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Annual report : National Institutes of Health (Volume 1952) online

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An estimate of the quantity and kind of total equipment, including per-
manent equipment having a depreciation value after five to ten years of opera-
tion, as well as small equipment was developed. At the same time, an estimate
of the approximate cost of purchasing equipment over and above that included in
the contract was approximately $12ij-,000. Up to the present time specifications
have been written and about three-fourths of the total list has been let on
contract .

The second step in planning was to develop a basic staff organization in
order to plan a realistic budget figure. The Nutrition Department of the Clin-
ical Center will serve the patient areas of each of the seven Institutes. The
department, functioning in two major areas, will include a food-production and
cafeteria unit and, secondly, a combined patient-serving and metabolic research
branch which will involve the operation of eleven floor kitchens with decen-
tralized food service and dishwashing facilities serving a maximum of fifty-two
patients each. It is anticipated that a majority of the patients in the Clini-
cal Center will be on a special diet therapy regime, each as a part of a spe-
cific research program conducted by the various Institutes. Planned also are
eight special research kitchens, with one dietitian to each kitchen, providing
for service to a maximum of ten patients. Only two of these kitchens, dealing
primarily with constant diets, will be opened during the first year of opera-
tion. From this step, the staff needs in terms of nonprofessional employees
was determined for each of the subunits of the department.

Recruitment of professional staff has moved along at a rather slow pace
because it was considered essential that the organizational pattern and the
graded positions be developed and the pattern accepted first. The recommenda-
tion was made that the total staff of dietitions be commissioned officer per-
sonnel. Other staff of the Nutrition Department are expected to come on duty
the early part of 1953'



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In collaboration with the personnel office of the Clinical Center, job
descriptions for each of the one-hundred twenty-three nonprofessional employees
were developed, and classification was made on the basis of these. Work was
begun with the Board of Examiners of the Civil Service Commission located at
the National Institutes of Health to develop an examination announcement to
fill six nonprofessional positions within the department: Cook, general and
metabolic kitchen cook; Baier, Meat cutter, Kitchen helper, general, and Food
service aide ,

Basic information was completed in order to substantiate our request for
appropriation funds to support the raw food budget for patients and the budget
for operating the cafeteria.

Up until this time, very little planning has been done with various
directors of the National Institutes of Health.

The significant professional society activities that have been a part of
the Nutrition staff have been as follows:

1. Presentation of paper entitled "Cooperative Planning of Dietary
Services" to the Association of Military Surgeons of October l8,
1952, by Edith A. Jones, Chief of the Nutrition Department.

2. Attendance at the annual meeting of the American Dietetic Associa-
tion on October 21-2^4-, 1952, Minneapolis, Minnesota.

3. Program Chairman for the District of Columbia Dietetic Association.

^4-. Continued as Chairman of a National Project No. 3 for the Food
Administration Section of the American Dietetic Association. The
work of this Committee is to develop a bibliography of kitchen
planning .

In summary, the Nutrition Department of the Clinical Center has spent
the last four months in developing many of the basic pattern and procedures
that will set the standard for its operation in 1953-

DIAGNOSTIC X-RAY DEPARTMENT

The early planning for the diagnostic X-ray service was carried largely
by Dr. Jack Masur, assisted by consultants Dr. Henry Kaplan of Stanford Uni-
versity and Dr. Russell Morgan of the Johns Hopkins Hospital. Tentative floor
plans for the diagnostic facilities and the darkroom were drawn up by the
Westinghouse X-ray Corporation. By July 1, 1951j these plans were on paper and
preliminary discussions had been held with Public Building Service officials
concerning certain structural problems.

Late in the calendar year 1951 the present chief of the Diagnostic X-ray
Department agreed to assist in achieving decisions concerning diagnostic X-ray
equipment, darkroom accessories, and personnel requirements, and periodic con-
sultation was provided during the latter part of 1951.

The present report covers the calendar year 1952. February 1952, the
Chief of the Diagnostic X-ray Department agreed to serve in this capacity on a
full-time basis effective July 1, 1952. In the interim he was to spend the



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major portion of his time as a radiologist at the Johns Hopkins Hospital devot-
ing whatever time was indicated at the National Institutes of Health to assist
in the planning and development of the X-ray department.

