The National Institute of Health: Uncle Sam's organization for medical

THE NATIONAL INSTITUTE OF HEALTH: UNCLE SAM'S ORGANIZATION FOR MEDICAL RESEARCH E. K. FOLTZ,* NAT~ONALINSTITUTE OP HEALTR. U. S. PUBLIC HEALTH SERVICE, D. C. WASHINGTON,

The action of Congress i n establishing a center for medical research reflects the public demand for a wider participation by the Government in matters pertaining to the citizen's health. For many years the physician has realized that there i s much with which he should be equipped over and abme theannamentarium of drugs which he now has available. Too busy zn his daily ministrations to the sick to engage in experimental work, he must look to others to effect discoveries for the benefit of the i n d i d u a l man, woman, and child. And a new outlook in the field of research now seems in the making. Recognizing the possibilities of expanded research, the United States Public Health Semice has proceeded to enlarge the scope of its laboraiories in accordance with Congressional legislation. In name the National Institute of Health is scarcely more than a year old, but in activities i t dates back many years, being formerly known as the Hygienic Laboratory. One of the provisos of the new legislation i s the establishment of research fellowships through gifts from philanlhropic sources. Thefunds so contributed are administered by the Government. I n view of Federal sponsorship it i s foreseen that wealthy persons will designate the Institute as a n outlet for their philanthropies. Already The Chemical Foundation, Inc., has provided a fund of $100,000 for research on chemical problems of a fundamental nature. The Institute i s organized so far into four sCientific divisions wifh a directing head and i s engaged upon a notable array of studies. Staffmembers are selected on account of special qualifications and are given wide latitude in their work. The Institute aims to provide ample facilities for its research workers so that they may give undivided attention to their chosen fields of activity.

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On a knoll overlooking the Potomac River in Washington is a group.of buildings little known to the residents of the capital city and less so to the average visitor. Yet world leaders in the public health sciences which in this instance include, among other branches, chemistry, physics, zoology, and bacteriology, are well acquainted with this Institute and its work; for it is here that the Federal Government, through the U. S. Public Health Service, maintains research laboratories handling matters that concern the health of every man, woman, and child in this country and, to a relative degree, those in foreign lands the world round. When a child is given diphtheria antitoxin, the family may rest assured that the doctor who administers the remedy is using a product that is as pure and potent as i t is humanly possible to make it; for the manufacturer who has produced the antitoxin holds a Federal license issued to him because

* Executive

Assistant.

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JOURNAL OF CHEMICAL EDUCATION

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ONE OF TAE SIX LABORATORIES DEVOTED TO RESEARCH ON CARBOHYDRATES The young woman is a chemist, the young man a chemical technician. Z

his establishment and his products have been inspected and found reliable by an expert of the U. S. Public Health Service. The same thing is true of certain other similar remedies used in the prevention or cure of infectious diseases. There are a t present 137 antitoxins, vaccines, viruses, and analogous products licensed for use by physicians, and the Federal Government keeps a watchful eye on all of them to see that they are pure and, so far as possible, to determine that they are potent. True i t is that your Government cannot guarantee the curative properties of a remedy any more than your health officer can guarantee that a pint of water taken before breakfast is good for indigestion. The best that the health officer can do is to assure his constituents that all his regulations governing the production of pure water in his town have been complied with. The inspection and licensure system applied to these biologic products, as they are called, is but one of the activities carried on by the Public Health Service a t the National Institute of Health. Indeed, though of utmost importance, this feature of the Institute's operations is looked upon largely as a routine procedure and is subordinate to its research work. At this Institute the Government has assembled a staff of experts whose business i t is to delve into the unknown and discover such fundamental and practical

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WHATEPPECIDOESCOOKINGHAYEUPON VITAMINS? In the nutritional laboratories the experimental diets are concerned chiefly with vitamin PP submitted to varying degrees of cooking a m 1 1 as in foods eaten raw.

