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Full text of "United States Navy Medical News Letter Vol. 35 No. 8, 22 April 1960"

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Rear Admiral Bartholomew W. Hogan MC USN - Surgeon General 
Captain Donald R. Childs MC USN - Editor 



Vol. 35 



Friday, 22 April I960 



No. 8 



TABLE OF CONTENTS 



ABSTRACTS 



RESERVE SECTION 



Systemic Lupus Erythematosus, . . Z 
Cardiotoxic Effects of 

Quinidine 5 

ECG Patterns of Hypertrophy .... 7 

Arteriosclerosis Obliterans 8 

Radiation Therapy of Benign 

Conditions 10 

Respect the Skin 13 

Indications for Preoperative 

Transfusions 14 

MISCELLANEOUS 



Screening for Officers not 

Available for Mobilization .... 25 
American Nurses Association 

Convention 2f> 

American Board Certifications , . 26 

AVIATION MEDICINE 

High Altitude Balloon Research 

and Development Program ... 28 

DENTAL SECTION 



Standard Prescription Form 

BuMed Notice 6150 16 

Captain Barr Receives Certificate 
of Exceptional Service 17 

Early Detection of Disease - ACP 
Postgraduate Course 18 

Recent Research Reports ...... 18 

Fropn the Note Book 21 



Extension Course in Oral 

Surgery 36 

Resuscitators in Dental Clinics. , 37 
Dental Treatment Prior to 

Transfer Overseas 37 

Course in Complete Dentures ... 38 
Personnel and Professional 

Notes 38 



Medical News Letter Vol. 35, No. 8 



Systemic Lupus Erythematosus 

Earlier detailed surveys of the disease systemic lupus erythematosus 
(SLE) have covered the natural history, clinical symptoms, diagnosis, and 
many aspects of treatment of the disease. The current report deals only 
with certain developments in the study of the disease which have occurred 
recently and have not been so extensively discussed. 

Abnormal Immunologic Reactions . Abnormal immunologic reactions 
have been found more frequently and in greater number in SLE than in any 
other disease. In addition to their number, these reactions are notable in 
two respects. First, the abnormal antibodies which have been identified 
are capable of reacting with the patient's own tissues and, therefore, the 
reactions appear to be autoimmune. Second, annong these antibodies is a 
group which reacts with the constituents of the cell nucleus — including nucleic 
acids — and probably represent the first clear example of antibodies to nuclear 
substances. 

One of the most fascinating aspects of SLE is the LE cell. This cell 
results from the alteration of the nucleus of a leukocyte by a factor in the 
serum of the patient. The affected nucleus becomes swollen, is extruded 
from the cell and is then engulfed by another leukocyte. This second leuko- 
cyte, containing within its cytoplasm the altered extruded nucleus, is the 
LE cell. In recent years, investigations employing immunologic and histo- 
chemical techniques have led to an understanding of the mechanism of this 
phenomenon and, concomitantly, to demonstration of the existence of anti- 
nuclear antibodies. 

The LE cell factor is not the only factor present in SLE serum which 
reacts with constituents of the nucleus. Other factors produce reactions 
which can be demonstrated by standard immunologic procedures. It has been 
possible to separate many of the antinuclear factors from one another and to 
demonstrate that there is at least one separate factor which reacts with each 
of the nuclear constituents. An individual SLE serum may contain all, some, 
or none of the antinuclear factors. 

The serum titers of the antinuclear factors are highest during disease 
activity and diminish or disappear during spontaneous or therapeutic remis- 
sions. Because of specific characteristics, the LE cell factor appears to be 
one nnember of a group of antinuclear antibodies. Recent histochemical inves- 
tigations confirm the conclusion that fornnation of LE cells is the result of an 
imnnunologic reaction. In addition to the antinuclear antibodies, at least one, 
and perhaps more, serum factors occur which fix the complement with con- 
stituents of cell cytoplasm. 

Although the antinuclear and antic ytoplasmic factors appear character- 
istically in SLE, they also occur in various diseases — other collagen diseases, 
several types of cirrhosis, nnacroglobulinemia, and occasional cases of 
leukemia. 



22 April I960 Medical News Letter 



Antibodies to red blood cells occurring in SLE have been demonstrated 
by the Coombs method, adding to the list of unusual antibodies known to occur 
in this condition. Antibodies to white blood cells and platelets have been 
demonstrated by agglutination techniques. The false positive Wassermann 
reaction is evidence for existence of the Wassermann reagin or antibody. 
In addition, a circulating gamma -globulin has been demonstrated to prolong 
the clotting time, probably by interfering with thronnboplastin, and the char- 
acteristic renal lesion has been shown to be the site of extensive deposition 
of gamma -globulin. 

Certain of the unusual antibodies can be detected readily in a clinical 
laboratory and have proved to be of diagnostic value. A positive Coombs 
test, a positive Wassermann reaction, a prolonged clotting time, and a 
positive LE cell preparation comprise a tetrad which is diagnostic of SLE. 
The presence of any one of these abnormalities suggests the diagnosis. 

The mechanism which gives rise to the unusual antibodies is unknown. 
The large number of antibodies which appear suggests that there is an abnor- 
mally reactive system for antibody synthesis which produces antibodies to 
nornnal cell constituents. The pathogenic significance of the various unusual 
antibodies is also not clearly understood. It is possible that they are bypro- 
ducts of an altered immunologic response rather than decisive pathogenic 
agents. 

When injected intradermally with homogenates of their own leukocytes, 
many patients with SLE have developed erythema and induration at the injec- 
tion site with an inflammatory infiltration. 

Whatever the pathogenic significance of the unusual antibodies or the 
peculiar skin reaction may prove to be, the demonstration of their existence 
by a variety of standard immunologic methods indicates the presence of a 
grossly abnornnal immune system. 

Incidence of the Disease . Ten years ago, SLE was considered a rare 
and usually fatal disease. It was recognized almost exclusively in its late 
stages. Since recognition of the LE cell phenomenon, the diagnosis has been 
made more frequently. However, the border lines distinguishing this disease 
from others have become less distinct. As a consequence, no unequivocal 
information is available dealing with the incidence of SLE in the general pop- 
ulation; but evidence for a familial occurrence is emerging. Data indicate in 
certain families a predilection for an abnormal immunologic response which 
may express itself as rheumatoid arthritis or as SLE, or may simply mani- 
fest itself as a serologic abnormality without evidence of clinical disease. 

