. 

Figure 12.20 Lucien Guze, M.D., and George Kalmanson, M.D., 

at the 1965 Middleton Award ceremony 

The 1967 Middleton Award went to Leonard Skeggs, Ph.D., of the Cleveland VA Hospital for 

developing automated laboratory test devices, which have revolutionized laboratory medicine, 

and for his studies of the biochemistry of hypertension. 

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Figure 12.21. Leonard Skeggs, Ph.D., Figure 12.22. The Autoanalyzer 

 1967 Middleton Award winner developed by Skeggs 

The Central Research Instrumentation Pool 

In the early 1960s, the Research and Education Newsletter listed equipment that users no 

longer needed. Persons who wanted the equipment contacted the Research Facilities office in 

Central Office Research Service for equipment transfer. The success of this popular program 

overloaded Central Office staff. The program was transferred to Supply Service, but that did 

not meet the need. In 1966, VA piloted a regional exchange program under the direction of the 

Southern Research Support Center at Little Rock, Ark. In 1968, this expanded to the Central 

Research Instrument Pool, dubbed “CRIP,” a nationwide instrument exchange program, that 

continued to be administered from the Little Rock VA Hospital. Nationwide listings of 

available equipment were distributed regularly, and investigators needing the equipment 

applied for it through their hospitals. In cases of multiple requests for an item, CRIP made a 

decision based on justified need.73 Generally, preference was given to appointees in the Career 

Development Program. The CRIP staff also brought disabled equipment to Little Rock for 

repair and distribution. This equipment pool later became a resource for training biomedical 

engineers. 

Changes in Central Office leadership 

After Dr. Edward Dunner left the directorship of Research Service in 1966, Harold Schnaper, 

M.D., who had been his Deputy, served as Acting Director for several months, until Lionel 

Bernstein, M.D., from the Chicago West Side VA Hospital came into the position (Chapter 

15). Shortly after Bernstein’s arrival, Dr. Wells resigned as ACMD/R&E to head a Regional 

Medical Program centered in Birmingham, AL. Bernstein became Acting ACMD/R&E and 

held that position until Thomas Chalmers, M.D., was appointed ACMD/R&E in 1968. 

During this period, Bernstein encouraged the Research Evaluation Committees to work toward 

refining the quality of VA research programs. However, it was not until after Chalmers’s 

arrival in 1968 that, relieved of his double duty as both ACMD/R&E and Director, Research 

Service, Bernstein moved to implement the major changes in the program attributed to him. 

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The second National Academy of Sciences study 

During 1966 and 1967, the National Research Council of the National Academy of Sciences 

again reviewed the VA research program, this time reviewing the education program as well. 

Their report, published in 1968, detailed the remarkable growth of the research program, both 

in terms of VA and non-VA monies. The number of publications from the VA research 

program had more than doubled between 1958 and 1966. As of FY 1966, 27 hospitals, all 

affiliated with medical schools, each were receiving $500,000 or more of VA medical research 

funds; 49 hospitals, 39 of them affiliated, were receiving between $100,000 and $500,000; and 

84 hospitals, of which only 22 were affiliated, received less than $100,000. This report noted 

that the non-affiliated hospitals were at a disadvantage due to their remoteness from academic 

medical centers, but urged them to continue in cooperative and collaborative studies. It also 

recommended that any new VA hospitals be built in close proximity to medical schools.74 

In its review of research management, the report describes the decentralized program. During 

the 1961-1966 period, institutional allocations to VA hospitals averaged 83 percent of the 

funds requested, suggesting that activity had been “more limited by existing investigative 

competence and facilities than by lack of funds.”74 The report lauds the activities of the 

Program Evaluation Committees that since 1965 had been reviewing individual research 

programs. It states: “In due course, it may be expected that all programs supported by 

Veterans’ Administration funds will be subject to review by an evaluating committee.”74 

The 1968 NAS report reviewed the activities of the four active Research Support Centers. 

Some review committee members doubted that “modestly staffed and equipped centers” such 

as these could “deliver the wide range of services stated in their mission.” In site visits, the 

committee members received mixed reviews about the type of help they were receiving from 

the Centers, because research personnel at a hospital close to a Center sought assistance more 

frequently than those in more remote institutions. The committee recommended, 

“That (VA) review the programs and accomplishments of its four Research Support 

Centers to determine whether they are accomplishing the purposes for which they were 

established and how their assistance to individual investigators can be enhanced.”75 

This report endorsed the Annual Research Conference, as well as the Study Groups, as 

excellent devices for fostering intellectual satisfaction and research interest in the staff. The 

report was very favorable toward the Research Career Development Program and formally 

recommended program continuation. Finally, in reviewing the quality of the research program, 

the committee once more concluded that, 

“The research program compares favorably with other broad national programs of 

biomedical research. It shares with them a significant quota of uninspired investigations 

but, on the whole, (VA) is to be commended on maintaining relatively high standards of 

quality of relating its program to its primary mission during a period of rapid growth.”76 

This second 1968 NAS report, with its recommendations, was both stimulus and justification 

for many of the changes begun in 1968. 

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References 

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4. Medical Research in the Veterans Administration, FY 1960. 5. 

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6. Kendall, E.C., Cortisone. New York: Charles Scribner's Sons, 1971, 83-93. 

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8. Research and Education Newsletter, July, 1960. Washington, DC: Research and Education 

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9. Research and Education Newsletter, July, 1965, Vol 6, 4. 

10. Telephone interview with Charles H. Halsted, M.D., son of James Halsted, M.D., March 12, 

1992. 

11. Telephone interview with John T. Farrar, M.D., March 26, 2001. 

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17. Citrin, Y., Sterling, K. and Halsted, J., "The mechanism of hypoproteinemia associated with 

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27. Research and Education Newsletter, November, 1962. 7-9. 

28. Interview with Lawrence Shaw, February 3, 1994 at Mr. Shaw’s home, Gainesville, FL. 

29. Research and Education Newsletter, May, 1960. 2. 

30. Telephone interview with Robert Efron, M.D., 1988. 

31. Interview with Lyndon Lee, M.D., April 7, 1988 at a restaurant in Bethesda, MD. 

32. Research and Education Newsletter, September, 1960. Washington, DC: Research and 

Education Office, VACO, 28. 

33. Research and Education Newsletter, May, 1961. 24. 

34. Telephone interview with Harold W. Schnaper, M.D., January 26, 1992. 

35. Telephone interview with James H. Matthews, M.D., May 25,1988. 

36. Letter from James H. Matthews, M.D. to author, written at Richmond, VA, April 14, 1988. 

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Education Office, VACO, 15. 

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38. Research and Education Newsletter, February, 1965. Vol. 6. Washington, DC: Research 

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39.	 Interview with Mark Walcott, M.D., April 5, 1988 at VACO. 

40. Research and Education Newsletter, November, 1965. Vol. 6. 1965, 4. 

41. Research and Education Newsletter, November, 1965. 5. 

42.	 Interview with Lawrence G. Christianson, M.D., May 4, 1992 at Dr. Christianson’s home in 

suburban Maryland. 

43. Shurley, J.T. and Bond, E., "Insulin shock therapy in schizophrenia." Medical Bulletin, 

1948. 

44. Serafetinides, E.A., Shurley, J.T., Brooks, R. and Gideon, W.P., "Electrophysiological 

changes in humans during perceptual isolation." Aerosp Med, 1972. 43: 432-434. 

45. Serafetinides, E.A., Shurley, J.T., Brooks, R. and Gideon, W.P., "Sensory versus perceptual 

isolation: a comparison of their electrophysiological effects." Aerosp Med, 1973. 44: 539­

541. 

46. Miller, W.C., Jr. and Shurley, J.T., "Treatment of insomniac patients with the air-fluidized 

bed." Am J Psychiatry, 1972. 128: 1147-1149. 

47. Popkin, M.K., Stillner, V., Osborn, L.W., Pierce, C.M. and Shurley, J.T., "Novel behaviors 

in an extreme environment." Am J Psychiatry, 1974. 131: 651-654. 

48. Serafetinides, E.A., Shurley, J.T. and Brooks, R.E., "EEG and the effects of photic 

stimulation at the South Pole." Aerosp Med, 1971. 42: 52-53. 

49. Natani, K., Shurley, J.T., Pierce, C.M. and Brooks, R.E., "Long-term changes in sleep 

patterns in men on the South Polar Plateau." Arch Intern Med, 1970. 125: 655-659. 

50.	 Joern, A.T., Shurley, J.T., Brooks, R.E., Guenter, C.A. and Pierce, C.M., "Short-term 

changes in sleep patterns on arrival at the South Polar Plateau." Arch Intern Med, 1970. 125: 

649-654. 

51. Natani, K. and Shurley, J.T. "Disturbed sleep and effect in an extreme environment. In: 

Sleep Physiology, Biochemistry, Psychology, Pharmacology, Clinical Implications." First 

European Congress on Sleep Research. Apr. Basel, Switzerland: S. Karger, Basel, 1972, 

426-430. 

52. Medical Research in the Veterans Administration, FY 1961. 12-14. 

295
 
 

 

 

 

 

 

 

53. Medical Research in the Veterans Administration, FY 1961. 68-70. 

54. Medical Research in the Veterans Administration, FY 1962. Washington, DC: Government 

Printing Office, 1962, 78-84. 

55. Medical Research in the Veterans Administration, FY 1964. Washington, DC: Government 

Printing Office, 1964, 82-86. 

56. Medical Research in the Veterans Administration, FY 1967. Washington, DC: Government 

Printing Office, 1967, 99-103. 

57. Medical Research in the Veterans Administration, FY 1973. Washington, DC: Government 

Printing Office, 1974, 94-95. 

58. Research and Education Newsletter, May, 1962. 7-8. 

59. Research and Education Newsletter, March, 1963. Vol. 4. 13. 

60. Research and Education Newsletter, April, 1965. 8-9. 

61. Medical Research in the Veterans Administration, FY 1966. Washington, DC: Government 

Printing Office, 1966, 87. 

62. Research and Education Newsletter, April, 1965. 9-10. 

63. Medical Research in the Veterans Administration, FY 1969. Washington, DC: Government 

Printing Office, 1969, 72-78. 

64. Medical Research in the Veterans Administration, FY 1964. 4. 

65. Interview with Martin Cummings, M.D., April 7, 1988 at Dr. Cummings' office in 

Washington, DC. 

66. Interview with Thomas Chalmers, M.D., July 29,1992 at a hotel lobby in Boston, MA. 

67. VA Telephone Directory. Washington, DC: 1962 

68. Research and Education Newsletter, September, 1962. Washington, DC: Research and 

Education Office, VACO, 7-8. 

69. Interview with Jules Cass, D.V.M., May 8, 1992 at the Cosmos Club in Washington, DC. 

70.	 Interview with Joe Meyer, Ph.D., May 4, 1992 at Dr. Meyer’s home in suburban Maryland. 

71. Research and Education Newsletter, September, 1960. 28-29. 

296
 
 

 

 

72. Research and Education Newsletter, January, 1964. 1. 

73. Medical Research in the Veterans Administration, FY 1969. 78. 

74. NAS-NRC, Evaluation of Biomedical Research and Education in the Veterans' 

Administration. Washington, DC: National Academy of Sciences, 1968, 28. 

75. NRC, Evaluation of Biomedical Research and Education in the VA. 1968, 30.
 

76. NRC, Evaluation of Biomedical Research and Education in the VA. 1968, 34.
 

297
 
(Intentionally Blank) 

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Chapter 13. The VA Cooperative Studies Program of the 1960s 

The Veterans’ health care system is such an excellent venue for cooperative clinical trials that it is 

understandable that VA is often—if erroneously—credited with being the birthplace of this form of 

clinical research. In fact, a few cooperative studies had been performed by others even before the 

landmark VA tuberculosis trials (Chapter 5), and the British Medical Research Council ran 

tuberculosis trials at about the same time as the VA trials. It is certainly accurate to say that VA 

clinicians were among the first to understand the power of this important tool for evaluating and 

improving patient treatment, and VA clinicians have applied its methodology to many clinical 

problems. 

In a cooperative study, investigators at different hospitals analyze a clinical problem by following 

exactly the same protocol and controlling as many factors as possible. Since there are inevitable 

differences between hospitals, even those within the VA system, the unique aspect stemming from 

one local environment becomes less important than it would be in a study conducted in a single 

hospital. Also, by working together, investigators can study many more patients affected by the 

condition in a shorter time than would be possible in a study limited to the patient population of a 

single hospital. Moreover, economies of scale make it practical to include professional coordination 

and statistical support. 

The earliest VA cooperative studies include the tuberculosis trials (Chapter 5), the 

psychopharmacology studies and the predecessor study of prefrontal lobotomy (Chapter 8), the 

hypertension studies (Chapter 9), and the earliest of the truly randomized VA studies, evaluation of 

the effect of isoniazide on multiple sclerosis conducted jointly with the Follow-up Agency (Chapter 

4). VA groups outside of Research Service spearheaded these early studies, but Research Service 

soon became involved, providing in differing degrees monetary, administrative or statistical 

support. By the early 1960s, the Research Service had assumed general responsibility for 

cooperative studies. Edward Dunner, M.D., who became Chief of the Clinical Studies Division of 

Research Service in 1958 (Chapter 12), transferred the tuberculosis studies to the Clinical Studies 

Division when he became Chief, formalizing a collaboration that had increased since the beginning 

of that research. 

Statistical support for VA Cooperative Studies 

VA Central Office statisticians who supported the early tuberculosis and hypertension trials worked 

for the agency’s Controller’s Office. In 1957, a Research Statistics Division consisting of five 

statisticians and headed by Clifford Bachrach, M.D., was established in that Office. 

Bachrach had graduated from medical school in 1941 and served as an Army doctor during World 

War II. After the war, he had earned an M.P.H. degree from Johns Hopkins University, taking “all 

the statistics courses they offered.” Subsequently, he was a Hopkins faculty member for 10 years, 

teaching statistics and epidemiology before joining VA. He organized a dedicated staff to begin 

collecting and sorting data and contributing their analyses of the clinical implications. In a 1992 

interview, Bachrach described the character of working with research statistics in those early days: 

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“I had a shop with about 10 or a dozen people... four of them were college graduates with some 

degree of training in statistics... (and there were) about seven or eight clerical people and a 

secretary. 

“The state of the art was 80-column punch (IBM) cards.... You had to write up your 

specifications (for a computer run) and you were behind the administrative parts of the VA in 

priority... a difficult way to work.” 

In view of the administrative barriers to using the fledgling data processing equipment, 

Bachrach expressed a continuing affinity for the simple 3-by-5 card. 

“I still think (the 3 by 5 card) is a wonderful device, for a number of reasons. I have always 

been strong on having people rub their noses in the data. I don’t like this business of putting it 

all into the machine and putting in a program that does an analysis of variance and getting out 

some things at the end, without looking at the distributions, looking at the peculiarities of the 

data that you see when you look at them one by one.”1 

In 1962, Dr. Bachrach left VA to accept a U.S. Public Health Service assignment in Israel. At 

about that time, the research statistics unit was moved to Research Service and became part of the 

Clinical Studies unit under Dr. Edward Dunner. Lawrence W. Shaw was recruited to the position of 

head statistician. 

Shaw had previously been Chief of the Records and Statistics Unit in the tuberculosis program of 

the U.S. Public Health Service, studying the epidemiology of BCG vaccination. His initial 

appointment in VA was to the Research Statistics Division in Research Service, where he was to be 

responsible for the statistical aspects of the cooperative studies that had formerly been under Dr. 

Bachrach. Shaw had graduated from Ohio Wesleyan University, earned an M.S. from the 

University of Pennsylvania, and pursued other graduate studies at Ohio State and Columbia 

Universities. Prior to joining the Public Health Service in 1945, he had been a statistician with the 

War Department. 

In the early 1960s, the source of statistical support for the Cooperative Studies Program varied 

markedly, depending on the type of study and investigators’ preferences. Statisticians in Central 

Office supported the medical studies. The ongoing surgical and cancer studies used contract 

statisticians, based at a university or employed by the Follow-up Agency. The psychiatric studies 

received their planning, administrative and statistical support from the Central Neuropsychiatric 

Research Laboratory (CNPRL) at the Perry Point (Md.) VA Hospital.2 

When the Research Support Centers (Chapter 12) were established, they were intended to support 

only individual research. However, they became sites of statistical expertise, and as time went on, 

the Eastern Research Support Center assumed statistical support for some of the Cooperative 

Studies. At the same time, the statisticians in Central Office who left were not replaced. By the end 

of the 1960s, the only statistician left was Shaw. His role became primarily one of coordinating 

studies rather than that of hands-on statistician. However, the hybrid system, with many of the 

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cooperative studies receiving statistical support from contractors overseen by Central Office 

coordinators, was well-established, and it continued into the 1970s. 

Governance of a Cooperative Study in the early 1960s 

Each cooperative study consisted of a chairman who was a VA clinician from one of the 

participating hospitals, a principal investigator at each hospital, a coordinator from VA Central 

Office, generally from Research Service, and a statistician. In most studies, consultants from 

outside VA also met with the group. Usually, an executive committee of the study’s key people 

(the chairman, VACO coordinator, statistician and selected participants) met frequently to review 

results and plan future strategy. In some studies, the chairman and coordinator served this function 

without a committee. All participants met once or twice yearly. Decisions were made by 

consensus. Generally, the participants themselves made the key decisions about the direction of 

their study, and overall guidelines were flexible. Before 1966, no centralized or other systematic 

external review process existed for cooperative studies. 

Funding for cooperative studies competed directly with individual research projects in a disciplinary 

area. Program Chiefs for the various areas of study were responsible for distributing the funds 

within those areas, using their best judgment as to whether a cooperative study or an individual 

investigator’s project should receive higher priority.3 

Cooperative Studies Evaluation Committee 

In 1966, the Cooperative Studies Evaluation Committee (CSEC) (Appendix IIi) was formed. Shaw 

and others felt a need to establish guidance for the Cooperative Studies Program. As Shaw 

described it in an interview: 

“My opinion was that the evaluation of quality research in the VA had proceeded along lines 

where there were field committees established to advise the VA on the quality of each and 

every research field (the Research Evaluation Committees)... I thought that trend was very 

good, and it moved progressively through all domains of VA research enterprises. There was 

no similar thing for cooperative studies. Cooperative studies were largely influenced by the 

VA coordinator... but (we proposed) to set up an evaluation committee that would work with 

all proposed new cooperative studies and comment on the wisdom of (the plan).” 

William Tucker, M.D., Director of the Medical Service and a long-time participant in the 

tuberculosis trials, chaired the first meeting of the CSEC on March 11, 1966. At this meeting, the 

group reviewed the Research Service’s current structure and where the Cooperative Studies 

Program fit into the Service. They accepted as their charge to consider current cooperative studies 

and new proposals for cooperative studies in all fields of medical research and related specialties. 

The Director of Research Service would decide which studies were to be evaluated. 

At its first meeting, the CSEC reviewed a proposal for a new cooperative study on osteoporosis. It 

did not approve the proposal as written but made extensive suggestions for improvement and 

recommended going ahead with a proposed pilot study. In this case, the pilot study did not lead to a 

complete study.3 After that, the CSEC met three times a year for some time and then settled into 

semi-annual meetings. This Committee continues to be active in today’s VA, and its 

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recommendations are routinely accepted as guidelines for funding new and continuing cooperative 

studies. 

Table 13.1. VA Cooperative Studies listed in annual reports, 1960-1970 

Name of Cooperative Study Years listed 

Antihypertensive agents (Chapter 9) 1956–1975 

Atherosclerosis 

Cardiology section 

 Anticoagulant 1957–1971 

 Drug cholesterol lowering 1961–1962 

 Drug lipid 1962–1971 

 Neurology section 

 Anticoagulant 1957–1962 

 Drug cholesterol lowering 1961–1962 

 Drug lipid 1962–1971 

 Estrogen 1963–1970 

 Diet section 

Low fat and unsaturated fatty acids 1957–1961 

Automatic cardiovascular data processing 1960–1974 

Diabetes mellitus 1958–1965 

Endocrine disorders 1958–1966 

Functional (nonorganic) deafness 1961 

Gastroenterology (gastric ulcer) 1959–1969 

Hepatitis 1967–1975 

Osteoporosis 1967–1969 

Arthritis – ankylosing spondylitis 1968–1970 

Nephrosis 1966 

Aging in men 1963–1964 

Endocrine morphology in aging 1965–1967 

Chemotherapy in psychiatry 1957–1973 

Outpatient psychiatry 1958–1964 

Multiple sclerosis 1957–1963 

Microbiology in multiple sclerosis: pilot study 1960–1962 

Amyotrophic lateral sclerosis 1958–1961 

Psychological research 1957–1962 

Chemotherapy of tuberculosis 1946–1974 

Chemoprophylaxis of tuberculosis 1963–1974 

Pulmonary function testing 1956–1965 

Coccidioidomycosis 1957–1961 

Fungus diseases (blasto-, histo-& crypto-coccosis) 1957–1972 

Oral exfoliative cytology 1961–1963 

Hospital infections study 1956–1963 

Coronary artery disease surgery 1957–1975 

Parkinson’s syndrome surgery 1956–1968 

Esophageal varices 1956–1975 

Solitary pulmonary nodules 1957–1968 

Ruptured intervertebral disk 1956–1967 

Techniques for early diagnosis of lung cancer 1957–1962 

Peptic ulcer surgery 1956–1972 

Evaluation of analgesics 1964–1975 

Peripheral vascular disease 1963–1968 

Esophageal cancer 1963–1972 

VA cancer chemotherapy study group 1956–1968 

Lung cancer chemotherapy study group 1957–1975 

VA cooperative urological group 1959–1975 

VA surgical adjuvant cancer chemotherapy study 1957–1975 

Infusion substudy 1963–1967 

University surgical adjuvant study 1958–1963 

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started cooperative studies of coccidioidomycosis, histoplasmosis and blastomycosis in the late

1950s. These diseases, while rare, can pose serious clinical problems in their severe forms. The 

cooperative approach was the only feasible way to conduct studies with the potential to yield

definitive answers about the best treatment. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Western cooperative cancer chemotherapy group 1961–1963
 

Pacific VA Cancer chemotherapy group 1961–1971
 

Southwest cancer chemotherapy group 1956–1964
 

Midwest cooperative chemotherapy group 1959–1964
 

Between 1960 and 1970, a total of 54 VA cooperative studies were listed in the annual reports to 

Congress (Table 13.1), covering a wide range of disciplines. In 1960, 34 were in progress; in 1970, 

21 were in progress; 12 studies were in progress throughout this entire period. 

A number of cooperative studies grew out of the tuberculosis trials (Chapter 5) and the annual 

conference they stimulated. These studies became independent of the tuberculosis trials 

themselves, though the same investigators were often involved. Among the studies included were 

research on the solitary pulmonary nodule, pulmonary function testing and fungal diseases of the 

lungs, each of which we will discuss in the next few pages. 

The solitary pulmonary nodule 

As part of the transition of the VA-Armed Forces studies from research specifically of tuberculosis 

to studies of pulmonary disease in general, the surgeons in the group began to study solitary 

pulmonary nodules that were discovered on routine chest X-rays. In 1957, a study of patients with 

such nodules began under the leadership of John Steele, M.D., of the San Fernando (Calif.) VA 

Hospital. 

Dr. Steele died before the final 10-year follow-up period was completed, and George Higgins, 

M.D., and statisticians from the group at the Follow-up Agency completed the analysis. Patients 

included in the study were male patients with asymptomatic, undiagnosed solitary pulmonary 

nodules less than 6 centimeters in diameter. All underwent surgery. In this group, 370 of the 

lesions proved to be malignancies that could be removed. These patients were then followed for 10 

years after surgery. The five-year survival was 38.5 percent and the 10-year survival 20.1 percent. 

Survival was longer in younger patients and those with smaller nodules. Comparing this series with 

a different series of VA patients who had resectable but symptomatic lung cancer, who had a 26.3 

percent 5-year survival, indicated the advantage of removing the cancer before it became 

symptomatic.4 

Chemoprophylaxis of tuberculosis (1963–1974) 

Another study spun off from the tuberculosis trials was a trial of isoniazid in the prevention of 

recurrence in patients with tuberculosis in remission. This trial, based on a study that showed a 

significant rate of reactivation of tuberculosis in VA patients with inactive disease, was a 

randomized double-blind study with three regimens, two with isoniazid and one with placebo only. 

A total of 7,036 patients with inactive disease, including some who had received prior 

chemotherapy, were treated for two years and then observed for five more years. In previously 

untreated patients, isoniazid led to fewer reactivations than experienced by patients receiving 

placebo, but previously treated patients, who had a very low rate of reactivation, showed no 

difference.5 

Fungal diseases 

Groups from VA and Armed Services hospitals in areas endemic for systemic fungal diseases 

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304

from VA and Armed Services itals in areas endemic for mic diseases 

Groups from VA and Armed Services hospitals in areas endemic for systemic fungal diseases 

started cooperative studies of coccidioidomycosis, histoplasmosis and blastomycosis in the late

1950s. These diseases, while rare, can pose serious clinical problems in their severe forms. The 

cooperative approach was the only feasible way to conduct studies with the potential to yield

definitive answers about the best treatment. 

Coccidioidomycosis

An example of the easy transition during the 1960s between a cooperative study and a loose 

coalition of persons interested in a problem involved the disease coccidioidomycosis. Especially in 

the Southwest and the deserts and valleys of California, where it is endemic, this disease was

important in the differential diagnosis of tuberculosis and was treated by the same pulmonary

specialists who treated tuberculosis. In 1957, a group interested in coccidioidomycosis met at the 

annual tuberculosis meetings and formed a cooperative study group. As a first step, they created a

registry of patients with systemic coccidioidomycosis and began meeting annually to discuss this

disease. By the early 1960s, it had become apparent that the only effective treatment, amphotericin 

B, was very toxic and that a randomized trial was not feasible at that time. Instead, the group

became a VA Study Group and continued their annual meetings to share clinical experiences and

the results of basic research.

At the 14th meeting of this group, in 1970, attendees included representatives from the VA hospitals 

at Fresno, Long Beach, Los Angeles, San Fernando, San Diego, Oakland and Sepulveda, Calif.;

Tucson and Phoenix, Ariz.; and the Western Research Support Center and VACO. Two Army 

hospitals, two Air Force hospitals, the Centers for Disease Control in Atlanta, the NIH, UC Davis,

USC, San Diego State University, and the Kern County, Calif., General Hospital were also

represented. By this time, the group had added the sponsorship of local pulmonary professional 

groups to its primary VA support.6 This group has continued to be active. The group is currently

under NIH sponsorship, with VA researchers as active members and John N. Galgiani, M.D., of the 

Tucson VA Medical Center as Secretary.7

Histoplasmosis

In this study, which began in 1957 and ended in 1972, 85 patients with chronic pulmonary

histoplasmosis were treated with amphotericin B, with doses randomized. Endpoints were the 

elimination of histoplasma from the sputum and the occurrence of amphotericin B toxicity. Both

were related to dosage and duration of therapy. The relatively small dose of amphotericin B, 0.5

grams given over the course of 3.5 weeks, controlled the infection in only two-thirds of the patients.

Even at this low dose, 80 percent had toxic reactions, but these did not require interrupting the

treatment, and re-treatment of patients who failed to respond was uniformly successful. On the 

other hand, a dose of 2.5 grams given over the course of 17 weeks controlled the infection in all

patients, but toxicity was reported in 86 percent of patients, and in 29 percent toxicity was so severe 

that therapy was discontinued. Participants in the study concluded that the best approach to using

this drug was to employ a dose intermediate between the two tested, or to use a small dose followed

by re-treatment when necessary.8

Blastomycosis

blastomycosis entered into the study, 41 were treated with amphotericin B and 43 received 2-

hydroxystilbamidine. The results showed that pulmonary blastomycosis of a noncavitary nature,

which was not extensive in its degree of involvement and was either not disseminated to other 

organs or disseminated only to the skin, responded well to either drug. When pulmonary

involvement was extensive or associated with cavitiesamphotericin B was the more effective 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Groups hosp syste fungal 

started cooperative studies of coccidioidomycosis, histoplasmosis and blastomycosis in the late 

1950s. These diseases, while rare, can pose serious clinical problems in their severe forms. The 

cooperative approach was the only feasible way to conduct studies with the potential to yield 

definitive answers about the best treatment. 

Coccidioidomycosis 

An example of the easy transition during the 1960s between a cooperative study and a loose 

coalition of persons interested in a problem involved the disease coccidioidomycosis. Especially in 

the Southwest and the deserts and valleys of California, where it is endemic, this disease was 

important in the differential diagnosis of tuberculosis and was treated by the same pulmonary 

specialists who treated tuberculosis. In 1957, a group interested in coccidioidomycosis met at the 

annual tuberculosis meetings and formed a cooperative study group. As a first step, they created a 

registry of patients with systemic coccidioidomycosis and began meeting annually to discuss this 

disease. By the early 1960s, it had become apparent that the only effective treatment, amphotericin 

B, was very toxic and that a randomized trial was not feasible at that time. Instead, the group 

became a VA Study Group and continued their annual meetings to share clinical experiences and 

the results of basic research. 

At the 14th meeting of this group, in 1970, attendees included representatives from the VA hospitals 

at Fresno, Long Beach, Los Angeles, San Fernando, San Diego, Oakland and Sepulveda, Calif.; 

Tucson and Phoenix, Ariz.; and the Western Research Support Center and VACO. Two Army 

hospitals, two Air Force hospitals, the Centers for Disease Control in Atlanta, the NIH, UC Davis, 

USC, San Diego State University, and the Kern County, Calif., General Hospital were also 

represented. By this time, the group had added the sponsorship of local pulmonary professional 

groups to its primary VA support.6 This group has continued to be active. The group is currently 

under NIH sponsorship, with VA researchers as active members and John N. Galgiani, M.D., of the 

Tucson VA Medical Center as Secretary.7 

Histoplasmosis 

In this study, which began in 1957 and ended in 1972, 85 patients with chronic pulmonary 

histoplasmosis were treated with amphotericin B, with doses randomized. Endpoints were the 

elimination of histoplasma from the sputum and the occurrence of amphotericin B toxicity. Both 

were related to dosage and duration of therapy. The relatively small dose of amphotericin B, 0.5 

grams given over the course of 3.5 weeks, controlled the infection in only two-thirds of the patients. 

Even at this low dose, 80 percent had toxic reactions, but these did not require interrupting the 

treatment, and re-treatment of patients who failed to respond was uniformly successful. On the 

other hand, a dose of 2.5 grams given over the course of 17 weeks controlled the infection in all 

patients, but toxicity was reported in 86 percent of patients, and in 29 percent toxicity was so severe 

that therapy was discontinued. Participants in the study concluded that the best approach to using 

this drug was to employ a dose intermediate between the two tested, or to use a small dose followed 

by re-treatment when necessary.8 

Blastomycosis 

This group carried out, also from 1957 through 1972, a randomized trial comparing two potential 

treatments for this rather rare systemic fungal disease. Of 84 patients with North American 

304
 
305

This group carried out, also from 1957 through 1972, a randomized trial comparing two potential 

treatments for this rather rare systemic fungal disease. Of 84 patients with North American

This group carried out, also from 1957 through 1972, a randomized trial comparing two potential 

treatments for this rather rare systemic fungal disease. Of 84 patients with North American

blastomycosis entered into the study, 41 were treated with amphotericin B and 43 received 2-

hydroxystilbamidine. The results showed that pulmonary blastomycosis of a noncavitary nature,

which was not extensive in its degree of involvement and was either not disseminated to other 

organs or disseminated only to the skin, responded well to either drug. When pulmonary

involvement was extensive or associated with cavities, amphotericin B was the more effective 

agent. Involvement of any organ other than the lung or skin was best treated with amphotericin B.9

Cooperative groups developing diagnostic methods

Several groups of hospitals were involved in collaborative efforts to improve diagnostic methods. 

Prominent among them were the pulmonary function study, the study of endocrine disorders and the 

automatic cardiovascular data processing group.

Pulmonary function testing 

A cooperative study between 1956 and 1965 was developed to standardize techniques and establish 

normal values for the multiple tests in use to evaluate pulmonary function. The research group

critically evaluated tests for measuring ventilation, lung volumes and alveolar capillary diffusion 

and then applied them to diagnostic and prognostic studies of patients with emphysema and those 

undergoing thoracic surgery.

Endocrine disorders

This group of investigators at 10 VA hospitals started in 1958 with the intention of using the 

randomized clinical trial method to study rare endocrine diseases such as Addison’s disease. 

However, the researchers agreed that standardization of diagnostic methods was needed first. They

developed the ACTH stimulation test for diagnosis of adrenal hypofunction or hyperfunction.

Based on data from over 6,000 such tests, they set the “gold standard” for these diagnoses in 1966. 

By the mid-1960s, the group developed a cluster of four subcommittees that contributed technical 

leadership in specific areas for development of cooperative study protocols. Pilot studies evaluated 

the effects of human growth hormone in renal failure, obesity and osteoporosis. With help from

their consultants, Drs. Berson, Yalow and Unger, 10 the research group developed immunoassays for

insulin, growth hormone, parathormone, TSH and ACTH. 

In 1966, this group was redesignated a “Study Group” and charged with identifying possible future 

cooperative studies. While such additional studies were never conducted, the contributions of this 

group to endocrinology were profound. The standardized ACTH test was widely used for diagnosis

of adrenal disease until radioimmunoassay of the adrenal compounds became reliable. And the 

improved availability of radioimmunoassay of the hormones benefited millions of patients.

Automatic cardiovascular data processing

group m osp ta s to co ect pat ent s program

automatic analysis and to advise him on improvements in the program. The following excerpts

from the annual Medical Research in the Veterans Administration give the flavor of this work:

1969: “Electrocardiograms of a series of 405 patients with pulmonary emphysema of

moderate or severe degree were studiedUsing a variety of statistical techniquesoptimal ECG 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

blastomycosis entered into the study, 41 were treated with amphotericin B and 43 received 2-

hydroxystilbamidine. The results showed that pulmonary blastomycosis of a noncavitary nature, 

which was not extensive in its degree of involvement and was either not disseminated to other 

organs or disseminated only to the skin, responded well to either drug. When pulmonary 

involvement was extensive or associated with cavities, amphotericin B was the more effective 

agent. Involvement of any organ other than the lung or skin was best treated with amphotericin B.9 

Cooperative groups developing diagnostic methods 

Several groups of hospitals were involved in collaborative efforts to improve diagnostic methods. 

Prominent among them were the pulmonary function study, the study of endocrine disorders and the 

automatic cardiovascular data processing group. 

Pulmonary function testing 

A cooperative study between 1956 and 1965 was developed to standardize techniques and establish 

normal values for the multiple tests in use to evaluate pulmonary function. The research group 

critically evaluated tests for measuring ventilation, lung volumes and alveolar capillary diffusion 

and then applied them to diagnostic and prognostic studies of patients with emphysema and those 

undergoing thoracic surgery. 

Endocrine disorders 

This group of investigators at 10 VA hospitals started in 1958 with the intention of using the 

randomized clinical trial method to study rare endocrine diseases such as Addison’s disease. 

However, the researchers agreed that standardization of diagnostic methods was needed first. They 

developed the ACTH stimulation test for diagnosis of adrenal hypofunction or hyperfunction. 

Based on data from over 6,000 such tests, they set the “gold standard” for these diagnoses in 1966. 

By the mid-1960s, the group developed a cluster of four subcommittees that contributed technical 

leadership in specific areas for development of cooperative study protocols. Pilot studies evaluated 

the effects of human growth hormone in renal failure, obesity and osteoporosis. With help from 

their consultants, Drs. Berson, Yalow and Unger, 10 the research group developed immunoassays for 

insulin, growth hormone, parathormone, TSH and ACTH. 

In 1966, this group was redesignated a “Study Group” and charged with identifying possible future 

cooperative studies. While such additional studies were never conducted, the contributions of this 

group to endocrinology were profound. The standardized ACTH test was widely used for diagnosis 

of adrenal disease until radioimmunoassay of the adrenal compounds became reliable. And the 

improved availability of radioimmunoassay of the hormones benefited millions of patients. 

Automatic cardiovascular data processing 

Computerization of the electrocardiogram (EKG or ECG) is now an accepted technology, assisting 

in the routine diagnosis of heart disease. One of the pioneers in this field was Hubert Pipberger, 

M.D., at the Washington (D.C.) VA Hospital. By the late 1960s, Dr. Pipberger had assembled a 

of collaborators fro eight VA h i l ll i EKG data using hi for 

305
 
306

Computerization of the electrocardiogram (EKG or ECG) is now an accepted technology, assisting

in the routine diagnosis of heart disease. One of the pioneers in this field was Hubert Pipberger, 

M.D., at the Washington (D.C.) VA Hospital. By the late 1960s, Dr. Pipberger had assembled a

Computerization of the electrocardiogram (EKG or ECG) is now an accepted technology, assisting

in the routine diagnosis of heart disease. One of the pioneers in this field was Hubert Pipberger, 

M.D., at the Washington (D.C.) VA Hospital. By the late 1960s, Dr. Pipberger had assembled a

group of collaborators from eight VA hospitals to collect patient EKG data using his program for 

automatic analysis and to advise him on improvements in the program. The following excerpts

from the annual Medical Research in the Veterans Administration give the flavor of this work:

1969: “Electrocardiograms of a series of 405 patients with pulmonary emphysema of

moderate or severe degree were studied. Using a variety of statistical techniques, optimal ECG 

measurements were determined for the differentiation of pulmonary emphysema ECG’S from

normal.

“They were divided into those which can be conveniently obtained through visual record 

analysis and those of a more complex nature obtained by digital computation. Using 14 ECG

measurements with a multivariate statistical technique, more than 80 percent of the emphysema

cases could be classified correctly with a false positive rate of only 5 percent. Thus, the

electrocardiogram could be improved substantially as a diagnostic tool for the recognition of

pulmonary emphysema which represents an increasing health hazard. 

“A similar study was performed on 452 ECG records from patients with ventricular conduction

defects. They were divided into those with and without a history of myocardial infarction.

Recognition of infarcts in the presence of ventricular conduction defects has always been a

most difficult problem in electrocardiography. Using multivariate statistics more than 50

percent of the infarcts could be classified correctly. The results were confirmed in 89 autopsy 

cases.11

1974: “In long-distance telephone transmissions of electrocardiograms, excessive noise

interference is frequently encountered. When records were transmitted from the VA Hospital

West Roxbury, Mass. to the VA Hospital, Washington, D.C., over a three-year period, data 

could not be successfully processed by computer because of high noise levels in approximately

8 percent of the cases. A digital filter was designed and tested, therefore, which led to

elimination of most of the interference without substantial distortions of the EGG data proper.

No more records were lost after application of the filter.

“Electrocardiograms from 191 patients with mitral stenosis were studied and compared with

510 records from normal subjects. Using a computer program based on multivariate analysis, it

was possible to diagnose correctly 74 percent of the cases, which compared very favorably

with the 44 percent recognized by conventional hand measurements.

“A new computer program was developed for the diagnosis of myocardial infarcts in the 

presence of ventricular conduction defects. When tested on 847 patients, it was possible to

identify records from patients with infarcts correctly in 61 percent of the cases.”12

During the 1970s, Pipberger and his colleagues compared, in patients with clear diagnoses 

independent of the EKG, the accuracy of the computerized analysis with that of nine experienced

electrocardiographers. The human interpreters had an accuracy of 54 percent, which improved to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

group of collaborators from eight VA hospitals to collect patient EKG data using his program for 

automatic analysis and to advise him on improvements in the program. The following excerpts 

from the annual Medical Research in the Veterans Administration give the flavor of this work: 

1969: “Electrocardiograms of a series of 405 patients with pulmonary emphysema of 

moderate or severe degree were studied. Using a variety of statistical techniques, optimal ECG 

measurements were determined for the differentiation of pulmonary emphysema ECG’S from 

normal. 

“They were divided into those which can be conveniently obtained through visual record 

analysis and those of a more complex nature obtained by digital computation. Using 14 ECG 

measurements with a multivariate statistical technique, more than 80 percent of the emphysema 

cases could be classified correctly with a false positive rate of only 5 percent. Thus, the 

electrocardiogram could be improved substantially as a diagnostic tool for the recognition of 

pulmonary emphysema which represents an increasing health hazard. 

“A similar study was performed on 452 ECG records from patients with ventricular conduction 

defects. They were divided into those with and without a history of myocardial infarction. 

Recognition of infarcts in the presence of ventricular conduction defects has always been a 

most difficult problem in electrocardiography. Using multivariate statistics more than 50 

percent of the infarcts could be classified correctly. The results were confirmed in 89 autopsy 

11 cases.

1974: “In long-distance telephone transmissions of electrocardiograms, excessive noise 

interference is frequently encountered. When records were transmitted from the VA Hospital 

West Roxbury, Mass. to the VA Hospital, Washington, D.C., over a three-year period, data 

could not be successfully processed by computer because of high noise levels in approximately 

8 percent of the cases. A digital filter was designed and tested, therefore, which led to 

elimination of most of the interference without substantial distortions of the EGG data proper. 

No more records were lost after application of the filter. 

“Electrocardiograms from 191 patients with mitral stenosis were studied and compared with 

510 records from normal subjects. Using a computer program based on multivariate analysis, it 

was possible to diagnose correctly 74 percent of the cases, which compared very favorably 

with the 44 percent recognized by conventional hand measurements. 

“A new computer program was developed for the diagnosis of myocardial infarcts in the 

presence of ventricular conduction defects. When tested on 847 patients, it was possible to 

identify records from patients with infarcts correctly in 61 percent of the cases.”12 

During the 1970s, Pipberger and his colleagues compared, in patients with clear diagnoses 

independent of the EKG, the accuracy of the computerized analysis with that of nine experienced 

electrocardiographers. The human interpreters had an accuracy of 54 percent, which improved to 

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62 percent when they were shown the results of the automated interpretation. The computer 

analysis was 76 percent accurate in the same cases. The superiority of computer analysis was 

attributed to the use of a Bayesian classification method and multivariate analysis by the 

computer.13 

Analgesia and anesthesia 

This 1963-1975 study involved a group of VA hospitals standardizing the effects of both new and 

established drugs for the relief of pain. It was led by William Forrest, M.D., an anesthesiologist at 

the Palo Alto (Calif.) VA Hospital and involved the cooperation of five VA hospitals. Stanford 

University’s Byron Brown, Ph.D., was the consulting statistician. The group developed practical 

questionnaires to assess pain and collaborated with trained nurse observers. In general, morphine 

was used as the comparison standard for parenteral agents, and codeine for oral agents. This group 

collaborated with the National Academy of Sciences’ National Research Council, Committee on 

Drug Addiction and Narcotics, which selected the important drugs to test, as well as with 

pharmaceutical companies that supplied the blinded agents. Many agents were evaluated during the 

course of this study. A subcommittee on animal anesthesia compiled a manual of anesthetic 

techniques for commonly used laboratory animals. 

These researchers were pioneers in computer analysis of the complex data generated from this type 

of study. In 1964, they reported: 

“Statistical methods of handling the data from the participating hospitals have been refined 

such that rapid computer analysis is now possible. Statistical tests have been applied to the 

computer method and the data has been examined by several methods with consistent results 

showing little variability.” 

These methods were later used in other cooperative studies. The transition to their use was 

expedited by Kenneth James, Ph.D., a statistician for the analgesia studies, who later joined the 

Hines Cooperative Studies Program Coordinating Center and subsequently became the founding 

Chief of the Coordinating Center at Palo Alto. 

Diabetes 

From 1958 through 1965 this study examined new oral drugs to control diabetes in patients with 

non-insulin-dependent diabetes mellitus. Eleven VA hospitals cooperated in the randomized, 

double-blind study comparing chlorpropamide, tolbutamide and placebo. The patients were highly 

selected, with only 121 chosen out of the 3,493 screened. Chlorpropamide controlled diabetes in 

more patients than did tolbutamide (83 percent vs 60 percent), but both drugs were more effective 

than placebo (26 percent). This study, together with similar studies by others, helped establish these 

drugs’ roles in diabetes care.14 

Atherosclerosis 

Investigators especially interested in heart disease or neurovascular disease participated in this study 

group. 

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The cardiology group focused on dietary control, and their efforts soon concentrated on a diet study 

in the domiciliary at the Los Angeles VA Hospital under the leadership of Seymour Dayton, M.D. 

The neurology group carried out a series of studies aimed at lowering the risk of stroke in patients 

with cerebral atherosclerosis. Their first effort, completed in 1960, was a study of anticoagulants. 

Investigators in nine VA hospitals studied 155 patients with documented cerebrovascular disease, 

either cerebral ischemia or cerebral infarction. The patients were divided equally on a random basis 

between treatment and control groups and observed for an average period of about nine and 12 

months, respectively, after entering the study. Although anticoagulation appeared to decrease the 

number of attacks of cerebral ischemia, there was no reduction in the incidence of new or recurrent 

strokes. A higher mortality rate was found in the treated patients, due in part to hemorrhagic 

complications. The study concluded that long-term anticoagulation is neither a practical nor 

effective method of treatment for the majority of patients with cerebrovascular disease caused by 

atherosclerosis.15 An independent, NIH-supported study reported similar findings around the same 

time. 

Next, the neurology group studied the effect of estrogens in preventing repeat stroke. Fifteen VA 

hospitals studied 572 men who had suffered cerebral infarctions, assigning them randomly by a 

double-blind protocol 1.25 mg Premarin daily, 5 mg Premarin daily or placebo. They found that 

estrogen administration did not reduce the incidence of cerebral infarction, transient cerebral 

ischemia or death due to vascular disease. In fact, the use of hormones was associated with a higher 

overall death rate. This was due to cancer and vascular disorders, such as pulmonary embolism, 

mesenteric thrombosis and heart failure and various other diseases. On the other hand, incidence of 

and death from myocardial infarction was decreased in treated patients compared with control 

patients. The investigators concluded that men with cerebral infarction received no benefit from 

estrogens given in moderate amounts for up to five years.16 

Another group of 20 VA hospitals studied the effect of clofibrate, a lipid-lowering drug, in 532 

patients who had suffered cerebral infarction or transient cerebrovascular ischemic attacks (TIA). In 

a randomized, double-blind study, patients were assigned to clofibrate, 2 grams daily, or to a 

placebo, and were followed for up to 41⁄2 years. Contrary to expectations, recurrence of cerebral 

infarction actually increased in patients receiving clofibrate compared to controls. The incidence of 

new myocardial infarction and new TIA was similar in both groups. Despite the more frequent 

strokes in treated patients, they had a decrease in mortality, partially explained by a lower death rate 

from these recurrences. There was no correlation between pretreatment lipid (cholesterol and 

triglyceride) values and the result of therapy. Use of clofibrate, however, was associated with a 

slight reduction of cholesterol and a sustained fall in triglyceride levels. The investigators 

concluded that this was not an effective way to prevent repeat vascular insults in stroke patients.17 

Gastric ulcer 

Gastroenterologists in 16 VA hospitals studied 638 patients with gastric ulcers that were not 

considered to be malignant based on X-ray. Patients were hospitalized and treated with antacids 

and diet, the standard treatment for peptic ulcer at that time. The 111 patients whose ulcers did not 

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heal sufficiently within 12 weeks of treatment were randomized either to immediate surgery or 

another 12 weeks of medical treatment. 

This study was published as a special supplement to the journal Gastroenterology.18 Dr. Morton 

Grossman summarized the complex and inconclusive results. Of those patients with unhealed 

ulcers randomized to further medical treatment, 42 percent healed completely in the second 12 

weeks of therapy. However, there was a high rate of recurrence of the ulcers in the medically 

treated patients during the two-year observation period. Cancer was found in 3.9 percent (25) of the 

638 patients, but the indicators for cancer were not clear-cut. Grossman concluded that, despite the 

tremendous effort and careful design of the study, its fundamental question, whether medical or 

surgical treatment is better for gastric ulcers that don’t heal promptly, remained unanswered.19 

Surgery for duodenal ulcer 

A cooperative group of VA surgeons started tracking the results of different types of surgery for 

duodenal ulcer in 1956. They published their retrospective analysis as a monograph in 1963.20 

After reviewing their findings, they concluded in 1972 that a prospective randomized study was 

needed to establish the best type of surgical procedure for this disease. 

For the prospective study, patients were selected who needed surgery for their ulcers. They were 

not randomized until the surgeon made sure, during their operation, that any of the four operations 

under study could be performed safely. At that point, a sealed envelope was opened in the 

operating room to identify the operation for the particular patient. In 17 VA Hospitals, 1,358 

patients with duodenal ulcer requiring operation were randomly assigned to vagotomy and drainage, 

vagotomy and distal antrectomy, vagotomy and hemigastrectomy, or gastric resection alone. 

The post-operative mortality and morbidity rates were least with vagotomy and drainage, but the 

incidence rate of recurrent ulcers during the two years after operation was highest with this 

procedure. The late sequelae tended to be more frequent and severe in relation to the amount of 

stomach removed. No statistically significant differences in the frequency of good and excellent 

results, as estimated by the surgeon, the patient or an independent physician, were found among the 

four surgical procedures.21 

Esophageal varices 

This very difficult clinical problem was studied by a group of surgeons for nearly twenty years 

(1956 through 1975) who attempted a randomized study comparing portacaval shunt surgery with 

non-surgical treatment. They studied patients who had known varices that had not yet bled and also 

patients who had already bled from their varices. They found that half of the medically treated 

patients would die from bleeding either from the varices or from other sources during the 31⁄2-year 

follow-up period. While the operative mortality (13.5 percent) was not itself a primary factor in 

survival after a prophylactic shunt, there were serious complications. Liver failure and ulcer disease 

were the most serious threats to the shunted patient if the patient survived one year after surgery. 

An operation in the setting of established liver disease was still incompatible with a lengthened 

survival. They concluded that the portacaval shunt was not recommended in the nonbleeding, 

established cirrhotic patient with recent ascites, jaundice or encephalopathy.22 

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In the even more dismal context of the patient who has already had bleeding from his or her 

esophageal varices, 155 patients were randomized, 78 given non-surgical treatment and 77 

receiving shunt surgery. They were followed for an average of 51⁄2 years. Of the medically treated 

patients, 37 percent survived the observation period, as did 55 percent of the shunted patients. The 

group concluded that “irrespective of the frequency or degree of previous or recent hemorrhage 

from varices, and previous or recent hepatic failure, the stabilized cirrhotic patient has a more 

favorable opportunity for a prolonged survival if he receives a portacaval shunt. Age, varying 

values of standard liver function tests, histological changes in the liver, the threat of peptic ulcer, the 

ravages of hepatic failure and post-shunt encephalopathy affect but do not appear to significantly 

alter this outcome, especially when the alternative is a conservative approach to a threat of lethal 

rehemorrhage.”23 

In the discussion after this study was presented, Ronald A. Malt, M.D., of Harvard Medical School 

and the Boston VA Medical Center, commented, “The enormous amount of data in the complete 

manuscript, and the objectivity with which Dr. Jackson and his colleagues have analyzed it, sets a 

new standard in this area. And I am afraid that the rest of us who are interested in portal 

hypertension are going to have to work a lot harder just to try to keep up with it.” 

Coronary artery surgery studies 

Angina pectoris and myocardial infarction, caused by obstruction of the coronary arteries, become 

increasingly important as a patient ages. Surgical attempts to improve coronary circulation came 

into common use in the 1960s, but no objective studies had been done by this time to prove whether 

the techniques actually helped patients. 

In 1960, a group of VA surgeons designed a cooperative study to evaluate the Beck procedure, in 

which powder was introduced into the pericardial sac to cause adhesions between the pericardium 

and the heart. About 150 patients were randomized either to surgery or to non-surgical treatment. 

After following these patients for four years, the group concluded that the outcome of surgery was 

no better than that of medical treatment.24 

Next, the group studied the Vineberg operation, a procedure in which the internal mammary artery 

was implanted into the ischemic myocardium, which at that time was the most widely used 

operation for coronary artery disease. A pilot study of the Vineberg procedure began in 1966 and 

was expanded to a full study in 1968. In all, 146 patients were enrolled. The long-term results 

showed no significant effect on survival after an average follow-up of 9.3 years.25 

By 1970, coronary artery bypass surgery had come into frequent use, and the group began a pilot 

study of that procedure (Chapter 18). 

Studies supported by the National Cancer Institute 

Another important group of studies were conducted in collaboration with the National Cancer 

Institute (NCI). These included surgical adjuvant studies, studies of medical treatment for 

inoperable lung cancer, and studies of treatment for prostate cancer. We’ll discuss each of these 

types of studies on the following pages. 

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Surgical adjuvant studies 

Shortly after Lyndon Lee, M.D. (Figure 12.5), arrived in VA Central Office in 1957 as Surgery 

Service Research Coordinator, Dr. John Barnwell introduced him to NCI Director Rodney Heller. 

Heller placed Lee on one of his Advisory Groups, and together they negotiated a collaborative 

program26 to study the effects of adjuvant treatments given patients at the time of their surgery for 

primary cancers. A group of interested VA surgeons was assembled and the Follow-up Agency 

agreed to provide statistical support. 

Over the next 25 years, this group studied almost 12,000 patients undergoing primary surgery for 

cancers of the lung, pancreas, esophagus, stomach, colon and rectum.28-27 As promising new 

treatments were identified, the group would decide whether to start a new protocol to test them. 

The statisticians from the Follow-up Agency would design the protocols for the trial, always with 

strict randomization: new treatment plus surgery compared with surgery alone. Possible dangers of 

the treatments were tracked carefully, and a protocol was discontinued if patients on the adjuvant 

treatment did not respond as well as the control group. 

Some of the most important findings of this group turned out to be the negative results. Adjuvant 

chemotherapy did not improve the outcome of surgery for cancers of the stomach, pancreas, 

esophagus or lung, findings that since have been repeatedly confirmed. Similarly, despite its 

popularity at the time, preoperative radiation did not improve the outcome of surgery for lung 

cancer. These negative findings spared patients the danger, discomfort and cost of futile efforts to 

improve their chances of cure. 

On the other hand, this group showed that preoperative radiation did improve the chance of cure in 

rectal cancer and that 5-fluorouracil adjuvant chemotherapy increased the numbers of disease-free 

patients as well as the overall survival of patients with colon cancer.27 

Treatment of inoperable lung cancer 

This cooperative study group, also supported by the NCI, systematically evaluated the effect of 

therapies on patients with inoperable pulmonary carcinoma. This series of carefully controlled 

clinical trials involving over 9,000 patients began in February 1958 and continued until 1975. 

At first, the group used an inert compound as a control against the agent to be tested because no 

valid evidence was available that any form of therapy prolonged the survival of patients with 

inoperable lung cancer. After cyclophosphamide was found to have a slight effect in prolonging 

survival in patients with extensive disease, this medication became the standard against which other 

therapeutic modalities were compared. The group’s first protocol showed that cortisone had a 

deleterious effect. In patients with disease limited to the thorax, they found that radiotherapy 

prolonged survival slightly. Cyclophosphamide and BCNU had similar effects, achieving a slight 

but statistically significant improvement in prognosis. 

Taking into account histologic type, the research team found that nitrogen mustard has its greatest 

effect on patients with highly and moderately differentiated squamous cell lung cancer types, while 

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cyclophosphamide was more effective in patients with undifferentiated small cell type. This 

differential effect of alkylating agents had been suspected before but had rarely been demonstrated 

with solid tumors such as bronchogenic carcinoma. 

In addition to its careful randomized treatment comparisons, this group kept meticulous clinical 

records and performed intensive histologic analysis of tumors. Their work improved the 

understanding of lung cancer pathology and identified patient characteristics that influence survival 

and response to treatment.12 

Prostate cancer studies 

This NCI-supported VA cooperative study group studied some 5,000 patients with prostate cancer 

between 1959 and 1975. Their early results conclusively showed that, while administration of 

stilbestrol in daily doses of 1.0 to 5.0 mg has a therapeutic effect on metastatic prostatic cancer, it 

causes cardiovascular complications. While these complications are dose-related, they disappear 

only when ineffective doses of stilbestrol are given. They also found bilateral orchiectomy to be of 

questionable value in any stage of prostatic carcinoma. 

The study group concluded that, owing to the cardiovascular complications, treatment with 

estrogens should be withheld in prostatic carcinoma with regional spread until the development of 

symptoms severe enough to warrant the risk of cardiovascular complications. They also concluded 

that, in early focal prostatic cancer of elderly men, no treatment should be given, as these tumors are 

very slow-growing and the complications associated with surgical or hormonal treatment outweigh 

any possible benefit of treatment. 

While additional advances have been made in prostate cancer treatment since these studies were 

completed, the finding of the adverse cardiovascular effect of high-dose stilbestrol had a profound 

effect on practice in the period following this study. 

Outpatient psychiatry 

Associated with the psychopharmacology group (Chapter 8) but separate from it was a cooperative 

group that worked in outpatient clinics in VA’s freestanding Regional Offices. Coordinated by 

Maurice Lorr, Ph.D., of VA Central Office, this group conducted single-protocol studies intended to 

improve treatment of psychiatric outpatients. The studies took advantage of the rating scales that 

Dr. Lorr was developing, and led to the development of other rating scales. 

In a 1960 study by this group, 23 VA mental hygiene clinics collaborated in a 12-week, doubleblind study of meprobamate and chlorpromazine to learn whether individual psychotherapy with a 

tranquilizer would be more effective in reducing anxiety and hostility than psychotherapy alone or 

psychotherapy with either of two control substances. One hundred eighty patients were randomly 

assigned to five treatment groups. Comparative analysis after eight weeks of treatment revealed 

that neither chlorpromazine nor meprobamate used adjunctively had an advantage over 

psychotherapy alone, or over psychotherapy with either of two control substances, in reducing 

anxiety and hostility. Both patients and therapists agreed with this finding. 

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A 1962 study evaluated the short-term effects of a new tranquilizer, chlordiazepoxide, on the 

anxiety and tension of newly accepted patients. The four-week project using a double-blind design 

was conducted in 23 VA mental hygiene clinics on 150 male patients referred for psychiatric care. 

Each patient was randomly assigned to one of six treatment groups. The effects of treatment were 

evaluated by means of 10 initial and terminal tests and on the basis of weekly self-reports on an 

adjective rating scale. In addition, patients assigned to psychotherapy were evaluated before and 

after treatment by their therapists. Patients on the drug under study reported significant reduction in 

anxiety and increased vigor during the first week, but these effects disappeared by the study’s close. 

However, psychotherapists reported that patients receiving the drug were significantly less severely 

ill and that their rapport with others improved. The prescribing physician also judged patients 

receiving the drug to be improved. On the other hand, all patients receiving a capsule, whether a 

placebo or an active drug, reported greater reduction in anxiety and depression and greater overall 

improvement than those not receiving a capsule.28 

Comments on the cooperative studies of the 1960s 

Most of the studies described here share features characteristic of VA cooperative studies of the 

1960s, characteristics that decreased or disappeared in later years. In general, such studies were 

products of an ongoing coalition of investigators focused on a general clinical problem. When one 

study was completed, the group, which by that time had formulated new questions, often moved on 

to another related study. This blurred the boundaries between studies, in contrast to the crisply 

defined studies begun in the 1970s and later. 

Many of these studies were coordinated and analyzed by contract statisticians, rather than by those 

within the VA. In some, protocol changes occurred by consensus rather than by decision of a 

formal review group. A large number of protocols were carried out, with continuity being provided 

by the group of physicians performing the studies rather than in the protocols themselves. A 

remarkable feature was the loyalty of the groups to their goals. Even the experience of one 

disappointment after another (as for the lung cancer treatment group) did not discourage them from 

seeking reliable ways to improve the outlook for their patients. 

Obsolescence of a drug or procedure is a problem that remains important in deciding which of these 

very ambitious and expensive studies to undertake. If something better comes along, the study is no 

longer relevant. But if something better doesn’t appear, learning whether the intervention will 

benefit the patient is an obvious step forward. Some cooperative studies begun in the 1960s were 

abandoned after a short period, either by the investigators themselves or by the Cooperative Studies 

Evaluation Committee, when it appeared that the promise of further benefits appeared limited. 

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References 

1. Interview with Clifford Bachrach, M.D., May 7, 1992 at Dr. Bachrach's home in 

Gaithersburg, MD. 

2. Interview with Lawrence W. Shaw, M.S., February 3, 1994 at Mr. Shaw’s home in Florida. 

3. Mimeographed document provided by Mr. Lawrence Shaw. "Highlights of the First Meeting 

of the Cooperative Studies Evaluation Committee." 1966. 

4. Higgins, G., Shields, T. and Keehn, R., "The solitary pulmonary nodule: Ten-year follow-up 

of Veterans Administration-Armed Forces Cooperative Study." Arch Surg, 1975. 110: 570­

575. 

5. Falk A and Fuchs, G.F., "Prophylaxis with isoniazid in inactive tuberculosis. A Veterans 

Administration Cooperative Study XII." Chest, 1978. 73: 44-48. 

6. Salkin, D. and Huppert, M. "Progress report of the Veterans Administration - Armed Forces 

Coccidioidomycosis Study Group, 1970." Veterans Administration - Armed Forces 

Coccidioidomycosis Study Group. San Francisco, CA: VA Hospital, San Fernando, 1970, 

14: 

7. Telephone interview with John N. Galgiani, M.D., September 27, 2002. 

8. Sutliff, W.D., "Histoplasmosis Cooperative Study V. Amphotericin B dosage for chronic 

pulmonary histoplasmosis." Am Rev Resp Dis, 1972. 105: 60-67. 

9. Busey, J.F., " Blastomycosis III. A comparative study of 2-hydrostilbamidine and 

amphotericin B therapy." Am Rev Resp Dis, 1972. 105: 812-818. 

10. Medical Research in the Veterans Administration, FY 1966. Washington, DC: Government 

Printing Office, 1966, 73-74. 

11. Medical Research in the Veterans Administration, FY 1969. Washington, DC: Government 

Printing Office, 1969, 81. 

12. Medical Research in the Veterans Administration, FY 1974. Washington, DC: Government 

Printing Office, 1974, 92-93. 

13. Milliken, J.A., Pipberger, H., Pipberger, H.V., Araoye, M.A., Ari, R., Burggraf, G.W., 

Fletcher, R.D., Katz, R.J., Lopez, J., E.A., McCans, J.L. and Silver, A.M., "The impact of an 

ECG computer analysis program on the cardiologist's interpretation. A cooperative study." J 

Electrocardiology, 1983. 16: 141-150. 

14. Katz, H.M. and Bissel, G., "Blood sugar lowering effects of chlorpropamide and 

tolbutamide. A double blind cooperative study." Diabetes, 1965. 14: 650-657. 

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15. Veterans Administration Cooperative study of Atherosclerosis Neurology Section, "An 

evaluation of anticoagulant therapy in the treatment of cerebrovascular disease." Neurology, 

1961. 11: 132-138. 

16. Veterans Administration Cooperative study of Atherosclerosis Neurology Section, 

"Estrogenic therapy in men with ischemic cerebrovascular disease: effect on recurrent 

cerebral infarction and survival." Stroke, 1972. 3: 427-433. 

17. Veterans Administration Cooperative Study of Atherosclerosis Neurology Section, "The 

treatment of cerebrovascular disease with clofibrate." Stroke, 1973. 4: 684-693. 

18.	 Littman, A., "The Veterans Administration cooperative study on gastric ulcer." 

Gastroenterology, 1971. 61: 567-640. 

19. Grossman, M.J., "Resume and comment in The Veterans Administration cooperative study 

on gastric ulcer." Gastroenterology, 1971. 61: 635-640. 

20. Postlethwait, R.W., Results of surgery for peptic ulcer; a cooperative study by twelve 

Veterans Administration hospitals. Philadephia: W.B. Saunders Company, 1963 

21.	 Price, W.E., Grizzle, J.E., Postlethwait, R.W., Johnson, W.D. and Grabicki, P., "Results of 

operation for duodenal ulcer." Surg Gynec Obstet, 1970. 131: 233-244. 

22. Jackson, F.C., Perrin, E.B., Smith, A.G., Dagradi, A.E. and Nadal, H.M., "A clinical 

investigation of the portacaval shunt: II. Survival analysis of the prophylactic operation." Am 

J Surg, 1968. 113: 22-42. 

23.	 Jackson, F.C., Perrin, E.B., Felix, W.R. and Smith, A.G., "A clinical investigation of the 

portacaval shunt: V. Survival analysis of the therapeutic operation." Ann Surg, 1971. 174: 

672-701. 

24. Medical Research in the Veterans Administration, FY 1968. Washington, DC: Government 

Printing Office, 1968, 85. 

25. Bhayana, J., Gage, A.A. and Takaro, T., "Long-term results of internal mammary 

implantation for coronary artery disease. A controlled trial by the participants of the 

Veterans Administration Coronary Bypass Surgery Cooperative Study Group." Ann Thorac 

Surg, 1980. 29: 234-242. 

26. Interview with Lyndon Lee, M.D., April 7, 1988 at a restaurant in Bethesda, MD. 

27. Hrushesky, W.J.M., "The Department of Veterans Affairs' unique clinical cancer research 

effort." Cancer, 1994. 74: 2701-2709. 

315
 
28. Medical Research in the Veterans Administration, FY 1962. Washington, DC: Government 

Printing Office, 1962, 66. 

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Chapter 14. The Research Career Development Program 

One of the major obstacles confronted by the VA medical research program in its early days after 

World War II was the shortage of clinicians with advanced training in research. Funds were 

available to support meritorious research, and by the mid-1950s the problems of inadequate space 

had begun to be addressed. Some of the very successful clinician-investigators who started their 

research in the 1950s—Roger Unger and Solomon Berson, for example—had no research training 

before they joined VA. But many of them were outstanding individuals with energy, stamina and 

intelligence, and the humility to learn from their colleagues and technicians and to persist beyond 

early mistakes. Many others who tried to enter research without the needed preparation soon 

became discouraged. Somehow, VA itself would have to find a way to attract and keep promising 

candidates if the research program was to grow and flourish. 

The Clinical Investigator program 

In 1956, Martin Cummings, M.D., Director of the Research Service, together with John 

Nunemaker, M.D., Director of the Education Service, supported by the new ACMD for Research 

and Education, John Barnwell, M.D., and the new Chief Medical Director, William Middleton, 

M.D., started a program to address the shortage of clinical researchers. Thus began what was to 

become the Research Career Development Program, which aimed to create an elite leadership corps 

of clinician-researchers within VA. They persuaded Marjorie Wilson, M.D., who had left Central 

Office in 1953 to complete her clinical training, to return to VA and start this program.1 She 

reviewed similar programs then in existence and tried to incorporate their best features. The result 

was the Clinical Investigator program. 

The VA FY 1957 annual report to Congress, Medical Research in the Veterans Administration, 

describes this new program: 

“Because of a national shortage of scientific manpower, the Veterans Administration 

undertook a program to train specially qualified and interested physicians in research 

methodology. Known as VA Clinical Investigators, 23 young physicians were selected for 

special training in disciplines of medical research with special reference to basic studies in 

problems of aging. These young scientists are nominated by the medical school Deans’ 

Committees after a local competition. The nominees are screened in national competition by a 

central selection committee. Those who are accepted will receive up to 3 years’ training in 

research under the guidance of a senior preceptor while at the same time sharing clinical work 

as a member of the staff of a VA hospital. A modest amount of money is provided for 

supplies, equipment, and technical assistance to their work. This new program has been 

favorably commented upon by leaders of academic medicine.”2 

Clinical Investigators were treated as an elite corps. Dr. Wilson, serving as their advisor, would 

visit them in their labs and help them with any administrative problems. 

All Clinical Investigators were invited to attend the annual VA research meetings, while other 

investigators had to compete for places on the program. In conjunction with these meetings, they 

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held special meetings of their own. At first, these were informal; the Clinical Investigators would 

get together to discuss mutual concerns.1 Later, these meetings became scientific sessions of 

increasing formality. 

The Clinical Investigator program developed into a huge success. Academic medical centers 

competed to recruit its graduates to their faculties. Nevertheless, many Clinical Investigators 

elected to remain in VA. The FY 1960 annual report to Congress about the VA research program 

notes that “The original purpose of the program was realized in the assignment of 16 previous 

Clinical Investigators to regular full-time staff positions by July 1 of this year.”3 

During its formative period, the Clinical Investigator program, though funded from the research 

budget, was administered by Education Service and perceived primarily as a training program. It 

soon became apparent that the awardees were already serious researchers, and in June 1961 the 

Research and Education Newsletter announced that, “The latest in a series of changes places the 

responsibility for the Clinical Investigator program in Research Service instead of the Education 

Service.”4 Although the awardees were not the beginners originally envisioned for the program, the 

Clinical Investigator appointment was key to their entering independent research careers, and most 

of them did so. 

The Senior Medical Investigator program 

In 1959, the Senior Medical Investigator program was begun to provide a small nucleus of wellestablished, highly successful clinician-scientists to serve as role models for younger research 

physicians. Dr. Wilson also initiated this program, modeling it on similar programs run by NIH and 

private foundations.1 The first two Senior Medical Investigators, Drs. Samuel Bassett and Edward 

Freis, were appointed in 1959. Senior Medical Investigators were expected to spend the majority of 

their time on research, while maintaining a clinical presence in the host hospital. They attended the 

annual research meetings with the Clinical Investigators and served as a critical audience for their 

research papers. 

Table 14.1. Senior Medical Investigators 

Year appointed Specialty 

Edward Freis, M.D. 1959 Cardiology (Chapter 9) 

Samuel Bassett, M.D. 1959 Nephrology 

Ludwig Gross, M.D. 1960 Hematology – oncology 

Oscar Auerbach, M.D. 1960 Pathology – pulmonary (Chapter 10) 

Morton Grossman, M.D. 1962 Gastroenterology 

Solomon Berson, M.D. 1963 Nuclear medicine – endocrinology (Chapter 11) 

Jay Shurley, M.D. 1967 Psychiatry 

Paul Heller, M.D. 1969 Hematology 

Rosalyn Yalow, Ph.D. 1972 Nuclear medicine (Chapter 11) 

Sidney Ingbar, M.D. 1973 Endocrinology 

Andrew Schally, Ph.D. 1973 Endocrinology 

William Oldendorf, M.D. 1978 Neurology 

Roger Unger, M.D. 1979 Endocrinology 

Leo Hollister, M.D. 1982 Psychopharmacology (Chapter 8) 

George Sachs, M.D. 1984 Gastroenterology 

Jeremiah Silbert, M.D. 1990 Endocrinology – aging 

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The accomplishments of individual Senior Medical Investigators (Table 14.1) made important 

contributions to medical science, and most continued in VA for the remainder of their careers. Five 

of them (Freis, Gross, Yalow, Schally, and Oldendorf) won Lasker Awards and Yalow and Schally 

each won a Nobel Prize. 

In the early days of this program, appointing Senior Medical Investigators was a very personal 

affair. Sometimes, candidates did not even know they had been nominated until they were informed 

of the selection.5, 6 Notification was by a personal phone call from Dr. Middleton or another high 

official in Central Office. Each Senior Medical Investigator reported directly to the Central Office 

and received the highest possible personnel classification in the system. Central Office negotiated 

directly about individual needs, including funds that would be directly earmarked for each program. 

The Research Associate program 

Even though the Clinical Investigator appointment had been intended as an entry-level position, 

successful applicants generally had some research experience already. In some subject areas it was 

especially difficult to gain enough experience to compete for these awards. A bridge was needed 

between the clinical training period and the Clinical Investigator appointment, an opportunity to 

gain enough research experience to demonstrate that a candidate was likely to become a successful 

researcher. The advocates for certain research areas were successful in establishing programs to 

meet the clinician-researcher shortages in their own areas—first among these areas, psychiatry and 

psychology. 

In 1961, VA announced a new program to alleviate the shortage of psychiatrists adequately trained 

for research. Directed by Samuel Kaim, M.D., the Research Associate in Psychiatry program 

involved a one-year training period for psychiatrists in the techniques of laboratory and clinical 

experimentation, under the overall guidance of a preceptor. The first two Research Associates in 

Psychiatry were appointed in March 1962, and a third began his work in June 1962.7 

At about the same time, a similar program of Psychology Research Associates was begun with four 

appointments under the direction of H. Elston Hooper, Ph.D.8 This program of two-year 

appointments for psychologists wishing to become research psychologists was announced late in 

1961. During its time as a separate program, 87 psychologists benefited from this training, 

described as “one of the most desirable postdoctoral experiences in the Nation.”9 

Shortly afterward, Research Associate openings were announced in other physician specialties in 

which a shortage of research talent was identified: pathology, physical medicine and rehabilitation, 

orthopedics, oral diseases and gastroenterology.10 Advocates of additional specialty areas made 

cases for establishing the Research Associate in their specialties, and by 1968, it had become a twoyear program available to all physician specialties. By the early 1970s, the Psychology Research 

Associate program had merged with the Physician Research Associate program, which was now 

open to all VA doctoral-level clinicians. 

The Medical Investigator program 

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By 1968, many distinguished physician-scientists in VA were considered to be too experienced for 

the Clinical Investigator appointment but not yet at the level of seniority to qualify as Senior 

Medical Investigator. At that time, a new position was introduced in the Research Career 

Development Program, the Medical Investigator, an appointment intermediate between Clinical 

Investigator and Senior Medical Investigator. The first five appointments were made the following 

year. This position was described as one that “provides established, successful investigators an 

opportunity to pursue research activities for a major portion of their time (at the discretion of the 

investigator) with the remaining (time) spent in teaching and patient care. Candidates selected will 

be those for whom VA can anticipate continued productivity.”11 This new position was wellreceived, and 5, 7 and 13 appointments were made in 1969, 1970 and 1971, respectively. 

With the Medical Investigator position in place, a “research career ladder” was now available to the 

career clinical scientist, though to move from one rung of the ladder to the next required approval of 

the review committee, and such approval was difficult to achieve. 

In 1972, budgetary problems prompted a rethinking about the expensive Medical Investigator 

program. A senior-level salary plus substantial research support ($40,000 per year) went with the 

appointment. James Pittman, M.D., the ACMD/R&E at that time (Chapter 15), decided to place a 

moratorium on the program.12 From 1973 through 1976, only eight appointments, including three 

reappointments, were made. 

In 1975, Thomas Newcomb, M.D., ACMD/R&D (Chapter 15) and Marguerite T. Hays, M.D., 

Director, Medical Research Service (Chapter 16), decided to revive the Medical Investigator 

program under new guidelines, discarding the “ladder” concept. The new Medical Investigator 

position was a six-year appointment not immediately renewable. An awardee could apply for 

renewal only after serving a year as staff clinician at his/her medical center. In 1977 and 1978, five 

new appointments were made annually under the new guidelines. Appointment as Medical 

Investigator continued to be a rare honor throughout the program’s existence. 

Research and Education Trainee program 

Even with the Research Associate program, there was still no “fellowship” level in the research 

career ladder. To fill this void, in 1968 Drs. Lionel Bernstein and Harold Schoolman, Directors of 

the Research and Education Services, established a fellowship program for young clinicians. Called 

Research and Education Trainees, these were physicians who had completed at least three years of 

postdoctoral clinical training. The traineeship allowed them to receive specialty training, including 

research experience. The research experience of these trainees was the responsibility of a “chief 

trainer” at the hospital, who selected the trainees and monitored their training experience. This 

program was funded by Research Service but administered by Education Service. A separate 

selection committee for each of 14 specialty areas reviewed applications from hospitals wanting to 

establish traineeship programs. This program grew over several years, and by the end of FY 1971, 

67 Traineeship programs had been established in 35 VA hospitals. These traineeships were 

abruptly discontinued during FY 1972, reportedly due to a decision by the Office of Management 

and Budget to terminate such programs, including those at the NIH as well as VA. Fortunately, the 

VA residency program was large enough to absorb the trainees into specialty residencies, and 

incumbent trainees were able to complete their programs. 

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The Associate Investigator program 

By the middle of the 1970s, competition for Research Associate positions had grown so keen that 

the qualifications of successful candidates were at an extremely high level. Persons with substantial 

bibliographies and established success in research began to edge out those wishing to enter a 

research career who had not yet had the opportunity to do so. At the same time, the VA research 

traineeship program, intended to meet this need, had been disbanded. To provide an entry level in 

the Research Career Development Program, a new position, the Associate Investigator, was 

established in 1976. To assure that this position remained targeted to entry-level applicants, it came 

with certain restrictions. Awardees received a lower salary than they would have received as staff 

physicians, and they were not eligible for a bonus being paid to VA physicians. There was a limit 

on the amount of research training and experience that a candidate could have before applying. 