facts as they can pertaining to health and disease and to find an answer, if possible, to a few of the thousands of questions that the layman is asking the scientist and that the scientist is asking himself. Demand for Research For many years the physician has realized that there is much with which he should be equipped over and above the armamentarium of drugs which the empiricism of the past has placed in his hands. The controversies that arose with the advent of bacteriology left too many things unsettled; and in more recent years there has broken upon the doctor's horizon a suspicion that all disease, in its last analysis, may be a chemical reaction in some way associated with the phenomenon we call life. With this viewpoint increasingly prevalent, he feels that the mysteries which Nature every day places in his path, as he visits the bedside of his patients, should be unlocked for the betterment of human kind. As for himself, he rarely has either the time or the means to give to research. So, ordinarily about all be can do is to lay to his daily task, taking note of obscure symptoms and reporting them to his favorite journal, and perhaps once a year stimulating his outlook

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APPARATUS EASILY SETUP A N D REMOVED IS ADVANTAGEOUS I N MUCH01' WORKON IN~ECTIOUS DISEASFS

1932

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by attending the convention of his medical association. This same physician must, therefore, of necessity usually look to others to search out the secrets of health and disease, and to effect discoveries for the benefit of the individual. This searching-out process already covers a notable roster of discoveries; yet the catalog of accomplishments is altogether too brief, in comparison with problems awaiting solution, to satisfy those engaged in running down the sources of human misery. And often it seems that the more that is found out about disease and its manifestations, the more there still remains hidden. We have, for example, the long list of infectious diseasesmaladies caused by living organisms taking up residence in the human body and bringing about conditions that upset the smooth working of the system and so causing bodily breakdown. This group of diseases has been combed over to some extent and remedies have been produced that are effectivein many cases; yet numbers remain inexplicable. Aside from the family of infectious diseases, there are the so-called "constitutional" diseases, causing misery and pain and distress. Often associated with these are mental disturbances with their tragic possibilities. Looking, up the statistics of our asylums, one may realize all too well that

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THEJ U N ~ O RI'HAKMACOLOGIST HERESHOWN HASA CONVENIENT LABORA.TORY

The apparatus was photographed "as is" duringworkan the standardization of ergot.

+ . there is an abundance of "brain trouble," some of it the result of infectious disease, some apparently hereditary, and yet another large proportion from-"Quien sabe?" as our good friends in Mexico say. Modern man is not a fatalist; unlike his ancestors, he is not content to suffer and die. The hundreds of hospitals, sanitaria, and health resorts testify to his struggle against disease; and a peep into the private home too often reveals an invalid, dependent upon loving hands to ease his distress, and his kin rightly demand that something be done.

Congress Steps In With such thoughts in mind, Congress turned its attention to medical research in a large way by establishing a center for the purpose. In reality the National Institute of Health is the old Hygienic Laboratory of the U. S. Public Health Service under another name. Back in 1887 Doctor J. J. Rinyoun, of the Public Health Service, opened a little clinical laboratory a t the Service Hospital in New York, where he hoped to improve methods of diagnosis. In those days the science of bacteriology was in its infancy and about the only function of chemistry in relation to the health of man was the compounding of drugs by the pharmacist or, as he was then

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CONVENIENCE O F MATERIALS SAVESANNOYANCE I N RESEARCH WORK Nothing is missing from this blood-counting outfit, unless it is the patient in a nearby hospital. I

generally known, the "prescription clerk." Time wrought a change. Doctor Kinyonn's little laboratory began to attract attention, so much so that Surgeon General Walter Wyman brought it to Washington, and in 1901 Congress gave it a name--the Hygienic Laboratory-provided funds for the erection of a small building and directed that it should "investigate matters pertaining to the public health." A broader legal enablement has perhaps never been given by the Congress of the United States, not even excepting the comprehensive legislation enacted incident to the World War. Under this authority the Public Health Service through its studies may undertake any kind of effort deemed advisable to promote health, at any time, anywhere, in any way, whether it relates to the biological sciences, to physical conditions, or to mental phenomena. From time to time, up to the present, Congress has granted increased funds and additional buildings for carrying out its intentions. Just recently the Federal legislative body enlarged the scope and functions of the Hygienic Laboratory by passage of an act sponsored by Senator Joseph E. Ransdell, whereby the name was changed to the National

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EQUAL FOOTING WITH MENAT THE NATIONAL INSTITUTE OF HEALTH, BOTHAS TO W O R S AND PAY

The young woman here seen is an expert serological tqhnidan and is reading the results of her work.

