The Bethesda Chronicles, Part 4: The Innovation Hub

Story by André B. Sobocinski, Historian

U.S. Navy Bureau of Medicine and Surgery

It is no understatement to say that Bethesda has long been a national center for medical research and innovation. Since 1942, medical personnel at the National Naval Medical Center—and later the Walter Reed National Military Medical Center—have consistently pushed the boundaries of medical science, while spearheading the development of new technologies and techniques that have strengthened our military’s ability to care for its wounded service members and their families.

A significant part of Bethesda’s medical research legacy is the Naval Medical Research Institute (NMRI), which was founded at the National Naval Medical Center on “Navy Day,” Oct. 27, 1942.

Throughout World War II, NMRI’s complement of military and civilian medical scientists and researchers—some of the most brilliant minds in the country—led an ambitious mission of “comprehensive research” relating to all aspects of military “problems.” Many of these efforts had immediate impact on the warfighters, and accomplished what the Navy’s 19th Surgeon General Rear Admiral Ross McIntire summarized as the: “prevention of disease, the relief of the suffering and the saving of lives.”

By World War II, medical research in the Navy was far from unchartered territory. In the first decades of the twentieth century, physician-scientist Rear Adm. Edward Stitt and others had turned the Naval Medical School into the nation’s premier tropical medicine and naval hygiene research center. And the inter-wars years (1919-1941) saw a vast array of ground-breaking medical research conducted at the Naval Medical School in Washington, D.C., the Submarine Base in New London, Conn., the Experimental Diving Unit, Navy Yard, Washington, D.C., aviation bases in Pensacola, Philadelphia, and San Diego and, of course, aboard ships at sea. During this period Navy medical personnel like Albert Behnke, John Poppen and many others helped unlock mysteries like decompression sickness, anti-G forces, oversaw the development of liquid plasma, spearheaded the development and testing of tetanus toxoid, and a means for combating heat stress aboard surface ships.

Capt. Albert Behnke is best known today for his pioneering work on decompression sickness, heat stress, human body composition and support the USS Squalus submarine rescue effort in 1939. He can also be credited as one of the forces behind the establishment of NMRI.
In the 1930s, Behnke conducted a series of experiments on the warships Nevada, Tuscaloosa, and New Orleans to assess how shipboard environments impacted combat effectiveness. The operational application of this work garnered the attention of Rear Adm. Ross McIntire, who was then serving as both Navy Surgeon General and primary physician to President Franklin Roosevelt. McIntire shared Behnke’s work with Roosevelt who took immediate interest. Having the ear of Roosevelt, Behnke championed the creation of a special laboratory focused on issues impacting the Navy and Marine Corps. Both Roosevelt and McIntire supported the idea and, Behnke’s proposed research laboratory came into being as NMRI.

NMRI’s plankowners included Capt. (later Rear Adm.) William Mann and Cmdr. Robert Draeger who served as NMRI’s first CO and XO, respectively. At the time, Mann was one of Navy Medicine’s leading strategic thinkers, and decades before helped initiate the concept of “field medical training” at Quantico, Virginia. Prior to reporting to NMRI, Draeger had earned some renown as an inventor of a microfilm camera designed to photograph publications at sea, and later adopted by American libraries. Mann and Draeger were joined by Dr. Andrew C. Ivy, the institute’s first scientific director. Ivy, a Northwestern University professor of physiology, later earn prominence as one of the developers of the Nuremburg Medical Code, a set of research principles on human use experimentation.

From its Bethesda headquarters, NMRI investigated practically every problem relating to the health of Navy and Marine Corps. And there is no denying that the organization had an air of a medical version “Q Branch” from the 007 novels and films. NMRI scientists researched and developed first aid kits for aviators, protective creams for flashburns, insect repellents and fungistatic agents, tested new uses for Penicillin, invented resuscitation devices, explored prevention of general effects of cold water immersion, new treatments for seasickness, transportation methods for whole blood, stood up the Navy’s first mobile nutrition units, and oversaw new treatments for and prevention techniques to ward against tropical diseases (including treatment for malaria, scrub typhus and schistosomiasis). But, all of these developments would follow in the wake of its first assigned project: devising a full-proof method for desalinating seawater and developing special food rations for the war’s unfortunate sea castaways.

Although there are no official statistics on how many World War II Sailors, Marines, merchant mariners, military aviators, and others awaited rescue at sea in World War II, a conservative estimate is tens of thousands. Following the loss of their ships or aircraft, these castaways would often face a gauntlet of inclement weather conditions, the threat of secondary enemy attacks, and even sharks. Even after evading these dangers, their fight for survival wasn’t over. Securing sustenance became paramount until rescue arrived. The human body is remarkably resilient, but unforgiving. Without food, an average person can last for about 21 days; water deprivation, however, is far more critical, with survival limited to just three days.