On February 11, 1952, specifications for X-ray equipment and for acces-
sory supply needs were transmitted to Public Buildings Service.

Attention was next directed to the development of permanent plans for
operation of the Diagnostic X-ray Department . Improvement in equipment and
development of new equipment necessitated some construction and design changes
within the X-ray department, such as the installation of a second high tension
line for operation of a Schonander biplane cassette changer.

It was recommended that film identification be accomplished by using a
small portable X-ray unit for film marking purposes, and plans for their con-
struction were developed with the PHS electronics laboratory in Rockville, Md.

In the same manner it was decided that alimiinum cylinders should be con-
structed for transportation of undeveloped film to the darkroom for processing,
and plans were drawn up for their construction at the instrument shop of the
National Institutes of Health.

Personnel and equipment requirements, as well as the budgetary needs for
the operation of the X-ray department for the fiscal years 1953 and 195^ were
developed. Other than the Chief of the Diagnostic X-ray Department, no person-
nel were employed during the calendar year 1952.

The Diagnostic X-ray Department was called upon by several governmental
departments for consultation and service during 1952. The Chief of the Depart-
ment served, upon request, as a member of the Radiation Safety Committee of the
National Institutes of Health. He was also asked to serve as a consultant in
radiology for the Outpatient Department of the Public Health Service at Jj-th and
C Streets, N.W. On request of the National Cancer Institute, he agreed to re-
view applications submitted to their organization for the loan of radium
throughout the country.

During the month of December 1952, the Chief of the Diagnostic X-ray
Department began the interpretation of all films taken in the Employee Health
Service Branch at the National Institutes of Health, This service was provided
at the request of Dr. Lynch, Medical Officer in Charge, Employee Health Service.
Consultation was likewise provided to various Institute members involving X-ray
film interpretation.

The Chief of the Diagnostic X-ray Department is a member of the faculty
of the Johns Hopkins University and serves as a part-time radiologist at the
Johns Hopkins Hospital. He had continued in this capacity until the time of
the writing of this report. This hospital association has proved valuable and
serves as a direct and ready means of consultation with Dr. Morgan and staff
without fee and at the same time affords an opportunity of maintaining a clini-
cal radiological experience.

During November 1952, an article entitled "Cardiac Mensuration by
Roentgenologic Methods" was published in the American Journal of Medical
Sciences. This article was written by Dr. Morgan and the Chief of the Diagnos-
tic X-ray Department. During this same period, preliminary work was directed



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toward the Eissembling of data and the writing of an article on an unusual
and rare type of congenital heart disease. This work is being conducted
by Dr. Robert Cooley, Associate Professor of Radiology at Johns Hopkins
Hospital, and the Chief of the Diagnostic X-ray Service at the Clinical
Center. It is anticipated that this paper will be published sometime
during 1953.

PATHOLOGIC ANATOMY SERVICE

At a series of meetings held in the Office of the Director, National
Institutes of Health, during January 1952, the Pathologic Anatomy Service was
organized, to consist of four sections: Siirgical Pathology, Dr. Harold L.
Stewart, Chief; Post Mortem Pathology, Dr. James H. Peers, Chief; Comparative
Pathology, Dr. W. T. S. Thorp, Chief; and Histochemistry, Dr. R. D. Lillle,
Chief. Dr. R. D. Lillie was designated also as chief of the Pathologic Anat-
omy Service, Dr. Harold L. Stewart as assistant chief, and supervisor of Histo-
pathologic technical services.

Much of the floor planning and equipment selection for the Pathologic
Anatomy area had been completed by a special ad hoc committee during 1950 and
1951j prior to the organization of the Service.

At a series of meetings held at intervals through 1952 (the period of
this report), allotment of space for various diagnostic services in Wing A,
2d floor, was agreed upon, several revisions of the 1953-^ budget were con-
sidered, and allotment of personnel to various functions was settled; a list of
outside consultants was selected and submitted to the Chief of Professional
Services, Clinical Center. Space requirements for Histochemistry and for Com-
parative Pathology have been or are in course of satisfactory arrangement.