Renal Disease . Renal disease provides the most difficult clinical 
problem in SLE today. This appears to be due to a change in the natural his- 
tory of the disease under the influence of steroid therapy. Most systemic 
manifestations of SLE respond to steroids, at least temporarily. Acute ful- 
minating fatal crises of SLE have almost ceased to occur. Subacute bacterial 
endocarditis is rare when compared to its incidence 20 years aigo. As a 



Medical News Letter Vol. 35, No. 8 



consequence (because the renal lesion does not respond to steroids as readily 
as do systemic lesions), the average length of life of the patient is increasing 
and renal disease has come to the fore as the major problem in management 
and as the prime cause of death. 

In renal disease of SL.E, the typical pathology is the "wire loop" lesion 
which is focal in nature, but may extend throughout the kidneys. Although 
its origin remains obscure, immune mechanisms may be involved. 

When response of renal disease to steroids occurs, the nnechanism of 
improvennent is unknown. Not all cases can be expected to respond to therapy. 
However, experience to date certainly does not permit the view that the kidney 
lesion cannot be reversed with treatment. The successes thus far obtained 
argue strongly in favor of treating all patients early and thoroughly in the hope 
of avoiding development of severe renal disease, and thus greatly prolonging 
the life span of the patient. 

General Therapy . In relation to therapy of the disease, no new devel- 
opments of significance have occurred. However, more experience has been 
gained in use of antimalarial drugs. As in the case of renal disease, some 
refinements of current methods appear possible. 

Antimalarial drugs are highly effective in discoid lupus erythematosus; 
variable results have been reported in SLE with and without steroids. Atabrine, 
100 to 300 mg. per day — or the equivalent in other drugs, such as Chloroquin 
and Plaquenil — has been used. The nnechanism of action is entirely unknown. 

One of the most important problems in therapy is the evaluation of the 
length of time corticosteroids should be continued and the dose which should 
be employed. Three distinct phases of patient response to therapy can be 
identified in most cases: (1) improvement of clinical symptoms; (2) improve- 
ment in blood abnormalities, especially in the sedimentation rate, gamma- 
globulin, albumin, and hemoglobin; (3) improvennent of hennaturia, azotemia, 
proteinuria, and the compronnised urea clearance. When prednisone approx- 
imating 50 nng. per day in an adult is used, arthritis, fever, pleuritic pain, 
and rash usually improve or disappear dramatically within a few days. The 
blood picture does not improve as quickly and return to normal is delayed 
until after treatment for 2 weeks to one month or longer. If renal disease is 
present, the hematuria is likely to persist for a minimum of 2 months. When 
treatment with steroids is continued until the blood and kidneys are normal 
or the abnormalities have become stabilized, there is likely to be a much lower 
incidence of exacerbations and advancing renal disease. In addition, there 
will be a greater number of remissions which will permit withdrawal of steroids. 

" Lupoid" Hepatitis . This term has recently been introduced— perhaps 
unwisely — to describe the liver disease which appears in a group of patients 
who also have certain symptoms connpatible with SLE and who have positive 
LE cell preparations. The nature of the hepatic lesion remains obscure, 
particularly in its early stages and in relation to SLE. It appears to be 
established that: (1) an unexplained cirrhosis (or chronic hepatitis) occurs 



22 April I960 Medical News Letter 



in young people, especially women, and (2) positive LE cell preparations 
and symptoms suggestive of SLE are present in some of these patients. 
While it is conceivable that these cases of hepatic disease are an unusual 
form of SLE, it is also conceivable that some of the symptoms and sero- 
logic abnormalities are a consequence of an immunologic abnormality in- 
duced in some way by the mechanism responsible for the liver injury. In 
pursuit of this lead, it will be highly desirable to examine cases of SLE for 
evidence of liver disease, and to search for immunologic abnormalities in 
cases of hepatic disease. (H, Holman, Systemic Lupus Erythematosus: 
J. Pediat. , 56^: 109-119, January I960) 

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Cardiotoxic Effects of Quinidine 

Quinidine has an established place in the managennent of certain car- 
diac arrhythmias, although the toxic effects produced by this drug remain a 
potential hazard. With the relatively recent advances in determining the 
plasma concentration of quinidine and the rather specific indications and 
cautions stressed when this drug is used in clinical practice, severe toxic 
reactions can be minimized, but probably never completely eliminated. 

Toxic manifestations of quinidine can be grouped into four major 
categories, only the last of which will be considered in this study. 

1. Allergy or indiosyncrasy which includes febrile reactions, skin 
eruptions, thrombocytopenia, and "quinidine shock. " 

2. Toxic reactions due to the inherent properties of the cinchona 
alkaloids which have been grouped under the term "cinchonisnn. " These 
include impairment of hearing, tinnitus, blurred vision, giddiness, light- 
headedness, and tremor. 

3. Gastrointestinal symptoms due to local irritation, such as nausea, 
vomiting, anorexia, colicky pain, and diarrhea. 

4. Cardiotoxic effects. 

The toxic effects produced by quinidine on the heart and its conduction 
system have long been recognized. This is the category in which most of the 
fatal accidents occur. Quinidine is a depressant of the cardiac muscular and 
conduction systems. Therefore, it is potentially capable of producing a wide 
variety of electrocardiographic changes. Widening of the QRS to more than 
0. 12 second, prolongation of the QT interval which may in part be due to QRS 
widening and/or prominent U-waves, depression of the ST -segment, low-voltage 
T -waves, and widening and notching of the P-waves may occur with therapeutic 
doses. 

When profound changes in cardiac rhythm appear, severe hemodynamic 
alterations soon follow. Ventricular premature beats or an increase in QRS 
width of 50% or more rarely in themselves lead to a fatal outcome if the drug 



Medical News Letter Vol. 35, No. 8 



is discontinued. However, such is not always true for complete A-V block, 
ventricular tachycardia, or ventricular fibrillation. Marked depression of 
the higher pacemakers is frequently followed by development of either an 
idioventricvilar rhythm progressing to asystole, or ventricular tachycardia 
and ventricular fibrillation. In these latter groups, acute circulatory col- 
lapse and death may ensue. 

When quinidine is employed in management of cardiac arrhythmia, 
initial small doses, repeated electrocardiograms, quinidine plasma concen- 
trations, and frequent and careful clinical appraisal of the patient must be 
instituted if the severe toxic manifestations are to be minimized. 