Early 1943, NMRI staff began experimenting with chemically processing seawater so that it could be drunk by personnel adrift on life rafts. In February 1943, NMRI physiologist Lt. Cmdr. Clair Spealman, H (S), USNR, developed a groundbreaking “multi-process filtering system for desalinating seawater.” A similar, but simpler method was soon after developed by NMRI in conjunction with by the Permutit Water Conditioning Company. The “Permutit-Navy Desalting Kit,” as it was known, contained a plastic drinking bag with a cloth filter at its base and five charcoal briquettes of desalting chemical. Through this resourceful invention, the castaway transformed seawater into drinkable water. They would fill the drinking bag with seawater, add a briquette, seal it tightly, and then shake it for around 20 minutes. This process produced a pint of filtered water accessible through a tube at the bottom. By war’s end, the kit was adopted by the Army, Navy as well as American Airlines.

Food was another concern for NMRI researchers who sought to develop a ready supply of emergency rations that could “lend itself to easy consumption and efficient metabolism.” Known as the “NMRI Emergency Ration,” these small cans consisted of high fat butterscotch tablets, hard candy fruit drops (containing citric acid to promote the flow of saliva), malted milk tablets, chewing gum, multivitamin tablets and a waterproof pouch. By 1944, the U.S. Navy adopted these emergency rations as part of a survival kit for aviators as well as to serve as the “U.S. Navy Emergency Ration for Life Rafts.”

After World War II, NMRI continued its impressive output of comprehensive research exploring methods for curbing malaria and other tropical diseases, furthering blood research, supporting aeromedical and undersea endeavors. NMRI partnered with other naval medical laboratories and research detachments in a global effort to safeguard the health and operational readiness of Navy and Marine personnel. Through a host of reorganizations, NMRI transformed from a hub for Navy Medicine’s research activities to a subordinate laboratory of the Naval Medical Research and Development Command (1974-1998) to finally, in 1998, an Echelon-4 headquarters command known as the Naval Medical Research Center (now known as the Naval Medical Research Command) in Silver Spring, Maryland.

Throughout its time in Bethesda, NMRI along with the Naval Medical School, Naval Dental School and Naval Hospital can be credited for the development of a number of high-profile and impactful innovations. These include:

The Acrylic Eye (1944). In the early 1940s—after hearing about new advances in ocular prosthetics, the Naval Hospital Bethesda’s Chief of the Ear, Nose and Throat Department worked with the researchers at the Navy Dental School to explore the development of an alternative to artificial glass eyes.

Since the 19th century, artisans in the German state of Thuringia were considered the unrequited masters of glass eye fabrication. Their craftsmanship was so unparalleled that at the beginning of World War II almost all of the artificial eyes in the United States came from Thuringia leading to an artificial eye shortage. In 1944, Navy dentists Capt. Rae Pitton, Lt. Cmdr. Phelps Murphey, Lt. Cmdr. LaMar Harris and medical illustrator Lt. Cmdr. Leon Schlossberg (Hospital Corps Officer) develop a process for fabricating acrylic eyes and forever revolutionizing the field of prosthetics.

“Mr. Disaster” and other training aids (1949-1953). In September 1949, Cmdr. Victor Niiranen reported to the Navy Medical School as the head of its Audio and Visual Department. The World War II veteran and maxillofacial prosthodontist took to the position with great gusto. Over the next four years, Niiranen devised numerous innovative training aids for the Navy including a life-like arm with simulated veins for practicing injections and blood withdrawal. He also developed a special mouth guard (“resilient plastic interdental splint”) for the National Boxing Association to prevent dental trauma in the boxing ring. But without a doubt, Niiranen’s most famous creation also had a most unforgettable name: “Mr. Disaster.” First exhibited by Niiranen on August 17, 1953, before a Navy audience in Washington, D.C, Mr. Disaster (aka, “Mark I”) was a life-size manikin used for demonstrating the treatment of trauma injuries. The pioneering simulacrum was sculpted by artist Louis Di Valentin and was made of plastic reinforced with fiberglass. What made this manikin truly innovative was a patented system for pumping “blood” (glycerin, water and red vegetable dye) to six major wound points on the legs, arms, abdomen, chest and mouth. The rate of blood flow was controlled by individual valves and the blood was stored in a tank at the manikin’s base. Mr. Disaster could be used to simulate everything from penetrating chest wounds to jaw fractures, and even choking by foreign body in the throat.