Despite these restrictions, large numbers of excellent candidates continued to apply for the few 

positions available. 

Review process for Research Career Development Program applicants 

At the time that the Clinical Investigator program was initiated in 1956, VA appointed a 

distinguished committee of outside academicians to review applications for appointment and 

recommend program policy (Appendix IIj). At first, this committee was called the Selection 

Committee for Clinical Investigators. In 1964, presumably because they also reviewed nominations 

for Senior Medical Investigator positions, the committee became the Selection Committee for 

Clinical and Senior Investigators. In 1971, in recognition of the increased complexity of the 

program it reviewed, it became the Research Career Development Committee. In the late 1970s, a 

few VA scientists were added to the committee to present the intramural viewpoint, but the 

committee continued to be largely an outside group. 

From the beginning, this committee concerned itself primarily with assuring that awardees’ research 

experience was the best possible for both the awardee and VA. 

Compensation of Research Career Development awardees 

Initially, Clinical Investigators and Research Associates received lower salaries than they would 

have earned as full-time staff clinicians. In 1961, the Clinical Investigator earned $9,000 per year.5 

The July-August, 1966 Newsletter contains the information that Research Associates were 

ordinarily staffed at Full Grade, Step 1, though in some cases they were given Intermediate Grade. 

Clinical Investigators entered at Intermediate Grade, Step 3, if board eligible, or Step 6 if board 

certified.15 At the same time, clinicians were being recruited one or two grades higher. This 

discrepancy in salary was apparently causing enough concern that it remained under review, with 

consideration given to making appointments at a grade level equal to those of staff physicians. 

Within the next several years, this transition was made, and subsequently these appointees received 

the same VA base salary as did their full-time clinician counterparts. 

However, in 1975, when VA physicians began to receive a salary bonus, Career Development 

awardees (except Senior Medical Investigators) were denied the bonus, as there was no 

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demonstrable shortage of candidates for the appointments. This led to turmoil in the program, with 

some appointees moving into patient-care positions, others accepting the lower salary, and others 

receiving salary compensation from their affiliated universities to make up the difference. Despite 

this problem, the program continued to be vigorous. The number of highly motivated, wellqualified candidates always exceeded the number of vacancies to be filled. During the 1980s, the 

administration of the physician’s bonus was liberalized to permit some bonus salary for Research 

Associates and Clinical Investigators, and the full bonus for Medical Investigators as well as Senior 

Medical Investigators. 

Administration of the Career Development Program 

After initiating the Clinical Investigator program, Dr. Marjorie Wilson administered it from her 

position in Education Service until she left Central Office in 1960. The first Senior Medical 

Investigators were appointed during her tenure, and she set up the review committee and established 

guidelines. After she left, the program administration shifted to Research Service. Dr. Harold 

Schnaper became coordinator for Internal Medicine awardees, and Dr. Lyndon E. Lee, Jr., for 

Surgery awardees. Later in the 1960s, as Program Chiefs were recruited to Central Office in the 

various clinical and research specialties (Chapter 12), the Program Chiefs became the primary 

Central Office contacts for the Career Development appointees in their particular fields. In 1965, 

Dr. Eli Nadel assumed responsibility for overall coordination of the program. 

In 1968, the Directors of the Research and Education Services, Drs. Lionel Bernstein and Harold 

Schoolman, formalized their concept of a research career ladder for clinicians, starting with the 

traineeship and culminating in the Senior Medical Investigator appointments. In recognition of the 

importance of this program, a formal Career Development Section was established within Research 

Service, which also had responsibility for the Traineeship program of Education Service. Chester 

W. DeLong, Ph.D., was its Chief. In 1971, this Section became a part of a new Career 

Development and Program Review Division in Research Service under Dr. DeLong. 

Figure 14.1. Chester W. DeLong, Ph.D. 

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In 1972, Ms. Darlene Whorley became Chief of the Career Development Section within that 

Division, and in 1973 Career Development again became a separate division in the new Medical 

Research Service, with Ms. Whorley continuing as its Chief. 

Figure 14.2. Darlene Whorley Figure 14.3. David Thomas 

In 1978, when Ms. Whorley left Central Office for the San Diego VA Medical Center, Mr. David 

Thomas became Chief, Career Development Section, a position he held until 1990. 

Follow-up of Research Career Development appointees 

From the beginning of the Research Career Development Program, VA was concerned with 

determining whether the initial goal of enhancing VA’s cadre of expert clinician-researchers had 

been met. The agency wanted to know if it was contributing its share to the nation’s medical 

research manpower. To answer these questions on a continuing basis, careful records were kept of 

all appointees to the program, with a systematic follow-up every few years. Retention in VA or in a 

university position was considered a measure of success. From the beginning, retention was 

impressive. While some attrition occurred as time went on, many graduates spent their entire 

careers in VA. 

In 1968, the current status of the 187 persons who had completed the Clinical Investigator program 

was listed in VA’s Annual Report to the Congress. Of the 182 former Clinical Investigators still 

alive and located, 68 were currently in VA and five were in other federal institutions (40 percent in 

federal employment). Sixty-six (36 percent) were in universities or private research institutes. 

Eight (4 percent) were receiving further training and 35 (19 percent) were employed in primarily 

non-research situations. 16 Compared with outcomes for similar programs providing research 

experience for junior clinician-researchers, this was considered to be an excellent result. 

A more recent systematic follow-up of Career Development Program awardees was carried out in 

1990. At that time, 1,781 of the 1,858 persons who were or had been in the program were located. 

Many of them had been appointed at more than one appointment level. They included 16 present or 

former Senior Medical Investigators, 70 Medical Investigators, 548 Clinical Investigators, 1,016 

Research Associates and 428 Associate Investigators. Of the 1,742 living, non-retired appointees 

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located, 834 remained in VA, yielding an overall retention of 48 percent. Another 369 (21 percent) 

were in universities. Seventeen (1 percent) were in governmental positions other than VA, 

including the NIH. Sixteen (1 percent) were in industry, and 506 (29 percent) were in private 

practice. Altogether, of those still active professionally, 70 percent held government or academic 

positions. 

Looking more closely at the 1,212 former Career Development appointees who had been in the 

program prior to 1981, 1,143 were located. Thirteen were retired and 24 had died. Of the remaining 

1106, 401 (36 percent) were still in VA and 14 (1 percent) were in other government service. Two 

hundred seventy-six (25 percent) were at universities, 13 (1 percent) were in industry and 402 (36 

percent) were in private practice.17 

Hence, 10 to 34 years after they began their assignments in the Career Development Program, 62 

percent of Career Development Program awardees who were still active professionally were in 

government or academic positions. The program had not only achieved its original goals, it had 

done so to a remarkable degree. Of those who remained in VA, many had become leaders, holding 

such titles as Associate Chief of Staff/Research (19), VA Service Chief (45), Chief of Staff (6), and 

many clinical section chiefs. 

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References 

1. Interview with Marjorie Wilson, M.D., April 29, 1988 at Dr. Wilson's office in Washington, 

DC. 

2. Medical Research in the Veterans Administration, FY 1957. Washington, DC: Government 

Printing Office, 4. 

3. Medical Research in the Veterans Administration, FY 1960. Washington, DC: Government 

Printing Office, 25. 

4. R&E Newsletter, June 1961. 15. 

5.	 Interview with Paul Heller, M.D., March 3, 1993 at Dr. Heller’s office at the Chicago 

Westside VA Medical Center. 

6. Interview with Oscar Auerbach, M.D., October 30, 1992 at Dr. Auerbach's office at the East 

Orange, NJ VAMC. 

7. R&E Newsletter, May, 1962. 19. 

8. R&E Newsletter, November, 1962. 14. 

9. Medical Research in the Veterans Administration FY 1968. Washington, DC: Government 

Printing Office, 16-17. 

10. Medical Research in the Veterans Administration FY 1967. Washington, DC: Government 

Printing Office, 53. 

11. Medical Research in the Veterans Administration FY 1969. Washington, DC: Government 

Printing Office, 14. 

12. Interview with James Pittman, M.D., February 27, 1992 at Dr. Pittman's office at the 

University of Alabama. 

13. R&E Newsletter, July 1962. 8-9. 

14. R&E Newsletter, January 1966. 2-3. 

15. R&E Newsletter, July-August 1966. 4. 

16. Medical Research in the Veterans Administration, FY 1968. Washington, DC: Government 

Printing Office, 15. 

17. Thomas, D. Review of Career Development Graduates. Medical Research Service, 1990. 

325
 
(Intentionally Blank) 

326
 
Section V. Maturation
 

1968-1980
 

327
 
(Intentionally Blank) 

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Chapter 15. Transition Years, 1968–1973 

The late 1960s and the 1970s saw the maturation of the VA Medical Research Service and the 

beginnings of today’s Health Services Research and Development Service and Rehabilitation 

Research and Development Service. 

Medical Research experienced a rocky and controversial transition, from a program 

personally governed by managers with close familiarity with the investigators and their 

projects, to one based on peer review and objective criteria. Until about 1968, funding of 

projects in VA was based on results of previous work. Budget was not a serious problem; 

money was available for programs that the experts in Central Office considered worth 

supporting. Even correcting for inflation, the budget was increasing enough to accommodate 

new programs without jeopardizing existing ones. Continuation of productive programs was 

encouraged. 

In 1968, new leaders committed to excellence in science introduced a program of peer review 

modeled after that of the NIH. Individual research programs received grant-type reviews. 

This system, imposed on an intramural program that had been relatively stable, led to turmoil 

and dramatic policy reversals. Over the next decade, the VA Medical Research Program 

gradually transformed itself into the peer review-driven program that exists today. 

New leadership in the Research and Education Office 

In 1966, Lionel Bernstein, M.D., Ph.D., a gastroenterologist who had been Associate Chief of 

Staff for Research and Education at the Hines VA Hospital in Chicago and then Chief of 

Medicine at the Chicago West Side VA, joined Central Office as Director, Research Service. 

At about the same time, Harold (Hack) Schoolman, M.D., who had been Chief of the VA 

Midwest Research Support Center at Hines, became Director, Education Service. 

Figure 15.1. Lionel Figure 15.2. Harold Schoolman, M.D 

Bernstein, M.D., Ph.D. 

Bernstein and Schoolman were good friends and considered themselves a team. For a time, 

each served as the other’s Deputy. They were well acquainted with Lucien Guze, M.D., the 

influential Chief of Staff for Research and Education at the Wadsworth VA Hospital in Los 

Angeles. Bernstein and Schoolman were hired into their VA Central Office (VACO) 

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positions by Dr. Ben Wells, but both believed Guze played a key role in their recruitment.1, 2 

In late 1968, Thomas Chalmers, M.D., came to Central Office as Assistant Chief Medical 

Director for Research and Education(ACMD/R&E.) Bernstein and Schoolman had actively 

recruited Chalmers and enlisted Chief Medical Director H. Martin Engle to help bring him to 

their team. Chalmers had been serving on the Cooperative Studies Evaluation Committee.3 

Together with Bernstein and Schoolman, he was dedicated to assuring high quality in the 

research program. 

Figure 15.3. Thomas Chalmers, M.D. 

End of the annual research conferences 

VA’s annual research conferences were becoming very large and costly in terms of both 

money and effort. Bernstein and Schoolman believed that the investigators would be better 

served by using the money to send them to meetings in their own specialties. After 1967, 

Research Service (later Medical Research Service) held only conferences for research 

administrators and advisors. Discontinuing the annual meetings meant that another setting 

was needed for presenting the agency’s Middleton Award. A suitable event in the recipient’s 

hometown was selected for the 1968, 1969 and 1970 awards. Dr. Middleton himself 

presented the 1971 and 1972 awards, at an Atlantic City, N.J., meeting of VA research 

administrators4

 and at the American Federation for Clinical Research; and for the 1973 award, 

a ceremony was held in VA Central Office, where the Administrator and Chief Medical 

Director did the honors. 

The Middleton Awardees, 1968-1973 

The 1968 Middleton Award went to Thomas Starzl, M.D., Ph.D., of the Denver VA Hospital, 

for his pioneering surgical transplantation of kidneys and other human organs, including the 

development of anti-lymphocyte serum and globulin to suppress rejection of transplanted 

organs. Starzl later accomplished the world’s first successful liver transplant. 

330
 
 

Figure 15.4. Thomas Starzl, M.D., Ph.D. 

Roger Unger, M.D., (Chapter 7) received the 1969 award “for his conception of the 

physiology of metabolism of fats and carbohydrates, to better therapy for diabetes patients.” 

Andrew V. Schally, Ph.D., who later received the Lasker Award and Nobel Prize for the 

isolation and synthesis of hypothalamic hormones, won the 1970 Middleton Award “for his 

investigations of the physiology and biochemistry of hypothalamic neurohormones.” 

Figure 15.5. Andrew S. Schally, Ph.D., receiving the 

Middleton Award from Emmanuel Bresler, M.D., Associate Chief of Staff for Research
 

and Education, New Orleans VA Medical Center 

In, 1971, Marcus Rothschild, M.D., was honored “for basic and clinical research on the 

pathological biochemistry of the liver in alcoholism and other types of liver disease.” 

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Figure 15.6. Marcus Rothschild, M.D., receiving the Middleton Award 

from Dr. Middleton 

The 1972 Middleton Award went to Kenneth Sterling, M.D., for his important work with 

radioactive tracers. He was cited for developing the 51Cr labeling of erythrocytes for in vivo 

study as a clinical tool, using labeled human serum albumin to determine albumin turnover 

rate and for his use of radioactive thyroid hormones to study the disposal and turnover of 

thyroxine and triiodothyronone in humans. 

Figure 15.7. Kenneth Sterling, M.D. (center), standing by the Middleton Award with
 

Rosalyn Yalow, Ph.D. (Chapter 11) and Bronx VA Medical Center Director
 

Harold Jaffrey 

Ludwig Gross, M.D. (Chapter 3) received the 1973 award “for demonstrating viral etiology of 

leukemia in mammals.” 

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Figure 15.8. Ludwig Gross, M.D., and Thomas Newcomb, M.D., by the Middleton 

plaque
 

New approach to allocating research funds 

Before the late 1960s, Central Office officials ran the research program in a very personal way, 

making most of the decisions about how much research money each hospital would receive. 

In the earliest days of the post-World War II VA research program, the Committee on Veterans’ 

Medical Programs (CVMP) (Chapter 4) had reviewed requests for individual VA research projects 

along with requests for research contracts from medical schools. These projects received peer 

review by the advisory committees of the National Research Council. At the same time (Chapter 

3), “research laboratories” were being established at VA hospitals, each with a Chief, equipment, 

laboratory space and employees. From the late 1940s on, these “laboratories” were under the 

jurisdiction of a hospital Research and Education (R&E) Committee. As these laboratories 

recruited capable researchers, they grew and expanded into hospital-based intramural research 

programs, still under the jurisdiction of a local R&E Committee. The laboratory chief, first called 

the Assistant Director of Professional Services for Research (ADPSR) and later the Associate Chief 

of Staff for Research and Education (ACOS/R&E), was the Secretary of the R&E Committee. In 

the late 1940s and early 1950s, the funding for a hospital’s research “laboratory” was in a stable, 

annualized budget. When new money was needed, the investigator submitted a request to Central 

Office through the R&E Committee and hospital management. The request was generally reviewed 

by the CVMP. If the CVMP recommended funding, Central Office would send the additional 

money to the hospital. 

This mechanism, considered to be unduly complicated, was discontinued in late 1952.5 After that, 

the R&E Committee at a VA hospital approved and recommended to Central Office, through the 

hospital manager, that additional research funds be made available to the hospital in a specified 

amount—for a specified purpose. Nevertheless, an attempt was made to provide each VA hospital 

engaging in research a definite annual research budget that it could count on. 

By April 1954, the CVMP recognized that VA had changed its research focus from extramural to 

intramural. Contractual research was being phased down. The Committee questioned the value of 

the National Research Council (NRC) concerning itself with the VA intramural program, although 

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there was a feeling that government-funded research should have a disinterested civilian group 

checking work quality and direction. At the time, Dr. George Marshall Lyon, VA ACMD/R&E, 

explained that money was allotted to intramural programs according to such factors as: 

 1. Institution size or site 

 2. Quality of proposed work 

 3. Available patients

 4. Degree of emphasis on particular fields 

 5. Local capabilities 

Dr. Lyon felt that help was needed at the policy level, but he did not invite review of individual 

research projects.6 

The first NRC survey of the VA Medical Research Program (Chapter 7), in 1960, describes it as 

highly decentralized, with four expert committees to advise the Chief Medical Director on nationallevel medical research policy and programming. In the survey, the NRC recommended that “the 

staff of the Research Service in the Veterans Administration’s Central Office should be 

strengthened by the addition of three or four persons who are highly skilled in research methods and 

research administration.” 

At the local level, scientific review by the Research and Education Committee and/or the Deans 

Committee was an option. Records from the 1950s at one hospital, Palo Alto (Calif.), document 

R&E Committee review of investigators’ written and oral presentations in defense of requests for 

support. But the review process was variable and undoubtedly was less complete at some hospitals. 

The hospital’s annual requests to Central Office were generally based on historic funding plus 

additions for proposed recruitments. Since the overall research budget was increasing during those 

years, money was available to support most worthwhile recruitments, and there was no compelling 

impetus to phase out less-productive programs. 

During the 1960s, VACO Research Service responded to the NAS recommendations and other 

pressures by boosting the scientific expertise in VA Central Office. Program Chiefs in various 

disciplines were appointed (Chapter 12). At the beginning of each fiscal year, the Director, 

Research Service, would allocate money to each of the Program Chiefs. They could use this money 

to recruit new investigators in their field and supplement the budgets of promising projects. 

Typically, the Program Chiefs traveled extensively, visiting individual investigators and potential 

recruits at the hospitals. When they were convinced that a new program was meritorious, they 

would provide funding for it, which would later be annualized into the hospital’s research budget. 

The Program Chiefs participated actively in annual meetings, both for VA-wide research and in 

their particular disciplines. In some cases, they arranged meetings of VA investigators at national 

specialty research meetings to discuss mutual concerns, especially policy matters. 

Some Program Chiefs established expert advisory committees in their disciplines to give general 

advice about research administration and some scientific review (Appendix IIg). This concept was 

focused and strengthened in 1965 when Drs. Marc J. Musser and Edward Dunner established 10 

Research Evaluation Committees, each under the leadership of a Program Chief from Central 

Office. These Committees (Appendix IIh) generally reviewed investigators’ progress reports, as 

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well as brief protocols for future research. Their advice helped the Program Chiefs to allocate funds 

and the hospital R&E Committee to distribute the research money received at the hospital. 

A second NRC report, released in 1968, noted that: “The Central Office has appointed in the last 

two years a number of evaluation committees that, in the near future, will examine all research 

supported by the Central Office.” It was recommended that VA enhance the role of its Research 

Evaluation Committees and, as appropriate, seek the advice of other outstanding peer-review groups 

to assure itself that its individual research projects were worthy of support.7 

Funding considerations in 1967 

By 1967, many knowledgeable observers felt that a change was needed for evaluation of VA 

research projects. At the NIH and elsewhere, a system of peer-review-based project funding was 

well established, and many felt that VA should undertake a similar type of program. 

This opinion was by no means universal. VA research was intramural, carried out by VA staff in 

VA hospitals. In this sense, it was similar to the NIH intramural program: At NIH, considerable 

scientific review existed within and across institutes, but NIH intramural research was not subject to 

a grant-type review. Some excellent work was being done in VA under the existing system. VA 

researchers flourished in an environment where they could count on consistent support for their 

research, even when they ventured into new, perhaps risky areas or followed up on ideas not 

hammered out in the peer review system. 

The hospital-based research programs often were still conceptualized as large “laboratories,” each 

with the ACOS/R&E serving as its Chief. Some ACOSs had built up huge and flourishing research 

programs at their hospitals. These were flourishing under what was, usually, a benign dictatorship. 

New and continuing support of an investigator’s projects was the prerogative of the R&E 

Committee, whose Secretary was the ACOS. In most cases, a simple memo or brief protocol was 

all that was required to justify funding a project. Newly hired staff members who entered the VA 

research program found it easy to get started. When new money was needed to set them up, a 

simple request to the Program Chief or Director of Research in Central Office usually sufficed. 

On the other hand, it was difficult to control the way research money was spent. While some 

exchange with clinical services, such as clinical use of research facilities or research use of clinical 

facilities, was to be expected, some research projects seemed to have stopped advancing knowledge. 

The rapid growth of the research budget during the late 1950s and early 1960s showed signs of 

stabilizing, while the roster of qualified and motivated investigators grew. Money needed to be 

redistributed from unproductive programs to more promising ones. These concerns led to 

establishment of a revolutionary concept, the “Part 1-Part 2” system. 

Part 1-Part 2 system 

In 1967, Dr. Lionel Bernstein introduced a new “Part 1-Part 2” plan forVA research budgetary 

administration. 

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Under this plan, Central Office “Part 1” funds were awarded to a hospital specifically for a VA 

investigator’s project. The amount of support was based on the advice of one of the Research 

Evaluation Committees. With a 20 percent allowance for local adjustments, these funds were 

earmarked for the specific research project. The plan was eventually to dispense about half of VA 

Research funds in this manner.2 

“Part 2” funds, on the other hand, were to be distributed as institutional allocations, partially 

following the historical model in place prior to that time. These funds continued to be dispensed 

locally on the advice of the local hospital R&E Committee. However, redistribution of Part 2 funds 

between VA hospitals was to be based on an institutional site visit. This review would determine 

how well Part 2 funds were used for recruiting new personnel, starting research programs and 

establishing common facilities, and how well it all combined to help the patient care program, 

To implement this Part 1-Part 2 concept, Lionel Bernstein established a Program Evaluation 

Section within Research Service and in late 1967 recruited Leon Bernstein, Ph.D. (no 

relation), from the Program Projects Grant Division of the National Heart Institute to be its 

Chief. Leon Bernstein, who had been a professor of physiology at the University College 

Hospital in London, had come to the Baltimore VA Hospital, where he was Acting 

ACOS/R&E—“acting” because he was not yet a U.S. citizen. He then moved to San 

Francisco, where he ran a laboratory at the VA hospital there and was briefly ACOS/R&E. 

From San Francisco, he moved to NIH but left there only a year later when Lionel Bernstein 

recruited him.8 

Figure 15.9. Leon Bernstein, Ph.D. 

Part 2 program 

With a system for evaluation of individual projects by the Research Evaluation Committees 

already in place, Leon Bernstein’s first effort was to establish a system to review institutionwide programs of individual VA hospitals, those to be funded by Part 2 money. Two large 

central committees (Appendix IIk) were established to oversee the Part 2 program reviews. 

Members of these committees served on audit teams that were to visit each hospital. In 

336
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

composing the team for a given hospital, the Central Office staff tried to assure that it 

included representatives of all major areas of research at that hospital. The plan was that 

these committees would visit hospitals on a three-year rotation basis, interviewing each 

hospital’s Research and Education Committee and all of its funded investigators. After this 

visit, the committee would recommend an amount for the Part 2 funding for that hospital for 

the next three years. This review was directed entirely at how well the hospitals were 

spending their “Part 2” monies, the undesignated general support research money they were 

receiving. Emphasis was placed on both the quality of research supported and the role of 

research in improving patient care. Projects that had passed “Part 1” review were exempted 

from Part 2 review. 

Plans and implementation did not always match. For example, in advance of the Part 2 group’s visit 

to Buffalo (N.Y.) in 1970, the ACOS/R&E received a long, complex form to be completed. He 

instructed the research investigators to write brief project summaries, about one page per project. 

The investigators did not understand that this site visit was going to determine their future —they 

had become accustomed to the system of Central Office Program Chiefs’ visits, which generally 

resulted in more funds for a specific program and did not threaten other parts of the program. 

The site visitors, led by Leon Bernstein himself, spent two days at Buffalo, interviewing all 

the investigators and meeting with the R&E Committee and top hospital administration. They 

toured the research space and asked penetrating questions. When the site visit report 

ultimately arrived at Buffalo, it analyzed all elements of the program with specific funding 

recommendations for each project, the total amounting to Buffalo’s entire Part 2 budget for 

the next three years. The casually assembled one-page summaries, together with a short 

interview between the investigator and the visitors, resulted in specific funding decisions. 

As the first round of Part 2 reviews progressed, a number of hospitals that had managed to 

build up large programs during the past 10 years were visited. In several, the emphasis on 

building up common resources had led to large amounts of money being placed under the 

control of the ACOS/R&E. As one ACOS/R&E expressed it, the site visitors “admired my 

extensive common resources very much, and then cut the budget.”9

 A number of very vocal 

ACOS/R&Es complained vigorously about the Part 2 program. Lionel Bernstein, the 

Director, supported Leon Bernstein and refused to make any alterations in the committees’ 

decisions. Failing to find a sympathetic ear in the Research Office, the complainers went to 

higher officials in Central Office. Soon, Central Office was full of polarized opinions for and 

against the Part 2 program. 

Part 1 reviews 

Once Part 2 program visits were well underway, Leon Bernstein turned his attention to 

reviewing individual research projects. The old Program Evaluation Committees were 

disbanded. One round of reviews was skipped to allow a “settling down.”8 Then a new group 

of Research Evaluation Committees (Appendix IIh) began to review projects.10, 11 Applicants 

received elaborate, complex instructions on how to present their projects. When instructions 

were not properly carried out, the projects were returned to the investigator without review. 

At the same time, these new committees received clear mission instructions to be much less 

337
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

permissive than the old Program Evaluation Committees. For the first time, major emphasis 

was on the prospective research plan as well as evaluation of the investigator’s research 

accomplishments. Scientists who had been accustomed to a cursory review of their research 

plan, resulting in continuation and expansion of their funding, suddenly found their projects 

being disapproved. Again, protests arose from the field. But leadership in Research Service 

stood firmly behind its new peer review system, followed by people complaining elsewhere in 

Central Office. The division of opinions within Central Office became even more 

pronounced. Officials responsible for patient care services worried that these changes in 

research policy were hurting important clinicians at the hospitals. 

Downfall of the Part 1-Part 2 program 

Lionel Bernstein, Schoolman and Chalmers had sought to use a much scaled-down version of 

the NIH national grants peer-review methodology within the context of a nation-wide 

intramural system of 170 VA hospitals. Their aim was to support high-quality research while 

enhancing the effect of research on VA patient care and on medical schools affiliated with VA 

hospitals. Many observers applauded their goals. But by late 1969 and early 1970, the Part 1­

Part 2 system was generating protests. Many considered the review process too rigid. Some 

of the most powerful ACOS/R&Es found their power bases eroding and objected 

strenuously.12, 13 The resulting controversy in Central Office eventually led to abrupt policy 

and leadership changes in the Research and Education Office and in Research Service. 

Leadership changes 

In January 1970, Mark (Jim) Musser, M.D., who had previously been Director, Research 

Service, and ACMD/R&E, became VA’s Chief Medical Director (CMD). He recruited 

Benjamin Wells, M.D., also a former ACMD/R&E, to return to Central Office as his Deputy. 

Musser and Wells had been keeping in touch with Research Service while they were at the 

Regional Medical Programs. They were concerned about the dissatisfaction in the field 

stirred up by the new Part 1-Part 2 program. They did not object to the peer review principle; 

indeed, the Program Evaluation Committees had started during their research leaderships. 

However, they were troubled by the rigidity of the present program and the abruptness of 

changes it imposed on the field.14 

On his first day as CMD, Musser met with Thomas Chalmers (the ACMD/R&E) and told him 

there were to be major changes in running the research program. Chalmers contacted NIH the 

same day, and accepted an appointment they had offered him earlier.3 A short time later, 

Lionel Bernstein and Harold Schoolman received memos to the effect that they were to be 

reassigned from their present positions. During the next month or so, Lionel Bernstein 

reviewed VA needs in Health Services Research and Development and wrote a prospectus for 

this program (Chapter 17). He then moved to the Department of Health, Education and 

Welfare. A few months later, Leon Bernstein was reassigned from his position as Chief, 

Program Evaluation Section, to head up a Health Services Research and Development 

15 program.

Musser appointed Lyndon Lee, M.D., his old Deputy from Research Service, to be the new 

338
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACMD/R&E. Lee held that position for about a year, until he became ACMD for 

Professional Services in February 1971. Lee was as unhappy as Musser about the way the 

Part 1-Part 2 program was being administered. Lee appointed as his deputy Laurence Foye, 

M.D., who had been Director of Education Service, and Foye then served as Acting 

ACMD/R&E during the 1971 interim between the terms of Lee and his successor, James 

Pittman, M.D. During the interim, until John Bailer, M.D., was recruited as Director of 

Research Service at the end of 1970, James Matthews, M.D., and Abraham Dury, Ph.D., “held 

the Research Program together.”13 Basic institutional research support of the Medical Centers 

was held more or less constant, with adjustments upward after successful Part 1 reviews but 

no response to unsuccessful reviews. After Leon Bernstein left Research Service, Chester 

DeLong, Ph.D., assumed responsibility for Program Review while continuing to run the 

Career Development Program. He recruited Mr. Gerald Libman to be responsible for 

Program Review and Ms. Darlene Whorley for Career Development. 

Under DeLong, the same basic system of Part 1 review was continued. The major difference 

was in its implementation. Minor irregularities in the applications were permitted, and 

deadlines were stretched in hardship cases. Also, an adverse Part 1 review did not result in a 

decrease in a hospital’s research budget. Only a recommendation for start-up of a new Part 1 

program or an increased support of an ongoing one affected the hospital’s budget.16 

“Total Institutional Review” 

Lyndon Lee recruited John Bailar, M.D., from the National Cancer Institute to be Director of 

Research Service. Bailar had worked with VA on the NCI-funded VA urology cooperative 

studies, including the important study of the use of stilbestrol in prostate cancer that showed a 

5mg/day dose to cause cardiovascular morbidity.17, 18 Lee hoped that Bailar, who had a strong 

background in epidemiology, would help makeVA a giant in this area.15 

Working with DeLong, Bailar started a program of “Total Institutional Review.” Under this 

program, the entire hospital research budget would be determined by a site visit made to the 

hospital every three years. In their budgetary recommendations, site visitors were to take into 

account currently approved Part 1 programs, existing common resources left from the Part 2 

program, and a projection of the hospital’s needs over the next three years as determined at 

the site visit and in consultation with representatives from the affiliated medical school. The 

Part 1 funds were merged into this total hospital research budget, and new funding was not to 

be expected until the next site visit. The Regional Coordinators organized and staffed these 

site visits. The visiting teams were made up of VA investigators and ACOS/R&Es, as well as 

deans and other leaders from affiliated medical schools. These were full-dress affairs, not 

much different from the old Part 2 visits, except that the visitors now took into account the 

hospital’s Part 1 experience. In addition, they attempted to sort through the optimistic input 

from the hospitals and medical schools to arrive at a realistic projection of expected growth 

over the ensuing three years. 

At the initiation of this institutional review program, the Part 1-Part 2 system, which had been 

“on hold,” was terminated. Hospital budgets were frozen at the level where they stood and 

remained essentially stable until the institutional site visit under the new system. Centralized 

339
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 1 review was discontinued and the hospital Research and Education Committees were 

expected to undertake peer review of their own research applications.19 

At the time this new program began and when the totally decentralized budgets had been 

allocated, there was inadequate funding to include all of the recently approved Part 1 

programs. These were funded at only 30 percent of approved levels, causing considerable 

hardship for “growing” programs. They had recently succeeded in recruiting “stars,” new 

investigators whose programs were reviewed at that time. As a result, during the next several 

years of total decentralization, growing programs found it hard to make ends meet. 

The institutional site visits continued with few problems until the visit to one of the largest 

research programs in the country. On that particular site visit, after a key visitor had to drop 

out at the last minute, enough controversy about the process arose that Dr. Musser decided to 

place a moratorium on that program as well.20-22 

With review of institutional and individual projects on hold, the responsibility of the 

ACOS/R&E and the R&E Committee at the hospital was now more clearly defined than 

before. The R&E Committees were expected to undertake their own peer review of programs 

and be accountable for the quality of research. Various systems were worked out, generally 

involving ad hoc reviews. Some groups of hospitals collaborated to review each other’s 

projects or set up regional peer review. There was general displeasure with the situation, 

however.23 

James A. Pittman, M.D., and Thomas F. Newcomb, M.D. 

Dr. James Pittman came to Washington from Birmingham, Ala., to become ACMD/R&E in 

mid-1971 and remained until 1973, when he returned to Birmingham as Dean of the 

University of Alabama Medical School. An endocrinologist and nuclear medicine physician, 

since 1956 Pittman had been Chief of Nuclear Medicine at the Birmingham VA Hospital, as 

well as at the University of Alabama at Birmingham. He was also a highly respected 

investigator in endocrinology. He recruited Lawrence Hobson, M.D., Ph.D., an expert in 

clinical pharmacology, to be his Deputy. 

340
 
 

 

 

 

 

 

 

 

 

 

Figure 15.10. James Pittman, M.D. Figure 15.11. Lawrence Hobson, M.D., Ph.D. 

A few months after Bailar returned to the National Cancer Institute, Pittman persuaded 

Thomas F. Newcomb, M.D., a hematologist and ACOS/R&E at the Gainesville (Fla.)VA 

Hospital, to come to Washington as Director, Research Service.21 

Figure 15.12. Thomas Newcomb, M.D. 

Newcomb and Pittman re-establish peer review 

Dr. Newcomb had been concerned about the problems he was encountering as ACOS/R&E at 

Gainesville stemming from the total decentralization of research funding. The R&E 

Committee was expected to use peer review in allocating their funds but was provided no 

guidance or help from Central Office in doing so. Newcomb had been trying to form a 

consortium of East Coast VA hospitals that would work together to substitute their own peerreview system for the absent Central Office peer-review mechanism. One of Newcomb’s first 

341
 
moved away from the Program Chiefs, most of them left Central Office. Also, there was a

need for an entity in Research Service to relate to the ACOS/R&E and through the ACOS to

the hospital’s research program as a whole. To meet this need, in 1969 Lionel Bernstein

appointed five of the Program Chiefs to double as “Regional (Research) Coordinators.” 

Laterthe five regions were reduced to fourandwith attritionthe number of Regional

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

acts after arriving in Washington was to re-establish peer-review committees, now known as 

Merit Review Boards, to evaluate individual programs. Decisions of these committees were 

advisory to the hospital R&E Committees and at first did not directly affect funding. 

Re-establishing these review committees was made more difficult by a new law requiring that 

all federal committees be chartered by the Office of Management and Budget (OMB). 

Newcomb worked with OMB to charter a new group of Merit Review Boards, but he also 

went ahead and set up individual peer review, even without a charter. For the first year or so, 

these Boards functioned ad hoc, without a charter. For one round of review, travel monies of 

the board members were denied. Deliberation was by conference call. However, in the 

beginning, Newcomb continued the system of decentralized total hospital funding with some 

adjustments in response to new merit reviews. It was not until 1974 that the new Merit 

Review Boards were actually chartered (Appendix II l).23 

RRAGs and the RAC 

Newcomb was bombarded with visitors who wanted him to help solve new problems at the 

hospitals, especially ones centered on meeting the needs of their new recruits. Other visitors 

described problems unanticipated by the institutional review group when their three-year 

budget was established. Some hospitals had not been visited before the moratorium and were 

still functioning with the same budgets they had in 1969. To address these diverse situations, 

Newcomb created a new advisory mechanism, the Regional Research Advisory Committees, 

or RRAGs, later called the RAGs.23 As initially conceived, the RRAGs were four 

committees, one from each of the four geographic research regions, each charged with 

reviewing proposals from another region. At first, the RRAGs met simultaneously every two 

months in Central Office. Each RRAG was set up as a three-person committee, with threeyear rotations, chaired by the member in his or her final year of RRAG service. 

The first assignment to the RRAGs was to review a backlog of administrative requests that 

Newcomb had been deliberating. These were generally sketchily documented, and the RRAG 

groups often found it difficult to decide whether a proposal had scientific merit. A major 

concern was whether the requested funding would be beneficial for the hospital’s patient care 

program. After a few meetings, the basic RRAG guideline was established that a proposal 

submitted for approval needed to meet a baseline of scientific merit as determined by an ad 

hoc review. If the proposal met this criterion, then the RRAG’s decision would be based on 

the expected impact of the requested funding on the hospital. 

Newcomb also formed an in-house Research Advisory Committee (RAC), which initially 

consisted of the four RRAG chairpersons, the Chair of the Cooperative Studies Evaluation 

Committee, and representatives from Professional Services, Health Services Research and 

Rehabilitation Research. This Committee met immediately after the RRAG meetings, 

reviewing the RRAG findings and making recommendations about them. It also discussed 

research policy and the needs of the research program. 

Regional Coordinators 

Even during the1960s, there were always vacancies in the roster of Program Chiefs; programs 

in those subject areas did not have a direct advocate in Central Office. As budgetary authority 

342
 
343

Even during the1960s, there were always vacancies in the roster of Program Chiefs; programs 

in those sub ect areas did not have a direct advocate in Central Office. As a

Even during the1960s, there were always vacancies in the roster of Program Chiefs; programs 

in those subject areas did not have a direct advocate in Central Office. As budgetary authority 

moved away from the Program Chiefs, most of them left Central Office. Also, there was a

need for an entity in Research Service to relate to the ACOS/R&E and through the ACOS to

the hospital’s research program as a whole. To meet this need, in 1969 Lionel Bernstein

appointed five of the Program Chiefs to double as “Regional (Research) Coordinators.” 

Later, the five regions were reduced to four, and, with attrition, the number of Regional

Coordinators shrank. By 1974, two remained. Just as the Program Chiefs had been perceived

by the field to have the real power during the early 1960s, the Regional Coordinators were 

now so perceived. The ACOS/R&E worked mostly with the Regional Coordinator and his or 

her assistant. They advised new ACOS/R&Es on their responsibilities and provided them

with information on which hospitals would be useful examples of how a research program

should be administered. They listened sympathetically to pleas and helped when they could.

Figure 15.13. Four of the five Regional Coordinators in 1968: Richard Filer, Ph.D.,

Elston Hooper, Ph.D., James Matthews, M.D., and Mark Walcott, M.D.

(Howard Chauncey, Ph.D. not shown) 

Program Specialists

By the time Newcomb came to Central Office, all of the Program Chiefs had departed. Drs.

Abraham Dury, Gerald G. Hine, James Matthews, and Elston Hooper, who had been Program

Chiefs, now had other responsibilities. Matthews was Newcomb’s Deputy, and when

Matthews left, Dury became the Deputy Director, Research Service. Hooper and Hine

continued as Regional Coordinators but were now expected to cover the whole country.

Research investigators in the field complained that they no longer had someone in Central 

Office who was both interested in and knowledgeable about their particular fields of scientific 

interest. Also, Central Office needed specialists in various research areas to carry on some of

the former Program Chiefs’ functions. To meet these needs, Newcomb established the

position of Program Specialist.

Program Specialists were chosen from successful VA research investigators in the various

subject areas. They were based at their field hospitals and spent only a minority of their time

functioning as Program Specialists. Their function was to serve as liaison between individual 

investigators and VA Central Office. Initially, their major activities were as ombudsmen, 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

j budgetary uthority 

moved away from the Program Chiefs, most of them left Central Office. Also, there was a 

need for an entity in Research Service to relate to the ACOS/R&E and through the ACOS to 

the hospital’s research program as a whole. To meet this need, in 1969 Lionel Bernstein 

appointed five of the Program Chiefs to double as “Regional (Research) Coordinators.” 

Later, the five regions were reduced to four, and, with attrition, the number of Regional 

Coordinators shrank. By 1974, two remained. Just as the Program Chiefs had been perceived 

by the field to have the real power during the early 1960s, the Regional Coordinators were 

now so perceived. The ACOS/R&E worked mostly with the Regional Coordinator and his or 

her assistant. They advised new ACOS/R&Es on their responsibilities and provided them 

with information on which hospitals would be useful examples of how a research program 

should be administered. They listened sympathetically to pleas and helped when they could. 

Figure 15.13. Four of the five Regional Coordinators in 1968: Richard Filer, Ph.D.,
 

Elston Hooper, Ph.D., James Matthews, M.D., and Mark Walcott, M.D.
 

(Howard Chauncey, Ph.D. not shown) 

Program Specialists 

By the time Newcomb came to Central Office, all of the Program Chiefs had departed. Drs. 

Abraham Dury, Gerald G. Hine, James Matthews, and Elston Hooper, who had been Program 

Chiefs, now had other responsibilities. Matthews was Newcomb’s Deputy, and when 

Matthews left, Dury became the Deputy Director, Research Service. Hooper and Hine 

continued as Regional Coordinators but were now expected to cover the whole country. 

Research investigators in the field complained that they no longer had someone in Central 

Office who was both interested in and knowledgeable about their particular fields of scientific 

interest. Also, Central Office needed specialists in various research areas to carry on some of 

the former Program Chiefs’ functions. To meet these needs, Newcomb established the 

position of Program Specialist. 

Program Specialists were chosen from successful VA research investigators in the various 

subject areas. They were based at their field hospitals and spent only a minority of their time 

functioning as Program Specialists. Their function was to serve as liaison between individual 

investigators and VA Central Office. Initially, their major activities were as ombudsmen, 

343
 
 

 

 

 

 

 

 

 

 

 

 

 

tasked with helping research investigators with problems. They also surveyed VA research in 

their fields and provided input for the annual report. Later, the Program Specialists were also 

asked to perform ad hoc scientific reviews of RRAG requests and suggest ad hoc scientific 

reviewers for Merit Reviews and Career Development applications. 

The amount of work asked of the Program Specialists varied considerably from field to field. 

As partial compensation for this extra, unpaid work, the busier Program Specialists were 

given a secretary to help them. In time, new Program Specialists were nominated from the 

field on three-year rotations. 

Basic scientists 

Early in Newcomb’s tenure as Director of Research Service, he faced turmoil among the basic 

scientists at several hospitals. Under the totally decentralized budgeting process, the R&E 

Committee had full responsibility for distribution of all institutional research funds and space. 

A few clinical leaders who did not accept the value of basic scientists to the hospital 

attempted to displace these scientists from their jobs and laboratories by pressuring the R&E 

Committees to remove them. Many of these displaced scientists were distinguished, 

academically acclaimed researchers who, not surprisingly, objected loudly and strongly. 

Newcomb sent Abraham Dury, previously the Program Chief for Basic Sciences, on site visits 

to meet with the scientists to try to resolve these problems. The R&E Committees’ decisions 

were overruled, and the scientists were protected. As a result of these problems, Dury 

established an informal advisory group, including representatives from these and other 

medical centers, to present the viewpoint of the Ph.D. scientists. 

Another outcome of Newcomb’s tenure was the establishment of budgetary “Cost Center 

104.” During the 1960s, the Program Chiefs had protected the basic scientists. But with total 

decentralization, they needed other salary protection. Cost Center 104 was formed separately 

in the hospital research budget to pay the salaries of non-clinician principal investigators, and 

associated funds could not be used for other purposes. Dury later received VA’s highest 

honor, the Exceptional Service Award, in part to recognize his work in stabilizing the role of 

the basic scientist within the research program. 

Research Career Development Program 

In 1969, Chester DeLong, Ph.D., was recruited from NIH to be Chief of the newly expanded 

Research Career Development Program (Chapter 14). His appointment was in Research 

Service, but he also reported to the Director of Education Service, as his responsibilities 

included the Research and Education Trainee program. De Long worked with the Career 

Development Committee to define the various rungs of the research career “ladder.” 

In early 1973, the OMB made the decision that research training programs were not in the 

best interests of the government. Along with NIH training grants, the VA Research and 

Education Trainee program was discontinued. In addition, Pittman and his staff decided that 

the Medical Investigator program was too expensive and placed a moratorium on appointment 

of new Medical Investigators. 

344
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phase-out of the Regional Research Support Centers 

By the time Pittman became ACMD/R&E, the four Research Support Centers had been 

operating for seven to nine years. Different Centers had developed specific specialties, but all 

had responsibility for supporting research in every hospital in their section of the country. 

Unfortunately, the effectiveness of this support appeared to be in inverse proportion to the 

distance of the Center from the hospitals served, and it became increasingly apparent that 

much of the function of the Support Center was local rather than general. Also, scientists in 

the Support Centers wanted to do research, not just support it. Moreover, these Centers 

constituted a rather large and conspicuous budget item. The 1968 National Academy of 

Sciences-National Research Council review of VA research had recommended that “the 

Veterans Administration review the programs and accomplishments of its four Research 

Support Centers to determine whether they are accomplishing the purposes for which they 

were established and how their assistance to individual investigators can be enhanced.”7 

At the same time, it had become apparent that statistical support beyond that provided by 

Central Office was needed for the Cooperative Studies Program. Up to this point, studies had 

been receiving statistical support from many sources, including statisticians from Central 

Office, the Follow-up Agency, universities and special VA laboratories. To standardize the 

statistical support of the cooperative studies, the West Haven (Conn.) and Hines (Ill.) 

Research Support Centers were transformed into Cooperative Studies Program Coordinating 

Centers (CSPCCs). This transformation was gradual; at first, they continued to do what they 

had been doing, but increasingly more of their efforts were directed to cooperative studies. 

The Western Research Support Center, which had emphasized bioengineering and computing, 

became the site of the Medical Research Information System (MRIS).4 For a time, it 

continued to offer courses in bioengineering and computing, but these tapered off with 

increasing information system demands. The Southern Research Support Center at Little 

Rock (Ark.) was disbanded, but some of its staff continued to run the Central Research 

Instrumentation Pool (CRIP).24 

In summary, the 1968-1973 period featured strong Central Office attempts to find a research 

administration design that incorporated peer review and streamlined and rationalized 

oversight. The goal was to achieve predictably high-quality research while protecting 

necessary basic research, clinical applications and promising avenues of research. This time 

of rapid administrative change, much of it controversial, set the stage for the stabilization that 

followed. At the same time, the research carried out in VA hospitals continued to prosper in 

the face of the new initiatives. High-quality staff had been hired through the Career 

Development Program, as had other scientists and clinicians. These factors led to the 

continuing development of laboratories and research programs in fields important to the care 

of the Veteran patient. 

345
 
 

 

 

 

 

 

 

 

Figure 15.14 Research budget, 1968-1973 

80 

70 

60 

50 

Current dollars 40 Deflated to 1968 dollars 

30 

20 

10 

0 

References 

1. Telephone interview with Harold Schoolman, M.D., March 1, 1988 and April 26, 1988. 

2. Interview with Lionel Bernstein, M.D., Ph.D., November 1, 1988 at Dr. Bernstein's office in 

Chicago, IL. 

3. Interview with Thomas Chalmers, M.D., July 29,1992 at a hotel lobby in Boston, MA. 

4. Benjamin B. Wells, M.D., "Circular 10-71-264. VA Medical Research and Education 

Conference, RCS 15-32-S." 12/9/71. 

5. National Academy of Sciences - National Research Council. "Minutes, 25th Meeting of the 

CVMP." December 5, 1952. Washington, DC: National Research Council, 1952, 522. 

6. National Academy of Sciences - National Research Council. "Minutes, 29th Meeting of the 

CVMP." April 20, 1954. Washington, DC: National Research Council, 1954, 536. 

7. National Academy of Sciences - National Research Council. Evaluation of Biomedical 

Research and Education in the Veterans Administration. National Research Council, 1968. 

29. 

8.	 Interview with Leon Bernstein, P.D., April 29, 1988 at Dr. Bernstein's home in Alexandria, 

VA. 

9. Interview with Leslie Zieve, M.D., September 21, 1992 at Dr. Zieve's home near 

Minneapolis, MN. 

Millions of dollars

1968 1969 1970 1971 1972 1973 

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10. Thomas C. Chalmers, M.D., "R&E Letter 69-5. Institution of new procedures for requesting 

designated support for individual (research) programs, as Part I of the institutional (research) 

allocation." 4/15/69. 

11. Thomas C. Chalmers, M.D., "R&E Letter 69-9. VA categorical research evaluation 

committees - Structure, functions and roster of members." 9/11/69. 

12. Interview with Gerald Libman, May 5, 1992 at Mr. Libman’s home in suburban Maryland. 

13.	 Interview with Abraham Dury, Ph.D., February 8, 1994 at Dr. Dury’s home in Florida. 

14. Interview with Ralph Casteel, May 3, 1988 at a restaurant in Bethesda, MD. 

15. Interview with Lyndon Lee, M.D., April 7, 1988 at a restaurant in Bethesda, MD. 

16. Interview with Chester DeLong, Ph.D., May 7, 1992 at Dr. DeLong’s Office in VACO. 

17. Bailar, J.C., 3rd, "Estrogen therapy for prostatic cancer." Prog Clin Cancer, 1970. 4: 387­

392. 

18.	 Interview with John Bailar, M.D., April 29, 1988 at Dr. Bailar's office in Washington, DC. 

19. Telephone interviews with Thomas Newcomb, M.D., March 15, 1988 and May 28, 1988. 

20. M.J. Musser, M.D., "Chief Medical Director's Letter IL 10-71-17. Revision of VA Research 

Program." 3/9/71. 

21. Interview with James Pittman, M.D., February 27, 1992 at Dr. Pittman's office in the Dean's 

Office at the University of Alabama School of Medicine. 

22. Lyndon E. Lee, M.D., "R&E Letter. Phase out of disapproved Part I research programs." 

7/10/70. 

23. Interview with Thomas Newcomb, M.D., March 29, 1992 at a hotel lobby in Washington, 

DC. 

24. Benjamin B. Wells, M.D., "R&E Letter 66-3. Central Research Instrument Pool." 6/21/66. 

347
 
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Chapter 16. Medical Research in VA Comes of Age, 1974–1980 

On the heels of increasingly complex organizational demands, a time had come for a genuine 

maturation of research as an institutional entity within VA. Although new opportunities to 

acquire personnel and funding had been widely welcomed, they had been accompanied by 

inevitable growing pains. A crucial era had arrived. VA’s leaders would be tested to 

effectively shape the research program into a stable enterprise that would not only encourage 

its participants, but also foster recognition and support for the future. 

During this time, a subtle but significant change was made in the nomenclature of facilities 

within the VA health care system. The longstanding term “hospital” was abandoned in favor 

of “medical center,” seen as more representative of the range of activities, including research, 

that was present at most VA locations. 

Reorganization of Research and Development 

As the activities of the Research Service, and simultaneously the Education Service, expanded 

and became more diverse, demands on the ACMD for Research and Education increased. 

There was a feeling, especially among the Education Service staff, that the needs of Research 

Service received preference in the R&E Office. Laurence Foye, M.D., Director of Education 

Service, campaigned to establish a separate Office of Academic Affairs.1 He was successful 

when the Department of Medicine and Surgery was reorganized during the Nixon 

Administration. This reorganization coincided with James Pittman’s departure in mid-1973 to 

become Dean of the Medical School at the University of Alabama. After the reorganization, 

the Offices of Academic Affairs and Research and Development were separate, with Foye and 

Thomas Newcomb as their respective ACMDs. The new office of Research and 

Development now comprised two Services and maintained a “staff office.” The Medical 

Research Service, the former Research Service, searched for a new Director to replace 

Newcomb. Carleton Evans, M.D., directed a revitalized Health Services Research and 

Development Service (Chapter 19), an outgrowth of the old administrative research and 

hospital computer programs. The Prosthetics Research Program, which originated as a staff 

office, would soon become a separate Service (Chapter 20). 

Organization of the Medical Research Service in 1974 

In April 1974, the author joined VA Central Office as Director, Medical Research Service. Her 

former position—ACOS/R&D at the Buffalo (N.Y.) VA Hospital had provided experience working 

within the VA research milieu, and appointments to several advisory groups and site visit teams, 

including one as chair of an original RRAG group, added specific familiarity with the Central 

Office research staff. 

In 1974, the Medical Research Service staff was much slimmer than the Research Service of the 

1960s. Program Chiefs no longer provided a strong professional presence, and their support staffs 

had been reassigned. In fact, the new Medical Research Service had only two physicians, a 

veterinarian and three Ph.D. scientists. Abraham Dury, Ph.D., who had previously been Program 

Chief for Basic Sciences (Chapter 12), was the Deputy Director and had been effectively running 

the Service, while the new ACMD/R&D, Dr. Thomas Newcomb, was focused on building new 

349
 
 

 

 

 

 

 

 

 

 

 

programs. Four staff assistants—one for each geographic region—handled day-to-day funding 

decisions, after consulting with Dury. Darlene Whorley was quietly and effectively running the 

Career Development Program, and Gerald Libman, assisted by two other executive secretaries and a 

small support staff, had stabilized the Merit Review program. 

Figure 16.1. Marguerite Hays, M.D. 

James Hagans, M.D., Ph.D., was heading the Cooperative Studies Program from his Miami 

office, assisted by Marian Brault in Washington. He worked vigorously to mold this program, 

which changed in many ways during the 1970s (Chapter 18). 

The Field Operations section administered undesignated research funds sent to the 

hospitals, which made up most of the budget. A hospital’s research budget was still largely 

based upon precedent, derived from the previous year’s budget, with adjustments that took 

into account new RRAG and Merit Review approvals. Even though many new funding 

decisions could now rely on RRAG recommendations, requests for new funding abounded. 

During the first few months after the author arrived, numerous visits were made by special 

pleaders; it was essential to stabilize the funding mechanism. The author appointed Elston 

Hooper, Ph.D., who had long experience and a deep understanding of the research program, to 

be Chief, Field Operations. In this new position, Hooper assumed the role that in the 1960s 

was that of the four Regional Coordinators and more recently of Dr. Dury himself. Hooper 

served as a buffer between the author and the “special pleaders.” 

Figure 16.2. H. Elston Hooper, Ph.D. 

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The Central Office staff members were bombarded by requests for expensive new and 

replacement equipment, and found these requests difficult to evaluate. An early decision was 

to appoint Gerald Hine, Ph.D., an instrumentation expert in his discipline of nuclear medicine, 

to review and administer research instrumentation. 

Figure 16.3. Gerald Hine, Ph.D 

Based on her experience as ACOS/R&D at Buffalo, the author was primarily concerned about 

two problems with the administration of the Medical Research Service. The first was its 

relative lack of flexibility: a hospital’s research budget tended to remain stable even though its 

programs varied. This made it difficult for a growing program to emerge successfully. On 

the other hand, the status quo was a highly satisfactory situation for a well-established 

research program, and especially for one with declining activity. A budgeting scheme was 

needed that was transparent—one based on discernible factors that reflected a hospital’s 

current research activities. 

Another concern was the general confusion in the field resulting from the many recent major policy 

changes. Most of the ACOSs were themselves unclear about current research policy and that 

uncertainty was amplified in the minds of the investigators they were supposed to be guiding. The 

program needed consistent policies that were acceptable to all interested parties in Central Office, 

acceptable in the field, and understood by all. It was vital that those most affected by policy 

changes—hospital researchers—had a clear understanding of the policies that would govern them. 

The Central Office Medical Research staff devoted considerable effort to describing policies 

explicitly and distributing the information to the field in clearly stated circulars and letters. 

Research was still officially functioning under a 1962 procedural manual so outdated that no 

one ever referred to it. It took the coordinated efforts of many within Central Office to 

completely review and process needed changes culminating in the issuance of a new manual 

in the early 1980s. 

Establishing a management information system as the basis for the research budget 

To make hospital research budgets more responsive to current activity, the author, Dury and 

Hooper worked with the staff of the Sepulveda (Calif.) Bioengineering and Computer Center 

(BECC) to expand and upgrade the Medical Research Information System, MRIS (which was 

soon expanded to include all of R&D and renamed the Research and Development 

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Information System, RDIS2

). 

Figure 16.4. Frederick Weibell, Ph.D. Chief of the BECC 

At that time, except for the Automated Hospital Information System (AHIS) at the 

Washington, D.C., VA Hospital (Chapter 19), no management information system existed in 

the VA medical program, and a congressional restriction forbade the purchase of new 

computers. Fortunately, Research already owned a computer at the BECC. Although 

antiquated—it used punched cards and was programmed in Fortran2

—it was available. So this 

was the machine drafted to support the original RDIS. 

In the new information system, each project was simultaneously reported to RDIS and the 

Smithsonian Science Information Exchange (SSIE). SSIE coded the projects and sent these 

codes, along with project summaries, to the BECC. Each project was then cross-tabulated in 

budgetary reports to a specific part of the medical center’s research budget. Other parts of the 

new system provided information about the numbers of principal investigators, the numbers 

of users engaged in animal studies, and the numbers of users of common resources at each 

hospital. Over several years, the system was revised until it was possible to combine this 

information with the results of Merit Review, RRAG review, the salaries of basic research 

scientists, Career Development Awards, Cooperative Studies activities and special 

laboratories, to establish a total hospital research budget. 

Common resources 

The major “soft,” and the most controversial, area in this budgetary scheme was the amount 

of core support or “common resources” to be allocated to each medical center’s research 

budget. These common resources were the residual from the old “Part 2” funds and 

sometimes constituted the majority of a hospital’s research budget. Working with advisors, 

the Medical Research Service established formulas for the appropriate funding for each 

common resource, based upon such factors as the number of investigators using that particular 

resource and the size of the total program. Using this analysis, the BECC calculated the 

projected funding for common resources for the various medical centers and then compared 

the results with each hospital’s existing funding level. In some cases, the discrepancies were 

great. It was decided to make gradual adjustments toward achieving equity, aiming for full 

implementation of the formula within five years. 

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The more alert ACOSs quickly caught on to this new system. New common resources began 

to appear in their annual reports. When these were the same as in most other hospitals, they 

were simply added into the formula. However, unique common resources also appeared, and 

it was difficult to decide whether they were appropriate. The RRAG groups tried to advise 

about them, but they found this difficult without on-site investigation. Later, site visits by the 

Research Advisory Committee helped influence these decisions. 

Figure 16.5 Medical research budget, 1974-1980 

0 

20 

40 

60 

80 

100 

120 

140 

Millions of dollars

Current dollars 

Deflated to 1974 dollars 

1974 1975 1976 1977 1978 1979 1980 

Establishing new budgetary policies 

In the late 1970s, one budget crisis occurred after another. At the same time that inflationcorrected dollars were shrinking (Figure 16.5), the number of qualified researchers seeking 

support was increasing. For several years, these budgetary strictures were met primarily by 

cutting back on non-Merit Reviewed programs. Under the decentralized program of the early 

1970s, Merit Review success had been rewarded with increased funding, yet lack of success 

had not resulted in decreases. A number of investigators continued to be supported from the 

“basic institutional support” at the medical centers, without applying to the Merit Review 

program, a carryover from “Part 2” funds. Many of these persons had never applied for Merit 

Review approval of their research. 

The author worked with Dr. Newcomb to communicate with others in Central Office about 

the problems and how they were being addressed. Policy changes were openly debated within 

Research and Development. At that time, John Chase, M.D., the Chief Medical Director, held 

daily staff meetings, which were attended by all the ACMDs as well as other key officials. 

These meetings provided an opportunity to discuss significant new events and possible policy 

changes. Newcomb received early feedback from those who were unhappy with proposed 

changes, allowing room to negotiate. They also talked to many ACOSs, during visits in both 

directions, phone calls and formal meetings. The ACOSs’ annual meetings included 

extensive open discussion of policy issues. 

353
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A system gradually evolved in which most of a hospital’s research funding was based upon 

Merit Review. The first step in this process was simply to inform the hospitals how their 

budgets had been calculated. The BECC group performed these calculations, using the RDIS 

budget report, which showed the calculations, including details about common resources. 

Funding for investigators appeared in various columns: “RAG,” “Merit Review approved,” 

“Merit Review disapproved” and “not reviewed.” Some ACOSs strongly protested 

identifying their budgets in this degree of detail, preferring the previous vagueness, which 

allowed more room for manipulation. But most seemed to prefer a transparent budgeting 

system. 

Once the basis of the budget was explicit, budget policy shifted. Except for very small 

programs, continuing programs were required to undergo Merit Review. Once this 

requirement had been widely announced and had survived intense debate, programs that had 

not yet been submitted for review were not funded. This caused turmoil among those who 

believed they could rely on political considerations to retain their funding. While the author 

and Dr. Dury tried to be as flexible and empathetic as possible in enforcing these new 

policies, they did indeed enforce them. Unlike the situation faced by the research leaders of 

the late 1960s, whose policies were reversed by their organizational superiors, Newcomb and 

CMD Chase were consistently supportive and never reversed decisions made in Medical 

Research Service, despite political pressure to do so. 

Once the principle of peer review for all individual programs was firmly in place, programs 

that failed peer review had to be dealt with. This was even more traumatic for participants 

than the actual review. Support of disapproved programs was tapered off gradually, to give 

investigators another chance to apply without closing down the project. The goal was to 

maintain the continuity important to an intramural program. 

In 1974, when this change in funding policy began, the National Academy of Sciences (NAS) 

was just beginning its third review of the VA Research program. The review was eventually 

published in 1977, which in retrospect was an unfortunate time for publication, as funding 

policies were in flux. Some of the policies the committee criticized had already changed by 

the time of their final report. The NAS group was particularly concerned that disapproved 

programs were being supported at the local level. 

As funding grew tighter, money was insufficient to fully fund even approved programs. 

Agencies funding extramural programs can deal with this problem by funding only programs 

receiving the best evaluations from their reviewers. However, the author and Dury believed, 

as had Lionel Bernstein and Leon Bernstein, that an intramural program should fund all of its 

peer-review-approved projects. If a program was not good enough to fund, the Merit Review 

Board should disapprove it. But when there is not enough money to fund all meritorious 

programs fully, the only alternatives are to exclude some of them or to reduce the amount of 

money awarded to each, the choice made by Medical Research Service. To do this, a sliding 

scale reflecting the priorities assigned by the Merit Review Boards was built into the 

computer program used in calculating the budget 

After 1975, the budget was a constant problem. VA was working hard to upgrade its patient 

354
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

care program, and attention was directed to medical care rather than to the research program. 

Some years, the research budget seemed a “sacrificial lamb” to achieve badly needed 

increases in the patient care budget. This budgetary squeeze finally led, in 1978, to a proposal 

that VA cut off funding to many hospitals with small research programs (Chapter 17). 

The OMB study of VA peer review 

As VA’s Merit Review Boards worked to gain OMB charters, a problem arose: OMB staff 

began to feel that VA, through its Merit Review Boards, was mimicking the NIH and its 

grants program. Newcomb’s response was that the VA merit review system was simply the 

application of quality control in an intramural system, which was very different from NIH’s 

extramural grants program. 

During the negotiation with OMB that eventually led to chartering the Merit Review Boards 

in 1972, the OMB staff required that VA and NIH conduct a joint “experiment” on peer 

review. This study, conducted in 1974 and 1975, compared the work of the VA Merit Review 

Boards with that of NIH Study Sections. Gerald Libman and his VA Program Review staff 

worked with the Executive Secretaries at the NIH to perform a blinded double review of VA 

projects. Applications to the NIH by VA staff were duplicated and sent to VA, with VA 

cover sheets. Comparable VA Merit Review applications were sent to the NIH, with NIH 

cover sheets, to enter into the NIH review process.3 Eventually, the NIH abandoned the 

study; many NIH staff were involved, often each with only one study project to handle, and 

they found the experiment to be too time-consuming and confusing. Anecdotally, in 

reviewing the results of the aborted study, VA was reassured about the quality of its Merit 

Review Boards. In most cases, the two agencies’ reviews were similar. When they differed, 

discrepancies tended to balance out, with some VA projects receiving better VA reviews and 

others better NIH reviews.4

 Though funding of VA applications was based only on VA 

results, some investigators felt that they were placed under double jeopardy. By the time the 

experiment was abandoned, the staff at the OMB had changed; the new staff did not pursue 

the study and allowed continuation of the Merit Review Boards.5 

Changes in the Merit Review system 

Secondary review 

As the results of Merit Review grew increasingly important to VA’s medical centers, a great 

deal of interest naturally centered on the reviews. In the early days, considerable pressure was 

applied to use the Director’s executive authority to reverse disapproval decisions. In the mid1970s, Medical Research Service established a second level of review, by a “Medical 

Research Council,” consisting of Medical Research Service senior staff and others in Central 

Office interested in research. The Council members reviewed all Merit Reviews, scrutinizing 

Merit Review Board recommendations one by one. When reviewers felt that the Board’s 

recommendation might have gone astray, they would recommend that the proposal be 

returned for additional review, perhaps by a different Board. The final decision was left to the 

Director, and on rare occasions the author reversed a disapproval decision. 

355
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Investigators in medical disciplines that lacked a Merit Review Board in their specific subject 

areas frequently complained that they were not receiving a fair review, although expert 

reviewers were always sought. While this problem plagues all peer-review systems, even at 

NIH, for VA the difficulty was compounded because fewer Boards existed so each Board was 

expected to cover a broad area. Since most nuclear medicine proposals were crossdisciplinary, they were generally reviewed by whatever specialty board seemed best suited to 

review them. After one round of Merit Review in which the performance of nuclear medicine 

proposals had been dismal, a special advisory group of nuclear medicine specialists rereviewed the proposals. These reviewers were informed of the actions of the primary boards 

and were asked to look for possible areas of unfairness. In virtually every case, however, they 

endorsed the Boards’ original decision. There is no way to know what their decisions would 

have been had they served as the primary review group. 

Appeals 

With so much now depending on Merit Review Board decisions, an investigator needed to be 

able to appeal a Board decision. But since unjustified appeals could swamp the system, only 

limited types of appeal were allowed.6 An in-house committee reviewed appeals with advice 

from the Program Specialists, but this mechanism did not work well. With staff members 

unenthusiastic about appeals, very few of them were upheld. 

Type 2, 3 and 4 Merit Review proposals 

Another innovation that was not very successful was the introduction of three new types of 

Merit Review proposal. In addition to the standard (“Type 1”) proposal, which included a full 

description of proposed research, the new Type 2 and Type 3 proposals were to be reviewed 

retrospectively. Type 2 proposals were for small projects funded at less than $25,000 yearly, 

in which the request was simply for continued funding at the existing level. Any ongoing 

program under $25,000 was eligible for Type 2 review. To be eligible for Type 3 review, the 

retrospective review of larger programs, the principal investigator needed to have been funded 

in VA’s research program for at least 10 years. Type 4 proposals were for pilot projects 

costing less than $25,000. 

The retrospective review of Type 3 programs fit the concept that a senior investigator who is 

consistently productive should be supported based on track record without the need to present 

a complex prospective research program. Some of the leading ACOSs favored this approach, 

and Rosalyn Yalow was a strong advocate. There was enthusiasm in the field, and Central 

Office received many Type 3 proposals. However, the Merit Review Boards frequently 

turned them down, owing to the absence of a prospective proposal. Even though Board 

members had been instructed about the criteria for Type 3 proposals and understood that they 

were supposed to be reviewing them retrospectively, they were uncomfortable without a 

complete prospective proposal to review. Other mechanisms for reviewing these proposals 

were considered, such as a bibliographic analysis. For one round, the RAG groups, rather 

than the Merit Review Boards, reviewed them. The RAG groups, however, were also 

uncomfortable with this new assignment. Eventually, early in the 1980s, the retrospective 

review alternatives were abandoned. As with the appeals mechanism, the concepts of Type 2, 

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3 and 4 reviews failed primarily because they were not well accepted by those whose job it 

was to implement them. 

The Research Career Scientist Program 

After a few years of the new budget policies, a number of independent Ph.D. scientists whose 

salaries had been built into their hospitals’ budgets lost their research funding. This presented 

the anomaly of a person being paid to conduct research who had no support for the research 

itself. As most of these researchers had been hired into government career appointments, it 

was not possible simply to terminate their appointments. Yet one could not justify continuing 

to pay their salaries. In 1977, Medical Research Service notified the medical centers where 

these unfunded scientists were located that unless they had achieved peer-reviewed research 

funding (VA or non-VA) by the beginning of the following fiscal year, the hospitals would 

receive no money for their salaries. Approximately 25 individuals were affected, and this 

decision generated great concern. However, the medical centers handled this crisis very well. 

Some of the scientists who were eligible to retire did so. Others stepped into other jobs at the 

hospital. A number of them said later that they were happier in their new positions. 

Clearly, it was desirable to avoid a recurrence of this situation. A new policy stated that, in 

the future, new non-clinician scientists could be hired into a career appointment only if they 

qualified for a new category entitled Research Career Scientist.7, 8 A Research Career Scientist 

appointment honored the most successful non-clinician scientists already within VA and 

provided a means of recruiting new “superstars.” A new committee reviewed applications, 

using criteria similar to those used by universities evaluating candidates for tenure. This 

committee set such high standards VA hospitals soon boasted an elite corps of research stars 

(Appendix VIII). 

The Research Career Development Program 

In 1975, VA physician’s bonus was introduced. Previously, VA physicians’ salaries had been 

fixed at the same level as other employees in the equivalent Civil Service grade. As a 

consequence, their salaries lagged so far behind those of physicians at other institutions that it 

was becoming very difficult to hire first-rate physicians into VA. The research program at 

that time was essential for recruiting and retaining physicians, and withholding research funds 

from an important clinician was controversial. The introduction of a bonus, however, made 

physicians’ salaries competitive with academic salaries, at least for a time. As a result, 

outstanding physician-scientists flocked into VA, and Medical Research Service had many 

new applications from talented investigators. This influx of talent occurred at the same time 

that the budget’s spending power began to decline. 

One problem imposed by the physician’s bonus affected the Research Career Development 

Program. Since the bonus was specifically directed to correct recruitment problems and 

vigorous competition existed for Career Development positions, there was no problem in 

recruiting persons into that program. For this reason, CMD Chase made an agreement with 

OMB staff that, if they would approve the physician’s bonus, he was willing to exclude from 

that bonus certain categories of physicians.9

 These categories included the Career 

357
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Development physicians. Suddenly, Research Associates, Clinical Investigators and Medical 

Investigators, who had been paid the same as their peers in the clinical services at their 

hospitals, were being paid considerably less. The consequence was a significant exodus from 

the program, particularly among the more senior persons, who took high-level positions at 

their medical centers, where they were eligible for the bonus. Some hospitals that had been 

active in nominating persons into the Career Development Program dropped out. Others, 

particularly when an affiliated medical school was willing to help make up the salary 

difference, continued to present outstanding candidates for Career Development positions. It 

turned out that many highly qualified young physicians were sufficiently interested in a 

research career that they were willing to accept smaller salaries in exchange for having extra 

time for research. The program continued to flourish. 

The Research Career Development program had become so popular that the qualifications of 

successful candidates continued to escalate. When the Clinical Investigator program was 

introduced in the late 1950s, it was considered to be an entry-level program (Chapter 7). But 

as Clinical Investigator positions became increasingly competitive, and applicants’ 

qualifications grew increasingly more impressive, a gap was left at the entry level. In the 

1960s (Chapter 12), this gap was filled by applicants for the Research Associate position. By 

the mid-1970s, qualification for the Research Associate position had escalated to the point 

that it was no longer accessible to truly entry-level persons. In fact, the rather modest 

research support that came with the appointment was only a fraction of the total support of 

some successful candidates. Most of them also applied for Merit Review and many for other 

sources of funding. In some instances, Clinical Investigators were running huge laboratories 

with a large number of staff, quite inappropriate for a person still in a developmental career 

phase. In hopes of discouraging fully independent investigators from pushing the 

“developing” investigators out of the Research Associate and Clinical Investigator slots, 

limits were placed on their funding. While this discouraged some over-qualified individuals, 

these positions continued to be very popular among well-qualified researchers.10 

Once again there was a need for entry-level positions in the Research Career Development 

Program. In setting up the new appointment level, constraints were placed to prevent it from 

also escalating and becoming filled with over-qualified incumbents. Only clinicians without 

research training except that incidental to their residencies were eligible. This new position 

was a two-year appointment, with one-year appointments available to those who had 

completed one-year research fellowships. Those with both M.D. and Ph.D.degrees were not 

eligible, as they had already benefited from research training. To further emphasize this as a 

junior position, successful candidates were salaried lower than the usual staff-physician 

levels, and were ineligible for the physician’s bonus.11 

Despite these constraints, good candidates soon applied for appointment to the new position 

of Associate Investigator. A major problem in their review was the nature of the research 

protocol itself. It was understood that these inexperienced candidates needed some help in 

writing their proposals. It became obvious that in some cases the preceptor had actually 

written the proposal; in others, the candidates themselves wrote it. Given this disparity, it was 

sometimes hard for the Career Development Committee to assess candidates. Increasingly, 

they emphasized their preference for a good (but not necessarily polished) proposal with 

358
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

evidence that the candidate had written it. 

The Career Development program was always considered important, and it received 

preferential funding. Until the mid-1970s, all approved applications were funded. However, 

with the budget squeeze of the 1970s, it became necessary to use priority cutoffs that became 

progressively restrictive. By the time the Associate Investigator position was introduced, 

even it required a priority cutoff, though it was more lenient than for the more senior 

positions. So it was introduced in a modest way, and funding of Associate Investigator 

positions was always very competitive. 

Newcomb and the author decided to reintroduce the Medical Investigator position, which had 

been under a moratorium for new appointments, by accepting limited numbers of applications 

starting in 1975. One problem had been that these expensive positions tended to be grouped 

in a few successful hospitals. This did not seem equitable, particularly since these mature and 

successful clinician-scientists could be important influences in hospitals with small research 

programs. In reintroducing the Medical Investigator position, its character was changed in a 

number of ways: (1) Only clinicians already on the VA staff could apply. (2) Each hospital 

had a limit of two Medical Investigators at any one time. (3) The appointment was for six 

years and could not be renewed unless the investigator had spent at least one year on the 

clinical staff at the completion of the earlier appointment. (4) In nominating a Medical 

Investigator, the hospital management had to promise to rehire that person on the clinical staff 

at the end of the appointment. In addition, at that time, Medical Investigators were ineligible 

for the physician’s bonus. Nevertheless, once the position was reopened, applications flooded 

in. Generally, not more than one or two of these expensive appointments were made at each 

semiannual round of Career Development reviews. 

Changes were also made in the Senior Medical Investigator program. Ludwig Gross and 

Oscar Auerbach both reached their 70th birthdays in 1975 and faced the then-mandatory 

retirement from VA. They could no longer be Senior Medical Investigators, but VA honored 

them as Senior Medical Investigator Emeriti and as Distinguished Physicians, an appointment 

available to retirees. Both continued to conduct research at their hospitals. These two 

vacancies made it possible to think about appointing new Senior Medical Investigators. 

William Oldendorf at Brentwood (Calif.) was made Senior Medical Investigator in 1978, and 

Roger Unger from Dallas, previously ACOS for Research, received the appointment in 

1979.12 

Middleton Awardees 

The 1974 and 1975 Middleton Awards were presented in VA Central Office with key officials 

present. 

The 1974 awardee was Paul Srere, Ph.D., from the Dallas VA Hospital, for his biochemical 

accomplishments on key cellular metabolic pathways regulating lipid and carbohydrate 

synthesis and storage. Dr. Srere was in one of the first group of Research Career Scientists to 

be appointed and was an active and valued advisor of the research program. 

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Figure 16.6. (left to right): Chief Medical Director Chase, Middleton Awardee Paul 

Srere and Administrator Richard Roudebush 

In 1975, Paul Heller, M.D., of the Chicago West Side VA Hospital was honored with the 

Middleton Award. Heller was a Czech who, after six years in Nazi concentration camps, had 

been able to come to the United States to finish his training and had then made a career in 

VA. He led VA’s important cooperative study on the sickle-cell trait. The Middleton Award 

honored him for his research in hematology, immunology, enzymology and metabolism, 

including findings on the mechanism of immunologic deficiency in multiple myeloma. 

For the next three years, the award was presented at a celebration held in conjunction with a 

meeting of research administrators and advisors. In 1976, it went to William Oldendorf, 

M.D., from the Brentwood VA Hospital in Los Angeles for his development of nuclear 

techniques in clinical neurology. These included the first description of computerized 

tomography, the development of techniques of cerebral blood flow measurement, elaboration 

of cerebrospinal fluid functions and characterization of blood brain barrier permeability. The 

first of these accomplishments , computerized tomography, was the basis of his 1975 Lasker 

Award and his later nomination for the Nobel Prize. 

Oldendorf’s introduction to VA research while he was Chief of Neurology at the Los Angeles 

VA Hospital clearly reflected the less structured, more personal approach to funding 

sometimes seen in earlier years. In a 1991 interview, he described being approached by 

Morton Grossman, the hospital’s acting research chief, who asked, “Bill, you’re interested in 

research aren’t you?” Oldendorf recalled what happened when he confirmed he was 

interested in doing research with a simple “yeah.” 