Management of the patient after development of the severe cardiotoxic 
manifestation of this drug has left much to be desired. Many drugs have 
been studied for their effect to revive the heart depressed by quinidine. Of 
the drugs tested — including epinephrine, norepinephrine, caffeine, acetyl- 
choline, ephedrine, and phenylephrine — epinephrine was found to be the 
most powerful and consistently effective drug. However, its use is contra- 
indicated in the presence of frequent ventricular ectopic beats, ventricular 
tachycardia, or ventricular fibrillation. Therefore, epinephrine appears 
to have a limited and nonspecific place in the treatment of this disorder. 

Experimental observations and case reports suggest that molar sodium 
lactate exerts an antagonistic effect on the cardiodepressant action of quin- 
idine, possibly by prodticing alterations in certain electrolyte concentrations 
and perhaps blood pH. 

Laboratory eMpeviments indicate that the "sodium-carrying" system 
in effect during polarization of the myocardial fiber is depressed by quinidine; 
consequently, there is an alteration of the normal cellular ionic shifts which 
occur during cardiac muscle contraction. Other studies demonstrate that 
quinidine renders the cell menr»brane less permeable to potassium ions. 
Results of various studies combine to indicate that quinidine exerts part, if 
not all, of its pharmacologic action on the heart by producing alterations in 
the ionic equilibrium which takes place during the cardiac cycle. This in- 
hibition of ionic transfer with the accompanying derangement of the normal 
sodium and potassium equilibrium is the probable mechanism by which 
quinidine depresses the cardiac conduction system. 

The clinical sequelae of the described changes are the alterations in 
cardiac rhythm encountered clinically. The ability of molar sodium lactate 
to counteract these derangements probably results from introduction of a 
high concentration of sodium ions, and not by alleviation of the depressant 
effect of quinidine on glucose and fructose uptake by the myocardium, as has 
been suggested by some. 

On the basis of experimental work and clinical studies thus far obtained, 
molar sodium lactate appears to offer a rational approach in the management 
of cardiotoxic effects of quinidine. (D.J. Bailey, Jr. , Cardiotoxic Effects of 
Quinidine and Their Treatment: A.M. A. Arch. Int. Med. , 105 ; 13-2Z, January 
1960) 



22 April I960 Medical News Letter 



ECG Patterns of Hypertrophy 

The correlation of the electrocardiogram with anatomic evidence of 
ventricular hypertrophy — while laden with numerous pitfalls — ^ still rennains 
the beat available means of determining the accuracy of the electrocardio- 
graphic diagnosis of ventricular hypertrophy. 

In 100 instances of isolated left ventricular hypertrophy (LVH) demon- 
strated at autopsy, a positive electrocardiographic diagnosis was made in 
85% by use of conventional criteria. However, in other studies designed to 
test the reliability of these criteria, it was found that a false -positive diag- 
nosis was made in 10 to 15% of cases. 

The electrocardiographic diagnosis of right ventricular hypertrophy 
(RVH) is naore difficiilt. In electrocardiographic studies, confirmed by 
autopsies, the correlation has ranged from 23 to 100% while the number of 
false -positive diagnoses has been as high as 33%. The correct electrocar- 
diographic diagnosis is more frequent in RVH due to congenital heart disease 
than to acquired heart disease. 

The significance of the rSR' pattern in right precordial leads is dis- 
cussed. Its occurrence in anatomic RVH and the problem of the electro- 
cardiographic diagnosis of RVH in the presence of right bundle -branch block 
(RBBB) are reviewed. 

Combined ventricular hypertrophy (CVH) is frequently missed in the 
electrocardiogram, the diagnosis having been made in only 8 to 26% of cases 
proved at autopsy. 

The unreliability of the electrocardiographic diagnosis of LVH in the 
presence of left bundle-branch block (LBBB) is documented. 

The precise electrophysiologic phenomena that occur in ventricular 
hypertrophy are still largely conjectural. The more commonly accepted 
hypotheses are reviewed. 

The lack of close correlation between ventricular wall thickness or 
respective ventricular muscle nuass and the individual electrocardiographic 
patterns is emphasized. Possible explanations for some of these discrepan- 
cies are presented. (R. C. Scott, The Correlation Between the Electrocardio- 
graphic Patterns of Ventricular Hypertrophy and the Anatomic Findings: 
Circulation, XXI : 256-291. February I960) 

S[t S}! * * * * 

Change of Address 

Please forward requests for change of address for the News Letter to: 
Commanding Officer, U. S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 

sis s|! il< sj; ;!; ;)! 



Medical News Letter Vol. 35, No, 8 



Arteriosclerosis Obliterans 

The diagnostic term "arteriosclerosis obliterans" denotes a degen- 
erative arteriopathy of the extremities and of the aorta and its branches that 
go to the extremities. It is characterized by occlusive lesions consisting 
primarily of atheromas which are often acconnpanied by fibrosis and calcifi- 
cation of the medial coat of the artery and which may be associated with 
thrombosis of varying extent. 

The authors reviewed the records and made follow-up studies of a group 
of 520 nondiabetic patients who were less than 60 years of age at the time a 
clinical diagnosis of arteriosclerosis obliterans was made and who had had 
at least one determination of plasma cholesterol. The purpose of the study 
was three-fold: to gain information as to pathogenesis of atherosclerosis; to 
accumulate evidence regarding factors that influence prognosis as to life and 
preservation of linnbs; and, to connpare prognosis as to life and limb of groups 
with and without surgical procedures designed to restore arterial continuity. 

FACTORS OF PATHOGENESIS 

Sex . Of the entire group of 5Z0 patients, 478 were men and 42 were 
women. This ratio is greater than that usually reported for white patients in 
this age group who have clinical evidence of coronary atherosclerosis. Nor- 
mal secretion of estrogens by the premenopausal woman may tend to protect 
against atherosclerosis of the arteries of the lower extremities and may 
extend for several years after the menopause. 

Plasma Cholesterol . The mean concentration of plasnaa cholesterol 
in men with arteriosclerosis obliterans was approximately 50 mg. per 100 ml. 
higher than that of either of the two control groups of men; the level in wonnen 
was approximately 35 mg. per 100 ml. higher than that of the nnen with this 
disease. The mean concentration of plasma cholesterol was 250 mg. per 
100 ml. , or greater, in 48% of the men and 74% of the women. 