An area for frozen section diagnosis adjacent to the operating room
floor has been allotted and equipment ordered.

A list of pathologists on duty or in process of employment at National
Institutes of Health has been prepared, containing data as to qualification
with the American Board of Pathology and experience.

Relations to Institutes and to National Institutes of Health- -Office of Director

Dr. Lillie holds post of Chief, Laboratory of Pathology and Pharmacology,
National Institute of Arthritis and Metabolic Diseases.

Dr. Stewart holds post of Chief, Laboratory of Pathology, National Can-
cer Institute.

Dr. Thorp holds posts of Chief, Laboratory Aids Branch, Office of Di-
rector, and Chief, Section on Comparative Pathology, Laboratory of Pathology
and pharmacology. National Institute of Arthritis and Metabolic Diseases.

Dr. Peers holds post of Chief, Pathologic Anatomy Section, Laboratory
of Pathology and Pharmacology, National Institute of Arthritis and Metabolic
Diseases.



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Drs. Laqueur, Fisher, Fite, Habermann, Loomls, Highman, Bangle, and
Longley serve as research workers in Laboratory of Pathology and Pharmacology,
National Institute of Arthritis and Metabolic Diseases.

Drs. Hilberg, Congdon, Dunn, Edgecomb, Eyestone, Leighton, Murphy,
Nadel, Schlyen, Steffee, Symeonidis, Velat serve as research workers in Labora-
tory of Pathology, National Cancer Institute.

Dr. Brecher serves also as Chief, Hematology Section, Clinical Pathol-
ogy Service, Clinical Center, and as a research worker in Laboratory of Pathol-
ogy and Pharmacology, National Institute of Arthritis and Metabolic Diseases.

It is contemplated that Dr. Thomas will form a research connection on
his arrival at Bethesda.

Dr. Sokoloff is research worker in Laboratory of Pathology and Phamia-
cology, National Institute of Arthritis and Metabolic Diseases, and his rela-
tion to the Pathologic Anatomy Service is to be established on his arrival at
Bethesda.

It is contemplated that Dr. Cristensen will also develop research in-
terests and affiliation with one of the Scientific Institutes.

Relation to External Agencies

The diagnostic services to the U. S. Indian Service and the Bureau of
Prisons, hitherto carried by Laboratory of Pathology and Pharmacology, National
Institute of Arthritis and Metabolic Diseases, will be ass-umed by the Pathol-
ogic Anatomy Service .

SOCIAL SERVICE DEPARTMENT

From July 1951 to July 1952, no staff was assigned to this Department.
During this period a report was prepared by Miss Cecile Hlllyer, outlining the
proposal for the structure and functions of the Social Service Department at
the Clinical Center. Miss Hillyer had spent a considerable period of time
visiting the outstanding hospitals of this country and obtaining detailed in-
formation about the functioning of their social service departments.

This report was available for the use of the director of the Social
Service Department when he was appointed in July of 1952. The basic proposal
was that a single integrated Social Service Department be established, making
use of both medical and psychiatric social case-work services. A new position
title and job description for program supervisors was recommended for the so-
cial workers who would be in charge of the case-work programs of the various
Institutes participating in the Clinical Center.

Following the appointment of the Chief, Social Service Department, these
proposals were reviewed with the administrative staff and the structure of the
department was approved as proposed. Job descriptions were prepared for the
various types of social service positions and were submitted for approval. The
budgetary requirements for the department were estimated and justifications
were prepared.



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Recruiting was begun after the different positions in the department
were approved, and potential candidates were interviewed for specific assign-
ments. The structure of the department was established to provide social
service coverage in four major areas: the National Heart Institute; the
National Cancer Institute; a combined program of neuropsychiatry to include the
National Institute of Mental Health and the National Institute of Neurological
Diseases and Blindness; and the fourth area was a combination of the programs
of the National Institute of Arthritis and Metabolic Diseases and the National
Microbiological Institute. It was proposed that a program supervisor be
assigned to be responsible for the social work program in each of these areas.
It was recommended that social case workers with medical and psychiatric social
work experience be assigned in these four areas of operations. An additional
area of service was recommended so that social case workers would be available
in the admissions program to provide assistance for individuals who sought ad-
mission to the Clinical Center but who were not eligible at the time of their
application. It was anticipated that it would be necessary to provide a refer-
ral service to other medical installations which might care for such applicants .