Institute of Health and funds were provided for extending its work. Recognizing the fact that many wealthy persons seek a responsible outlet where their philanthropies may be devoted to the alleviation of human sufferingin exactly the manner they wish, the act authorizes the Secretary of the Treasury to accept, on behalf of the United States, gifts made by will or otherwise for study, investigation, and research in fundamental problems of the diseases of man and matters relating thereto and for the acquisition of grounds or for the erection, equipment, and maintenance of buildings and premises. Already The Chemical Foundation, Inc., through its president, Francis J. Garvan, has provided a fund of $100,000 to be used for research on chemical problems of a fundamental nature. The legal restrictions thrown around such gifts assure the donors that funds will be used for the purpose intended and for no other. Unlike funds raised by "drives," "campaigns," community chests, and in similar ways, where it is necessary to divert a percentage to pay the expense of administration, not a single cent can be deducted for this purpose from contributions to the National Institute of Health.

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To BE SURE THAT BIOLOGIC PRODUCTS PUT BY COMMBRCIAI. ESTABLISHMENTS ARE CLEANAND POTENT, WHEREA P.OTENCYSTANDARD IS PRACT~CABIE, TAEY MUSTBE TESTED PHYSIOLOGICALLY "Better a mouse t1M.n a man." How Fellowships Are Awarded One of the splendid features of the act mentioned is a proviso whereby the income from gifts and bequests may be devoted to the establishment of fellowships for undertaking studies of problems connected with health and disease. These fellowships are awarded by the Surgeon General of the Public Health Service, with approval by the Secretary of the Treasury, who investigates the record and scientific ability of candidates to see that they are qualified. Fellowships are ordinarily thought of as positions given out by universities to promising students, with the object of developing their capabilities and, as a result of good work, granting them an advanced degree. The Public Health Service goes about the fellowship business in a somewhat different way. It does not appoint a feuow for the purpose of giving him training and experience. The candidate must have an unusual background and show special aptitude in his chosen profession; he must possess insight and peculiar ability to pursue research. A recent graduate, or a man or woman of wide accomplishment, may have unique capabilities for handling

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a given problem, such as scientific poise, originality, and genius for work, marking him as exceptional in his sphere of effort. As there is no standard by which to measure such qualifications, competitive examination is not practicable. The opinion of persons competent to judge his ability is the guide, therefore, in making appointment. It may be interesting to know that the selection of fellows, or research associates as they are designated, is not restricted to American citizens. Inasmuch as science is not bounded by political frontiers, Congress has wisely left the way open to secure the best to be had the world over. The intent of the Government is to choose experts only, regardless of age, sex, race, or nationality. hojects under Way The laboratory space now available is occupied to the full with projects suitable for investigation and relating to practical as well as fundamental problems. A glance a t the following schedule of studies, actually in progress, will convey a fair idea of the scope and kind of work handled a t the Institute. Nutrition with special reference to (1) lengthening the list of foodstuffs known to be useful in the prevention and cure of pellagra, and (2) to concentrating, if possible, the pellagra-preventive vitamin. The effect of freezing on biologic products, particularly those used in the prevention of diphtheria. , Typhus fever of the United States. Rocky Mountain spotted fever, a disease untilflecently thought to prevail exclusively in the northwest but now known to be present in Delaware, Pennsylvania, Maryland, the District of Columbia, Virginia, and North Carolina; its nature, virulence, etiology, and means of control. The effect of various salts and sugars upon the viability of certain microorganisms. Xemolytic streptococci (blood-destroying pus germs); comparison of strains, colony variants. Meningococcus meningitis; efforts to put its serum treatment on a more reliable basis. Undulant fever; (1) type differentiation and (2) epidemiology. Post-vaccination sequelae. Tularemia; viability of the organism in rabbits held in cold storage. The etiology of trachoma. Pathologic histology. Preparation of catalogs of parasites reported for animal hosts; four key catalogs are under way and seven have already been issued. Cancer; (1) the biochemical characteristics of malignant versus normal cells, (2) tissue culture, (3) the chemistry of cell division, (4) chemotherapy.