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Figure 16.7. William Oldendorf accepting the Middleton Award as Administrator Max 

Cleland smiles 

 “He (Grossman) said, ‘Have you got any funding?’ and I said, ‘No.’ Then he asked, ‘Could 

you use $3,000?’ 

“Could I! And so I had an account of 3,000 bucks set up. With that, I got a double sodium 

iodine head detector made up. And I did all that old work with the boluses measuring blood 

flow going through the head. And I used the same funds to build the first CT scanner...Did 

everything myself.”13 

Oldendorf conceived the idea for the CT scanner as a way to avoid the pain and complications 

suffered by patients who had to be studied by pneumoencephalography to detect brain lesions. 

He set up the prototype scanner in the den at his home, using, among other things, an old 

model railroad train track. 

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Figure 16.8. The prototype for the Figure 16.9. Oldendorf in his den in 1961 

CT scanner with the CT scanner prototype 

In 1977, Charles Lieber, M.D., of the Bronx (N.Y.) VA Medical Center received the 

Middleton Award for his studies of the toxicity of alcohol, including elucidation of its 

interaction with drug, lipid and uric-acid metabolism, and the pathogenesis of fatty liver and 

cirrhosis in humans and nonhuman primates. 

Figure 16.10. Charles Lieber, M.D. 

The 1978 award went to Victor Herbert, M.D., also of the Bronx, for “developing scientific 

tools to diagnose nutrient deficiencies, measure nutrient binding proteins, demonstrate 

selective deficiency of nutrients in one cell line but not another, and applying the scientific 

criteria of safety and efficacy to nutrition folklore.” 

In 1979, Edward Freis, M.D. (Chapter 9) received the award for his “studies of hypertension 

that proved the efficacy and life saving qualities of medical treatment.” 

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Figure 16.11. Norman Talal, M.D., receiving the Middleton Award 

From Acting Administrator Rufus Wilson 

Norman Talal, M.D., a Medical Investigator at the San Francisco VA Medical Center, 

received the 1980 award in a VACO ceremony from Acting Administrator Rufus Wilson. He 

was cited “for the development of immunological concepts derived from the study of patients 

and animal models for autoimmune and endocrine systems which has led to new theoretical 

and therapeutic considerations for human diseases.” 

New honors for VA researchers 

In addition to VA’s own Middleton Award, in the 1970s VA researchers were honored with 

many prestigious awards, including five Lasker Awards and two Nobel Prizes. 

Lasker Awards 

After the Nobel Prize, the Lasker Award is arguably the top honor for an American medical 

researcher. Edward Fries, M.D., received the Lasker Award in 1972 for “his demonstration of the 

life-saving effectiveness of drugs in the treatment of moderate hypertension” (Chapter 9). Ludwig 

Gross, M.D., of the Bronx, won it in 1974 for “his original discovery of leukemia- and cancerinducing viruses in mammals, and the elucidation of their biology and epidemiology” (Chapter 3). 

And recognizing his original concept of the principles demonstrating the feasibility of computerized 

tomographic scanning, William Oldendorf, M.D., won it in 1975 for “discoveries which have 

envisaged a revolution in radiology”. 

According to the Lasker Foundation, more than half of those honored with the Lasker Award for 

Basic Medical Research since 1962 later received the Nobel Prize. This was true of VA’s Nobel 

Prize laureates Rosalyn Yalow and Andrew Schally, both also honored with Lasker Awards. 

Schally won the Lasker Award in 1975, cited as one “whose research has expanded our knowledge 

of the interplay between the hypothalamus and the endocrine system.” Yalow’s 1976 Lasker Award 

was “for the discovery and development of the technique of radioimmunoassay” (Chapter 11). 

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Figure 16.12. Celebration at the Bronx VA Medical Center the day Rosalyn Yalow 

heard she would receive the Nobel Prize: (Left to right) Ludwig Gross, Bernard Roswit, 

Rosalyn Yalow, Thomas Chalmers (Dean, Mt. Sinai School of Medicine), Julius Wolf 

(Chief of Staff), Bernard Straus (former Chief of Medicine who had helped Yalow 

recruit Berson), Marguerite Hays and Herbert Rose (ACOS/R&D). 

Nobel Prize 

In 1977, Rosalyn Yalow from the Bronx and Andrew Schally from New Orleans were 

awarded the Nobel Prize. This was a time of great excitement in VA’s Research and 

Development office. On the day the prizes were announced, the author went to the Bronx for 

a celebration in the afternoon and both she and Newcomb attended an evening celebration in 

New Orleans. Later, VA held a reception at the Capitol in honor of its Nobel laureates. 

Schally was received by the King of Spain shortly after the Prize ceremony. Both later 

received many honorary degrees. 

The two winners had rather different reactions to the honor. Schally quickly dug back into his 

laboratory, determined, as he put it, to win a second Nobel Prize. Yalow, on the other hand, 

took her prize as an opportunity to support the VA research program that had supported her. 

She declared widely that she had never applied for NIH funding but had depended entirely on 

VA for support of her laboratory. 

Yalow campaigned for VA research funds at the level of Administrator in VA, and also with 

Congress. To the Central Office Research staff, her efforts were a mixed blessing. Certainly, 

the VA research effort needed the publicity and the exposure she provided. On the other 

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hand, she was strongly opposed to the use of peer review for evaluation of research and 

expressed her opinion freely and in high places. 

Figure 16.13. Andrew Schally (second from left) next to King Juan Carlos I of Spain 

After discussions with Yalow about research administration, VA Administrator Max Cleland 

appointed a special research advisory committee, which Yalow chaired. The committee 

included Edward Rall, M.D., head of the intramural program at NIH, Julius Axelrod, 

Ph.D.,Nobel laureate from NIH, Morton Grossman, M.D., Ph.D., VA Senior Medical 

Investigator, and a few others of similar distinction. The committee reviewed the medical 

research program, its current status and the way it was administered. They learned about the 

Career Development Program, Cooperative Studies and the new high-priority programs, but 

their primary interest was the Merit Review system. The committee reviewed it in 

considerable detail, paying particular attention to the way results were used. In the end, the 

committee not only rejected the idea of abolishing the Merit Review program, but some of the 

visitors favored abruptly discontinuing disapproved programs. 

Personnel changes 

Dr. Abraham Dury retired in 1976 and, after a nationwide search for a new Deputy Director 

of Medical Research Service, Elston Hooper assumed the position. In 1978, Betty Uzman, 

M.D., who was then the ACOS/R&D at Shreveport (La.) offered to come to Central Office if 

she was needed. A person of her talents was certainly needed, but there was no appropriate 

staff opening at the time. She joined Central Office as “Assistant Chief of Field Operations.” 

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Soon, the incumbent Chief transferred to a different job and Uzman became Chief. Under her 

guidance, the Field Operations program became systematic and responsive to the field. She 

saw to it that policies were clear and decisions as fair as possible. Uzman was a strong 

advocate of peer review and opposed any administrative adjustment to Merit Review 

recommendations. 

Figure 16.14. Betty Uzman, M.D. 

When Elston Hooper retired in late 1978, Earl Freed, Ph.D., became the new Deputy Director 

of Medical Research Service. In his previous position of research coordinator in the Mental 

Health and Behavioral Sciences Service in Central Office, Freed had achieved good relations 

with Medical Research Service. He had been a successful research investigator for many 

years at the Lyons (N.J.) VA Hospital and consequently understood the requirements of 

psychology research and the research needs of the unaffiliated hospitals. 

Figure 16.15. Earl Freed, Ph.D. 

Mr. Wayne Tippets, Administrative Officer for Medical Research Service from 1974 to 1978, 

entered the program to become a Medical Center Director, and Mr. Dennis Roth became 

Administrative Officer. Roth later became Administrative Officer for the ACMD/R&D and 

remained in that taxing position into the 1990s. 

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Figure 16.16 Dennis Roth and Wayne Tippets 

When Gerald Libman moved in 1977 from his position as Chief of the Program Review 

Division, the unit that administered the Merit Review program, Jane Schultz, Ph.D., a scientist 

from the Ann Arbor (Mich.) VA Medical Center, became Chief. When she returned to her 

laboratory in 1979, Howard Berman, Ph.D. assumed the leadership of that complex operation. 

In the summer of 1978, Newcomb left Central Office for San Antonio (TX) to be Chief of 

Staff at the VA Medical Center there and Associate Dean of the University of Texas, San 

Antonio medical school. At about the same time, Dr. Chase completed his four-year term as 

Chief Medical Director and left Central Office. After a search that lasted several months, 

Administrator Cleland named James C. Crutcher, M.D., from the Atlanta VA Medical Center, 

as CMD. Crutcher was an unexpected choice, as he had no Central Office experience. He 

had been Chief of Medicine for many years at Atlanta and more recently had been ACOS for 

Education. He was also a Brigadier General in the Army Reserve. Laurence Foye had left 

shortly before Chase, so the Deputy CMD position was also vacant. Crutcher asked Donald 

Custis, M.D., a retired Navy Vice Admiral, at that time Deputy ACMD for Academic Affairs, 

to serve as Deputy CMD. After he had been in Washington for several months, Crutcher 

appointed the author to the ACMD/R&D position. Betty Uzman then became Director, 

Medical Research Service. 

Figure 16.17. Jane Schultz, Ph.D. Figure 16.18. Howard Berman 

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The Innovative Research Program 

While her appointment to the ACMD/R&D position was being considered, the author, with 

Chief Medical Director Crutcher and Administrator Cleland, met with Senator Alan Cranston. 

Cranston, Chairman of the Senate Veterans Affairs Committee, was a very powerful figure in 

Veterans’ politics. Rosalyn Yalow had many conversations with him about her ideas on 

research. Cranston’s keen interest in the VA research program was apparent, as he inquired 

about research philosophy and, in particular, about attitudes toward peer review. He asked 

how the research leaders were making allowances for innovative programs that might not be 

recognized by the peer-review groups. Later, Cleland learned that the Senator was willing to 

agree to the author’s appointment on the condition that 2 percent of the VA research budget 

be set aside for “innovative programs.” 

Uzman and the author worked together to establish an “Innovative Research” program within 

the constraints of the research budget and the peer-review system. Much of this requirement 

could be met within the current Merit Review system by identifying particularly innovative 

programs with the help of the Merit Review Boards; these innovative programs would then be 

funded preferentially. A separate category in the RDIS budgeting system was established to 

accommodate this preferential funding. 

The Research Program Specialists sorted through current projects in their areas searching for 

innovative programs. The Merit Review Boards identified projects they considered 

particularly innovative. A letter to the field announced this new “innovative research” 

program and invited persons who felt their research to be particularly innovative to write. 

While these projects never quite added up to the Senator Cranston’s 2 percent requirement, 

making inquiries from his staff a bit awkward, a sincere attempt was made to meet it without 

violating the principle of peer review. 

Special Emphasis Areas 

An effort had always been made to direct VA research money to solving health problems of 

greatest importance to Veterans. The centrally directed research programs of the 1920s and 

1930s narrowly focused on such problems. During the post-World War II period, with 

university affiliations, this effort was less direct. Pragmatically, if a VA doctor could justify a 

research project on scientific grounds, VA supported it. In most cases, these projects were 

relevant to the Veteran, because Veterans were the patients of these doctors. In addition, 

focused programs were undertaken, including those of the Advisory Committee on Aging 

Research and the centralized programs on prosthetics, tuberculosis and psychiatric disease. 

Nevertheless, by the mid-1970s, with implementation of peer review and depletion of Central 

Office professional research staff, little effective effort was being devoted to boosting VAsupported research in the areas of particular importance to the Veteran patient. It became 

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difficult to respond constructively to the ever-present pressures from Congress and influential 

groups to divert research funds into their areas of particular interest. It seemed wise to define 

some explicit research priorities oriented to the special needs of the VA patient.14 The first 

approach to this task was to identify VA’s most prevalent patient care problems. These were 

categorized as “Special Emphasis Areas,” which were announced in a 1977 Research and 

Development Letter to the field15 specifically inviting cooperative studies in these areas. 

High Priority Research Programs 

In addition to encouraging research in these Special Emphasis Areas, a few “High Priority 

Areas” were selected for preferential funding. These High Priority Areas were intentionally 

narrow and never consumed a large part of the budget, to avoid depleting the general funds 

supporting the Merit Review program. During the late 1970s, High Priority programs were 

begun in aging, the biology of alcoholism, the biology of schizophrenia and tissue 

regeneration. 

In defining its original High Priority Areas, VA deliberately stayed away from topics heavily 

emphasized by other agencies. Even though VA had large numbers of patients with cancer 

and heart disease, these areas of research were well-funded by the NIH, so that a small, 

directed initiative by VA did not seem appropriate. 

Aging 

The High Priority Area in aging was already in place, as research in the Geriatric Research 

Education and Clinical Centers (GRECCs) was receiving preferential funding. The original 

GRECC program, spearheaded by Paul Haber, M.D., while he was ACMD for Extended Care, 

had been passed into law and funded, together with money to pay the salaries of research staff 

within the GRECCs. But the research staff needed support to carry out their research. The 

original GRECC units were “tooling up” when the author arrived in VA Central Office in 

1974, and Haber lobbied hard to have her provide earmarked research support. The Medical 

Research leadership, however, insisted that these new programs be peer reviewed. A 

compromise was reached: GRECC research projects were required to undergo Merit Review, 

but those approved would be fully funded even if other research budgets were being cut. This 

arrangement lasted into the 1980s, when budget constraints made its continuance impractical. 

By that time, research in the GRECCs had been well established. 

The GRECCs, in their educational effort, sponsored Geriatric Fellowships for clinicians 

wanting to specialize in this area. In 1980, as a part of the Aging High Priority program, 

Medical Research Service offered a one-year research extension of these fellowships, handled 

within the Associate Investigator program.16 

Aging research outside of the GRECCs, quantitatively much greater than that within the 

GRECCs, was considered to be in a Special Emphasis Area but received no budgetary 

preference. 

New High Priority Areas: Alcoholism, Schizophrenia and Tissue Regeneration 

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VA patient demographics guided the choice of the next two High Priority Areas. Alcoholism 

and its related diseases caused the most VA hospital admissions. Schizophrenia was clearly 

responsible for the largest number of patients occupying beds in the VA medical system at 

any given time. To leverage the existing strengths of VA research without duplicating 

research being done elsewhere, the biology of these conditions was selected for focused VA 

programs. 

To coordinate the High Priority programs from the Central Office, Robert Allen, Ph.D., was 

recruited from the NIH. He organized conferences and meetings, took charge of tracking all 

the defined High Priority Areas to assure their protected budget lines, and interacted with the 

individuals in the programs. Allen became the glue holding these programs together, and kept 

them pointed toward their goals. 

Figure 16.19. Matthew Kinnard, Ph.D., Chief of Field Operations, 

and Robert Allen, Ph.D. 

Alcoholism 

David Rutstein, M.D., at that time a VA Distinguished Physician in Boston, visited Newcomb 

in 1977 and urged that VA follow up on recent interesting studies on the familial incidence of 

alcoholism. Stimulated by Rutstein’s enthusiasm, CMD Chase held a meeting attended by Sir 

Hans Krebs (who was interested in the biology of alcohol and friend of Paul Srere, Ph.D., 

from Dallas), Rutstein, Srere and a number of other VA scientists, along with a sprinkling of 

Central Office staff. One outcome of this meeting was a conference on the biology of 

alcoholism held in Florida in January 1978. The consensus was that the greatest need was to 

recruit competent scientists from other areas into the area of alcoholism. 

Marcus Rothschild, M.D., Chief of Nuclear Medicine at the Manhattan VA and a Middleton 

Award winner for his research on the liver, was interested in this problem. He agreed to 

spend three months in Central Office, where he started a program of “Alcoholism Scholars”: 

scientists with M.D. or Ph.D. degrees who were not currently working for VA were invited to 

present applications for three-year fellowships to work in a VA laboratory on the biology of 

alcoholism. This program received 85 applicants in its first review cycle. Rothschild formed 

a special committee to review the applications, and 13 Alcoholism Scholars were chosen. 

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The following year, VA scientists as well as non-VA scientists were permitted to apply, and 

six more Alcoholism Scholars were selected from 60 applicants. 

These Alcoholism Scholars (Appendix IX), most quite young, were treated as an elite corps. 

They received their appointment certificates in ceremonies attended by the VA Administrator 

and Chief Medical Director. They were brought together to share their research experiences. 

Of the 13 Scholars in the first round, all recruited from outside VA for this program, nine 

continued with VA careers after their appointments expired. 

Figure 16.20. Marcus Rothschild, M.D. 

A third round in this effort, known as the “Innovative Alcoholism” program, was directed to 

innovative proposals from VA laboratories. Announcement of this program aroused much 

interest from VA researchers who were not primarily in the field of alcoholism research and 

generated 97 letters of intent, followed by 63 full proposals. After review by special 

committees in June 1981, 11 projects were selected as both innovative and highly meritorious. 

Owing to a budget shortfall, their funding was postponed until October 1982. 

A task group reviewed the program in early 1982 and recommended that the VA alcohol 

research program be expanded to include clinical research combining the basic work under 

way with studies incorporating VA’s large patient care effort in this area. In response, the 

Medical Research Service announced a competition for Clinical Research Centers in 

Alcoholism. After extensive review, the first such Center was awarded to San Diego VA 

Medical Center, with Mark Schukit, M.D., one of the original Alcoholism Scholars, as its 

Chief. 

Schizophrenia 

Claude Baxter, Ph.D., from the Sepulveda (Calif.) VA Medical Center, spent six months in 

Central Office to launch the High Priority research program in schizophrenia. Baxter, a 

neurochemist well known for his work with GABA in the brain, reviewed the literature on the 

biology of schizophrenia, which he found to be extensive and complex. He then identified the 

experts in the field, both within VA and from universities in the United States and abroad. 

Many of these scholars were invited to a conference held in Harper’s Ferry, W.Va., in April 

1979, where they presented formal papers, subsequently edited in a Proceedings volume.17 

This meeting reviewed the state of the art in research on the biology of schizophrenia. The 

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participants also considered how VA could best launch a focused attack on the problem. The 

conference consensus was that VA should establish Centers of Excellence in the biology of 

schizophrenia, initially directed toward improving classification of the various types of 

schizophrenia as a necessary requisite to meaningful biologic approaches to addressing the 

disease. 

Figure 16.21. Attendees at the Harper’s Ferry meeting on schizophrenia research, 1979. 

First row: C.E. Beck, E.D. Bird, Hiatt, Betty Uzman, Robert Allen, Aaron Janowski, 

A.L. Goldstein, Joseph Zubin. Second row: Phillip May, J.E. Kleinman, Sheri 

Buchsbaum, Monte Buchsbaum. Third row: Earl Freed, W.T. Carpenter, Jr., Robert 

Savage, Theodore P. Zahn, Jack Ewalt, J.R. Perez-Polo, D.R. Weinberger, F.A. Henn, 

Arthur Yuweiler, T. Melnechuk, Philip Berger, Joseph Collins, W.A. Brown, N.R. 

Schoolar, H.A. Nazrallah, J.O. Cole, J.A. Gfeller, D.H. Ingvar, T.M. Itil, J.W. Mason, 

Claude Baxter, Loren Mosher, Marguerite Hays, J.M. Davis, R.T. Canoso, M.M. Singh. 

Proposals for Schizophrenia Biologic Research Centers (SBRCs) were formally solicited in 

September 1979.18 Nineteen medical centers sent letters of interest, seven were invited to 

submit full applications, and six did so. The Bronx VA Medical Center was chosen for 

funding of an SBRC, with Kenneth L. Davis, M.D., as its Chief, and funding began in January 

1981. During 1981, after another competition, a second SBRC was selected at the Palo Alto 

VA Medical Center. Staff in both of these SBRCs published widely on schizophrenia and 

other mental illnesses, but the original goal of biologically based classification proved elusive. 

Regeneration 

VA Administrator Max Cleland, a Vietnam Veteran who had lost both legs and one arm in a 

grenade explosion, was interested in the prospects of limb regeneration. VA defined “tissue 

regeneration” as a High Priority research area. Vernon Nickel, M.D., Director of the 

Rehabilitation Engineering Research and Development Service (Chapter 20), together with 

Robert O. Becker, M.D., Middleton Award-winning orthopedic surgeon at the Syracuse 

(N.Y.) VA Medical Center, organized a conference on “The Mechanisms of Growth Control.” 

Becker was a pioneer in this area, having studied the effects of electrical stimulation on bone 

growth and repair. The conference, held Sept. 26–28, 1979, was widely attended by scientists 

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and others interested in tissue regeneration from all over the United States and from Russia, 

Japan and Canada. 

The Paralyzed Veterans of America service organization was strongly supportive of research 

in the area of spinal cord regeneration. At the same time, basic neurobiology studies, many 

being carried out within the VA research program, suggested that such regeneration might no 

longer be in the realm of science fiction. Betty Uzman, whose scientific specialty was 

neurobiology and who knew most of the principal players in the area of nerve regeneration, 

assumed responsibility for the regeneration High Priority Area.19 

The formal VA regeneration program began taking form in 1980, when Dr. Uzman chaired a 

planning committee that met in Palo Alto, Calif., and recommended that VA establish an 

Office of Regeneration Research. A competition ensued for this office, which was established 

at the Portland (Ore.) VA Medical Center in early 1981, with Frederick Seil, M.D., a 

neurologist with an active research program in nerve regeneration, as its Chief.20 During the 

1980s and 1990s, this Office coordinated regeneration research in VA, defined which VA 

research projects fit into the High Priority concept for preferential funding, published a 

newsletter, and later established a training program in regeneration research. Through Dr. 

Seil and his office, VA held biennial conferences on regeneration research that were well 

attended and encouraged collaborations in the field. Most of the effort was in the area of 

neural regeneration, work supported in collaboration with the Paralyzed Veterans of America 

and the VA Rehabilitation Research Service, as well as Medical Research Service. 

How useful was the concept of High Priority programs? 

Although the amount of extra funds earmarked for these high-priority programs was relatively 

small, the programs proved productive. In addition to their scientific contributions, they 

helped to satisfy some of the special interest groups that wanted to divert VA resources to 

areas of their particular concern. 

Tissue regeneration 

The conferences, newsletter and personal encouragement from the Office of Regeneration 

Research supported expansion of VA research in this field and led to some early successes in 

regeneration in the central nervous system. 

One of the leaders in this field is Stephen Waxman, M.D., Ph.D., who was a part of the 

original planning group for this initiative. Dr. Waxman was Chief of Neurology at the Palo 

Alto VA Medical Center until 1985, when he became Chair of Neurology at Yale. The 

Eastern Paralyzed Veterans of America donated a Neuroscience Research Center on the West 

Haven (Conn.) VA campus to house the joint VA-Yale program of regeneration research 

under Dr. Waxman’s leadership. Beginning while in Palo Alto, Waxman’s laboratory studied 

the South American knife fish, Sternarchus, which has the ability to regenerate the spinal cord 

in its tail when the tail is bitten off by a predator. This process was studied in the laboratory 

in normal and tail-amputated Sternarchus, using anatomic, electron microscopic and cell 

culture studies. The source of the regeneration was identified as the ependymal cells of the 

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center of the spinal cord. This seminal work has been expanded in other laboratories to 

produce some nerve regeneration in certain mammals. While still a long leap to regeneration 

of cells in a human’s severed spinal cord, the objective is no longer considered hopeless.21, 22 

Schizophrenia 

The Bronx Schizophrenia Biologic Research Center remains active. The VA program is now 

fully integrated with that of the Mount Sinai School of Medicine and is the location of a large 

group of researchers in biologic psychiatry. One of its most important findings has been the 

correlation of homovanillic acid with schizophrenic symptoms. The group has been studying 

the genetics of schizophrenia and, through a gene bank, has established pedigrees of 

schizophrenic families. A bank of brains donated by deceased schizophrenia patients led to 

the finding that schizophrenic brains are depleted of dopamine. The group has also studied 

Alzheimer’s disease, devised scales for its assessment, and developed tacrine, the first drug 

approved by the Food and Drug Administration to combat the disease.23 

Biology of alcoholism 

The 19 Alcoholism Scholars appointed in 1979 and 1980 (Appendix IX) were still publishing 

scholarly papers as of a 2002 review, and 15 (87 percent) were conducting research on the 

biology of alcoholism. 

Marc Schukit, M.D., of the original group of Scholars, has won many awards for his genetic 

studies of alcoholism. His laboratory tried to identify the specific genes involved in 

alcoholism. He described the significance of his most important findings as a key to 

formulating a theory that alcoholism’s genetic causes are heterogeneous; selecting a particular 

marker of risk, showing that the marker, a low level of response to alcohol, related to a family 

history of alcoholism and predicted alcoholism 15 years later. He and his colleagues had 

studied a group of 453 subjects and were in the process, in 2002, of studying their 444 

offspring. Schukit commented, “I also hope that some of my work in comorbid psychiatric 

disorders in the context of alcohol and drug dependence has been useful to the field.”24 

Boris Tabakoff, Ph.D., who spent 1984 to1990 in high positions at the National Institute on 

Alcohol Abuse and Alcoholism (NIAAA), was, in 2002, chair of the Department of 

Pharmacology at the University of Colorado, where he was studying the cellular effects of 

alcohol. Tabakoff said: 

“I believe that we were the first to link brain vasopressin and vasopressin-like peptides to 

the development of tolerance to alcohol. We described different forms of alcohol 

tolerance (those that involved learning and conditioning and those that did not involve 

components of learning). We demonstrated that one could, with manipulation of brain 

vasopressin peptides and modulation of brain noradrenergic systems, control the learned 

forms of tolerance, while leaving the other components of tolerance intact.” 

Tabakoff also demonstrated the involvement of the NMDA (N-methyl-D-aspartate) 

glutamatergic systems in the acute and chronic effects of ethanol with initial results that 

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showed that ethanol was significantly and potently inhibiting NMDA receptor function. He 

noted that: 

“My ideas were then extended to encompass the chronic effects of ethanol. These results 

substantiated that the NMDA receptor system responds (adapts) to ethanol administration 

by an upregulation of receptor number and receptor function.” 

Tabakoff extensively studied the effects of ethanol on the dopamine receptor-stimulated 

adenyl cyclase activity. He said: 

“The work continued with demonstrations of the chronic effects of ethanol, and the 

adenylyl cyclase systems and the observation that human alcoholic subjects had lower 

platelet adenylyl cyclase activity compared to controls. This clinical study was done 

while I was at the Westside VA in Chicago. 

“More currently, in the adenylyl cyclase area, we have created transgenic animals and 

null mutant mice, as well as utilizing selective breeding techniques and QTL analysis 

which all point to the role that adenylyl cyclase plays in the etiology of alcohol tolerance 

and dependence.”25 

Carrie Randall, Ph.D., who was recruited into the Alcoholism Scholars program at the 

Charleston (S.C.) VA Medical Center, received the Distinguished Alcohol Research Award 

from the Research Society on Alcoholism in 1998 and the Keller Award from NIAAA in 

2000. She stated that the VA Alcoholism Scholar award allowed her to “build an independent 

research program from the ground up.” She remained in VA for 14 years, until she was 

recruited to the State University of South Carolina. Randall studied the role of prostaglandins 

in the etiology of Fetal Alcohol Syndrome and was, in 2002, studying the relationship 

between social anxiety and the use/misuse of alcohol.26 

Adron Harris, Ph.D.’s work focused on the study of drug addiction with emphasis on 

alcoholism. He clarified several molecular targets of alcohol action in the brain and studied 

actions of ethanol on GABA receptors.27 

Raj Laksman, Ph.D., at the Washington (D.C.) VA Medical Center made significant 

contributions in the field of alcoholic hyperlipidemia. He found that the condition is partly 

due to the formation of abnormal triglyceride-rich remnant particles that are defectively 

cleared by the liver.28 

Anna Taylor, Ph.D., of the Brentwood (Calif.) VA Medical Center and UCLA, focused her 

research on the neurobiology of alcoholism. She was among the first to demonstrate that 

prenatal exposure to ethanol produces a consistent pattern of enhanced neuroendocrine and 

behavioral responses to stress and psychoactive drugs, including ethanol, in adult fetal 

alcohol-exposed offspring. Recognizing that alcohol affects neural and endocrine systems 

that are intimately involved in immunological responses, her team of investigators 

demonstrated adverse effects of alcohol on immune competence following prenatal as well as 

adult exposure.29 

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Ladislav Volicer, M.D., Ph.D., is one of the Alcohol Scholars who later moved into a 

different field, but one also of great importance to VA. He continued his basic 

neuropharmacological research and also initiated some clinical studies looking at factors 

influencing genetic predisposition to alcoholism. Volicer became the medical director of a 

Dementia Special Care Unit at the GRECC in Bedford, Mass., and developed a palliative care 

program for patients with advanced dementia. This program, which was described in JAMA,30 

was among the first to consider advanced dementia a terminal disease. 

John Crabbe, Ph.D., of the Portland (Ore.) VA Medical Center was an early proponent of 

genetic animal models and provided insight about the relationships among the different 

behavioral components of the overall alcoholic syndrome. For example, he contributed to our 

understanding that alcohol consumption and severity of alcohol withdrawal are negatively 

genetically coupled in rodents.31 

These leaders are among many who helped the High Priority programs started in the late 

1970s to serve VA and its patients so well. One of the advantages of a relatively small, inhouse research program like the VA Medical Research program was found in its 

administrative flexibility; all that was necessary to start these programs was an initial decision 

to proceed, recruitment of the staff and expertise needed, and money set aside. Later, when it 

seemed to those in charge that these programs were no longer necessary, they could be 

abandoned in favor of other new initiatives. 

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References 

1. Telephone interview with Laurence Foye, M.D., March 12, 1988. 

2. Foye, L.V., Jr., M.D., "10-77-219 Circular. FY 1977 VA R&D Information Systems 

(RDIS)." September 23, 1977. 

3. Newcomb, T.F., M.D., "IL 15-74-12 R&D Letter. VA-NIH Review Feasibility Study." 

June 4, 1974. 

4. Interview with Howard Berman, May 1, 1992 at Mr. Berman’s office in the Westbard 

Building of NIH. 

5. Interview with Thomas Newcomb, M.D., March 29, 1992 at a hotel lobby in Washington, 

DC. 

6. Jacoby, W.J., Jr., M.D., "10-80-34 Circular. Merit Review Appeal Process." February 19, 

1980. 

7. Foye, L.V., Jr., M.D., "10-77-61 Circular. PhD Scientist Appointments in Medical Research 

(Program 821)." March 15, 1977. 

8. Foye, L.V., Jr., M.D., "10-77-60 Circular. Research Career Scientist." March 14, 1977. 

9. Foye, L.V., Jr., M.D., "10-75-277 DM&S Circular. Special pay for physicians and 

dentists." November 12, 1975. 

10. Newcomb, T.F., M.D., "IL 15-75-5 R&D Letter. Medical Research Service Career 

Development Program." July 30, 1975. 

11. Newcomb, T.F., M.D., "IL 15-77-16 R&D Letter. R&D Career Development Program." 

November 18, 1977. 

12. Thomas, D. "Data base of information about Career Development appointees." 1989. 

13. Interview with William H. Oldendorf, M.D., November 5, 1991 at Dr. Oldendorf's office at 

Brentwood VA Medical Center. 

14. Newcomb, T.F., M.D., "10-76-177 Circular. R&D Priority Assessment." August 17, 1976. 

15. Newcomb, T.F., M.D., "IL 15-77-8 R&D Letter. Planning and Development of 

Cooperative Studies in Special Emphasis Areas." June 24, 1977. 

16. Jacoby, W.J., Jr., M.D., "10-80-186 Circular. Opportunity of research training for geriatric 

fellows." August 29, 1980. 

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17. Perspectives in Schizophrenia Research. Baxter, C.F. and Melnechuk, T., eds.; New York, 

NY: Raven Press, 1980. 

18. Hays, M.T., M.D., "IL 15-79-11 R&D Letter. Solicitation of Letters of Intent for 

Schizophrenia Biologic Research Centers." September 5, 1979. 

19. Uzman, B.G., M.D., "A report on progress in research High Priority Areas." Newsletter: 

Research and Development in Health Care, Washington, DC, December, 1979. 7. 

20. Hays, M.T., M.D., "IL 15-80-4 R&D Letter. VA Regeneration Research." May 21, 1980. 

21. Anderson, M.J. and Waxman, S.G., "Neurogenesis in adult vertebrate spinal cord in situ and 

in vitro: a new model system." Ann NY Acad Sci, 1985: 213-233. 

22. Form and Function of the Brain and Spinal Cord. Waxman, S.G., ed. Cambridge, MA: MIT 

Press, 2001, 231-233. 

23. Interview with Kenneth Davis, M.D., November 9, 1993 at Washington, DC hotel lobby. 

24.	 Letter from Marc Schuckit, M.D. to author, written at San Diego, CA, March 18, 2002. 

25. Letter from Boris Tabakoff, Ph.D. to author, written at Denver, CO, April 1, 2002. 

26. Letter from Carrie Randall, Ph.D. to author, written at Charleston, SC, May 10, 2002. 

27. Letter from Adron Harris, Ph.D. to author, written at Austin, TX, April 28, 2002 (Email). 

28.	 Letter from Raj Lakshman, Ph.D. to author, written at Washington, DC, April 19, 2002. 

29. Letter from Anna Taylor, Ph.D. to author, written at Los Angeles, CA, July 9, 2002. 

30.	 Letter from Vladislav Volicer, M.D., Ph.D. to author, written at Bedford, MA, May 10, 

2002. 

31. Letter from John Crabbe, Ph.D. to author, written at Portland, OR, March 14, 2002. 

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Chapter 17. Meeting Funding Challenges: “Project Scissors” 

In November of 1977, VA’s medical research program encountered a crisis, as pressures to restrict 

federal budgets and growing demand for research funding collided in a way that sent shock waves 

through the community of investigators, VA research managers, hospital administrators and medical 

school affiliates. 

The immediate, precipitating factor was arrival at VA of the President’s budget for fiscal year 1979, 

which proposed a cut in the Medical Research budget to well below current (fiscal year 1978) 

operating dollars. The Research Service believed that most of the “fat” had already been cut out of 

the program and that it would be impossible to operate under the proposed budget with a “business 

as usual” approach. Something more drastic would be necessary; aggressive reductions would have 

to be made, in an effort that would become informally known as “Project Scissors”. 

Although the President's budget does not represent final funding decisions (the actual budget is 

ultimately determined by Congressional appropriation, a lengthy process worked out over several 

months), VA was obliged to prepare to operate at the proposed, lower level. Before the actual 

budget figure for the next fiscal year would be known, several developments would take place: 

 The research program's national leaders thoroughly explored cost-cutting options, and 

formulated a new policy that would eliminate or curtail research funding at locations that 

appeared unproductive; 

 Criteria were established to weigh relative productivity of research, such as instances of 

findings being published; 

 An unprecedented series of nearly three-score site visits by small teams of researchers and 

administrators were made to evaluate ongoing projects; 

 An ad hoc national “caucus” took place, at which investigators and administrators from 

throughout the system expressed concerns, debated solutions and ultimately reached a level 

of consensus on the logic and fairness of the evolving funding process; and 

 A new method of supporting research at facilities with small research programs was 

established, in the form of two regional research and development offices. 

The problem had been brewing for some time, as a cost-conscious period in federal budgeting had 

led to three years of relatively “straight line” funding for VA's medical research program. At the 

same time, VA was recruiting many excellent physician-scientists, willing and able to do needed 

research. To deal with these pressures, VA had already increased peer review and, on advice of the 

Merit Review Boards, gradually phased out programs. This was a painful process, as VA research 

is an intramural program and the people losing funding were VA’s own employees. The cuts 

clearly triggered reassignments, resignations and retirements. 

The Medical Research Service was supporting research programs in 123 VA medical centers with a 

total annual budget of $123 million. Ninety percent of the support was concentrated in 56 medical 

centers with large research enterprises. The other medical centers conducting research fell into 

several categories. In some cases, research support had started at modest levels when the medical 

center participated in a cooperative study or was given another special assignment. When that 

purpose was fulfilled, some of the “core” support remained and often paid for the salaries of one or 

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two employees. In other cases, especially those distant from a medical school, one or two 

individuals consistently carried out high-quality research; they continued to be productive and 

received Merit Review Board approval despite their isolation. The monies sent to those distant 

medical centers supported the productive investigators and included additional “core support” for 

local research administration. There also were situations where a highly affiliated hospital, with 

academically qualified physicians, was small enough that the justifiable number of research 

physicians was small. And then there were situations of an emerging program on its way up, or a 

declining program on its way down. 

Despite changes over the preceding decade, administration of research money remained highly 

decentralized. The medical center’s Research and Development Committee had much of the 

responsibility for deciding how to best use the money sent. As for review from Central Office, 

larger projects underwent individual Merit Review and the research of newly recruited investigators 

was reviewed by the Research Advisory Groups (RAG). Site-visit teams had been reviewing the 

overall research programs at medical centers with medium and large research budgets. Except for 

occasional Central Office staff member administrative site visits, medical centers with total budgets 

below $550,000 per year had not ordinarily been visited. Central Office staff often were not 

familiar with how these smaller research programs were using their money. 

Medical Research Service staff wanted to protect the two most highly regarded programs, the 

Research Career Development and Cooperative Studies Programs. Both had been maintained at 

constant budgets during the recent budget squeeze. 

VA’s medical research budget had grown steadily during the 1950s and 1960s but had leveled off 

after fiscal year 1975 (Figure 16.5 in Chapter 16). At the same time, the program, which received 

congressional attention in earlier days, was now relatively “invisible.” While the Department of 

Medicine and Surgery and the Administrator’s Office spoke of the importance of the program, they 

did not seek increased budgets. Research received relatively little attention in VA’s congressional 

hearings. Despite all the publicity and recognition that had been generated on Capitol Hill, and 

even despite the 1977 Nobel Prizes won by VA scientists Rosalyn Yalow and Andrew Schally, the 

picture had not changed. 

Settling on a plan 

After they learned of the proposed FY 1979 budget cut, the Medical Research Service staff 

evaluated three potential responses: 

1.	 A year of “no new initiatives.” With this plan, VA would not start any programs in new highpriority research areas, would not start research where it didn’t already exist (including in 

newly constructed hospitals), and would not support new affiliations or newly recruited staff. 

2.	 Redirect funds by a variety of budgetary manipulations, including restricting dollar support for 

any individual investigator or any medical center. Some advisors felt they should cut off 

funds of part-time VA staff. Others recommended a retroactive application of a merit review 

“pay line.” All these options involved reneging on a commitment made after peer review 

approval of the research’s scientific merit. All but the merit review pay line, the Medical 

Research Service staff believed, would undercut the research of some of VA’s best 

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investigators. 

3.	 The third approach, which earned the sobriquet “Project Scissors,” was to entirely cut off 

funding from medical centers with marginal programs. The rationale was that a research 

program needs a “critical mass” of scientists to maintain quality. The National Research 

Council of the National Academy of Sciences, in its1976 report Biomedical Research in The 

Veterans Administration, had recommended withdrawing research support from hospitals not 

affiliated with medical schools. Other advisors agreed with this approach. Review of funding 

patterns showed that, with few exceptions, hospitals with small research programs put 

proportionally more support into common resources and into projects that had been approved 

only locally, with less support provided for Merit Review-approved research. 

Of the three options considered, cutting off smaller programs involved the fewest Merit Reviewapproved programs and was the approach chosen. Many medical centers would be affected. 

Depending on which were finally identified, approximately 55 with the smallest research budgets 

would need to be cut to save the necessary monies. In response to advice from the Research 

Advisory Committee, Medical Research Service also decided to place a $100,000 limit on VA 

support of any investigator’s program. 

The author was prominently involved in these deliberations and actions, having been Director of 

VA Medical Research for more than three years. Thomas Newcomb, M.D., the ACMD/R&D, 

worked closely with the author in evaluating options and agreed on this approach. It next needed to 

be discussed with those higher in the VA administration. Newcomb asked the author to present the 

plan to Dr. Chase, the Chief Medical Director and Dr. Thomas Fitzgerald, the Deputy in charge of 

medical center operations. The three discussed the adverse effects expected from each cost-cutting 

measure. Chase asked the author for her recommendation. She proposed cutting the small 

programs and offered to exercise care. She also recommended placing a $100,000 limit on the large 

individual programs, reasoning that these programs could remain viable and probably find other 

support. Chase agreed and said he would bring the matter to Administrator Cleland’s attention, 

cautioning that they could not talk publicly about the budget until after the President’s budget 

message of January 23, 1978. 

Choosing the “Scissors” medical centers 

To identify which medical centers’ research programs to cut, the Medical Research Service staff 

decided that except for a few places with so little research support that they could persuade their 

management to accept an administrative decision, they would first visit the targeted sites. 

The 75 medical centers with the least research funding were the likely candidates. The BECC staff 

at the Sepulveda (Calif.) VA Medical Center, which handled the R&D Information System, coded 

and retrieved information about the abstracts, papers and books published by research investigators 

at these 75 medical centers. For balance, information was gathered about the three centers with the 

most research money. They decided to site-visit all but one of the medical centers on the list that 

received total funds of less than $300,000. The exception, a medical center with only $150,000, had 

produced so many publications in prestigious journals that they eliminated it from the “at risk” list. 

In the group with funding between $300,000 and $550,000, the decision to visit was made primarily 

on the basis of an index of medical journal publications used to score work being done at each 

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location. After an analysis of the index, 11 medical centers, 10 of them with research funding over 

$300,000 per year, escaped further review. 

Eight medical centers with research funding under $12,000 per year were “zeroed out” after the 

author called the Medical Center Director to discuss the situation. The Director of a ninth medical 

center that had received only $936 that year persuaded the author to make a site visit because of 

their pending medical school affiliation. 

The 58 medical centers to be site-visited included all the others with research funding below 

$150,000, 16 of the 17 with funding between $150,000 and $300,000, and 7 of 17 with research 

funding between $300,000 and $550,000. 

The site visit teams 

Twelve teams of site visitors were selected—each with two members, an Associate Chief of Staff 

for Research and Development (ACOS/R&D) from a VA medical center and a VA clinicianscientist. All site visitors had Merit Review funding of their own research. Generally, one team 

member was from a medical center with a large research program and one from a modest program. 

Each site visitor made three to five visits, some with one partner and others with another partner. 

Site visitors were recruited by telephone. They were asked to commit time during late January and 

early February and also to attend a meeting in Central Office Feb. 22 and 23, 1978. The embargo 

on budget information prevented any of them from knowing the purpose of their visits. 

By Christmas, all site visitors had received information about their partners and which hospitals 

they would visit. Medical Research Service had formally requested permission for their 

participation from their medical center directors and had also notified those programs that would be 

site-visited, telling them when the visit would be and who would be visiting. They could not, of 

course, be told why they were being visited. During January, materials for site visitors were 

compiled. The BECC group at Sepulveda assembled packets showing each hospital’s funding 

pattern for the past four years and listing all investigators with their funding histories, roles in the 

medical center, salary source, publication histories and the amount of time they reported spending 

on research. These information packets were sent to the medical centers for verification and 

updating. The updated information was ready for the site visitors when they arrived. A site 

visitors’ questionnaire was developed to help them make succinct evaluations. 

Announcing “Project Scissors” 

In early January, other persons in Central Office were notified about these plans, including the list 

of the medical centers to be site-visited between Jan. 23 and Feb. 20. Representatives of the other 

major offices in the Department of Medicine and Surgery were invited to the Feb. 22-23 meeting. 

On Jan. 23,1978, President Carter announced his budget plan to Congress. That morning, the 

author read this message on a conference call to all the research programs: 

“As you may know, today is the day that President Carter announces his Fiscal Year 1979 

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budgetary recommendations to the Congress. This budget has been prepared by the Office of 

Management and Budget after considering the needs of all parts of the executive branch of the 

government. The President’s budget request for Fiscal Year 1979 will impose a severe 

constraint on the medical research budget. This means that drastic action has become 

necessary. A number of options are possible, and they have been discussed, not only within 

R&D but with the Chief Medical Director and the Administrator. 

“Two decisions have been made. The first is that, with but a few exceptions in high priority 

research areas, we will place a $100,000 ceiling on the funding of programs of individual 

investigators. The second, more far-reaching decision is to terminate medical research funding 

in many health-care facilities. In a few cases, I have already talked to the Directors of the 

facilities and informed them that no FY 1979 funds will be sent. The other facilities are still in 

process of being identified. 

“Site visits to selected hospitals will occur during the next month. The visitors are being asked 

to assemble as strong a case as they can for maintaining medical research funding at the 

hospitals they visit. I’m sure that those of you who are being visited will help them to do this. 

On February 22 and 23, there will be a meeting here in Washington at which the site visitors 

will present their findings. As a result of this meeting, we will assemble a listing of the 

facilities, ranking them according to our best assessment of the relative importance of 

maintaining the medical research program. 

“As things look now, basic institutional medical research funding will have to be terminated in 

the majority of the facilities being site-visited. This is a process that will be very painful. We 

would like to assist investigators at the facilities where funding is to be discontinued who have 

high priority merit review approvals, and who wish to do so, to transfer to facilities with 

continuing programs. If those of you who are not being site-visited during the next month, and 

hence who are not in jeopardy of losing your medical research programs, will inform us of your 

staffing needs, we may be able to help you locate some fine investigators. 

“In addition to this stricture on our operating budget, the current FY 1979 construction budget 

contains no major or minor research construction. 

“There is still hope, of course, that the final budget allocation from the Congress will make this 

entire effort needless. I sincerely hope that, in the end, it turns out to have been a waste of time 

and effort. But we have no real reason to believe that this hope has any basis. We have, 

therefore, no choice but to proceed on the assumption that the current budget is to be the final 

budget.” 

The announcement left people stunned. While many site visitors had suspected something like this 

was in the wind, others were shocked to be involved in such an unpleasant process. People at the 

affected medical centers were understandably upset. 

Medical Research Service prepared a letter to site visitors, for distribution coinciding with the 

President’s budget announcement, explaining what was going on and containing a suggested 

agenda. If the program was affiliated, they were asked to visit the medical school or to talk to its 

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representatives. They were expected to meet with the Research and Development Committee to 

review their procedures and attitudes and to try to interview all of the research investigators. Site 

visitors were asked to orient their visits to the positive. They were to serve, in the late February 

meeting, as advocates for medical centers they had visited. Obviously, salient negative aspects 

should be included. However, their primary role was to present reasons the program should be 

continued, rather than the opposite. 

The next month was one of frantic activity. A number of site visitors became so upset by the 

turmoil their visits caused at medical centers that they protested. 

The caucus 

By the Feb. 22-23 meeting, emotions among site visitors had reached a high pitch. One 

ACOS/R&D devised a plan by which site visitors would agree to vote unanimously a top score to 

all programs reviewed. This would, in effect, eliminate the possibility of using site visit results. He 

decided to drop this approach when another ACOS organized a Feb. 21 caucus of site visitors to 

consider a joint stand. He proposed that the caucus consider stating that: 

“1. The site visitors are unwilling and unable to advise Research Service in Central Office 

about which individual hospitals should have their research programs completely eliminated. 

2. The administrative officers in Central Office Research Service who have decided on this 

policy should implement it themselves without help. 

3. They should evaluate the adverse effects of this implementation. 

4. The caucus members understand that other alternative policies might well result in
 

significant restrictions of funds to their own institutions.” 

This caucus met as planned and later asked the author to join the meeting for her response to the 

sentiments expressed by the group. She explained that all were hoping that none of the process 

would prove necessary, as work was being done on a number of fronts to try to influence Congress 

to increase the budget. However, it was necessary to prepare for the possibility of no increase. She 

explained that their descriptive input was critical to the meeting, but that their votes, while helpful, 

were not essential. She again asked them to present all of the arguments they could muster in favor 

of retaining research at each of the medical centers they represented. 

The group agreed jointly to vote a simple yes-no question. For each medical center, each attendee 

would vote that the program be retained or discontinued. If all site visitors wanted to vote for 

continuing all programs, their input would nevertheless be useful to other attendees in making 

decisions. The author pointed out that, in their presentations, the comment that “I would gladly give 

up money from my own program to retain this program” would indeed be a strong argument. After 

considerable discussion, this approach was accepted. The author agreed to put the caucus 

resolutions on the agenda first thing in the morning. 

The meeting 

The next days’ meetings were attended by 95 persons: site visitors, representatives from other parts 

of Central Office and most VA Medical Research field advisors. Each was given information about 

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the medical centers to be reviewed and asked to vote either to retain or discontinue each program. 

The medical centers were reviewed in groups relatively comparable to each other, eight or nine in a 

group. For each medical center, the site visit team leader and partner described their visit. At the 

end of each group of presentations, the assemblage reviewed the medical centers in the group and 

made an effort to rate them against each other. Attendees rated the medical centers as they heard 

about them, and also reviewed their ratings at the end of the second afternoon in light of what they 

had heard about the entire group. The site visitors were true to their task of presenting the positive 

side, but in some cases it became apparent that some research money was indeed being wasted. As 

time went on, site visitors and other attendees began to work from the same viewpoint. 

By the end of the second day, a consensus had emerged about a number of issues: 

 Even at medical centers with the smallest programs and a fair degree of mediocrity, there 

were occasional bright lights. Individual scientists managed to carry out excellent research 

despite lack of a supportive environment. There was general consensus that these persons 

should be allowed to continue. 

 Frequently, money allocated outside of peer review, for administrative support and small 

projects, was not being used well. 

 Smaller research programs would benefit from outside support of the type provided by the 

university in closely affiliated medical centers. The group considered pairing smaller centers 

with stronger ones. 

Also by the end of the second day, a proposal emerged that VA set up Regional Offices to 

administer smaller research programs. These offices would take over administrative chores now 

being done at each medical center. Administrative monetary support would be given to the Regional 

Offices to support the assigned research programs, rather than directly to the medical centers. The 

Regional Offices would also provide scientific support and “know-how” for their research 

programs. 

Waiting 

Over the next few months, the threatened program cutoffs received considerable attention. The 

impact was brought up in congressional hearings, stimulating specific research program hearings by 

the Senate Veterans Affairs Committee. Medical Research Service was invited to defend its 

position in meetings with a number of members of Congress. Contacts with Senators and 

Representatives were coming from many of the affected medical centers and Cleland was being 

pressured to have the White House reconsider VA’s research budget. 

The next months were anxious times for the medical centers at risk as they waited for final 

resolution of the budget in Congress. It was not until almost the beginning of the next fiscal year 

that the final budget was signed containing a $10 million increase for Medical Research. As a 

result, it was possible to continue medical research funding at all of the medical centers that had 

been visited. 

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One year later 

Toward the end of fiscal year 1979, the author wrote to the visited medical centers, requesting 

feedback about the effects of the review process. Research at 49 of the site-visited medical centers 

had now come under the jurisdiction one of two new Regional Offices—one at Livermore, Calif., 

with Werner Schlapfer, Ph.D., as Chief, and the other at Perry Point, Md., with William Pare, Ph.D., 

as Chief. As a result, these medical centers had little or no local discretionary research monies. On 

the other hand, the Chiefs of the Regional R&D Offices had, by this time, visited them all. 

Responses about the Regional Offices ranged from “it is another level of bureaucracy” and “the loss 

of our autonomy is bad” to “it is our only source of hope” and “it was the major positive effect of 

the process.” 

One of the medical centers, which subsequently showed an increase in both funding and activity, 

complained of the enormous amount of time required for preparation for the site visit. But their 

outcome was generally positive, as the research program had received significant support from top 

hospital management, substantive support from its affiliated university, input from the Veterans’ 

organizations, and strong support from their members of Congress. The director of one hospital 

with a small research program, which had decided to close out research entirely, said the site visit 

had helped them realize that they were not an appropriate site for a research program. 

Another medical center, which reported decreases in funding and activity since the site visit, said 

that their program was in serious difficulty now and had lost five people. They said that the top 

hospital administration had assumed that their program would be discontinued and the affiliation 

was in jeopardy. On the other hand, a comparable hospital in the same funding range reported 

increased activity. Their medical school and community support had increased, and they had made 

the decision to push their affiliation. Another medical center that had increased its research activity 

since the visit described the severe negative effect on local morale, despite having received a great 

deal of support from medical center management, the affiliated school, the community and 

members of Congress. 

With regard to the site visit process itself, a number of hospital officials wrote that it had been 

helpful and had improved communications with Central Office. 

Many, however, complained of the long period of uncertainty, and pointed out that a written game 

plan would have been helpful. They described the drain on the time of the ACOSs seeking 

personnel replacements. “We cannot over-emphasize the negative effect resulting from ambiguous 

communications from Central Office. Obviously the whole system would work better if Central 

Office provided continuous encouragement rather than continued threat of withdrawal of financial 

support.” And, “The period of time between notification of the site visit and receipt of fiscal year 

1979 budget information was fraught with uncertainty, dampening of research activities and 

resigning of research staff.” 

The individual impact on members of the research program included personal stress and 

discouragement. Some continued to feel pessimistic despite the restoration of their funds. There was 

resentment about the threat that small programs were to be cannibalized by the large, wellorganized, well-staffed and well-funded research centers. Some responders said that it was now 

386
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hard to interest physicians in research and that the enthusiasm among clinicians to engage in 

relatively minor direct care-related projects had been dampened. “There’s a feeling among the 

clinical staff . . . that VACO is unsympathetic to their commitment to VA and the contributions they 

have made to this hospital.” On the other hand, another hospital reported that the process had 

increased the support for research by the patient care elements. They have “closed the ranks 

between various professions and focused attention on the need for research.” Another hospital said, 

“Many individuals involved in patient care, but only peripherally concerned with research, 

expressed great dismay about possible loss of the research program and felt they could not remain 

affiliated with a VA Medical Center where research was not done.” 

Other hospitals reported that “to the extent that the department chairmen, dean, and faculty of the 

school were unified in their support of the research program, the site visit was beneficial in making 

school officials recognize the critical need for research support for full-time academic faculty 

recruited to the VA.” 

With regard to the lessons learned, respondents discussed reassessment of their priorities and 

recognition of the need to improve their procedures and accountability. They had also learned from 

site visitors about the importance of RAG and Merit Review and exploration of extra-VA funds. A 

number also mentioned an increased awareness of the value of maintaining good communications 

with Veterans groups and congressional representatives. As one respondent said, “Now that the 

eyes of many are on us, if we do not deliver, with some haste, a high level of productivity, then time 

may not grant us a second respite.” 

Ten years later 

Of the 49 medical centers whose research was originally assigned to the regional offices in the 

aftermath of Project Scissors, 23 had no Merit Review or RAG programs in 1978 and so were 

funded only through the Regional Research and Development Offices. The other 26 programs had 

one or more approved RAG or Merit Review programs and continued to receive those funds. But 

the regionalized medical centers received no other direct funding. Instead, they were dependent for 

their support on the Regional Offices. 

By 1988, 15 of the site-visited medical centers originally “zeroed out” had abandoned research. On 

the other hand, 13 medical centers that had received no research funds at all in fiscal year 1978 (and 

hence had not been reviewed in Project Scissors) were now receiving research funds. In most cases, 

the Regional Offices had played a major role in helping those “new” medical centers to establish 

research programs. 

Three programs originally not regionalized became so weak that they were subsequently added to 

the Regional Offices’ responsibility. One of them, after working closely with the Regional Office 

for four years, revived and regained independence in 1986. Another program that was originally 

regionalized was made independent in 1982, and a third was expected to become independent late 

in 1988. There were a few rather spectacular successes. One program that had no research at all in 

1978 had three funded Merit Reviews, two RAGs and one Clinical Investigator in 1988. Another 

had four Merit Review approved investigators in 1988, and a third had three. Another hospital, just 

beginning its affiliation in 1978 with only one investigator, 10 years later had eight funded 

387
 
 

 

investigators receiving more than $400,000 in annual support. 

The overall experience for “regionalized” medical centers over the 10 years from 1978 to 1988 is 

shown in Figure 17.1 and the top chart in Figure 17.2. It is apparent that many of them remained 

successful in the face of increasing competition. 

Figure 17.1. Ten years’ experience of the two Regional Research Offices 

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Figure 17.2. Summary of relative funding experience of the three groups of research 

programs 

The independent medical centers 

Fifteen medical centers site-visited during Project Scissors were not assigned to Regional Offices. 

Their research programs seemed to be large enough to constitute a “critical mass” and to be well 

administered locally. The relative funding positions five and 10 years later for these 15 medical 

centers is compared in the lower part of Figure 17.2 with those of 11 medical centers in 

approximately the same funding range that were not site-visited. Surprisingly little difference 

existed between the two groups of medical centers. If we assume that publication productivity is a 

reasonable predictor, we would have expected the medical centers that were site-visited to do 

considerably less well than those that were spared. It is possible that the experience of being sitevisited under threatening circumstances stimulated the success of some of the research programs. 

Total number of funded medical centers 

Perhaps the most unexpected outcome of Project Scissors was stabilization of the total number of 

medical centers receiving research funds. This number had been declining year by year just before 

1978. In fiscal year 1978, 127 medical centers received Medical Research money; in 1988, there 

were 125. This stabilization most likely can be credited to the Regional Office Chiefs, who actively 

encouraged and helped investigators from small research programs who wished to compete in 

research to do so. 

389
 
 

 

 

Policy impact of Project Scissors 

The general principles suggested by the Project Scissors site visitors, and later endorsed by other 

advisors, remained in place 10 years later and continued in subsequent years. A qualified and 

motivated person at any VA medical center, with local approval, may compete for research funds 

through the peer review processes. While the medical centers that have done well usually continue 

to be those with strong medical school affiliations, no restriction exists on opportunities for 

investigators from other medical centers. 

390
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 18. The Cooperative Studies Program of the 1970s 

As the 1960s progressed, Lawrence Shaw, A.M., increased his role as Chief of the 

Cooperative Studies Program, establishing a strong Cooperative Studies Evaluation 

Committee (CSEC) and Cooperative Studies Program Coordinating Centers (CSPCCs). By 

the end of his tenure in 1972, while he had not yet brought psychiatry studies under the 

centralized program, the program had become fairly unified. Shaw had come up through the 

ranks in Central Office. His manner was rather low-key; the success of his leadership 

depended on eliciting cooperation from those willing to cooperate.1 

After Shaw retired in the spring of 1972, a search committee sought a new Chief. Meanwhile, 

William Best, M.D., from Hines (Ill.) acted as Chief. He commuted back and forth to 

Washington, trying to hold the Cooperative Studies Program together. Best was on the search 

committee and contacted James Hagans, M.D., Ph.D., to see if he would be interested in 

taking the job.2

 Hagans had personal reasons to stay in Miami, and turned down the job. 

However, because the Chief of the Cooperative Studies Program spent considerable time 

away from his office, it was finally decided that the office need not be based in Washington as 

long as the Chief made frequent trips to Central Office. So Hagans was approached again, 

this time with the prospect of establishing an office in Miami from which to administer the 

Cooperative Studies Program. Dr. Thomas Newcomb, who had recently accepted the position 

of Director, Research Service, and had not yet come to Washington, was attending a meeting 

in Hollywood, Fla.. He arranged to meet Hagans, who presented him with an overall plan for 

how he would run the Cooperative Studies Program. The two reviewed it carefully, and 

Newcomb agreed that it seemed viable. Hagans accepted the position and immediately began 

to exert strong leadership in guiding the program in the direction he considered best.3 

Figure 18.1. James Hagans, M.D., Ph.D. 

Organizational changes 

Hagans’s first effort was to strengthen support of Cooperative Studies by the CSPCCs. In 

addition to the CSPCCs that had evolved from the old Regional Research Support Centers at 

Hines and West Haven, Conn. (Chapter 15), he started a CSPCC at Perry Point, Md.. From 

391
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the beginning, the Central Neuropsychiatric Research Laboratory (CNPRL) (Chapter 8) at 

Perry Point had handled statistical and planning support for cooperative studies in psychiatry. 

The Perry Point CSPCC evolved from that part of CNPRL’s activities. Initially, it 

concentrated on psychiatric cooperative studies, but, as time went on, the responsibilities of 

the various CSPCCs became evenly distributed. 

The CSPCCs at Hines and West Haven, reflecting their experience as Regional Research 

Support Centers, were still supporting local and regional research in addition to the 

cooperative studies. At first, Hagans forbade this. The incumbent Chiefs of the Centers were 

reluctant to change from their old missions, and there were gradual changes in leadership. 

Later, once the Centers were functioning effectively in support of the nationwide cooperative 

studies, Hagans relaxed this rule to permit some support of the local research program in 

exchange for hosting the Centers. 

By 1978, the three CSPCCs were working at capacity, and Hagans decided that a new CSPCC 

was needed on the West Coast. After a competition among medical centers wanting to host 

such a Center, Palo Alto (Calif.) was chosen as the site for the fourth CSPCC. By 1980, all 

four CSPCCs were receiving new studies in rotation, covering all types of disciplines. The 

four Chiefs and their administrators met regularly. Guidelines were established and accepted 

by all. Administration of the studies was predictable and carefully supervised. 

A central pharmacy was established in 1972 at the Washington (D.C.) VA Medical Center. 

This pharmacy now coordinated all studies using drugs or experimental devices, instead of the 

ad hoc systems of the past. By the late 1970s, the central pharmacy had outgrown its space at 

the Washington hospital and was moved to the Albuquerque (N.M.) VA Medical Center. 

This Cooperative Studies Program Clinical Research Pharmacy Coordinating Center 

(CSPCRPCC) has grown to become an important player in the program, participating in study 

design, manufacturing study drugs, keeping close track of study drugs and devices and 

reviewing the protection of human subjects at the various study sites.3 

Under Hagans, the Cooperative Studies Program evolved from the rather relaxed program of 

past times, largely decentralized and encouraging individual initiative, to a much more 

centralized program with strict attention to statistics and experimental design. Some study 

groups with a longstanding record of one study after another became less active. As funding 

became increasingly limited, Hagans worked to find other sources of funds, especially the 

NIH. He accepted some funds from private firms, but with very careful controls to prevent 

conflicts of interest. 

Dr. Hagans introduced a structured system in which an investigator with an idea for a 

cooperative study first submitted a “précis,” a brief description of the proposed study. A 

triage group reviewed it and many proposed studies were rejected at this stage. If approved 

by triage, the proposal was assigned to one of the CSPCCs and a formal planning process 

began. A committee, including the investigator and other subject-area experts, as well as 

statisticians from the CSPCC, met several times to complete a plan. The polished proposal 

eventually went before the Cooperative Studies Evaluation Committee for review. If 

approved by the CSEC (Appendix IIi), it joined a queue for funding. 

392
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hagans insisted that, in the Cooperative Studies Program, separate groups perform the 

research, direct the project and evaluate it. Hence, he arranged meetings of the groups of 

investigators from the cooperating hospitals, the people actually carrying out the research. In 

addition, an “Operations Committee” reviewed data at regular intervals and directed the 

project. Of the participants in a cooperative study, only the Chairman also served on this 

committee, which made such critical decisions as when a participating hospital was not 

performing adequately and should be dropped, when an arm of the study should be changed 

or dropped owing to interim statistical results, and when the study had achieved its goal. 

Evaluation was by the CSEC, which reviewed proposed projects and also ongoing projects to 

determine if, after three years, they warranted continuation. 

In addition, each CSPCC maintained a Human Rights Committee to review each project 

annually for the protection of subjects. This Committee served as an additional protection, 

adding a second human rights review to that performed by the Institutional Review Board at 

each participating medical center. 

The studies 

The cooperative studies begun in the 1970s (Table 18.1) differed from earlier studies. Each 

now had a crisply defined goal and clear endpoint. Though some pilot studies were 

completed, they were limited in scope and limited to defining the feasibility of a specific 

study. Whereas earlier study groups set their own goals and sometimes freely departed from 

their primary studies, now an outside group carefully monitored each variation in study 

design. Some of the longstanding study groups adapted to this new system; others closed. 

The group of hypertension researchers (Chapter 9) continued to conduct studies under the new 

system, as did the group of cardiologists and surgeons studying the impact of coronary artery 

surgery on patients with coronary artery disease. On the other hand, the pulmonary study 

group that had started with the 1946 tuberculosis trials (Chapter 5) held its last published 

meeting in 1972 and completed its last report in 1974. The studies of analgesics (Chapter 13) 

and of psychopharmaceuticals (Chapter 8), which had performed one study after another 

without CSEC review, closed during the mid-1970s, in part because their leaders found it 

more difficult to work within the new system. 

Sickle cell trait 

An important study begun in 1972 determined the clinical importance of sickle cell trait (Hb 

AS) and glucose-6-phosphate dehydrogenase deficiency (G-6-PD). The Chair was Paul 

Heller, M.D., of the Chicago West Side VA Medical Center. While the homozygous 

abnormality (Hb SS), known as sickle cell anemia, causes a well-known illness, it was not 

known whether the heterozygous Hb AS caused any problems. The impact of G-6-PD, which 

is fairly common in African Americans, was also unknown. Anecdotal reports had suggested 

that sickle cell trait would cause an increase in pulmonary infarctions, vascular complications 

of diabetes, deaths from myocardial infarction and prolonged hospitalization after surgery. G6-PD was thought to be associated with increased infections, especially pneumonia. Patients 

with both abnormalities were expected to have longer hospital stays and increased mortality. 

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Table 18.1. Cooperative studies started during the 1970s 

Medical 

Antihypertensive drugs 

Propranolol 1972–1975

 Bethedine vs guanethedine in severe hypertension 1972-1975 

Efficacy of treatment of mild hypertension (pilot) 1974–1977 

Prazosin vs hydralazine 1976–1977 

Oxyprenolol vs propranolol 1976–1977 

Ticrynafen vs hydrochlorothiazide 1977–1978

 Propranolol vs hydrochlorothiazide as first hyptertension rx 1978–1980

 Low dose reserpine with chlorthalidone 1978–1980 

Captopril 1980–1982 

Nadolol 1980–1981 

Hepatitis 

Immune vs hyperimmune globulin in needlestick 1972–1976 

Immune vs hyperimmune serum globulin in post-transfusion 1973–1976

 Hepatitis and drug abuse (observational) 1973–1976 

Hepatitis and dentistry 1979–1981 

Alcoholic hepatitis 1978–1983 

Sickle cell trait 1972–1976 

Crohn’s Disease 

Prednisone, sulfasalazine, azathioprine, placebo 1972–1977

 Sulfasalazine plus prednisone vs prednisone 1976–1977 

Medical treatment of heart disease 

Aspirin therapy in unstable angina 1974–1982 

Vasodilator therapy of myocardial infarction 1974–1981 

Vasodilators in chronic heart failure 1980–1985 

Renal failure self-care dialysis 1975–1981 

Platelet aggregation in diabetes (aspirin and persantine) 1977–1983 

Anticoagulants in the treatment of cancer 1977–1981 

Urinary tract infections 1976–1978 

Nafcillin therapy in staphylococcal bacteremia 1979–1981 

Antiepileptic drugs 1978–1984 

Surgical 

Surgery of coronary artery disease 

Stable angina (vein bypass) 1970–1974+20yr FU 

Unstable angina (vein bypass) 1976–1982+10yr FU 

Radiotherapy vs surgery vs delayed hormonal rx in prostate ca 1974–1981 

Bowel preparation for colon operations 

 Placebo vs active therapy 1975–1976 

Oral vs oral plus iv 1976–1982 

Heart valve replacement 1977–1995 

Surgical shunt vs medical treatment in alcoholic cirrhosis ascites 1979–1984 

Neuropsychiatric 

Drugs and sleep 1975–1977 

Treatment of psychotic patients 

Hospital vs community foster care 1970–1974 

Day treatment in aftercare 1973–1977

 Characteristics of effective ward milieu 1975–1978 

Community vs VA nursing home vs hospital 1978–1982 

Aphasia 

Individual vs group therapy 1973–1977 

Hospital vs home treatment 1979–1983 

Alcohol and drug dependence 

LAAM-methadone 1973–1975 

Antabuse in rx of alcoholics on methadone maintenance 1977–1980 

Antabuse in the treatment of alcoholism 1979–1983 

Lithium in alcoholics (pilot) 1979 

Dental 

Plaque control 1978–1982 

Dental implants 1978–1990 

Alloys for dental restorations 1980–1990 

394
 
 

 

 

 

 

 

 

 

 

 

 

 

This prevalence study screened 65,154 African-American patients at 15 VA medical centers 

for these two abnormalities. Sickle cell trait was present in 7.8 percent, G-6-DP in 11.2 

percent and both abnormalities in 0.9 percent. Clinical data were retrieved from the VA 

centralized Patient Treatment File on 4,900 patients with sickle cell trait, 1,422 with 

hemoglobin C trait, 6,741 with G-6-PD and 18,294 with normal hemoglobin. Contrary to 

expectations, the only significant effects of sickle cell trait were found to be essential 

hematuria and a small increase in the incidence of pulmonary infarction. G-6-DP and 

hemoglobin C trait had no adverse effect at all. 

This study made it possible to reassurance the many patients found to have sickle cell trait 

among those screened for sickle cell disease and to alleviate the anxiety of patients with 

hemoglobin C and G-6-DP. It also provided important information about the frequency of 

hemoglobin abnormalities, including some of the rarer types. One previously undescribed 

abnormal hemoglobin (Hemoglobin Arlington Park) was identified among the 65,154 patients 

screened.4 

Hepatitis 

A series of studies of transfusion-related hepatitis also had an important impact. A study 

begun in 1969 compared the effectiveness of a preparation of immune serum globulin (ISG) 

in preventing transfusion-related hepatitis. Incidence of hepatitis was significantly reduced 

with ISG. Of special importance was the finding that only a quarter of the cases of hepatitis 

were due to the hepatitis B virus. The others were caused by a previously unrecognized virus, 

originally called nonA-nonB hepatitis, now known as hepatitis C. When investigators traced 

the origins of the transfused blood, they found that the nonA-nonB virus was associated with 

commercially available blood but not with donated blood. This important finding, confirmed 

in later studies, led to the effort to fill needs for blood from healthy volunteer donors rather 

than from paid donors who were more likely to carry the nonA-nonB virus.5 

These findings were confirmed in studies comparing ISG with a serum globulin hyperimmune 

to hepatitis B (HBIG) in preventing post-transfusion hepatitis B and also needlestick 

hepatitis.6 HBIG was more effective than ISG in preventing hepatitis B but not in preventing 

nonA-nonB hepatitis. 

The same investigators searched for evidence of liver disease in asymptomatic parenteral 

narcotic drug abusers. They found that the majority had laboratory evidence of liver disease, 

and determined that repeated liver biopsies would be needed to screen adequately for liver 

disease in these patients.7 

Another research team studied the efficacy of 30 days of treatment with either a 

glucocorticosteroid (prednisolone) or an anabolic steroid (oxandrolone) in moderate or severe 

alcoholic hepatitis. Of the patient population studied, 132 with moderate disease and 131 

with severe disease were randomly assigned to one of three treatments: prednisolone, 

oxandrolone or placebo. In the 30-day period, mortality did not differ significantly in the 

groups receiving steroid therapy from mortality in the placebo group: 13 percent of 

moderately ill patients and 29 percent of severely ill patients died. But although neither 

395
 
aspirin treatment (324 mg in buffered solution daily) taken for 12 weeks by 1,266 men with

unstable angina (625 taking aspirin and 641 placebo). The incidence of death or acute myocardial 

infarction was 51 percent lower in the aspirin group than in the placebo group, with no difference in

gastrointestinal symptoms or evidence of blood loss between the two groups. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

steroid improved short-term survival, oxandrolone therapy was associated with improved 

long-term survival, especially in patients with moderate disease. Among those who survived 

for one or two months after the start of treatment, the six-month death rate was 3.5 percent 

after oxandrolone and 19 to 20 percent after placebo (P = 0.02). No consistent long-term 

effect was associated with prednisolone therapy.8 

A study of hepatitis and dentistry conducted at 126 VA dental clinics between 1979 and 1981 

enrolled 963 dental personnel. At that time, universal precautions (gloves and mask) were not 

yet widespread in dentistry, and exposure to hepatitis-infected blood and saliva from patients 

was likely. The study showed that serological evidence of hepatitis B infection increased with 

the number of years working in the dental environment, from 7.4 percent for those working 

five or fewer years to 17.8 percent for those working more than 30 years. As a result of this 

study, immunization to hepatitis B was strongly recommended for dental workers.9 

Cardiology studies 

Surgery for coronary artery disease 

Although the group that had been evaluating surgical operations for coronary artery disease 

(Chapter 13) began to look at patients undergoing coronary artery bypass surgery (CABG) in 

1970, they began their definitive study of this procedure in 1972. Between 1972 and 1974, 

686 patients were enrolled by 13 VA hospitals. 

The criteria for enrolling a patient in this protocol were carefully defined. Randomization to 

medical or surgical treatment was done centrally by the West Haven (Conn.) CSPCC. 

Soon after intake into the study was completed in December 1974, preliminary statistical 

analysis showed that the 91 patients who had obstruction of the left main coronary artery had 

a better survival rate if they received surgery than if they were maintained on medical 

treatment. This result was published and well received.10 

However, the results associated with the remaining 595 patients, who were followed for an 

average of 36 months, showed no significant difference between the surgically and medically 

treated groups.11 This report stimulated a vigorous response from advocates of the procedure, 

and considerable controversy.12 

However, VA supported its cooperative study group, who continued their studies to further 

refine the circumstances that warranted surgery in this condition. After longer follow-up and 

further study, they defined other “high risk” conditions, in addition to left main coronary 

artery obstruction, that favored surgery. The results of these studies, and of subsequent work 

by others, led to guidelines for the selection of patients who would benefit from CABG.13 

Aspirin in unstable angina 

Twelve VA medical centers participated in a double-blind, placebo-controlled randomized trial of 

396
 
397

Twelve VA medical centers artici ated in a double-blind, lacebo-controlled randomized trial of

Twelve VA medical centers participated in a double-blind, placebo-controlled randomized trial of

aspirin treatment (324 mg in buffered solution daily) taken for 12 weeks by 1,266 men with

unstable angina (625 taking aspirin and 641 placebo). The incidence of death or acute myocardial 

infarction was 51 percent lower in the aspirin group than in the placebo group, with no difference in

gastrointestinal symptoms or evidence of blood loss between the two groups. 

This study showed that aspirin has a protective effect against acute myocardial infarction in

men with unstable angina.14 This was among the first of over 100 studies of the effect of

antiplatelet therapy in preventing myocardial infarction and death in patients with unstable

angina. The study has been cited countless times in support of using aspirin in these patients,

and the therapy that has become standard medical practice.

Acute myocardial infarction with left ventricular failure

Between 1975 and 1981, 11 VA medical centers cooperated in a study of whether the vasodilator 

nitroprusside would improve outcomes in patients with acute myocardial infarctions complicated by

increased left ventricular filling pressure. While nitroprusside was already in widespread use in this

situation, it carried the risk of decreased coronary blood flow. An objective study of its risks and

benefits was needed. The randomized double-blind, placebo-controlled trial assessed the efficacy 

of a 48-hour infusion of sodium nitroprusside in 812 male participants with presumed acute 

myocardial infarction and left ventricular filling pressure of at least 12 mm Hg. The results were

complex. Treatment did not significantly affect overall mortality rates at 21 days (10.4 percent in

the placebo group and 11.5 percent in the nitroprusside group) and at 13 weeks (19.0 percent and

17.0 percent, respectively). However, timing was critical: The drug had a deleterious effect in

patients whose infusions were started within nine hours of the onset of pain (mortality at 13 weeks, 

24.2 percent vs. 12.7 percent; P = 0.025), but it had a beneficial effect in those whose infusions 

were begun later (mortality at 13 weeks, 14.4 percent vs. 22.3 percent; P = 0.04). The investigators 

concluded that nitroprusside should probably not be used routinely in patients with high left

ventricular filling pressures after acute myocardial infarction, but that patients with persistent pump

failure might receive sustained benefit from short-term nitroprusside therapy.15

Chronic congestive heart failure

Congestive heart failure continues to be a major cause of death among Veterans as well as in the 

general population. In 1980, 11 VA medical centers undertook a study to see whether treatment 

with vasodilators would improve the life span of patients with this disorder. They randomly

assigned 642 consenting men with impaired cardiac function and reduced exercise tolerance who 

were already taking digoxin and a diuretic for their heart failure to receive additional double-blind

treatment. This involved placebo, prazosin (20 mg per day) or the vasodilating combination of 

hydralazine (300 mg per day) and isosorbide dinitrate (160 mg per day). Follow-up averaged 2.3

years (range, six months to 5.7 years). At two years, mortality was reduced by 34 percent among

patients treated with hydralazine and isosorbide dinitrate (P<0.028), 25.6 percent in the hydralazineisosorbide dinitrate group versus 34.3 percent in the placebo group; at three years, mortality was 

reduced 36 percent (36.2 percent versus 46.9 percent). Mortality in the prazosin group was similar

to that in the placebo group. Left ventricular ejection fraction, a measure of left ventricular function, 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

p p p 

aspirin treatment (324 mg in buffered solution daily) taken for 12 weeks by 1,266 men with 

unstable angina (625 taking aspirin and 641 placebo). The incidence of death or acute myocardial 

infarction was 51 percent lower in the aspirin group than in the placebo group, with no difference in 

gastrointestinal symptoms or evidence of blood loss between the two groups. 