Tobacco Smoking . At the onset of symptoms of arteriosclerosis oblit- 
erans, 97. 5% of the men were smokers and 33% smoked 20 or more cigarettes 
a day. In a control group of male patients without this disease, 26% were non- 
smokers and 33% smoked 20 cigarettes or more a day. This suggests that 
tobacco smoking may produce some sort of peripheral arterial injury and nnay 
be a factor in localization of atherosclerosis in a certain small group of sus- 
ceptible individuals. Also, it is possible that in some patients with athero- 
sclerosis, tobacco smoking may be a factor in the secondary arterial throm- 
bosis that occurs. 

Obesity . With a weight of more than 200 lbs. in n:ien and of more than 
175 lbs. in women as an index of obesity, only 5% of the authors' series were 
obese. It would appear that in middle-aged nondiabetic patients, obesity is 
not conamonly associated with arteriosclerosis obliterans and probably, is not 
a significant factor in pathogenesis. 



ZZ April I960 Medical News Letter 



Hypertension . Of the study group, 25% had blood pressure greater 
than the arbitrary values of 150 mm. Hg. systolic and 90 mm. diastolic 
chosen as the upper limits of normal as compared to 9% in the control group 
of 100 male patients. It is noteworthy that three -fourths of the patients with 
arteriosclerosis obliterans did not have hypertension. It would appear that 
hypertension cannot be considered a frequent accelerating factor in the pro- 
cess of arteriosclerosis obliterans. 

SYMPTOMS AND COMPLICATIONS 

All 520 patients had a history of intermittent claudication in one or 
both lower extremities. This was the only symptom of occlusive arterial 
disease in 380 patients (73. 1%). Rest pain was noted by 85 patients (16. 3%) 
and was interpreted to be pain due to local tissue ischemia or pain due to 
ischemic neuropathy of larger nerve trunks. Ischemic ulceration or gan- 
grene was observed in 55 patients (10. 6%). The incidence of rest pain, 
neuropathy, ulceration, and gangrene was greater in patients whose prox- 
imal arterial occlusion was in the femoral artery than in those whose 
occlusion was in the aorto-iliac vessels. 

A history of previous myocardial infarction or chest pain consistent 
with angina pectoris existed in 16% of the entire group. The incidence of 
clinical coronary arteriosclerosis is slightly greater in patients with occlu- 
sion of the fenroral artery than in patients with aorto-iliac involvement. 

TREATMENT 

In general, the following basic regimen was recommended for all 
patients: abstinence from tobacco; protection of feet; low fat diet for those 
with increased plasma cholesterol; one or more courses of IM injections of 
deproteinated pancreatic extract for those with intermittent claudication; 
oscillating bed for those with ischemic rest pain, ischemic neuropathy, or 
ischemic ulcers or gangrene. Unilateral or bilateral surgical lumbar sym- 
pathetic ganglionectomy was performed on 44 patients; amputation of the 
leg was performed on 21 (4%) because gangrene was found to be extensive 
and unresponsive to conservative treatment. Only 2% of the patients with 
aorto-iliac disease required amputation of the leg at the Wvao. of their first 
visit while 5% of those with involvement of the femoral artery required am- 
putation at that time. 

PROGNOSIS 

Survival Rates . Survival rates for the traced patients is significantly 
lower than that for the general population. The cause of death could not 
always be determined with accuracy, but in 76 patients (approximately 75% 



10 Medical News Letter Vol. 35, No. 8 

of those known to have died in the follow-up period) the cause of death was 
probably arteriosclerosis of the coronary arteries. 

Percent Survival 3 years 6 years 10 years 

Normal population 96.0 92.8 83,0 

Femoral artery occlusion 86. 80. 1 57. Z 

Aorto-iliac occlusion 81.9 73. 46. 6 

The 5-year survival rate is significantly lower for patients who had 
clinical coronary arteriosclerosis and for those who had had a cerebro- 
vascular accident than for those who did not. However, the authors con- 
sider that the lower survival rate for those with coronary disease is not 
influenced by the disease of the lower extremities. 

Subsequent Annputation . The incidence of subsequent amputations 
during the 5 -year period following original examination and diagnosis was 
4. 9% for the 465 traced patients, only 3% for those with intermittent claudi- 
cation as the only symptom, 3. 8% for those with more severe degrees of 
ischemia as manifested by rest pain or ischemic neuropathy, and 19- 6% for 
those with gangrene or ulceration. Data indicate that ischemic ulceration 
or gangrene is of more serious import, insofar as survival of an extremity 
is concerned when the proximal site of occlusion is in the femoral artery 
than when it is in the aorto-iliac region. 

Of the traced patients who smoked at the time of diagnosis and who sur- 
vived 5 years, 88 had continued to smoke and 71 had abstained from smoking 
after the diagnosis was made. Of interest is the finding that 11. 4% of all who 
continued to smoke required an amputation within the 5-year period while 
none who abstained fronn smoking required amputation during this period. 
Because all patients of the series were treated before the advent of 
direct arterial surgery for segmental arterial occlusion, it is believed that 
the subsequent course of the disease in these patients may be used as a basis 
for comparative evaluation of results in patients subjected to direct arterial 
surgical procedures. (J.L. Juergens, N. W. Barker, E. A. Hines Jr. , 
Arteriosclerosis Obliterans: Circulation, XXI : 188-195, February I960) 

^ >^ ^ ^ ^ ^ 

Radiatioji Therapy of Benign Conditions 

Soon after their discovery in 1895, roentgen rays were put to practical 
use by physicians. Acute radiation reactions — local and systemic effects of 
large doses delivered in a short time — promptly manifested themselves and, 
in due course, their sequelae appeared. 

In the face of current apprehension about use of roentgen rays, thera- 
peutic radiologists are grateful to have physicians in other fields point out 
that "irradiation for benign conditions may produce tissue changes more 



22 April i960 Medical News Letter 11 



disabling than the original condition for which the x-rays were administered. " 
However, scientists should be able to objectively evaluate this question: 
How has the greater understanding of radiation hazards affected the indica- 
tions and contraindications for the dosimetry and techniques of irradiation 
in benign conditions? 

Cellulitis, Furuncles, Carbuncles . With the passing of the years, 
widespread and often unnecessary administration of chemicals has produced 
two thoroughly unpleasant results: drug reaction and resistant strains of 
bacteria. The lesson to be learned is plain — the use of these valuable mat- 
erials should be reserved for a time of real need to fight infections which 
threaten to cripple or kill. The part that radiation can play in reducing their 
use is too often ignored. 