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The pharmacology of so-called Jamaica ginger paralysis. The standardization of certain drugs. Fundamental researches on sugars; (1) improvement of themethods for preparing sugars and their derivatives, (2) determination of the structures of sugars. In prosecuting its researches, the National Institute of Health has no desire to build up an organization merely for the sake of size. It cares nothing for publicity unless that publicity is the vector of facts useful to human kind; and the Institute views the problems of health and disease from the broad scope of human advancement. With this in mind it moves forward in its assault on the common enemy. The attack may take a direct course and result in sudden achievement or i t may follow devious paths and be waged for years with scarcely a ray of hope ahead. Already six years have been spent on a bacteriological study of trachoma with little to show for the effort. Many years were spent by the Public Health Service on pellagra before its underlying cause was dernonstrated. Sometimes a problem is studied intermittently instead of continuously, so that improved technic and methods of approach may have time to "incubate," or the results so far achieved may be tried out and criticized by research workers elsewhere. When, however, a couclusion is reached, an account of the work to the minutest detail is published in the form of a bulletin or an original paper.

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Publications and Authorship As "rushing into print" is frowned upon, manuscripts must be submitted to the Director for critical perusal, after which they go to other offices for scientific or editorial comment. Every manuscript issuing from the Institute must meet two essentials; (1) the work described must be scientifically sound, and (2) the description must be lucid and orderly throughout. Excellent English is desirable, but clarity and brevity are requisite. Authors are generally called upon to discuss their manuscripts before approval for publication. The criticism a t such times is not always pleasant, but it is welcomed. Short papers of highly technical nature are frequently published in periodicals outside the Government. Approval from officialsources must be obtained before publication in private journals and the same critical supervision is applied to such articles as with manuscripts submitted for official publication. Authorship credit is carefully guarded. An author's reference to work done by others must be accompanied by bibliographic citation. Collateral assistance given the research worker must be acknowledged by him in the article. Material assistance adding to the originality of the work entitles the giver to joint authorship. On the other hand, a supervising officer

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not directly engaged in the studies does not necessarily participate in authorship, even though he assigned the subject for study and followed the experiments with suggestive advice. It not infrequently happens that a leading expert may hold an inferior authorship status in an important scientific paper for the reason that his share in the actual work consisted largely of check-up experiments and critical analyses. Thus a subordinate staff scientist may outrank an outstandmg authority in co-authorship. The Institute has no printed rules or regulations governing the fine points of authorship, but its unwritten law in this respect is stringent. It may he worth while to note that all work produced in whole or in part while on official status is the property of the Government. The executive authorities may disapprove the publication of a manuscript. In this case the author has no legal recourse; his correct procedure is to repeat his work, if pronounced of doubtful merit, or to revise his manuscript if the fault lies in its write-up. Work published by the Institute is distributed by the Government on mailmg lists of selected names revised annually. These lists are made up in the form of "keys" or class groups. A correspondent may write in to the Institute and request that his name be put on the mailing list. If unknown, he is asked to state what line of scientificwork particularly interests him so that his name may be added to the mailing key fitting his professional activity. Advisory ~ o a r d k C

The Advisory Board of the Hygienic Laboratory has been reorganized under the terms of a recent Act of Congress, and its functions have been enlarged under the name "National Advisory Health Council" to act in a consulting capacity to the Surgeon General of the Public Health Service, not only in respect to research problems of the Institute hut with reference to all public health activities of the Service. There is a voluntary organization of public-spirited men acting as a Conference Board, with headquarters in the National Press Building, Washington. The purpose of this Board is to keep the public informed upon the aims and work of the National Institute of Health, and to assist in the conservation of the public health.

Scheme of Organization The Institute is organized as a field station of the United States Public Health Service. The whole plan of organization is to put the work of the Institute on a high plane of efficiency, so that its researches may go forward with every advantage, whether originating from within or from without. The activities are grouped into working divisions. There are a t present a division of pathology and bacteriology, one of medical zoology, another