This study showed that aspirin has a protective effect against acute myocardial infarction in 

men with unstable angina.14 This was among the first of over 100 studies of the effect of 

antiplatelet therapy in preventing myocardial infarction and death in patients with unstable 

angina. The study has been cited countless times in support of using aspirin in these patients, 

and the therapy that has become standard medical practice. 

Acute myocardial infarction with left ventricular failure 

Between 1975 and 1981, 11 VA medical centers cooperated in a study of whether the vasodilator 

nitroprusside would improve outcomes in patients with acute myocardial infarctions complicated by 

increased left ventricular filling pressure. While nitroprusside was already in widespread use in this 

situation, it carried the risk of decreased coronary blood flow. An objective study of its risks and 

benefits was needed. The randomized double-blind, placebo-controlled trial assessed the efficacy 

of a 48-hour infusion of sodium nitroprusside in 812 male participants with presumed acute 

myocardial infarction and left ventricular filling pressure of at least 12 mm Hg. The results were 

complex. Treatment did not significantly affect overall mortality rates at 21 days (10.4 percent in 

the placebo group and 11.5 percent in the nitroprusside group) and at 13 weeks (19.0 percent and 

17.0 percent, respectively). However, timing was critical: The drug had a deleterious effect in 

patients whose infusions were started within nine hours of the onset of pain (mortality at 13 weeks, 

24.2 percent vs. 12.7 percent; P = 0.025), but it had a beneficial effect in those whose infusions 

were begun later (mortality at 13 weeks, 14.4 percent vs. 22.3 percent; P = 0.04). The investigators 

concluded that nitroprusside should probably not be used routinely in patients with high left 

ventricular filling pressures after acute myocardial infarction, but that patients with persistent pump 

failure might receive sustained benefit from short-term nitroprusside therapy.15 

Chronic congestive heart failure 

Congestive heart failure continues to be a major cause of death among Veterans as well as in the 

general population. In 1980, 11 VA medical centers undertook a study to see whether treatment 

with vasodilators would improve the life span of patients with this disorder. They randomly 

assigned 642 consenting men with impaired cardiac function and reduced exercise tolerance who 

were already taking digoxin and a diuretic for their heart failure to receive additional double-blind 

treatment. This involved placebo, prazosin (20 mg per day) or the vasodilating combination of 

hydralazine (300 mg per day) and isosorbide dinitrate (160 mg per day). Follow-up averaged 2.3 

years (range, six months to 5.7 years). At two years, mortality was reduced by 34 percent among 

patients treated with hydralazine and isosorbide dinitrate (P<0.028), 25.6 percent in the hydralazineisosorbide dinitrate group versus 34.3 percent in the placebo group; at three years, mortality was 

reduced 36 percent (36.2 percent versus 46.9 percent). Mortality in the prazosin group was similar 

to that in the placebo group. Left ventricular ejection fraction, a measure of left ventricular function, 

397
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

rose significantly at eight weeks and at one year in the group treated with hydralazine and 

isosorbide dinitrate but not in the placebo or prazosin groups. 

This study showed that the addition of hydralazine and isosorbide dinitrate to the therapeutic 

regimen of digoxin and diuretics in patients with chronic congestive heart failure can have a 

favorable effect on left ventricular function and mortality.16 

Valvular heart disease 

Improvements in cardiac surgery have allowed patients with damaged heart valves to receive valve 

replacements that correct their disorder. Both mechanical valves and animal (porcine) valves have 

been used, and both have their advantages and disadvantages. Mechanical heart valves are durable 

but are thrombogenic (tend to cause clotting), requiring that patients take anticoagulants. In 

contrast, bioprosthetic valves are less thrombogenic but are of limited durability due to tissue 

deterioration. To compare the advantages and disadvantages of these two approaches, between 

1977 and 1982 13 participating VA medical centers randomized 575 patients who needed 

replacement of their mitral or aortic heart valve to receive either a mechanical or porcine valve. 

During an average follow-up of 11 years, no difference was found between the two groups in the 

probability of death from any cause or of any valve-related complication. A much higher rate of 

structural valve failure was experienced by patients who received bioprosthetic valves (11-year 

probability, 0.15 for aortic valves and 0.36 for mitral valves) than was experienced by those who 

received mechanical valves (no valve failures; P<0.001). However, this difference was offset by a 

higher rate of bleeding complications in patients with mechanical valves than in those with 

bioprosthetic valves (11-year probability, 0.42 and 0.26, respectively; P<0.001) and by a greater 

frequency of periprosthetic valvular regurgitation in patients with mechanical mitral valves than in 

those with mitral bioprostheses (11-year probability, 0.17 and 0.09, respectively; P = 0.05). 

From the results of this study and the review of similar studies by others, the authors were able to 

provide guidance about which type of valve is better for a particular patient.17 

Antibiotic prophylaxis in colon surgery 

During the 1970s, some surgeons were using oral antibiotics to supplement mechanical bowel 

cleansing in preparing patients for surgery of the colon and rectum. This use, however, was 

controversial. In general, using antibiotics to prevent infection rather than treat it was considered 

unwise: Bacterial flora were likely to become resistant to the antibiotics used, promoting the spread 

of resistant organisms in the individual patient and in the environment. On the other hand, small 

studies of the use of prophylactic oral antibiotics suggested that these fears were unfounded and that 

many infections could be avoided by prophylactic use of antibiotics. 

To gain a better understanding of the potential value of antibiotic prophylaxis, a cooperative study 

was designed in which oral antibiotics (neomycin and erythromycin) or placebo were given the day 

before surgery in addition to vigorous mechanical cleansing of the bowel. The original plan had 

been to study 287 patients, the number projected for a clear-cut answer if infection rates were 20 

percent without oral antibiotics and 10 percent with them. The difference revealed by the study was 

398
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

even more dramatic. Forty-three percent of patients in the placebo group developed infections, 

compared to only 9 percent of those receiving antibiotics the day before surgery. 

This study reflected the wisdom of the system Hagans had established. Only the monitoring 

Operations Committee saw the data and its statistical analysis on a periodic basis. The members of 

the Operations Committee did not actually enroll or follow the patients in the study, so there was no 

way that their knowledge of the preliminary results could affect the objectivity of the study. When 

the Operations Committee reviewed the data from the first 116 patients, the answer to the study 

question was clear: Antibiotic treatment conferred a benefit. At that point, the Operations 

Committee announced the results and stopped the study. Henceforth, patients were no longer 

jeopardized by receiving the less favorable treatment.18 All would receive the benefit of 

prophylactic antibiotics to reduce the likelihood of infection. 

On the other hand, a later study, which examined the benefit of adding intravenous antibiotics to the 

established preparatory regimen of mechanical bowel cleaning together with oral antibiotics, failed 

to show a significant advantage. In order to establish this negative finding, it was necessary to 

study 1,128 patients over a five-year period. Even then, the results with added IV antibiotic were 

somewhat better, though not significantly so. A doubt remained that an even larger study might 

uncover a small preference for adding the IV antibiotic. Unlike the first study, which changed the 

practice of surgeons both in VA and elsewhere, this later study had much less impact19 despite the 

tremendous effort it involved. 

Recurrent urinary infections in men 

The natural history and treatment of recurrent urinary infections in women had been well studied by 

the 1970s, but appropriate treatment in men was still not established. Studies in women had shown 

that antibiotic treatment of bladder infections was effective after only 10 days of treatment, while 

infections of the upper urinary tract required prolonged therapy. At three VA medical centers, 38 

male patients with recurrent urinary infections, most with prostatic infection, were treated in a 

double-blind study with either 10 days or 12 weeks of antibiotic therapy. Most patients given only 

10 days’ treatment had recurrences with the same organism within four weeks.20 The cure rate was 

better with 12 weeks, but the difference failed to reach significance (p=.06). 

Anticoagulants in the treatment of cancer 

By the end of the 1970s, considerable evidence had accumulated implicating blood coagulation 

reactions in the growth and spread of malignancy. It was found that platelets may accumulate on 

embolic tumor cells and facilitate their adhesion to the endothelium at distant sites, perhaps by 

enhancing blood coagulation reactions. Another possibility was that platelets may promote tumor 

cell proliferation by contributing a growth-promoting factor or through interactions mediated by 

prostaglandins. Inhibition of tumor growth and spread by platelet-inhibitory drugs had been 

demonstrated in several experimental tumor systems, and preliminary data suggested that similar 

effects were seen in human malignancy.21 

To evaluate the importance of this evidence that spread of malignancy is associated with 

blood clotting mechanisms, between 1976 and 1981, 13 VA medical centers studied the effect 

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of warfarin anticoagulation on outcome in patients with cancer of the lung, colon and rectum, 

prostate, and head and neck. The most dramatic finding was that warfarin doubled the 

survival time of patients with small-cell carcinoma of the lung. Median survival for 25 

control patients was 24 weeks; for 25 warfarin-treated patients, it was 50 weeks. This 

difference could not be accounted for by differences between groups in performance status, 

extent of disease, age or sex. The survival advantage associated with warfarin administration 

was observed both for patients with extensive disease and for those who failed to achieve 

complete or partial remission. The warfarin-treated group also demonstrated a significantly 

increased time to first evidence of disease progression. These results suggested that warfarin 

was useful in the treatment of small-cell carcinoma of the lung and also supported the 

hypothesis that the blood coagulation mechanism is involved in the growth and spread of 

cancer in humans. This result was so definitive that the Operations Committee decided to 

stop adding patients in the study arm involving small-cell lung cancer.22 

No differences in survival were observed between warfarin-treated and control groups for the 

other cancers studied.23 

Care of patients with schizophrenia 

Psychotropic drugs (Chapter 8) revolutionized the care of schizophrenic patients, but they did not 

cure them. A series of cooperative studies carried out in the 1970s, led by Margaret Linn, Ph.D., a 

social worker at the Miami VA Medical Center, studied the post-hospital treatment of these 

patients. One of the most important of these studies compared the effect of differing characteristics 

of day treatment programs. In this study, conducted in ten VA Day Treatment Centers between 

1973 and 1977, schizophrenic patients who were eligible for day treatment at the time of hospital 

discharge were randomly assigned to receive day treatment plus drugs or drugs alone. They were 

tested before assignment and at six, 12, 18 and 24 months on social functioning, symptoms and 

attitudes. Community tenure and costs were also measured. The Day Treatment Centers were 

described on process variables every six months for the four years of the study. 

Some Centers were found to be more effective than drugs alone in treating chronic schizophrenia 

patients, and others were not, although all of the Day Treatment Centers improved the patients’ 

social functioning. Six of the Centers were found to significantly delay relapse, reduce symptoms, 

and change some attitudes. Costs for patients in the successful Centers were not significantly 

different from costs for the group receiving only drugs. The Centers with the most successful 

outcomes offered more occupational therapy and a sustained reassuring environment. Centers with 

a treatment philosophy encouraging high patient turnover had poorer results. Surprisingly, poorer 

results were also associated with Centers that had more professional staff hours and group therapy.24 

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References 

1. Interview with Lawrence W. Shaw, M.S., February 3, 1994 at Mr. Shaw’s home in 

Gainesville, Florida. 

2.	 Interview with William Best, M.D., April 26, 1994 at a hotel lobby in Washington, DC. 

3. Telephone interview with James Hagans, M.D., Ph.D., April 24, 1988. 

4.	 Heller, P., Best, W.R., Nelson, R.B. and Becktel, J., "Clinical implications of sickle-cell trait 

and glucose-6-phosphate dehydrogenase deficiency in hospitalized black male patients." N 

Eng J Med, 1979. 300: 1001-1005. 

5.	 Seeff, L.B., Wright, E.C., Zimmerman, H.J. and McCollum, R.W., "VA cooperative study 

of post-transfusion hepatitis, 1969-1974: incidence and characteristics of hepatitis and 

responsible risk factors." Am J Med Sci, 1975. 270: 355-362. 

6. Seeff, L.B., Wright, E.C., Finkelstein, J.D., Greenlee, H.B., Hamilton, J., Leevy, C.M., 

Tamburro, C.H., Vlahcevic, Z., Zimmon, D.S., Zimmerman, H.J., Felsher, B.F., GarciaPont, P., Dietz, A.A., Koff, R.S., Kiernan, T., Schiff, E.R., Zemel, R. and Nath, N., 

"Efficacy of hepatitis B immune serum globulin after accidental exposure." Lancet, 1975: 

939-941. 

7. Seeff, L.B., Zimmerman, H.J., Wright, E.C., Schiff, E.R., Kiernan, T., Leevy, C.M., 

Tamburro, C.H. and Ishak, K.G., "Hepatic disease in asymptomatic parenteral narcotic drug 

abusers: a Veterans Administration collaborative study." Am J Med Sci, 1975. 270: 41-47. 

8. Mendenhall, C.L., Anderson, S., Garcia-Pont, P., Goldberg, S., Kiernan, T., Seeff, L.B., 

Sorrell, M., Tamburro, C.H., Weesner, R., Zetterman, R., Chedid, A., Chen, T., Rabin, L. 

and Veterans Administration Cooperative Study on Alcoholic Hepatitis, "Short-term and 

long-term survival in patients with alcoholic hepatitis treated with oxandrolone and 

prednisolone." N Engl J Med, 1984. 311: 1464-1470. 

9. Schiff, E.R., de Medina, M.D., Kline, S.N., Johnson, G.R., Chan, Y.-K., Shorey, J., 

Calhoun, N. and Irish, E.F., "Veterans Administration cooperative study on hepatitis and 

dentistry." JADA, 1986. 113: 390-396. 

10. Takaro, T., Hultgren, H.N., Lipton, M.J., Detre, K.M. and participants in the study group, 

"The VA Cooperative Randomized Study of Surgery for Coronary Arterial Occlusive 

Disease II: Subgroup with significant left main lesions." Circ, 1976. 54: III-107-117. 

11. Murphy, M.L., Hultgren, H.N., Detre, K.M., Thomsen, J., Takaro, T. and Participants, 

"Treatment of chronic stable angina: A preliminary report of survival data of the 

randomized VA cooperative study." New Engl J Med, 1977. 297: 621-627. 

401
 
 

 

 

 

 

 

 

 

 

 

 

 

12. Jones, D.S., "Visions of a cure; visualizations, clinical trials and controversies in cardiac 

therapeutics, 1968-1998." Isis, 2000. 91: 504-541. 

13.	 Kirklin, J.W., Akins, C.W. and Blackstone, E.H., "ACC/AHA guidelines and indications for 

coronary artery bypass surgery. A report of the American College of Cardiology/American 

Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular 

Procedures (Subcommittee on Coronary Artery Bypass Surgery)." Circ, 1991. 83: 1125­

1173. 

14. Lewis, H.D., Davis, J.W., Archibald, D.G., Steinke, W.E., Smitherman, T.C., Doherty, J.E., 

Schnaper, H.W., LeWinter, M.M., Linares, E., Pouget, J.M., Sabarwal, S.C., Chesler, E. and 

DeMots, H., "Protective effects of aspirin against acute myocardial infarction and death in 

men with unstable angina." N Engl J Med, 1983. 309: 396-403. 

15. Cohn, J.N., Franciosa, J.A., Francis, G.S., Archibald, D.G., Tristani, F., Fletcher, R., 

Montero, A., Cintron, G., Clarke, J., Hager, D., Saunders, R., Cobb, F., Smith, R., Loeb, H. 

and Settle, H., "Effect of short-term infusion of sodium nitroprusside on mortality rate in 

acute myocardial infarction complicated by left ventricular failure. Results of a Veterans 

Administration Cooperative Study." N Engl J Med, 1982. 306: 1129-1135. 

16. Cohn, J.N., Archibald, D.G., Ziesche, S., Franciosa, J.A., Harston, W.E., Tristani, F., 

Dunkman, W.B., Jacobs, W., Francis, G.S., Flohr, K.H., Goldman, S., Cobb, F.R., Shah, 

P.M., Saunders, R., Fletcher, R., Loeb, H., Hughes, V.C. and Baker, B., "Effect of 

vasodilator therapy on mortality in chronic congestive heart failure." N Engl J Med, 1986. 

314: 1547-1552. 

17.	 Hammermeister, K.E., Sethi, G.K., Henderson, W.G., Oprian, C., Kim, T., Rahimtoola, S. 

and Veterans Administration Cooperative Study on Valvular Heart Disease, "A comparison 

of outcomes in men 11 years after heart-valve replacement with a mechanical valve or 

bioprosthesis." N Engl J Med, 1993. 328: 1289-1296. 

18. Clarke, J.S., Condon, R.E., Bartlett, J.G., Sherwood, L., Gorbach, L., Nichols, R.L. and 

Ochi, S., "Preoperative oral antibiotics reduce septic complications of colon operations." 

Ann Surg, 1977. 186: 251-259. 

19. Condon, R.E., Bartlett, J.G., Greenlee, H.B., Schulte, W.J., Ochi, S., Abbe, R., Caruana, 

J.A., Gordon, E., Horsley, S., Irvin, G., Johnson, W., Jordan, P., Keltzer, W.F., Lempke, R., 

Read, R.C., Schumer, W., Schwartz, M., Storm, R.K. and Vetto, R.M., "Efficacy of oral and 

systemic antibiotic prophylaxis in colorectal operations." Ann Surg, 1983. 118: 496-502. 

20. Smith, J.W., Jones, S.R., Reed, W.P., Tice, A.D., Deupree, R.H. and Kaijser, B., "Recurrent 

urinary tract infections in men. Characteristics and response to therapy." Ann Int Med, 1979. 

91: 544-548. 

21.	 Zacharski, L.R., Henderson, W.G., Rickles, F.R., Forman, W.B., Cornell, C.J., Jr., Forcier, 

R.J., Harrower, H.W. and Johnson, R.O., "Rationale and experimental design for the VA 

402
 
 

 

Cooperative Study of Anticoagulation (Warfarin) in the Treatment of Cancer." Cancer, 

1979. 44: 732-741. 

22.	 Zacharski, L.R., Henderson, W.G., Rickles, F.R., Forman, W.B., Cornell, C.J., Jr., Forcier, 

R.J., Edwards, R., Headley, E., Kim, S.H., O'Donnell, J.R., O'Dell, R., Tornyos, K. and 

Kwaan, H.C., "Effect of warfarin on survival in small cell carcinoma of the lung. Veterans 

Administration Study No. 75." Jama, 1981. 245: 831-835. 

23.	 Zacharski, L.R., Henderson, W.G., Rickles, F.R., Forman, W.B., Cornell, C.J., Forcier, J., 

Edwards, R.L., Headley, E., Kim, S.-H., O'Donnell, J.F., O'Dell, R., Tornyos, K. and 

Kwaan, H.C., "Effect of warfarin anticoagulation on survival in carcinoma of the lung, 

colon, head and neck, and prostate." Cancer, 1984. 53: 2046-2052. 

24. Linn, M.W., Caffey, E.M., Klett, C.J., Hogarty, G.E. and Lamb, H.R., "Day treatment and 

psychotropic drugs in the aftercare of schizophrenic patients." Arch Gen Psychiatry, 1979. 

36: 1055-1066. 

403
 
(Intentionally Blank) 

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Chapter 19. Beginnings of Health Services Research 

and Development in VA 

Today’s VA Health Services Research and Development (HSR&D) Service is a major player 

in the overall research effort in VA and a leader in its field. It took shape toward its present 

form during the 1970s, with its major growth occurring after 1990, but the recent program has 

its roots in multiple earlier efforts. 

Maximizing both the quality and cost-effectiveness of medical care has always been a central 

concern for VA. As early as 1929, the Veterans’ Bureau’s Medical Council (Chapter 1) asked 

the Bureau’s Research Section to compare the standards of medical care in Bureau hospitals 

with civilian hospitals. After reviewing the data presented to them by the Research Section, 

the Council concluded: “There exist at present no satisfactory standards according to which 

treatment can be appraised. Neither civilian nor bureau institutions rate treatment according 

to the same, let alone uniform, standards.”1 

Today, the Bureau’s descendant, the Department of Veterans Affairs, maintains a vigorous 

and well-coordinated HSR&D program. It employs an interdisciplinary approach that draws 

on all relevant scientific methodologies and applies the scientific method to evidence-based 

management to assure that health care decisions will be based on fact. Improving the practice 

of medicine within the context of reality is its central goal. 

This approach is the result of the combination and evolution of many methodologies. These 

include the operations research methods developed during World War II, psychometrics (the 

mathematical, especially statistical, design of psychological tests and measures), economics, 

decision analysis and management theory as well as aspects of computer science and other 

disciplines. This chapter traces some of these methodologies and their early intertwining into 

the emerging HSR&D program of the 1970s. 

The Fort Howard Program and the Management Systems and Standards Service 

Signs of VA’s first formal effort to conduct research in how to improve health services appear 

in 1958, when a research program was launched by Linus Zink, M.D., head of the 

Administrative Section in the Central Office Department of Medicine and Surgery. To 

organize and direct this program, he recruited John Willoughby, then Assistant Manager at the 

Ann Arbor (Mich.) VA Hospital. The charge of this new Management Systems and 

Standards Service was to conduct research in developing efficient hospital systems, an effort 

fully backed by the Director of Professional Services at that time, Irvin Cohen, M.D. 

Willoughby directed the new Service from the Washington office, where Peter Korstad 

performed generalized hospital studies. For more innovative studies, Willoughby set up a unit 

at the Fort Howard (Md.) VA Hospital. This unit’s original responsibility was to work with 

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hospital staff to minimize waste. Although there were concerns among the local staff that the 

findings could lead to layoffs, Cohen made it clear that the Fort Howard group’s mission was 

not to achieve local savings, but to develop data that might be used in developing national 

priorities. Initially, the Fort Howard group did not address professional areas such as 

physician staffing, even though Cohen expressed the intention of extending the studies in that 

direction.2 

Leon Gintzig, who held a Ph.D. in Hospital Administration, started and led the Fort Howard 

operation. Around February 1960, John Peters was assigned to Fort Howard as Associate 

Director of what was now called the Health Services R&D Service. The plan was to locate 

HSR&D on a research floor at the new Washington, D.C., VA hospital, which was under 

construction. Until it was completed, the group worked at Fort Howard. 

At the Fort Howard Hospital, the HSR&D unit established VA’s first intensive care unit to 

test the value of individual monitoring. They also tested a concept for reorganizing smaller 

hospitals by centralizing the administrative management into a single service. This was tried 

out at a half dozen test facilities. 

Aware of the need to have medical information stored in a manner enabling easy extraction 

and analysis of data, they also tried to get a medical information system keyed into a 

computer but lacked the requisite technical competence to do this effectively. After the 

program was moved to the new Washington VA Hospital, this effort evolved into the 

Automated Hospital Information System (AHIS).3 

The Central Office Administrative Research Program 

In 1963, a Committee on Administrative and Developmental Research was formally 

announced to the field, with Peter Korstad as Chairman and seven other members including 

Charles Chapple M.D. of Research Service; Clyde Lindley, M.A., from psychopharmacology 

studies; and Daniel Rosen, the highly respected head of the statistics program. The 

Committee was to “review projects submitted for administrative and developmental research 

to recommend priorities for their initiation throughout the VA system.” This included plans 

for the administrative and developmental research laboratory at the VA Hospital in 

Washington, D.C.4 Three years later, in 1966, this Committee was replaced by an 

Administrative Research Committee, which was charged with general advice and proposal 

review5

 and whose members were mostly ACMDs. At that time, Korstad was made an 

alternate to the chairman, and R.E. Smith, of the Administrative Research Staff, became 

Executive Secretary. 

By 1966, the Administrative Research Program had been placed within the Systems and 

Standards Service with John M. Buchanan as Director and William H. Kirby, M.D. as Deputy 

Director.6 Its mission included conducting formal studies to test hypotheses related to 

administrative aspects of a health services operation. The program also was expected to 

conduct basic research, defined as “investigative activity directed toward an increase in 

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knowledge (in fields relevant to VA’s goals) rather than a practical application thereof”. In 

addition, the Administrative Research Program’s mission included involvement in 

developmental research in the form of “investigative activity in which the systematic use of 

knowledge is directed toward the production of more useful services, devices, systems and 

methods.”7 

During the following year, the Administrative Research Program solicited cooperation in a 

survey of job attitudes being undertaken by a group of Ph.D. scientists at the VA hospital in 

Downey, Ill. A project reviewing utilization and efficacy of Incentive Therapy programs was 

announced in 1965.8 

In 1968, the Administrative Research Committee was abolished, with the explanation that: 

“With the reorientation of the Administrative Research program to emphasize central 

planning and direction, the Committee is no longer essential.”9 The next year, a circular 

soliciting suggestions for Health Services Research and Development projects was distributed 

to field hospitals.10 

The Automated Hospital Information System (AHIS) 

Meanwhile, the efforts at computerization begun at Fort Howard were expanding at the new 

Washington VA Hospital, which boasted a new computer system far more powerful than the 

one the Fort Howard unit had tried to use. The envisioned goal was to find a means to 

contend with a major problem: “the reams of paperwork connected with providing medical 

care and treatment for Veterans (that) have always been the bane of doctors, nurses and other 

professionals in the Veterans Administration.”11 

During the 1957-1961 period under VA Administrator Sumner Whittier, a major effort was 

made to automate the paperwork activities of the VA’s Insurance and Veterans Benefits 

departments.11 The staggering load of paperwork in the patient care program was a 

compelling reason to try to extend this technology to the VA hospital system. In 1961, Chief 

Medical Director Middleton set in motion projects to use computer technology to increase 

efficiency and quality in VA hospitals, with the goal of total automation of the hospitals’ 

information systems. Among its many positive effects would be that all necessary 

information concerning a patient, from admission to discharge, would be recorded 

electronically. Armed with this information, the admitting physician would then give the 

Veteran an examination to determine the needs for hospitalization. If the examination 

confirmed the need, the system would automatically check availability of a suitable bed, and 

indicate the location (such as ward and building) of that bed to the admitting physician. Other 

relevant services within the hospital would simultaneously be notified about support services 

that were needed. Subsequently, instructions concerning patient needs (e.g., prescriptions to 

the pharmacy and dietetic needs) would continue to flow through the system. 

Regional data processing centers were planned to assemble all this information and service 

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the information needs of designated VA medical installations within specific geographical 

11

areas.

Work toward this utopian goal began in 1961, when, under a VA contract, the Systems 

Development Corporation (SDC) in Los Angeles began work on computerizing clinical care. 

It analyzed data from the West Los Angeles VA Hospital and set up simulations of ward 

activities, bed control, laboratories and other hospital functions. 

That same year, work toward this automation goal also began in VA Central Office. 

Lawrence Christianson, M.D., who had been Chief of Medicine and Chief of Staff at the Fort 

Meade (S.D.) VA Hospital, came to Central Office in early 1961 as Assistant Director of 

Medical Service. Later that year, he was put in charge of the 50-member data processing staff 

charged with developing automated systems for payroll, personnel, management control, 

clinical applications and research. 

By 1965, the two projects were combined to form the Automated Hospital Information 

System (AHIS), now using an up-to-date computer facility located at the new Washington VA 

Hospital. The goal was to create a prototype for a nationwide management information 

system, working closely with nurses and doctors at the hospital to design, develop and 

program simulations of all hospital activities. 

The first AHIS applications, for admissions and discharges, presented little difficulty. But the 

study of pharmacy operations required complex interaction with the medical staff, nurses, 

pharmacists and administrative staff working in the pharmacy. While the hospital was 

enthusiastic about this effort, Central Office officials were nervous about it, so programmers’ 

efforts were redirected to automating radiology. In retrospect, this system, requiring 

expensive mainframe hardware, was ahead of its time. According to Dr. Christianson, 

“Someone did a cost-benefit analysis of this system about 1969 and found that the whole 

system might save 2 FTEE (employees).”12 

During his period as ACMD/R&E (1968-1969), Thomas Chalmers, M.D., had some 

acquaintance with AHIS during the day he spent each week at the Washington VA Hospital. 

At that time, Chalmers championed the effort to computerize all patient information, but in 

retrospect he felt that the initiative was premature as the available hardware and software 

weren’t up to the job.13 

In 1969, Christianson moved to Research Service as Program Chief in Neurology and 

Regional Coordinator for the Northeast Region. Oren Skouge, M.D., who had left his 

position as Deputy Chief Medical Director after a change in administrative leadership, spent 

most of 1970 at the Washington hospital working on AHIS. By this time, the administrative 

records 

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had been automated and the AHIS staff were working on automating the professional records. 

Skouge also expressed the opinion that the technology for this task simply hadn’t been there. 

Another problem was that doctors refused to use a keyboard to enter patient information. To 

make matters worse, maintaining the large IBM computer consumed several hundred 

thousand dollars annually.14 

By 1972, when Al Gavazzi became Director of the Washington VA Hospital, the 

Administrative Research Program there had been split into three groups. The first group was 

working on the automation of direct patient care problems, led by Hubert Pipberger, M.D., 

who had begun computerizing EKGs while the hospital was still located in the Mt. Alto 

section of Washington. Other hospital clinicians also saw computers as the answer to patient 

care problems and were trying to perfect various types of patient care systems. 

The second group, the AHIS central group, included people with administrative interests who 

were trying to place medical administration and medical records on the computer and make 

the computerized system clinically useful. 

The third group, the former Health Systems Research unit that had moved from Ft. Howard to 

Washington when the new hospital opened, now comprised a staff of seven people headed by 

Leon Gintzig. They were addressing practical problems of hospital layout. 

Wendell Musser, M.D., who became ACMD for Planning and Evaluation in 1970, was 

responsible for Central Office coordination of AHIS as well as for other aspects of Health 

Services R&D. In his opinion, AHIS was “a huge bottomless pit.” By 1970, it had already 

cost $2.4 million, with little to show in the way of visible product or value added to 

administrative efficiency or care. A formal review of AHIS brought unfavorable results, and 

in1972, the decision was made to reduce further support for AHIS development. 

After that, there was little widespread support for AHIS, and funding became difficult. The 

core funding came from the Department of Data Management in Central Office and the 

Washington hospital’s medical staff, who had remained enthusiastic about the project. 

The first effort under Gavazzi involved placing computers in nursing stations to allow 

computerization of orders to the pharmacy and lab and then radiology. Centralization of the 

patient record was also attempted. Staff physicians, especially neurosurgeon Paul Schaeffer, 

M.D., devoted considerable time to this endeavor. 

Central Office officials who felt that the AHIS project was ill-advised called this system of 

local support the “Underground Railway.” But according to Gavazzi, this Central Office 

opposition was not universal. Key officials such as James Pittman and John Chase, and later 

Donald Custis and W.J. Jacoby, were supportive.15 

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Walter Whitcomb, M.D., recalled that when he arrived in VACO in 1979 to head the medical 

computer program, his whole team spent some time at the Washington VA Medical Center 

learning about AHIS. Terminals were in use on all clinical units. By this time, the ICU had 

been automated. Whitcomb recalled that two or three programmers working in the MUMPS 

language at the medical center were working on AHIS. It was a very expensive program, and 

as computer technology advanced, it was increasingly viewed as archaic. 16 

Nevertheless, AHIS continued to function at Washington VA Hospital through the 1970s and 

into the early 1980s, and the staff at the facility supported it. According to Jack Divers, who 

joined the AHIS team in 1975 as a programmer in IBM assembly language, the program ran 

on an IBM 360-40 mainframe computer, with all code in IBM assembly language. Well 

before Divers’s arrival, the program had been completed and was then, in 1975, in its 

maintenance phase. The 52 terminals scattered throughout the hospital handled a variety of 

tasks, including administrative matters (patient admissions, discharges and transfers); clinical 

laboratory tests, which could be ordered on the computer from the wards and results sent to 

the ward computer terminals; and radiology scheduling. 

No health care provider was specifically assigned to AHIS, so each clinical service designated 

its own coordinator and the AHIS staff would meet with doctors to talk about their needs. 

Many physicians recognized the potential of the AHIS for improving health care in myriad 

ways; the Chief of Radiology would meet with technicians to discuss improvements that 

could be made to the radiology subsystem, and other groups of subject-matter specialists 

would also get together to discuss their needs. 

The computer system proved cumbersome. Six times a day, it was necessary to close it down 

for 10 minutes to back it up onto tape. And it was very demanding: A staff of 20 were on hand 

simply to maintain the program. The development phase had ended, but at its peak at least 50 

people worked on the system. Still, in Divers’s opinion, the actual design of the system was 

very good. 

An audit staff of VA people not associated with AHIS reviewed all proposed changes to the 

system. If a hospital service requested a change, an auditor reviewed it and then passed it on 

to a programmer. The resulting change was again reviewed by the auditor, who then might 

give permission to implement it on the system. Testing any part of the system, however, was 

very expensive. No duplicate system existed, so all changes had to be implemented on a test 

set of disks. At 2 a.m., the system was shut down until 5 a.m., to allow time to install the test 

system. 

In 1975, the AHIS staff had a long-term plan to replace the hardware, which was by then 

grievously outdated. Procurement problems, however, prevented them from getting new 

equipment and the AHIS systems was forced to continue to run on the old equipment. 

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The system-wide computerized hospital information system eventually developed by VA 

differs from AHIS, but much of the basic design for data flow used in AHIS remains 

embedded in the current system.17 

Health Services Research and Development Service in VA Central Office 

Despite the efforts mentioned above, the Central Office leadership identified a need for more 

progress in the study of health care delivery. In 1971, Dr. Lionel Bernstein, former Director 

of Research Service, was given a special assignment to review hospital operations. His review 

resulted in a paper identifying a need for a more active program in Health Services Research. 

Leon Bernstein, Ph.D., who also had just left Research Service, was assigned to be Director of 

a newly constituted HSR&D Service that incorporated the Administrative Research Service as 

well as other functions.18 

In October 1972, Carleton Evans, M.D., succeeded Leon Bernstein as Director of the HSR&D 

Service, which continued to be located in the Office of Planning and Evaluation, under Wendell 

Musser, M.D. Evans had been at the San Francisco VA Hospital, where he had built up an 

outpatient department. While there, a medical school classmate, Dr. Gerald Charles, returned from 

the military as a resident. Charles and Evans collaborated on a Health Services Research and 

Development study of physician extenders. They trained young people from the inner cities to 

perform triage using protocols and to function as physician’s assistants. Charles had learned about 

this approach in the Army, where trained corpsmen successfully performed triage. The study was 

funded by the Federal Model Cities Program. When Wendell Musser heard about this activity, he 

visited San Francisco and recruited Evans. At that time, recalled Evans, HSR&D Service focused 

primarily on “industrial engineering.” Without any money of its own, the Service was forced to seek 

CMD approval to do something beyond the routine. Consequently, very little research was going on 

and, in Evans’s opinion, the studies being done when he arrived in Central Office were mundane. 

Figure 19.1. Carleton Evans, M.D. 

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The newly conceptualized Health Services Research and Development Service began work in 

earnest with Evans as Director. Thomas Newcomb, M.D., who had been Director of Research 

Service and was now ACMD/R&D, was Evans’s new boss. At first, the HSR&D Service, 

which had a staff of some 125 people, was given responsibility for VA’s computer design and 

installation throughout the agency in addition to establishing health services research as a 

vigorous activity. Most of its computer staff, however, lacked the requisite training and 

appropriate experience for the task, and it seemed unlikely that they were up to the job. By 

1976, the computer responsibility had moved to a separate office, making it possible to 

concentrate on starting a true research program in Health Services Research. 

Until then, HSR&D lacked its own budget and, except for a handful supported from Medical 

Research funds, projects were supported by the patient care budget. Newcomb and Evans 

worked strenuously to achieve a line item in the congressional budget to support HSR&D. In 

1976, some funds were found to support new programs, and in October 1976 (for the fiscal 

year 1977 budget), HSR&D was written into VA’s legislation with the addition of the words 

“including... health services research.” The 1977 HSR&D budget was $3.6 million, and it 

remained at about $3 million until a gradual rise beginning in 1983. 

Figure 19.2 Hea lth Services Res. and Dev. budget, 1976-1980 

4 

3.5 

3 

2.5 

Current dollars 2 Deflated to 1976 dollars 

1.5 

1 

0.5 

0 

Millions of dollars

1976 1977 1978 1979 1980 

The HSR&D Service continued to respond to short-term needs of the medical department 

with “management-type” studies conducted by Central Office staff or by contractors, until a 

field-based research program was introduced in the mid-1970s. In 1975, VA hospitals were 

invited to apply for support of projects (“investigator-initiated research.”). A committee of 

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experts assembled to provide peer review, and the first review meeting was held in June 1975. 

The results were disappointing: The proposed investigators were inexperienced in health 

services research and lacked guidance on how to prepare a health services research protocol. 

The committee provided extensive advice to the authors of those proposals that seemed to 

have merit. Some of these were rewritten and resubmitted for the next meeting of the 

committee, which continued to hold semiannual review meetings. By October 1976, when 

funds to support projects were in hand, seve projects of the 55 that were reviewed were ready 

to be funded. Over the next four years, submission rates remained modest, and funding was 

similarly selective (Table 19.1), with the review board holding to a high standard 

Table 19.1. Beginnings of Investigator-Initiated Health Services Research and Development

 Fiscal Year

 1976 1977 1978 1979 1980 

Investigator-initiated projects* 

Number reviewed 55 64 74 60 44 

Number funded 7 9 15 14 8 

Percent funded 13 14 20 23 18 

*Information provided by Carol Girard of the Management Decision and Research Center, VA Boston Healthcare 

System, October 11, 2001. 

In addition to this nascent intramural program, the young Health Services Research program 

supplemented its intramural efforts with contracts, just as the early Medical Research program 

had depended heavily on contracts to investigators outside of VA. Contracts were negotiated 

when there were “emergent high-priority research needs.”19 

The main challenge of Health Services Research in the 1970s was to build capacity, the same 

challenge that had faced the Medical Research program in the 1940s and 1950s. Without 

increased capacity, expansion of intramural research was impossible. Evans tried several 

approaches to meet this challenge. In the Investigator-Initiated Research program, the early 

review committee provided instruction as well as evaluation for aspiring researchers. In 

addition, a program of university affiliations was established, with an associated training 

program. 

In 1975, the National Center for Health Services Research of the Department of Health, 

Education and Welfare issued a grant solicitation for health services research centers to 

“conduct health services research, provide educational opportunities, develop research 

agendas responsive to regional and local needs, and render technical assistance.” 19 VA 

hospitals were invited to work with their medical school affiliates in preparing these 

applications. When the university affiliate’s center was funded, VA received enough support 

for a small unit (Table 19.2). 

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Table 19.2. Affiliations of VA hospitals with University Centers for Health Services Research* 

1975-1981 

University Affiliated VA Hospital 

University of California at Los Angeles Brentwood 

Wadsworth 

University of Washington Seattle 

University of Michigan Ann Arbor** 

University of Missouri Columbia, MO** 

Johns Hopkins University Perry Point 

University of North Carolina Fayetteville 

Durham 

University of Pennsylvania Philadelphia 

Yale University West Haven** 

Massachusetts Institute of Technology Boston 

University of Florida Gainesville** 

*The university centers were funded by the National Center for Health Services Research of the Department of Health, 

Education and Welfare.19 

**These centers had Health Services Research Training Programs, funded by Education Service. 

The staff of these units, assisted by their university affiliates, were then expected to apply for 

more research support from VA and other funding agencies. Four of these VA hospitals also 

received positions for trainees. While the program of the National Center for Health Services 

Research terminated after its initial five-year funding period, some of the VA-university 

partnerships established in these centers served as the basis for the VA Centers of Excellence 

in Health Services Research started in the 1980s. 

Figure 19.3. Richard Greene, M.D., Ph.D. 

414
 
 

 

In 1978, Evans recruited Richard Greene, M.D., Ph.D., to be a staff physician in HSR&D 

Service. Greene had been working with a group consulting in health services research and 

had most impressive credentials. Previously, he had been a Ph.D. molecular biologist in the 

NIH intramural program. In addition to his medical and scientific education, he held an 

M.P.H. from Johns Hopkins University. Not long after Greene arrived in 1979, Evans left for 

an intergovernmental detail to the National Academy of Sciences, and Greene became 

Director of HSR&D Service. A few months later, Vernon Nickel, M.D., the founding 

Director of Rehabilitative Engineering Research and Development Service, left for California 

to become a professor; Greene also served as Acting Director of that Service while a search 

was on for Nickel’s replacement. Next, Betty Uzman left to go to the Memphis VA Hospital, 

and Greene became Acting Director of Medical Research, as well, later becoming permanent 

Director of Medical Research Service. Later in the 1980s, Greene became ACMD/R&D. 

415
 
 

 

 

 

References 

1. "Report of group in research in conjunction with committee on treatment and cure of 

veterans." US Veterans' Bureau Medical Bulletin, 1929. 5: 230. 

2. Interview with Mr. John Willoughby, May 4, 1992 at Mr. Willoughby’s home. 

3.	 Interview with Mr. John Peters, February 27, 1992 at Mr. Peters's office at the University of 

Alabama at Birmingham. 

4. H. Martin Engle, M.D., "Memorandum No. 10-63-25. Committee on Administrative and 

Developmental Research." 8/14/63. 

5. H. Martin Engle, M.D., "Memorandum No. 10-666-3. Administrative Research 

Committee." 2/25/66. 

6. VA Central Office Telephone Directory. Washington, DC: 1967, 32. 

7. Orin T. Skouge, M.D., "Circular 10-66-279. The Administrative Research Program." 

12/22/66. 

8. Benjamin B. Wells, M.D., "R&E Letter 65-2. Request for cooperation in research project." 

2/26/65. 

9. H. Martin Engle, M.D., "Memorandum No. 10-68-7. Abolishment of Administrative 

Research Committee." 4/4/68. 

10. Orin T. Skouge, M.D., "RCS 13-109-5. Survey of Suggested Health Services Research and 

Development Projects." 7/8/69. 

11. Adkins, R.E., "The Automated Hospital Information System", in Medical Care of Veterans. 

1967, U.S. Government Printing Office: Washington, DC 390-391. 

12. Interview with Lawrence Christianson, M.D., May 4, 1992 at Dr. Christianson’s home in 

suburban Maryland. 

13. Interview with Thomas Chalmers, M.D., July 29,1992 at a hotel lobby in Boston, MA. 

14. Telephone interview with Orin Skouge, M.D., August 3, 1992. 

15. Interview with Mr. Al Gavazzi, May 6, 1992 at Mr. Gavazzi’s home in suburban Virginia. 

16. Telephone interview with Walter Whitcomb, M.D., August 11, 1992. 

17. Telephone interview with Mr. Harold (Jack) Divers, January 14, 1994. 

416
 
 

18. Interview with Leon Bernstein, M.D., April 29, 1988 at Dr. Bernstein's home in suburban 

Virginia. 

19. Kruegel, D. and Evans, C., "The organization of health services research in the Veterans 

Administration." J Med Systems, 1981. 5: 157-162. 

417
 
(Intentionally Blank) 

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Chapter 20. VA Research in Rehabilitation 

Before the Oct. 1, 1973, establishment of the Research and Development Office, including 

Prosthetics Research, VA research in prosthetics and sensory aids was the responsibility of the 

clinical service that served Veterans who needed these devices. And only in 1976 did research in 

rehabilitation become a Service in its own right. 

Post-war research guided by NRC committees 

In the first 31 years after World War II, from 1945 to 1976, the National Research Council (NRC) 

of the National Academy of Sciences played an active role in encouraging and supporting research 

in prosthetics and sensory aids, both in VA and elsewhere. NRC committees reviewed proposals 

for contracts in support of prosthetics research, held meetings to review state-of-the-art prosthetics 

and advise on new directions, and interacted directly with contractors. Funds supporting contracts 

came from the Office of Scientific Research and Development (OSRD) and the War Department 

from 1945 to 1947; after that, VA provided the funding. Public Law 729, 80th Congress, June 19, 

1948, formally authorized VA research in the fields of prosthetics and sensory devices and provided 

a budget of $1 million per year. The law required VA to “make available the results of such 

research so as to benefit all disabled people.” The budget remained flat until 1962, when the $1 

million funding ceiling was lifted by Public Law 87-572, which authorized “such funds as were 

necessary” for the program.1 

Until the mid-1970s, the VA research program in prosthetics and sensory aids consisted primarily of 

contracts funded by VA, supervised by VA staff and reviewed by NRC committees.2 

The NRC committee structure in support of this program changed from time to time (Appendix 

IIm), with shifts in the perception of needs and changes in the agencies (including VA) supporting 

research in prosthetics and sensory aids. NRC involvement began with a meeting to review the 

needs of amputees. The meeting, sponsored by the Army at the request of the NRC, was held at 

Northwestern University on Jan. 30-Feb. 1, 1945. One outcome of this meeting was a Committee on 

Prosthetic Devices formed by the NRC in April of that year. In October, the wartime OSRD 

transferred its Committee on Sensory Devices to the NRC. From then until 1975, the NRC 

continued to play a key role in guiding research in prosthetics and sensory devices, a large fraction 

of it supported by VA. 

The 1945 meeting has been described as the beginning of modern research in prosthetics.3 It was 

held just after the annual meeting of the American Academy of Orthopedic Surgeons in Chicago, 

and orthopedic surgeons were well represented by physicians including Henry Kessler and Paul 

Magnuson. The attendee representing the OSRD was Paul Klopsteg, Ph.D., Sc.D., a physicist at 

Northwestern University and Director of Research at Northwestern’s Technological Institute. 

Through subsequent reorganizations, these committees were guided in the early days by the 

Executive Director, Brig. Gen. F.S. Strong, Jr. An early assistant to General Strong was Eugene 

Murphy, who played a key role in the VA program.4 

419
 
 

 

 

 

 

 

 

 

 

Eugene Murphy, Ph.D. 

Dr. Eugene Murphy, himself paraplegic as a result of childhood poliomyelitis,5

 was a mechanical 

engineer. He spent World War II on leave from his graduate studies at the Illinois Institute of 

Technology teaching mechanical engineering students at the University of California in Berkeley 

and conducting research, supported by OSRD, on the stability of bonded wire in strain gages. 

These gages were used to measure the stretching of reinforcing bars in steel structures such as 

bridges and large ships. 

Figure 20.1. Eugene Murphy, Ph.D. 

Murphy was a friend of Howard D. Eberhart, B.S.E.E., professor of civil engineering at Berkeley, 

who lost a leg in a wartime research accident in 1944. Ironically, Eberhart had gained an interest in 

prosthetics research and knew the men he would come to work with in this field before the accident 

made him a user of the technology. Already acquainted with Murphy through professional 

engineering interests, he had been consulted by Verne Inman, M.D., an orthopedic surgeon at UC 

Medical School in San Francisco, concerning the biomechanics of the shoulder joint. After 

Eberhart’s injury, Dr. Inman was his surgeon. 

The accident that caused the loss of Eberhart’s leg occurred while he was studying the stress on 

concrete from landing aircraft. While trying to develop more efficient reinforcing patterns for the 

concrete, to facilitate building longer runways for bombers with less material, he was run over by a 

trailer weighted to represent the landing gear of a B-29. 

At the Mare Island Naval Hospital, under the guidance of Navy physician Henry Kessler—a leading 

expert in prosthetics—Eberhart was fitted with a conventional wooden foot and mechanical ankle 

joint prosthesis. In visits from Murphy, the two became interested in measuring the stresses 

involved in using this type of artificial leg. Back at the civil engineering laboratory in Berkeley, 

they rigged up various rudimentary measuring devices as Eberhart walked about as a test subject. 

Their research indicated strains on the prosthetic limb were far greater than initially supposed, and 

the two engineers realized that more sophisticated techniques were needed to measure the 

complexities involved in the dynamic motion of simple walking.1 

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Murphy described their experience to key people at the NRC, pointing out that little was really 

known about the mechanics of walking—knowledge critical to developing prosthetic lower limbs. 

The NRC officials were sufficiently impressed that Murphy became an assistant to Gen. Strong, 

helping to launch the NRC’s initial effort in prosthetics research. Eberhart and Inman were given a 

contract for a formal research project, which endured for the next 35 years, leading to significant 

progress and understanding in the field of prosthetics.4 

Prosthetics and Sensory Aids Service 

In 1948, after Public Law 729 from the 80th Congress provided funding to VA in support of 

prosthetics research, Murphy moved from his staff job with the NRC to VA. Research in 

prosthetics and sensory aids in VA was administered by the new Prosthetics and Sensory Aids 

Service in VA Central Office. Its first Director was Augustus Thorndike, M.D., a prominent 

orthopedic surgeon at Harvard, who never moved to Washington. Dr. Thorndyke was well 

connected in the medical community, and he used his contacts in the American Medical 

Association, the American College of Surgeons, and other professional organizations to help raise 

the profile of VA’s work in prosthetics and sensory aids. The Assistant Director for Operations, 

Robert E. Stewart, D.D.S., was based in the Central Office. After Thorndike retired in 1955, Dr. 

Stewart became Director, a position he held until he retired in 1973. 

Figure 20.2. Augustus Thorndike, M.D. Figure 20.3. Robert E. Stewart, D.D.S. 

Murphy, as Assistant Director for Research, was based in New York City at the VA Regional 

Office. A “Prosthetics Testing and Development Laboratory” had been established in New York in 

1945 by Walter Bura, who was in charge of VA’s clinical prosthetics program from 1945 to 1948. 

This unit was independent of the NRC effort. 

VA Prosthetics Center in New York 

In 1955, Dr. Stewart, by then Director of the Prosthetics and Sensory Aids Service, visited the 

Sunnybrook Hospital in Toronto, where he learned about its prosthetics center that served 18 health 

centers throughout Canada and also engaged in research. He felt that a similar center would benefit 

VA. In 1956, he established the VA Prosthetics Center (VAPC) in New York. This Center 

combined a clinical operation with the research and evaluation effort already ongoing under Dr. 

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Murphy. Later, it established satellite stations at several VA hospitals.6 

The research carried out at the VAPC constituted most of VA’s intramural research in prosthetics 

and sensory aids before the 1973 reorganization that brought prosthetics research into the Office of 

Research and Development. While the VAPC carried out a variety of practical projects, primarily 

to improve upper and lower limb prostheses, it became increasingly involved in the evaluation of 

devices developed by others. It established a network of VA Prosthetics Service units at VA 

hospitals willing and able to evaluate new devices. In some cases, when the new device was clearly 

beneficial, it would be adopted in VA for general clinical use. The VAPC also played an active role 

in prosthetics education. Its activities were extensively discussed in the review of the prosthetics 

and sensory aids program by Stewart and Bernstock published in 19737

 and were regularly 

reviewed in the Bulletin of Prosthetics Research. 

Dr. Murphy’s role 

While he supervised the intramural research at the VAPC, Eugene Murphy’s most important role 

was to coordinate the contracts program. Frank Coombs, who joined the program in the 1970s, 

described Murphy as a superb expeditor, the “bee in the flower garden, cross-pollinating things,” 

who exchanged and furthered ideas. When he learned what one person was doing, he was quick to 

think of whom that person should confer with and would get them together, and then follow up.4,8 

Bulletin of Prosthetics Research 

A key contribution led by Murphy was the publication of information to be shared within the 

prosthetics and sensory aids community. From 1954 to 1972, with VA support, the NRC published 

a journal called Artificial Limbs. To cover the broader field of research included in its Prosthetics 

and Sensory Aids research program, VA started its own Bulletin of Prosthetics Research in 1964. 

Murphy continued as its editor until he retired in 1983. 

The Bulletin of Prosthetics Research presented VA-sponsored research, both as progress reports and 

original articles, and also presented other research in the field. Recognized as a primary source of 

state-of-the–art information about research in prosthetics and sensory aids, by 1983 the Bulletin had 

expanded to include all areas of rehabilitation and changed its title to reflect its broader scope. 

Today known as the Journal of Rehabilitation Research and Development, this journal continues to 

expand and contribute to its field. 

Early prosthetics research supported by VA 

University of California at Berkeley 

Work under the contract with UC Berkeley was begun even before VA took over funding of 

contracts in 1947. Researchers conducted classic fundamental studies on human locomotion, or gait 

analysis. Their early studies included limb and pelvis motion during locomotion and patterns of 

muscle activities in the lower limbs and trunk. To investigate these phenomena, they developed 

glass walkways and force plates. They used three-dimensional cinematography along with the force 

plates to greatly expand knowledge of human walking. This work had national and international 

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impact on the field of motion analysis. The team also performed materials testing and made studies 

of structural design that led to improvements in artificial-limb alignment and suction-socket design 

that reduced pain in amputee fittings. Later products completed under this long-lasting contract 

were the development of casting techniques and plastic laminates for sockets, improvement in the 

suction socket, a casting technique for total contact sockets for above-knee amputees, a patellartendon-bearing socket for below-knee amputees, a safety-lock knee and a 

Table 20.1. Comparison of rehabilitation research projects funded in 1973 with those funded in 1980 10, 11 

(1973 funding included where known 12) 

Intramural projects active in 1973, terminated by 1980
 

Orthopedics and prosthetics
 

Moore et al VAMC, San Francisco Immediate postoperative prostheses 

McDowell VAMC, Richmond Immediate postoperative arm orthoses 

Spinal cord injury
 

Davis VAMC, Miami Paralysis, spasticity and pain
 

Extramural projects active in 1973, terminated by 1980
 

Oversight
 

McLaurin Nat’l Academy of Sciences Advisory committee $167,000 

Sensory aids
 

Causey et al University of Maryland Hearing aid research 55,000 

Carhart, Olsen Northwestern University Test proced, binaural hearing aids
 

Benham et al Bionic Instruments, Inc. Laser cane for blind 35,000 

Cooper et al Haskins Laboratory, Inc. Speech output- reading machine 134,400 

Mauch, Smith Mauch Laboratories Reading machines 145,600 

Weisgerber Am. Inst. Res., Palo Alto Training - Mauch Stereotoner 

Hathaway, Butow Hadley School for Blind Reading machine training 20,000 

Orthopedics and prosthetics
 

Mauch Mauch Laboratories Hydraulic limbs 110,000
 

Bennett New York University Evaluation of prostheses 20,930 

Lyman et al University of California, LA Externally powered arm 49, 800
 

Sarmiento et al University of Miami Improved fitting procedure-leg 59,000
 

Graupe Colorado State University EMG-act contr for art upper arm 15,600
 

Perry Rancho Los Amigos Clinical gait analyzer 

Spinal cord injury
 

Newell, Leavitt Texas A&M Engineering Automotive adaptive equip 

Scott Mobility Engineering Passenger safety, vehicle for handicap 

Perry, Allen Rancho Los Amigos Bed-chair
 

Other
 

Cochran St. Lukes Hosp, NYC Electrical stimulation of bone healing
 

Chase, Babb Univ Calif, LA Lit search on electrode implantation 

Intramural projects active both in 1973 and 1980
 

Orthopedics and prosthetics
 

Burgess, Lippert Seattle VAMC Improved amputation and prostheses 

 (Contract to University of Washington in 1973, Seattle VAMC in 1980) 

Sensory Aids
 

Acton, De L’Aune West Haven VAMC Reading and mobility aids 

Malmazian, Farmer Hines VAMC Reading and mobility aids 

Hennessey et al Palo Alto VAMC Reading and mobility aids 

Other
 

Schweiger, Lontz Wilmington VAMC Maxillofacial materials 

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 (Contract to Temple University in 1973, Wilmington VAMC in 1980) 

Lee et al Castle Point VAMC Hemodynamic evaluation in amputees 

Hoaglund et al San Francisco VA Lower limb prostheses, locomotion

 (Contract to UC Berkeley in 1973, San Francisco VAMC in 1980) 

Extramural projects active both in 1973 and 1980 

Orthopedics and prosthetics 

Thompson, Childress Northwestern Univ. Powered prostheses 

Seamone, Schmeisser Johns Hopkins Ext powered arms, robots, wheel chair 

 Hall, Rostoker Southwest Res Inst Permanent artificial limbs 

Intramural projects active in 1980, started after 1973 

Rehabilitation Research and Development Centers

 Hines VAMC Multidisciplinary program 

Leifer Palo Alto VAMC Multidisciplinary program 

Sensory Aids 

Kelly Atlanta VAMC Wheelchairs, reading and mobility 

Linvill et al Palo Alto VAMC Communication system for the blind 

Orthopedics and prosthetics 

Cochran et al Castle Point VAMC Electrical stimulation of bone transplants 

Mears Pittsburgh VAMC Joint wear particles 

Murray Wood VAMC Normal and abnormal motion 

Marsolais Cleveland VAMC Engineering – Orthotics and prosthetics 

Fortune, Leonard Wash, DC VAMC Grouting materials 

Spadaro Syracuse VAMC Electrical stimulation of hard tissue 

Cooper Iowa City VAMC Foot biomechanics 

Lippert, Burgess Seattle VAMC Below-knee physiological suspension 

Weinstein New Orleans VAMC Orthopedic implant retrieval 

Golbranson San Diego VAMC Gait analysis 

Malone et al Tuscon VAMC Postoperative prosthesis, arm and leg 

Spinal cord injury 

Perkash, Motloch Palo Alto VAMC Seating systems 

Vistnes Palo Alto VAMC Pressure sores 

Rossier West Roxbury VA Wheelchair – Myoelectric control 

Weibell et al Sepulveda VAMC Wheelchair power steering 

Bohlman et al Cleveland VAMC Spinal cord monitoring 

Sypert, Munson Gainesville VAMC Spinal cord regeneration 

Peckham Cleveland VAMC FES – upper extremity 

Hussey, Rosen West Roxbury VA Muscle control by electrical stimulation 

Other 

Goldstein et al Gainesville VAMC Artificial larynx 

Hood, Schoen Gainesville VAMC Lung reaction to biomaterials 

Griffin, Schiavi Nashville VAMC Neuromuscular deficit techniques 

Extramural projects active in 1980, started after 1973 

Sensory Aids 

Clark, Savoie Telesensory Systems Speech output for reading aid 

Orthopedics and prosthetics 

Swanson Blodgett Med Ctr Grommet bone liner 

Banks NASA Lewis Res Finger joint grommets 

Matsen Univ. Washington Neuromuscular structure viability 

Spinal cord injury 

Roemer et al UC Santa Barbara Bladder volume determination 

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pneumatic swing-control knee. Inman and Eberhart’s work also resulted in the prosthetic foot that 

became the standard for its time, the Solid-Ankle Cushion-Heel (SACH) foot.9 

Mauch laboratories 

Another long-time contractor was Hans Mauch, who developed hydraulic swing-control knees and 

ankles and also worked on reading machines. Mauch had played a major role in developing 

Germany’s V1 missile, and came to the U.S. with Werner von Braun. 

Frank Coombs described Mauch as a “hydraulics wizard.” He applied his expertise to the process 

of biomechanically replicating the motion of the human knee and ankle. The knee is far more 

sophisticated than a simple hinge; mechanically recreating its motion requires a variable center of 

rotation. Mauch’s hydraulic configuration allowed the leg to swing forward normally during 

walking; then it would dampen its stopping point and suppress any backward motion. Mauch 

applied the same technology to the ankle joint by constructing a variable mechanical replica that 

adjusted to variations in up and down angles.8 

University of California at Los Angeles 

Another early contract that continued for many years was with UCLA. In the early years, the 

UCLA investigators collaborated with Northrup Aircraft, in Hawthorne, Calif. The UCLA-Northrup 

group did classic studies of upper-extremity motion comparable to those of the lower limb done at 

UC Berkeley. They identified the basic requirements for upper-extremity prostheses and developed 

improved models. But probably the UCLA group’s most important contribution, which began in 

1953 with VA prosthetics research funding, was a university-level prosthetics education course. 

This was soon followed by similar courses at New York University and Northwestern University. 

They taught up-to-date methods and worked to make prosthetics a profession. These programs, 

while not strictly centered on research, provided formal accreditation for prosthetists, a qualification 

that soon was required by VA for those who fitted Veterans with prosthetics.13 

Northwestern University and the Rehabilitation Institute of Chicago 

Northwestern University had been the cradle for modern prosthetics research, hosting the seminal 

1945 meeting and providing the original NRC committee staff. In those early days, Northwestern 

had a contract for reviewing the literature and patents related to artificial limbs that led to a lengthy 

report on the state of the art. The University’s researchers also worked on methods for testing 

artificial legs. 

In 1954, largely as a result of the personal efforts of VA’s Dr. Paul Magnuson, the Northwesternaffiliated Rehabilitation Institute of Chicago (RIC) was founded in the city’s downtown. In 1958, a 

VA-sponsored Prosthetics Research Center was set up within the RIC. Its Chief was an orthopedic 

surgeon, Dr. Clinton Compere, one of the key professionals sustaining the new RIC. Dr. Compere, 

a combat surgeon in the South Pacific, had been chief of an Army amputee unit following WWII 

and knew Dr. Magnuson. The new program was charged with evaluating special amputation 

situations to facilitate the development and fit of appropriate devices. From its inception, the 

Prosthetics Research Program worked with the nearby Chicago Research VA Hospital, later called 

425
 
 

 

 

 

 

 

 

 

 

 

 

 

 

the Chicago Lakeside VA Medical Center, drawing clinical collaboration from the VA hospital as 

well as from its host, the RIC. 

A wide variety of prosthetic devices were developed at the Northwestern unit. Early on, its 

engineers became interested in use of external power in prosthetics. In 1966, electrical engineer 

Dudley Childress, Ph.D., joined the staff. In 1968, he and his associates fitted the first selfcontained and self-suspended trans-radial myoelectric prosthesis. With this system, which later 

became commercially available, the amputee activates the same muscles that had controlled the 

original arm. Electrodes on the skin then pick up the muscle activation signal which is 

electronically amplified to control small motors in the artificial arm. The first person ever fitted 

with such a device later became a successful New York banker who also used later generations of 

the myoelectric hand. A large cadre of individuals were fitted in this way in Chicago, and they 

provided design feedback to Childress and his team. 

Figure 20.4. Dudley Childress, Ph.D. 

The Prosthetics Research Laboratory, attached to VA Lakeside Hospital, became known world wide 

for practical and elegant myoelectric systems. VA held a national educational course at 

Northwestern University’s prosthetics school in the early 1970s, enrolling approximately 50 

students, where VA clinicians learned how to fit the new prostheses. This event launched 

myoelectric prosthetics for American Veterans. Subsequently, Childress designed a new prehension 

mechanism that used two motors acting in synergy. Thirty years later, the principle was still 

employed in three commercially available prosthetic systems. The Myo-Pulse modulation scheme 

that Childress created for the myoelectric signal processor was revolutionary because of its high 

performance and simplicity of design. The modulation principle, which essentially eliminates delays 

in the electronics, enables a prosthesis to respond instantly to its wearer’s wishes. 

Childress and John Billock were successful using the Northwestern socket that Billock designed for 

people with trans-radial amputations. They also had success with transhumeral amputations by using a 

body-powered elbow and myoelectric hand controlled with a myoelectric signal from the biceps and 

426
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

triceps brachii. This fitting method is standard today in VA and civilian prosthetics facilities. The team 

also developed a multi-state myoelectric arm that allowed the biceps and triceps to control four degrees 

of freedom of the arm. 

Childress and his team at the RIC Prosthetics Research Center were also leaders during the 1970s and 

1980s in the development of many rehabilitation-engineering systems for people with spinal cord 

injuries. They were the first to design and commercially introduce the “sip and puff” wheelchair 

controller for those with high-level quadriplegia. Ms. Margaret Pfrommer, who had significant 

quadriplegia, had a 25-year tenure in their laboratory as a laboratory assistant. The group developed a 

wide range of assistive equipment for persons with similar significant disabilities. Such equipment is 

now common and much advanced, but during the 1970s and early 1980s very few devices of this kind 

were available. Ms. Pfrommer used the “sip and puff” wheelchair, and the Childress team designed 

many devices around this control concept. Items developed and marketed through a national company 

included the first solid-state environmental control system for office and/or home and the first dedicated 

computer (in 1973) that allowed a person to serve as a receptionist and office assistant. Pfrommer 

demonstrated the effectiveness of this equipment in her home as well as in the laboratory. Her home was 

adapted so that she could live alone, with caregivers needed only in the morning and evening. Childress 

integrated her rocking bed with a positive pressure ventilator. She became a strong advocate for 

technology in rehabilitation and was a compelling spokesperson and example for what persons with 

disability could do if given the proper tools.14, 15 

University of Washington: The Prosthetics Research Study, Seattle 

In 1964, Ernest Burgess, M.D., an orthopedic surgeon in Seattle and Chief of the amputee clinic at 

the Seattle VA Hospital, organized a VA-sponsored study of the theoretical and practical aspects of 

Immediate Postsurgical Prosthetic Fitting (IPPF). This technique had recently been described by a 

Polish surgeon and professor, M. Weiss, M.D. On hearing about Professor Weiss’s work, Burgess 

organized a national workshop of VA clinic team directors and other leaders in the prosthetic and 

amputee rehabilitation field to review this new technique. After the workshop, VA funded Burgess 

and his co-workers to undertake a clinical investigation. A laboratory was established at the Pacific 

Northwest Research Center, and the clinical base for the program was centered on the Seattle VA 

Hospital campus but involved all of the hospitals affiliated with the University of Washington. 

The first cases of IPPF, patients cared for by a team with Dr. Burgess as the surgeon, were 

successful. Within a few months, it had become apparent that these patients had less postoperative 

pain and their rehabilitation was faster than in the past. However, it also became clear that many 

areas called for further research. In subsequent years, this group studied surgical and casting 

techniques, materials, wound healing, measurement of tissue circulation, selection of amputation 

site and many related issues. It redefined the surgical procedure of amputation as a part of the 

rehabilitation procedure and introduced a new family of surgical reconstruction techniques and a 

series of new prosthetic devices.16 

During the 1980s, collaborating with engineers at Boeing Aerospace, Burgess’s laboratory 

developed the Seattle Foot system, incorporating light-weight, responsive materials that capture an 

amputee’s natural movement. Dr. Burgess is personally credited with having strongly advocated 

one particularly distinctive attribute of the system: an energy saving and return feature. As the 

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wearer brings the foot down, the structure absorbs and briefly stores excess energy from the 

downward momentum; as the wearer begins lifting the foot for the next step, the stored energy is 

released to spring the foot up, giving the wearer a positive sense of “pushing off.”17 

Combining this system with computer-aided design and manufacture, the Seattle group developed a 

method for producing better-fitting prostheses more quickly and inexpensively than was possible 

before. This system, the CAD-CAM system, is now being used widely in VA and elsewhere. It is 

being used successfully to provide inexpensive and comfortable limbs for amputees in Vietnam and 

other countries that have been ravaged by land mines from recent wars.18 

Sensory aids research 

The need for improved care of those who became blind or deaf as a result of their military service 

concerned the wartime Committee on Medical Research of the Office of Scientific Research and 

Development. In January 1944, the OSRD formed a Committee on Sensory Devices. This 

Committee was transferred to the NRC in October 1945, when the OSRD closed down its 

operations. In 1950 the Committee sponsored a book titled Blindness: Modern Approach to the 

Unseen Environment that reviewed the state of the art in assistive technology for limited vision. In 

a 1954 NRC reorganization, this committee was dissolved and its activities ceased. The NRC did 

not review or support sensory aids research for the next 10 years. In 1964, at the request of VA, the 

NRC established a new Subcommittee on Sensory Aids under its Committee on Prosthetics 

Research and Development.19 Administration of sensory aids research in VA was part of the 

prosthetics research program, led by Eugene Murphy in the New York office during the entire 

period leading up to, and for several years after, the 1973 reorganization of VA. While some 

contracts related to hearing aids were consistently in the portfolio, the effort was focused on 

blindness. 

VA’s specialized care of the blinded Veteran began with establishment of the first Center for 

Rehabilitation of the Blind at the Hines VA Hospital in Chicago. In this program, selected blind 

Veterans were trained in a variety of skills.20 This Center, and the Blind Centers later established at 

the Palo Alto and West Haven VA Hospitals, provided VA with a focus, as well as willing 

participants, in efforts to improve life for Veterans and others with severe visual impairment.. 

Mobility aids for the blind 

Development of an effective obstacle detector to help blind persons navigate has long been a 

challenge. VA began supporting research directed to this problem in the 1940s. 

In 1948, VA bought 25 “Signal Corps Devices,” single-channel obstacle detectors built by RCA. 

VA contracted for their evaluation with Thomas A. Benham, a blind faculty member at Haverford 

College. Professor Benham reported on his results and suggested improvements in a 1952 report. 

In 1953, VA contracted with Haverford to allow Benham to oversee development of an improved 

device. Haverford subcontracted work to a commercial firm, Bionic Instruments. Over the next 16 

years, under VA contract, 10 devices were developed, ultimately including practical laser canes for 

the blind. The 1975 product, the C-5 Laser Cane, emitted three pulses of infrared light, directed up, 

down and straight ahead. The light is reflected from an object in front of it and detected by a 

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photodiode placed behind a receiving lens. The angle made by the reflected ray passing through the 

lens indicates the distance of the object detected. The cane makes a sound when the downward 

beam detects a drop-off or the upward beam detects an overhead barrier. Sounds of different 

frequencies indicate the barriers ahead, in front of and above the user. VA developed the training 

programs necessary for proper use of this device. It proved to be appropriate only in certain 

circumstances, for highly motivated users and for training of the newly blind, who later were able to 

maneuver without it. The cost and skills required were substantial, but they were less than those 

needed for use of a guide dog.21 

Reading machines 

The early contracts from the NRC supporting research on reading machines for blind Veterans 

involved attempts to translate printed material to sound. This work ended in 1954 when the 

Committee on Sensory Devices was dissolved.22 Between 1954 and 1958, VA and NRC sponsored 

a series of five conferences for people interested in further development of reading machines, but 

there was essentially no governmental support of research to advance the field during that period. 

These conferences attracted wide attention: from 11 attendees at the first conference in 1954 to 68 

at the fifth in 1958. Despite the lack of funding, the conferences stimulated new ideas.23 

In 1957, VA started a funded program to develop reading machines for those with severe visual 

impairment. The earliest product of this new program was the improved Optophone, developed at 

Battelle Memorial Institute by upgrading and transistorizing a device developed in the 1940s by 

RCA. This device translated the printed word into a series of nine tones representing portions of the 

letters in each word. Five prototypes were produced and a group of blind students and adults 

learned to use it. Several blind VA employees became experts in its use, but reading was very slow. 

The Battelle device was never widely distributed, but led to other more widely accepted devices.24 

In the Mauch Laboratories, in addition to the prosthetics development described earlier, Hans 

Mauch started a reading machine project in 1957 that lasted 20 years. His first contract from VA 

was to contribute to the Batelle Optophone. His first assignment: to develop an improved tracking 

device, which he called the Colineator. Soon, Mauch and his colleagues were working on a 

machine that produced speech-like sounds in response to letter shapes. When this did not prove 

practical, Mauch moved to the use of recorded phonemes based on letter shapes, using the “spelled 

speech” system being developed under VA contract by Professor Milton Metfessel of the University 

of Southern California. This “Cognodictor” went through a number of modifications leading to a 

field prototype delivered in 1969 and to further improvements up until 1976. 

Meanwhile, Mauch was also developing a hand-held probe that gave tactile responses to letters, a 

device called the Visotactor. It was like a miniature version of the Optophone, except that its output 

was tactile rather than auditory. Mauch then changed the output to a system of sounds instead of the 

tactile output, producing the Visotoner. The Visotactor, Visotoner and Optophone were all practical 

for reading when used by well-motivated, thoroughly trained and intelligent blind users. At best, 

however, reading was slow. Mauch continued to improve these small, relatively inexpensive 

“direct translation” devices and in 1972 produced the Stereotoner, which took advantage of a double 

array of detectors to speed the letter recognition process by producing its tones binaurally. The 

Visotactor, Visotoner and Stereotactor were originally intended to be useful components in the 

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development of the Cognodictor. In fact, in the hands of trained users, they were more practical 

when used directly; they continued to be used by a few blind readers, while the Cognodictor never 

entered the practical-use phase of development.25, 26 

Franklin Cooper of the Haskins Laboratory in New York (and later in New Haven, Conn.) and his 

colleagues had worked on the reading machine concept in the 1940s under the Committee on 

Sensory Devices. They had developed a device that produced a tone pattern in response to the 

shapes of letters. However, Cooper’s interest had turned more and more to the problem of 

production of standard English, and the laboratory conducted fundamental linguistic research 

toward that end. When VA started funding its reading machine program in 1957, Haskins received 

a contract to produce “audible outputs of reading machines for the blind.” For a shorter-range 

product, they had a second contract for an interim device—a reading machine that could recognize a 

vocabulary of up to 7,200 words. Since optical character recognition was not yet developed, for 

input they used a punched-tape system from the printing industry. Ability to read these tapes 

would, in principle, make a wide variety of printed material accessible to blind persons. The shortrange project never reached the clinical testing phase, but the long-range project, production of 

synthetic speech from the written word, led to important theoretical advances. 

Mauch’s group developed a system of linguistic rules to synthesize speech, leading to their primary 

product, Speech Synthesis by Rule. Eventually, in 1973, they produced a prototype reading 

machine that provided a version of synthetic speech. It depended on a commercially available 

optical character reader and on four Haskins developments: a text-to-phoneme dictionary look-up, 

stress and intonement assignment, Speech Synthesis by Rule, and a parallel resonance synthesizer. 

Editorial corrections were needed at several points in the process. While a usable reading machine 

did not result from the many years of research that the Haskins Laboratory carried out with VA 

funding, the basic knowledge gained was important to the ultimate development of a practical 

reading machine in the mid-1970s.27, 28 

VA was active in reading machine development until 1978, but none of the devices developed 

under VA contract was ultimately successful in the market. The first commercially successful 

devices were the Optacon, a tactile Braille-like instrument using air jets, developed by James Bliss, 

Ph.D., and John Linvill, Sc.D., at Stanford Research Institute and Stanford University, and the 

Reading Machine of Dr. Raymond Kursweil, Ph.D., which produced electronic speech in response 

to text. The Optacon was a direct competitor for the Stereotoner, and comparative testing showed 

both to be useful. However, the Optacon was marketed and the Stereotoner never reached the open 

market even though it was less expensive.29 

Though they were not themeselves initially funded by VA, the successful developers of reading 

machines benefited from the work that had been done under VA contract. The Kurzweil machine 

took advantage of the linguistic knowledge gained in the basic research done by the Haskins group. 

Both the Optacon and the Kurzweil Reading Machine were evaluated in VA’s Blind Centers. 

Linvill, in fact, was a coinvestigator of a VA intramural project at the Palo Alto VA Medical 

Center’s Blind Rehabilitation Center during the late 1970s,30 and Bliss and Linvill’s company, 

Telesensory Systems, Inc., had a VA contract in 1980 to develop a speech output for the Optacon.31 

All of the important devices designed to assist blind persons in reading have been tested and 

compared in VA Centers.32 

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Emergence of a new Rehabilitation Engineering R&D Service, 1973–1980 

When VA reorganized its research and education program in 1973, setting up the new Office of 

Research and Development with Thomas Newcomb, M.D., as the first ACMD/R&D, the old 

Prosthetics and Sensory Aids Service was divided. Its clinical responsibility remained in the 

Professional Services, its training activities became a part of the Academic Affairs program and its 

research and development became a Prosthetics Research Program in the new Office of Research 

and Development. At that time, Dr. Stewart, who, as Director of the Prosthetics and Sensory Aids 

Service had taken an active interest in the research program, retired. Dr. Murphy and the VA 

Prosthetics Center remained in New York, but the center of research administration for the program 

moved to Washington. Thomas Radley, M.D., Assistant Director of Surgery Service in Central 

Office, became the Acting Director of the new Prosthetics Research Program under Dr. 

Newcomb.33 

Newcomb believed that VA research in rehabilitation needed increased status and support and that 

these could be gained if the program were administered by a separate Service in the R&D Office. 