For Niiranen, Mr. Disaster was born out of a need for a “realistic” casualty care training aid for all members of the Navy; but he also knew it had value beyond the military services. From 1953 to 1956, Niiranen hit the road exhibiting the manikin at 34 dental and medical meetings across the country and covering some 53,000 miles in the process. He even appeared on the popular television show, “You Asked for It” demonstrating the manikin’s versatility before an estimated nation-wide audience of 20 million viewers.

Biotelemetry (1949). While attached to NMRI, Navy physician Capt. Norman Lee Barr developed a biotelemetry system to monitor the body and skin temperatures, electrocardiograms, and respiration rates of aviators. In Feb.1949, Barr used his aerial lab to monitor the heart rates of patients at a hospital in Greece and relay this data to an aircraft carrier off of Port Lyautey, Morocco. The data was then transmitted into a naval communications system picked up in Washington, D.C., and then conveyed by telephone to the National Naval Medical Center in Bethesda. Four years later, using ultra-high frequency radio equipment, Barr used his “flying laboratory” to capture physiological data of a jet pilot flying at an altitude of 52,000 feet and then transmitting it to a ground station at Anacostia, D.C. In addition to monitoring the pilot, tracking oxygen supplies and pressurization schedules, heart rates, and breathing rates the data also enabled Barr to study the pilot’s reaction time, body stress and strain under vigorous flying conditions. Barr noted in a 1954 article that the project marked the first time in aviation history that “a physician on the ground has been able to conduct a physical examination of a pilot in the air.”

Establishment of the First Tissue Bank in the World (1949). The world’s first tissue and bone bank was established at the National Naval Medical Center by Navy orthopedic surgeon George Hyatt. By the end of the 1950s, the tissue bank contained some 12,000 deposits of tissue transplanted to more than 2,500 patients around the globe.

Radioisotope Therapy (1940s-1950s). In the 1940s and 1950s, Navy radiologists at Bethesda stood vanguard in the development of the field of “atomic medicine,” studying radiological safety, introducing photodosimetry, and establishing procedures in the clinical use of radioisotopes.

Air Turbine Handpiece (1956). Inspired by a 1953 demonstration of a hydraulic contra-angle air turbine handpiece invented by Robert J. Nelson, Carl Pelander, and John Kumpula, dental officers Capts. Curtiss Schantz and Bill Ludwig envisioned a similar compressed-air system for use by the Navy. Cmdr. John V. Borden, a reserve dental officer, took on this project while assigned to the Naval Dental School. In June 1956, Borden developed a free running air-driven turbine handpiece that required less pressure to cut a tooth structure.

Organ Transplantation Research (1965-1968). It was a chance encounter at the Army-Navy Club in April 1965, between the aviator and inventor Charles Lindbergh and Lt. Vernon Perry of the Bethesda’s tissue bank that pumped new life into the artificial heart. Perry recruited Lindbergh as a “guest scientist.” Over the next three years, Lindbergh commuted regularly between his home in Darien, Connecticut and Bethesda to work on improving his perfusion pump. In Lindbergh, Perry not only got a talented engineer and a famous face for the project, but also a tireless worker. Perry later recalled, “His industry in the laboratory was overwhelming. . . he had the ability to work around the clock. His younger colleagues accustomed to a more normal 12 to 14 hours at the bench soon gave way. When we were forced to retreat from exhaustion, he would carry on, monitoring the apparatus, answering our phone calls, and writing in his journal. When we, after a good sleep, would next see him, he was as fresh as we and would comment that he had caught ‘a few winks here and there,’ probably expressed in this manner in an effort to reduce our own humiliation.”

Ultimately the Lindbergh-Perry collaboration led to improvements in the original pump, two publications, and new hope for those whose lives depended on organ transplantations.

Sources:

About NMRC. Naval Medical Research Command (n.d.), Retrieved from: https://www.med.navy.mil/Naval-Medical-Research-Center/

“Bethesda.” BUMED General Correspondence Files, 1942-1970. Record Group 52, National Archives II in College Park, MD.

Bethesda, National Naval Medical Center, Command Operation Reports, 1966-1972.

Bureau of Medicine and Surgery (u.p. 1946). “Naval Medical Research Institute.” Administrative History of the U.S. Medical Department in World War II.

The History of the Medical Department in World War II: A Narrative and Pictorial Volume (NAVMED P-5031), Volume 1 (1953). Washington, DC: Government Printing Office.

National Naval Medical Center News/Journal, 1948-1971.

Ullman, V. (April 1945). Research in preventive medicine. The Hospital Corps Quarterly.