During the period from July 1 to December of 1952, a beginning was made
on the development of program and policies for the Social Service Department.

In December, the assistant chief of the Department was selected. Miss
Ellen Walsh, case work supervisor at Saint Vincent's Hospital in New York City.

The space requirements for the Social Service Department were recom-
mended and the provision for a central dictating system to be used by the case-
work staff was taken under consideration, and approval for such was recommended.

MEDICAL RECORD DEPARTMENT

Personnel, space, and equipment necessary for the Medical Record Depart-
ment were considered early In the organizational plans for the Clinical Center.
The chief of the Medical Record Branch, Division of Hospitals, Bureau of Medi-
cal Services, served as consultant regarding these needs. The present chief of
the Medical Record Department accepted the position in April 1952. From the
time of the first Interview in 1951 until reporting for full-time duty Septem-
ber 15,. 1952, she was able to devote part-time to the organizational plans of
the Medical Record Department,

The responsibility of the Medical Record Department Includes "develop-
ment and direction of a system of medical records and statistical reports which
will promote the best medical care of the patient and will meet the varied needs
of the hospital and the several research Institutes of the National Institutes
of Health, in providing basic data for medical research, evaluation of clinical
services, planning and developing additional programs and activities, medical
education, and other medical administrative and medico- legal needs."

In the organizational plans, these responsibilities have been divided
into two sections: Medical record research service and medical record opera-
tion service. Each of these services will be directed by a well-qualified med-
ical record librarian. Every step in the organizational plans has been
directed toward the need of the Clinical Center - recognlzing that this institu-
tion is unique and that procedures and systems must be tailor-made and not
copied from another hospital.



- 22il- -

The first meeting on medical records with representatives of the Insti-
tutes present was held May 2, 1952, almost a year prior to the anticipated
opening of the Center. Basic principles of record and report systems were dis-
cussed. The following recommendations were considered:

1. Installation of the unit system of numbering records. (The same
number is to be used for all admissions of the patient on the in-
patient and out-patient services.)

2. Installation of a centralized record system. (All patients' records
are to be filed in the Medical Record Department . )

3. Centralization of data pertaining to the clinical care of the pa-
tient. (All pertinent information pertaining to the patient is to
be recorded on the patient's record.)

h, . Installation of addressograph system. ("Charger plates" to be used
for laboratory requests and headings on medical record forms. Other
uses, e.g., index cards, are to be explored.)

5- Installation of follow-up . system of patients discharged. All infor-
mation obtained following discharge of patients should be considered
a part of the unit record.

The Chief Medical Record Librarian attended the First International Con-
gress of Medical Record Librarians in London in September 1952 and the Annual
Conference of the American Association of Medical Record Librarians in Washing-
ton the following month. During the present year she is serving as President
of the District of Columbia Association of Medical Record Librarians and is
chairman of a committee for the American Association to survey the medical rec-
ord librarian field. This survey is being conducted jointly by the American
Association of Medical Record Librarians and the Division of Public Health
Methods, Public Health Service. During the past eighteen months as an Analyst
in the Division of Public Health Methods she has completed a monograph entitled
Records and Reports of Local Health Departments — Criteria and Methods for
Organization, Maintenance, and Use. This monograph will be published in the
spring of 1953 tiy the Public Health Service. She is also serving as a member
of the Task Force of the Division of Medical and Hospital Resources, Bureau of
Medical Services, to develop standards for patient care in hospitals and re-
lated institutions.