He gained the support of the Veterans’ service organizations that were especially interested in 

people with disabilities and of others in VA Central Office.34 His effort was rewarded when, in 

1976, the Prosthetics Research Program was given Service status and renamed the Rehabilitation 

Engineering Research and Development Service.35 This new designation reflected the 

understanding that research needs in rehabilitation transcended the scope of prosthetics and sensory 

aids alone. 

Figure 20.5 Rehabilitation Engineering R&D budget, 1974-1980 

9 

8 

7 

6 

5
 

Current dollars
 

Deflated to 1974 dollars 4 

3 

2 

1 

0 

Budget increases Millions of dollars

1974 1975 1976 1977 1978 1979 1980 

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The new Service, set up with congressional approval and with a new mission, was rewarded with 

more money to spend. The Veterans’ service organizations were enthusiastic about the new 

direction, and the national climate favored improving the lot of people with disabilities. 

The 1947 congressional appropriation of $1 million for the VA Prosthetics Research program had 

not been increased at all by 1976, after inflation was taken into account. Now VA requested and 

received additional money to support its new effort. Between 1976 and 1980, the Rehabilitation 

Engineering R&D Service’s congressional appropriation had more than doubled. Even taking into 

account the high rate of inflation in those years, this four-year increase was substantial (Figure 20.5) 

and made it possible to move in new directions. 

Program moves from contracts to intramural research 

By the late 1970s, things were very different in VA than they had been when the contractual 

prosthetics research program began in 1947. Medical Research had become a vigorous intramural 

program, recognized widely as beneficial to VA’s Veteran patients. Newcomb and his colleagues 

were convinced that VA would benefit more from an intramural program of rehabilitation research 

than from a purely contractual program. It was also believed that VA patients were more likely to 

receive direct benefits if the research was done in VA hospitals. A major policy change was agreed 

upon: In the future, where possible, VA research funds for rehabilitation research would be 

allocated to VA investigators.34 When feasible, the contracts that remained would be supervised by 

a VA investigator and assigned to a VA medical center.8 

By 1980, the majority of the research supported by VA Rehabilitation Engineering R&D budget 

was either carried out in VA hospitals or involved VA staff (Table 20.1). 

VA forms its own peer-review system for rehabilitation research 

From its inception, peer review for the VA rehabilitation research program was by the NRC’s 

Committee on Prosthetics Research and Development (CPRD). By the mid-1970s, change was 

desired.8 Although the Committee’s membership rotated regularly, it became difficult to find 

qualified members with no conflicts of interest, and reappointments were frequent. In 1975, 

Newcomb offered a contract to NAS to review the activities of its CPRD. The Academy declined 

the contract, and the following year, by mutual agreement, the CPRD disbanded.34 

This left VA with a need for a peer-review mechanism for its rehabilitation research program. At 

first, Dr. Murphy supervised the review process from his New York base, primarily using ad hoc 

written reviews. But by this time, both Medical Research Service and Health Services R&D 

Service had systems of Merit Review Boards meeting regularly to review proposals. In 1976, the 

new Rehabilitation Engineering R&D Service held its first Merit Review Board meeting.8 

First two Rehabilitation Engineering R&D Centers 

To create an academic base to boost VA rehabilitation research, Newcomb and his advisors decided 

to set up Centers of Excellence in Rehabilitation Research at VA hospitals that had close affiliations 

with schools of engineering. In 1976, Dr. Chase, the Chief Medical Director, signed a Request for 

Proposals sent to all VA hospitals describing the criteria envisioned for such Centers: 

432
 
 

 

 

 

 

 

 

 

 

 

 

 “a. Close proximity to and preferably location on premises of a VA health care facility with 

substantial clinical programs in important areas of rehabilitation, e.g., spinal cord injury, blind 

rehabilitation, amputee clinic, geriatric medicine, maxillo-facial restoration, prosthetics and 

orthotics clinics, etc.

 b. Ready access to engineering expertise preferably from a major academic institution. 

 c. Close proximity to a medical school.

 d. Association with allied health schools such as physical and occupational therapy with 

expertise in electromyography, biomechanics, kinesiology, etc.”36 

A committee of experts reviewed the applications and site-visited the leading candidates. The 

application from the Hines (Ill.) VA Medical Center, in affiliation with the Illinois Institute of 

Technology, received the committee’s highest recommendation. In second place was the 

application from the Palo Alto (Calif.) VA Medical Center and the Stanford School of Engineering. 

Since only one Center could be approved, in 1977 Hines was awarded the first Center, together with 

support for renovation of space and funds to hire a cadre of investigators and support staff. Soon, 

however, Palo Alto was also funded for a Rehabilitation Engineering R&D Center.34 

Rehabilitation Engineering R&D Service recruits its first Director 

Shortly after Rehabilitation Engineering R&D became a Service, the search for a Director began. 

Vernon Nickel, M.D., from Ranch Los Amigos Hospital in Downey, Calif., near Los Angeles, 

became intrigued with the potential of the new Service and eventually accepted the Directorship in 

late 1977. He saw the appointment as an opportunity to “build something new,” and he approached 

it with great enthusiasm.17 

Figure 20.6. Vernon Nickel, M.D. 

Frank Coombs, an engineer who had joined the Service a few months before Nickel arrived, served 

as Nickel’s assistant. Coombs was an organized person capable of making changes smoothly. He 

and Nickel had complementary talents that made for an effective start of the new organization. 

Nickel traveled extensively, meeting with VA investigators and with others interested in the 

program. He took seriously the responsibility to expand the program beyond the limits of 

433
 

 

 

 

 

 

prosthetics and sensory aids. Under his leadership, the program grew and became more and more 

intramural. It also began to encompass extensive work in the rehabilitation of spinal cord injury, 

including development of robotic “servants” for the severely paralyzed, improved wheelchairs, 

electrical stimulation of paralyzed muscles and prevention of pressure sores. New programs began 

in restorations for people with mutilating facial deformities and for those with loss of the larynx. A 

number of more basic rehabilitation-related research programs were also started. (Table 20.1). 

In 1979, the Rehabilitation R&D Service joined with Medical Research Service in identifying tissue 

regeneration as a high-priority research area. Basic research in regeneration was encouraged, as 

well as more attempts to apply current science to achieving regeneration, especially of nerves and 

the spinal cord. The first of a series of conferences, organized by Medical Investigator Robert 

Becker, an orthopedic surgeon who used electrical stimulation to enhance bone healing, was held in 

Syracuse NY in 1979. Attendees reviewed the state of the art and recommended that VA undertake 

an organized effort in this area. Tissue regeneration has since been a long-term VA research 

priority, still supported by the two Services. 

During 1980, Dr. Nickel left Central Office to return to the West Coast. The new Service was 

beginning to grow and flourish. In 1983, its name was simplified, and it is now the Rehabilitation 

R&D Service. Later Directors have encouraged the growth that began in the 1970s and have 

continued to guard the quality of VA-supported rehabilitation research. 

434
 
 

 

 

 

 

 

 

 

 

 

References 

1. Stewart, R. and Bernstock, W., Veterans Administration prosthetic and sensory aids 

program since World War II. Washington, DC: U.S. Government Printing Office, 1977, 66. 

2. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 31-109. 

3. Interview with Dudley Childress, Ph.D., April 8, 2001 at Dr. Childress's home in Wilmette, 

IL. 

4. Interview with Eugene F. Murphy, Ph.D., October 29, 1992 at Dr. Murphy's home in New 

York, NY. 

5. Childress, D., Ph.D., "Eugene F. Murphy (1913-2000): Polymath of prosthetics." 

Capabilities, 2001. 10: 1-2. 

6. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 125. 

7. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977. 

8. Interview with Frank Coombs, May 4, 1992 at the RRD Office in Washington, DC. 

9. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 34-41, 70-74. 

10. Nickel, V.L., "Veterans Administration rehabilitative engineering research and development 

programs." Bulletin of Prosthetics Research, 1980. 17: 65-143. 

11. Murphy, E.F., "Highlights of other VA research programs." Bulletin of Prosthetics 

Research, 1974. 11: 109-173. 

12. Letter from Director, Prosthetic and Sensory Aids Service to Director, Supply Service, 

1/30/73. 

13. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 51-52, 91. 

14. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 86-87. 

15. Childress, D., Ph.D., personal communication with author, February 6, 2002. 

16. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 93-96. 

17. Interview with Vernon L. Nickel, M.D., January 15, 1992 at a restaurant in San Diego, CA. 

18. Interview with Ernest Burgess, M.D., November 4, 1992 at Dr. Burgess's office in Seattle, 

WA. 

435
 
 

 

 

 

 

19. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 30-31. 

20. Haugen, J.S., Reading Machines for the Blind: A study of Federally supported technology 

development and innovation, 1943-1980. Blacksburg, VA: Virginia Polytechnic Institute 

and State University, 1995, 47. 

21. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 102-104. 

22. Haugen, Reading Machines for the Blind. 1995, 13-20. 

23. Haugen, Reading Machines for the Blind. 1995, 50-54. 

24. Haugen, Reading Machines for the Blind. 1995, 62-68. 

25. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 98-100, 105-109. 

26. Haugen, Reading Machines for the Blind. 1995, 69-97. 

27. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 104-105. 

28. Haugen, Reading Machines for the Blind. 1995, 98-118. 

29. Haugen, Reading Machines for the Blind:. 1995, 8. 

30. Nickel, V.L., "Veterans Administration rehabilitative engineering research and development 

programs." Bulletin of Prosthetics Research, 1980. 17: 113-115. 

31. Nickel, V.L., "Veterans Administration rehabilitative engineering research and development 

programs." Bulletin of Prosthetics Research, 1980. 17: 111-112. 

32. Telephone interview with Gregory Goodrich, Ph.D., January 29, 2002. 

33. Stewart and Bernstock, VA prosthetic and sensory aids program. 1977, 3-4. 

34. Interview with Thomas Newcomb, M.D., March 29, 1992 at a hotel lobby in Washington, 

DC. 

35. Chase, J.D., M.D., "IL 10-76-2 Chief Medical Director's Letter. Rehabilitation Engineering 

R&D Service." January 20, 1976. 

36. Chase, J.D., M.D., "IL 10-76-40 Chief Medical Director's Letter. Rehabilitative 

engineering research and development center." August 5, 1976. 

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Epilogue, 1981-2010 

The VA research and development program continued to evolve after 1980. Today, under the 

leadership of Joel Kupersmith, M.D. , who has been VA’s Chief Research and Development Officer 

since July 2005, VA’s Research and Development program is an acclaimed model for conducting 

superior bench-to-bedside research. As it has long been, the Office of Research and Development 

(as it is now called) still serves as a model of research excellence, fully integrating fundamental, 

clinical and applied research. 

VA continues to attract exceptional investigators and fosters dynamic collaborations with other 

federal agencies, academic institutions, and private industry. The Career Development Program for 

researchers, whose origins are described in this book, continues to accelerate the development of 

top-caliber investigators; VA’s Cooperative Studies Program still thrives; and the peer-review 

program, the subject of past controversy, ensures all VA research meets the highest standards of 

scientific excellence. 

Among the accomplishments of VA researchers since 1980 have been the development, in 1984, of 

the nicotine patch; the demonstration that one aspirin tablet a day reduced the rate of heart attacks; 

the identification, in 1994, of a gene associated with a major risk for schizophrenia; the invention of 

the first powered ankle-foot prosthesis in 2007; the largest ever clinical trial of psychotherapy to 

treat post-traumatic stress disorder, launched in 2003, and the largest health study ever of Vietnamera women Veterans, begun in 2009. Also in 2009, VA’s Clinical Research Pharmacy 

Coordinating Center, in Albuquerque, New Mexico, was named one of the five recipients of the 

2009 Malcolm Baldrige National Quality Award, the nation’s highest award for organizational 

excellence. The Center manages the devices and pharmaceuticals that are used in research trials 

conducted within the VA health care system. 

Today’s Office of Research and Development is a leader in conducting comparative effectiveness 

research—head to head studies that help clarify which among two or more health interventions 

works better for a given health condition in certain patients. VA has instituted a technology transfer 

program, which helps VA researchers commercialize their inventions. A Quality Enhancement 

Research Initiative (QUERI), started in the late 1990’s, facilitates the clinical use of treatments, 

tests and models of care that are supported by research evidence. 

Personalized medical research, tailoring health care treatment programs to individual patients, is a 

subject of great interest to many VA researchers, as is the new science of Genomics—the study of a 

person’s genetic information to help tailor therapies to each person’s genetic makeup. As this book 

goes to press in early 2010, VA is about to begin the process of collecting genetic specimens from 1 

million veterans. These samples will help the Department to optimize medical care for veterans; 

enhance the development of tests and treatments for relevant diseases, and examine the potential of 

emerging genomic technologies. 

Today’s VA has put rehabilitation research on a true scientific footing by adding basic science in 

finding solutions to the needs of veterans with disabilities. There are now thirteen Rehabilitation 

Research and Development Centers of Excellence, including a center for brain rehabilitation 

research; one for limb loss and prosthetic engineering; one for the restoration of nervous system 

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function, and a rehabilitation outcomes research center, which evaluates rehabilitation programs and 

interventions that result in optimal patient outcomes. 

For the future beyond 2010, VA Secretary Eric K. Shinseki has established thirteen challenges the 

Department faces as it transformed into a high-performing organization that is better aligned with 

21st century veterans and their needs. Among them is to “Perform Research and Development to 

Enhance the Long-Term Health and Well-Being of Veterans.” The Secretary intends for VA 

research to continue to play a leading role in the advancement of clinical medical knowledge, 

particularly in health issues associated with military service, by excelling in research and 

development of evidence-based clinical care and delivery system improvements to enhance the 

long-term health and well being of veterans. It is a path the Office of Research and Development is 

well prepared to follow. 

Since 1980, the Office has continued to cope with competition for funding. Its leaders rely more 

and more on the Merit Review process to make difficult decisions among programs. Increasingly, 

the criterion for supporting projects has become scientific merit as determined by peer review, with 

less emphasis placed than in the past on assuring the continuity of the programs of established VA 

investigators.. By the end of the 1980s, a “pay line” was in place for all of the R&D programs, so 

that even a program a peer review group approved as meritorious would not be funded unless it had 

received a high priority score. While the Research Advisory Group continued to provide funding 

for new researchers into the 1990s, it became harder and harder to get funding through that source, 

and the program was eventually abandoned. 

Medical Research Service’s Career Development Program continued to be very prestigious, but 

funding limitations in the 1980s and 90s made awards increasingly difficult to obtain at that time. 

Health Services R&D Service added its own Career Development Program in 1991, and it has 

nourished an important cadre of young health services researchers. Eventually, in the late 1990s, 

the Career Development Program was restructured to serve primarily junior applicants and to 

include appointments in all areas of Research and Development. The Medical Investigator and 

Senior Medical Investigator Career Development levels, designed for established investigators, 

were discontinued. 

In the mid-1990s, the Cooperative Studies Program became a freestanding Service, and Cooperative 

Studies support became equally available to projects in Medical Research, Health Service Research 

and Development (HSR&D), Biomedical Laboratory Research and Development (BLR&D) and 

Rehabilitation Research and Development (RR&D.) 

VA’s Research and Development program continues to be an essential part of the Department’s 

mission to provide cutting-edge health care to America’s veterans. Based on its past 

accomplishments, the “jewel in the crown” of VA health care will shine brightly for many years to 

come. 

438
 
Appendices
 

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(Intentionally Blank) 

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Appendix I. Middleton Awards, 1960-1995 

Awardee Medical center Citation 

1960 Solomon Berson, M.D Bronx For showing that injected insulin is capable of inducing 

Rosalyn Yalow, Ph.D. Bronx an immune response which can be quantitated. 

1961 Hubert Pipberger, M.D. Wash, DC For pioneering the computer processing of the 

electrocardiogram. 

1962 Leslie Zieve, M.D. Minneapolis For studies of phospholipids and phospholipases. 

William C. Vogel Minneapolis 

1963 Stanley Ulick Bronx For his work in the chemistry and metabolism of 

mineralocorticoid hormones. 

1964 Robert O. Becker, M.D. Syracuse For his identification of electrical control systems in 

living organisms, including man. 

1965 Lucien Guze, M.D. LA Wadsworth For discerning the host-parasite relatinship in chronic, 

George Kalmanson, M.D. LA Wadsworth infectious kidney disease. 

1966 Leo Hollister, M.D. Palo Alto For numerous, signifiacnt contributions in the field of 

therapeutic drugs for mental illness. 

1967 Leonard T. Skeggs, Ph.D. Cleveland For automated laboratory test devices and 

biochemistry of hypertension. 

1968 Thomas Starzl, M.D. Denver For pioneering surgical transplantation of kidneys and 

other human organs, including the development of 

anti-lymphocyte serum and globulin to suppress the 

 rejection of transplanted organs. 

1969 Roger Unger, M.D. Dallas For his conception of the physiology of metabolism of 

fats and carbohydrates, better to better therapy for 

diabetes patients. 

1970 Andrew V. Schally New Orleans For his investigations of the physiology and 

biochemistry of hypothalamic neurohormones. 

1971 Marcus Rothschild, M.D. New York For basic and clinical research on the pathological 

biochemistry of the liver in alcoholism and other types 

of liver disease. 

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1972 Kenneth Sterling, M.D. Bronx Developed the 51-Cr-labelling of erythrocytes for in vivo 

study as a clinical tool; first to use labelled human 

serum albumin for determinations of rates of turnover of 

this molecule in man and first to use 131-I-labelled 

thyroxine and triiodothyronine to study the disposal 

and turnover rates of these hormones in man. 

1973 Ludwig Gross, M.D. Bronx For demonstrating viral etiology of leukemia in 

mammals. 

1974 Paul Srere, Ph.D. Dallas Biochemical accomplishments on key cellular 

metabolic pathways regulating lipid and carbohydrate 

synthesis and storage. 

1975 Paul Heller, M.D. Chicago WS Research in hematology, immunology, enzymology 

and metabolism, including findings on the mechanism 

of immunologic deficiency in multiple myeloma, a 

form of cancer. 

1976 William Oldendorf, M.D. Brentwood Development of nuclear techniques in clinical 

neurology; the first description of computerized 

tomography; development of techniques of cerebral 

blood flow measurement; elaboration of cerebrospinal 

fluid functions; and characterization of blood brain 

barrier permeability. 

1977 Charles Lieber, M.D. Bronx Toxicity of alcohol, elucidation of its interaction with 

drug, lipid and uric acid metabolism, and the 

pathogenesis of fatty liver and cirrhosis in man and 

subhuman primates. 

1978 Victor Herbert, M.D. Bronx Developing scientific tools to diagnose nutrient 

deficiencies, measure nutrient binding proteins, 

demonstrate selective deficiency of nutrients in one 

cell line but not another, and applying the scientific 

criteria of safety and efficacy to nutrition folklore. 

1979 Edward Freis, M.D. Washington, DC Studies of hypertension that proved the efficacy and 

life saving qualities of medical treatment. 

1980 Norman Talal San Francisco For the development of immunologic concepts derived 

from the study of patients and animal models for 

autoimmune and malignant disorders, and for exploring 

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the interface between the immune and endocrine 

systems which has led to new theoretical and 

therapeutic considerations for human diseases. 

1981 Sami I. Said Oklahoma City For his contributions to the understanding of metabolic 

and endocrine aspects of lung disease, and for his 

discovery and characterization of vasoactive intestinal 

peptide (VIP). 

1982 Abba J. Kastin New Orleans For his contributions to neuroendocrinology and for 

pioneering work with brain peptides, characterized by 

the many aspects of his concept of their multiple, 

independent actions. 

1983 (2 awardees) 

Norman H. Bell Charleson, SC For contributions to the basic science of hormone 

secretion and mineral metabolism and for delineating 

the metabolism of Vitamin D in normal and disease 

states. 

Sydney Finegold LA Wadsworth For firmly establishing the importance of anaerobic 

bacteria in infections of all types; describing the 

clinical picture and unique features of such infections; 

developing simple, rapid methods for diagnosing 

anaerobic infections; and for laboratory and clinical 

studies leading to effective therapy of these infections. 

1984 Kosaku Uyeda Dallas for contributions in the field of carbohydrate 

metabolism and biochemical mechanisms 

of enzyme action. 

1985 Albert L. Jones, M.D. San Francisco For contributions to our understanding of the synthesis, 

transport and catabolism of plasma lipoproteins, for 

showing the effects of drugs and aging on liver structure 

and function, for describing the mechanism of transport 

of peptide hormones and immunoglobulin to their sites 

of action and for the co-discovery of the M cell and its 

role in the intestinal immune response. 

1986 Aaron J. Marcus, M.D. New York For persistent innovation in the study of platelet 

function, leading to the first isolation of a coagulationpromoting lipid from human platelets, for discovering 

arachidonic acid in platelets, for the first direct 

demonstration of the interaction of the acetyl group of 

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aspirin with platelets and for the demonstration of 

platelet-leukocyte interactions. 

1987 Gerald M. Reaven, M.D. Palo Alto For demonstration of the relationship between degree 

of hyperglycemia and insulin response to oral glucose, 

for the conceptual definition, subsequent quantification, 

and major development of the idea that insulin 

resistance is a major factor in the pathogenesis of 

NIDDM, for bringing understanding to the abnormal 

lipoprotein metabolism characteristic of diabetics, and 

for persistent leadership in the application of research 

knowledge to the treatment of diabetes. 

1988 Lawrence F. Eng, Ph.D. Palo Alto For identification, characterization and 

immunocytochemical studies of glial fibrillary acidic 

protein (GFAP), the intermediate filament protein of 

differentiated astrocytes. GFAP has become a 

prototype antigen in central nervous tissue identification 

and a standard marker for fundamental and applied 

neurobiology at an interdisciplinary level. Antibodies to 

GFAP are used routinely in medical centers throughout 

the world to assist in the diagnosis of brain tumors. 

1989 (2 awardees) 

Edwin H. Beachey, M.D. Memphis For fundamental contributions to the understanding of 

bacterial pathogenesis, including the molecular basis 

for the adherence of bacteria to host cells, the 

molecular mechanisms of streptococcal virulence, and 

the immunology of Group A streptococci, particularly 

the immunopathogenesis of rheumatic fever and the 

development of novel synthetic and recombinant 

streptococcal vaccines. 

Makio Ogawa, M.D. PhD Charleston For the development of a culture system for pluripotent 

hematopoietic stem cells, the demonstration that 

differentiation of hematopoietic stem cells is a 

stochastic process, and the elucidation of the 

biological activities of hematopoietic growth factors. 

1990 No award given 

1991 Young S. Kim, M.D. San Francisco For internationally recognized contributions in the study 

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of protein digestion and absorption; the metabolism of 

glycoproteins and glycolipids of colon and pancreas in 

health and in malignancy; and the control mechanisms 

of patterns of colon cancer growth and differentiation. 

1992 George Sachs, MB,ChB, LA Wadsworth For internationally recognized contributions in the study

 DSc of the mechanisms of gastric acid secretion and 

treatment of ulcer disease 

1993 (2 awardees) 

Neil Kaplowitz, M.D. LA OPD For the elucidation of the regulation of hepatic 

glutathione. Developing a comprehensive understanding 

of the regulation of glutathione synthesis by hormones 

and cysteine availability and glutathione turnover 

through release into bile and blood via carrier-mediated 

transport. Identifying a fundamental defect in 

mitochondrial glutathione defense in experimental 

alcoholic liver disease. 

John B. Hibbs, Jr., M.D. Salt Lake City For the discovery of the pathway and recognition of the 

importance of nitric acid synthesis; the demonstration 

of the role of nitric acid in mammalian physiology. 

1994 Larry R. Squire, M.D. San Diego 

1995 Gerald F. DiBona, M.D. Iowa City 

V
 
(Intentionally Blank) 

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Appendix IIa. The Consultants on Hospitalization (White Committee), 1921-

19231 

William Charles White, M.D., chairman, Medical director of the Tuberculosis League Hospital, 

Pittsburgh and former professor of neuropathology and psychiatry, Indiana University. He had been 

in charge of hospitalization of the tuberculous for the Red Cross in France and Italy. He was a 

member of the executive committee of the National Tuberculosis Association and chaired its 

Committee on Medical Research from 1920 until 1946.2 

Figure AppIIa.1: William Charles White, M.D., 

chairman of the Committee of Consultants, 1921-1923. 

Frank Billings, M.D., Dean of the faculty of Rush Medical School. Dr. Billings was later also 

appointed to the Medical Council but resigned before its first meeting. Billings was a leader in 

many fields of organized medicine. He had been president of the AMA from 1902 to 1904, then 

treasurer until 1911. In 1905, he led the committee responsible for starting the Council on 

Pharmacy and Chemistry.3 At the time of the White Committee’s activities, he was a trustee of the 

AMA.4 He was an early informal advisor to the Veterans’ Bureau before the Medical Council was 

formed. 

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Figure AppIIa.2: Frank Billings, M.D. 

John G. Bowman, an educator who was Chancellor of the University of Pittsburgh when the White 

Committee was active. At the time he was appointed, he had spent six years as Director of the 

American College of Surgeons. He had previously been secretary of the Carnegie Foundation. As 

Director of the American College of Surgeons, he arranged for a 1916 grant from Carnegie to 

launch a program of hospital standardization. He spearheaded the College's program of voluntary 

hospital standardization, the beginnings of the accreditation system for hospitals in the United 

States.5, 6 

Pearce Bailey, M.D., Former President of the American Neurological Association. During World 

War I, he had established and headed a division of neurology and psychiatry in the Army. He 

served only three months on the White Committee, presumably resigning because of ill health, 

although his name appears on many of the White Committee decisions. He died in 1922.7 

Figure AppIIa.3: Pearce Bailey, M.D. 

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George H. Kirby, M.D., Consultant to Director, New York Psychiatric Institute (Replaced Dr. 

Bailey.) Dr. Kirby was one of the original members of the Medical Council (see Appendix IIb). 

Advisory committee to the White Committee: 

The members of this advisory committee collected much of the information used by the White 

Committee in making its decisions about where new veterans’ hospitals should be located. They 

traveled extensively, visiting potential sites for new hospitals.8 

Thomas W. Salmon, M.D., Chairman, represented the National Committee for Mental Hygiene. Dr. 

Salmon was one of the original members of the Medical Council (see Appendix IIb) 

Figure AppIIa.4: Thomas W. Salmon, M.D. 

Haven Emerson, M.D., Medical Director the Bureau of War Risk Insurance on assignment from the 

Public Health Service. He had been Commissioner for Health of the City of New York before 

World War I, and, during WWI was Chief Epidemiologist of the A.E.F.9 He was Medical Director 

of the Veterans’ Bureau in 1921 (see below). 

Harry A. Pattison, M.D., Supervisor of Medical Services of the National Tuberculosis Association. 

He was also a member of the Medical Council throughout its existence (see Table 1.2) 

T. B. Kidner also represented the National Tuberculosis Association.1 

C. H. Lavinder, M.D., Medical Director, U.S. Public Health Service. He was in charge of the 

Public Health Service hospitals serving the veteran. He was known for his earlier research on 

pellagra.10 

Frederick C. Smith, M.D., Assistant Surgeon General and later also Medical Director, also 

represented the U.S. Public Health Service. Later he was an active member of the Medical Council 

(see Table 1.2). 

Walter L. Treadway, M.D., Surgeon, U.S. Public Health Service, also represented that agency. At 

that time, he was associated with the Department of Preventive Medicine at Harvard Medical 

School. He later became an Assistant Surgeon General, as Director of the Narcotics Division, 

which later became the Division of Mental Hygiene of the Public Health Service.11 

Col. C. M. Pearsall represented the National Home for Disabled Volunteer Soldiers.1 

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References 

1. White, William C. and others, Report of Consultants on Hospitalization. 1923), 6. 

2. Long, Esmond R., "Wm. Charles White." Am Rev Tuberculosis, 1948. 57: 538-542. 

3. Burrow, James G., AMA: Voice of American Medicine. (Baltimore: The Johns Hopkins 

Press, 1963), 74-75. 

4. Anonymous obituary, "Dr. Frank Billings." J Am Med Assn, 1932. 99: 1187-1188. 

5. Who Was Who in America. Vol. 4. (Chicago: Marquis - Who's Who, Incorporated, 1968), 

106. 

6. Stevens, Rosemary, In Sickness and in Wealth: American Hospitals in the Twentieth 

Century. Basic Books, 1989), 116. 

7. Dana, Charles L., "Obituary - Pierce Bailey, M.D." Arch Neurol Psychiatr, 1922. 7: 360­

364. 

8. White, William C. and others, Report of Consultants on Hospitalization. 1923), 5-6. 

9. Emerson, Haven, "Haven Emerson," in History of the Interurban Clinical Club, 1905-1937, 

Reisman, David, Editor. 1937, The John C. Winston Company: Chicago, Philadelphia and 

Toronto 117-118. 

10. Schwarz, J.C., Who's Who among Physicians and Surgeons. (New York: J.C.Schwarz, 

1938), 691. 

11. Schwarz, J.C., Who's Who among Physicians and Surgeons. (New York: J.C.Schwarz, 

1938), 1213-1214. 

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Appendix IIb. The Medical Council 

The Executive Committee 

Ray Lyman Wilbur, M.D.,(Figure 1.1, Chapter 1) “Permanent Chairman,” was, at the time he was 

appointed to the Medical Council, the President of Stanford University and the President of the 

American Medical Association. Wilbur began his medical career in the horse and buggy days, had 

joined the clinical faculty of the Cooper Medical College (later Stanford Medical School) and had 

later been its Dean. A college friend of Herbert Hoover, in 1929 he became Hoover’s Secretary of 

the Interior and oversaw the building of the Hoover Dam.1

 Soon after he became Secretary, he 

began his address to the tenth meeting of the Council with the comment that he was in a hurry. 

“Unfortunately, in setting this meeting for this morning, I forgot that Friday morning was the day 

for the meeting of the Cabinet. I realized that the deliberations of your delegation were much more 

important than anything which would take place at the Cabinet meeting, but I have to make a good 

showing and pretend that the Cabinet meeting is more significant.”2 At that meeting, Wilbur 

stepped down as Chairman of the Medical Council, though he stayed on as a member. Lewellys F. 

Barker, Emeritus Professor of Medicine at Johns Hopkins University and a founding member of the 

Medical Council, was elected Chairman.3 

Lewellys F. Barker, M.D., (figure 1.8, Chapter 1) Chairman of the Medical Council after 1929, was 

a Canadian who had gone to Johns Hopkins Medical School for postdoctoral training and stayed on 

as a faculty member in pathology. From 1900 to 1905, he was Chairman of the Department of 

Anatomy at Rush Medical College, but then he returned to Hopkins to succeed Dr. William Osler as 

Chairman of Medicine. He had widespread medical interests. He had served on commissions to 

study tropical diseases in the Philippines and San Francisco. He was president of the National 

Committee for Mental Hygiene from 1909 to 1918. He was Consulting Neurologist to the 

Diagnostic Center at the Washington, D.C. Veterans’ Hospital and had written a textbook on the 

nervous system. He contributed an article to the Medical Bulletin on epidemic encephalitis4

 and he 

was an editor of a journal on endocrinology. At the time the Medical Council was formed, he was 

no longer Chairman at Johns Hopkins, having stepped down rather than to give up his extensive 

private practice when the full time system for faculty was instituted there.5

 He continued to be 

active on the Council through its final meeting in 1939, taking part in the two conferences on 

medical research held in 1930 and 1935.6-8 

H. Kennon Dunham, M.D., Vice Chairman throughout the life of the Council, was a tuberculosis 

expert, Associate Professor of Medicine and head of the Department of Tuberculosis at the 

University of Cincinnati and Medical Director of the county tuberculosis hospital. During his 

training, he studied anatomy, and his major early research demonstrated the x-ray findings 

characteristic of tuberculosis. Dr. Dunham set up the first Veterans’ Bureau Diagnostic Center, 

established at the Cincinnati General Hospital.9-11 He published in the Medical Bulletin a review of 

241 cases of nontuberculous lung diseases seen at the Cincinnati Diagnostic Center in 1925 and 

1926, mostly patients initially thought to have tuberculosis.12 

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Figure AppIIb.1: H. Kennon Dunham, M.D. 

Malcolm T. MacEachern, M.D., the permanent Secretary of the Council, was a Canadian 

gynecologist who came to the United States in 1923, after having been a hospital administrator in 

Canada. In 1923, he became Associate Director, later Director, of hospital activities for the 

American College of Surgeons, a position he held until 1950. In this capacity, he coordinated the 

accreditation review of all Veterans’ Bureau hospitals by the American College of Surgeons. He 

was President of the American Hospital Association (1924-5). A recognized expert in hospital 

organization and management, he wrote books on hospital organization and management and on 

medical records.13 

Roy D. Adams, M.D., the permanent Secretary of the Executive Committee, was a Washington, 

D.C. internist and Professor of Clinical Medicine at George Washington University. He was the 

Chief Consultant for the second Diagnostic Center, established in Washington, D.C. in 1925.14 Dr. 

Adams was active throughout the life of the Council. He attended the conference held in 1935 to 

advise the Veterans Administration about research in cardiovascular and neuropsychiatric diseases.8 

Group on Investigation and Research 

All of the members of this Group continued to be active advocates of research throughout the life of 

the Medical Council, except for Michael Davis, who became inactive after 1927.

 Louis I. Dublin, Ph.D., Chairman, (Chapter 1, Figure 1.9) was a strong voice for establishing 

research in the Veterans’ Bureau. A statistician who was vice-president of the Metropolitan Life 

Insurance Company, he had been with Metropolitan since 1909. His studies on mortality became 

guidelines for life insurance and public health. He spearheaded Metropolitan’s programs of home 

nursing, health education, tuberculosis control and other welfare services for policyholders and 

employees. His studies of the sequelae of infectious diseases (especially typhoid fever and scarlet 

fever) led to an understanding of the need to control their incidence. He also studied chronic 

diseases, including the role of obesity.15, 16 Dr. Dublin was an active lobbyist for improving 

veterans’ health care as the veterans’ hospitals came under increased stress toward the end of World 

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War II.17 As one of the original members of the Committee on Veterans’ Medical Problems,18he 

continued to advise the VA as late as 1946. Dr. Dublin’s influence on the early research program is 

especially reflected in the statistical studies published by the chief of the Research Subsection, Dr. 

Matz. 

Alfred E. Cohn, M.D., was another very active member of the Group on Investigation and Research. 

He was a cardiologist who devoted his career to clinical research. In 1909, when he returned from 

two years’ study in Germany, he brought back with him an electrocardiograph machine, the first in 

the Western hemisphere. In 1911, he joined the staff of the Rockefeller Institute, bringing his 

electrocardiograph with him. He studied the size of the heart by x-ray, the action of cardiac drugs, 

the effect of aging on the heart. He classified heart diseases and compiled statistics on the various 

types.19, 20 In 1924, as founding editor of the Journal of Clinical Investigation, he wrote a landmark 

editorial “Purposes in Medical Research” for the first issue.21 He continued active on the Medical 

Council through its final meeting in 1939 and took take part in the 1935 conference to advise on 

research on cardiovascular and neuropsychiatric diseases in the Veterans Administration.8 

Michael M. Davis, Jr., who held a Ph.D. in political science and was an expert on clinic 

organization, was an active early participant, both in the Group on Investigation and Research and 

the Group on Hospitals, Dispensaries and General Medical Welfare. Davis was an early and 

vigorous innovator in the economics and organization of health care in the United States. As 

Director of the Boston Dispensary, he examined the outcomes of clinic care, using statistical 

procedures. His analysis revealed that, among other problems, patients who could afford to pay 

something and so were not eligible for charity care but who could not afford private care were being 

neglected by the health care system. For workingmen with venereal diseases, he introduced 

evening clinics, staffed by salaried physicians instead of the volunteers who staffed the charity 

clinics. The salaries of these physicians were covered by a 50 cent fee from each patient. 

Beginning in 1925, he was one of the founders of and a leader in the Committee on the Costs of 

Medical Care.22 

At the time he served on the Medical Council, Davis was Executive Secretary of the United 

Hospital Fund in New York.23 In 1925, at the Veterans’ Bureau‘s request, he conducted a study of 

clinic efficiency at the New York Regional Office, using an “unbiased” sample of treatment 

records. He found that patients’ records were so scattered and cumbersome that it was virtually 

impossible for the treating physician to know about a patient’s previous examinations and 

treatments.24 

Davis attended only four meetings of the Medical Council, but he was active through the sixth 

meeting, in November 1926, when the Group on Investigations and Research proposed that a 

unified outpatient record be carried out on a trial basis.25 

Allen K. Krause, M.D., an active member until the mid-1930s, was a specialist in tuberculosis 

research. During the time he was most active in Medical Council activities, he directed the Dows 

Laboratory at Johns Hopkins University, a privately endowed laboratory dedicated to research in 

tuberculosis. He was also Associate Professor of Pathology at Johns Hopkins and Editor of the 

American Review of Tuberculosis.26, 27 In addition to his service on the research Group, he served 

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on the Council subcommittee to advise on the Medical Bulletin, and on a subcommittee to advise on 

outpatient care. 

Figure AppIIb.2: Allen K. Krause, M.D. 

Horatio M. Pollack, Ph.D., who attended all Council meetings after he was appointed at the second 

meeting, served as the Director of the Statistical Bureau of the New York Department of Mental 

Hygiene from 1911 to 1944. He was editor of Psychiatric Quarterly and advisor in statistics for the 

National Committee for Mental Hygiene.28 He was an authority on the hospital and social aspects 

of mental diseases, and wrote a book on the subject.29 He contributed an article, “Annual National 

Statistics of Institutions for the Insane, Feeble-Minded, Epileptic and Delinquent,” to the Medical 

Bulletin.30 

Joseph W. Schereschewsky, M.D., had been Assistant Surgeon General of the Public Health Service 

in charge of the division of scientific research. He conducted studies on the cause of pellagra. 

During his more active period on the Medical Council (1924-1929), he was on detail to Harvard 

University, in charge of investigations in cancer for the Public Health Service, a program that 

eventually led to the National Cancer Institute.31 His epidemiological studies of the trends in cancer 

mortality from 1900 to 1920 showed a 56% increase, only part of which could be ascribed to factors 

such as improved diagnosis.32 

Group on Neuropsychiatry 

All of the members of this Group remained active in Medical Council activities except for Drs. 

Kirby and Salmon. Drs. White, Salmon, Barrett, Kline and Lorenz had been members, together 

with three other neuropsychiatrists, of a four-day conference called in 1922 and chaired by Dr. 

White that had resulted in an official definition of “neuropsychiatric disease” for the Veterans’ 

Bureau’s use and recommendations for the construction needs for neuropsychiatric hospitals.33 

Daniel J. McCarthy, M.D., Chairman, was a neurologist and neuropsychologist who was professor 

of medical jurisprudence at the University of Pennsylvania School of Medicine. He had an 

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extensive record of public service and was the author of several important textbooks. A firm 

believer in the medical nature of psychiatric diseases, he believed that “in every case of true insanity 

...there are pathological changes produced in the brain, although these may...be too subtle and 

recondite to be discovered by our present means of research.”34 McCarthy remained active on the 

Medical Council through 1929 but did not attend either of the meetings during the 1930s. He was 

one of the Counselors who urged the Veterans’ Bureau to conduct more research. In an article in 

the Medical Bulletin referring to the epidemics of lethargic encephalitis, he wrote, “The evil effects 

of this one disease both mentally and physically and the chronicity of the sequellae would warrant 

the United States in establishing an institution of research, in connection with the Veterans’ Bureau, 

to search out the cause and investigate the effects of the disease. One can easily estimate the cost to 

the Government of the Parkinsonian group alone and the sheer necessity for an intensive study of it 

in an institute devoted to pure research and manned by expert experts free from the necessity of 

hospital routine and paper work. Congress should be made to realize that the great weakness of the 

Veterans’ Bureau is not having some such institution and that this is not due to the bureau but to the 

rigidity of the laws governing the bureau.”35 

Albert M. Barrett, M.D., was a strong advocate for neuropsychiatric research and attended the 1935 

conference to advise on research on cardiovascular and neuropsychiatric diseases in the Veterans 

Administration.8

 He was chairman of the Department of Psychiatry at the University of Michigan 

and had established the Michigan State Psychopathic Hospital, the first university-affiliated 

psychiatric hospital. His interests spanned neuropathology to psychodynamics.36 

Figure AppIIb.3: Albert M. Barrett, M.D. 

C. Macfie Campbell, M.D., was Professor of Psychiatry at Harvard Medical School and medical 

director of the Boston Psychiatric Hospital. Primarily a clinician and teacher, he had earlier been at 

the Phipps Psychiatric Institute at Johns Hopkins.37 

George H. Kirby, M.D., attended only the first and third meetings of the Medical Council, but as 

one of the four members of the White Committee he presumably provided “institutional memory.” 

He was a psychiatrist and Director of the New York State Psychiatric Institute, which, during his 

directorship, became a part of Columbia University.38, 39 

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George M. Kline, M.D., was Commissioner for Mental Health for the State of Massachusetts. He 

was credited with increasing the release rate in Massachusetts mental hospitals from 8% to 48%, 

and for the fact that the rate of increase in mental disease in that state was below the increase in the 

population.40, 41 He attended all of the meetings of the Medical Council until his death in 1933.

 William F. Lorenz, M.D., a strong advocate for neuropsychiatric research, attended the 1935 

conference to advise on research on cardiovascular and neuropsychiatric diseases in the Veterans 

Administration.8

 He was Professor of Psychiatry at the University of Wisconsin and Director of the 

Wisconsin State Psychiatric Institute. A veteran of the Spanish American War as well as WWI, he 

had participated in the U.S.P.H.S. study of pellagra. His psychiatric research included remedies for 

treating syphilis of the central nervous system and investigation of carbon dioxide treatment of the 

psychoses.42 

Figure AppIIb.4: William F. Lorenz, M.D. 

Glenn E. Myers, M.D., was a psychiatrist in practice in Los Angeles and Medical Director of the 

Compton Clinic. He served on the National Committee for Mental Hygiene and was a Councilor of 

the American Psychiatric Association.43 He joined the Medical Council at its third meeting in 1925 

and after that time attended most of its meetings. Dr. Myers contributed an article, “Personality 

change in the course of general medical and surgical disorders” to the Medical Bulletin44 and 

coauthored a 1930 paper in J.A.M.A. with Dr. Crossman on "The Neuropsychiatric Problem in the 

U.S. Veterans' Bureau."45 

Thomas W. Salmon, M.D., (Figure AppIIa.4) attended only the second and third meetings of the 

Medical Council, but he brought previous experience with the Veterans’ Bureau, since he had been 

Chairman of the Advisory Committee to the White Committee. He was a leader in the field of 

mental hygiene, and, at the time he joined the Medical Council, he was head of the Department of 

Psychiatry at Columbia University.46, 47 

Sidney I. Schwab, M.D., a neuropsychiatrist from St. Louis and Professor of Clinical Neurology at 

Washington University, was active throughout the life of the Medical Council. He had served on a 

National Research Council committee on war neuroses.48 

Douglas A. Thom, M.D., a psychiatrist, was Director of the Division of Mental Hygiene for the 

State of Massachusetts.49 He attended all meetings of the Medical Council. He contributed two 

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articles to the Medical Bulletin, one in 1926 urging, among other recommendations, that a stateordered psychiatric examination of accused criminals precede legal proceedings, to provide an 

objective assessment,50 and one in 1930 on epilepsy.51

 William Alanson White, M.D., another strong advocate for neuropsychiatric research, attended the 

1935 conference to advise on research on cardiovascular and neuropsychiatric diseases in the 

Veterans Administration.8

 He had testified before the White Committee. White was the 

Superintendent of St. Elizabeth’s Hospital in Washington, D.C., where the first American use of 

malarial treatment for neurosyphilis had been carried out in 1922. He was also Professor of 

Psychiatry at George Washington and Georgetown Medical Schools and at the US Army and US 

Navy Medical Schools. A strong advocate of Freudian theory, he also emphasized psychological 

and pathological research at St. Elizabeth’s. He is credited with many advances in the care of 

patients with serious mental illness.52 He wrote an article in the Medical Bulletin about “The 

therapeutic value of hospital social services.”53 

Figure AppIIb.5: William Alanson White, M.D. 

Group on Tuberculosis 

Drs. Baldwin, Dunn, Miller and Pattison, together with three other tuberculosis specialists, were 

members of a 1922 conference (chaired by Dr. Baldwin) to advise the Veterans’ Bureau on 

tuberculosis problems.54 

Roy D. Adams, M.D., Chairman, was also on the Executive Committee (see above). 

Edward R. Baldwin, M.D., a pioneer in tuberculosis research from Trudeau Sanitorium at Saranac 

Lake, joined the Medical Council in 1928 and attended meetings in November 1928 and May 1929. 

He published widely, especially on the effects of hypersensitivity in tuberculosis, and was an early 

editor of American Review of Tuberculosis.55 Dr. Baldwin was the president of the National 

Association for the Study and Prevention of Tuberculosis in 1916, when the Association, with 

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support from the Metropolitan Life Insurance Company (of which Louis Dublin was a key player), 

started a demonstration project in Framingham, Massachusetts that showed that active public health 

intervention would decrease incidence of tuberculosis.56 

H.Kennon Dunham, M.D., was also on the Exexutive Committee (see above). 

William LeRoy Dunn, M.D., an internist specializing in tuberculosis in Asheville North Carolina, 

attended the first six meetings of the Medical Council. He was well known for his therapeutic 

method of treating patients with complete bed rest on open porches in the fresh mountain air.57 It 

seems likely that he was affiliated with the Oteen Veterans’ Hospital in Asheville, the Veterans’ 

Bureau’s premier tuberculosis hospital, with 1100 beds, all for treatment of tuberculosis. Dr. Dunn 

was on the original ad hoc committee of the Medical Council that recommended a policy of 

research (see text). He spoke strongly in favor of statistical studies. At its eighth meeting, in April 

1928, the Medical Council noted that he was seriously ill and voted him a “tribute”.58 He died in 

1928. 

Figure AppIIb.6: William LeRoy Dunn, M.D. 

James Alexander Miller, M.D., Director of the Tuberculosis Service at Bellevue Hospital in New 

York, attended only the third meeting of the Medical Council. He had been a leader in tuberculosis 

control since, in 1903, he organized the Bellevue tuberculosis clinic and cared for the tuberculosis 

patients who were housed in tents on the hospital grounds.59 

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Figure AppIIb.7: James A. Miller, M.D. 

Harry A. Pattison, M.D., specialized in the rehabilitation of patients with tuberculosis. He was 

Supervisor of the Medical Service of the National Tuberculosis Association and had represented 

that association on the Advisory Committee to the White Committee.60 He later became Director of 

the Potts Memorial Institute, Livingston, New York.61 Dr. Pattison spearheaded an effort by the 

Medical Council to provide transitional care for tuberculous patients who had completed their acute 

treatment but who needed occupational therapy and increased activity under medical supervision.62 

He also chaired a committee on Social Service and Followup.63 

Frederick C.Smith, M.D., Assistant Surgeon General of the Public Health Service, had been one of 

the Public Health Service’s representatives on the Advisory Committee to the White Committee.64 

He also represented the Public Health Service on the National Committee to supervise the 

Framingham Community Health and Tuberculosis Demonstration in 1917-1923. He testified on 

behalf of the Public Health Service in the 1923 Senate hearings investigating inappropriate sale of 

Government property, the hearings which eventually led to Charles Forbes's conviction and 

imprisonment. At that time, as during his service on the Medical Council, he was in charge of the 

Public Health Service hospital system.65 

Group on General Medicine and Surgery 

Ray Lyman Wilbur, M.D., chairman, is discussed above (Executive Committee). 

Lewellys F. Barker, M.D., an internist and neurologist with widespread interests, is also discussed 

above (Executive Committee). 

Benjamin W. Black, M.D., was appointed to the Medical Council in late 1928 and active through its 

1931 meeting. He had been the Veterans’ Bureau Medical Director from 1926 to 1928 and was the 

Medical Director of the Alameda County Hospital in California when he joined the Council.66 

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Figure AppIIb.8: Benjamin W. Black, M.D., 

Medical Director, Veterans’ Bureau, 1926-1928, 

then member of the Medical Council 

George W. Crile, M.D., a well-known pioneer in surgery and Director of Research for the 

Cleveland Clinic,67 attended only the first and third meetings of the Medical Council. 

Joel E. Goldthwait, M.D., an orthopedic surgeon from Harvard recognized for his contributions to 

rehabilitation,68 was active in the organizational stage of the Medical Council but resigned after 

attending the first three meetings. 

Dean D. Lewis, M.D., Professor and Chairman of Surgery at Johns Hopkins School of Medicine, 

replaced Dr. Crile on the Medical Council. During WWI, he organized Base Hospital 13 from the 

staff of Presbyterian Hospital in Chicago and took it to France.69, 70 He attended two meetings, in 

1928 and 1929. 

George M. Piersol, M.D., an internist with an interest in rehabilitation, was Professor of Clinical 

Medicine (subsequently of Physical Medicine and Rehabilitation) at the University of Pennsylvania 

and later Dean of its Graduate School of Medicine. He served as Medical Director for the Bell 

Telephone Company and editor of the American Journal of the Medical Sciences.71 He attended 

most of the meetings of the Medical Council throughout its existence. 

Figure AppIIb.9: George M. Piersol, M.D. 

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John B Walker, M.D., an orthopedic surgeon from New York City and Clinical Professor at 

Columbia University’s College of Physicians and Surgeons, replaced Dr. Goldthwait on the 

Medical Council. He had been associated with veterans’ health care since WWI.72 He wrote a 

comprehensive review of the outcomes of all of the fractures of record sustained during the World 

War, published in a series of articles in the Medical Bulletin.73-76 He attended all meetings of the 

Medical Council after 1927. 

Group on hospitals, dispensaries and general medical welfare 

Colonel Robert U. Patterson, M.D., (Figure 1.4) chaired this group. He was a career Army medical 

officer, who became Surgeon General of the Army in 1931. After his retirement from the Army in 

1935, he was Dean of the medical school at the University of Oklahoma and later at the University 

of Maryland. Earlier, from September 1921 until February 1923, he was detailed from the Army to 

the Veterans’ Bureau, where he served as Medical Director.77 In that position, which he held during 

the notorious Forbes administration, he was said to have won “not only the respect but also the 

affection of his associates, because of his courage, directness, honesty and fairness.” He attended 

meetings of the Medical Council regularly, including the 1939 meeting. 

Louis H. Burlingham, M.D., also a regular attendee, was the Superintendent of Barnes Hospital and 

a Lecturer in hospital administration at Washington University School of Medicine.78 

Michael M. Davis, Jr., Ph. D., was also a member of the Group on Investigations and Research (see 

above). 

Charles A. Elliott, M.D., was appointed to the Medical Council in 1929 to replace Dr. Granger (see 

below). Elliott had been a member of the Yellow Fever Commission and Vice President of the 

American Medical Association. In 1933, he became Dean of Consultants for the Veterans’ Hospital 

at Hines, Illinois.79 

Sigismund S. Goldwater, M.D., Director of Mount Sinai Hospital in New York City and later 

Commissioner of Health for that city,80 attended only the February, 1925 meeting. 

Frank B. Granger, M.D., a neurologist and physiotherapist, was appointed to the Medical Council in 

1925 and attended all of its meetings until his death in October 1928. He had organized and 

directed the Department of Physiotherapy, Division of Physical Rehabilitation, in the Office of the 

Surgeon General of the Army.81 

XXI
 
 

Figure AppIIb.10: Frank B. Granger, M.D. 

Malcolm D. MacEachern, M.D., was also a member of the Executive Committee (see above). 

W. C. Rappeleye, M.D., Superintendent of New Haven Hospital and a Professor in hospital 

administration at Yale University School of Medicine, was also the Director of the Commission on 

Medical Education.82 In 1931, he became Dean of the College of Physicians and Surgeons at 

Columbia University.83 He attended most of the meetings of the Medical Council, including the 

final one in 1939. 

Winford H. Smith, M.D., Director of The Johns Hopkins Hospital,84 attended three meetings of the 

Medical Council between 1925 and 1928. 

XXII
 
 

 

 

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35. McCarthy, D.J., "Lethargic Encephalitis." US Veterans' Bureau Medical Bulletin, 1926. 2: 

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44. Myers, G.E., "Personality Change in the Course of General Medical and Surgical 

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D., Editor. 1935, Charles Scribner's Sons: New York. 16: 313. 

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51. Thom, D.A., "Epilepsy." US Veterans' Bureau Medical Bulletin, 1930. 6: 435-443. 

52. Overholser, W., "William Alanson White," in Dictionary of American Biography, Schuyler, 

R.L., Editor. 1958, Charles Scribner's Sons: New York. Supplement 2 711-712. 

53.	 White, W.A., "The Therapeutic Value of Hospital Social Services." US Veterans' 

Administration Medical Bulletin, 1931. 7: 774-778. 

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issue 6: 7, 24. 

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J.A. and James, E.T., Editors. 1974, Charles Scribner's Sons: New York. Supplement 4 

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Facilities under Public Act 384 (Approved March 4, 1921). Washington, DC: 

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63. "Program of the Ninth Conference of the Medical Council with the Director and the Medical 

Director of the United States Veterans' Bureau, 12-14 November, 1928." Medical Council. 

Washington, DC, 2. 

64. White et al., Report of the Consultants on Hospitalization 

65.	 Smith, F.C., M.D., witness. "Testimony of Doctor Frederick Charles Smith." Hearings 

Before the Select Committee on Investigation of Veterans' Bureau, United States Senate. 

Washington, D.C.: Government Printing Office, 651-664. 

66. Who Was Who in America. Vol. 2. Chicago: A.N. Marquis Co., 1950, 64. 

67. Earle, A.S., "George Washington Crile," in Dictionary of American Biography, James, E.T., 

Editor. 1973, Charles Scribner's Sons: New York. Supplement 3 200-203. 

68. "Notes and Discussion." US Veterans' Bureau Medical Bulletin, 1926. 2: 330. 

69.	 Brieger, G.H., "Dean De Witt Lewis," in Dictionary of American Biography, James, E.T., 

Editor. 1973, Charles Scribner's Sons: New York. Supplement 3 457-458. 

70. David, V.C., "Dean Dewitt Lewis, M.D.: 1874-1941." Arch Surg, 1941. 43: 1150-1152. 

71. Who Was Who in America. Vol. 4. Chicago: Marquis - Who's Who, Incorporated, 1968, 

573-574. 

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73.	 Walker, J.B., "Late Results of Fractures of the Long Bones - a Statistical Study of World 

War Cases - I." United States Veterans' Bureau Medical Bulletin, 1927. 3: 293-314. 

74.	 Walker, J.B., "Late Results of Fractures of the Long Bones - a Statistical Study of World 

War Cases - II." United States Veterans' Bureau Medical Bulletin, 1927. 3: 409-427. 

75.	 Walker, J.B., "Late Results of Fractures of the Long Bones - a Statistical Study of World 

War Cases - III." United States Veterans' Bureau Medical Bulletin, 1927. 3: 525-543. 

76.	 Walker, J.B., "Late Results of Fractures of the Long Bones - a Statistical Study of World 

War Cases - IV." United States Veterans' Bureau Medical Bulletin, 1927. 3: 651-657. 

77. "Former Medical Director Becomes Surgeon General of the Army." US Veterans 

Administration Medical Bulletin, 1931. 7: 783-784. 

78. Who Was Who in America. Vol. 2. Chicago: A.N. Marquis Co., 1950, 92. 

79. "Death of Dr. Charles A. Elliott." US Veterans Administration Medical Bulletin, 1939. 16: 

191. 

XXVII
 
80. Duffy, J., "Sigismund Schulz Goldwater," in Dictionary of American Biography, James, 

E.T., Editor. 1973, Charles Scribner's Sons: New York. Supplement 3. 

81. Who Was Who in America. Vol. 1. Chicago: A.N. Marquis Co., 1942, 476. 

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83. Lamb, A.R., The Presbyterian Hospital and the Columbia-Presbyterian Medical Center. 

New York: Columbia University Press, 1955, 285-286. 

84. Who Was Who in America. Vol. 4. Chicago: Marquis - Who's Who, Incorporated, 1968, 881. 

XXVIII
 
 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix IIc. The Committee on Veterans’ Medical Problems (1946-1959) 

Ad Hoc Committee on Veterans Medical Problems (1946) 

(Formed to Establish the NAS-VA Collaboration) 

Dr. Edward Churchill, Professor of Surgery, Harvard Med School Boston, MA, chairman 

Dr. Norman Q. Brill, Veterans Administration 

Dr. W. McK. Craig, Prof of Neurosurgery, Univ of Minnesota, Mayo Clin, Rochester, MN 

Dr. Louis I. Dublin, Metropolitan Life Insurance Company 

Dr. Perrin H. Long, Professor of Preventive Med, Johns Hopkins School of Med, Baltimore, MD 

Dr. William S. McCann, Professor of Medicine, University of Rochester, Rochester, NY 

Dr. Harold A. Sofield, Assistant Professor of Bone and Joint Surg, Northwestern Univ Sch of Med 

Dr. Milton C. Winternitz, Prof of Pathology, Yale University School of Medicine, New Haven, CT 

Dr. Harold G. Wolff, Associate Prof of Medicine, Cornell Univ Medical College, New York, NY 

NAS Staff 

Michael E. DeBakey, M.D., Assist Prof of Surg, Tulane Univ Sch of Medicine, New Orleans, LA; 

Former Director, Surgical Consultants Division, Office of The Surgeon General, U.S. Army 

Beebe, Gilbert W., Ph.D. Milbank Memorial Fund; Former Chief, Analysis and Reporting Branch, 

Control Division, Office of The Surgeon General, U.S. Army 

Committee on Veterans Medical Problems (Standing committee of the NAS) 

Terms beginning 1946, 1947, or 1948 

Dr. O.H. Perry Pepper, 1946-1951, chairman 1946-1950 

Dr. F. J. Braceland, 1946-1948 

Dr. E. D. Churchill, 1946-1948 

Dr. E. McK. Craig, 1946-1949 

Dr. L. I. Dublin, 1946-1948 

Dr. M. E. DeBakey, 1946-1959 

Dr. Perrin H. Long, 1946-1954 

Dr. W. C. Menninger, 1946-1948 

Dr. J. R. Miller, 1946-1948 

Dr. H. J. Morgan, 1946-1948 

Dr. C. P. Rhoads, 1946-1948 

Dr. M. D. Winternitz, 1946-1948 

Terms beginning 1949, 1950 or 1951 

Dr. W. C. Davison, 1951-1959, chairman 1951-1956 

Dr. H. Glenn Bell, 1951 

Dr. Morris Fishbein, 1949-1951 

Dr. LeRoy Johnson, 1951-1954 

Dr. Chester S. Keefer, 1950-1951 

Dr. Herbert H. Marks, 1949-1954 

Dr. Roy Turner, 1951-1952 

Dr. John C. Whitehorn, 1949-1950 

XXIX
 
 

 

 

 

 

Dr. Stewart Wolf, 1951-1952 

Dr. Harold G. Wolff, 1949-1949 

Dr. Barnes Woodhall, 1951-1952 

Terms beginning 1952, 1953, or 1954
 

Dr. Esmond R. Long 1952-1959, chairman 1957-1958 

Dr. J. E. Finesinger, 1952-1959 

Dr. A. McGehee Harvey, 1952-1954
 

Dr. Donald Mainland, 1954-1957 

Dr. H. Houston Merritt, 1952-1954 

Terms beginning 1955 or later
 

Dr. William S. Stone, 1957-1959, chairman 1959 

Dr. David A. Boyd, Jr., 1956-1957 

Dr. W. Edward Chamberlain, 1957-1959 

Dr. Currier McEwen, 1957-1959 

XXX
 
 

 

 

Appendix IId. Central Advisory Committee on Radioisotopes (1947-1961) 

(Constant membership, except for Dr. Morgan, who left the committee sometime between 1952 and 

1959.) 

Stafford Warren, M.D., Dean, UCLA School of Medicine, Los Angeles, CA, chairman; formerly 

Chief Medical Officer, Manhattan Engineer Project, 1943-46, Special consultant for Western labs 

Hymer Friedell, M.D., Professor of Radiology, Western Reserve School of Medicine, formerly 

Deputy Chief Medical Officer, Manhattan Engineer Project, 1943-46, Special consultant for Central 

labs 

Shields Warren, M.D., Professor of Pathology, Harvard Medical School, Boston, MA, Director, 

Division on Medicine and Biology, Atomic Energy Commission, 1947-1952, Special consultant for 

Eastern labs 

Perrin H. Long, M.D., Professor of Preventive Medicine, Johns Hopkins University, Baltimore, MD 

Hugh Morgan, M.D., Professor of Medicine, Vanderbilt University, Nashville, TN 

XXXI
 
(Intentionally Blank) 

XXXII
 
 

 

 

 

Appendix IIe. Advisory Committee on Research

 (Constant membership, 1955-1960) 

Hayman, Joseph M., Jr., M.D., Dean, Tufts College Medical School, Boston, MA

 Chairman 

Amberson, James Burns, M.D., Professor of Medicine, College of Physicians and Surgeons, 

Columbia University, later Consultant, Chest Service, Bellevue Hospital, New York, NY 

Berryhill, Walter Reese, M.D., Dean, University of North Carolina School of Medicine, Chapel 

Hill, NC 

Moyer, Carl A., M.D., Professor of Surgery, later Chairman, Department of Surgery, Washington 

University School of Medicine, St. Louis, MO 

Wolff, Harold G., M.D., Professor of Medicine, later Professor of Neurology, Cornell University 

Medical College, New York, NY 

XXXIII
 
(Intentionally Blank) 

XXXIV
 
 

 

 

 

 

 

Appendix IIf. Advisory Committee on Research (1961-1968)* 

Wolff, Harold G., M.D. 1961 Prof. Neurology, Cornell Univ. Med. College 

Chairman 1961 

Warren, Stafford L., M.D. 1961-1962; 1967-1968 Dean, UCLA School of Medicine 

Chairman 1962 

Child, Charles G., III, M.D. 1961-1968 Chairman, Department of Surgery, University of Michigan 

Medical School 

Mirsky, I. Arthur, M.D. 1961-1964 Chairman, Department of Clinical Science, University of 

Pittsburgh School of Medicine 

Rose, Harry M., M.D. 1961-1964 Chairman, Department of Microbiology, Columbia University 

College of Physicians and Surgeons 

Stead, Eugene A., Jr., M.D. 1961-1968 Chairman, Department of Medicine, Duke University 

School of Medicine 

Stellar, Eliot, Ph.D. 1961-1968 Institute of Neurological Sciences, University of Pennsylvania 

School of Medicine 

Ebert, Richard V., M.D. 1963-1968 Professor and Head, Department of Medicine, University of 

Arkansas School of Medicine 

Stein, Marvin, M.D., 1965-1968 Professor of Psychiatry, Cornell Medical School 

Leavitt, Lewis A., M.D.1967-1968 Chairman, Department of Physical Medicine, Baylor University 

College of Medicine 

* Source: Listings in the annual reports (Medical Research in the Veterans Administration). 

The committee chairman is not listed after 1962. 

XXXV
 
(Intentionally Blank) 

XXXVI
 
 

 

Appendix IIg. Research Program Committees Active in FY 1964 

Basic sciences

 VA members: 

Henry Kamin, Ph.D., Durham, Chairman 

Dexter S. Goldman, Ph.D., Madison 

Leslie Zieve, M.D., Ph.D., Minneapolis 

Leon Bernstein, Ph.D., San Francisco

 Consultant: 

Philip Handler, Ph.D., Duke University

 Coordinator: 

Joe Meyer, Ph.D., VACO 

Cancer

 VA members: 

 Ludwig Gross, M.D., Bronx 

Julius Wolf, M.D., Bronx 

Lino Arduino, M.D., Des Moines 

Helmut R. Gutman, M.D., Minneapolis 

Gustave Kaplan, M.D., New York 

Henry P. Close, M.D., Philadelphia 

George A. Higgins, M.D., Washington, DC 

Raymond Yesner, M.D., West Haven 

Consultants: 

Sidney Farber, M.D., Harvard 

Kenneth M. Endicott, M.D., Director, NCI 

Warren H. Cole, M.D., University of Illinois 

Sidney Weinhouse, M.D., Temple 

 Coordinator: 

Lyndon E. Lee, M.D., VACO 

Cardiovascular diseases

 VA members: 

Henry K. Schoch, M.D., Ann Arbor 

Elvin E. Eddelman, M.D., Birmingham 

Maurice B. Strauss, M.D., Boston 

Craig Borden, M.D., Chicago 

Mark W. Wolcott, M.D., Coral Gables 

Benjamin Friedman, M.D., Dallas 

E. Harvey Estes, M.D., Durham 

Morton L. Pearce, M.D., Los Angeles 

Milton Rubini, M.D., Los Angeles 

Mervin J. Goldman, M.D., Oakland 

Eli Ramirez, M.D., San Juan 

Harold Dodge, M.D., Seattle 

XXXVII
 
Edward Freis, M.D., Washington, DC

 Consultant: 

James V. Warren, M.D., Ohio State College of Medicine 

 Coordinator: 

Harold W. Schnaper, M.D., VACO 

Infectious disease

 VA members: 

William Merchant, M.D., Ann Arbor, Chairman 

Charles Hurwitz, Ph.D., Albany 

Lewis J. Griffith, Ph.D., Batavia 

Thomas G. White, Ph.D., Dallas 

Sydney M. Finegold, M.D., Los Angeles 

Wendell H. Hall, M.D., Minneapolis 

Horace H. Zinneman, M.D., Minneapolis 

Lawrence G. Wayne, Ph.D., San Fernando 

H. Brownell Wheeler, M.D., West Roxbury

 Consultants: 

L. Joe Berry, Ph.D., Bryn Mawr College 

M. Michael Sigel, Ph.D., Variety Children’s Research Foundation, Miami 

 Coordinator: 

James H. Matthews, M.D., VACO 

Pulmonary disease

 VA members: 

Roy H. Behnke, M.D., Indianapolis, Chairman 

William Hentel, M.D., Albuquerque 

Ralph A. Vogel, Ph.D., Atlanta 

Kaye Kilbourne, M.D., Durham 

Gladys L. Hobby, Ph.D., East Orange 

John K. Curtis, M.D., Madison 

Reeve H. Betts, M.D., Oteen 

Attilio D. Renzetti, Jr., M.D., Salt Lake City 

Nicholas D. D’Esopo, M.D., West Haven 

Consultant: 

John H. McClement, M.D., Bellevue 

 Coordinator: 

James H. Matthews, M.D., VACO 

Oral diseases

 VA members: 

Philip Person, D.D.S., Ph.D., Brooklyn, Chairman 

Irwin W. Scopp, D.D.S., New York, secretary 

Harold H. Niebel, D.D.S., Chicago WS 

James B. Taylor, D.D.S., Long Beach 

Joseph L. Rabinowitz, Ph.D., Philadelphia 

XXXVIII
 
 Consultants: 

Herbert K. Cooper, D.D.S., Lancaster, PA 

Harry Lyons, D.D.S., Dean, School of Dentistry, Medical College of Virginia 

 Coordinator: 

William M. Goodwin, D.D.S., VACO 

Psychiatry, neurology and psychology

 VA members: 

Alex D. Pokorney, M.D., Houston, Chairman 

Norman Geschwind, M.D., Boston 

Lewis J. Sherman, Ph.D., Brockton 

Robert L. Green, M.D., Durham 

Kevin Barron, M.D., Hines 

Janet T. Spence, Ph.D., Iowa City 

Sidney Cohen, M.D., Los Angeles 

Edward C. Beck, Ph.D., Salt Lake City 

Lewis Bernstein, Ph.D., Wood 

Consultant: 

David A. Hamburg, M.D., Stanford 

 Coordinators: 

Samuel C. Kaim, M.D., VACO 

Richard N. Filer, Ph.D., VACO 

XXXIX
(Intentionally Blank) 

XL 
 

 

 

 

 

 

 

 

 

 

 

Appendix IIh. Program Evaluation Committees (1967-1968) 

These committees initiated the systematic peer review of individual research programs within the 

medical research program. They are mentioned in the FY 1966 annual report to the Congress, 

which states that they have gradually supplanted the Research Program Committees. However, 

their memberships are listed only in the FY1967 and 1968 annual reports. They were succeeded in 

1969 by the Research Evaluation Committees, and in 1972 by the Merit Review Boards. Except 

where noted, members are listed for both years. 