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of pharmacology, and still another of chemistry. Each division is presided over by a chief who is responsible to the Director for the work and personnel of his division. These chiefs of division are not mere administrators; they are leaders in their respective professions and take their places with sleeves rolled up by the side of their associates. While members of the personnel are nominally attached to various divisions, individual workers may have interests in extra-divisional groups and so divide their time among several projects. A bacteriologist, for example, may work in association with a chemist, a zoologist, and a physicist; a pharmacologist may devote most of his time to chemical researches or may find it necessary to collaborate with a cytologist or a pathologist. The working divisions are seen, therefore, not as organizations devoted exclusively to projects of their own, but as bran&es of a big family with common ends. This plan of operation affords freedom of action and conduces to a high esprit de corps, especially so when every one knows that he is assured credit for every piece of research in which he may participate. Perhaps nothing is more disconcerting to a research worker than to have administrative duties foisted upon him, causing him to lose time and distract thought which he wants to devote to his studies. The Institute therefore maintains a business unit for the purpose of relieving the scientific staff of annoyances incident to obtaining supplies and subordinate personnel. Appointment of 'Personnel The Director of the Institute is detailed from the corps of commissioned medical officers by the Surgeon General of the Public Health Service for a term of office, which term may be renewed. During the. forty years that the organization has been in existence, there have been but four directors. The late Dr. Joseph J. Kinyoun; Dr. Mil& J. Rosenau, now head of the Department of Preventive Medicine, Haward University; Dr. John F. Anderson, director of the Biological Department of E. R. Squibb & Sons; and Dr. George W. McCoy, the present incumbent. Members of the scientific staff are detailed from the corps of officers of the Public Health Service or are chosen from lists of eligibles supplied by the United States Civil-Service Commission, who establish their roster through competitive examination. After one has passed an examination, his name becomes available not only to the National Institute of Health but to other Government departments requiring assistance of similar qualifications. Therefore, a person seeking appointment in the Institute should write to the Civil-Service Commission, a t Washington, requesting full information concerning forthcoming examinations for positions fitting his qualifications.

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The Institute's corps now comprises 19 medical officers, 36 non-medical scientists, 17 highly trained technicians, 8 mechanics, 16 administrative and clerical personnel, and 60 subordinate assistants; many of the latter perfom work of technical character. The members of this staff of 155 are subject to travel orders and may he detailed for temporary duty away from Washington on short notice when field investigations require. Twenty-four of the corps are women, who occupy positions on the same footing as men, both as to work and pay, no discrimination being made in appointment or promotion. The Institute aims to secure the best to be had, regardless of sex. Two of the working units are, in fact, in charge of women, viz.; the library and the section on illustrations; in both of these sections women supervise men workers. The corps shows a wide diversity of religious preferences, varied political tendencies, and social and financial groupings; but while engaged in the work to he done all join hands in the fight against our common enemy, disease.

Salaries Salary is always an interesting subject to bring up. A great deal of misinformation concerning Government salaries is prevalent throughout the country. The impression seems general that public service is soft and easy, with big pay and little work. For decades the Government has had difficulty in securing and retaining the services of legal, executive, and technical workers falling in the higher saiary brackets. Only within the last year or so has the supply of this type of public servants reached any approach to the demand. Heretofore industry has been able to attract and keep the best. The National Institute of Health has had to contend with this situation. As in other technical governmental agencies, members of the Institute's staff have from time to time tendered their resignations to accept better paying positions elsewhere. And it takes no prophet to forecast a return to the same condition as soon as business regains its feet. The pay of technicians and subordinates is on a much better basis and compares fairly well with that received for similar work in private employment. Remuneration for scientists a t the National Institute of Health ranges from a dollar a year for consultants to $7500 for directing heads. The professional staff is graded as follows: Chiefs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $6500to$7500 Principals.. . . . . . . . . . . . . . . . . . . . . . . . . . . 5600 to 6400 Seniors... . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4600 to 5400 Full ................................. 3800to 4600 Assodates.. . . . . . . . . . . . . . . . . . . . . . . . . . . 3200 to 3800 Assistants.. . . . . . . . . . . . . . . . . . . . . . . . . . . 2600 to 3200 Juniors ............................... 2000tO 2600