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OFFICE OF THE DIRECTOR

Page

Laboratory Aids Branch 227

Personnel Branch 228

Management Analysis 23O

Buildings Management Branch 23I

Purchase and Supply Branch 22k

Financial Management Branch 237

Research Facilities Planning Branch 239

Scientific Reports Branch 2i<-0



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OFFICE OF THE DIRECTOR

July 1, 1951 - December 31, 1952

LABORATORY AIDS BRANCH

The research worker must be supported by a wide range of technical serv-
ices, such as provision of culture media, experimental animals, animal care-
takers, laboratory attendants, and scientific equipment developed in coopera-
tion with the research worker. These aids to research require the services of
technical and professional personnel capable of constructing unique precision
instruments not available on the commercial market, of breeding animals of
standard quality (necessary to controlled research studies) and of controlling
disease outbreaks in the various animal colonies. These services at the Na-
tional Institutes of Health are provided by the Laboratory Aids Branch.

The Branch provides central cleaning and sterilization of glassware for
the laboratories and the Clinical Center, and is responsible also for the ani-
mal cage washing and sterilization facilities in the Clinical Center. A large
quantity of mechanical equipment for glassware preparation and cage cleaning
was installed during this reporting period to provide a more efficient opera-
tion with a minimum increase of personnel.

The Laboratory Attendant Section is a central facility which dally fur-
nishes sterile glassware, fresh foods, and laundry to the Institutes. In I952
the section processed 350 more tubs of glassware than in the previous year,
with the same number of personnel. An employee of this section has been work-
ing with engineers in the Research Facilities Planning Branch toward mechanical
washing of glassware and improvements in use of detergents. This section will
be moved to the Clinical Center in 1953, where better facilities will be avail-
able and where it will function as a central glassware and cage -washing facil-
ity. Laundry and fresh food distribution then will be taken over by another
branch. The Animal Section provides the laboratories with experimental animals,
including animals of known genetic background.

During 1952 this section furnished to the laboratories 732,835 mice, of
which 575,751 were general purpose and 157,084 had known genetic backgrounds.
Twenty different strains of mice are produced at NIH. While mice are in most
demand, the section also provided NIH researchers with 65,000 other experimen-
tal animals, including rabbits, guinea pigs, rats, and hamsters.

An inbred group of mice was taken over by Geneticist George E. Jay, Na-
tional Cancer Institute, in 1951. During that year emphasis was placed on im-
proving the strains and maintaining production for the Cancer Institute. In
March of I952 production began to increase, and by December I952 it had tripled.
The colony now is comparable in size and quality to any in the United States.
In 1952 additional facilities were established at the Rockville Farm for main-
taining dogs on long-term experiments for the Institutes, thus releasing valu-
able space in the animal areas of the NIH buildings.

As the result of efforts by an employee in the Animal Section to stand-
ardize animal cage design, the Institutes can now order cages by a reference
number instead of submitting lengthy specifications.



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The Instrument Section, in cooperation with the research worker, de-
signs and constructs intricate scientific equipment that is not available in
the commercial market. In 1952 there was a considerable increase in the amount
of developmental work on equipment needed by the laboratories, particularly
with respect to the Clinical Center.

A pipette washing machine was developed which cleans l60 pipettes at one
operation, does a better cleaning job than any previous method known, but does
not etch the glass in the operation. This has resulted in a considerable sav-
ing of ■^man-hours and hundreds of dollars worth of pipettes.

A treadmill was developed for the Heart Institute for use by patients
in a controlled temperature room.

The demand for electronic work in the Institutes has increased three-
fold, both in development of new equipment and repair of existing equipment,
while the number of employees has remained the same.

The Media Section provides the laboratories with both stock and experi-
mental media. Approximately 1,000 different media were prepared. There was
also a growing demand for experimental media, due possibly to new research
activities .

PERSONNEL BRANCH

The Personnel Branch is responsible for employer -employee relation-
ships at NIH, as maintained within the framework of Civil Service Commission
laws and regulations and Department and Public Health Service policies.

Personnel Generalists

Under the existing pattern of orgsuaization, most of the operating rela-
tionships among supervisors and employees and the Personnel Branch are con-
ducted by personnel generalists who serve assigned organizational areas. Dur-
ing the reporting period, the personnel generalists completed more than 4,700



Online LibraryNational Institutes of Health (U.S.)Annual report : National Institutes of Health (Volume 1952) → online text (page 27 of 29)