[Dr. Terry:] There are more than 140,000 patient admissions to the hospitals
of the Public Health Service every year.
Our patients include American seamen like ship's carpenter Danny Callahan,
who received care at the Boston Hospital,
officers and enlisted men of the US Coast Guard, Coast and Geodetic Survey, other uniformed services
and their dependents, American Indians, Alaskan natives, federal prisoners,
and other groups designated by the Congress.
We also provide medical education for interns, residents, medical students,
and many others in our hospitals.
The first responsibility of our hospitals is the health of our patients.
The second responsibility is medical education.
Medical research is one of the most important factors in providing the best patient care,
and the best medical education.
Today, several of our hospitals are conducting research in association with medical schools
and other institutions.
For example, the Public Health Service hospital in New Orleans has developed a comprehensive
research and training program in cooperation with the medical school at Tulane University.
One of the people who recently played a major role in this program is Dr. John L. Wilson,
former medical officer-in-charge at New Orleans and who is now retired from the service.
Through the enterprise of Dr. Wilson, this building on the hospital grounds
was converted into a research facility, the Seamen's Memorial Laboratory.
The director of research at New Orleans is Dr. John J. Walsh,
who received his research training at Tulane.
I've asked Dr. Walsh and his colleagues to give us a brief report on their program.
[Dr. Walsh:] We could define the research activities in the Public Health Service hospitals
as directed towards one objective, that of better patient care,
with the inevitable accompaniment of better professional training and better professional status.
It has been our philosophy to have a diversified program not dependent upon one man,
nor upon one discipline.
Currently, we have approximately 4000 square feet of laboratory space and 31 fulltime people
working in our research laboratory.
It has been our feeling that these fulltime academicians and fulltime investigators
should be available to the hospital for teaching and consultative purposes,
and also to help to create the atmosphere of intellectual stimulation and curiosity
so necessary if we would make a hospital
a teaching institution and not a trade school in which merely techniques are learned.
Briefly, our overall program is as follows.
There is a tropical medical section, which is an integral component
of the Department of Tropical Medicine and Public Health at Tulane.
Work in this area is primarily concerned with natural and acquired resistance
to parasitic infections.
In the second of our three major sections, research endeavors
are oriented towards the surgical field.
This project is concerned currently with the application of regional perfusion
to the treatment of malignancies.
The third major area of investigation which concerns our laboratory is that concerned
with cardiovascular diseases and specifically with studies of the dilated heart.
[Dr. Terry:] The research on the dilated heart at New Orleans is under the personal direction
of Dr. Walsh and Dr. George E. Burch, professor and chairmen of the Department of Medicine
at Tulane.
Dr. Burch is known around the world for his research in heart disease.
[Dr. George E. Burch:] As we know, one of the great problems in cardiology is the problem
of a large heart,
Most patients who die of heart disease either die because of congestive heart failure,
which is as a rule associated with a large dilated heart, or from coronary disease
with myocardial ischemia.
Our main interest is to try to first define as well as we can what a large heart is.
We're attempting to approach this both from the anatomical point of view,
not necessarily just gross anatomy, but from the point of view of detailed microscopic studies.
as well as from the point of view of electron microscopy.
In addition, a chemical definition will be attempted of trying to define the inorganic chemical state
of the dilated heart as well as certain aspects of organic chemical changes.
In addition to that, an effort is being made to treat the dilated heart,
particularly in patients who have so-called intractable failure,
where efforts have been made to use usual conventional
therapeutic procedures and still the patient seems to go downhill.
One of the ideas that has been proving to be of considerable success
is the idea of long bed rest.
Patients have been placed in bed for periods varying from six months to a year or even more,
and so far this has been proving to be of considerable value to these patients
who would have been dead if it were not for this period of rest.
Unfortunately, this does take a great deal of time in order to see through enough patients
to have an idea as to what the statistical significance of all this is, but even with
a few number of patients,
we know so far that this has a great deal to offer at the moment.
[Dr. Terry:] Research at the New Orleans hospital includes several disciplines.
One of these is biochemistry.
Here is Dr. Joseph Arcos, associate professor of biochemistry at Tulane,
to explain the work being done in this field.
[Dr. Joseph Arcos:] The program of the biochemistry section centers on the study
of alterations in endoplasmic cellular membranes.
The same techniques are applied to investigate these alterations during the process
of heart dilatation and during chemical carcinogenesis in the liver.
At the present time, we are studying the mitochondrial membrane by following
changes in the swelling ability and shape of this cell particle.
The first slide shows a phase of the procedure for isolation of mitochondria.
All these operations involving living tissues are carried out at near zero degrees centigrade
in the cold room.
Incidentally, the young man pictured here is a second year medical student at Tulane University
School of Medicine who is receiving research orientation while conducting
a [?] research project at the U.S. Public Health Hospital Research Laboratory.