Audiology and Speech Pathology Research 

Hardy, William G., Ph.D. John Hopkins University, Baltimore, MD, Chairman 

Eisenson, Jon, Ph.D. Stanford University, Palo Alto, CA 

Jerger, James, Ph.D. Baylor University, Houston, TX 

Knox, Albert W., Ph.D. VAH Kansas City, MO 

Schuell, Hildred M., Ph.D. VAH Minneapolis, MN 

Simon, George, Ph.D. VAH Washington, DC 

Coordinator: Matthews, James H., M.D. Chief, Clinical Res in Pulmonary Diseases, VACO 

Basic Sciences Research 

van Wagtendonk, Willem J., Ph.D. VAH Coral Gables, FL, Chairman 

Clark, William G., Ph.D. VAH Sepulveda, CA 

Fisher, Edwin R., M.D. VAH Pittsburgh, PA 

Fisher, Harvey F., Ph.D. VAH Kansas City, MO 

Johnson, Shirley A., Ph.D. VAH Washington, DC 

Linker, Alfred, Ph.D. VAH Salt Lake City, UT 

Singer, Thomas P., Ph.D. VAH San Francisco, CA 

Sinex, Marott, Ph.D. Boston University, Boston, MA 

Towbin, Eugene J., M.D., Ph.D. VAH Little Rock, AK 

Tyler, Albert, Ph.D. California Institute of Technology, Pasadena, CA 

Utter, Merton, Ph.D. Western Reserve University, Cleveland, OH 

Yuwiler, Arthur, Ph.D. VAH Los Angeles, CA 

Coordinator: Meyer, Joe, Ph.D. Chief, Research in Basic Science, VACO 

Cardiovascular Research 

Pearce, Morton L., M.D. VAH Los Angeles, CA, Chairman 

Cohn, Jay N., M.D. VAH Washington, DC 

Frederickson, Donald S., M.D. (1968) National Heart Institute, Bethesda, MD 

Goldman, Mervin J., M.D. VAH San Francisco, CA 

Stamler, Jeremiah, M.D. (1968) City of Chicago Board of Health, Chicago, IL 

Warren, James V., M.D. (1968) Ohio State University Medical School, Columbus, OH 

Coordinator: Schnaper, Harold W., M.D. Codirector, Cardiovascular Research & Training Center, 

University of Alabama Medical Center, Birmingham, AL 

Endocrinology and Metabolism 

Oliner, Leo, M.D. VAH Indianapolis, IN , Chairman 

Boling, Eldon A., M.D. VAH Boston, MA 

XLI
 
 

 

 

 

 

 

 

 

 

Bollett, Alfred Jay, M.D. Medical College of Georgia, Augusta, GA 

Frawley, Thomas F., M.D. St. Louis University School of Medicine, St. Louis, MO 

Nelson, Don, M.D. Latter-day Saints Hospital, Salt Lake City, UT 

Rich, Clayton, M.D. VAH Seattle, WA 

Schwartz, Theodore B., M.D. Presbyterian-St. Luke’s Hospital, Chicago, IL 

Coordinator: Rosenberg, C.A., M.D. Assistant Director, Education Service, VACO 

Hematology Research 

Heller, Paul, M.D. VAH Chicago, IL (West Side), Chairman 

Cartwright, George E., M.D. University of Utah College of Medicine, Salt Lake City, UT 

Gurney, Clifford, M.D. Rutgers University Medical School, New Brunswick, NJ 

Hall, Charles A., M.D. VAH Albany, NY 

Jaffee, Ernest Richard, M.D. Albert Einstein College of Medicine, Bronx, NY 

Kraus, Alfred P., M.D. University of Tennessee College of Medicine, Memphis, TN 

McFarland, William, M.D. VAH Washington, DC 

Scott, James L., M.D. VAH Los Angeles, CA 

Sundberg, Dorothy R., M.D. University of Minnesota Medical School, Minneapolis, MN 

Whitcomb, Walter H., M.D. VAH Oklahoma City, OK 

Coordinator: Nadel, Eli M., M.D. Chief of Research in Pathology, Hematology and Laboratory 

Medicine, VACO 

Infectious Disease Research 

Merchant, William R., M.D. VAH Ann Arbor, MI, Chairman 

Berry, L. Joe, Ph.D. Bryn Mawr College, Bryn Mawr, PA 

Hobby, Gladys L., Ph.D. VAH East Orange, NJ 

Lepper, Mark H., M.D. Presbyterian-St. Luke’s Hospital, Chicago, IL 

Sigel, M. Michael, Ph.D. The Variety Children’s Research Foundation, Miami, FL 

Woods, Alexander H., M.D. VAH Tucson, AZ 

Coordinator: Matthews, James H., M.D. Chief, Clinical Res in Pulmonary Diseases, VACO 

Oral Diseases 

Shannon, Ira L., D.M.D., M.S.D VAH Houston, TX, Chairman 

Giddon, Donald, D.M.D., Ph.D. Tufts University of Dental Medicine, Boston, MA 

Hoerman, Cpt. Kirk C., DC, USN, D.D.S. Office of Naval Research, Washington, DC 

Kapur, Krishan K., D.D.S., D.M.D., M.S. VAH Boston, MA 

Person, Philip, D.D.S., Ph.D. VAH Brooklyn, NY 

Phillips, Ralph W., M.S., D. Sc. Indiana University School of Dentistry, Indianapolis, IN 

Coordinator: Chauncey, Howard H., Ph.D., D.M.D. Chief, Research in Oral Diseases, VACO 

Pathology and Laboratory Medicine Research 

Yesner, Raymond, M.D. VAH West Haven, CT, Chairman 

Benson, Ellis S., M.D. University of Minnesota Medical Center, Minneapolis, MN 

Bloodworth, J.M.B., M.D. VAH Madison, WI 

Cote, Roger A., M.D. VAH Boston, MA 

Ende, Norman, M.D. VAH Nashville, TN 

Fisher, Edwin R., M.D. University of Pittsburgh, Pittsburgh, PA 

XLII
 
 

 

 

 

 

 

 

 

 

 

Gyorkey, Ferenc, M.D. VAH Houston, TX 

Kinney, Thomas D., M.D. Duke University Medical Center, Durham, NC 

MacDonald, Richard A., M.D. VAH Denver, CO 

Stowell, Robert E., M.D. University of California, Davis, CA 

Wissler, Robert, M.D. University of Chicago, Chicago, IL 

Coordinator: Nadel, Eli M., M.D. Chief, Research in Pathology, Hematology, and Laboratory 

Medicine, VACO 

Psychiatry, Neurology, Psychology Research 

Becker, Robert O., M.D. VAH Syracuse, NY, Chairman 

Barron, Kevin, M.D. VAH Hines, IL 

Bernstein, Lewis, Ph.D. VAH Wood, WI 

Cleveland, Sidney E., Ph.D. VAH Houston, TX 

Costa, Erminio, M.D. College of Physicians & Surgeons of Columbia University, NY 

Hamburg, David A., M.D. Stanford University School of Medicine, Palo Alto, CA 

Hamilton, Charles L., Ph.D. VAH Coatesville, PA 

Mirsky, I. Arthur, M.D. University of Pittsburgh School of Medicine, Pittsburgh, PA 

Oldendorf, William H., M.D. VAH Los Angeles, CA 

Pierce, Chester M., M.D. VAH Oklahoma City, OK 

Ross, Mathew, M.D, Harvard Medical School, Massachusetts General Hosp., Boston, MA 

Stellar, Eliot, Ph.D. University of Pennsylvania, Philadelphia, PA 

Zigler, Edward, Ph.D. Yale University, New Haven, CT 

Coordinators: 

Filer, Richard N., Ph.D. Chief, Research in Psychology, VACO 

Kaim, Samuel C., M.D. Director, Staff for Alcoholism and Related Disorders, VACO 

Pulmonary Disease Research 

Behnke, Roy H., M.D. VAH Indianapolis, IN, Chairman 

Cugell, David W., M.D. Northwestern University, Chicago, IL 

Filley, Giles, M.D. University of Colorado, Denver, CO 

Kilburn, Kaye H., M.D. VAH Durham, NC 

Kory, Ross C., M.D. VAH Wood, WI 

McClement, John H., M.D. Chest Service, Bellevue Hospital, New York, NY 

Coordinator: Matthews, James H. M.D. Chief, Clinical Res in Pulmonary Diseases, VACO 

Surgical Research 

Webb, Watts, M.D. VAH Dallas, TX, Chairman 

Campbell, Gilbert, M.D. University of Arkansas, Little Rock, AK 

Cohn, Isidore, M.D. Louisiana State University, New Orleans, LA 

Egdahl, Richard, M.D. University Hospital, Boston, MA 

Humphrey, Edward W., M.D., Ph.D. VAH Minneapolis, MN 

Pierce, Converse, M.D. Emory University, Atlanta, GA 

Newton, William T., M.D. VAH St. Louis, MO 

Sigel, Bernard, M.D. VAH Philadelphia, PA 

Stickel, D.L., M.D.VAH Durham, NC 

XLIII
 
 

 

 

 

Vester, John, M.D., Ph.D. Good Samaritan Hospital, Cincinnati, OH 

Wheeler, H. Brownell, M.D. VAH West Roxbury, MA 

Coordinator: Wolcott, Mark W., M.D. Chief, Research in Surgery, VACO 

Gastroenterology Research (1968 listing only) 

Donaldson, Robert M., Jr., M.D. Boston University Medical School, Boston, MA, Chairman 

Crane, Robert K., Ph.D. Rutgers Medical School, New Brunswick, NJ 

Farrar, John T., M.D. Medical College of Virginia, Richmond, VA 

Grossman, Morton I., M.D., Ph.D. VAH, Los Angeles, CA 

Jackson, Francis C., M.D. VAH, Pittsburgh, PA 

Menguey, Rene, M.D., Ph.D. University of Chicago School of Medicine, Chicago, IL 

Summerskill, William H.J., D.M., B.Ch Mayo Clinic, Rochester, MN 

Coordinator: Bernstein, Lionel M., M.D., Ph.D. Director, Research Service, VACO 

XLIV
 
 

 

 

 

 

Appendix IIi. Cooperative Studies Evaluation Committee 

Members appointed through 1980 

Lilienfeld, Abraham, M.D. 1966-1969 Professor of Chronic Diseases, School of Public Health, 

Johns Hopkins University, Baltimore, MD 

McClaughry, Robert, M.D. 1966-1967 Chief, Eastern Research Support Center, VA Research 

Service, West Haven, CT 

Schmidt, L.H., Ph.D. 1966-1969 Director, National Center for Primate Biology, Davis, CA 

Tucker, William B., M.D. 1966-1968 Director, Medical Service, VACO, Washington, DC 

Chairman, 1966-1968 

Wolf, Julius, M.D. 1966-1971 Associate Chief of Staff for Research and Education, VA Hospital, 

Bronx, NY 

Zubrod, C. Gordon 1966-1970 Scientific Director for Chemotherapy, National Cancer Institute, 

Bethesda, MD 

Remington, Richard D., Ph.D. 1967-1971 Professor of Biostatistics, University of Michigan, Ann 

Arbor, MI, then Associate Dean, University of Texas School of Public Health, Houston, TX 

Chairman 1969-1971 

Behnke, Roy H., M.D. 1967-1971 Chief, Medical Service, VA Hospital, Indianapolis, IN 

Feinstein, Alvan R., M.D. 1968-1971 Chief, Eastern Research Support Center, VA Research 

Service, West Haven, CT 

Blaisdell, Frank William, M.D. 1969-1972 Associate Professor of Surgery, University of California, 

San Francisco, CA 

Cole, Jonathan, M.D. 1969-1972 Superintendent, Boston State Hospital, Boston, MA 

Ostfeld, Adrian, M.D. 1969-1972 Department of Epidemiology and Public Health, Yale University 

School of Medicine, New Haven, CT 

Kory, Ross C., M.D. 1970-1973 Associate Chief of Staff for Research and Education, VA Hospital, 

Wood, WI 

Schoolman, Harold M., M.D. 1970-1973 Assistant to the Director for Medical Program 

Development and Evaluation, National Library of Medicine, Bethesda, MD 

XLV
 
 

 

 

 

 

Meinert, Curtis L., Ph.D. 1971-1974 Department of Epidemiology and Biostatistics, University of 

Maryland, Baltimore, MD 

Chalmers, Thomas, M.D. 1972-1974 Director, Clinical Center, National Institutes for Health, 

Bethesda, MD 

Chairman, 1972-1974 

Anello, Charles, Sc.D. 1973-1975 Director, Division of Statistics, Bureau of Drugs, Food and Drug 

Administration, Rockville, MD 

Bearman, Jacob, Ph.D. 1973-1975 Professor of Biometry, University of Minnesota, Minneapolis, 

MN 

Jackson, Francis C., M.D. 1973-1975 Special Assistant to the Chief Medical Director for 

Emergency and Disaster Medical Services, VA Central Office, Washington, DC 

Lipton, Morris, M.D. 1973-1975 Professor of Medicine, University of North Carolina, Chapel Hill, 

NC 

Schwartz, Charles I., M.D. 1973-1975 Chief of Staff, VA Hospital, Lexington, KY 

Zeppa, Robert, M.D. 1973-1975 Professor and Chairman, Department of Surgery, University of 

Miami, Miami, FL 

Cornfield, Jerome 1974-1976 Professor of Biostatistics, George Washington University, 

Washington, DC 

Finkel, Marion, M.D. 1974-1977 Deputy Director, Bureau of Drugs, Food and Drug 

Administration, Rockville, MD 

Fries, Edward D., M.D. 1974-1977 Senior Medical Investigator, VA Hospital, Washington, DC 

Littman, Armand, M.D., Ph.D. 1974-1977 Chief, Medical Service, VA Hospital, Hines, IL 

Chairman, 1975-1977 

Takaro, Timothy, M.D. 1975-1978 Chief of Staff, VA Medical Center, Asheville, NC 

Best, William R., M.D. 1976-1979, 1983-1986; Associate Dean, University of Illinois School of 

Medicine, Chicago, IL 

Chairman 1978-1979, Chairman, 1985-1986 

Klerman, Gerald, M.D. 1976-1977, 1982-1984; Professor of Psychiatry, Harvard Medical School, 

Boston, MA 

XLVI
 
 

O’Brien, William M., M.D. 1976-1979 Professor of Medicine, University of Virginia School of 

Medicine, Charlottesville, VA 

Brown, Byron William, Ph.D. 1977-1980 Professor and Head, Division of Biostatistics, Stanford 

University School of Medicine, Palo Alto, CA 

Grizzle, James E., Ph.D. 1977-1980 Professor and Chairman, Department of Biostatistics, School of 

Public Health, University of North Carolina, Chapel Hill, NC 

Temple, Robert, M.D. 1977-1980 Director, Division of Cardio-Renal Drug Products, Food and 

Drug Administration, Rockville, MD 

Hollister, Leo E., M.D. 1978-1981 Chief, GRECC, VA Medical Center and Professor of Medicine 

and Pharmacology, Stanford University School of Medicine, Palo Alto, CA 

Zimmerman, Hyman, M.D. 1978-1980 Chief, Medical Service, VAMC, and Professor of Medicine, 

George Washington University School of Medicine, Washington, DC 

Chairman, 1980 

Carr, Edward A., Jr., M.D. 1979-1982 Professor and Chairman, Department of Phamacology and
 

Therapeutics, School of Medicine, State University of New York, Buffalo, NY 

Colton, Theodore, Sc.D. 1979-1982 Professor of Public Health, Epidemiology and Biostatistics, 

Boston University School of Public Health, Boston, MA 

Nichols, Ronald Lee, M.D. 1979-1981 Professor of Surgery, Tulane University School of Medicine, 

New Orleans, LA 

Colwell, John A., M.D., Ph.D. 1980-1983 Associate Chief of Staff for Research and Development, 

VA Medical Center and Professor of Medicine, University of South Carolina School of Medicine, 

Charleston, SC 

Chairman, 1982-1983
 

Davis, Clarence E., Ph.D. 1980-1983 Professor of Biostatistics, School of Public Health, University 

of North Carolina, Chapel Hill, NC 

Knatterud, Genell L., Ph.D. 1980-1983 Vice President, Maryland Medical Research Institute, 

Baltimore, MD 

Sobel, Solomon, M.D. 1980-1983 Director, Division of Metabolism and Endocrinology, Food and 

Drug Administration, Rockville, MD 

XLVII
 
(Intentionally Blank) 

XLVIII 
 

 

 

 

 

 

 

 

Appendix IIj. Career Development Committee 

(called Selection Committee For Clinical Investigators before 1971) 

Members appointed before 1981 

Appointed before 1960 

Amberson, James B., M.D. 1956-1960 Professor of Medicine, College of and Surgeons, Columbia 

University, New York, NY 

Chairman 1956-1960 

Moyer, Carl A., M.D. Professor of Surgery, Washington Univ. School of Medicine, St. Louis, MO 

Chairman 1961 

Finland, Maxwell, M.D. 1956-1968 Associate Professor of Medicine, Harvard Medical School, 

Boston, MA 

Chairman 1962-1968 

Dorst, Stanley E., M.D. 1956-1961 Dean, School of Medicine, Univ. of Cincinnati, Cincinnati, OH 

Wolff, Harold G., M.D. 1956-1960 Professor of Medicine, Cornell University Medical College, 

New York, NY 

Appointed 1960-1964 

Eichna, Ludwig W., M.D. 1961-1964 Chairman, Department of Medicine, State University of New 

York, Downstate, Brooklyn, N.Y. 

Stare, Fredrick J., M.D. 1961-1968 Professor and Head, Department of Nutrition, Harvard 

University School of Public Health, Boston, MA 

Wolf, Stewart G. Jr., M.D. 1961-1968 Chairman, Department of Medicine, University Oklahoma 

School of Medicine, Oklahoma City, OK 

Altemeier, William A., M.D. 1962-1963 Professor of Surgery, University of Cincinnati School of 

Medicine, Cincinnati, OH 

Howell, James T., M.D. 1962-1964 Assistant Director, Henry Ford Hospital, Detroit, MI 

Danowski, Thaddeus, M.D. 1964-1970 Professor of Research, University of Pittsburgh School of 

Medicine, Pittsburgh, PA 

Rhoads, Jonathan, M.D. 1964-1970 The I. S. Ravdin Institute, University of Pennsylvania Hospital, 

Philadelphia, PA 

XLIX
 
 

 

 

Volker, Joseph F., M.D. 1964-1972 Director of Research and Graduate Studies, Medical School of 

Alabama, 1919 Seventh Avenue, South, Birmingham, AL 

Appointed 1965-1969 

Sherry, Sol, M.D. 1967-1971 Professor of Medicine, Washington University School of Medicine, 

St. Louis, MO 

Chairman 1969-1971 

Goldberg, Leon I., M.D., Ph. D. 1969-1973 Director, Division of Clinical Pharmacology, Emory 

University School of Medicine, Atlanta, GA 

Silen, William, M.D. 1969-1973 Chairman, Department of Surgery, Beth Israel Hospital, Harvard 

Medical School, Boston, MA 

Siperstein, Marvin, M.D., Ph.D. 1969-1973 Professor of Medicine, University of Texas Medical 

School at Dallas, Dallas, TX 

Appointed 1970-1974 

Robins, Eli, M.D. 1971-1975 Professor and Head, Department of Psychiatry, Washington 

University Medical School, St. Louis, MO 

Chairman 1972-1975 

Hook, Edward W., M.D. 1974-1978 Professor and Chairman, Department of Medicine, University 

of Virginia School of Medicine, Charlottesville, VA 

Chairman 1976-1978 

Appel, Stanley H., M.D. 1971-1975 Chairman, Division of Neurology, Duke University Medical 

Center, Durham, NC 

Dixon, Frank J., M.D. 1971-1973 Head, Division of Experimental Pathology, Scripps Clinic and 

Research Foundation, La Jolla, CA 

Goldstein, Leonard D., Ph. D. 1971-1976 Chairman, Department of Psychology, University of 

Cincinnati, Cincinnati, OH 

Liddle, Grant W., M.D. 1971-1974 Chairman, Endocrinology and Metabolism Division, Vanderbilt 

University School of Medicine, Nashville, TN 

Zuidema, George D., M.D. 1971-1974 Chairman, Department of Surgery, Johns Hopkins 

University School of Medicine, Baltimore, MD 

Eliel, Leonard P., M.D. 1973-1977 Vice President, University of Oklahoma Medical School, 

Oklahoma City, OK 

L
 
 

 

 

 

 

 

 

 

 

 

 

McManus, J. F. A., M.D. 1973-1977 Dean, College of Medicine, Medical University of South 

Carolina, Charleston, SC 

Salley, John J., D.D.S., Ph. D. 1973-1977 Dean, University of Maryland School of Dentistry, 

Baltimore, MD 

Wang, Yang, M.D. 1973-1976 Associate Professor of Medicine, University of Minnesota, 

Minneapolis, MN 

King, Thomas C., M.D. 1974-1978 Professor of Surgery, Columbia Presbyterian Medical Center, 

New York, NY 

Pool, Judith G., Ph.D. 1974-1975 Professor of Medicine, Stanford University School of Medicine, 

Stanford, CA 

Appointed 1975-1980 

Schilling, Robert F., M.D. 1976-1980 Professor of Medicine, Univ. of Wisconsin, Madison, WI 

Chairman 1978-1979 

Behnke, Roy H., M.D. 1979-1982 Chairman & Professor, Department of Internal Medicine, 

University of South Florida College of Medicine, Tampa, FL 

Chairman 1980-1982 

Bergofsky, Edward H., M.D. 1975-1979 Professor, State University of New York, Stonybrook, NY 

Tyor, Malcolm P., M.D. 1975-1979 Professor and Chief, Division of Gastroenterology, Duke 

University Medical Center, Durham, NC 

Wagner, Henry N. Jr., M.D. 1975-1979 Professor of Medicine, Radiology and Environmental 

Health, The Johns Hopkins Medical Institution, Baltimore, MD 

Freinkel, Norbert, M.D. 1975 Professor of Medicine, Northwestern University Medical School, 

Chicago, IL 

Diamond, Ivan, M.D., Ph.D. 1976-1979 Associate Professor of Neurology, University of California 

School of Medicine, San Francisco, CA 

Lipton, Morris, M.D., Ph.D. 1976-1979 Director, Biological Science Research Center, University of 

North Carolina School of Medicine, Chapel Hill, NC 

Kuida, Hiroshi, M.D. 1976-1980 Professor and Chairman, Division of Cardiology, University of 

Utah College of Medicine, Salt Lake City, UT 

Sterman, Maurice B., Ph.D. 1976-1980 Chief, Neuropsychology Research, VA Hospital, Sepulveda, 

CA 

LI
 
 

 

Bernard, Louis J., M.D. 1977-1980 Professor and Chairman, Department of Surgery, Meharry 

Medical College, Nashville, TN 

Fullmer, Harold, D.D.S. 1977-1981 Director & Associate Dean, University of Alabama School of 

Dentistry, Birmingham, AL 

Kowal, Jerome, M.D. 1977-1980 Chief of Staff, VA Hospital, Cleveland, Ohio 

Warner, Nancy E., M.D. 1977-1978 Professor and Chairman, Department of Pathology, University 

of Southern California School of Medicine, Los Angeles, CA 

Cluff, Leighton E., M.D. 1978-1979 Vice President, Robert Wood Johnson Foundation, Princeton, 

New Jersey 

McCabe, William R., M.D. 1979-1983 Professor of Medicine & Microbiology, Boston University 

School of Medicine, Boston, MA 

Suzuki, Kinuko, M.D. 1979-1982 Professor of Pathology, Albert Einstein College of Medicine, 

Bronx, NY 

Volwiler, Wade, M.D. 1979-1983 Professor of Medicine, University of Washington School of 

Med., Seattle, WA 

Moore, Robert Y., M.D., Ph.D. 1980-1983 Professor & Chairman, Department of Neurology, State 

University of New York at Stony Brook, Stony Brook, NY 

Papper, Solomon, M.D. 1980-1982 Distinguished Professor and Head, Department of Medicine, 

University of Oklahoma Health Science Center, Oklahoma City, OK 

LII
 
 

 

 

 

 

Appendix IIk. Institutional Research Programs Evaluation Committees (Part 2) 

Membership of these committees is listed here as recorded in the annual report to the Congress, 

Fiscal Years 1969, 1970 and 1971. The program began in Calendar Year 1968 and terminated in 

March, 1970. Membership was stable except where noted. 

Committee A 

Sprague, Charles C., M.D. Dean, University of Texas, Southwestern Medical School at Dallas, TX 

Chairman 1970-1971 

Wiggers, Harold C., Ph.D. Executive Vice President and Dean, Albany Medical College of Union 

University, Albany, NY 

Chairman 1969 

Aspis, Samuel L., M.D. Hospital Director, VAH, Cleveland, OH 

Burch, Neil, R., M.D. Professor of Mental Science, the University of Texas Graduate School of 

Biomedical Sciences; Associate Professor, Psychiatry, Baylor College of Medicine; Head, Division 

of Psychophysiology, Texas Research Institute of Mental Sciences, Houston, TX 

Howell, David S., M.D. (1969) Chief, Rheumatology and Arthritis Section, University of Miami 

School of Medicine, Miami, FL 

Lester, Richard, M.D. Chairman, Department of Radiology, Duke University School of Medicine, 

Durham, NC 

Nadel, Eli M., M.D. (1969) Associate Dean and Professor of Pathology, St. Louis University School 

of Medicine, St. Louis, MO 

Rich, Clayton, M.D. (1969-1970) Associate Dean for Research and Facilities, University of 

Washington, Seattle, WA 

Robbins, Stanley L, M.D. Professor and Chairman, Department of Pathology, Boston University 

School of Medicine, Boston, MA 

Sigel, Bernard, M.D. (1969) Professor of Surgery and Dean, Women’s Medical College of 

Pennsylvania, Philadephia, PA 

Simeone, Fiorindo A., M.D. (1970-1971) Professor of Medical Science, Chairman, Section of 

Surgery, Division of Biological and Medical Sciences, Brown University, Providence, RI 

Vickerstaff, Hugh Hospital Director (1970-1971), VAH, Nashville, TN 

Warren, James V., M.D. Chairman, Department of Medicine, Ohio State University Medical 

School, Columbus, OH 

LIII
 
 

 

 

Zieve, Leslie, M.D. (1970-1971) ACOS/R&E, VAH, Minneapolis, MN 

Executive secretary 

Libman, Gerald Chief, Office of Scientific Evaluation, VA Central Office, Washington, DC 

Committee B 

Burrows, Leslie R., D.D.S., Ph.D. Dean, Scholl of Dentistry, University of Colorado Medical 

Center, Denver, CO 

Chairman 1969 

Bird, Robert M., M.D. Dean, University of Oklahoma School of Medicine, Oklahoma City, OK 

Chairman 1970-1971 

Best, William R., M.D. Director, Midwest Research Support Center, VAH, Hines, IL 

Brunson, Joel G., M.D. (1969) Chairman, Department of Pathology, University of Mississippi 

Medical Center, Jackson, MS 

Cohn, David V., Ph.D. ACOS/R&E, VAH, Kansas City, MO 

Goodale, Fairfield, Jr., M.D. (1970-1971) Chairman, Department of Pathology, the Medical College 

of Virginia, Virginia Commonwealth University, Richmond, VA 

Gottlieb, Abraham, M., M.D. Director, VAH, Palo Alto, CA 

Lhamon, William T., M.D. Professor and chairman, Department of Psychiatry, Cornell University 

Medical Center, New York, NY 

Page, Lot B., M.D. Chief of Medicine, Newton-Wellesley Hospital, Newton Lower Falls, MA 

Proctor, Donald F., M.D. Professor of Environmental Medicine, Associate Professor of 

Laryngology and Otology, Johns Hopkins School of Hygiene, Baltimore, MD 

Ravitch, Mark, M.D. (1969) Professor of Surgery, University of Pittsburgh School of Medicine, 

Montefiore Hospital, Pittsburgh, PA 

Waddell, William R., M.D. (1970-1971) Chairman, Department of Surgery, University of Colorado 

Medical Center, Denver, CO 

Williams, Clyde, M.D. Chairman, Department of Radiology, University of Florida Health Center, 

Gainesville, FL 

Executive secretary 

Libman, Gerald Chief, Office of Scientific Evaluation, VA Central Office, Washington, DC 

LIV
 
 

 

 

Appendix IIl. Merit Review Board Members Appointed 1972-1980 

Merit Review Board for Alcoholism and Drug Dependence 

(Clinical Pharmacology) 

Cochin, Joseph, M.D., Ph.D. Professor of Pharmacology, Boston University School of Medicine, 

Boston, MA 

Chairman, 1972-1974 

Harris, Louis S., Ph.D. 1975 – 1978 Professor & Chairman, Department of Pharmacology, Medical 

College of Virginia, Richmond, VA 

Chairman, 1975-1978 

Inturrisi, Charles E., Ph.D. 1977 – 1980 Associate Professor of Pharmacology, Cornell Medical 

College, New York, NY 

Chairman 1979-1980 

Chafetz, Morris, M.D. 1972 Director, National Institute of Alcohol Abuse and Alcoholism, 

Rockville, MD 

Cole, Jonathan O., Ph.D. 1972 – 1975 Superintendent, Boston State Hospital, Boston, MA 

Davis, Virginia E., Ph.D. 1972 – 1975 Director, Neurochemistry & Addiction Research, VA 

Hospital, Houston, TX 

Holliday, Audrey R., Ph.D. 1972 Department of Psychiatry, University of Chicago Pritzker School 

of Medicine, Chicago, IL 

Hollister, Leo E., M.D. 1972 – 1975 Medical Investigator, VA Hospital, Palo Alto, CA 

Lieber, Charles, M.D. 1972 – 1975 Chief, Section of Liver Disease and Nutrition, VA Hospital, 

Bronx, NY 

Ludwig, Arnold M., M.D. 1972 – 1975 Professor of Psychiatry, University of Kentucky, Lexington, 

KY 

Martin, William R., M.D. 1972 – 1973 Chief, National Institute of Mental Health Addiction 

Research Center, Lexington, KY 

McGlothlin, William H., Ph.D. 1972-1975 Professor of Psychology, University of California, Los 

Angeles, CA 

LV
 
 

 

 

 

 

Mclsaac, William M., M.D. 1972 – 1973 Director, Texas Research Institute of Mental Sciences, 

Houston, TX 

Nowlis, Vincent, Ph.D. 1972 – 1975 Consultant, Drug Abuse Council, Washington, DC 

Way, Edward L., Ph.D. 1972 – 1975 Professor of Pharmacology and Experimental Therapeutics, 

University of California Medical Center, San Francisco, CA 

Jarvik, Lissy, M.D. 1974 – 1977 Chief, Psychogenetics Unit, VA Hospital (Brentwood), Los 

Angeles, CA 

Kissin, Benjamin, M.D. 1974 – 1977 Director, Kings County Addictive Disease Hospital, Brooklyn, 

NY 

Mayfield, Demmie G., M.D. 1974 – 1977 Chief of Psychiatry, VA Hospital, Providence, RI 

Meyer, Roger E., M.D. 1978 – 1981 Chairman, Department of Psychiatry University of Connecticut 

School of Medicine, Farmington, CT 

Chairman, 1980-1981 

Mandel, H. George, Ph.D. 1975 – 1978 Professor and Chairman, Department of Pharmacology, 

George Washington University School of Medicine, Washington, DC 

Schildkraut, Joseph J., M.D. 1975 – 1978 Professor of Psychiatry, Massachusetts Mental Health 

Center, Boston, MA 

McMillan, Donald E., Ph.D. 1976 – 1979 Professor of Pharmacology, University of North Carolina 

School of Medicine, Chapel Hill, NC 

McNay, John L. Jr., M.D. 1976 – 1979 Department of Medicine, VA Hospital, San Antonio, TX 

Robinson, Donald S., M.D. 1976 – 1979 Associate Professor of Medicine, University of Vermont 

College of Medicine, Burlington, VT, later Professor & Chairman, Department of Pharmacology, 

Marshall University School of Medicine, Huntington, WV 

Mendelson, Jack H., M.D. 1977 – 1980 Professor of Psychiatry, Director, Alcohol and Drug Abuse 

Research Center, McLean Hospital, Belmont, MA 

Rennick, Barbara R., M.D. 1977 – 1980 Professor of Pharmacology, State University of New York 

at Buffalo, Buffalo, NY 

LVI
 
 

 

 

 

 

Martin, William R., M.D., 1978 – 1981 Professor and Chairman, Department of Pharmacology, 

University of Kentucky, Lexington, KY 

Nuite-Belleville, Jo Ann, Ph.D. 1978 - 1981 Assistant Professor of Pharmacology, Georgetown 

University School of Medicine, Washington, DC 

Nies, Alexander, M.D. 1979 – 1982 Professor of Psychiatry, Marshall University School of 

Medicine, Huntington, WV, later Psychiatry Service, VA Medical Center, Newington, CT 

Perrier, Donald, Ph.D. 1979 – 1982 Associate Professor of Pharmaceutical Sciences, College of 

Pharmacy, University of Arizona, Tucson, AZ 

Woods, James H., Ph.D. 1979 – 1982 Associate Professor of Pharmacology and Psychology, 

University of Michigan School of Medicine, Ann Arbor, MI 

Blake, David A., Ph.D. 1980 – 1983 Associate Professor of Pharmacology, Johns Hopkins School 

of Medicine, Baltimore, MD 

Finkle, Bryan S., Ph.D. 1980 – 1983 Associate Professor of Biochemistry, Phamacology & 

Toxicology, University of Utah, Salt Lake City, UT 

O’Brien, Charles P., M.D. 1980 – 1983 Director, Drug Dependency Treatment and Research Unit, 

VA Medical Center, Philadephia, PA 

Merit Review Board for Basic Sciences 

Estabrook, Ronald W., Ph.D. 1972-1975 Professor of Biochemistry, later Dean, Graduate School of 

Medical Sciences, University of Texas, Dallas, TX 

Chairman, 1972-1975 

Barker, Robert, Ph.D. 1975-1978 Professor & Chairman, Department of Biochemistry, Michigan 

State University, East Lansing, MI 

Chairman, 1976-1978 

Orme-Johnson, William H., III, Ph.D. 1977-1980 Professor of Biochemistry, University of 

Wisconsin School of Medicine, Madison, WI 

Chairman, 1978-1980 

Blakley, Raymond L., Ph.D., D. Sc. 1978-1980 Professor of Biochemistry, University of Iowa 

College of Medicine, Iowa City, IA 

Chairman 1980-1981 

LVII
 
 

Fishman, William H., Ph.D. 1972-1975 Director, Cancer Research Center, Tufts University School 

of Medicine Boston, MA 

Kamin, Henry, Ph.D. 1972-1975 Professor of Biochemistry, Duke University Medical Center, 

Durham, NC 

Lindsay, Raymond H., Ph.D. 1972-1975 Director of Pharmacology Research, VA Hospital, 

Birmingham, AL 

Linker, Alfred, Ph.D. 1972-1975 Research Biochemist, VA Hospital, Salt Lake City UT 

Moldave, Kivie, Ph.D. 1972-1975 Professor of Biochemistry, California College of Medicine, 

University of California, Irvine, CA 

Porter, John W., Ph.D. 1972-1975 Chief, Lipid Metabolism Laboratory, Madison, WI 

Putnam, Frank, Ph.D. 1972-1975 Professor of Molecular Biology and Biochemistry, Indiana 

University, Bloomington, IN 

Setlow, Jane K., Ph.D. 1972-1975 Biology Division, Oak Ridge National Laboratory, Oak Ridge, 

TN 

Srere, Paul, Ph.D. 1972-1975 Chief, Biochemistry Unit, VA Hospital, Dallas, TX 

Wold, Finn, Ph.D. 1972-1975 Professor, later also Head, Department of Biochemistry, University of 

Minnesota Medical School, Minneapolis, MN 

Irving, Charles C., Ph.D. 1974-1977 Chief, Cancer Research Laboratory, VA Hospital, Memphis, 

TN 

Vahouny, George V., Ph.D. 1974-1977 Professor of Biochemistry, George Washington University 

School of Medicine, Washington, DC 

Williams, Charles H., Jr., Ph.D. 1974-1977 Research Biochemist, VA Hospital, Ann Arbor, MI 

Jones, Mary Ellen, Ph.D. 1975-1978 Professor of Biochemistry, University of Southern California 

School of Medicine, Los Angeles, CA 

Vesell, Elliot S., M.D. 1975-1978 Professor and Chairman, Department of Pharmacology, 

Pennsylvania State University College of Medicine, Hershey, PA 

LVIII
 
 

 

 

 

Willis, John S., Ph.D., 1975-1978 Professor of Physiology and Biophysics University of Illinois, 

Urbana, IL 

Atkinson, Daniel, Ph.D. 1976-1979 Professor of Chemistry, University of California, Los Angeles, 

CA 

Bitensky, Mark, M.D. 1976-1979 Professor of Pathology, Yale University School of Medicine, 

New Haven, CT 

Fitch, Frank W., M.D., Ph.D. 1976-1979 Professor of Pathology, University of Chicago Medical 

School, Chicago, IL 

Goldberg, Burton D., M.D. 1976-1979 Professor of Pathology, New York University School of 

Medicine, New York, NY 

Silbert, Jeremiah E., M.D. 1976-1979 VA Outpatient Clinic, Boston, MA 

Simpson, Melvin V., Ph.D. 1976-1979 Professor of Biochemistry, State University of New York 

School of Medicine, Stony Brook, NY 

Smuckler, Edward A., M.D., Ph.D. 1976-1979 Professor & Chairman, Department of Pathology, 

University of California School of Medicine, San Francisco, CA 

Bresnick, Edward, Ph.D. 1977-1980 Professor & Chairman, Department of Biochemistry, 

University of Vermont School of Medicine, Burlington, VT 

Dempsey, Mary E., Ph.D. 1977-1980 Professor of Biochemistry, University of Minnesota School of 

Medicine, Minneapolis, MN 

Farber, John L., M.D. 1978-1981 Associate Professor of Pathology, Temple University Medical 

School, Philadelphia, PA 

Forte, Leonard R., Ph.D. 1978-1981 Research Pharmacologist, VA Hospital, and Associate 

Professor of Pharmacology, University of Missouri Medical School, Columbia, MO 

Hoffee, Patricia A., Ph.D., 1978-1981 Professor of Microbiology, University of Pittsburgh School 

of Medicine, Pittsburgh, PA 

Jackson, Michael J., Ph.D. 1978-1981 Professor of Physiology, George Washington University 

Medical School, Washington, DC 

LIX
 
 

 

Brown, Barbara I., Ph.D. 1979-1982 Professor of Biological Chemistry, Washington University 

School of Medicine, St. Louis, MO 

Davidson, Eugene A., Ph.D. 1979-1982 Professor and Chairman, Department of Biochemistry, 

Pennsylvania State University School of Medicine, Hershey, PA 

Lane, Bernard P., M.D. 1979-1982 Professor of Pathology, State University of New York Medical 

School, Stony Brook, NY 

Noller, Harry F., Jr., Ph.D. 1979-1982 Professor of Biology, University of California, Santa Cruz, 

CA 

Papermaster, David S., M.D. 1979-1982 Associate Professor of Pathology, Yale University Medical 

School, New Haven, CT 

Schwartz, Stephen M., M.D. 1979-1982 Associate Professor of Pathology, University of 

Washington School of Medicine, Seattle, WA 

Baker, Nome., Ph.D. 1980-1983 Research Biochemist, VA Medical Center (Wadsworth), Los 

Angeles, CA 

Bodley, James W., Ph.D. 1980-1983 Professor of Biochemistry, University of Minnesota School of 

Medicine, Minneapolis, MN 

Elbein, Alan D., Ph.D. 1980-1983 Professor of Biochemistry, University of Texas School of 

Medicine, San Antonio, TX 

Kearney, Edna B., Ph.D. 1980-1983 Associate Research Biochemist, VA Medical Center, San 

Francisco, CA 

Merit Review Board for Mental Health and Behavioral Sciences 

Pokorny, Alex D., M.D. 1972-1975 Chief, Psychiatry and Neurology Service, VA Hospital, and 

Vice Chairman, Department of Psychiatry, Baylor College of Medicine, Houston, TX 

Chairman, 1972-1975 

Silverman, Albert, M.D. 1975-1978 Professor & Chairman of Psychiatry, University of Michigan 

Medical School, Ann Arbor, MI 

Chairman, 1975-1978 

Parsons, Oscar A., Ph.D. 1977-1980 Professor of Psychiatry & Behavioral Sciences, University of 

Oklahoma Medical School, Oklahoma City, OK 

Chairman, 1979-1980 

LX
 
 

Cole, Jonathan O., M.D. 1979-1982 Professor of Psychiatry, Harvard Medical School, Boston, MA 

Chairman, 1981-1982 

Bernstein, Lewis, Ph.D. 1972-1975 Chief, Psychology Service, VA Center, Wood, WI 

Freedman, Daniel X., M.D. 1972-1975 Professor of Biological Sciences and Chairman, Department 

of Psychiatry, University of Chicago, Chicago, IL 

Hollender, Marc H., M.D. 1972-1975 Professor of Psychiatry, Vanderbilt School of Medicine, 

Nashville, TN 

Morris, Robert, Ph.D. 1972-1975 Professor of Social Planning, Director, Levinson Gerontological 

Policy Institute, Brandeis University, Waltham, MA 

Nathan, Peter E., Ph.D. 1972-1975 Professor of Psychology and Psychiatry, Rutgers University, 

New Brunswick, NJ 

Nurnberger, John E., M.D. 1972 –1973 Professor and Chairman, Dept. of Psychiatry, Indiana 

University Medical School, Indianapolis, IN 

Overall, John E., Ph.D. 1972-1975 Research Professor of Neurology and Psychiatry, University of 

Texas Medical Branch, Galveston, TX 

Pishkin, Vladimir, Ph.D. 1972-1975 Chief Research Psychologist, VA Hospital, Oklahoma City, 

OK 

Stein, Marvin, M.D. 1972-1975 Professor of Psychiatry, Mt. Sinai School of Medicine, New York, 

NY 

Winokur, George, M.D. 1972-1975 Professor of Psychiatry, University of Iowa School of 

Medicine, Iowa City, IA 

Butters, Nelson M., Ph.D. 1974-1977 Associate Chief, Psychology Research, VA Hospital, Boston, 

MA 

Greenblatt, Milton, M.D. 1974-1977 Chief, Psychiatry Service, VA Hospital, Sepulveda, CA, 

Professor of Psychiatry, University of California School of Medicine, Los Angeles, CA 

Hersen, Michel, Ph.D. 1974-1977 Professor of Clinical Psychiatry, Western Psychiatric Institute 

and Clinic, Pittsburgh, PA 

Beck, Edward C., Ph.D. 1975-1978 Director, Neuropsychological Research, VA Hospital, Salt Lake 

City, UT 

LXI
 
 

 

 

Waziri, Rafiq, M.D. 1975-1978 Associate Professor of Psychiatry, University of Iowa School of 

Medicine, Iowa City, IA 

Moos, Rudolf H., Ph.D. 1976-1978 Chief of Research (Psychiatry), VA Medical Center and 

Professor of Psychiatry, Stanford University School of Medicine, Palo Alto, CA 

McKinney, William T. Jr., M.D. 1976-1979 Professor and Chairman, Department of Psychiatry, 

University of Wisconsin Medical School, Madison, WI 

Obrist, Paul A., Ph.D. 1976-1979 Division of Health Affairs, Department of Psychiatry, University 

of North Carolina School of Medicine, Chapel Hill, NC 

Satz, Paul, Ph.D. 1976-1979 Professor of Psychology, University of Florida School of Medicine, 

Gainesville, FL 

Stunkard, Albert, M.D. 1976-1979 Professor of Psychiatry, University of Pennyslvania School of 

Medicine, Philadelphia, PA 

Fink, Max, M.D. 1977-1980 Professor of Psychiatry, State University of New York School of 

Medicine, Stony Brook, NY 

Goldstein, Gerald, Ph.D. 1977-1980 Chief, Research Service, VA Hospital (Highland Drive), 

Pittsburgh, PA 

Ackerman, Sigurd, M.D. 1978-1981 Assistant Professor of Psychiatry, Albert Einstein School of 

Medicine, Bronx, NY 

Alexander, A. Barney, Ph.D. 1978-1981 Head, Dept. of Psychophysiology, National Asthma 

Center, Denver, CO 

Andreasen, Nancy, M.D., Ph.D. 1978-1981 Associate Professor of Psychiatry, University of Iowa 

School of Medicine, Iowa City, IA 

Cicchetti, Domenic V., Ph.D. 1978-1981 VA Medical Center, West Haven, CT 

Fann, William E., M.D. 1978-1983 Chief, Psychiatry Service, VA Medical Center, Houston, TX 

Meier, Manfred, Ph.D. 1979-1982 Professor & Director of Neuropsychology Lab, University of 

Minnesota School of Medicine, Minneapolis, MN 

Rush, John, M.D. 1979-1982 Associate Professor, University of Texas, Southwestern Medical 

School, Dallas, TX 

LXII
 
 

 

 

 

Winokur, Andy, M.D. 1979-1982 Assistant Professor of Psychiatry, University of Pennsylvania 

School of Medicine, Philadelphia, PA 

Gentry, W. Doyle, Ph.D. 1980-1983 Professor of Psychiatry & Behavioral Science, University of 

Texas Medical Branch, Galveston, TX 

Kramer, Milton, M.D. 1980-1983 Assistant Chief, Psychiatry Service, VA Medical Center, 

Cincinnati, OH 

Maxim, Peter E., M.D., Ph.D. 1980-1983 Associate Professor of Psychiatry and Behavioral 

Sciences, University of Washington School of Medicine, Seattle, WA 

Merit Review Board for Mental Health and Behavioral Sciences 

Pokorny, Alex D., M.D. 1972-1975 Chief, Psychiatry and Neurology Service, VA Hospital, and 

Vice Chairman, Department of Psychiatry, Baylor College of Medicine, Houston, TX 

Chairman, 1972-1975 

Silverman, Albert, M.D. 1975-1978 Professor & Chairman of Psychiatry, University of Michigan 

Medical School, Ann Arbor, MI 

Chairman, 1975-1978 

Parsons, Oscar A., Ph.D. 1977-1980 Professor of Psychiatry & Behavioral Sciences, University of 

Oklahoma Medical School, Oklahoma City, OK 

Chairman, 1979-1980 

Cole, Jonathan O., M.D. 1979-1982 Professor of Psychiatry, Harvard Medical School, Boston, MA 

Chairman, 1981-1982 

Bernstein, Lewis, Ph.D. 1972-1975 Chief, Psychology Service, VA Center, Wood, WI 

Freedman, Daniel X., M.D. 1972-1975 Professor of Biological Sciences and Chairman, Department 

of Psychiatry, University of Chicago, Chicago, IL 

Hollender, Marc H., M.D. 1972-1975 Professor of Psychiatry, Vanderbilt School of Medicine, 

Nashville, TN 

Morris, Robert, Ph.D. 1972-1975 Professor of Social Planning, Director, Levinson Gerontological 

Policy Institute, Brandeis University, Waltham, MA 

Nathan, Peter E., Ph.D. 1972-1975 Professor of Psychology and Psychiatry, Rutgers University, 

New Brunswick, NJ 

LXIII
 
 

 

 

 

Nurnberger, John E., M.D. 1972 –1973 Professor and Chairman, Dept. of Psychiatry, Indiana 

University Medical School, Indianapolis, IN 

Overall, John E., Ph.D. 1972-1975 Research Professor of Neurology and Psychiatry, University of 

Texas Medical Branch, Galveston, TX 

Pishkin, Vladimir, Ph.D. 1972-1975 Chief Research Psychologist, VA Hospital, Oklahoma City, 

OK 

Stein, Marvin, M.D., 1972-1975 Professor of Psychiatry, Mt. Sinai School of Medicine, New York, 

NY 

Winokur, George, M.D. 1972-1975 Professor of Psychiatry, University of Iowa School of 

Medicine, Iowa City, IA 

Butters, Nelson M., Ph.D. 1974-1977 Associate Chief, Psychology Research, VA Hospital, Boston, 

MA 

Greenblatt, Milton, M.D. 1974-1977 Chief, Psychiatry Service, VA Hospital, Sepulveda, CA, 

Professor of Psychiatry, University of California School of Medicine, Los Angeles, CA 

Hersen, Michel, Ph.D., 1974-1977 Professor of Clinical Psychiatry, Western Psychiatric Institute 

and Clinic, Pittsburgh, PA 

Beck, Edward C., Ph.D. 1975-1978 Director, Neuropsychological Research, VA Hospital, Salt Lake 

City, UT 

Waziri, Rafiq, M.D. 1975-1978 Associate Professor of Psychiatry, University of Iowa School of 

Medicine, Iowa City, IA 

Moos, Rudolf H., Ph.D. 1976-1978 Chief of Research (Psychiatry), VA Medical Center and 

Professor of Psychiatry, Stanford University School of Medicine, Palo Alto, CA 

McKinney, William T. Jr., M.D. 1976-1979 Professor and Chairman, Department of Psychiatry, 

University of Wisconsin Medical School, Madison, WI 

Obrist, Paul A., Ph.D. 1976-1979 Division of Health Affairs, Department of Psychiatry, University 

of North Carolina School of Medicine, Chapel Hill, NC 

Satz, Paul, Ph.D. 1976-1979 Professor of Psychology, University of Florida School of Medicine, 

Gainesville, FL 

Stunkard, Albert, M.D. 1976-1979 Professor of Psychiatry, University of Pennyslvania School of 

Medicine, Philadelphia, PA 

LXIV
 
Fink, Max, M.D. 1977-1980 Professor of Psychiatry, State University of New York School of 

Medicine, Stony Brook, NY 

Goldstein, Gerald, Ph.D. 1977-1980 Chief, Research Service, VA Hospital (Highland Drive), 

Pittsburgh, PA 

Ackerman, Sigurd, M.D. 1978-1981 Assistant Professor of Psychiatry, Albert Einstein School of 

Medicine, Bronx, NY 

Alexander, A. Barney, Ph.D. 1978-1981 Head, Dept. of Psychophysiology, National Asthma 

Center, Denver, CO 

Andreasen, Nancy, M.D., Ph.D. 1978-1981 Associate Professor of Psychiatry, University of Iowa 

School of Medicine, Iowa City, IA 

Cicchetti, Domenic V., Ph.D. 1978-1981 VA Medical Center, West Haven, CT 

Fann, William E., M.D. 1978-1983 Chief, Psychiatry Service, VA Medical Center, Houston, TX 

Meier, Manfred, Ph.D. 1979-1982 Professor & Director of Neuropsychology Lab, University of 

Minnesota School of Medicine, Minneapolis, MN 

Rush, John, M.D. 1979-1982 Associate Professor, University of Texas, Southwestern Medical 

School, Dallas, TX 

Winokur, Andy, M.D. 1979-1982 Assistant Professor of Psychiatry, University of Pennsylvania 

School of Medicine, Philadelphia, PA 

Gentry, W. Doyle, Ph.D. 1980-1983 Professor of Psychiatry & Behavioral Science, University of 

Texas Medical Branch, Galveston, TX 

Kramer, Milton, M.D. 1980-1983 Assistant Chief, Psychiatry Service, VA Medical Center, 

Cincinnati, OH 

Maxim, Peter E., M.D., Ph.D. 1980-1983 Associate Professor of Psychiatry and Behavioral 

Sciences, University of Washington School of Medicine, Seattle, WA 

Merit Review Board for Cardiovascular Studies 

Dodge, Harold T., M.D. 1972-1975 Professor of Medicine, University of Washington School of 

Medicine, Seattle, WA 

Chairman 1972-1975 

LXV
 
 

 

 

Parmley, William W., M.D. 1975-1978 Professor of Medicine, University of California School of 

Medicine, San Francisco, CA 

Chairman, 1976-1978 

Pitt, Bertram, M.D. 1978-1981 Professor of Medicine, University of Michigan School of Medicine, 

Ann Arbor, MI 

Chairman, 1979-1981 

Abboud, Francois M., M.D. 1972-1975 Professor of Medicine, University of Iowa School of 

Medicine, Iowa City, IA 

Angell, William W., M.D. 1972-1975 Chief, Cardiovascular Surgery, Santa Clara Valley Medical 

Center, San Jose, CA 

Cohn, Jay N., M.D. 1972-1975 Chief, Hypertension and Clinical Hemodynamics Research, VA 

Hospital, Washington, DC, later Professor of Medicine, University of Minnesota School of 

Medicine, Minneapolis, MN 

Dammann, J. Francis, Jr., M.D. 1972-1975 Director of Pediatric Cardiology Research, University of 

Virginia School of Medicine, Charlottesville, VA 

Fozzard, Harry A., M.D. 1972-1975 Professor of Medicine and Physiology, University of Chicago 

School of Medicine, Chicago, IL 

Luchi, Robert J., M.D. 1972-1975 Chief, Medical Service, VA Hospital, Houston, TX 

Mitchell, Jere H., M.D. 1972-1975 University of Texas, Southwestern Medical School, Dallas, TX 

Ross, Richard S., M.D. 1972 Professor of Medicine, Johns Hopkins University School of Medicine, 

Baltimore, MD 

Tarazi, Robert C., M.D. 1972-1975 Staff Member, Research Division, Cleveland Clinic, Cleveland, 

OH 

Thomas, Wilbur A., M.D. 1972-1975 Professor of Pathology, Albany Medical College, Albany NY 

Wallace, Andrew G., M.D. 1972-1975 Professor of Medicine, Duke University Medical School, 

Durham, NC 

Zimmerman, Ben George, Ph.D. 1972-1975 Associate Professor of Pharmacology, University of 

Minnesota Medical School, Minneapolis, MN 

Frohlich, Edward D., M.D. 1974-1977 Vice President for Research and Education, Alton Ochsner 

Medical Foundation, New Orleans, LA 

LXVI
 
 

 

 

Harrison, Donald C., M.D. 1975-1978 Professor of Medicine, Stanford University School of 

Medicine, Stanford, CA 

Nies, Alan S., M.D. 1975-1978 Associate Professor of Pharmacology and Medicine, Vanderbilt 

University School of Medicine, Nashville, TN 

Boineau, John P., M.D. 1976-1979 Chief of Cardiology, VA Hospital, Augusta, GA 

Knoebel, Suzanne B., M.D. 1976-1979 Staff Physician, VA Hospital, Professor of Medicine, 

Indiana University School of Medicine, Indianapolis, IN 

Morad, Martin, Ph.D. 1976-1979 Associate Professor of Physiology, University of Pennsylvania 

School of Medicine, Philadelphia, PA 

Rolett, Ellis L., M.D. 1976-1979 Chief, Cardiology Section, VA Center, Wadsworth, Los Angeles, 

CA, later Professor of Medicine, Dartmouth University Medical School, Hanover, NH 

Gunnar, Rolf M., M.D. 1977-1980 Professor of Medicine, Loyola University Stritch School of 

Medicine, Maywood, IL 

Sambhi, Mohinder P., M.D., Ph.D., 1977-1980 Chief, Hypertensive Division, VA Hospital, 

Sepulveda, CA 

DeMaria, Anthony, M.D., 1978-1982 Associate Professor of Medicine, University of California 

School of Medicine, Davis, CA 

Halushka, Perry V., M.D., Ph.D. 1978-1981 Associate Professor of Pharmacology and Medicine, 

Medical University of South Carolina, Charleston, SC 

Herman, Michael V., M.D. 1978-1981 Chief, Division of Cardiology, Mt. Sinai School of 

Medicine, New York, NY, later New York Medical College, Valhalla, NY 

Holt, John H. Jr., M.D. 1979-1982 Chief, Cardiology Section, VA Medical Center, Birmingham, 

AL 

Horwitz, Lawrence D., M.D. 1979-1982 Professor of Medicine, University of Colorado School of 

Medicine, Denver, CO 

Lazzara, Ralph, M.D. 1979-1982 Chief, Cardiovascular Section, VA Medical Center, Professor of 

Medicine, University of Oklahoma School of Medicine, Oklahoma City, OK 

Ullrick, William C., Ph.D. 1979-1982 Professor of Physiology, Boston University School of 

Medicine, Boston, MA 

LXVII
 
 

 

 

Douglas, Janice G., M.D. 1980-1983 Associate Professor of Medicine, Case Western University 

School of Medicine, Cleveland, OH 

Kerber, Richard, M.D. 1980-1983 Professor of Medicine, University of Iowa School of Medicine, 

Iowa City, IA 

Merit Review Board for Endocrinology 

Cahill, George F., Jr., M.D. 1972-1975, Professor of Medicine, Harvard Medical School, Boston, 

MA 

Chairman, 1972-1975 

Raisz, Lawrence G., M.D. 1974-1977, Professor of Medicine, University of Connecticut School of 

Medicine, Farmington, CT 

Chairman, 1974-1977 

Lockwood, Dean, M.D. 1976-1979, Professor of Medicine, University of Rochester School of 

Medicine, Rochester, NY 

Chairman, 1977-1979 

Mulrow, Patrick, M.D. 1978-1981, Professor and Chairman, Department of Medicine, Medical 

College of Ohio, Toledo, OH 

Chairman, 1979-1981 

Doe, Richard, M.D., Ph.D. 1972-1975 Professor of Medicine, University of Minnesota School of 

Medicine, Minneapolis, MN 

Heaney, R. P., M.D. 1972-1975 Vice President for Health Sciences, Creighton University, Omaha, 

NE 

Hershman, Jerome, M.D. 1972-1975 Clinical Investigator, VA Hospital, Birmingham, AL, later 

Chief, Endocrinology, VA Wadsworth Hospital Center, Los Angeles, CA 

Kipnis, David M., M.D. 1972-1975 Head, Endocrinology & Metabolism, later Chairman, 

Department of Medicine, Washington University School of Medicine, St. Louis, MO 

Lipsett, Mortimer B., M.D. 1972-1975 Associate Scientific Director, NICHD, National Institutes of 

Health, Bethesda, MD 

Nelson, Donald H., M.D. 1972-1975 Professor of Medicine, University of Utah School of 

Medicine, Salt Lake City, UT 

Porte, Daniel, Jr., M.D. 1972-1975 Associate Chief of Staff, VA Hospital, Seattle, WA 

LXVIII
 
Steiner, Donald F., M.D. 1972-1975 Professor of Biochemistry, University of Chicago, Chicago, IL 

Utiger, Robert, M.D. 1972-1975 Associate Professor of Medicine, University of Pennsylvania 

School of Medicine, Philadelphia, PA 

Orth, David N., M.D. 1974-1977 Professor of Medicine, Vanderbilt University School of Medicine, 

Nashville, TN 

Spritz, Norton, M.D. 1974-1977 Chief, Medical Service, VA Hospital, New York, NY 

Melby, James C., M.D. 1975-1978 Professor of Medicine, Boston University School of Medicine, 

Boston, MA 

Nuttall, Frank Q., M.D., Ph.D. 1975-1978 Chief, Endocrine and Metabolism Section, VA Hospital, 

Minneapolis, MN 

Sussman, Karl, M.D. 1975-1978 Staff Physician, VA Hospital, and Professor of Medicine, 

University of Colorado School of Medicine, Denver, CO 

Woeber, Kenneth A., M.D. 1975-1978 Professor of Medicine, University of California School of 

Medicine, San Francisco, CA 

Anast, Constantine S., M.D. 1976-1979 Associate Chief of Staff for Research, VA Hospital, 

Columbia, MO 

Horton, Richard, M.D. 1976-1979 Professor of Medicine, University of Southern California School 

of Medicine, Los Angeles, CA 

Surks, Martin I., M.D. 1976-1979 Head, Division of Endocrinology and Metabolism, Montefiore 

Hospital Medical Center, Bronx, NY 

Krieger, Dorothy T., M.D. 1977-1978 Professor of Medicine, Mt. Sinai School of Medicine, New
 

York, NY
 

Lukert, Barbara P., M.D. 1977-1980 Associate Professor of Medicine, University of Kansas School 

of Medicine, Kansas City, KS 

Reaven, Gerald M., M.D. 1977-1980 Medical Investigator, VA Hospital, Palo Alto, CA 

Braverman, Lewis, M.D. 1978-1981 Professor of Medicine, University of Massachusetts School of 

Medicine, Worcester, MA 

LXIX
 
 

 

Solomon, Solomon S., M.D. 1978-1981 Chief, Endocrinology & Metabolism Section, VA Medical 

Center, Memphis, TN 

Chase, Lewis R., M.D. 1979-1982 Chief, Unit 1, Medical Service, VA Medical Center, St. Louis, 

MO 

Frohman, Lawrence A., M.D. 1979-1982 Director, Division of Endocrinology, Michael Reese 

Medical Center, Chicago, IL 

Kourides, Ione A., M.D. 1979-1982 Member, Sloan-Kettering Cancer Center, New York, NY 

Pollet, Robert J., M.D. 1979-1982 Assistant Chief, Endocrinology and Metabolism, VA Medical 

Center, Tampa, FL 

Troen, Philip, M.D. 1979-1982 Department of Medicine, Montefiore Hospital, Pittsburgh, PA 

Arnaud, Claude, M.D. 1980-1983 Chief of Endocrinology , VA Medical Center, San Francisco, CA 

Blackard, William G., M.D. 1980-1983 Professor of Medicine, Medical College of Virginia, 

Richmond, VA 

Merit Review Board for Gastroenterology 

Trier, Jerry S., M.D. 1972-1975 Associate Professor of Medicine, Boston University School of 

Medicine, later Professor of Medicine, Harvard Medical School, Boston, MA 

Chairman, 1972-1975 

Kaplan, Marshall M., M.D. 1974-1977 Professor of Medicine, Tufts University School of Medicine, 

Boston, MA 

Chairman, 1975-1977 

Fallon, Harold J., M.D. 1976-1979 Professor & Chairman, Department of Medicine, Medical 

College of Virginia, Richmond, VA 

Chairman, 1977-1979 

Powell, Don W., M.D. 1977-1980 Professor of Medicine, University of North Carolina School of 

Medicine, Chapel Hill, NC 

Chairman, 1979-1980 

Ostrow, J. Donald, M.D. 1979-1982 Chief, Gastroenterology Section, VA Medical Center 

(Lakeside), Chicago, IL 

Chairman, 1980-1982 

LXX
 
 

 

 

 

 

 

 

Benson, John A. Jr., 1972-1975 Professor of Medicine, University of Oregon Medical School, 

Portland, OR 

Conn, Harold O., M.D. 1972-1975 Chief, Liver Disease Section, VA Hospital, West Haven, CT 

Englert, Edwin, Jr., M.D. 1972-1975 Chief, Gastroenterology Service, VA Hospital, Seattle, WA 

Gray, Gary M., M.D. 1972-1975 Associate Professor of Gastroenterology, Stanford University 

School of Medicine, Stanford, CA 

McGuigan, James E., M.D. 1972-1975 Professor of Medicine, University of Florida College of 

Medicine, Gainesville, FL 

Moody, Frank G., M.D. 1972-1975 Professor of Surgery, University of Utah Medical Center, Salt 

Lake City, UT 

Palmer, Robert H., M.D. 1972-1975 Associate Professor, Dept. of Medicine, University of Chicago, 

Chicago, IL, later Adjunct Professor, The Rockefeller University, New York, NY 

Pope, Charles E. II, M.D. 1972-1975 Chief, Gastroenterology Service, VA Hospital, Seattle, WA 

Rubin, Walter M., M.D. 1972-1975 Professor of Medicine, The Medical College of Pennsylvania, 

Philadelphia, PA 

Schoenfield, Leslie J., M.D., Ph.D. 1972-1973 Director, Gastroenterology, Cedars of Lebanon 

Hospital, Los Angeles, CA 

Scheig, Robert, M.D. 1972-1975 Associate Dean, Regional Activities, Yale University School of 

Medicine, New Haven, CT, later Chief, Medical Service, VA Hospital, Newington, CT 

Soergel, Konrad H., M.D. 1972-1975 Professor of Medicine, Milwaukee County General Hospital, 

Milwaukee, WI 

Winship, Daniel H., M.D. 1972-1975 Associate Professor of Medicine, University of Missouri 

Medical Center, Columbia, MO 

Hendrix, Thomas R., M.D. 1974-1977 Professor of Medicine, The Johns Hopkins University 

School of Medicine, Baltimore, MD 

Morrissey, John F., M.D. 1974-1977 Professor of Medicine, University of Wisconsin School of 

Medicine, Madison, WI 

Phillips, Sidney F., M.D. 1974-1977 Associate Professor of Medicine, Mayo Medical School, 

Rochester, MN 

LXXI
 
 

 

Cohen, Sidney, M.D. 1975-1978 Associate Professor of Medicine, University of PA School of 

Medicine, Philadelphia, PA 

Jones, Albert L., M.D. 1975-1978 Chief, Cell Biology Laboratory, VA Hospital, San Francisco, CA 

Singleton, John, M.D. 1975-1978 Associate Professor of Medicine, University of Colorado Medical 

School, Denver, CO 

Adibi, Siamak, M.D., Ph.D. 1976-1979 Chief, Gastroenterology & Nutrition, Montefiore Hospital, 

Pittsburgh, PA 

Alpers, David H., M.D., 1976-1979 Professor of Medicine, Washington University School of 

Medicine, St. Louis, MO 

Grundy, Scott M., M.D. 1976-1979 Chief, Metabolism Section, VA Hospital, San Diego, CA 

Isenberg, Jon, M.D. 1976-1979 Chief, Gastroenterology Service, VA Center (Wadsworth), Los 

Angeles, CA 

Giannella, Ralph A., M.D. 1977-1980 Chief, Gastrointestinal Section, VA Hospital, Lexington, KY 

Gregory, Peter B., M.D. 1977-1980 Associate Professor of Medicine, Stanford University School of 

Medicine, Stanford, CA 

Silverstein, Fred E., M.D. 1977-1980 Associate Professor of Medicine, University of Washington 

School of Medicine, Seattle, WA 

Beeken, Warren L., M.D. 1978-1981 Professor of Medicine, University of Vermont School of 

Medicine, Burlington, VT 

Behar, Jose, M.D. 1978-1981 Assistant Professor of Medicine, Rhode Island Hospital, Providence, 

RI 

Ito, Susumu, Ph.D. 1978-1981 Professor of Anatomy, Harvard Medical School, Boston, MA 

Hanson, Russell F., M.D. 1979-1982 Associate Professor of Medicine, University of Minnesota 

Medical School, Minneapolis, MN 

Schedl, Harold P., M.D. 1979-1982 Professor of Medicine, University of Iowa College of Medicine, 

Iowa City, IA 

Spenny, Jerry G., M.D. 1979-1982 Chief, Gastroenterology Research, VA Medical Center, 

Birmingham, AL 

LXXII
 
 

 

Binder, Henry J., M.D. 1980-1983 Professor of Medicine, Yale University School of Medicine, 

New Haven, CT 

Goyal, Raj K., M.D. 1980-1983 Professor of Medicine, University of Texas Health Science Center, 

San Antonio, TX 

Lester, Roger, M.D. 1980-1983 Professor of Medicine, University of Texas Health Science Center, 

Houston, TX 

Jensen, Dennis M., M.D. 1980-1983 Staff Physician, Gastroenterology Section, VA Medical 

Center(Wadsworth), and Assistant Professor of Medicine, University of California School of 

Medicine, Los Angeles, CA 

Merit Review Board for Hematology 

Harrington, William J., M.D. 1972-1975 Professor of Medicine, University of Miami School of 

Medicine, Miami, FL 

Chairman, 1972-1975 

Haut, Arthur, M.D. 1974-1977 Professor of Medicine, University of Arkansas School of Medicine, 

Little Rock, AK 

Chairman, 1975-1977 

Allen, Robert H., M.D. 1975-1978 Associate Professor of Medicine, Washington University School 

of Medicine, St. Louis, MO, later Professor of Medicine, University of Colorado School of 

Medicine, Denver, CO 

Chairman, 1977-1978 

Harris, John W., M.D. 1977-1980 Professor of Medicine, Case Western Reserve School of 

Medicine, Cleveland, OH 

Chairman, 1978-1980 

Robinson, Stephen H., M.D. 1979-1982 Professor of Medicine, Harvard Medical School, Boston, 

MA 

Chairman, 1980-1982 

Conley, C. Lockard, M.D. 1972-1975 Professor of Medicine, Johns Hopkins University, School of 

Medicine, Baltimore, MD 

Finch, Stuart C., M.D. 1972-1975 Professor of Medicine, Yale University School of Medicine, New 

Haven, CT 

Hall, Charles A., M.D. 1972-1975, 1978-1981 Medical Investigator, VA Hospital, Albany, NY 

LXXIII
 
 

 

 

 

Jaffe, Ernest, M.D. 1972-1975 Professor of Medicine, Albert Einstein College of Medicine, Bronx, 

NY 

Kaplan, Manuel, M.D. 1972-1975 Chief, Hematology Section, VA Hospital, Minneapolis, MN 

Masouredis, Serafeim, M.D., Ph.D. 1972-1975 Professor of Pathology, University of California 

School of Medicine, San Diego, CA 

Spaet, Theodore H., M.D. 1972-1975 Head, Department of Hematology, Montefiore Hospital & 

Medical Center, Bronx, NY 

Stohlman, Frederick, Jr., M.D. 1972-1975 Director of Medicine, Research & Hematology, St. 

Elizabeth’s Hospital, Brighton, MA 

Marcus, Aaron J., M.D. 1974-1977 Chief, Hematology Section, VA Hospital, New York, NY 

Sheehy, Thomas W., M.D. 1974-1977 Chief, Medical Service, VA Hospital, Birmingham, AL 

Bank, Arthur, M.D. 1975-1978 Professor of Medicine, Columbia University College of Physicians 

and Surgeons, New York, NY 

Boggs, Dane R., M.D. 1975-1978 Professor of Medicine, University of Pittsburgh School of 

Medicine, Pittsburgh, PA 

Rosenfield, Richard E., M.D. 1975-1978 Professor of Pathology, Mount Sinai Medical School, New 

York, NY 

Miller, Kent D., M.D., Ph.D. 1976-1979 Professor of Medicine, University of Miami School of 

Medicine, Miami, FL 

Furie, Barbara C., Ph.D. 1977-1980 Assistant Professor of Medicine, Tufts University School of 

Medicine, Boston, MA 

Shattil, Sanford J., M.D. 1977-1980 Chief, Hematology, VA Medical Center, Phildelphia, PA 

Bove, Joseph R., M.D. 1978-1981 Professor of Laboratory Medicine, Yale University School of 

Medicine, New Haven, CT 

Golde, David W., M.D. 1978-1980 Department of Medicine, University of California, Los Angeles, 

Los Angeles, CA 

Kan, Yuet Wai, M.D. 1978-1981 University of California School of Medicine, San Francisco, CA 

LXXIV
 
 

Johnson, Gerhard, M.D. 1980-1983 Hematology Section, VA Medical Center, Minneapolis, MN 

Menache-Aronson, Doris, M.D. 1980-1983 Associate Director, Blood Services Laboratories, 

Bethesda, MD 

Merit Review Board For Immunology 

Plotz, Charles, M.D., Med.Sc.D. 1972-1975 Professor of Medicine, State University of New York 

School of Medicine Brooklyn, NY 

Chairman, 1972-1975 

Butler, Vincent P., Jr., M.D., 1974-1977 Professor of Medicine, Columbia University College of 

Physicians and Surgeons, New York, NY 

Chairman, 1975-1977 

Gill, Thomas J., III, M.D. 1976-1979 Professor and Chairman, Department of Pathology, University 

of Pittsburgh School of Medicine, Pittsburgh, PA 

Chairman, 1977-1979 

Spitler, Lynn E., M.D. 1977-1980 Director, Laboratory of Cellular Immunology, Children’s 

Hospital of San Francisco, San Francisco, CA 

Chairman, 1979-1980 

Ward, Peter A., 1979-1982 Professor and Chairman, Department of Pathology, University of 

Connecticut School of Medicine, Farmington, CT, later Professor and Chairman, Department of 

Pathology, University of Michigan School of Medicine, Ann Arbor, MI 

Chairman, 1980-1982 

Baum, John, M.D. 1972-1975 Professor of Medicine, University of Rochester School of Medicine, 

Rochester, NY 

Bennett, J. Claude, M.D. 1972-1975 Professor of Medicine, University of Alabama School of 

Medicine, Birmingham, AL 

Braun, William E., M.D. 1972-1975 Director of Research and Histocompatibility Laboratory, 

Cleveland Clinic, Cleveland, OH 

Friou, George J., M.D. 1972-1975 Professor of Medicine University of Southern California School 

of Medicine, Los Angeles, CA 

Hollingsworth, James W., M.D. 1979-1975 Professor of Medicine, University of Kentucky College 

of Medicine, Lexington, KY 

Kaplin, Melvin H., M.D. 1972-1975 Cleveland Metropolitan General Hospital, Cleveland, OH 

LXXV
 
 

 

 

Reichlin, Morris, M.D. 1972-1975 Chief, Clinical Immunology, VA Hospital, Buffalo, NY 

Talal, Norman, M.D. 1972-1975 Chief, Clinical Immunology and Arthritis, VA Hospital, San 

Francisco, CA 

Hurd, Eric R., M.D. 1974-1977 Associate Professor of Medicine, University of Texas South 

Western Medical School, Dallas, TX 

Rapaport, Felix T., M.D. 1974-1977 Professor of Surgery, New York University School of 

Medicine, New York, NY 

Sharp, Gordon C., M.D. 1975-1978 Professor of Medicine, University of Missouri School of 

Medicine, Columbia, MO 

Stroud, Robert, M., M.D. 1975-1978 Professor of Medicine, University of Alabama School of 

Medicine, Birmingham, AL 

Yoo, Tai June, M.D. 1975-1978 Staff Physician, VA Hospital and Associate Professor of Medicine, 

University of Iowa College of Medicine, Iowa City, IA 

Chess, Leonard, M.D. 1976-1980 Assistant Professor of Medicine, Harvard Medical School, 

Boston, MA, later Associate Professor of Medicine, Columbia University College of Physicians and 

Surgeons, New York, NY 

Winchester, Robert, J., M.D. 1976-1979 Associate Professor of Immunology, Rockefeller 

University, New York, NY 

Barnett, Eugene V., M.D. 1977-1980 Professor of Medicine, University of California School of 

Medicine, Los Angeles, CA 

Kreider, John, W., M.D. 1977-1980 Associate Professor of Pathology, Pennsylvania State 

University College of Medicine, Hershey, PA 

Monaco, Anthony P., M.D. 1977-1980 Associate Professor, later Professor, of Surgery, Harvard 

Medical School, Boston, MA 

Gligli, Irma, M.D. 1978-1979 Professor of Dermatology and Experimental Medicine, New York 

University School of Medicine, New York, NY 

Grant, J. Andrew, M.D. 1978-1981 Associate Professor of Medicine and Genetics, University of 

Texas Medical Branch, Galveston, TX 

Schur, Peter H., M.D. 1978-1981 Associate Professor, later Professor of Medicine, Harvard Medical 

School, Boston, MA 

LXXVI
 
 

Ferrone, Soldano, M.D. 1979-1982 Associate Member, Department of Molecular Immunology, 

Scripps Clinic and Research Foundation, La Jolla, CA 

Rabin, Bruce S., M.D. 1980-1983 Associate Professor of Pathology, University of Pittsburgh 

School of Medicine, Pittsburgh, PA 

Rosenberg, Jerry C., M.D. 1980-1983 Professor of Surgery, Wayne State University School of 

Medicine, Detroit, MI 

Stevens, Mary B., M.D. 1980 – 1983 Associate Professor of Medicine, Johns Hopkins University 

School of Medicine, Baltimore, MD 

Tubergen, David G., M.D. 1980-1983 Associate Professor of Pediatrics, University of Colorado 

School of Medicine, Denver, CO 

Merit Review Board for Infectious Diseases 

Jackson, George G., M.D. 1972-1975 Professor of Medicine, University of Illinois School of 

Medicine, Chicago, IL 

Chairman, 1972-1975 

Gorbach, Sherwood L., M.D. 1974-1977 Professor of Medicine, Tufts University School of 

Medicine, Boston, MA 

Chairman, 1975-1977 

Andriole, Vincent, M.D. 1975-1978 Professor of Medicine, Yale University School of Medicine, 

New Haven, CT 

Chairman, 1977-1978 

Mandell, Gerald L., MD. 1977-1980 Associate Professor, later Professor of Medicine, University of 

Virginia Medical School, Charlottesville, VA 

Chairman, 1978-1980 

Douglas, R. Gordon, Jr., M.D. 1979-1982 Professor of Medicine and Microbiology, University of 

Rochester School of Medicine, Rochester, NY 

Chairman, 1980-1982 

Couch, Robert, M.D. 1972-1975 Professor of Microbiology and Medicine, Baylor College of 

Medicine, Houston, TX 

Des Prez, Roger, M.D. 1972-1975 Chief, Medical Service, VA Hospital, Nashville, TN 

LXXVII
 
 

 

Finegold, Sydney, M.D. 1972-1975 Chief, Infectious Disease Section, VA Hospital (Wadsworth), 

Los Angeles, CA 

Kass, Edward Harold, M.D. 1972-1975 Director, Channing Laboratory, Boston City Hospital, 

Boston, MA 

Kunin, Calvin, M.D. 1972-1975 Chief, Medical Service, VA Hospital, Madison, WI 

Remington, Jack S., M.D. 1972-1975 Associate Professor of Medicine, Stanford University 

School of Medicine, Palo Alto, CA 

Sanders, W. Eugene, Jr., M.D. 1972-1975 Associate Professor of Medicine and Immunology, 

University of Florida School of Medicine, Gainesville, FL, later Professor and Chairman, 

Department of Medical Microbiology, Creighton University School of Medicine, Omaha NE 

Allen, James C., M.D. 1974-1977 Professor of Medicine, State University of New York School of 

Medicine, Buffalo, NY 

Medoff, Gerald, M.D. 1974-1977 Professor of Medicine, Washington University School of 

Medicine, St. Louis, MO 

Alford, Robert H., M.D. 1975-1978 Chief, Infectious Disease Section, VA Hospital, Nashville, TN 

Weissmann, Gerald, M.D. 1975-1978 Professor of Medicine, New York University School of 

Medicine, New York, NY 

Kaye, Donald, M.D. 1976-1979 Professor and Chairman, Department of Medicine, Medical College 

of Pennsylvania, Philadelphia, PA 

Stevens, Jack G., D.V.M., Ph.D. 1976-1979 Reed Neurological Research Center, University of 

California School of Medicine, Los Angeles, CA 

Waldman, Robert H., M.D. 1976-1979 Professor and Chairman, Department of Medicine, 

University of West Virginia School of Medicine, Morgantown, WV 

Abernathy, Robert S., M.D. 1977-1980 Professor of Medicine, University of Arkansas for Medical 

Sciences, Little Rock, AR 

Hirschman, Shalom Z., M.D. 1977-1980 Professor of Medicine, Mt. Sinai School of Medicine, New 

York, NY 

Norden, Carl W., M.D. 1978-1981 Montefiore Hospital, Pittsburgh, PA 

LXXVIII
 
 

 

Phair, John P., M.D. 1978-1981 Professor of Medicine, Northwestern University Medical School, 

Chicago, IL 

Sheagren, John N., M.D. 1978-1981 Chief, Medical Service, VA Medical Center, Ann Arbor, MI 

Sparling, Philip F., M.D. 1979-1981 Professor of Medicine and Bacteriology, University of North 

Carolina School of Medicine, Chapel Hill, NC 

Washington, John A. II, M.D. 1979-1982 Head, Clinical Microbiology Section, Mayo Clinic, 

Rochester, MN 

White, Arthur Clinton, M.D. 1979-1982 Chief, Infectious Deseases Section, VAMC and Professor 

of Medicine, Indiana University School of Medicine, Indianapolis, IN 

Apicella, Michael A., M.D. 1980-1983 Professor of Medicine, University of Nevada School of 

Medicine, Reno, NV 

Bennett, John E., M.D. 1980-1983 Head, Clinical Mycology Section, National Institute for Allergy 

and Infectious Diseases, Bethesda, MD 

Clark, Robert A., M.D. 1980-1983 Associate Professor of Medicine, Boston University School of 

Medicine, Boston, MA 

Merit Review Board for Nephrology 

Schreiner, George E., M.D. 1972-1975 Professor of Medicine, Georgetown University School of 

Medicine, Washington, DC 

Chairman, 1972-1975 

Suki, Wadi N., M.D. 1974-1977 Professor of Medicine, Baylor College of Medicine, Houston, TX 

Chairman, 1975-1977 

Kirkendall, Walter M., M.D. 1975-1978 Professor of Medicine, University of Texas Medical 

School, Houston, TX 

Chairman, 1977-1978 

Hayslett, John P., M.D. 1976-1979 Associate Professor of Medicine, Yale University School of 

Medicine, New Haven, CT 

Chairman, 1978-1979 

Kjellstrand, Carl M., M.D. 1978-1981 Professor of Medicine and Surgery, University of Minnesota 

School of Medicine, Minneapolis, MN 

Chairman, 1979-1981 

LXXIX
 
 

 

 

Eknoyan, Garabed, M.D. 1972-1975 Staff Physician, VA Hospital, Houston, TX 

Galletti, Pierre M., M.D. 1972-1975 Professor of Medicine, Biology & Medical Science, later Vice 

President for Biology and Medicine, Brown University, Providence, RI 

Kountz, Samuel, M.D. 1972-1975 Associate Professor of Surgery, University of California School 

of Medicine, San Francisco, CA, later Chairman, Dept. of Surgery, State University of New York 

College of Medicine, Brooklyn, NY 

Lavender, A. R., M.D. 1972-1975 Chief, Renal Section, VA Medical Center, Hines, IL 

Ogden, David A., M.D. 1972-1975 Chief, Renal Section, VA Medical Center, Tucson, AZ 

Seldin, Donald W., M.D. 1972-1973 Professor of Medicine, The University of Texas, Southwestern 

Medical School, Dallas, TX 

Robinson, Roscoe R., M.D. 1973-1976 Professor of Medicine, Duke University School of 

Medicine, Durham, NC 

Coburn, Jack W., M.D. 1975-1978 Chief, Nephrology Section, VA Medical Center (Wadsworth), 

Los Angeles, CA 

Friedman, Eli A., M.D. 1975-1978 Professor of Medicine, State University of New York School of 

Medicine, Brooklyn, NY 

Vaamonde, Carlos A., M.D. 1975-1978 Chief, Nephrology Section, VA Medical Center, Miami, FL 

Foulkes, Ernest C., M.D. 1976-1979 Professor of Environmental Health and Physiology, University 

of Cincinnati Medical School, Cincinnati, OH 

Stein, Jay H., M.D. 1976-1978 Professor of Medicine, University of Texas Health Science Center, 

San Antonio, TX 

Purkerson, Mabel L., M.D. 1977-1980 Associate Professor of Medicine, Washington University 

School of Medicine, St. Louis, MO 

Hoyer, John R., M.D. 1978-1981 Associate Professor of Pediatrics, Harvard Medical School, 

Boston, MA 

Massry, Shaul G., M.D. 1978-1981 Professor of Medicine, University of Southern California 

School of Medicine, Los Angeles, CA 

Weinman, Edward J., M.D. 1978-1981 Chief, Renal Section, VA Medical Center, Houston, TX 

LXXX
 
 

Kurtzman, Neil A., M.D. 1979-1982 Professor of Medicine, University of Illinois School of 

Medicine, Chicago, IL 

Navar, Luis G., Ph.D. 1979-1982 Professor of Physiology and Biophysics, University of Alabama 

Medical School, Birmingham, AL 

Di Bona, Gerald F., M.D. 1980-1983 Chief, Medical Service, VA Medical Center, Iowa City, IA 

Epstein, Murray, M.D. 1980-1983 Associate Director, Nephrology, VA Medical Center, Miami, FL 

Merit Review Board for Neurobiology 

Weiner, Norman, M.D. 1972-1975 Professor of Pharmacology, University of Colorado School of 

Medicine, Denver, CO 

Chairman 1972-1975 

Standaert, Frank G., M.D. 1974-1977 Chairman, Department of Pharmacology, Georgetown 

University School of Medicine and Dentistry, Washington, D.C. 