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Appointment may be made to any salary within the range, depending upou the-qualifications of the candidate and the requirements of the position with regard to education, training, and experience. Promotion depends upon two contingencies: (1) the individual's production, and (2) the funds available. The pay of technicians ranges from $1740 to $2800. Technicians are generally recruited from the ranks of subordinates who have proved their mettle. These workers occupy a very important place in the organization as it is upou them that the research workers depend for routine procedures; they are the 6ngers of the Institute. A technician may enter the professional grades by securing a college degree; but even in his own grade he may reach such proficiency as to participate in researches and enjoy authorship either in collaboration or independently. . The subordinate personnel in the various laboratories of the Institute are known as "attendants" and perform the rougher work. The only educational requirement for this class of personnel is the ability to read and write and do simple computations. Attendants begin at $1260 a year and may rise to $1680. By demonstrating ability, adeptness, and capacity they may be promoted into the ranks of the technicians with the pay and privileges of that respected group. All full-time personnel of the Institute are granted 30 days' vacation with pay each year, exclusive of Sundays, holidays, and Saturday afternoons, and 10 additional days in thcevent of illness. This long vacation period gives them plenty of opportunity tospend their earnings; and as the majority of them own cars and like travel, the chance to return the taxpayer's money is at hand. There is a delightful rumor current in Washiugton that merchants in distant towns and hamlets accord a hearty welcome to the automobile bearing a District of Columbia license plate. Handling Scientific Literature The Institute maintains an up-to-the-minute reference library pertaining to its specialties and has daily access to other Government scientific libraries in Washington totaling about 1,500,000 volumes. Over 200 periodicals come to its read'ing room from all over the world and in a variety of languages. As it is impossible for one to spend seven hours daily at the bench and keep up with the literature of 200 publications, the material in these periodicals is brought to the attention of st& members through the medium of informal meetings. Certain numbers of the journals are assigned to each member according to his linguistic attainments and in a few words he reviews his quota for the benefit of all. In this manner the world's news in public health matters is not allowed to grow cold.

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The library not only performs the usual work of caring for books, but has a t its head a bibliographer who has a working command of many languages and who is of marked assistance in preparing bibliographies and reviews of literature covering studies about to be undertaken or already in progress. Educational Facilities The question has often been asked, What chance has a beginner a t the National Institute of Health? The answer is, none. Being a research establishment, the Institute has no niche for the individual without trainmg and experience. Every person appointed to the corps must have experience that will make him an asset right a t the beginning. This does not mean that he has no chance to learn after he has secured appointment. To the contrary, his opportunities for rising are good. This brings up the subject of educational facilities a t the Institute. The act of Congress establishing the National Institute of Health provides that "the facilities of the institute shall from time to time be made available to bona fide health authorities of states, counties, or municipalities for purposes of instruction and investigation." This makes i t possible for accredited representatives of health organizations to come to the laboratories, in the capacity of observers or as working associates, and pick up approved technic and advanced methods of handling problems for application in the work of their home organizations. It does not mean that a student fresh from school may come to the National Institute of Health for training. The Institute maintains iio seminar or course of instruction for general teaching. The intention of Congress was not to establish a school but to make the Institute and its facilities of practical, work-a-day use to health officials everywhere. Hazards of Research

A search of the records of the Public Health Service reveals the fact that 127 cases of infection in line of duty have occurred whiie its officers and employees were engaged npon investigational or repressive measures in connection with the fight against disease. Of these, 27 ended in death. The Institute's share was 38 infections, of which 5 resulted fatally. These infections cover a wide gamut of disease and do not include accidents as such, among which may be mentioned contusions, hernias, fractures, bums, and injuries from chemical explosions. Nor do they include scores of tests and experiments, many of them distressing, performed by the medical personnel upon themselves and npon non-medical volunteers. These cover such procedures as inoculations with serums, vaccines, and so on, to determine their potency or therapeutic efficacy; infestations with animal parasites to test remedies; the ingestion of exn-

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dates and other material from human cases of disease to determine infectious or non-infectious nature; and related experiments necessary in medical research. Some of these experiments required great courage on the part of the human volunteer. Use of Animals in Experimental Work A large part of the experimental work, aside from the purely chemical and physical studies, necessarily involves the use of animals. Like other similar laboratories, in its ,medical researches the Institute is forced to adopt the slogan "Better a mouse than a man." Almost needless to say, the animals used in experimental work receive the utmost consideration. With the object of seeing that the rules governing the humane treatment of animals are faithfully carried out, an inspector-makes frequent unannounced visits to all parts of the institution where animals are under experiment or are kept and notes the details of anesthesia and of the feeding and sanitary conditions. Should any one be derelict in the proper treatment of animals, he would not only be suspended from duty but might be summoned to court for violating the humane laws.

The National Institute of Health: Uncle Sam's organization for medical

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