The second slide shows members of our group injecting into the guinea pig deoxycorticosterone
which produces heart dilatation following [?] administration.
The third slide shows the measuring by photometry of the pattern of mitochondria swelling.
The investigator pictured here is a science student from Formosa
taking part in the research training program of Tulane University Medical School.
The fourth slide illustrates an extension of this approach; that is, to study changes
in the shape of the mitochondria such as elongation, shortening, or curling.
Such alterations are determined by following the particulate dissymmetry
by light scattering at various wavelengths.
Finally, the last slide shows a phase of another research orientation of our program.
Here, a change is produced by various chemical agents in the macromolecular fine structure
of proteins are studied by following in a polarimeter, the optical rotation of the solutions.
In this way, we hope to obtain information on the mechanism of drug action
at the basic macromolecular level.
[Dr. Terry:] Although prolonged bed rest is a basic therapy in the treatment of the patients
participating in the dilated heart studies at New Orleans, drug therapy is also important.
The pharmacology studies are under the direction of Dr. Thomas D. Darby,
Associate Professor of Pharmacology at Tulane.
[Dr. Thomas D. Darby:] Investigations with intact hearts and with hearts in situ are
are now in progress in our laboratories.
In this slide, an isolated heart is demonstrated.
An Anderson isolated heart perfusion apparatus is used in combination with a bubble-type oxygenator
and Sigma motor pump system.
In these studies, the coronary arteries are perfused with oxygenated blood
obtained from donor animals.
The purpose of these experiments is to determine the direct effects of a drug or a combination
of drugs on the force of contraction of heart muscle.
In the next slide, an experiment is being carried out with a heart in situ.
In this study, direct measurements of the drugs on the force of contraction of the heart
are being compared with hemodynamic parameters.
In this study, a total body perfusion is carried out.
Blood is removed from the right atrium of the dog and returned to the left atrium of the dog.
In this way the right ventricle and lungs are bypassed.
The blood is oxygenated in a bubble-type oxygenator and pumped back to a reservoir
which returns the blood to the left atrium.
Measurements of isometric contractility, isotonic contractility, and all-force velocity curves
can be obtained from the non-working ventricle.
These measurements are compared with isometric tension in the working ventricle.
In addition to the biochemical, physiological, and pharmacological studies,
clinical studies of drug effects are also in progress.
One of the medical residents is largely engaged in the clinical studies
and takes part in the laboratory experiments.
The residents are an important part of our applied research program.
They are daily in contact with therapeutic problems and are willing to work to obtain the answers.
The training in our laboratories is also multidiscipline.
In addition to the Public Health Service personnel, there are two graduate students in pharmacology
from Tulane University, and two medical students from LSU receiving training here.
[Dr. Terry:] A total of 30 patients have taken part in the dilated heart studies at New Orleans
and 20 of these have now been discharged.
Here is the x-ray taken of the heart of Mrs. Erma Francis when she was admitted to the hospital
as a special study patient for this research program.
Here is her heart as it is today, and here are the two x-rays side by side.
Dr. Walsh visited Mrs. Francis and interviewed her where she is now employed.
[Dr. John J. Walsh:] Erma I think our listeners might like to know where you're working.
Would you mind telling us please?
[Erma Francis:] I work at Chalmette Laundry, one of the largest laundries in the city of New Orleans.
[Dr. John J. Walsh:] Erma, what kind of symptoms were you having before you went into the
New Orleans Public Health Service Hospital?
[Erma Francis:] I was having severe pain in the chest, between the bust you know,
and the stomach down here, and I was very swollen and full of fluids and my feet and legs
and everything were swollen and I had vomiting spells.
[Dr. John J. Walsh:] And you had had heart trouble for some time before that,
hadn't you, Erma?
[Erma Francis:] Yes I had.
I found that I had an enlarged heart since 1937, and from 1958 I had trouble, trouble on and off,
in and out of the hospital until November, around November 1958, I was sent to Charity,
and then from Charity I went to Public Health Hospital, and for about six months to nine months
I didn't do anything but rest.
Then after that I began to go down, go to the bathroom and walk around,
until I was discharged in August 1959.
[Dr. John J. Walsh:] Now since you've gotten out of the hospital Erma,
have you had any trouble with your heart?
[Erma Francis:] I haven't had any trouble, I've been feeling fine and I work every day,
you see the kind of work that I am doing, okay?
[Dr. John J. Walsh:] And how hot is it in here right now?
[Erma Francis:] It's really hot right now, but it doesn't bother me.
[Dr. John J. Walsh:] I understand it's 109 right now.
[Erma Francis:] Yeah.
[Dr. Terry:] Here's another photo of Ms. Francis taken recently at the New Orleans hospital.
She still takes a great deal of interest in the heart project and returns nearly every week
to help with the care of patients.