Chairman 1975-1977 

Glaser, Gilbert H., M.D. 1975-1978 Professor & Chairman, Department of Neurology, Yale 

University School of Medicine, New Haven, CT 

Chairman 1977-1978 

Anderson, Edmund G., Ph.D. 1976-1979 Professor and Chairman, Department of Pharmacology, 

University of Illinois College of Medicine, Chicago, IL 

Chairman 1978-1979 

Bass, Norman H., M.D. 1978-1981 Professor of Neurology, University of Virginia Medical School, 

Charlottesville, VA, later Professor and Chairman, Department of Neurology, University of 

Kentucky School of Medicine, Lexington, KY 

Chairman, 1979-1981 

Asbury, Arthur, M.D. 1972-1975 Chief, Neurology Service, VA Hospital, San Francisco, CA, later 

Professor and Chairman, Department of Neurology, University of Pennsylvania School of 

Medicine, Philadelphia, PA 

Barondes, Samuel, M.D. 1972-1975 Professor of Psychiatry, University of California School of 

Medicine, San Diego, CA 

Efron, Robert, M.D., 1972-1975 Associate Chief of Staff, Research and Education, VA Hospital, 

Martinez, CA and Professor of Neurology, University of California School of Medicine, Davis, CA 

LXXXI
 
 

 

 

 

 

 

Ferrendelli, J.A., M.D. 1972-1975 Assistant Professor of Pharmacology and Neurology, 

Washington University Medical School, St. Louis, MO 

Hollien, Harry, Ph.D. 1972-1975 Professor, Communication Sciences Laboratory, University of 

Florida, Gainesville, FL 

Kornetsky, Conan, Ph.D. 1972-1975 Professor of Psychiatry (Psychology) and Pharmacology, 

Boston University School of Medicine, Boston, MA 

Lajtha, Abel, Ph.D. 1972-1975 N.Y. State Research Institute for Neurochemistry and Drug 

Addiction, Dept. of Mental Hygiene, State of N.Y., Ward’s Island, N.Y. 

Quarton, Gardner C., M.D. 1972-1975 Director, Mental Health Research Institute, The University 

of Michigan, Ann Arbor, MI 

Segundo, Jose P., M.D. 1972-1975 Department of Anatomy, University of California School of 

Medicine, Los Angeles, CA 

Welch, Keasley, M.D. 1972-1975 Professor of Neurosurgery, Harvard Medical School, Boston, MA 

Woodbury, Dixon M., M.D. 1972-1975 Professor of Pharmacology, University of Utah College of 

Medicine, Salt Lake City, UT 

Ziegler, Dewey, M.D. 1972-1975 Professor of Medicine and Neurology, University of Kansas 

School of Medicine, Kansas City, KS 

Chow, Kao Liang, Ph.D. 1974-1977 Professor of Neurology, Stanford University School of 

Medicine, Palo Alto, CA 

Teas, Donald C., Ph.D. 1974-1977 Professor, Department of Speech, Communications Sciences 

Laboratory, University of Florida, Gainesville, FL 

Lasek, Raymond J., Ph.D. 1975-1978 Associate Professor of Anatomy, Case Western Reserve 

University School of Medicine, Cleveland, OH 

O’Reilly, Sean, M.D. 1975-1978 Professor of Neurology, The George Washington University 

School of Medicine, Washington, DC 

Rosomoff, Hubert, M.D. 1975-1978 Professor and Chairman, Department of Neurological Surgery, 

University of Miami School of Medicine, Miami, FL 

Alksne, John F., M.D. 1976-1979 Professor of Neurosurgery, University of California School of 

Medicine, San Diego, CA 

LXXXII
 
 

 

 

 

Hogan, Edward L., M.D. 1976-1979 Professor and Chairman, Department of Neurology, Medical 

University of South Carolina, Charleston, SC 

Kornfeld, Mario, M.D. 1976-1979 Associate Professor of Pathology, University of New Mexico 

School of Medicine, Albuquerque, NM 

Zomzely-Neurath, Claire E., D.Sc. 1976-1979 Assistant Member, Department of Biochemistry, 

Roche Institute for Molecular Biology, Nutley, NJ 

Kennedy, Thelma T., Ph.D. 1977-1980 Professor of Physiology and Biophysics, University of 

Washington School of Medicine, Seattle, WA 

Killam, Eva K., Ph.D. 1977-1978 Professor of Pharmacology, University of California School of 

Medicine, Davis, CA 

Mirsky, Allan F., Ph.D. 1977-1980 Professor of Psychiatry and Neurology, Boston University 

School of Medicine, Boston, MA 

Viemeister, Neil, Ph.D. 1977-1980 Associate Professor of Psychology, University of Minnesota, 

Minneapolis, MN 

Forman, David S., Ph.D. 1978-1981 Naval Medical Research Institute, National Naval Medical 

Center, Bethesda, MD 

Grossman, Robert G., M.D. 1978-1981 Professor of Neurosurgery, University of Texas Medical 

Branch at Galveston, Galveston, TX 

Seiden, Lewis S., Ph.D. 1978-1981 Professor of Pharmacology and Physiological Science, 

University of Chicago School of Medicine, Chicago, IL 

Gonatas, Nicholas K., M.D. 1979-1982 Professor of Pathology, University of Pennsylvania School 

of Medicine, Philadelphia, PA 

Mayer, Richard F., M.D. 1979-1982 Acting Chairman, Department of Neurology, University of 

Maryland School of Medicine, Baltimore, MD 

North, Richard A., M.D. 1979-1982 Associate Professor of Pharmacology, Stritch School of 

Medicine, Loyola University, Maywood, IL 

Passonneau, Janet V., Ph.D. 1979-1982 Chief, Laboratory of Neurochemistry, NINCDS, National 

Institutes of Health, Bethesda, MD 

LXXXIII
 
 

 

 

 

Sypert, George, M.D. 1979-1982 Staff Neurologist, VA Medical Center, and Associate Professor, 

later Professor, of Neurosurgery and Neurosciences, University of Florida School of Medicine, 

Gainesville, FL 

Henn, Fritz A., M.D., Ph.D. 1980-1983 Associate Professor of Psychiatry, University of Iowa 

School of Medicine, Iowa City, IA 

MacDonald, Robert L., M.D., Ph.D. 1980-1983 Associate Professor of Neurology, University of 

Michigan School of Medicine, Ann Arbor, MI 

Moushegian, George, Ph.D. 1980-1983 Director, Callier Center for Communication Disorders, 

Dallas, TX 

Merit Review Board For Oncology 

Hall, Thomas C., M.D. 1972-1975 Professor of Medicine and Pharmacology, University of 

Rochester School of Medicine and Dentistry, Rochester, NY, later, University of Southern 

California Cancer Center, Los Angeles, CA 

Chairman, 1972-1975 

Goldenberg, David, M.D., Sc.D. 1974-1977 Professor of Pathology, University of Kentucky School 

of Medicine, Lexington, KY 

Chairman, 1975-1977 

Hollinshead, Ariel, Ph.D. 1976-1979 Professor of Medicine, George Washington University School 

of Medicine, Washington, DC 

Chairman, 1977-1979 

Neiderhuber, John E. M.D. 1978-1981 Associate Professor of Surgery and Microbiology, 

University of Michigan School of Medicine, Ann Arbor, MI 

Chairman, 1979-1981 

Greenwald, Peter, M.D. 1972-1975 Director, Cancer Control Bureau, New York State Dept. of 

Health, Albany, NY 

Hammond, William G., M.D. 1972-1975 Chief, Clinical Investigations Branch, Division of Cancer 

Grants, National Cancer Institute, Bethesda, MD, later Chief of Staff, VA Hospital, Sepulveda, CA 

Loeb, Virgil, Jr., M.D. 1972-1975 Associate Professor of Clinical Medicine, Washington University 

School of Medicine, St. Louis, MO 

Morton, Donald, M.D. 1972-1975 Chief, Surgical Service, VA Hospital, Sepulveda, CA 

LXXXIV
 
 

 

 

Nickson, James J., M.D. 1972-1975 Chairman, Radiation Therapy, Michael Reese Hospital, 

Chicago, IL, later Professor of Radiology, University of Tennessee School of Medicine, Memphis, 

TN 

Parry, William L., M.D. 1972-1975 Chief, Urology Service, VA Hospital, Oklahoma City, OK 

Selawry, Oleg, M.D. 1972-1975 Chief, NCI-VA Medical Oncology Service, VA Hospital, 

Washington, DC 

Sherwin, Russell P., M.D. 1972-1975 Professor of Pathology, University of Southern California 

School of Medicine, Los Angeles, CA 

Wolberg, William, M.D. 1972-1975 Professor of General Surgery and Clinical Oncology, 

University of Wisconsin School of Medicine, Madison, WI 

Berg, John W., M.D. 1974-1977 Professor of Preventive Medicine, University of Iowa College of 

Medicine, Iowa City, IA 

Gittes, Ruben F., M.D. 1974-1977 Professor of Urological Surgery, Harvard Medical School, 

Boston, MA 

Fink, Mary A., Ph.D. 1975-1978 Acting Associate Director, Research Program, National Institutes 

of Health, Bethesda, MD 

Gutmann, Helmut R., M.D. 1975-1978 Biochemist, VA Hospital, Minneapolis, MN 

Nathanson, Larry, M.D. 1975-1978 Professor of Medicine, Tufts University School of Medicine, 

Boston, MA 

Talley, Robert W., M.D. 1975-1978 Chief, Division of Oncology, Henry Ford Hospital, Detroit, MI 

Bowen, James M., M.D., Ph.D. 1976-1979 Professor of Virology, M.D. Anderson Hospital, 

Houston, TX 

Mihich, Enrico, M.D. 1976-1979 Director, Department of Experimental Therapeutics, Roswell Park 

Memorial Institute, Buffalo, NY 

Perez, Carlos A., M.D. 1976-1979 Professor of Radiology, Washington University School of 

Medicine, St. Louis, MO 

Fudenberg, Hugh H., M.D. 1977-1980 Professor and Chairman, Department of Basic and Clinical 

Immunology, Medical University of South Carolina, Charleston, SC 

LXXXV
 
 

 

 

Goldstein, Allen L., Ph.D. 1977-1980 Professor of Biochemistry, University of Texas Medical 

Branch, Galveston, TX 

Rosen, Fred, Ph.D. 1977-1980 Associate Director, Grace Cancer Drug Center, Roswell Park 

Memorial Institute, Buffalo, NY 

Yesner, Raymond, M.D. 1977-1980 Chief Laboratory Service, VA Hospital, West Haven, CT 

Yonemoto, Robert H., M.D. 1977-1980 Department of General and Oncological Surgery, City of 

Hope National Medical Center, Duarte, CA 

Cohen, Martin H., M.D. 1978-1981 Assistant Chief, NCI-VA Medical Oncology Branch, VA 

Medical Center, Washington, DC 

Lijinsky, William, Ph.D. 1978-1980 Director, Chemical Carcinogenesis, Frederick Cancer Research 

Center, Frederick, MD 

Lippman, Marc E., M.D. 1978-1981 Head, Medical Breast Cancer Section, National Cancer 

Institute, National Institutes of Health, Bethesda, MD 

Lopez, Diana M., Ph.D. 1979-1982 Associate Professor of Microbiology, University of Miami 

Medical School, Miami, FL 

Parker, Robert G., M.D. 1979-1982 Professor of Radiology, University of California School of 

Medicine, Los Angeles, CA 

Gale, Glen R., Ph.D. 1980-1983 Pharmacologist, VA Medical Center, Charleston, SC 

Hellstrom, Karl E., M.D. 1980-1983 Program Head, Division of Tumor Immunology, Fred 

Hutchinson Cancer Research Institute, Seattle, WA 

Heppner, Gloria H., Ph.D. 1980-1983 Chairman, Department of Immunology, Michigan Cancer 

Foundation, Detroit, MI 

Hilf, Russell, Ph.D. 1980-1983 Professor of Biochemistry, University of Rochester School of 

Medicine, Rochester, NY 

Reddy, Janardan K., M.D. 1980-1983 Professor of Pathology, Northwestern University Medical 

School, Chicago, IL 

Merit Review Board for Oral Biology (1972-1975) 

Sharry, John J., D.M.D. 1972-1975 Dean, Medical University of South Carolina College of Dental 

Medicine, Charleston, SC Chairman 1972-75 

LXXXVI
 
 

 

Boyne, Philip J., D.D.S. 1972-1975 Professor and Chairman of Oral Surgery, University of 

California, Center for the Health Sciences, Los Angeles, CA 

Hefferen, John J., Ph.D. 1972-1975 Director, Division of Biochemistry, American Dental 

Association, Chicago, IL 

Loiselle, Raymond J., D.D.S. 1972-1975 Chief, Dental Service, VA Hospital, Tampa, FL 

MacKenzie, Richard S., D.D.S., Ph.D. 1972-1975 Professor of Dental Education, University of 

Florida College of Dentistry, Gainesville, FL 

Person, Philip, D.D.S., Ph.D. 1972-1975 Medical Investigator, VA Hospital, Brooklyn, N.Y. 

Schiffman, Elliott, Ph.D. 1972-1975 Biochemist, Laboratory of Biochemistry, National Institute of 

Dental Research. Bethesda, MD 

Merit Review Board for Respiration 

Boren, Hollis C., M.D. 1972-1975 Chief, Pulmonary Disease Section, VA Medical Center, Wood, 

WI later Medical Investigator, VA Medical Center, Tampa, FL 

Chairman, 1972-1975 

Snider, Gordon L., M.D. 1975-1978 Chief, Pulmonary Disease Section, VA Medical Center, 

Boston, MA 

Chairman, 1976-1978 

Cohen, Allen B., M.D., Ph.D. 1977-1980 Professor of Medicine, Temple University School of 

Medicine, Philadelphia, PA 

Chairman, 1978-1979 

Wahrenbrock, Eric A., M.D. 1977-1980 Associate Professor of Anesthesia, University of California 

School of Medicine, San Diego, CA 

Chairman, 1979-1980 

Kaltreider, H. Benfer, M.D. 1978-1981 Chief, Respiratory Care, VA Medical Center, San 

Francisco, CA 

Chairman, 1980-1981 

Kettel, Louis J., M.D. 1972-1975 Chief, Pulmonary Disease Section, VA Medical Center, Tucson, 

AZ 

Kilburn, Kaye H., M.D. 1972-1975 Professor of Medicine, Duke University School of Medicine, 

Durham, NC later Chief, Pulmonary Disease, VA Hospital, Columbia, MO 

LXXXVII
 
Kleinerman, Jerome, 1972-1975 Head, Department of Pathology Research and Clinical Pathology, 

St. Lukes Hospital, Cleveland, OH 

Laver, Myron B., M.D. 1972-1973 Dept. of Anesthesiology, Massachusetts General Hospital, 

Boston, MA 

Liebow, Averill A., M.D. 1972-1975 Professor of Pathology, University of California School of 

Medicine, San Diego, CA 

Loudon, Robert G., M.B., Ch.B. 1972-1975 Professor of Medicine, University of Cincinnati School 

of Medicine, Cincinnati, OH 

Ross, Joseph C., M.D. 1972-1975 Professor of Medicine, later Chairman, Department of Medicine, 

Medical University of South Carolina, Charleston, SC 

Said, Sami I., M.D. 1972-1975 Chief, Pulmonary Disease Section, VA Medical Center, Dallas, TX 

Hamilton, Lyle E., Ph.D. 1974-1977 Principal Scientist, VA Medical Center, Wood, WI 

Marshall, Bryan E., M.D. 1974-1977 Professor of Anesthesiology, University of Pennsylvania 

School of Medicine, Philadelphia, PA 

Sharp, John T., M.D. 1974-1977 Program Director, Pulmonary Disease, VA Medical Center, Hines, 

IL 

Cross, Carroll E., M.D. 1975-1978 Associate Professor of Medicine and Human Physiology, 

University of California School of Medicine, Davis, CA 

Daly, Walter J., M.D. 1976-1979 Professor & Chairman, Department of Medicine, Indiana 

University School of Medicine, Indianapolis, IN 

Greenberg, S. Donald, M.D. 1976-1979 Professor of Pathology, Baylor College of Medicine Texas 

Medical Center, Houston, TX 

Petty, Thomas L., M.D. 1976-1979 Professor of Medicine, University of Colorado School of 

Medicine, Denver, CO 

Menkes, Harold A., M.D. 1977-1980 Associate Professor of Medicine, Johns Hopkins University 

School of Medicine, Baltimore, MD 

Cherniak, Neil S., M.D. 1978-1981 Chief, Pulmonary Section, VA Medical Center, Cleveland, OH 

LXXXVIII
 
 

 

 

 

Gold, Warren M., M.D. 1978-1979 Professor of Medicine, University of California School of 

Medicine, San Francisco, CA 

Massaro, Donald J., M.D. 1978-1981 Medical Investigator, VA Medical Center, and Professor of 

Medicine and Physiology, University of Miami School of Medicine, Miami, FL 

Eldridge, Frederic, M.D. 1979-1982 Professor of Medicine and Physiology, University of North 

Carolina School of Medicine, Chapel Hill, NC 

Hayes, John A., M.D. 1979-1982 Associate Director, Mallory Institute of Pathology, Boston, MA 

Lieberman, Jack, M.D. 1979-1982 Chief, Respiratory Disease Section, VA Medical Center, 

Sepulveda, CA 

Matthay, Richard A., M.D. 1979-1982 Associate Professor of Medicine, Yale University School of 

Medicine, New Haven, CT 

Cheney, Frederick W., Jr., M.D. 1980-1983 Professor of Anesthesiology, University of Washington 

School of Medicine, Seattle, WA 

Last, Jerold A., M.D. 1980-1983 Professor of Medicine, University of California School of 

Medicine, Davis, CA 

Weil, John V., M.D. 1980-1983 Professor of Medicine, University of Colorado School of Medicine, 

Denver, CO 

Merit Review Board in Surgery 

Eiseman, Ben A., M.D. 1972-1974 Professor of Surgery, University of Colorado School of 

Medicine, Denver, CO 

Chairman 1972-1973 

Bryant, Lester, M.D. 1972-1975 Professor of Surgery, University of Kentucky School of Medicine, 

Lexington, KY, later Professor of Surgery, Louisiana State University School of Medicine, New 

Orleans, LA 

Chairman 1973-1975 

Siegel, John H., M.D. 1975-1978 Professor of Surgery, State University of New York School of 

Medicine, Buffalo, NY 

Chairman 1975-1978 

Condon, Robert E., M.D. 1977-1980 Chief, Surgical Service, VA Center, Wood, WI 

Chairman 1978-1980 

LXXXIX
 
 

 

 

 

 

Hechtman, Herbert B., M.D. 1978-1981 Associate Professor of Surgery, Harvard Medical School, 

Boston, MA 

Chairman 1980-1981 

Artz, Curtis P., M.D. 1972-1975 Professor of Surgery, Medical University of South Carolina, 

Charleston, SC 

Blaisdell, F. William, M.D. 1972-1975 Professor of Surgery, University of California School of 

Medicine, San Francisco, CA 

DelGuercio, Louis, M.D. 1972-1975 Director of Surgery, St. Barnabas Medical Center, Livingston, 

NJ 

Dudrick, Stanley J., M.D. 1972-1975 Associate Professor of Surgery, University of Pennsylvania 

School of Medicine, Philadelphia, PA, later Professor and Chairman, Department of Surgery, 

University of Texas School of Medicine, Houston, TX 

Egdahl, Richard H., M.D. 1972-1974 Professor of Surgery, Boston University School of Medicine, 

Boston, MA 

Menguy, Rene B., M.D., Ph.D. 1972-1975 Professor of Surgery, University of Rochester School of 

Medicine, Rochester, NY 

Merendino, K. Alvin, M.D., Ph.D. 1972-1975 Professor of Surgery, University of Washington 

School of Medicine, Seattle, WA 

Orloff, Marhsall J., M.D., Ph.D. 1972-1975 Professor of Surgery, University of California School of 

Medicine, San Diego, CA 

Powers, Samuel R.,Jr., M.D., D.Sc. 1972-1975 Professor of Surgery, later Professor and Chairman, 

Department of Surgery, Albany Medical College of Union University, Albany, NY 

Schumer, William, M.D. 1972-1975 Chief of Surgery, VA Hospital (West Side), Chicago, IL 

Simmons, Richard L., M.D. 1972-1975 Associate Professor, later Professor, of Surgery and 

Microbiology, University of Minnesota School of Medicine, Minneapolis, MN 

Wolf, James, M.D. 1972-1973 Chief of Surgery, VA Hospital, Richmond, VA 

DenBesten, Lawrence, M.D. 1974-1977 Chief, Surgical Service, VA Hospital, Iowa City, IA 

Kouchoukos, N.T., M.D. 1974-1977 Associate Professor of Surgery, University of Alabama School 

of Medicine, Birmingham, AL 

XC
 
 

 

 

Sherman, Roger T., M.D. 1974-1977 Professor and Chairman, Department of Surgery, University 

of South Florida College of Medicine, Tampa, FL 

Skillman, John J., M.D. 1974-1977 Department of Surgery, Harvard Medical School, Boston, MA 

Collins, John A., M.D. 1975-1978 Professor of Surgery, Stanford University School of Medicine, 

Stanford, CA 

Peters, Richard, M.D. 1975-1978 Professor of Surgery, University of California School of 

Medicine, San Diego, CA 

Starzl, Thomas E., M.D., Ph.D. 1975-1978 Professor and Chairman, Department of Surgery, 

University of Colorado School of Medicine, Denver, CO 

Storer, Edward H., M.D. 1975-1978 Chief, Surgical Service, VA Hospital, West Haven, CT 

Sumner, David S., M.D. 1975-1978 Professor of Surgery, Southern Illinois School of Medicine, 

Springfield, IL 

Alexander, J. Wesley, M.D. 1976-1979 Director, Transplantation Division, University of Cincinnati 

Medical Center, Cincinnati, OH 

McDonald, John C., M.D. 1976-1979 Professor of Surgery, Tulane University School of Medicine, 

New Orleans, LA, later Professor and Chairman, Department of Surgery, Louisiana State University 

School of Medicine, Shreveport, LA 

Norman, John C., M.D. 1976-1979 Director, Cardiovascular Surgery Research Laboratories, Texas 

Heart Institute, Houston, TX 

Paulson, David F., M.D. 1976-1979 Director, Urology Research, VA Hospital, and Associate 

Professor of Urologic Surgery, Duke University School of Medicine, Durham, NC 

Williams, G. Melville, M.D. 1976-1979 Professor of Surgery, Johns Hopkins University School of 

Medicine, Baltimore, MD 

Schloerb, Paul R., M.D. 1977-1980 Professor of Surgery, University of Kansas School of 

Medicine, Kansas City, KS, later Professor of Surgery, University of Rochester School of Medicine, 

Rochester, NY 

Tyers, G. Frank O., M.D. 1977-1980 Professor of Surgery, University of Texas Medical Branch, 

Galveston, TX, later Division of Cardiovascular and Thoracic Surgery, Vancouver General 

Hospital, Vancouver, BC 

XCI
 
 

 

 

 

 

Way, Lawrence W., M.D. 1977-1980 Chief, Surgical Service, VA Hospital, San Francisco, CA 

Barnes, Robert W., M.D. 1978-1981 Chief, Vascular Surgery, VA Medical Center, Richmond, VA 

Kinney, John M., M.D. 1978-1981 Professor of Surgery, Columbia University College of 

Physicians and Surgeons, New York, NY 

Moss, Gerald S., M.D. 1978-1981 Professor of Surgery, University of Chicago School of Medicine, 

Chicago, IL 

Thompson, Roby C., Jr., M.D. 1978-1980 Professor and Chairman, Department of Orthopedic 

Surgery, University of Minnesota School of Medicine, Minneapolis, MN 

Hakala, Thomas R., M.D. 1979-1982 Chief, Urological Surgery, VA Medical Center and Professor 

of Urological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 

Jonasson, Olga M., M.D. 1979-1982 Professor of Surgery, Department of Surgery, Cook County 

Hospital, Chicago, IL 

Nichols, Ronald L., M.D. 1979-1982 Professor of Surgery, Tulane University School of Medicine, 

New Orleans, LA 

Walker, William E., M.D. 1979-1982 Assistant Professor of Surgery, University of Texas Medical 

Science Center, Houston, TX 

Jones, R. Scott, M.D. 1980-1983 Assistant Chief of Surgery, VA Medical Center, Durham, NC 

Matthews, Larry S., M.D. 1980-1983 Professor of Orthopedic Surgery, University of Michigan 

School of Medicine, Ann Arbor, MI 

Nicholas, Gary G., M.D. 1980-1983 Associate Professor of Surgery, Pennsylvania State University 

School of Medicine, Hershey, PA 

Sheldon, George F., M.D. 1980-1983 Professor of Surgery, University of California School of 

Medicine, San Francisco, CA 

XCII
 
 

 

 

 

 

 

 

 

 

 

 

Appendix IIm. NAS-NRC Committees Planning and Advising VA on 

Rehabilitation Research 

1/30–2/1/45 Meeting at Thorne Hall, Northwestern University, sponsored by Panel 

on Amputations, Committee on Surgery, Division of Medical 

Sciences, NRC-NAS 

April–Autumn 1945 Committee on Prosthetic Devices, jointly under Division of Medical 

Sci. and Division of Engineering & Industrial Research, NRC-NAS. 

Jan 1944–Nov 1945 Committee on Sensory Devices, organized by OSRD, transferred 

NRC Oct, 1945. 

to 

Nov 1945–Nov 1946 Board for Prosthetic and Sensory Devices with two Committees: 

Committee on Prosthetic Devices and Committee on Sensory Devices 

Nov 1946–July 1947 Committee on Artificial Limbs and Committee on Sensory Devices, 

under the Division of Engineering and Industrial Research, NRCNAS. 

July, 1947–1955 Advisory Committee on Artificial Limbs. 

(Contracting now to be done directly by VA and by Armed Services 

rather than by NRC.) 

General F.S. Strong, Jr. Executive Director 

Identified research needs. 

Recommended research projects to the VA 

Used funds to tool up new projects 

Procured models to “prime the pump” 

Organized and held workshops and meetings 

Prepared reports 

Exhibits at scientific meetings 

Published journal Artificial Limbs from 1954–1972, 5000 circulation 

Nov 1948–1954 Committee on Sensory Devices now in Division of Anthropology and 

Psychology. 

1955–1959 Advisory Committee on Artificial Limbs became Prosthetics 

Research Board with two Committees: Committee on Prosthetics 

Research and Development and Committee on Prosthetics Education 

and Information, again jointly under Division of Medical Sciences 

and Division of Engineering and Industrial Research, NRC-NAS. 

1959–1976 Committee on Prosthetics Research and Development, Division of 

 Engineering and Industrial Research, NRC-NAS. 

XCIII
 
1964–1976 New Subcommittee on Sensory Aids established at VA request under 

Committee on Prosthetics Research and Development. 

XCIV
 
 

 

 

 

 

 

 

Appendix III. Selected Technical Bulletins 

1946 

Heinle, R., “Folic acid in the treatment of macrocytic anemias” 

Pinner, M., “The bacteriological diagnosis of pulmonary tuberculosis” 

Simmons, J., “Treatment of malaria”
 

Leifer, W., Padget, P., Pillsbury, D., & Johnson, B., “The management of syphilis”
 

Means, J., “New methods of treating thyrotoxicosis” 

Walker, A., “Recent changes in the composition of commercial penicillin” 

Walker, A., “The treatment of poisoning by arsenicals and mercury with BAL” 

White, J., “Surgery of the autonomic nervous system” 

Walker, A., “The fractionation of plasma proteins” 

1947 

Lennox, W., “The treatment of the epileptic veteran” 

Frank, J., “Management of emotional reactions in patients with somatic disease” 

Homans, J., “Venous thrombosis in the lower limbs, its present day treatment” 

Leifer, W., “The medical management of neurosyphilis” 

Elsom, K., “Amebiasis with special reference to its late complications” 

Ruffin, J., “Vagotomy in the treatment of peptic ulcer” 

Romansky, M., “The current status of penicillin therapy” 

Streptomycin Committee, VACO, “A preliminary statement concerning the effects of 

streptomycin upon tuberculosis in man” 

Most, H. “Clinical aspects and treatment of the more common intestinal parasites of 

 man” 

Most, H., “Schistosomiasis in the veteran” 

Ozarin, L., “Electric shock therapy” 

Alexander, H., “The pathogenesis of allergic disorders and the pronciples of their 

 management” 

Capps, R., “The present status of viral hepatitis, with particular reference to chronic and 

residual forms” 

Duncan, G., “The management of diabetes mellitus” 

Campbell, P., “The diagnosis and treatment of acute and chronic external otitis” 

1948 

Owen, G., “Late residuals of primary coccidioidomycosis”
 

Bradford, F., “The diagnosis and treatment of intervertebral disk rupture”
 

Ebert, R., “The measurement of cardiac output” 

Paster, S., “Shock therapies of the psychoses”
 

Shurley, J., and Bond, E., “Insulin shock therapy in schizophrenia” 

Most, H., “Management of vivax malaria in the veteran” 

DeGraff, A., “Management of cardiac failure”
 

Solomon, H., “Prefrontal leukotomy, an evaluation” 

Bors, E., “Spinal cord injuries” 

Hayman, J., “The measurement of renal function” 

XCV
 
 

 

 

 

 

 

 

 

 

1949 

Leifer, W., “The management of syphilis” 

Leifer, W., “The medical management of neurosyphilis” 

Spink, W., “Diagnosis and management of brucellosis (undulant fever) ” 

Dripps, R., “Spinal anesthesia for diagnosis, prognosis and therapy” 

Strauss, M., “The biology of pernicious anemia” 

Lyon, G., “Radioisotopes in medicine” 

Riley, R., “The measurement of pulmonary function” 

Schroeder, H., “Arterial hypertension” 

Gootnik, A., “The use of digitalis, with special reference to its toxicity” 

Comroe, J., “The mode of action of drugs upon the autonomic nervous system” 

Rosenberg, E., “Rheumatoid arthritis, with especial reference to its treatment”
 

Wilbur, D., “The vitamins and vitamin deficiency disease”
 

1950 

Florsham, P., & Thorn, G., “The diagnosis and treatment of adrenal cortical insufficiency” 

Welt, L., & Seldin, D., “The pathologic physiology and treatment of edema” 

Rhoads, C., “Present trends in cancer research, a general discussion” 

Beck, C., “Treatment of cardiac arrest” 

Elsom, K., “Chronic nonspecific ulcerative colitis”
 

Wortis, S., & Pfeffer, A., “The management of alcoholism” 

Lyon, G., “Some aspects of medical planning in atomic warfare” 

Wright, I., “The treatment of coronary thrombosis with myocardial infarction” 

Canfield, N., Glorig, A., & Ansberry, M., “Audiology - the science of hearing” 

Wagley, P., “A consideration of certain aspects of blood transfusions with particular reference 

to the clinical complications” 

1951 

Ruffin, J., “The management of peptic ulcer” 

Ravdin, I., & Gimbel, N., “Parenteral protein nutrition” 

Elsom, K., “The management of gastro-intestinal hemorrhage” 

Baehr, G., & Levitt, M., “The diseases of collagen” 

Isbell, H., “Acute and chronic barbiturate intoxication”
 

Beeson, P., “Fever of obscure origin” 

Hanlon, C., “The surgical treatment of cardiovascular disease” 

North, J., “Cancer and other tumors of the stomach” 

Daniels, W., & MacMurray, F., “Differential diagnosis and management of pyogenic 

 meningitis” 

Lindsay, J., “The differential diagnosis of vertigo” 

Longcope, W., “Sarcoidosis” 

1952 

Finland, M., “Pneumonia: present status of diagnosis and treatmen” 

Peabody, F., “The care of the patient” 

Rhodes, J., “Malignancy of the colon and rectum”
 

XCVI
 
 

 

 

 

 

 

 

 

 

1953 

Talbott, J., “Gout and gouty arthritis”
 

Machella, T., “Acute and chronic pancreatitis”
 

Frank, J., “Group psychotherapy” 

Stanbury, J., & Means, J., “New methods of treating thyrotoxicosis” 

Lorr, M., “Multidimensional scale for rating psychiatric patients 1. Hospital form”
 

Bennett, I., Jr., “Poisoning due to substances commonly substituted for ethyl alcohol”
 

Weir, J., “Gallstones” 

Ozarin, L., “The care and treatment of the psychotic patient with tuberculosis” 

Most, H., “Management of vivax malaria in the veteran” 

Schwartz, S., “Clinical aspects of porphyrin metabolism”
 

1954 

Kolff, W., “Dialysis in the treatment of uremia - artificial kidney and peritoneal

 lavage” 

Bennett, I., “Bacteremia” 

Hudson, P., “Benign and malignant tumors of the prostate gland” 

Klatskin, G., “Leptospirosis” 

Welt, L., “The pathogenesis and management of dehydration” 

Schroeder, H., “The treatment of arterial hypertension” 

Joyner, C., “Coronary atherosclerosis - pathogenesis and therapeutic implications” 

Kossman, C., “Electrocardiography and vectorcardiography” 

Strecker, E., “General principles of psychotherapy” 

Doull, J., “Leprosy” 

1955 

Jones, R., Jr., “Medical management of patients with incurable cancer”
 

Howard, J., “Differential diagnosis and therapy of spontaneous hypoglycemia” 

Pillsbury, D., “Topical and systematic therapy in diseases affecting the skin” 

Maier, H., “Intrathoracic tumors” 

Warren, R., “Recent advances in the surgery of arterial diseases” 

Smith, H., “Notes on the history of renal physiology” 

XCVII
 
(Intentionally Blank) 

XCVIII 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1947 

Appendix IVa. Early research contracts approved by the Committee on 

Veterans Medical Problems 

(Information extracted by the author from the minutes of the Committee on Veterans Medical 

Problems, archives of the National Academy of Science) 

Lennox, W.G., Cushing VA Hospital, Framingham, MA “VA Medical Problems” $75,000 

Adler, D.L., University of Oregon, Eugene, V.A. Hospital, Roseburg, and V.A. Hospital, Portland, 

OR, “Nature of Schizophrenic Thought Processes” No funds requested 

Walker, A. E., John Hopkins Hospital, “Posttraumatic Epilepsy Registry” $11,620 

Moore, T.V., Catholic University of America, “Nature of Neuropsychiatric Breakdown” No funds 

requested 

Brill, N.Q., N. P. Division, VACO “Follow-Up of Psychoneuroses in Veterans” $47,500 

Brill, N.Q., N. P. Division, VACO “Follow-Up of Psychoses in Officer Veterans” $15,700 

Menninger, K.A., Winter VA Hospital, Topeka, “Value of Finger Painting in N.P. Disorders” 

$20,644 

Powermaker, F., N.P. Division, VACO, “Group Therapy in V.A. Hospitals and Clinics” $45,768 

Woodhall, B., V.A. (Consultant on Peripheral Nerves) and Duke Medical School, Durham, NC, 

“Follow-Up Peripheral Nerve Injuries” $ 100,090, including: 

White, J.C. Boston Study Center $13,200; renewed 1951 for $2,700. 

Davis, L. Chicago Study Center $20,500, renewed 1951 for $5,000. 

Grundfest, H. New York’s Study Center $22,500 

Lewey, F.H. Philadelphia’s Study Center $21,340 

Naffziger, H. San Francisco’s Study Center $22,500 

Elkin, D.C., Emory University School of Medicine and Emory University, Atlanta, GA, “FollowUp of Traumatic Aneurysms and A-V Fistulae” $24,000 

Woodhall, B, Duke Medical School, Durham, NC, “Neuropathology of Peripheral Nerve Injuries” 

$7,335 

Most, H., New York University College of Medicine, Emory University, “Follow-Up of 

Schistosomiasis in Veterans” $3,450 

Hayman, J.M., Western Reserve University, Cleveland, OH; Gordon, J.E., Harvard University, 

Boston, MA; Bang, F.B., John Hopkins University, Baltimore, MD; Palmer, W.L., University of 

Chicago Medical Ctr., Chicago, IL “Follow-up of Schistosomiasis Japonica Acquired in Military 

Service” $22,775 

XCIX
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Burch, G.E. and DeBakey, M.E., Tulane University School of Medicine, New Orleans, LA, 

“Follow-Up of Arterial Injuries in Veterans” $78,950 

Myers, J. A., University of Minn., Minneapolis, “Tuberculosis in Veterans” $3,000 

Schwartz, H.G., Washington University, St. Louis, Mo., Barnes Hospital, St. Louis, MO, “EEG in 

Focal Epilepsy” $16,300 

Turner, R.H, Tulane University, New Orleans, LA, “Liver Function Following Hepatitis” $20,500 

Pollock, L.J., Veterans Administration Hospital, Hines, IL, Northwestern University, Chicago, 

“Spinal Cord Injury” $11,000 

Michael, Max, Lawson Veterans Administration Hospital, Chamblee, GA, “Pathogenesis of 

Arthritis” $5,400 

Neefe, J.R., University of Penn., Philadelphia, “Liver Function Following Hepatitis” $28,600 

Barr, J.S., “Follow-Up Study of Fractured of Carpal Scaphoid” $20,500 

Rapaport, D., Winter Veterans Administration Hospital, Topeka, KS, “Selection for Psychiatry 

Training” $23,595 

Kelly, E.L., University of Michigan, Ann Arbor, MI, “Selection for Training in Clinical 

Psychology” $29,500 

Carhart, R., Northwestern University, Evanston, IL, “Aural Rehabilitation” $17,825 

Wolff, H.G., Veterans Administration Hospital #81, Bronx, NY, “Personality and stress in 

Epilepsy” $24,800 

Wolff, H.G., Veterans Administration Hospital #81, Bronx, NY, New York Hosp., Institute of 

Psychological Research, Teachers’ College, Columbia University (Contracting Institute Cornell 

University Medical College), “The Development of An Instrument that will Collect A large Body 

of Significant Medical and Psychiatric Data for Diagnostic and Prognostic Appraisal” $18,500 

Haldeman, H.O., University of California Medical School, San Francisco, CA, “Experimental 

Study of Traumatic Lesions of Joints and Method of Their Surgical Repair” $5,320 

Flanagan, J.C., “Preliminary Study of The Incidence of Psychoneurotic Disorders Among Former 

AAF Aircrew Candidates” $8,610 

White, P.D., Massachusetts General Hospital, “Follow-Up Studies On Patients With 

Neurocirculatory Asthenia, Anxiety Neurosis, Effort Syndrome, and Allied States” No funds 

requested 

C
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Warren, R., “Follow-Up Study of War Wounds Of The Hands” $2,554 

Wolff, H.G., Veterans Administration Hospital #81, Bronx, NY, “Studies on the Pathogenesis and 

Treatment of Myasthenia Gravis” $8,450 

Kelly, F.P., “Post-Traumatic Osteomyelitis: Comparison of Recurrence Rate Following Two Forms 

of Treatment” $2,350. 

Nesbitt, S., University of Minnesota School of Medicine, Veterans Administration Hospital, “Liver 

Function Status of World War II Veterans in Relation To Past Presence or Absence of Hepatitis or 

Its Sequelae” $26,750 

Brown, J.R., Veterans Administration Hospital, Minneapolis, MN, “Rehabilitation of Chronic 

Neurologic Patients” $14,800 Revised 1949 as “Neurophysiological Studies in Neurological 

Disorder” $13,400 

1947 applications not approved: 10, including 2 with VA participation. 

1948 

Lieby, G.M., Birmingham VA Hospital Van Nuys, CA, “Chemotherapy of Coccidioidomycosis” 

$20,900 Renewed in 1950 by Lack, A. for $28,200 

Sternberg, T.H., “Mental Status and Treatment in Paresis” $10,000 

Bender, M.B., New York University School of Medicine, “After Effects of Head Injuries In World 

War II (With Emphasis on Perceptual Function)” $6,150 

Yater, W.M., “Life History of Coronary Artery Disease In Veterans” $6,500 

Leiby, G.M., Birmingham VA Hospital, Van Nuys, CA, “A-Conjunctival Capillaroscopy, BPlethysmograpy, C-Circulation Velocity, D-Vector-Cardiography” $11,996 

Fulton, J.F., Yale University School of Medicine, New Haven, CT, “Physiological Basis Of The 

Operation of Frontal Lobotomy” $35,100 

Bellows, J.G., “Effects of The Various Antibiotics On Experimental and Clinical Ocular Infections” 

$11,000 

Beeson, P.B. and Michael, M., Emory University and Lawson VA Hospital, “Sarcoidosis” $21,460 

Talbot, D.R., “EEG Studies In Relapsing Malaria and In Psychoses” Amount not recorded 

Moore, R. A., Washington University, “Tumors Of The Testis” $10,700 

Engleman, E. P., VA Hospital, San Francisco, CA, “Follow-up Studies In Rheumatic Fever In 

Veterans” $10,600 

CI
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Winternitz, M.C., Yale University School of Medicine, “Etiology and Pathogenesis Of 

Cardiovascular Renal Disease” $14,700 

Shumacker, H.B., Jr., Indiana University School of Medicine, “Paraplegia Research Unit” $26,142 

Leiby, G.M., Birmingham VA Hospital, Van Nuys, CA, “Investigation of Antithyroid Activity of 

Certain Drugs” $3,900 

Elkin, D.C., Grady Memorial Hospital and Emory University, Atlanta, GA, “Evaluation of the Use 

of Anticoagulants Particularly Heparin in the Therapy of Circulatory Insufficiency” $6,750 

Bieter, R.N., University of Minnesota Veterans Administration Hospital, “Clinical Testing of 

Narcotic Drugs” $16,569 

Taplin, G.V., Van Nuys, CA (Probably Birmingham VA Hospital), “Radioisotope Diagnosis” 

$3,974 

Chaikoff, I.L., University of California Medical School, Berkeley, “Factors in Prevention of Liver 

Injury” $17,100 

McGuire, J., Cardiac Laboratory, University of Cincinnati, Cincinnati, OH, “Cor Pulmonale and 

Related Pulmonary Physiology” $16,232 

Weyrauch, H.M., University of California Medical School, San Francisco, CA , “Healing of the 

Prostatic Fossa after Transurethral Prostatectomy. The Pathogenesis of Prostatic Hypertrophy in the 

Dog” $1,620 

Stewart, J.D., University of Buffalo Medical School, Buffalo, NY, “Physiological Adjustments to 

Hemorrhage and the Fate of the transfused Red Blood Cell” $26,700 

Donahue, W.T., University of Michigan, Ann Arbor, MI, “Study of A2 Electronic Reader for the 

Blind” $15,600 

Padget, P., John Hopkins University, Baltimore, MD; Webster, B., Cornell University School of 

Medicine, New York, NY, “The Natural History of Cardiovascular Syphilis” $15,478 

Davis, H., Central Institute for the Deaf, St. Louis, MO, “Methods for Diagnosis of Impairment of 

Hearing and Application to Aural Rehabilitation” $11,716 

1948 applications not approved: 19, including 6 with VA participation. 

Wuehrmann, A., Tufts Dental College, Boston, MA, “Improvements in Diagnosis of Periodontal 

and Periapical Involvements of Teeth” $15,140 

CII
 

1949 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hampton, A.O., Walter Reed General Hospital, Garfield Memorial Hospital, Washington, DC, 

“Delayed Effects of One Million Volt Irradiation on Gastro-intestional Tract and on Testicular 

Tumors” $18,900 

Blades, B., George Washington University Medical School, Washington, DC, “Studies of the 

Nerve Supply of the Human Lung with Particular Reference to the Physiology and Mechanism of 

Bronchoconstriction” $33,510 

Decamp, P.T., Tulane University School of Medicine, “Experimental Methods for the Repair of 

Defects in Great Vessels” $1,762 

Meschan, I., Veterans Administration Hospital, Little Rock, AK, “Microradiography, a Microscopic 

Radiographic Study of Tissues” $7,500 

Jergesen, F.H., University of California Medical School, Materials Testing Laboratory College of 

Engineering, Ft. Miley Veterans Administration Hospital, San Francisco, CA, “Fractures of the 

Shafts of the Long Bones” $7,000 

Schepens, C.L., Massachusetts Eye and Ear Infirmary, Boston, MA, “Examination Procedure and 

Treatment Methods of Retinal Detachment” $11,750 

Tryon, R. C., Ballache, E. L., University of California, Berkeley, CA, “Research Survey of Some 

Social Psychological Correlates of Psychiatric Disorders” $20,990 

Hudack, S. S., Columbia University College of Physicians and Surgeons, New York, NY, “To 

Study the Methods of Application of Plastic Materials in Reconstructive Surgery” $20,000 

Nielson, J.M., Los Angeles VA Hospital Wadsworth General Hospital Brentwood Neuropsychiatric 

Hospital Domiciliary, “Evaluation of the Problem of Epilepsy in Veterans in the Los Angeles Area” 

$40,697 

Kirk, P.L., University of California Medical School, Berkeley, CA, “Histochemistry of the Liver as 

Applied to Biopsy Material from Clinical Cases” $9,500 

Beecher, H.K., Massachusetts General Hospital Boston, MA, “Role of Anesthesia in Production of 

Peripheral Vascular Impairment or Occlusion” $4,445 

Long, C.N.H., Yale University School of Medicine New Haven, CT, “Characterization of Meningopneumonitis, a Virus of Psittacosis-lymphogranuloma venereum” $2,500 

Marwin, R.M., University of North Dakota School of Medicine, Grand Forks, ND, “Ultrasonic 

Studies, Selective Filtrations and Differential Centrifugations of Pathogenic Fungi for the Purpose 

of Obtaining Diagnostic Antigens Plus Specific Antisera” $9,800 

Simeone, F.A., Massachusetts General Hospital Boston, MA, “Autonomic Control of Renal 

Circulation” $3,000 

CIII
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1950 

Peyton, F.A., University of Michigan, Ann Arbor, “Determination of Physical Constants and 

Mechanical Characteristics in Dental Restorations” $18,600 

1949 applications not approved: 19, including 7 with VA participation. 

Ingelfinger, F,. Evans Memorial Hospital and Massachusetts Memorial Hospital Boston, “The 

Effect of Drugs, Especially Sedatives, in Patients With Hepatic Disorder” $9,950 

Hanger, F.M., Presbyterian Hospital, New York, NY, “Effect of Cortisone on Mesenchymal 

Derangements of the Liver” $1,700 

Phillips, R.W., Indiana University School of Dentistry Indianapolis, IN, “Dimensional Change in 

Various Hydro-Colloids and Stones as Affected by Certain Manipulative Variables” $3,800 

Randall, H.M., University of Michigan, Ann Arbor, “Adaptation of Infrared Spectroscopy to 

Bacteriological Work” $10,000 

Freeman, S., Northwestern University Medical School and Veteran’s Hospital Hines, IL, “Effects of 

Congestive Heart Failure on Renal Hemodynamics and Sodium Excretion” $7,480 

Elkin, D.C., Emory University Hospital, GA; Churchill, E.D., Massachusetts General Hospital, 

Boston; De Takats, G., University of Illinois College of Medicine; Burch, G.E., Tulane University 

School of Medicine, “Investigation of Late Results in Individuals Who Sustained Trenchfoot, 

Immersion Foot, or Frostbite in World War II” $67,187 

Vorwald, A.J., The Saranac Laboratory of The Edward L. Trudeau Foundation, Saranac, NY, 

“Influence of Cortisone Upon Chronic Inflammatory Disease of the Lung” $8,700 

Adolph, W., Birmingham VA Hospital, Van Nuys, CA, “The Use of Microopulverized 

Radiopaques in X-Ray” No amount stated 

Zieve, L., University of Minnesota School of Medicine, Veterans Administration Hospital, 

Minneapolis “Evaluation of the Factors Influencing the Discriminative Power of a Battery of Liver 

Function Tests” $8,250 

Lewey, F.H., University of Pennsylvania Graduate School of Medicine, “Early and Late Phases of 

Peripheral Nerve Injuries” $21,400 

Grundfest, H., Columbia University and Neurological Institute, “Investigation of 

Electromyographic, Autonomic, Vascular and Sensory Changes in Peripheral Nerve Injuries” 

$28,000 

CIV
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shank, R.E., Washington University School of Medicine, St. Louis, MO, “A Cytochemical Study 

of Liver in Patients with Hepatic Disease with Particular Reference to the Metabolism of 

Carbohydrate and Nucleic Acid” $14,100 

Lindsay, J.R., University of Chicago, “The Study of Functional and Histological Changes Resulting 

from Experimental Lesions of the Labyrinth” $8,892 

Vandegrift, W.B., Veterans Hospital, Fort Howard, MD, “New Techniques in Preparation of Tissue 

for Microscopic Examination” $3,000 

Wisenbaugh, P.E., Veterans Administration Hospital, Cleveland, OH, “Effects of Selective 

Depletion of Plasma Albumin in Dogs” $3,300 

Smith, W.K., University of Rochester, School of Medicine, Rochester, NY, “Functions Represented 

in the Medial and Basal Regions of Cerebral Cortex. Normal Responses and Effects of Lesions” 

$7,300 

Kobrak, H.G., University of Chicago, Chicago, “A Systematic Study on the Utilization of Prosthetic 

Appliances in the Middle Ear for Treatment of Conduction Type Deafness” $3,950 

Thomas, C.B., Johns Hopkins Medical School, Baltimore, MD, “Study of Precursors of 

Hypertenson and Coronary Artery Disease” $20,500 

Peters, H.N., VA Hospital, North Little Rock, AK, “Habit Retraining During Sub-shock Insulin 

Treatment in Schizophrenics” $31,305 

Tarlov, I.M., New York Medical College, NY, NY, “Spinal Cord Compression: Experimental Study 

Bearing on Clinical Treatment” $7,500 

1950 applications not approved: 40, including 12 with VA participation. 

1951 

Auerbach, S.H., Thayer VA Hospital, Nashville, TN, “Systematic Histologic Study of the Trachea 

and Bronchi” $2,925 

Kingsley, G.R., Wadsworth VA Hospital, Los Angeles, CA, “A Study of the Relationship of 

Arsenic to Proteins and Other Components of Human Tumor Tissue” $9,100 

Freeman, L.H., Indiana University Medical Center, Indianapolis, Indiana, “Possibility of Repair of 

the Injured Spinal Cord” $10,170 Renewal 1953 $16,000 

Dochez, A.R., Veterans Administration Hospital, Bronx, N.Y., “Immunochemical Studies on 

Rheumatoid Arthritis” $10,750 

Lucke, B., Armed Forces Institute of Pathology, Washington, DC, “Diagnosis of Neoplasia” $5,000 

CV
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Grady, H.G., Armed Forces Institute of Pathology, Washington, DC, “Study of Pathology of 

Disease in Military and Veterans Age Group. Production of Educational Material in this Field” 

$20,000 

Crocker, T.T., University of California Medical School, San Francisco, CA, “Chemical and 

Metabolic Studies of the Virus of Meningo-Pneumonitis” $17,715 

Grino, A., Cleveland VA Hospital Cleveland, OH, “Regeneration of the Central Nervous System” 

$3,700 

Light, R.A., Vanderbilt University School of Medicine, Nashville, TN, “Role of the Autonomic 

Nervous System in Control of the Pulmonary Vascular Bed” $9,950 

Salkin, D., Weimer, H.E., Boak, R.A., V.A. Hospital, San Fernando, CA, “Distribution of Serum 

Polysaccharides in Tuberculosis” $4,550 

1951 applications not approved: 22, including 8 with VA participation. 

1952 

Yeoman, A., VA Hospital, White River Junction, VT, “Clinical Chemical Studies of Acid-Base 

Abnormalities” $7,400 

Howry, D. H., VA Hospital, Denver, CO, “The Utilization of Ultra High Frequency Sound for the 

Visualization of Soft Tissue Anatomy and Pathology” $27,468 

Rosvold, H.E., Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 

“The Psychobiology of Emotional Behavior” $22,000 Renewal 1953 $15,000 

Blades, B., George Washington University, Washington, DC, “Effect of Lung Ischemia Upon 

Pulmonary Function.” $9,439 

Beecher, H.K., Massachusetts General Hospital, “Study of Metabolic & Other Latent Effects of 

Hypotensive Spinal Anesthesia” $10,400 

Campbell, J.B., Columbia University, NY, “Use of Sterotaxically Placed Radon for Selected 

Quantitated Lesions in the CNS of Laboratory Animals” $5,101 Renewal 1953 $11,749 

1952 applications not approved: 13, including 5 with VA participation. 

1953 

Washer, F.E., National Bureau of Standards, Washington, D.C., “Development of Performance 

Specifications for corrected Curve Lenses” $8,125 

Blades, B, George Washington University Hospital, Washington, D.C., “Studies in Liver 

Circulation” $9,978 

CVI
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Freeman, L.H., Indiana University Medical Center, “Possibility of Repair of the Injured Spinal 

Cord” $16,000 

Crocker, T.T., University of California Medical School, San Francisco, CA, “Chemical and 

Metabolic Studies of the Virus of Meningo-Pneumonitis” $17,715 

Light, R.A., Vanderbilt University School of Medicine, Nashville, TN, “Role of the Autonomic 

Nervous system in Control of the Pulmonary Vascular Bed” $9,300 

Washer, F.E., National Bureau of Standards, Washington, DC, “Development of Performance 

Specifications for ‘Corrected Curve’ Lenses” $8,125 

Harvey, A. M., The Johns Hopkins Hospital, Baltimore, MD, “Application of Stable Isotopes to 

Medical Problems of Research and Practice” $9,500 

Doull, J.A., Leonard Wood Memorial, Washington, DC, “Clinical Evaluation Studies in Leprosy” 

$3,000 

Pincus, G., Hoagland, H., The Worcester Foundation for Experimental Biology, Shrewsbury, MA, 

“Assessment of the Functional Status of the Adrenal Cortex and Gonads by Urinary Steroid 

Analysis in Psychotic and Non-Psychotic Subjects” $15,300 

Shambaugh, G., Jr., and Carhart, R., Northwestern University, “Evaluation of the Supplemental 

Value of the Aquaphor Prosthesis for the Post-Fenestrated Ear” $4,850 

Urist, M.R., University of California Los Angeles School of Medicine, “The Mechanism of 

Osteogenesis in Normal and Slow Healing Fractures, Delayed and Non-Union, Bone Defects from 

War Wounds, and Various Bone Graft Operations” $15,000 

Kobrak, H. G., “Artificial Sound Conduction in the Ear. A Clinical and Laboratory Investigation on 

the Improvement of Sound Conduction in The Ear by Usage of Middle Ear Prosthesis” $1,000 

1953 applications not approved: 18, one of them with VA participation. 

CVII
 
(Intentionally Blank) 

CVIII 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix IVb. Contracts for Research in Prosthetics and Sensory Aids begun 

before 1950 

Contractor Approx dates Important contributions 

Haskins Laboratories 1944–1954 Tested sensory devices for Committee on Sensory 

New York Aids 

Northrop Aircraft 1945–1951 Requirements for arm prosthesis 

Hawthorne, CA Shoulder-shrug operated elbow 

 (Birmingham VA, Improved hook control 

 Van Nuys, CA) Wrist rotation for below elbow arms

 Suction socket, light-weight prostheses 

UC Berkeley 1945–1970s Fundamental studies on human locomotion 

 Improved analysis of limb alignment

 Improved socket design

 Four-bar linkage knee 

 Six-bar knee for knee disarticulation amputees 

Northwestern Univ. 1945–1954 Literature and patent review 

Evaluation of newly developed artificial limbs 

Alderson Research 1946–1952 Electric arm development and evaluation 

(originally IBM) 

Catranis, Inc 1946–1950 Foot, knee, integrated leg development 

Syracuse, NY 

UCLA 1946–1970s Fundamental studies on arm and hand motion 

 Clinic started 1952 – trained prosthetists 

New York University 1948–1970s Evaluation of artificial limbs 

Mauch Laboratories 1948–1978 Swing-and-stance hydraulic control knee 

Dayton, OH Hydraulic ankle 

 Reading machines 

CIX
 
(Intentionally Blank) 

CX 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix Va. Radioisotope Services active in September, 19621 

Hospitals with full licenses (clinical and research) 

Albany, New York 

Albuquerque, New Mexico 

Ann Arbor, Michigan 

Atlanta, Georgia 

Birmingham, Alabama 

Boston, Massachusetts 

Bronx, New York 

Brooklyn, New York 

Buffalo, New York 

Chicago Research, Illinois 

Chicago Westside, Illinois 

Cincinnati, Ohio 

Cleveland, Ohio 

Coral Cables (Miami), Florida 

Dallas, Texas 

Dearborn, Michigan 

Denver, Colorado 

Durham, North Carolina 

East Orange, New Jersey 

Fort Howard, Maryland 

Fresno, California 

Hines, Illinois 

Houston, Texas 

Indianapolis, Indiana 

Iowa City, Iowa 

Jackson, Mississippi 

Kansas City, Kansas 

Little Rock, Arkansas 

Long Beach, California 

Los Angeles, California 

Louisville, Kentucky 

Madison, Wisconsin 

Martinsburg, West Virginia 

Memphis, Tennessee 

Minneapolis, Minnesota 

Nashville, Tennessee 

New Orleans, Louisiana 

New York, New York 

Oakland, California 

Oklahoma City, Oklahoma 

Omaha, Nebraska 

Philadelphia, Pennsylvania 

Pittsburgh (Univ Dr), Pennsylvania 

Charles A. Hall, M.D. 

G. A. Youngman, M.D. 

James Sisson, M.D.
 

James C. Coberly, M.D.
 

James A. Pittman. Jr., M.D. 

Belton A. Burrows, M.D. 

Solomon A. Berson, M.D. 

vacant 

Richard P. Spencer, M.D.
 

John A. D. Cooper, M.D.
 

G. A. Williams, M.D. 

John Imarisio, M.D.
 

Reginald A. Shipley, M.D. 

C. G. Wherry, M.D.
 

J. R. Rubini, M.D.
 

E. R. Powner, M.D. 

H. Elrick, M.D.
 

M. P. Liebling, M.D.
 

 Maurice Small, M.D.
 

A. T. Faulk, M.D.
 

S. H. Cheu, M.D.
 

 Ervin Kaplan, M.D.
 

Clarence P. Alfrey, M.D.
 

Leo Oliner, M.D.
 

Richard E. Peterson, M.D. 

Arthur T. Tuma, M.D.
 

Paul R. Schloerb, M.D.
 

H.H. Perkins, M.D.
 

Ralph E. Bodfish, M.D.
 

William H. Blahd, M.D.
 

N. Nataro, M.D.
 

Frank Larson, M.D.
 

Arthur F. Abt, M.D.
 

M.L. Fields, M.D.
 

Leslie Zieve, M.D.
 

W.L. Alsobrook, M.D.
 

E.H. Bresler, M.D.
 

Marcus A. Rothschild, M.D.
 

Jack F. Mangum, M.D.
 

Walter H. Whitcomb, M.D.
 

Richard E. Ogborn, M.D. 

Arlyne T. Shockman, M.D.
 

John Vester, M.D.
 

CXI
 
 

 

 

 

 

 

 

 

 

 

Portland, Oregon John R. Walsh, M.D.
 

Providence, Rhode Island B.C. Claunch, M.D.
 

Salt Lake City, Utah Lindy Kumagai, M.D.
 

San Francisco, California vacant 

San Juan, Puerto Rico J.V. Rivera, M.D.
 

Seattle, Washington Clayton Rich, M.D.
 

St. Louis, Missouri Neil I. Gallagher, M.D.
 

Syracuse, New York Robert B. Chodos, M.D.
 

Washington, D.C. William McFarland, M.D.
 

West Haven, Connecticut D.L. Buchanan, M.D.
 

Wood, Wisconsin Robert C. Meade, M.D. 

Hospitals with limited licenses 

Augusta, Georgia 

Baltimore, Maryland
 

Batavia, New York 

Bay Pines, Florida 

Big Spring, Texas 

Dayton, Ohio 

Des Moines, Iowa 

Fort Harrison, Montana 

Grand Junction, Colorado
 

Huntington, West Virginia 

Kecoughtan, Virginia 

Oteen (Asheville), North Carolina 

Perry Point, Maryland 

Pittsburgh (Leach Farm Road), Pennsylvania
 

Richmond, Virginia 

Sepulveda, California 

Sunmount, New York 

Togus, Maine 

Tucson, Arizona 

Wadsworth, Kansas 

West Roxbury, Massachusetts 

White River Junction, Vermont 

1. "Research in radioisotopes: Veterans Administration radioisotope services." Research and 

Education Newsletter, December, 1962. 16. 

CXII
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix Vb. Clinical uses of radioisotopes in VA hospitals, FY 19621 

(65 hospitals) 

Diagnostic Uses Patients Tests 

Evaluation of Thyroid Status (1-131) 11,744 14,893 

Thyroid Scans (1-131) 1,761 1,868 

Protein-bound iodine (1-131) 723 764 

Tri-iodo-thyronine binding (in-vitro) 878 2,294 

Blood volume (1-131 HSA) 3,071 3,526 

Red cell mass, survival time, or GI loss (Cr-51) 2,511 3,490 

Schilling test (Co-60, Co-58, or Co-57) 2,153 2,935 

Ferro-kinetics (Fe-59) 327 374 

Coronary flow or radiocardiogram 517 634 

Fat absorption Studies (1-131) 1,477 1,950 

Kidney function or renograms (Hippuran, etc.) 2,283 2,668 

Liver Function (1-131 Rose Bengal) 401 423 

Electrolyte balance measurements (K-42, Na-24, etc.) 347 367 

Brain Tumor localization 139 143 

Miscellaneous 802 862 

Total 29,134 37,191 

Therapeutic Uses Patients Doses 

Hyperthyroidism (1-131) 426 521 

Thyroid ablation in Cardiac disease (1-131) 35 66 

Thyroid Carcinoma (1-131) 19 20 

Polycythemia vera or leukemia (P-32) 164 284 

Malignant effusion (Au-198 or CrP04) 26 26 

Bone Metastases (P-32 Polymetaphosphate) 20 44 

Miscellaneous 8 8 

Total 698 969 

1. Moseley, A. Graham, "Consolidated report of clinical uses of radioisotopes." Research and 

Education Newsletter, September, 1962. 17. 

CXIII
 
(Intentionally Blank) 

CXIV 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix VI. Special Laboratories Active During the 1950s and 1960s 

Oncology 

Cancer and Leukemia	 Ludwig Gross Bronx 1953-58

 (Became Senior Medical Investigator in 1958) 

Cancer Research Leslie Zieve Minneapolis 1961-68 

Gastroenterology 

Gastrointestinal Research 

Liver and Metabolic Research 

David Sun, 

Hyman Zimmerman 

Wash, D.C. 

Wash, D.C. 

1961-66 

1965-68 

Neuropsychiatry 

Epilepsy, later called Neurology 

Neurophysiology-Biophysics Research 

Neuropharmocology

Psychopharmacology

Psychiatric and Psychosomatic Res. 

Study of Unpredicted Deaths 

F.A. Quadfasel Boston 

Robert Efron Boston 

 (Became Medical Investigator in 1971) 

 Amadeo Marrazzi Pittsburgh

 William Clark Sepulveda 

 Roy Mefferd Houston 

Edwin S. Schneidman Wadsworth 

later Norman Farberow 

1952-62 

1961-71

 195?-56 

1960-69 

1958-68 

1958-70 

Special Dental Laboratories 

Dental Prostheses for Elderly 

Dental Filling Materials 

Development of Dental Structures 

Oral Tissue Metabolism 

Oral Physiology 

unknown PI Bay Pines 

unknown PI Long Beach 

unknown PI Coral Gables 

Philip Person Brooklyn 

 (Became Medical Investigator in 1970) 

Ira Shannon Houston 

195?-57 

195?-57 

195?-56 

1955-70

1967-70 

Tuberculosis, infectious and pulmonar

Tuberculosis 

Tuberculosis 

y diseases 

Martin Cummings Atlanta 

until 1953, then unknown PI 

unknown PI Baltimore 

1950-57 

195?-57 

Pulmonary Diseases 

New Tuberculosis Drugs 

Tuberculosis 

Mycobacteria 

Microbiology 

Chronic Infectious Disease 

Lloyd Hedgecock 

unknown PI 

Edwin Brosbe 

 Ernest Runyon 

Stuart Mudd 

Gladys Hobby 

Kansas City 

West Haven 

 Long Beach 

Salt Lake City

Philadelphia 

East Orange 

19??-61 

195?-56 

195?-61 

1958-63 

1959-68 

1960-8 

Other 

Medical Electronic Data Processing, 

Pituitary Bank 

Domiciliary Lipid Diet Research 

Hubert Pipberger, Wash, D.C. 

 (Became Medical Investigator in 1971) 

Harold Elrick Denver 

Seymour Dayton Wadsworth 

and Phoenix 

1957-71

1959-63 

1959-70 

CXV
 
 

 

 

 

 

 

 

 

 

 

Normative Aging Study Benjamin Bell Boston OPC 1963-

present

 later Jeremiah Silbert, then Pantel Vokonas 

Nuclear Medicine and Biology Merton Quaife Omaha 1964-67
 

Special Laboratories in Support of Cooperative Studies 

Central Neuropsychiatric Research Lab Quentin Holzapple Perry Point 1958-75
 

then James Klett (Ch. 8) 

Outpatient Psychiatry Research Maurice Lorr Washington, D.C. 1953-67

 (Ch.8) 
 

Tuberculosis Coop Study Control Lab William Redmond Atlanta 1958-68
 

later Ruth Wichelhausen
 

CXVI
 
 

 

 

 

 

 

 

 

Appendix VII. Publications from VA Research Service in the 1950s and 1960s 

Periodicals 

Medical Research in the Veterans Administration, the annual report to Congress. Published 

annually, 1957 through 1975: 

R&E Newsletter, Research and Education in Medicine. Published several times a year, 1960 

through 1968. 

VA medical monographs reporting work by the Follow-up Agency:

 (1) Tuberculosis in the Army of the United States in War II, 1955. 

(2) A Follow-Up Study of World War II Prisoners of War, 1955. 

(3) A Follow-Up Study of War Neuroses, 1956. 

(4) Peripheral Nerve Regeneration: A Follow-Up Study of 3,656 World War II Injuries, 

1957. 

(5) A Follow-Up Study of Head Wounds in World War II, 1961. 

Other 

VA Prospectus, Research in Aging, 1958 

Thyroid Scanning, a manual, 1960 

The Interim Report of the VA Cooperative Study on Oral Exfoliative Cytology, 1961 

CXVII
 
(Intentionally Blank) 

CXVIII 
 

 

 

 

 

 

1978 

Appendix VIII. Research Career Scientists appointed before 1981 

Khahlil Ahmed, Ph.D. Minneapolis Toxicology 

Virginia E. Davis, Ph.D. Houston	 Cellular mechanisms of 

tolerance of and dependence on 

alcohol and related drugs 

Walter B. Dempsey, Ph.D. Dallas	 Medical and microbial genetics 

Silvio Fiala, M.D. Martinsburg Chemical carcinogenesis 

CXIX
 
 

 

 

 

 

 

Harvey F. Fisher, Ph.D. Kansas City Molecular biochemistry 

James M. Fujimoto, Ph.D. Wood	 Pharmacology of addicting 

drugs 

William R. Goff, Ph.D. West Haven Neurophysiology 

G.D. Hsiung, Ph.D. West Haven Virology 

Milton Huppert, Ph.D. Long Beach Medical mycology 

CXX
 
 

 

 

 

George Melnykovych, Ph.D. Kansas City	 Cell biology and cancer research 

Carlo Moscovici, Ph.D. Gainesville Genetics and biology of 

oncoviruses 

Thomas B. Mulholland, Ph.D. Bedford Psychophysiology 

Herbert T. Nagasawa, Ph.D. Minneapolis Medicinal chemistry 

CXXI
 
 

 

 

 

 

Martin Sax, Ph.D. Pitsburgh UD	 X-ray crystallography of 

proteins 

Paul A. Srere, Ph.D. Dallas	 Cellular enzymology 

Leo Vroman, Ph.D. Brooklyn	 Physiology of interfaces 

Harry Walter, Ph.D. Long Beach	 Biology of cell surfaces 

CXXII
 
 

 

 

 

1979 

Charles H. Williams, Jr., Ph.D. Ann Arbor Enzyme biochemistry 

Joseph Zubin, Ph.D. Pittsburgh HD	 Evaluation of psychiatric 

treatments 

Nome Baker, Ph.D. LA (Wadsworth) Tumor-lipid biochemistry 

Claude F. Baxter, Ph.D. Sepulveda Neurochemistry 

CXXIII
 
 

 

 

 

Denis R. Burger, Ph.D. Portland Histocompatability 

Daniel G. Colley, Ph.D. Nashville Infectious diseases 

Allen Frazer, Ph.D. Philadelphia Biology of psychiatric disorders 

James W. Hamilton, Ph.D. Kansas City Hormone biochemistry 

CXXIV
 
 

 

J. Alan Johnson, Ph.D. Columbia, MO Genesis of hypertension 

Raymond Lindsay, Ph.D. Birmingham	 Physiology and pharmacology 

of thyroid 

Alfred Linker, Ph.D. Salt Lake City	 Connective tissue
 

polysaccharides
 

Richard N. Lolly Sepulveda Neuropathology, especially of 

the retina 

CXXV
 
 

 

 

 

 

Vladimir Pushkin, Ph.D. Oklahoma City	 Neuropsychology 

Michael Schotz, Ph.D. LA(Wadsworth) Lipid and lipoprotein 

biochemistry 

Kosaku Uyeda, Ph.D. Dallas Enzyme biochemistry 

Lawrence G. Wayne, Ph.D. Long Beach Bacteriology 

CXXVI
 
 

 

 

1980 

Arthur Yuwiler, Ph.D. LA (Brentwood) Neurobiochemistry 

Truett Allison, Ph.D. West Haven Electrophysiology 

Joseph Bernsohn, Ph.D. Hines CNS metabolism 

Liard S. Cermak, Ph.D. Boston Memory 

CXXVII
 
 

 

 

 

Donnell Creel, Ph.D. Salt Lake City	 Anatomy and electrophysiology 

of vision 

Thomas L. Feldbush, Ph.D. Iowa City	 Immunologic memory 

Robert J. Fitzgerald, Ph.D. Miami Oral microbiology 

Robert G. Garrison, Ph.D. Kansas City	 Microbiology 

CXXVIII
 
 

 

 

 

 

 

Charles C. Irving, Ph.D. Memphis Chemical carcinogenesis 

Don Justesen, Ph.D. Kansas City	 Behavioral and 

electrophysiological effects 

of microwave irradiation 

Margaret W. Linn, Ph.D. Miami	 Stress and oncology 

Ulysses S. Seal, Ph.D. Minneapolis Biochemical endocrinology 

CXXIX
 
 

 

M. Barry Sherman, Ph.D. Sepulveda Neuropsychology 

F. Thomas Shipp, Ph.D. San Francisco Speech pathology 

CXXX
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix IX. Alcoholism scholars, 1979-1983 

Round 1 – started 3-year appointments in 1979. Recruited from outside of VA 

Awardee	 Sponsoring Research topic Current status 2002 

VAMC 

Bertram I. Cohen, Ph.D. New York, NY Effects of alcohol on lipid In NYU- affiliated 

metabolism in experimental hosp, studying lipids 

animals and man 

John C. Crabbe, Ph.D. Portland, OR	 Systematic analysis ofthe Alcohol research 

relationships among several Portland VAMC 

responses to ethanol using 

a behavior/ genetic approach 

Edward Gallaher, Ph.D. Palo Alto, CA	 A physiological approach to Alcohol research 

the study of ethanol tolerance Portland VAMC 

and physical dependence: The 

application of control system 

analysis 

R. Adron Harris, Ph.D. Columbia, MO Effects of alcohol intoxication Alcohol research 

and dependence on ion University of Texas 

transport and neurotransmitter 

release by synaptosomes 

Anastascio Hoyumpa, Nashville, TN Alcohol and thiamine Alc.&liver research 

M.D. metabolism San Antonio VAMC 

William Kenney, Ph.D. San Fran, CA Influence of ethanol and Retired from Amgen 

acetaldehyde on membranebound enzymes 

Elizabeth Rowe, Ph.D. Kansas City, MO Molecular mechanisms of Alc.&lipid research 

alcoholism Kansas City VAMC 

Marc Schuckit, M.D. San Diego, CA A basic research program to Alcohol research 

study etiology of alcoholism San Diego VAMC 

Francis R. Simon, M.D. Denver, CO	 Effect of alcohol ingestion on Alc&liver research 

the structure and function of Denver VAMC 

liver surface membrane 

CXXXI
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Boris Tabakoff, Ph.D Chicago WS, IL Dopamine and Alcohol research 

neurohypophyseal peptides in Univ Colorado 

alcohol tolerance&depend’ce High positions in 

NIAAA 1984-1990 

Anna N. Taylor, Ph.D. Brentwood, CA Fetal alcoholism in rats: Alcohol research 

Central neural effects; an West LA VAMC 

animal model for addiction 

Pushpa Thadani, Ph.D. Washington, DC Effects of acute and chronic Leads neuroscience 

maternal ethanol ingestion on center at NIDA 

maturation of CNS, endocrine 

and cardiovascular systems in 

the offspring 

Ladislav Volicer, Boston, MA	 Study of etiol. of alcoholism Dementia research 

M.D., Ph.D. and the investigation of the Bedford VAMC 

biochemical- pharmacologic 

and cellular biologic effects 

and responses to alcohol 

Round 2 – started 3 year appointments in 1980. Both VA and non-VA investigators eligible 

Awardee	 Sponsoring Research topic Current status 2002 

VAMC 

Enrique Baraona, M.D. Bronx, NY Mechanism and consequence Alcohol research 

of the alcohol-induced Bronx VAMC 

alterations of microtubules (retired) 

M. Raj Lakshman, Ph.D. Washington, DC Metabolic and genetic basis Alcohol research 

for alcoholic hyperlipidemia Washington VAMC 

Lawrence Lumeng, M.D. Indianapolis IN	 Genetic and biochemical Alcohol research 

factors in the etiology of Indianapolis VAMC 

alcoholism 

Carrie L. Randall, Ph.D. Charleston, SC	 Offspring of alcoholics: An Alcohol research 

animal model to study the Medical Univ. SC 

etiology of alcoholism 

Thomas L. Smith, Ph.D. Tucson, AZ	 Neurochemical prerequisites Alcohol research 

of alcohol addiction Tucson VAMC 

CXXXII
 
 

 

M. David Ullman, Ph.D. Bedford, MA Contribution of structural Geriatrics&alc. res 

lipids to the etiology of Bedford VAMC 

alcoholism 

CXXXIII
 
(Intentionally Blank) 

CXXXIV 
 

 

Appendix X. Persons interviewed 

William Adams, M.D.
 

Ernest Allen, Ph.D.
 

Herbert Allen, M.D.
 

Hal O. Anger 

Joan Armer, R.N. 

Oscar Auerbach, M.D. 

Clifford Bachrach, M.D.
 

John Bailar, M.D.
 

Maureen S. Baltay
 

Marion Barry
 

Claude Baxter, Ph.D. 

Chester Bazel, R.Ph. 

Gilbert Beebe, Ph.D. 

Howard Berman 

Leon Bernstein, M.D. 

Lionel Bernstein, M.D.
 

William Best, M.D. 

Robert Birch, M.D.
 

William Blahd, M.D.
 

Dorothy Bluestein 

Hollis Boren, M.D.
 

Linda Boxer, M.D., Ph.D.
 

Marion Brault 

Norman Q. Brill, M.D.
 

Ernest Burgess, M.D. 

Belton Burrows, M.D.
 

Allen B. Cady, M.D.
 

Eugene Caffey, M.D.
 

Arthur Cain, M.D.
 

Chu Carr 

Jules Cass, D.V.M.
 

Ralph Casteel 

Thomas Chalmers, M.D.
 

Sonny Chang, Ph.D. 

John D. Chase, M.D. 

Robert A. Chase, M.D. 

Howard H. Chauncey, Ph.D., D.M.D.
 

Lawrence G. Christianson, M.D.
 

Sidney E. Cleveland, Ph.D.
 

Betty Cobbs 

Marvin Cohen, M.D.
 

David Cohn, Ph.D. 

Frank Coombs 

John A.D. Cooper, M.D. 

CXXXV
 
 

 

 

Gregory Crowe 

Lawrence Crowley, M.D. 

Martin Cummings, M.D. 

David N. Daniels, M.D. 

Carolyn Davidson 

Kenneth Davis, M.D. 

Michael DeBakey, M.D. 

Chester DeLong, Ph.D. 

Walter Dempsey, Ph.D. 

Gerald DeNardo, M.D. 

Paul Densen, Ph.D. 

Nicholas D’Esopo, M.D. 

Vincent DeVita, M.D. 

Daniel Deykin, M.D. 

Harold (Jack) Divers 

Abraham Dury, Ph.D. 