Many questions about how radiation influences infections have never 
been fully answered. However, it seems definite that there is no direct 
bactericidal action, nor is there any direct increase of antibody production. 
The improvement which follows is probably due to the action of ionizing 
energy on the cellular exudate accompanying the inflammation and on the 
capillary bed. 

Whatever the exact mechanism of its action, roentgen therapy is an 
adjunct of proved value in treatment of many infections. A nonspecific form 
of treatment, it stimulates the natural defenses of the body. It does not sen- 
sitize the patient and does not lead to development of resistant bacterial 
strains. The number of cases of cellulitis, furuncles, and carbuncles that 
can be cleared up by rest, hot compresses, and indicated surgical drainage 
would surprise young physicians who have entered practice since the use of 
antibiotics and chemotherapy has become rampant. The judicious supple- 
mentation of these simple measures with roentgen therapy helps to abort or 
localize many of the more threatening or stubborn infections. In truly dif- 
ficult cases, antibiotics or chemotherapy are, of course, needed. But even 
in these cases the use of radiation can reduce the total amount of drugs or 
antibiotics given. 

Exact comparison of results cannot be made, but the clinical convic- 
tion is overwhelming — a gentle prodding of the body's defense mechanism 
with small doses of roentgen rays is effective. Properly carried out, the 
procedure is safe and is a more conservative measure than use of chemo- 
therapy or antibiotics, 

Tuberculous Cervical Lymphadenitis . To a greater degree than most 
other infections against which irradiation at one time was a major defense, 
tuberculous cervical lymphadenitis is handled successfully by drugs. Many 
open cavity cases of pulmonary tuberculosis become drug resistant, but few 
cases of tuberculous cervical lymphadenitis do. That the drug resistant cases 
are few does not decrease the value of roentgen therapy in those instances. 

Chronic Sinusitis; Chronic Lymphoid Folliculitis and Hyperplasia . 
Because of desirability of avoiding radiation exposure in children and the 



12 Medical News Letter Vol. 35, No. 8 



efficiency of chemotherapy and antibiotics, roentgen therapy of acute infec- 
tions in the upper respiratory tract usually is not recommended. However, 
with increasing bacterial resistance, chronic infections in this region occur 
more frequently and need to be considered. Chronic sinusitis and chronic 
lymphoid folliculitis and hyperplasia are not easily managed; failure to 
correct them naay lead to deafness, asthma, and bronchiectasis. Roentgen 
therapy may give relief which will help the child get through a difficult per- 
iod of growth and development without permanent disability. Use in adults 
has minimal attendant hazard and frequently is of considerable benefit. 

Acute and Subacute Nonsuppurative Thyroiditis . The inflammatory 
reaction in some cases of thyroiditis may be an expression of immunity res- 
ponse to antibodies of thyroglobulin produced when it escapes from injured 
acini. When other measures — including antithyroid drugs and steroids — are 
not promptly effective and their withdrawal is followed by relapse, irradia- 
tion should be used. The nnechanisni of its action in this condition is unknown, 
but its effectiveness has been thoroughly docunaented. 

As there is a possibility that small amounts of radiation over the thryoid 
in infancy and childhood may increase the incidence rate of carcinoma of that 
gland, radiation treatment of thyroiditis in the very young should be restricted. 
On the other hand, benefits of wise use of small doses of irradiation for thy- 
roiditis in adults far exceeds the somatic hazard. 

Warts . Of paranaount importance is close cooperation between the der- 
matologist and radiologist. Neither one alone can acconnplish as nnuch as 
when working together. The treatment of nnosaic warts is an example — 
irradiation makes the mosaic wart more amenable to subsequent treatment 
by the dernaatologist- 

It is recommended that irradiation be used as the initial form of therapy 
in subungual warts only. In others, medical measures are first given an ade- 
quate, but not unduly prolonged, trial. If the wart persists, radiation therapy 
is administered. If it still persists, the verruca is usually smaller and more 
superficial and can be treated medically again with greater hope of success. 

Because of the greater susceptibility of youthful tissues to radiation 
injury, the younger the child, the more determined should be the medical effort 
to cure the lesion. 

Herpes Zoster . Irradiation of involved posterior root ganglions often 
relieves the pain associated with herpes zoster. Possible causes for unnec- 
cessary failure are: (1) undue attention to skin lesions; (2) inadequate pen- 
etration of radiation; (3) insufficient number of treatments; (4) irradiation of 
too short a length of the cord — at least two segments above and below the sus- 
pected nerve roots should be included in the field. 

Subacromial Bursitis . Symptoms of this condition requiring medical 
attention are usually encountered in the middle aged and elderly. Therefore, 
concern about hazards is a minor factor in deciding whether to use radiation. 
Irradiation has the greatest chance of success when the clinical diagnosis can 



22 April I960 Medical News Letter 13 



be confirmed by demonstration of calcification in the roentgenogram and when 
synnptoms are of brief duration. The effect is due, presumably, to absorp- 
tion of inflamnnatory elements with consequent relief from tension followed 
by healing. The longer the symptoms have been present, the greater will be 
the irreversible tissue damage. 

In connparing results produced by different methods of treatment, it is 
important to know which treatment was used first. As most of the acute 
episodes will respond to the initial form of therapy, it is easy to misinterpret 
statistics. In a case in which the first method of therapy has failed, relief 
from any type of therapy is apt to be slow. 

Tinea Capitis . Patients with this condition are usually school children, 
too young for irradiation of a benign condition to be undertaken lightly. Never- 
theless, when other therapy fails, radiation epilation must be done. A new 
antibiotic, griseofulvin, may relieve the radiologist of this unpleasant necessity. 

Benign Skin Disorders . New forms of topical therapy, steroids, and 
chemotherapeutic agents are meeting most needs in these areas, which include 
acne, and pruritus ani and vulvae. If a patient suffering from one of these con- 
ditions cannot be relieved by these means, he presents an unusual problem 
and it is not likely that adjunctive roentgen therapy can solve it. 

Summary . Advances in drug therapy have eliminated roentgen therapy 
in some benign conditions and sharply reduced it in others. However, it still 
occupies an important place in this field and its usefulness in some conditions 
is increasing. With greater understanding of radiation hazards by the radiol- 
ogist, indicated roentgen therapy for benign conditions can be adm.inistered 
without significant danger. (G. Cooper Jr. , Radiation Therapy of Benign 
Conditions; Am. J. Roentgenol. , 83_: 538-550, March I960) 

^ iii ^< i^ 1^ i^ 

Respect the Skin 

We are hearing and reading a good deal about postoperative infections 
and the various possible sources of contamination. It is important that we 
continue to critically review our techniques, habits, and beliefs so as to 
reduce the likelihood of such complications with their increased morbidity 
and mortality. The surgeon should be most critical of his own techniques 
and those of his associates. We must practice and teach respect for the 
skin. The skin is a wonderful creation that is a protective, defensive cover- 
ing aiding in the temperature control of the body and in excretions. If treated 
and handled gently its defensive and reparative mechanism.s will respond, 
giving good results. 