One of the resident physicians now working on the cancer project is Dr. James N. Winblad,
a resident in surgery.
Dr. Winblad began his research in cancer perfusion.
[Dr. James N. Winblad:] If you had asked me if I would want to go down to Tulane
and spend a year in relative isolation working on a basic research program that perhaps had no direct
clinical bearing or no direct clinical relationship, I would have been relatively uninterested.
But what happened was that we were able to work on a relatively basic problem, that is
the development of techniques for isolation perfusion of extremities and other regions of the body
and then apply this to the treatment of human cancer in a relatively short time,
that is, in a span of relatively few months.
We developed the technique in dogs for extracorporeal circulation and regional perfusion,
and then applied it in the treatment of human patients with cancer.
[Dr. Terry:] The present medical officer-in-charge at New Orleans is Dr. John A. Trautman,
who has served at several Public Health Service hospitals
and was formerly director of the Clinical Center in Bethesda, Maryland.
[Dr. John A. Trautman:] I considered that research over the years in our hospitals as one of the
best recruiting devices that we could possibly have, and I believe that if the service
is to go forward
and to attract proper personnel, career people to carry on the work of the service, that the service
will have to develop its research facilities in our hospitals to the utmost.
We are leaders in the field of medicine not only in the United States, but in the world.
It behooves is us in the service to have the best possible research facilities,
the best hospitals, to accomplish the aims which every good clinical facility should have.
[Dr. Terry:] When we began organizing this present research program at our New Orleans hospital,
we were fortunate to have the fullest possible cooperation and encouragement
from one of the nation's leaders in medical education, Dr. Maxwell Lapham,
dean of Tulane Medical School.
[Dr. Maxwell Lapham:] The close affiliation of the U.S. Public Service Hospital
with the school of medicine at Tulane University has many important facets.
In the first place it unifies two institutions which are dedicated to medical training and medical care.
It allows for the interchange of staff and facilities,
specifically the facilities of the Public Health Service hospital
are of tremendous help to the school of medicine here, because our students and faculty
can work with the different kinds of patients from far-flung areas and also learn more about
the objectives and responsibilities of the Public Health Service hospitals.
Moreover, the hospital staff members who have medical school appointments have assisted greatly
in our teaching programs.
On the side of the hospital staff, there is opportunity to work with men who are dedicated
not only to medical training and medical service but to pursuing basic and clinical research.
Many of the hospital staff members find a deep satisfaction in pursuing a more or less
academic career within the framework of their Public Health Service responsibilities.
This should be of assistance in recruiting people into careers in the health service
throughout the country.
They will have the satisfaction of knowing that in addition to rendering superior medical care,
they are contributing to medical knowledge through research within both institutions.
[Dr. Terry:] The Public Health Service is indebted to Dean Lapham, to Dr. George Burch, and to other
members of the Tulane Medical School for their generous cooperation, their enthusiasm and
encouragement in helping us to carry forward the research program at New Orleans.
In addition to New Orleans, we're conducting research in other Public Health Service hospitals,
in the Indian Health Program, and in the hospitals in the federal prisons.
One of the most important types of research we're now conducting is the inter-hospital project
where several Public Health Service hospitals join together on a common problem
with a single protocol.
Here is the Public Health Service hospital at Staten Island,
which serves as administrative center for the first inter-hospital project.
Seven hospitals are now conducting investigations in the clinical pharmacology of various drugs
designed for the treatment of essential hypertension.
These inter-hospital investigations will help to speed up the testing of new drugs.
Our Baltimore hospital pioneered heart research in the service in cooperation
with the National Heart Institute and also has an important program in cancer chemotherapy
in cooperation with the National Cancer Institute.
Our Seattle hospital and the medical school of the University of Washington
are setting up a cooperative research program.
Our San Francisco hospital is working out details for research and association
with a major medical center and with the medical school.
Research in the Indian hospitals has developed around the clinical health problems of the Indians.
For example, at the present time pilot studies are being planned or conducted on diabetes, anemia,
cervical cancer, nutrition, trachoma, otitis media, and diseases of the gallbladder.
Since 1930, the Public Health Service has had responsibility for directing the medical program
of the Bureau of Prisons and the Department of Justice, which maintains 22 hospitals.
For several years, we have conducted research projects in many fields of investigation
with the aid of volunteer prisoner patients.
It is the aim of the Public Health Service to develop these research activities in our hospitals
in order to provide our patients with the best possible medical care and to enhance
the quality of the medical education.
Research also provides the opportunity for physicians and others in the service to extend
the range of their skills and to add greater depth to their professional judgment.
It is essential that we make these opportunities available because our ultimate success
in fulfilling our responsibilities for the health of the nation depends directly upon the skill,
the wisdom, and the dedication of the men and women in the Public Health Service.
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