Richard V. Ebert, M.D. 

E.E. Eddleman, M.D.
 

Robert Efron, M.D.
 

Roger Egeberg, M.D. 

Seymour Eisenberg, M.D.
 

Frederick Eldridge, M.D.
 

James Elliott, M.D. 

Robert Ellsworth, Ph.D. 

Lawrence Eng, Ph.D.
 

H. Martin Engel, M.D. 

Carleton Evans, M.D. 

George Fairweather, Ph.D.
 

Robert Farese, M.D. 

Lori Fertel 

William Figueroa, M.D.
 

Richard Filer, Ph.D. 

James Finklestein, M.D.
 

Robert Fitzgerald, Ph.D. 

Robert Fleming
 

Lysia Forno, M.D.
 

Irene Forrest, Ph.D. 

William H. Forrest, M.D.
 

Laurence Foye, M.D.
 

James Fozard, Ph.D. 

Earl Freed, Ph.D. 

Edward Freis, M.D.
 

Andrew Gage, M.D.
 

Al Gavazzi 

Samuel Gershon, M.D.
 

Bruno Gerstl, M.D. 

CXXXVI
 
 

 

 

Margaret Giannini, M.D.
 

Gerald Goldstein, Ph.D. 

Richard Goode, M.D.
 

Harold Goodglass, Ph.D.
 

Clo Gooding
 

Gregory Goodrich, Ph.D.
 

David Goodwin, M.D.
 

Earl Gordon, M.D.
 

Abraham Gottlieb, M.D.
 

Mark Graeber, M.D. 

Howard W. Green, M.D.
 

Richard Greene, M.D., Ph.D.
 

Ludwig Gross, M.D. 

George Gulevich, M.D.
 

Lee Gurel, Ph.D. 

Paul Haber, M.D.
 

Francis Haddy, M.D., Ph.D.
 

James Hagans, M.D., Ph.D.
 

Charles Hall, M.D.
 

Charles H. Halsted, M.D., son of James Halsted, M.D.
 

Paul Heller, M.D.
 

Victor Herbert, M.D.
 

George Higgins, M.D. 

Richardson Hill, M.D.
 

Gladys L. Hobby, Ph.D. 

Esther Hodges 

William Hofman, M.D. 

Leo Hollister, M.D. 

David S. Howell, M.D. 

Herbert N. Hultgren, M.D.
 

Seymour Jablon
 

Henry Jones, M.D.
 

Samuel C. Kaim, M.D.
 

Martin S. Kalser, M.D., Ph.D. 

Eugene Kanabrocki, Ph.D.
 

Ervin Kaplan, M.D.
 

Abba Kastin, M.D.
 

Laurence H. Kedes, M.D.
 

Paul Kennedy
 

Robert Kevan 

C. James Klett, Ph.D.
 

Leonard Knott 

Shoichi Kohatsu, M.D.
 

Bert Kopell, M.D.
 

Ross Kory, M.D.
 

Jon C. Kosek, M.D.
 

CXXXVII
 
 

 

 

Leonard Krasner, Ph.D. 

Jeannette Landis 

Milton Landowne, M.D.
 

Alfred Lawton, M.D.
 

Lyndon Lee, M.D.
 

Larry Leifer, Ph.D. 

Gerald Libman 

Charles Lieber, M.D. 

Clyde J. Lindley 

Armand Littman, M.D. 

Richard Lolley, Ph.D. 

Leon Lombroso, Ph.D. 

Theodore Lorei, M.S.W. 

Maurice Lorr, Ph.D.
 

Sanford Mabel, Ph.D. 

Roy Maffley, M.D.
 

Joseph Mason 

Jack Matoole, M.D.
 

James H. Matthews, M.D.
 

Richard Mazze, M.D. 

Willa McBride 

Donna McCartney
 

Burley McCraw
 

Dennis McGinty, Ph.D. 

Paul W. McReynolds, Ph.D.
 

Jeffrey Meade, M.D., son of Robert Meade, M.D.
 

Shirley Meehan, Ph.D., M.B.A.
 

Sherman Mellinkoff, M.D.
 

Thomas Merigan, M.D.
 

Joe Meyer, Ph.D. 

Ralph Meyerson, M.D.
 

James Grier Miller, M.D., Ph.D.
 

Anne Moore 

Rudolph Moos, Ph.D. 

James Moses, Ph.D. 

Eugene F. Murphy, Ph.D.
 

Wendell Musser, M.D.
 

Boyce Nall 

Thomas Newcomb, M.D.
 

Vernon Nickel, M.D. 

John C. Nunemaker, M.D.
 

Charles P. O’Brien, M.D., Ph.D. 

William H. Oldendorf, M.D.
 

John Overall, Ph.D. 

William Page, Ph.D. 

William Pare, Ph.D. 

CXXXVIII
 
 

 

 

Cecil Peck, Ph.D. 

Inder Perkash, M.D.
 

John Peters 

Jon Peters, P.T.
 

Adolph Pfefferbaum, M.D.
 

Lajos Piko, Ph.D. 

James A. Pittman, M.D.
 

Robert Prien, Ph.D. 

John Prusmak, M.D.
 

Jose Rabinowitz, Ph.D. 

Malcolm J. Randall 

Gerald Reaven, M.D.
 

Paul Rogers, Esq.
 

Charles A. Rosenberg, M.D.
 

Joseph Ross, M.D.
 

Bernard Roswit, M.D. 

Dennis Roth
 

Walton Thomas Roth, M.D.
 

Marcus Rothschild, M.D.
 

Robert Rynearson 

Mohinder Sambhi, M.D.
 

Andrew Schally, Ph.D. 

Harold Schnaper, M.D.
 

Robert Schneiter 

Harold Schoolman, M.D.
 

Robert Schrek, M.D.
 

Ruth Schrek 

Leonard Seeff, M.D., Ch.B.
 

Robert Shamaskin 

Lawrence Shaw 

Austin Shug, Ph.D. 

Jay Shurley, M.D.
 

David G. Simons, M.D.
 

Orin T. Skouge, M.D.
 

James J. Smith, M.D.
 

Marion Smith, Ph.D. 

David H. Solomon, M.D.
 

George F. Solomon, M.D.
 

Harold Sox, M.D.
 

Herta Spencer, M.D.
 

Jerry Spenney, M.D.
 

Leonard Spolter, Ph.D. 

Norton Spritz, M.D.
 

Paul Srere, Ph.D. 

Barry Sterman, Ph.D. 

Robert E. Stewart, D.D.S. 

CXXXIX
 
 

 

 

Richard Streiff, M.D.
 

Leon Swell, Ph.D. 

Robert Swenson, M.D.
 

Keith Taylor, M.D. 

David D. Thomas 

William C. Thomas, M.D.
 

Samuel Threefoot, M.D.
 

Jereld R. Tinklenberg, M.D.
 

Leonard Ullman, Ph.D. 

Roger H. Unger, M.D. 

Kosaku Uyeda, Ph.D. 

William Valentine, M.D.
 

Hugh Vickerstaff 

Harry E. Walkup, M.D. 

John Weakland
 

James Wear, Ph.D. 

Fred Weibell, Ph.D. 

Louis Jolyon West, M.D. 

Walter Whicomb, M.D. 

Darlene Whorley
 

Clyde Williams, M.D., Ph.D. 

John Willoughby
 

Marjorie T. Wilson, M.D.
 

Mark Walcott, M.D.
 

Julius Wolf, M.D.
 

Stewart G. Wolf, M.D.
 

Rosalyn S. Yalow, Ph.D.
 

Jerome Yesavage, M.D.
 

Larry Yuen 

Vincent P. Zarcone, M.D.
 

Leslie Zieve, M.D.
 

Hyman Zimmerman, M.D.
 

Eugene Zukowsky, Ph.D.
 

CXL
 
 

 

 

 

 

 

 

 

Appendix XI. Organization of research within the VA 

The VA research program reflects the nature of the VA itself, a service organization dedicated to 

the American war veteran. Research has always been an integral part of the VA, but the VA’s 

structure has changed with time, as has the status of its research component. This description is 

intended to reduce confusion for the reader who is not familiar with this structure. The major 

changes with time are summarized as organizational charts. 

The research unit has consistently been part of the VA’s medical program, which itself is a part of a 

larger organization with additional responsibilities (pensions, insurance, etc). Until 1930, the 

overall organization was called the Veterans’ Bureau (with narrower responsibilities). It then 

became the Veteran’s Administration, with a broader charge. In 1989, Congress made it a Cabinetlevel Department, the Department of Veterans Affairs. For simplicity, here the organization will 

usually be called simply “the VA”. The entire VA is headed by a Presidential appointee, called the 

Director until 1930, the Administrator for Veterans’ Affairs until 1989 and subsequently the 

Secretary for Veterans’ Affairs. 

The medical program was called the Medical Service until 1946, when a new law redefined it. It 

was then called the Department of Medicine and Surgery (DM&S) until 1989, and now it is the 

Veterans’ Health Administration. Its leader was called the Medical Director from 1922 to 1946, the 

Chief Medical Director (CMD) from 1946 to 1989, and is now the Undersecretary for Health. He 

reports to the Administrator or Secretary.

 Figure AppXI.1: VA organization, 1922-1946 

CXLI
 
 

 

 

 

 

 

 

 Figure AppXI.2: VA organization, 1946-1953 

Most of the early research after the end of World War II was clinical in nature. In fact, some of the 

most important early research studies (the tuberculosis studies and the psychopharmacology studies) 

emanated from offices primarily responsible for direct patient care. As a separate Research Service 

grew within the Central Office, its members worked with staff of these patient-care services to 

assist them in the research that they had begun. As time went on, Research Service took more and 

more responsibility for those studies. 

Soon after the end of World War II, Research Chiefs were included on the staffs of a number of 

Professional Service units (Figure AppXI.2). During the 1960s, when Research Service had 

Program Chiefs in various patient care areas, there was active exchange between the Research 

Service Program Chiefs and the Research Chiefs in the respective patient care services. As the 

research program became stronger and more diverse in the 1970s and 1980s, the need for these 

formally designated Research Chiefs elsewhere in VACO decreased; but members of the patient 

care services continued to play an active advisory role in the research program. 

CXLII
 Figure AppXI.3: VA organization, 1953-1973 

Figure App XI.4: VA organization, 1973-1989 

CXLIII
(Intentionally Blank) 

CXLIV 
 

 

 

 

 

Index 

A 

Abt, Arthur, 96 

Acheson, E. Donald, 271
 

Adams, Roy D., 30, 46, 60 

Adams, William, 98, 106–7, 108 

Adams, Winthrop, 15 

Addison’s disease, 195, 305 

African Americans
 

cancers, 50 

sarcoidosis, 134
 

sickle cell anemia, 197, 360, 393, 395 

tuberculosis, 134, 144 

aging. See gerontology
 

alcoholism, 54, 218, 370–2
 

Alcoholism Scholars scientists, 371, 374–6
 

alcohol toxicity, 362 

Allaben, G. R., 48
 

Allen, C. D., 42 

Allen, Ernest, 184 

Allen, Herbert, 169 fig. 6.2, 170 fig. 6.6, 171,
 

with patient 171 fig 6.7 

Allen, Robert, 370, 372 fig. 16.21 

allergy and disease, 52, 53 

Allison, S. T., 160
 

Alpert, Louis, 98 

Alzheimer’s disease, 374 

Amberson, J. Burns, 156, 188 

American Academy of Orthopedic Surgeons, 419 

American Board of Nuclear Medicine, 177 

American Cancer Society, 242, 243 

American Journal of Cancer, 48 

American Journal of Psychiatry, 28 

American Journal of Syphilis, 28 

American Journal of the Medical Sciences, 28 

American Legion, 8, 31
 

American Medical Association, 33 44, 153 

American Psychiatric Association, 52, 220 

American Red Cross, 8, 127
 

American Review of Tuberculosis, 28, 29, 153 

American Trudeau Society, 145, 151 

American Tuberculosis Association, 143 

amphotericin B, 304, 305 

analgesia, 307
 

anesthesia, 307 

angina, 397
 

angiography, 57 

animal research standards, 284–5 

Annals of Internal Medicine, 53, 55, 231 

anticoagulants, 307–8 

antidepressants, 218. See also specific drug names 

antivivisectionists, 244 

Archives of Environmental Health, 244 

Archives of Internal Medicine, 55 

Armed Forces Institute of Pathology, 56 

Armstrong, Mark, 231 

Armstrong, Wallace, 169 fig. 6.3 

Army Medical School, 42 

arsenic, 245
 

arterial injuries, 128 

asbestos, 245 

aspirin, 397
 

atherosclerosis, 307–8 

Atomic Bomb Casualties Commission, 136 

atomic medicine, 167–77, 196 

Auerbach, Oscar 241 fig.10.1 

Senior Medical Investigator program, 188, 280, 

359 

smoking and lung cancer, 192, 241–5 

tuberculosis pathology, 102 

Aurbach, Gerald, 252–3 

Autoanalyzer, 290 fig. 12.22 

Automated Hospital Information System (AHIS),
 

406, 407–10
 

Axelrod, Julius, 365
 

B 

Bachrach, Clifford A., 271, 299–300
 

bacterial infections research, 42–3 

bacteriological studies, 101–2
 

Bailar, John, 339, 341 

Baker, Nome, 176 

Bakke, John, 231 

Bambery, Anne, 40
 

Barker, Lewellys F., 13, 13 fig. 1.8, 30, 46, 60 

Barnwell, John 145 fig.5.2 

and American Trudeau Society, 145
 

Atlanta VA hospital visit, 95 

on cooperative studies, 221
 

and Cummings, 183 

expansion of research scope, 185
 

Public Health Service studies, 155 

583 
 

 

 

 

 

 

Index 

Streptomycin Committee, 146 

Streptomycin Conference (third), 152–3 

Streptomycin controls, 149 

Barrett, Albert M., 47 

Bassett, Samuel 106 fig.3.15 

cortisone studies, 98 

metabolic studies, 108 

on NIH funding, 184 

potassium deficiency syndrome, 106
 

Senior Medical Investigator, 280, 318
 

Battelle Memorial Institute, 429 

Bauer, Franz, 172 

Baxter, Claude, 287, 372, 372 fig. 16.21 

Baylink, David, 177 

beagles, smoking research, 244, 245
 

Beck, C. E., 372 fig. 16.21 

Becker, Robert, 288, 289 fig. 12.19, 373, 434 

Beebe, Gilbert, 123, 126–7, 127 fig.4.3 

131 fig. 4.5, 149, 214
 

Beecher, Harold, 125 

Beeson, Paul, 125 

Benham, Thomas A., 428 

Bennett, Ivan F., 214 

benzodiazepines, 210 

Berger, Philip, 372 fig. 16.21 

Berman, Howard, 367, 368 fig. 16.18
 

Bernstein, Leon, 336, 336 fig. 15.9, 337, 338, 339, 

410 

Bernstein, Lionel 329 fig.15.1 

career ladder for clinicians, 322 

Central Office positions, 329–30 

operations review, 410
 

Part 1-Part 2 System, 335, 336, 337, 338 

research program quality, 290 

Berson, Solomon 

Middleton Award, 189, 288 

radioimmunoassay, 172, 192 

radioisotope program, 103, 176 

Radioisotope Service, 249, 250–253
 

Senior Medical Investigator program, 280 

and Unger, 193 fig. 7.7, 193 

with Yalow, Unger and Jorpes 254 fig. 11.4
 

Best, William, 391 

Bikini Atoll nuclear tests, 167, 173 

bile salts, 41–2 

Billings, Frank, 7 

Billock, John, 426 

Bird, E. D., 372 fig. 16.21 

Blades, Brian, 125 

Blahd, William, 108, 174, 176 

blastomycosis, 303, 304 

blindness. See vision impairments 

Blindness: A Modern Approach to the Unseen
 

Environment, 428 

Bliss, James, 430 

Bliss, Raymond, 167 

Blumenthal, Basil, 55
 

Boeing Aerospace, 427
 

Bogen, Emil, 155 

Boone, Joel, 168, 184 

Borden, Craig, 110, 195
 

Bradley, Omar N.
 

and Ebert, 109 

medical corps, 90
 

post-War reform, 89 

Public Law 79-293, 91 fig. 3.1 

Truman appointment, 145 

VA hospitals and medical schools, 92
 

Braslow, Joel, 221 

Brault, Marian, 350
 

breast cancer, 104 

Bresler, Emmanuel, 331 fig. 15.5
 

Brief Psychiatric Rating Scale, 218, 220 

Brill, Norman, 125 

Brown, Byron, 307 

Brown, Donald V., 271 

Buchanan, John M., 406
 

Buchsbaum, Monte, 372 fig. 16.21 

Buchsbaum, Sheri, 372 fig. 16.21 

Buerger’s disease, 135 

Bulletin of Prosthetic Research, 422 

Bunn, Paul, 155 

Bura, Walter, 421 

Burch, George, 125
 

Bureau of Soldier Rehabilitation, 8 

Bureau of War Risk Insurance, 5, 6, 8 

Burgess, Ernest, 427
 

Burrows, Belton, 170 fig. 6.6, 174, 177
 

C 

C-5 Laser Cane, 428–9
 

Caffey, Eugene Jr., 214, 216, 219 

584 
 

 

 

 

 

 

Index 

Calebresi, Massimo, 231 

Cameron, Charles, 243
 

Camp Travis, TX, 35 

Cancer, 242 

Cancer Research, 50 

cancers 

adjuvant treatments, 310–2 

and anticoagulants, 399–400 

chemotherapy, 133 

cooperative studies, 190, 191 

and genomes, 104 

and viruses, 104, 105, 332
 

See also smoking and cancers; specific types
 

(for ex., thyroid cancer); Tumor Research
 

Laboratory
 

Cannan, R. Keith, 132 

cardiography, 196 

cardiology, 47, 197–8, 230, 231, 396–8 

cardiovascular disease, 53, 55–7, 110
 

cooperative studies, 231–5, 310, 396–8
 

See also Veterans Administration units, 

Cardiovascular Research Unit 

Carpenter, W. T., Jr., 372 fig. 16.21
 

Carr, Lewis W., 276 

Cassen, Benedict, 169 fig. 6.2, 6.3, and 6.4, 171, 

172 fig. 6.8 

Cass, Jules S., 284–5, 285 fig.12.18
 

Casteel, Ralph, 94, 94 fig. 3.4, 98, 174 

Cavalieri, Ralph, 177 

Cecil and Loeb Textbook of Medicine, 228, 233 

Centers for Disease Control, 183 

Chaikoff, I. L., 125 

Chalmers, Thomas, 233, 330, 330 fig. 15.3, 338, 

364 fig. 16.12, 408,
 

Chamberlain, W. Edward, 189 

Chapple, Charles 189 fig. 7.5 

biographical details, 188–9 

Committee on Administrative and
 

Developmental Research, 406 

and Meyer, 286 

psychiatric cooperative studies, 214 

R&E publications, 272, 273 

Chardack, William, 196–7 

Charles, Gerald, 410–1 

Chase, John
 

and alcoholism studies, 371 

and budget issues, 354, 381 

and Middleton awardees, 360 fig. 16.6 

physicians bonus program, 357–8 

position changes, 367 

rehabilitation research, 433 

staff meetings, 353 

Chauncey, Howard W., 278 fig. 12.12 

Chernoff, Arthur, 286 

Childress, Dudley, 426 fig. 20.4
 

chloral hydrate, 209 

chlordiazepoxide, 218, 312–3 

chlorothiazide, 231 

chlorpromazine (Thorazine) 

cooperative studies, 213, 214–5, 218
 

first use of, 210 

outpatient studies, 312 

and schizophrenia, 212 

chlorpropamide, 307
 

Chodos, Robert, 170 fig. 6.6, 177 

Christianson, Lawrence G., 279, 408
 

chromate and lung cancer, 242 

Civil Service system, 58, 90, 91 

Cleland, Max, 361 fig. 16.7, 365, 368, 373 

clofibrate, 308 

coccidioidomycosis 

cooperative studies, 190, 303, 304 

extramural research, 125
 

Milton Hubert, 195 

rattlesnake research, 107
 

Cognodictor, 429 

Cohen, Irving, 405 

Cohn, Alfred E., 17, 25, 46 

Cohn, David, 176 

cold-pressor test, 55 

Cole, Jonathan O., 214, 219, 372 fig. 16.21 

Colineator, 429 

colon surgery, and antibiotics, 398–9
 

Committee on Med Research WW II(CMR), 125 

Committee on Veterans Medical Problems
 

(CVMP), 123–5, 128–30, 136, 189, 281 

compensation of VA researchers, 321–2 

Compere, Clinton, 425 

computerization. See VA information systems 

congestive heart failure, 397–8 

Conrad, Loyal, 231 

Controversies in Clinical Medicine, 234 

585 
 

 

 

 

 

 

Index 

Controversy in Internal Medicine (Goldring and
 

Chasis), 228–9 

Coombs, Frank, 424, 434 

Cooney, James, 167 

Cooper, Franklin, 430 

Cooper, John A. D., 98, 195 

Cooperative Studies Program See Veterans 

Administration Programs
 

coronary artery disease study, 56
 

cortisone, 92, 98–9, 108, 109 

Council on National Defense, 4 

Coxsakie virus, 105 

Crabbe, John, 376 

Cranston, Alan, 368 

Crossman, Edgar O., 12, 12 fig. 1.7, 14, 17, 19,
 

32, 39 

Croupette, 188 

Crutcher, James C., 367
 

CT scanners, iv, 361, 362 fig. 16.8, 362 fig. 16.9
 

Cummings, Martin 183 fig. 7.2 

annual report of research projects, 186, 187 

Central Office positions, 96, 183 

cortisone research, 98 

on Magnuson, 94, 95 

tuberculosis research, 109
 

Cushing, Edward Harvey (Pat), 93, 95, 95 fig. 3.5, 

101, 125, 189 

Custis, Donald, 367 

Cutler, Max, 47, 48 

D 

Dallborf, Gilbert, 105 

Davis, J. M., 372 fig. 16.21 

Davis, Kenneth L, 372 

Davis, Michael, 15, 17 

Dawes, Charles E., 8 

Dayton, Seymour, 307–8
 

DeBakey, Michael 123 fig. 4.1 

contract research, 125 

as lobbyist, 185 

and Medical Follow-up Agency, 126–7, 131
 

fig. 4.5
 

NRC/VA cooperation, 123
 

on post-WWII VA capabilities, 90 

on VA hospital-medical school partnerships, 91
 

deLong, Chester, 322, 322 fig. 14.1, 339, 344 

dementia praecox. See schizophrenia 

Denardo, Gerald, 177 

Densen, Paul, 149 

Department of Health, Education and Welfare. 

National Center for Health Services
 

Research, 413
 

D’Esopo, Nicholas, 154, 155 

Devoe, Ralph G., 105 

diabetes, 106–7, 193–4, 253, 307, 331
 

diagnostic centers
 

Chicago, IL, 31 

Cincinnati, OH, 19, 30 

Hines VA hospital, 31, 46, 47 

and Medical Bulletin, 32 

and medical schools, 17, 31 

1930s, 25
 

1939 assessment, 59 

Palo Alto, CA, 30, 31, 31fig2.1 

San Francisco, CA, 31 

Washington, DC, 30 

diagnostic methods, cooperative studies of, 305
 

diet and disease, 52, 53 

digoxin, 397–8 

Divers, Jack, 409, 410 

Dodge, Harold, 231
 

dogs. See beagles, smoking research
 

Donati, Robert, 177
 

Dorst, Stanley E., 188 

Driver, William J., 284 

drug abuse, 218 

Dublin, Louis, 15–6, 16 fig. 1.9, 17, 26, 59 

Dunham, H. Kennon, 15, 30, 37 

Dunner, Edward 

and Central Neuropsychiatric Research
 

Laboratory, 215 

and Cooperative Studies Program, 299 

coordination of cooperative studies, 190 

with Gross and Guze 269 fig. 12.4
 

with Kaim, 274 fig. 12.6
 

position changes, 269, 290 

Research Evaluation Committees, 334 

VA/Armed Forces cooperative study on
 

tuberculosis, 154 

duodenal ulcers, 309 

Duran, Marguerite, 187 

Dury, Abraham 279 fig. 12.14
 

586 
 

 

 

Index 

Advisory Committee on Problems of Aging, 

189 

and basic science, 344 

Exceptional Service Award, 344
 

budget issues, 354 

Medical Research Service, 349
 

and MIS, 351 

Part 1-Part 2 System, 339
 

position changes, 278, 343 

E 

Eberhart, Howard D., 420, 421, 422
 

Ebert, Richard, 92, 109, 110, 195 

Economy Act of 1933, 25
 

Eddleman, E. E., 196, 231 

Efron, Robert, 272 

Egeberg, Roger, 97 fig. 3.7, 106, 107 

Eisenberg, Seymour, 192
 

Eisentraut, Ann, 193 

electric shock therapy, 54, 190 

electrocardiograms, 55, 56, 57, 305–6 

Elliott, Charles A., 31 

Emerson, Haven, 9, 9 fig. 1.3 

endocrine disorders, 191, 305 

Engle, H. Martin (Hal), 245, 283–4, 330 

epilepsy, 45, 51-3, 192 

esophageal varices, 309–10 

estrogen, 48, 308, 312 

Evans, Carleton, 349, 410, 411 fig. 19.1, 414 

Ewalt, Jack, 372 fig. 16.21 

F 

Falk, Abraham, 110, 154 

Federal Board for Vocational Education. 

Rehabilitation Division, 8 

Federal Model Cities Program, 411 

Feldman, William, 154 

Ferebee, Shirley H., 155–6 

fetal alcohol syndrome, 375
 

Fetta, L. Tracy, 272 

Fialla, G., 250 

Filer, Richard, 343 fig. 15.13 

Finland, Maxwell, 188 

fish, bitterling, 48 

Fitzgerald, Thomas, 381 

Fitzsimons General Army Hospital (CO), 148 

Florsheim, Peter, 92
 

fluid metabolism, 96 

Forbes, Charles R., 9, 9 fig 1.2, 10
 

Forrest, William, 307 

Foster, H. E., 42 

foundations, 26, 27 

Foye, Laurence, 338–9, 349 

fractures, long bone, 42-3 

Freed, Earl, 366, 367 fig. 16.15, 372 fig. 16.21 

Freis, Edward 230 fig. 9.1 

American Society for Clinical Investigation 

meeting, 233
 

background and accomplishments, 229–31
 

hypertension research, 192, 227–8 

Lasker Award, 363 

Middleton Award, 362–3 

and Schnaper, 275 

Senior Medical Investigator program, 188, 280, 

318 

Fremont, Rudolph, 231 

Friedell, H. L. (Hymer), 168, 169 fig. 6.3 

Funk, Ian, 214 

Furth, Jacob, 104 

G 

Gage, Andrew, 196–7, 198 

Galgiani, John N., 304 

Garfinkel, Lawrence, 243 

gastric ulcers, 308–9 

gastrin, 253, 254 

gastroenterology, 195 

Gavazzi, Al, 408, 409 

Geigy Pharmaceuticals, 218 

gerontology, 189, 235, 281, 286, 369–70 

Gerstl, Bruno, 102–3, 103 fig. 3.12, 195 

Gilchrist, H. L., 37 

Gilford, Solomon, 57 

Ginsburg, S. T., 214 

Gintzig, Leon, 406, 409 

Glick, Seymour, 252 

Goldman, Ralph, 98, 106, 107–8, 108 fig 3.16 

Goldsmith, Harry, 214 

Goldstein, A. L., 372 fig. 16.21 

Goodwin, William E., 171 

Gorham, Donald, 218 

Gorton, Ralph, 177 

587 
 

 

 

 

 

 

 

 

 

 

Index 

gout, 108 

grants (NIH), 93, 98, 109, 171, 184–5, 392. See 

also National Institutes of Health, peer
 

review model 

Greatbatch, Wilson, 197
 

Greene, Richard, 413 fig 19.3, 414, 415 

Gregg, Alan, 26 

Griffith, Charles, 46, 58
 

Gross, Ludwig 103 fig. 3.13
 

background and accomplishments, 103–5 

laboratory 105 fig. 3.14
 

Lasker Award, 363 

leukemia research, iv 

Middleton Award, 332, 333 fig. 15.8 

Senior Medical Investigator program, 188, 280, 

359 

with Dunner and Guze 269 fig. 12.4 

Yalow celebration, 364 fig. 16.12 

Grossman, Morton 

gastroenterology research, 195, 308–9 

and Oldendorf, 361–2 

Senior Medical Investigator program, 280 

special research advisory committee (1977), 

365 

Yalow on, 254 

Groves, Leslie R., 167 

Grow, Malcolm, 167 

Growth, 48 

Gutman, Helmut, 176 

Guze, Lucien, 289, 329 

with Kalmanson 289 fig 12.20 

H 

Haber, Paul, 369 

Haddy, Francis, 98, 195 

Hagans, James, 350, 391 fig. 18.1, 391–2 

Halsted, James A., 98, 174, 195, 268 fig 12.3, 

268–9 

Hammarsten, James, 99, 110 

Hammond, Cuyler, 242, 243, 244 

hand injuries, 134–5 

Hand-Schuller-Christian syndrome, 108 

Harding, Warren G., 8, 9, 10
 

Harper’s Ferry schizophrenia conference, 372–3
 

Harris, Adron, 375–6 

Harris, R. L., 42 

Harris, William, 154
 

Haskins Laboratory, 430 

Hawley, Paul 

appointment by Bradley, 89 

and Committee on Veterans Medical Problems, 

123 

and medical corps, 90 

and nuclear medicine, 167 

Public Law 79-293, 91 fig. 3.1 

tuberculosis in veterans, 145 

VA hospital-medical schools affiliations, 92 

Hays, Marguerite T. , 350 fig. 16.1 

budget issues, 353, 354, 381, 382–3, 386 

and Cranston, 368 

Harper’s Ferry schizophrenia conference, 372
 

fig. 16.21 

Medical Investigator Program, 320, 359 

Medical Research Service, 351 

Yalow celebration, 364 fig. 16.12 

head injuries, 135 

heart, missiles in, 136 

heart valve replacement, 398 

heart x-rays, 55
 

Heller, Benjamin, 110, 195
 

Heller, Paul, 196, 360, 393, 395 

Heller, Rodney, 310–1 

hemoglobin diseases, 196 

Henn, F. A., 372 fig. 16.21 

Hentel, William, 154 

hepatitis, 130, 134, 253–4, 395–6 

Herbert, Victor, 362 

heroin addiction treatment, 218 

heterophile antibodies, 51-3 

Higgins, George, 303 

Hill, A. Bradford, 154–5 

Hill, Lister, 185 

Hine, Gerald, 175, 175 fig 6.14, 176, 343, 351 fig.
 

16.3 

Hines Cancer Treatment Center, 47 

Hines, Frank T. 10 fig. 1.5 

appointment by Harding, 10 

management style, 58 

and medical corps, 90 

and veterans’ care, 11, 12
 

Hinshaw, Corwin, 149, 155 

histoplasmosis, 190, 303, 304 

588 
 

 

 

 

 

 

 

 

 

 

 

 

Index 

Hobby, Gladys, 102 irradiation, million volt, 130
 

Hobson, Lawrence, 340 340 fig. 15.11 

Hodgkin’s disease, 135
 

Hollister, Leo, 213, 213 fig. 8.3, 214, 216, 289 

Holsopple, J. Quinter, 211, 212, 214, 215 

Hooper, H. Elston 350 fig. 16.2
 

field operations, 350 

Medical Research Information System (MRIS), 

351 

position changes, 274–5
 

as Program Chief, 273, 343 

and Research Associate Program, 279, 319 

retirement, 366 

with Filer, Matthews and Walcott 343 fig.
 

15.13 

hormones and prohormones, 255 

Huddleston, James A., 53
 

Huff, Rex, 176, 176 fig. 6.15 

human growth hormone, 252, 253, 305 

Huppert, Milton, 196 

hydralazine, 232, 397–8
 

hydrochlorathiazide, 232
 

hydroxyzine, 218 

hyoscine, 209
 

hypertension, 192, 227, 228–9, 234–5, 230 fig. 9.2 

See also cardiovascular disease 

hyperthyroidism, 171 

hypoglycemia, 253 

hypothalamic hormones, 331 

I 

Ijams, George E., 46, 46 Fig. 2.5 

imipramine, 210 

Immediate Postsurgical Prosthetic Fitting, 427 

immunological studies, 102–3 

Indian Health Service, 61 

influenza, 35
 

informed consent, 147, 159–60 

Ingelfinger, Franz, 125 

Ingvar, D. H., 372 fig. 16.21 

Inman, Verne, 420, 421, 422 

institutional allocations. See Veterans 

Administration, Part 1-Part 2 System
 

insulin antibodies, 252 

insulin metabolism, 251–2 

insulin shock therapy, 52–3, 54, 92, 210, 280 

Irving, Charles C., 176 

Isolette infant incubator, 188 

isoniazid, 132, 133, 190, 299, 303 

isosorbide dinitrate, 397–8 

Itil, T. M., 372 fig. 16.21
 

J 

Jablon, Seymour, 128, 129 fig. 4.4
 

Jaffrey, Harold, 332 fig. 15.7 

James, Kenneth, 307
 

Jenkins, Richard L., 211, 212, 214
 

Johns Hopkins University, 26 

Johnson, Lyndon, 284 

Journal of Clinical Investigation, 25, 28, 252 

Journal of Nervous and Mental Diseases, 37 

Journal of Rehabilitation Research and 

Development, 422 

Journal of the American Medical Association, 28,
 

110, 153, 232
 

K 

Kaim, Samuel C., 218, 273, 274, 279, 319 

with Dunner 274 fig. 12.6 

Kalmanson, George, 289, 

with Guze 289 fig.12.20
 

Kaplan, Irvin, 174, 176 

Keefer, Chester, 230
 

Kennedy, John, 197
 

Kessler, Henry, 420
 

Kevan, Robert, 93, 94, 94 fig. 3.3
 

kidney cancer, 104 

Kinnard, Matthew, 370 fig. 16.19 

Kirby, William H., 406 

Kirkendall, Walter, 231 

Kistin, Albert, 55, 57 

Kleinman, J. E., 372 fig. 16.21 

Klett, C. James, 215, 216 fig. 8.5, 221
 

Klopstag, Paul, 419
 

Koch, Robert, 146 

Kolff, Willem, 92 

Korstad, Peter, 405, 406
 

Kracke, Roy, 91–2 

Krause, Allen K., 17, 26, 30, 37 

Krayer, Otto, 230 

Krebs, Hans, 371 

589 
 

 

 

 

 

 

 

 

L 

Index 

Krupp, Marcus, 98 

Kumagai, Lindy, 177 

Kurtze, John, 132 

Kurzweil, Raymond, 430 

Kurzweil Reading Machine, 430 

Laksman, Raj, 376 

Landowne, Milton, 56, 57 

Langley Act, 6, 9 

Lanz, Henry, 169 fig. 6.2, 170 fig. 6.6 

Lasker Award 

Freis, Edward, 190, 234, 363 

Oldendorf, William, 360 

Schally, Andrew F., 331
 

Senior Medical Investigator winners, 319
 

Lasker, Mary, 185, 233 

Lasky, Julian, 215 

Lathrop, Julia C., 4 

Lawrence, John, 107 

Lawton, Alfred H., 95, 96–7, 97 fig. 3.7, 101, 106, 

170 fig. 6.6 

Lazell, Edward E., 51–4
 

Leconnen, Ann, 107 

Lee, Lyndon 274 fig. 12.5 

adjuvant treatments, 310–1 

appointment by Musser, 338–9
 

and cardiac pacemaker, 197 

coordination of cooperative studies, 190–1 

position changes, 274, 276 

as Program Chief, 273 

radioisotope program, 174 

Research Career Development Program, 322 

with Walcott and Meyer 277 fig. 12.9
 

Leroy, Geo., 170 fig. 6.6 

leukemia, iv, 49-51, 103, 104–5, 108, 332 

leukocytes, 49–50 

Levin, Melvin, 108 

Libby, Raymond, 169 figs. 6.2, 6.3, and 6.4; 170 

fig. 6.6; 171
 

Libman, Gerald, 339, 355, 367 

Lieber, Charles, 362, 362 fig. 16.10 

Life, 242, 244 

Lindley, Clyde, 214, 219, 220, 406 

Lindsay, Raymond, 176
 

Linvill, John, 430 

Lipton, Morris, 195
 

lithium, 219, 221 

Littman, David, 231
 

liver transplants, 196, 331 

Livings, Dorothy, 154 

lobotomies, 125, 210, 211–2 

Loma Linda School of Medicine, 106
 

Long, Cyril N. H., 125 

Long, Esmond R., 155 

Long, Perrin H., 168
 

Lorenz, William F., 46, 47, 60 

Lorr, Maurice, 100, 211, 211 fig. 8.2, 214, 312 

Lucke, Baldwin, 104
 

lumbar disk disease, 136
 

lung cancer, 242–5, 311, 400 

Lyon, George Marshall 96 fig. 3.6
 

at conferences 169 fig. 6.3, 170 fig. 6.5, 170
 

fig. 6.6 

Atomic Medicine program, 167–70, 183 

and Cummings, 94 

funding, 185, 334 

nongovernmental gifts policy, 98 

R&E positions, 93, 95 

with advisory committee 168 fig. 6.1
 

M 

MacEachern, Dr., 60 

Mack, Julian W., 4 

Macy, V. Everit, 4 

Madison, Leonard, 192 

Magnuson, Paul 93 fig. 3.2 

and Cummings, 183 

hospital design and construction, 98 

Palo Alto visit, 60 

personal characteristics, 94 

prosthetics, 425 

Public Law 79-293 91 fig. 3.1 

R&E positions, 93 

VA hospital-medical schools affiliations, 92 

on veterans care, 89–90, 95
 

Mahoney, Florence, 185 

Mainland, Donald, 131 

Maisel, Albert Q, 61 

malaria, 29, 30, 36, 37, 44, 45, 54 

Malt, Ronald A., 310
 

Manhattan Project, 167 

590 
 

 

 

 

 

 

 

 

 

 

 

 

Index 

Marine Hospitals, 4, 5–6 

Marrazzi, Amedeo, 214 

Martin, Albert, 42 

Mason, J. W., 372 fig. 16.21 

Masters’ exercise test, 55
 

Matthews, James, 275 fig. 12.7, 339, 343, 343 fig.
 

15.13 

Matz, Philip B. 34 fig. 2.3, 40 fig. 2.4
 

background and accomplishments, 34–40 

death of, 40
 

Dublin on, 59
 

field hospital projects, 45 tab. 2.8
 

syphilis research, 41 

Mauch, Hans, 424, 429, 430 

Mauch Laboratories, 425
 

Maudlin, Bill (cartoons of), 241 

Mayo Clinic, 27, 31, 147, 149 

May, P.R.A., 372 fig. 16.21 

Mazer, Milton, 55 

McAdoo, William, 4 

McCall, Mary, 193 

McDermott, Walsh, 155
 

Meade, Robert, 177 

Means, J. H., 92 

“The Mechanisms of Growth Control” 

(conference), 373 

Medical Bulletin 25, 26, 32-34, 33 fig. 2.2
 

articles by clinicians 43-44 tab. 2.6 

cessation of publication, 92 

comparison with other journals, 1926 28 tab.2.1 

and curative medicine, 15
 

and diagnostic centers, 32
 

first issue, 19, 25 

publication frequency, 25
 

subjects, 33 tab. 2.3 

tuberculosis articles, 144
 

medical centers. See veterans’ hospitals
 

Medical Follow-up Agency, 123, 125, 126–32, 

132–6 

medical literature, overview, 1926, 28–29 

medical records, 127–8
 

medical research, defined, 26-7 

Medical Research Information System (MRIS), 

283, 345, 351 

Medical Research in the Veterans Administration, 

186–7, 272, 305–6, 317 

medical schools. See veterans’ hospitals, and 

medical schools 

Mella, Hugo, 40, 54
 

Mellon, A.W., 6 

Melnechuk, T., 372 fig. 16.21 

Meneely, George, 169 figs. 6.2 and 6.3; 170 fig. 

6.6
 

Menetriere’s disease, 269 

mental illness
 

antipsychotic drugs, 192–3 

Brief Psychiatric Rating Scale, 218, 220 

cooperative studies (chemotherapies), 190, 218 

Multidimensional Scale for Rating Psychiatric
 

Patients, 212 

psychiatric inpatients, 39 tab 2.6, 209 fig. 8.1,
 

221–2 

psychoactive drugs, 1950s, 209–10, 213 

research programs (1950s and 1960s), 100 

Veterans’ Bureau follow-up study, 38–9 

World War I veterans, 58 

See also electric shock therapy; insulin shock
 

therapy; psychosis; schizophrenia 

meprobamate, 312 

merchant seaman, 4 

Merchant, William, 98 

Merck and Co., 98
 

mercurochrome, 42 

Messinger, Emanuel, 53
 

metabolic studies, 107–8, 359 

Metfessel, Milton, 429
 

methadone, 218 

metrazol, 53, 54 

Metropolitan Life Insurance Company, 26 

Meyer, Joe 

background and accomplishments, 286–7 

position changes, 278 

as Program Chief, 273 

Radioisotope Conference (1949), 169 fig. 6.4 

Radioisotope Service, 176 

Research Conference (1965), 277 fig. 12.9 

Michael, Max, 99, 109 

Middleton Award, 190, 288–9, 330–2, 359–63, 

373 

Middleton, William 186 fig 7.3 

background and accomplishments, 185–6 

and basic science, 286 

591 
 

 

 

 

 

 

 

Index 

and Middleton Awards, 330, 332 fig 15.6 

Research Advisory Committee, 189
 

and smoking research, 245 

VA annual report, 187 

military hospitals, Civil War era, 5
 

Mirsky, I. Arthur, 229–30 

Moise, T. S., 183 

Morgan, Hugh, 168 

Moros, N., 53
 

Morton, Mortimer E., 168, 169 fig. 6.3, 170 fig.
 

6.6 

Moseley, A. Graham 173 fig 6.10 

background and accomplishments, 173–4 

and Cummings, 183 

as Program Chief, 273 

Radioisotope Conference (1950), 170 figs. 6.5
 

and 6.6 

radioisotope program, 183 

Radioisotope Service, 168
 

with Weiler 173 fig. 6.11
 

Mosher, Loren, 372 fig. 16.21 

Moyer, Carl A., 188 

Multidimensional Scale for Rating Psychiatric
 

Patients, 212 

multiple sclerosis, 132–3, 299 

Murphy, Eugene, 419, 420 fig. 20.1, 420–1, 422, 

428, 432 

Murrow, Ed, 242 

Musser, Mark J. (Jim) 266 fig 12.1 

and Auerbach, 245 

background and accomplishments, 266 

and basic science, 286 

budget issues, 284 

as Chief Medical Officer, 338 

and Efron, 272 

nuclear medicine, 175 

Research Evaluation Committees, 334 

and Senior Medical Investigator program, 280
 

and Wells, 268, 289 fig. 12.19 

Musser, Wendell, 409, 410 

mycology, 196, 303 

myocardial infarction, 397 

myoelectric prosthetics, 426 

N 

Nadel, Eli M., 278 fig. 12.13, 322 

National Academy of Sciences, 96, 100, 123, 272, 

354. See also Veterans Administration 

agencies
 

National Academy of Sciences, National Research 

Council 

Committee on Prosthetics Research and 

Development, 432 

Committee on Sensory Devices, 428, 429 

Committee on Veterans Medical Problems
 

(CVMP), 123–5, 128–30, 136, 189, 281 

Medical Follow-up Agency, 126-136
 

advisory committees and subcommittees, 125 

and prosthetics research, 419 

and sensory aids research, 428 

surveys of VA research, 197, 290–1, 354 

National Cancer Institute, 93, 133, 191, 270, 310
 

National High Blood Pressure Education Program,
 

234 

National Institute of Health (NIH forerunner), 26­

7, 93 

National Institute of Mental Health (NIMH), 219, 

220 

National Institutes of Health (NIH) 

Aging Study, 57
 

fellows, 96 

grants availability, 184–5
 

lectures, 104
 

NIH Councils and VA research, 283 

peer review model, 329, 335, 338, 355 

publication of studies, 198
 

See also grants (NIH) 

Navy Hospital (Sampson, NY), 148 

neuroblastoma, 104 

neurocirculatory asthenia, 55
 

neuropsychiatric studies, Executive Committee 

216 fig. 8.6
 

Newcomb, Thomas 341 fig. 15.12 

budget issues, 353, 354, 381 

Cooperative Studies Program, 391 

Medical Investigator Program, 320, 359 

Medical Research Service, 349–50 

Office of Research and Development, 431
 

peer review, 341–2 

with Gross, 333 fig. 15.8
 

position changes, 367 

New England Journal of Medicine, 39, 55, 243 

592 
 

 

 

 

 

 

Index 

New York Department of Mental Health, 220 

Nickel, Vernon, 373, 414–5, 433, 434, 434 fig.
 

20.6
 

NIH. See grants (NIH); National Institutes of
 

Health (NIH) 

nitroprusside, 397 

Nobel Prize
 

1970s, 364–5 

Axelrod, Julius, 365 

Berson, Solomon, 363 

Freis, Edward, 190 

lobotomies, 210
 

Oldendorf, William, 360 

radioimmunoassay, 249 

Schally, Andrew F., 286, 363, 364 

Senior Medical Investigators, 319 

Yalow, Rosalyn, 172, 176, 255, 363, 364 

Northrup Aircraft, 425 

Northwestern University, 425–7 

nuclear medicine, 167–77, 196 

Nunemaker, John C., 96, 101–2, 183, 183 fig. 7.1,
 

184, 186 

nutrition studies, 362 

O 

Office of Management and Budget (OMB), 341, 

355 

Ogburn, Richard, 174, 174 fig 6.12
 

Oldendorf, William, iv, 359, 360–2, 363 

Middleton Award 361 fig 16.7 

with CT prototype 362 fig 16.9
 

Oliner, Leo, 177 

Optacon, 430
 

Optophone, 429 

Overall, John, 217–8 

Owen, Seward E., 47–8 

P 

pacemakers, cardiac, 196–7 

Palmer, Carroll, 155 

Palumbo, L. T., 196 

Papper, Solomon, 98, 195 

paraaminosalicylic acid (PAS), 161 

Paralyzed Veterans of America, 373, 374 

parathyroid hormone, 252 

Pare, William, 387 

Parke Davis Company, 107 

Parkinson, Thomas, 4 

Part 1-Part 2 System, 335–9 

Patterson, R. U., 9, 10 fig. 1.4 

Pauling, Linus, 286
 

penicillin, 147 

pentaquine, 230 

peptic ulcers, 269 

Perez-Polo, J. R., 372 fig. 16.21 

peripheral nerve injuries, 130, 134 

Perry, H. Mitchell, 235 

Peters, John, 406 

Peterson, Richard, 174 

Pfeiffer, K. R., 100 

Pfeiffer’s bacillus, 35 

Pfizer, Charles, 242
 

Pfrommer, Margaret, 427 

phenobarbital, 214–5 

phenothiazines, 215 fig. 8.4, 218 

Piersol, George M., 60 

Pilz, Clifford, 231 

Pipberger, Hubert, 231, 288, 305–6, 408 

Pittman, James, 176, 320, 339, 340 fig. 15.10,
 

340–1, 344
 

Plymore, Margaret McCrindle, 277 fig. 12.11, 278 

pneumocholin, 42 

pneumococcus, 35, 41–2 

pneumoconioses, 56, 57
 

pneumonia, 30, 35, 38, 41–2, 43, 44
 

pneumothorax, 143, 145
 

poison gas, 3, 37–8, 38 tab. 2.4 

Pollack, Horatio M., 17, 40 

Potts, John, 252–3 

POWs. See prisoners of war 

Prasad, Ananda, 269
 

Premarin, 308 

President’s Commission on Aging, 283 

President’s Federal Council for Science and
 

Technology, 283 

President’s Office of Science and Technology, 

124, 125 

Prince, Linneaus H., 41, 48, 51 

Principles and Practice of Medicine (Osler), 227 

prisoners of war, 135 

program chiefs 274-279
 

Project Scissors, 379–90, 388 fig. 17.1, 389 fig. 

593 
 

 

 

 

Index 

17.2
 

prolans, 47, 48 

promazine, 214–5 

proposals, Types 1, 2 and 3, 355–6 

prostate cancer, 312, 339 

prosthetics, 419–28 

psychiatry, outpatient, 312–3 

psychoneurosis, 130, 134
 

psychosis, 44, 45, 51–4, 58, 190 

Public Health Service 

coordination of agencies, 8 

hospitals, 9 

Hygienic Laboratory, 26
 

Marine Hospitals, 5 

and Matz, 35
 

streptomycin studies, 155–7, 158–9 

transfer of funds, 98 

and tuberculosis, 143 

Tuberculosis Evaluation Center, 183
 

veterans’ hospitals, 6 

Public Law 79-293, 14, 90, 91, 92 

Public Law 80-729, 419, 421 

Public Law 87-572, 419
 

pulmonary disease, 190, 305. See also tuberculosis
 

pulmonary nodules, 303 

Q 

Quimby, Edith, 249 

R 

Rabinowitz, Joseph, 176
 

radiation, 47–51 

radioimmunoassay (RIA), 172, 192, 194, 249–56, 

305 

radioiodine therapy, 92 

radioisotope program. See under Veterans 

Administration programs 

Radiology, 50 

radionuclide scanners, 171–2 

Radley, Thomas, 431 

Rall, Edward, 365 

Ralston, B. O., 106
 

Ramin, B., 154 

Ramirez, Eli, 231 

Randall, Carrie, 375 

Ransmeier, John, 127 

ratbite fever (sodoku), 37, 43, 44 

rattlesnakes, 107 

Rauwolfia serpentina, 210, 213 

RCA, 428 

Reader’s Digest, 61 

reading machines, 429–30 

Rehabilitation Institute of Chicago, 425–7 

Reilly, William, 170 fig. 6.6 

Reisinger, John, 55 

Relman, Arnold, 229 

Research and Education (R&E), 271–2 

research methods 

bioassay, 47–8 

blind studies, 232, 233 

case reports, 29, 32
 

cell counts, 49 

clinical trials, 92, 132, 161, 210
 

field studies, 156
 

informed consent, 147, 159–60 

1920s, 28–30 

placebo-controlled studies, 161 

preclinical research, 33 

psychiatric protocols, 217 

randomization, 154–5, 156
 

statistical methods, 54, 59, 128, 131, 161, 191 

streptomycin controls, 149, 151, 157–8 

streptomycin protocol, 148
 

time-lapse photography, 50–1 

twins, 133 

x-rays, 149, 151 

(see also streptomycin and tuberculosis)
 

research projects, 1926, 29-30 tab. 2.2 

reserpine, 213, 232 

rheumatic fever, 130, 134 

Richardson, David, 231 

Richardson, Elliot, 233–4 

Rich, Clayton, 177 

Ring the Night Bell (Magnuson), 90
 

Robb, George, 57 

Roberts, Charles S., 54 

Rockefeller Institute, 26, 27 

Rogers, Lester, 11, 11 fig. 1.6 

Roosevelt, Eleanor, 145 

Roosevelt, Theodore, 4 

Roosevelt, Theodore Jr., 8 

Rose, Herbert, 364 fig. 16.12 

594 
 

 

 

 

 

 

 

Index 

Rosenberg, Charles A., 276, 276 fig. 12.8
 

Rosen, Daniel, 406 

Ross, Joseph, 170 fig. 6.6, 171 

Roswit, Bernard, 103, 169 fig. 6.2, 249, 250, 364
 

fig. 16.12 

Roth, Dennis, 367, 367 fig. 16.16 

Roth, Jesse, 252 

Rothschild, Marcus, 176-177, 331, 332 fig. 15.6, 

371 

Roudebush, Richard, 360 fig. 16.6 

Rowe, Leo S., 4 

Rutstein, David, 370–1 

S 

Saccomanno, Geno, 245 

St. Elizabeth’s Hospital, 51 

sanocrysin, 146, 156 

sarcoidosis, 109, 134, 186, 190 

Saunders, W., 169 fig. 6.2, 170 fig. 6.6 

Schaeffer, Paul, 409 

Schally, Andrew F.
 

Lasker Award, 363 

Meyer recruitment of, 286 

Middleton Award, 331, 331 fig. 15.5 

Nobel Prize, 249, 364 

post-Nobel efforts, 365
 

with king of Spain, 365 fig. 16.13
 

Scheele, Leonard, 167 

Schereschewsky, Joseph W., 17, 26
 

schizophrenia 

day treatment centers, 400 

follow-up studies, 130, 135 

High Priority Research Programs, 370, 372–3 

Lazell and Prince study, 51–2 

lithium, 219
 

pharmacological studies, 214–5 

phenothiazide drugs, 215 fig. 8.4 

reserpine, 213 

Schlapfer, Werner, 387
 

Schmidt, R. H., Jr., 154 

Schnaper, Harold W., 273, 275, 279, 290, 322 

Schooler, N. R., 372 fig. 16.21 

Schoolman, Harold, 329 fig. 15.2 

322, 329–30, 338 

Schrek, Robert, 48–51, 49 fig. 2.6, 50 fig. 2.7 

Schukit, Mark, 372, 374–5
 

Schultz, Jane, 367, 368 fig. 16.17 

Schwartz, Spencer, 154 

Science, 48 

Seager, Henry R., 4 

Sears, Thaddeus, 98
 

Seattle Foot system, 427
 

Seaview Hospital, 102 

See It Now, 242 

Seil, Frederick, 373
 

Seldin, Donald, 92 

Sensenbach, Willis, 192
 

sensory deprivation, 280
 

Shannon, James, 230 

Shatz, Michael, 176 

Shaw, Lawrence, 231–2, 271, 300, 301, 391 

Shipley, Reginald, 170 fig. 6.6, 171
 

Shock, Nathan, 57 

Shumway, Norman, 98
 

Shurley, Jay, 92, 280, 280 fig 12.15 

sickle cell anemia, 197, 360, 393, 395
 

Simons, David G., 277, 277 fig. 12.10 

Skeggs, Leonard, 289, 290 fig. 12.21 

Skouge, Orin, 408 

sleep research, 280 

Small, Maurice, 154
 

Smith, James J., 175 

Smith, R. E., 406 

Smithsonian Science Information Exchange, 352
 

fig. 16.4 

smoking and cancers, 50, 102, 192, 241–5. See 

also Surgeon General’s report on smoking 

and Health 

“Smoking and Health; Report of the Advisory
 

Committee to the Surgeon General of the
 

Public Health Service,” 50, 243 

Society of Nuclear Medicine, 176 

sodium dehydrocholate, 41-2 

sodium oleate, 53 

Soldiers’ Homes, 4, 6 

Solid-Ankle Cushion-Heel foot, 423 

Solomon A. Berson Research Laboratory, 254 

Special Action Office for Drug Abuse Prevention, 

218 

Special Emphasis Areas, 369 

Speech Synthesis by Rule, 430 

Spencer, Richard, 177 

595 
 

 

 

 

 

 

 

 

 

 

 

Index 

spinal cord injuries, 427
 

Springer, N. Norton (Ned), 215 

Srere, Paul, 287, 359, 360 fig. 16.6, 371 

Stanford University, 430
 

Stanton, Joseph, 230 

staphylococcal infections, 190 

Starzl, Thomas, 195, 330, 331 fig. 15.4
 

Steele, John, 303 

Stein, Justin J., 42 

St. Elizabeth’s Hospital, 26 

Sterling, Kenneth, 269, 332 

 Middleton Award, with Yalow and Jaffrey 

332 fig.15.7
 

Sternarchus, 374 

Sternberg, Thomas, 98, 125
 

Sterotoner, 429, 430 

Stewart, Robert E., 421, 422 fig. 20.3
 

stilbestrol, 312, 339 

Storey, Patrick, 154 

Stout, Perdy, 243, 244 

Straus, Bernard, 99, 364 fig. 16.12 

Strauss, Maurice, 99, 195 

Streeter, R. G., 154 

streptomycin
 

adverse effects, 150–1 

National Research Council studies 154-5 

Public Health Service studies, 155–7
 

randomized studies, 154–5 

Technical Bulletin, 92 

and tuberculosis, 102, 109, 110, 146–60
 

Streptomycin studies, comparison 157 tab. 5.3
 

See also tuberculosis
 

Streptomycin Committee, 146 

Streptomycin Conferences, 149–50, 152–3, 155–6, 

150 fig 5.4 

stroke, 308
 

Strong, F. S. Jr., 419, 421 

Surgeon General’s report on smoking and health, 

50, 243 

surgery, adjuvant treatments and, 310–1 

surgery, innovations, 196 

syphilis, 36, 38, 41, 44, 58, 125 

Systems Development Corporation, 407 

T 

Tabakoff, Boris, 375 

tacrine, 374
 

Talal, Norman, 363 fig.16.11 

Taplin, George, 125
 

Taylor, Anna, 376 

Technical Bulletins, 92, 96, 127 

Telesensory Systems, 430 

testicular cancer, 47–8, 130, 250 

thiamine, 218 

thiocyanate, 55 

Thomas, David, 322 fig. 14.3 

thoracoplasty, 143, 145 

Thorndike, Augustus, 421 fig 20.2 

Thorn, George, 92 

thyroid cancer, 250 

thyroid metabolism, 251, 332
 

Tippets, Wayne, 367 fig 16.16
 

tissue regeneration, 373, 374, 434 

tobacco industry, 244, 245 

tolbutamide, 307 

tracheostomy, 244 

Training Guide for a Course in Radiological 

Defense, 167 

tranquilizers. See chlorpromazine; Rauwolfia
 

serpentina; reserpine 

Traum, Aaron H., 55, 56
 

Treasury Department, Bureau of Pensions, 25
 

TRIGA reactor, 174 fig. 6.13
 

Truman, Harry S., 90–1, 145 

tubercle bacillus, 146, 147, 152, 153, 155 

tuberculosis 

Atlanta studies, 109 

Auerbach study, 102, 241–2 

chemotherapy reports in Index Medicus, 159
 

tab. 5.4
 

and climate, 144 

cooperative study on chemotherapy of
 

tuberculosis, 154 fig. 5.5 

first study results, expert review 151 tab 5.1 

first study results, clinician review 152 tab 

5.2
 

Gerstl study, 102–3 

Group on Tuberculosis (Veterans’ Bureau), 16
 

Matz on, 35
 

Medical Research Council tuberculosis study,
 

154–5, 158, 157 tab. 5.2
 

Minneapolis studies, 110
 

596 
 

 

 

 

 

 

 

 

 

 

 

 

Index 

mortality rates, 143 

non-pulmonary, 152 

patient load, 144 fig. 5.1, 145 

prisoners of war, 135 

and psychiatric studies, 211 

and psychosis, 190–1 

Public Health Service studies, 158–9
 

streptomycin studies, 146–60 

Tuberculosis Cooperative Study Laboratory, 

271 

Tuberculosis Evaluation Center, 183
 

Tuberculosis Service, 100
 

VA-Armed Forces trial treatment regimens, 

154 

World War I veterans, 58 

See also pulmonary nodules; streptomycin, and
 

tuberculosis 

Tubis, Manual, 172 fig. 6.9, 176 

Tucker, William, 110, 155, 271, 301 

Tumor Research Laboratory, 47, 51, 60. See also
 

Owen, Seward and Schrek, Robert 

Turner, William J., 53 

turtle serum, 146 

twins registry, 133
 

2-hydroxystilbamidine, 304
 

U 

ulcerative colitis, 135–6
 

Ulick, Stanley, 288, 289 fig. 12.19 

Unger, Roger, 192–4, 193 fig. 7.6 and 7.7, 252, 

331, 359 

with Yalow, Berson and Jorpes 254 fig 11.4 

University of California, Berkeley, 422–3 

University of California, Los Angeles, 425 

University of California, Los Angeles, School of 

Medicine, 106, 107, 184
 

University of Michigan, Mental Health Institute, 

220 

University of Washington, 427–8 

uranium miners, 245 

urinary infections, 399 

Urist, Marshall, 125 

Uzman, Betty, 366 fig 16.14, 368, 372 fig. 16.21,
 

373, 415
 

Van Winkle, W., 153 

vasodilators, 397–8 

veratrum viride, 230 

Veterans Administration (VA) 

Annual report to Congress on research, 187 fig. 

7.4
 

Basic Science, 286, 343–4 

catalog of research projects (1956), 187 

 cooperative studies, 190–1, 302-4 tab. 13.1, 

394 tab. 18.1
 

Dental Research, 100 

extramural research, 125–6 

formation, 25
 

NAS survey of projects (1959), 198 

and National Research Council contracts, 124 

nuclear medicine, 166–7, 196 

Part 1-Part 2 System, 335–40 

pharmacy, 392, 408 

Project Scissors, 379–90
 

publication frequency, 110 fig. 3.17, 198 

 Research articles in Medical Bulletin 45-6 tab. 

2.8

 Special Emphasis Areas, 369 

Technical Bulletins 92 

Technical Bulletin 3-30, 127 

Veterans Administration centers 

Bioengineering and Computer Center (BECC) 

(Sepulveda, CA), 351, 352, 354, 381, 382
 

Blind Centers, 428 

Centers of Excellence in Health Services
 

Research, 414
 

Clinical Research Centers in Alcoholism, 371–
 

2 

Cost Center 104, 344 

Day Treatment Centers, 400 

Geriatric Research Education and Clinical 

Centers (GRECC), 369–70 

Prosthetics Centers and Prosthetics Service
 

units, 421–2
 

Prosthetics Research Center (and laboratory)
 

(Chicago), 425–6 

Research Support Centers, 282–3, 290, 300,
 

344–5 

Schizophrenia Biologic Research Centers, 372–
 

3, 374 

Veterans Administration committees
 

597 

V 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Index 

Advisory Committee on Problems of Aging,
 

188, 281, 369 

Advisory Committee on Radiobiology and
 

Radioisotopes, 281 

Advisory Committee on Research, 189, 281 

Central Advisory Committee on Radioisotopes, 

168 fig. 6.1 

Committee on Administrative and
 

Developmental Research, 406–7 

Cooperative Studies Evaluation Committee, 

301 

Medical Advisory Committee on Radiobiology 

and Radioisotopes, 167–8
 

Program Evaluation Committees, 337 

Regional Research Advisory Committees, 342 

Research Advisory Committee, 342
 

Research and Education Committees, 340, 

343–4 

Research Career Development Committee, 281 

Research Evaluation Committees, 281, 334–5, 

337 

Selection Committee for Clinical Investigators,
 

188 

special research advisory committee (1977), 

365 

Study Groups, 235, 281–2 

See also National Academy of Sciences, 

National Research Council committees 

Veterans Administration conferences
 

radioisotope conferences 169 figs. 6.2, 6.3 and 

6.4; 170 figs. 6.5 and 6.6 

neuropsychiatry conferences, proceedings 219
 

fig 8.7
 

research conferences, annual, 101, 101 fig.
 

3.11, 189, 197, 220 fig. 8.7, 287–8, 330 

Veterans Administration councils 

Medical Research Council, 355
 

Special Medical Advisory Group, 60
 

Veterans Administration departments 

Department of Medicine and Surgery (DM&S), 

90, 91, 183, 349 

Medical Department, 89, 90 

Veterans Administration funding 

 common resources funding, 352–3 

contract administration, 126 fig. 4.2 

 health services R&D budget 412 fig. 19.2 

medical centers, 389 fig. 17.2

 rehabilitative engineering R&D budget 432 fig. 

20.5 

research appropriations, 186 

 research budget, 1947-1953, 99, 100, 99 fig.
 

3.9, 100 fig. 3.10
 

research budget, 1954-1959, 198 fig. 7.8 

 research budget, 1960-1967, 283–4 , 283 fig.
 

12.16 

research budget, 1968-1973, 345 fig. 15.14 

research budget, 1974-1980, 353 fig. 16.5

 See also Veterans Administration, Project 

Scissors 

Veterans Administration Geographic 

Epidemiology Division, 271 

Veterans Administration human resources 

Associate Investigator program, 321 

Career Development Committee, 344 

Clinical Investigator Program, 187, 279, 317–8, 

357 

Geriatric Fellowships, 370 

Medical Investigator Program, 320, 344, 357, 

359 

Nuclear Medicine Training Programs, 176 

physicians bonus program, 357–8 

Program Chiefs, 273 tab. 12.1, 334, 337, 342, 

343 

Program Specialists, 343 

Regional (Research) Coordinators, 342, 343
 

fig. 15.13 

Research and Education trainees, 320–1 

Research Associate program, 279, 319, 357 

Research Career Development Program, 187–8, 

317–24, 357–8 

Research Career Scientists, 357 

Research Program Chiefs, 273–8 

Research Program Specialists, 368 

Selection Committee for Clinical Investigators,
 

188 

Senior Medical Investigator program, 188, 241, 

280, 318–9, 318 tab. 14.1 

staffing problems, 60, 61, 145, 211, 357 

World War II staff losses, 89 

See also Alcoholism Scholars scientists 

 funding history, 333-5 Veterans Administration information systems 

598 
 

 

 

 

 

Index 

Automated Hospital Information System
 

(AHIS), 406, 407-10 

Medical Research Information System (MRIS), 

283, 345, 351 

Research and Development Information
 

System (RDIS), 351–2 

Veterans Administration laboratories 

Central Neuropsychiatric Research Laboratory
 

(CNRL), 212–3, 215–7, 219–20, 391–2, 300 

neuropsychiatry laboratories, 47, 51, 53
 

special research laboratories, 192, 270 

Veterans Administration offices 

Contract Office, 126 

Office of Academic Affairs, 349 

Office of Regeneration Research, 373 

Office of Research and Development, 349, 411
 

Professional Services Office, 174, 175 

Regional Research Offices, 388 fig. 17.1
 

Veterans Administration programs 

Central Research Instrument Pool (CRIP), 290, 

345 

Clinical Investigator Program, 188, 279, 317–8,
 

357 

Cooperative Studies Program, 161, 191 tab.
 

7.1, 217, 221, 271, 299–302, 302-3 tab.13.1, 

313, 345, 350, 391–3, 394 tab. 18.1, See 

also chapters 5, 8 and 9 

High Priority Research Program, 369–73 

human resources. See Veterans Administration 

human resources 

Hypertension Screening and Treatment 

Program (HSTP), 235 

Innovative Alcoholism program, 371 

Innovative Research Program, 368 

intramural research programs, 89, 97, 110–1, 

265, 334, 354 

intramural research programs, prosthetics, 432–
 

3 

Medical Investigator Program, 320, 344, 357, 

359 

Merit Review Boards and program, 341, 350, 

353, 354–6, 368, 433 

Nuclear Medicine Training Programs, 176 

physicians bonus program, 357–8 

Prosthetics Research Program, 123, 349 

radioisotope program, 95, 97, 98, 103, 169, 270 

Research Associate program, 279, 319, 357 

Research Career Development Program, 187–8, 

317–24, 357–8 

Senior Medical Investigator program, 188, 241, 

280, 318–9
 

Veterans Administration sections 

Atomic Medicine Section, 100, 175 

Program Evaluation Section, 336 

Veterans Administration services 

Health Services Research and Development 

Service, 329, 349, 405, 412, 413 tab. 19.1
 

Medical Research Service, 349–51 (see also
 

Veterans Administration, Project Scissors) 

Neuropsychiatry Service, 100 

Nuclear Medicine Service, 175 

Prosthetics and Sensory Aids Service, 421, 431 

Rehabilitation Engineering Research and
 

Development Service, 329, 373, 423-4 tab.
 

20.1 

Research and Education Service, 93, 173 

Systems and Standards Service, 406 

Tuberculosis Service, 100, 109, 110
 

Veterans Administration units 

Cardiovascular Research Unit, 56-8, 60 

Neuropsychiatric Research Units, 52-55 

Research Statistics unit, 300 

Tumor Research Unit, 48-52 

veterans’ benefits, 4–5, 11 

Veterans’ Bureau, 11 

advisors, 12
 

establishment of, 8 

intramural research programs, 3 

leadership positions, 3–4
 

mismanagement, 9–10 

Postdoctoral Training and Research Division, 

40, 41 

problems under investigation, 1926, 30 tab. 2.2 

research director position, 18–9, 25 

and Veterans Administration, 25 

Veterans’ Bureau Medical Bulletin
 

bacterial infections research, 42 

case reports, 29 

compared to other medical journals, 28 

Matz research in, 36–7 

research overview 1925-1941, 43–4 

research volume, 41 

599 
 

 

 

 

 

 

 

 

Index 

topic distribution, 32–4
 

Veterans’ Bureau Medical Council 

Committee on Investigation and Research, 15–
 

24 

Group on Tuberculosis, 16 

the Depression, 25, 59 

establishment of, 13 

funding (1930s), 46 

Neuropsychiatric Committee, 17 

1939 recommendations, 59–60 

praise for, 15 

and tuberculosis, 144 

VA Medical Corps, 14 

veterans, Civil War, 4 

veterans, disabled 

compensation, 11
 

pensions and, 4 

veterans, health needs of, 36, 133, 369. See also
 

specific illnesses
 

veterans’ hospitals
 

appropriations, 5, 6 

Automated Hospital Information System
 

(AHIS), 406, 407–10 

Blind Centers, 428 

and cardiovascular disease, 36 

and cortisone research, 98
 

design and construction, 97, 98
 

establishment of, 4 

laboratories in, 184, 266
 

“medical centers” terminology, 349
 

patient load, 58 fig. 2.8 

Prosthetics Centers and Prosthetics Service
 

units, 421–2
 

radioisotope departments, 167, 168 

Research and Education Committees in, 101, 

270 

research laboratories in, 97, 105–6 

site visits, 380, 381–2, 384, 386 

substandard care in, 89–90 

and tuberculosis, 143 

See also Veterans Administration, Project 

Scissors 

veterans’ hospitals, and medical schools 

Cummings and, 184 

Diagnostic Centers, 17 

Health services research, 414 tab. 19.2 

Hines and, 91–2 

Magnuson and, 94
 

post-World War II, 61–2 

pre-World War II, 27 

Schrek and, 49 

Welt and, 96
 

veterans’ hospitals, locations
 

Albuquerque, NM, 392 

Atlanta, GA, 109 

Birmingham, AL, 196 

Boston, MA, 192, 196 

Bronx, NY, 44–5, 103–5, 147, 172, 194, 249, 

372, 374 fig. 16.12 

Buffalo, NY, 197–8 

Chicago Lakeside (previously Research) (IL),
 

98, 196 

Chicago Westside, IL, 197
 

Des Moines, IA, 196 

East Orange, NJ, 102 

Fort Howard, MD, 405–6 

Framingham, MA, 171 

Halloran (Staten Island) (NY), 102 

Hines, IL, 42, 46, 47, 147, 282, 433
 

Houston, TX, 190 

Little Rock, AR, 282, 290 

Livermore, CA, 147 

Memphis, TN, 190 

Minneapolis, MN, 109–11
 

Mt. Alto (DC), 186 

New Haven, CT, 11 

Northport, NY, 47, 51-53, 210 

Oakland, CA, 102–3, 195 

Omaha, NE, 105–6 

Oteen, NC, 147 

Palo Alto, CA, 7–8, 15, 30-1, 40-1, 60, 213, 

373, 392 

Palo Alto, CA (rehabilitation center), 433 

Perry Point, MD, 44-5, 212, 391–2 

Portland, OR, 373 

Rutland Heights, NJ, 147, 160 

Salt Lake City, UT, 101–2
 

San Diego, CA, 372 

San Fernando, CA, 148, 196–7 

Sepulveda, CA, 282, 286, 287, 351 

St. Cloud, MN, 40-1, 48-9, 53
 

Sunmount, NY, 148 

600 
 

 

 

 

 

Index 

Wadsworth (Los Angeles, CA), 106–8, 171, 

184 

Washington, DC, 30, 32, 34, 47, 55-7, 105–6, 

185–6, 230, 282 

West Haven, CT, 391, 392 

veterans, Korean War, 134 

veterans, records of, 127–8 

veterans, twins, 133 

veterans, Vietnam War, 133 

veterans, World War I 

cardiovascular disease, 55, 56 

fractures, 42-3 

physicians, 58 

research and care, 3 

tuberculosis, 143
 

veterans’ hospitals, 4 

See also poison gas 

veterans, World War II
 

cardiovascular disease, 55–6 

follow-up studies, 130, 134, 135, 136
 

hypertension, 227 

peptic ulcers, 269 

and smoking, 241 

and tuberculosis, 145 

twins, 133 

Vineberg operation, 310
 

vision impairments, 428–9 

Visotactor, 429 

Visotoner, 429 

Visscher, Morris, 109 

Vogel, William, 288 

Volicer, Ladislav, 376 

Vorwald, Arthur, 40 

W 

Walcott, Mark W., 276–7, 277 fig. 12-9, 343 fig.
 

15.13 

Walker, Arthur, 92, 100, 145 fig 5.3, 146–9, 152, 

160 

Walker, J. B., 42-3 

Walkup, H. E., 154 

Walsh, John, 254 

warfarin, 399–400 

Warren, Shields, 168 

Warren, Stafford, 168, 184 

Wasserman, F., 170 fig. 6.6
 

Wasserman tests, 34, 36
 

Watson, Cecil, 109 

Waxman, Stephen, 374
 

Weibell, Frederick, 352 fig. 16.4
 

Weiler, Harold F. 97 fig 3.8 

laboratory design and equipment, 97, 183, 184 

with Moseley, 173 fig. 6.11
 

Radioisotope Conference (1950), 170 figs. 6.5
 

and 6.6 

Weinberger, D. R., 372 fig. 16.21 

Weiss, H. A., 48 

Weiss, M., 427 

Wells, Benjamin B. 267 fig. 12.2 

and Auerbach, 245 

background and accomplishments, 266–8 

and basic science, 286 

as Deputy Chief Medical Officer, 338 

and Becker, 289 fig. 12.19 

recruits of, 329 

resignation, 290 

White House meeting, 284
 

Wells, Herbert, 109 

Welt, Louis, 92, 93, 96, 97 

Whitcomb, Walter, 177, 409 

White Committee, 6–8 

White House meeting, 284 fig. 12.17
 

White, William Alanson, 26, 30, 46, 51 

White, William C., 6 

Whittier, Sumner, 407 

Whorley, Darlene, 323 fig. 14.2, 339 

Wilbur, Ray Lyman 8 fig. 1.1
 

as advisor, 12, 13
 

on clinical research, 27 

and curative medicine, 14
 

diagnostic centers, 30 

Palo Alto VA hospital, 7–8, 15, 60 

response to Reader’s Digest article, 61 

Wilcox, Blanche, 55-57
 

Wilcutts, W. L., 167 

Williams, Ed, 170 fig. 6.6 

Willoughby, John, 405 

Wilson, Marjorie 

Clinical Investigator Program, 188, 317 

contract administration, 126 

inventory of research projects, 187 

position changes, 183–4
 

601 
 

 

 

 

 

Index 

Research Career Development Program, 322 

Senior Medical Investigator program, 318 

Wilson, Rufus, 363 fig. 16.11 

Wilson, Woodrow, 4, 6 

Winternitz, Milton, 125, 131 

Wolfe, H. S., 4 

Wolff, Harold G., 188 

Wolff, Michael, 125 

Wolff-Parkinson-White syndrome, 57 

Wolf, Julius, 364 fig. 16.12 

Woodhall, Barnes, 125 

Y 

Yalow, Rosalyn 

background, 249–50 

and Cranston, 368 

with Guinea pig, 253 fig. 11.3 

in laboratory, 250 fig 11.1 

Lasker Award, 363 

Middleton Award, 189, 288 

Nobel Prize, 255 fig. 11.5, 364 fig 16.12 

post-Nobel efforts, 365 

radioimmunoassay, 172, 192 

Radioisotope Service, 175–6 

radioisotope unit (Bronx), 103 

with Berson, Unger and Jorpes 254 fig.11.4 

with Sterling, 332 fig. 15.7 

Yuweiler, Arthur, 372 fig. 16.21 

Z 

Zacharewich, Francis, 177 

Zahn, T.P., 372 fig. 16.21 

Ziegler, Edwin E., 41–2 

Zieve, Leslie 

contract research, 125 

Cooperative Study of Radioiodine Therapy of 

Hyperthyroidism, 171 

Middleton Award, 288 

nuclear medicine, 176 

Radioisotope Conference (1950), 170 fig. 6.6 

Tuberculosis Service, 110 

Zimmerman, Hyman, 98–9, 105–6, 196 

Zink, Linus, 405 

Zubin, Joseph, 372 fig. 16.21 

zygosity. See twins registry 

602