The surface and crypts of the skin may harbor microorganisms dan- 
gerous to the host and to others contacted. Thorough cleansing of the hands 
before examining patients or changing dressings is elementary but too often 
disregarded. 



14 Medical News Letter Vol. 35, No. 8 



The hands of all attending the sick may be the greatest hazard the patient 
encounters in the hospital. 

Subcutaneous, intramuscular, and intravenous injections are impor- 
tant avenues of drug and fluid administration. Disastrous infections have 
occurred and may occur if preparation of the skin of the recipient and 
administrator are neglected prior to injection. Each injection carries a 
risk. Too many indicated and unnecessary injectio-ns are badly given. 

In the operating room, cleansing of the hands of the surgical team 
and the operative area, even though routine, must be well done. When well 
cleaned, the skin is only clean, never sterile. The skin of the operative area 
should not be handled and palpated unless the operator plans to change his 
gloves before entering the deeper layers or body cavities. The skin edges 
of the wound and the exposed clean surface must be well covered throughout 
the surgical procedure and the edges again exposed at the time the skin is 
closed. When carefully protected, the sutures and ligatures will not drag 
along the exposed skin edges and carry organisms into the depths of the 
wound, nor will the operator continually be handling potentially contaminated 
instruments that are allowed to rest on exposed skin. 

Fine ligatures and sutures are of excellent quality today, and their use 
greatly aids in lessening the amount of foreign material left in the wound. 
The skin edges approximated accurately without constriction or strangulation, 
with the aid of fine suture nnaterial, will give excellent results and minimal 
cause for wound infections. Heavy suture material for the skin should be of 
historic interest only. 

Antibiotics and chemotherapy are great aids when needed, but should 
never replace the confidence developed in fundamental surgical principles. 
Respecting the skin is basic whether the patient's condition is nnedical or 
surgical, and the surgeon particularly should practice and teach it. 
(E.H. Fell, Respect the Skin, Editorial: Am. J. Surg. ,_99: Z65, March I960) 

****** 
Indications for Preoperative Transfusions 

The preoperative transfusion of blood has been asserted to be bene- 
ficial when the patient to be operated on has cancer or is cachectic. This 
assertion was based on the discovery that the cachectic person usually had 
a blood volume significantly smaller than that which it was estimated he 
had when in good health. 

Studies have shown that the starved person possesses a blood volume 
relative to body weight that is equal to, or proportionately greater, than 
that which he had before the weight was lost. However, the mass of red 
cells in the circulation of the starving individual falls roughly in proportion 
to the loss of weight. 



22 April I960 Medical News Letter 15 



There are some who have recommended the transfusion of plasma 
to the malnourished patient before an operation because it was presumed 
that he suffered from a plasma protein deficit. This attitude was based on 
the findings that the concentrations of protein in the plasma of the inalnour- 
ished sick person were often below those characteristic of the plasma of 
persons in good health. 

To date, all evidence indicates that upon comparing the blood volumes 
and total circulating plasma proteins of the malnourished ill person with 
the blood volumes and total circulating proteins of normal lean individuals 
of similar stature, the malnourished ill person is usually found to possess 
per unit of body mass a blood volume slightly larger and a plasma protein 
mass at least equal to these parameters in the normal lean person. 

These observations have distinct clinical significance. The belief 
that the malnourished sick person suffers from chronic oligemic shock 
must be abandoned. The transfusion of blood and transfusion of plasma to 
correct theoretical deficits in red cell and plasma protein masses in the 
malnourished sick patient are unwarranted unless a deficit of the red cells 
or circulating protein relative to body weight exists. The only way to deter- 
mine surely the need for transfusing blood or plasma preoperatively into 
persons who have not lost blood is to measure the total red cell volume and 
plasma volume with methods that are accurate. 

The moderate reduction of concentrations of hemoglobin and red cells 
that often accompanies cachexia in persons who do not lose blood does not 
constitute an anemia; the red cell volumes of these patients usually still 
bear the same relationship to the individuals' nonedematous weights that are 
observed in lean or norm.al persons. The hemoglobin values and red cell 
counts are usually low because the cachectic person's plasma volume per unit 
of body mass is larger than in a well-nourished person. The cachectic person 
should not be looked upon as being anemic so long as his red cell mass bears 
the same relationship to a unit of his weight as does that of a well -nourished 
person. On the other hand, cachectic persons may have a true anemia with 
reduced red cell volumes but normal total blood volumes relative to body 
weight. 

The decrease in circulation time which accompanies an anemia is 
indicative of the comipensatory changes in the circulation which provide for 
maintenance of a constant supply of oxygen to the tissues in the face of a 
reduced carrying capacity of the blood. Thus, the effect of an anemia will 
depend on the circulatory reserve of the individual. It will also depend on 
the varying needs of the tissues for oxygen; the effect, if any, of surgical 
operations on this factor is unknown. If there is no increase in the rate of 
oxygen consumption during operation over that of the resting state, an already 
tolerable anemia need not be corrected. 

Troubles associated with the transfusion of blood are rather protean, 
and the authors believe that malnourished patients may be particularly 



16 Medical News Letter Vol. 35, No. 8 



susceptible to transfusional circulatory overloading. In these patients, the 
biologic response to transfusion of whole blood is determined by the ability 
of the organism to eliminate from the circulating fluids the plasnna and 
plasma protein portion of the infusion while retaining the red cells. For- 
tunately, the truly anemic individual is, with but few exceptions, capable of 
making these adjustments. However, at tinnes, in individuals having blood 
volumes of 100 ml. /Kg. or more, peripheral edenna, or incipient cardiac 
failure, transfusion of blood is attended by acute pulmonary edenna and death. 
In these patients, administration of packed red blood cells might be naore 
appropriate. 

Other reasons given for transfusing the cachectic patient are: 

(1) "Give him a transfusion to pick him up a bit. " Are cachectic 
individuals who die following transfusions "picked up?" 

(2) "He hasn't been eating — give him some blood, it's superb food. " 
The caloric equivalent of the proteins, fat, and carbohydrate in a liter of 
blood is about 900 calories. 

(3) "His hennoglobin is low — give him a transfusion so that his wound 
will heal. " No basis exists for this concept. 

(4) "He is starved and won't stand the operation well. I won't operate 
on him until he has been transfused. " This concept also has been disproved. 

So far as extant evidence goes, the answer to the question, "When 
should transfusions of blood be given to cachectic persons preoperatively? " 
ia in no way different from that pertaining to the case of the well -nourished. 
Give him blood preoperatively: (1) during, or after, acute loss of blood which 
has been sufficient to produce physiologically significant oligemia; (2) vhen 
there exists an oligemic anemia. (J. C. Peden Jr. , et al, , A Consideration of 
Indications for Preoperative Transfusions Based on Analysis of Blood Volunnes 
and Circulating Proteins in Normal and Malnourished Patients With and Without 
Cancer: Ann. Surg., 1^: 303-318, March I960) 

# sjt ijc ^ :jc !{c 

BUMED NOTICE 6 1 50 28 March I960 

Subj: Standardization of Department of Defense Prescription Form 
(DD Form 1289) 

This directive provides that officers of the Medical and Dental Corps and 
civilian physicians employed by the Navy shall use DD Fornn 1289 for all 
official prescriptions when stocks of NavMed 148 forms are exhausted. 

****** 

Use of funds for printing this publication has been approved by the 
Director of the Bureau of the Budget (19 June 1961). 



22 April I960 Medical News Letter 17 



Captain Barr Receives Certificate 
of Exceptional Service 

A Bureau of Medicine and Surgery Certificate of Exceptional Service 
was presented to Captain Norman L. Barr MC USN (Ret) on 28 March I960 
during ceremonies in the office of the Surgeon General of the Navy, Rear 
Admiral Bartholomew W. Hogan. 

Admiral Hogan presented the Certificate in recognition of research 
work accomplished by Captain Barr during his naval career. A former 
Director of the Bureau of Medicine and Surgery's Astronautical Division, 
Captain Barr retired from the Navy on 1 September 1959 following more 
than 21 years of active service. 

The citation on the Certificate states: 

"For his brilliant research which has enhanced the readiness and 
competence of the naval services in Fleet Defense and its medical- 
aeronautical and astronautical operations. 

An indefatigable and purposeful worker, he succeeded, through his 
researches, in increasing significantly the capabilities of pilots and 
crews to perform their function of protecting the Fleet. He developed 
systems, now in use by the Navy, for simulated instrument-flying con- 
ditions in instrument -training aircraft cockpits. He was the first to 
determine and explain the need for artificial lights in aircraft cockpits 
for high-altitude daylight flight. He was also the first to measure and 
report the important effects of atmospheric brightness on the visibility 
of cockpit instruments. He designed instruments to compute visibility 
range and to measure physical variabilities influencing visibility. He 
perfected a system for reducing the hazards due to the blinding effects 
of glare from aircraft searchlights during night attacks. He devised 
systems for gathering and automatically recording physiological data 
from airborne pilots, and frona. animal and human occupants of earth- 
orbiting vehicles, transmitting it to the ground by radio and relaying 
it to a central laboratory by radio and telephone from any part of the 
world. 

In recognition of these extraordinary achievements, as well as for 
numerous other significant contributions to aviation medicine, the 
Bureau of Medicine and Surgery, with pleasure and justifiable pride, 
awards him this Certificate of Exceptional Service for his truly out- 
standing career in the service of his- country. " (TIO, BuMed) 

A A s it ^ j9c ^ 



18 Medical News Letter Vol. 35, No. 8 



ACP Postgraduate Course 
Early Detection and Prevention of Disease 

A postgraduate course — Early Detection and Prevention of Disease — 
sponsored by the American College of Physicians, is to be presented by 
the Department of Public Health and Preventive Medicine, University of 
Pennsylvania School of Medicine, Philadelphia, Pa. ,9-13 May I960. 

The course will present a critical evaluation of possibilities and 
techniques for diagnosis of disease at an early stage and prevention of 
disease where prevention is possible. Special emphasis will be placed 
upon the detection of disease before the development of readily recognized 
signs and symptonns. The course will include an up-to-date review of the 
practical experience of clinics and individuals who have been actively en- 
gaged in efforts to detect asymptomatic disease and to prevent its progre.aS 
and complications. Consideration will be given to established methods; to 
procedures which may still be considered experimental; and to frank and 
objective appraisal of the values of methods and procedures. 

Applications are desired from eligible Medical officers who meet 
criteria as outlined in BuMed Instruction 1520. 8 and are currently assigned 
to duty in the Middle Atlantic States. Application should be made to the Chief, 
Bureau of Medicine and Surgery via chain of command. Tuition fees will be 
paid by the Bureau and travel and perdiem orders issued for attendance of 
approved candidates. 



Recent Research Reports 

U.S. Naval Medical Research Institute, NNMC, Bethesda, Md . 

1. The Hydrogen Ion Titration Curve of a Polynucleotide Capable of Under- 
going a Helix-Coil Transition. NM 02 01 00. 01. 11, 14 August 1959. 

2. Changes in Growth of Trypanosoma Lewisi After Multiple Transfer in 
Normal and Calorically-Restricted Heterologous Mouse Hosts, NM 52 
02 00.01.07, 11 September 1959. 

3. The Heterologous Host as a Research Tool in Nutrition Studies on Para- 
sitic Protozoa. Lecture and Review Series No. 59-4, 11 September 1959- 

4. Growth of the Rat Trypanosome During 220 Serial Passages in Adequately 
Fed Mice. NM 52.02 00. 1. 06, 1 1 September 1959- 

5. Growth of the Rat Trypanosome During 300 Serial Passages in Calorically 
Restricted Mice, NM 52 02 00.01.05, H September 1959. 

6. Kinetics of the System a-Chymotrypsin Methyl Hippurate Water Hydroxyi- 
amine: The Role of "Water in Enzymatic Hydrolysis. NM 01 01 00. 02. 10, 

8 October 1959. 



Z% April I960 Medical News Letter 19 



7. Survival of Spermatozoa Following Drying. NM 71 01 00. 07. 04, 13 Oct- 
ber 1959. 

8. Cholesterol Biosynthesis in Bullfrog Sciatic Nerve. Report No. 15. 

II. Concentration Dependence of C^-Unit Incorporation. MR005. 06-0010. 01, 
Report No. 15, 23 October 1959- 

9. Some Toxicological Properties of a New Series of Aryl Ethers Derived 
from Trans-2-Aminocyclohexanol. Report No. 16. MR005. 06-0010. 01, 
23 October 1959- 

10. An Enzymatic Examination of the Structure of the Collagen Macromole- 
cule. MR005. 08-0001. 02. Report No. 11, 6 November 1959- 

11. Studies with Drug -Resistant Strains of Psittacosis Virus. I. Comparison 
of Four Strains Used In Mixed Cultures. MR005. 09-1200.03, Report No.l, 

16 November 1959. 

12. Further Studies of Small Vessel Anastomosis and Replacement in the Dog. 
I. Plastic Prostheses, II. An Unidentified Host Variable Affecting Results. 
MR005. 02-0006. 02, Report No. 1, 20 November 1959. 

13. Localized Cytomegalic Inclusion Disease of Lacrimal Glands in the NMRI-D 
Strain Caries Susceptible Rat. MR005. 12-5000.01, Report No. 7, 4 Dec- 
ember 1959. 

U.S. Naval Medical Research Laboratory, U.S. Naval Submarine Base , 
New London, Conn . 

1. * An Exploratory Study of the Relationship of Autonomic Resiliency to 

Manifest Anxiety and Selected Personality Traits. Report No. 307, 
NM 23 02 20.01.05, March 1959. 

2. The Personal Inventory Barom.eter (PIB). 11. Obverse Factor Analysis 
with PIB Items as a Validating Technique with Submarine School Criteria. 
Report No. 2, Subtask No. 1, NM 23 02 20, 6 May 1959. 

3. Mechanisms in Development of Interstitial Emphysema and Air Embolism 
on Decompression from Depth. Report No. 300, NM 24 02 20. 02, 01, 

20 July 1959. 

4. *The Loudness Difference Limen for Tones in Noise. Report No. 314, 

NM 22 01 20. 02. 01, August 1959. 

5. The Relationship of Tattoos to Personal Adjustment Among Enlisted 
Submarine School Volunteers. Report No. 319, NM 23 02 20. 01. 07, 

17 September 1959- 

6. Dental Observations Made While Wintering in Antarctica in 1956 - 1957. 
Report No. 302. NM 24 01 20. 06. 01, 15 October 1959- 

7. *Approaches to the Study of Motivation of Officer Candidates for the 

Submarine Service. Report No. 321, MR005. 14-2100. 02. 02, 16 October 
1959. 

8. How Red Is Red? Report No. 303. NM 22 01 20.01.07, 18 October 1959. 

9. Comparison of High Acuity Scores on Snellen and Ortho-Rater Tests. 
NM 23 01 20. 04. 01, 20 October 1959. 



ZO Medical News Letter Vol. 35, No. 8 



10.*BibHography of Sensory Deprivation, Isolation, and Confinement. 
MR005. 14-2100.03.04, January I960. 

11. Memorandum Report 60-2: Recommendations for Minimal Red Light 
Levels on Board Submarines. NM005. 14-1100. 01. 06, 14 January I960. 

12. Multiple Checkerboard Acuity Tester. Memorandum Report 60-3. 
MR005. 14-2001. 03. 03, 19 January I960. 

13. Auditory Fatigue Following High Frequency Pulse Trains. Report No. 306, 
NM 22 03 20. 02. 01, 21 January I960. 

14. Underwater Visual Communication. Memorandum Report 60-5. MR005. 14- 
1001.01.11, 16 February I960. 

* Items indicated above were inadvertently listed under Reports from Medical 
Research Unit No. 3, Cairo, Egypt in the Medical News Letter of 19 February 
1959, Vol. 35, No. 4. 

U.S. Naval Radiological Defense Laboratory, San Francisco 24, Calif . 

1. The Estinnation of the Non-Recuperable Injury Caused by Ionizing Radiation. 
USNRDL-TR-226, 18 April 1958. 

2. Studies on Transfer of Antibody Formation by Iso-and Hetero-Transplants. 
USNRDL-TR-297, 9 February 1959. 

3. Lethal Graft Versus Host Reaction Induced in X-Irradiated Fj Hybrids by 
Parental Strain Leukocytes. USNRDL-TR-296, 10 February 1959. 

4. Gastrointestinal Function During Exposure to X-Rays. USNRDL-TR-299, 
18 February 1959 

5. The Relation of the Metabolism of Sulfobromophthalein Sodium to Its Blood 
Clearance in the Rat. USNRDL-TR-298, 18 February 1959- 

6. . Liver Function in Regenerating Rat Liver. CrP04 Colloid Uptake and Bile 

Flow. USNRDL-TR-320, 15 April 1959. 

7. Inhibition of DNA Synthesis by Sodium Ions. USNRDL-TR-319, 12 May 1959. 

8. Studies on the Mechanism of Secondary Disease: The Parental-Fj Hybrid 
Radiation Chimera. USNRDL-TR-324, 13 May 1959- 

9. Antigenic Stimuli for Trans plantation Imnnunity to Rat Bone Marrow Hetero- 
grafts in Lethally X-Irradiated Mice. USNRDL-TR-254, 7 July 1959. 

10. Some Factors Which Influence Radiation Conditioned Avoidance Behavior 
in Rats. USNRDL-TR-345, 28 July 1959. 

11. Conditioned Avoidance Behavior Induced by Low Dose Neutron Exposure. 
USNRDL-TR-345, 28 July 1959- 

12. Radiation Induced Conditioned Avoidance Behavior in Rats, Mice, and Cats. 
USNRDL-TR-351, 28 July 1959. 

13. Influence of Diet Fat on Post-Irradiation Growth and Food Utilization in 
the Rat. USNRDL-TR-351, 13 August 1959. 

14. Acceptance of Rat and Mouse Lung Grafts by Radiation Chimeras. USNRDL- 
TR-376, 12 October 1959. 

^ Sfc ^ i^ 3JC )|C 



22 April 1960 Medical News Letter 21 



From the Note Book 

The Surgeon General Attends SHAPE Meetings . The Surgeon General of 
the Navy, RADM Bartholomew W. Hogan, attended the Medical Conference 
of the Surgeons General of the NATO countries at SHAPE Headquarters in 
Paris, France, 6-8 April I960. Following the conference, ADM Hogan 
visited several naval medical activities in the European area, and at the 
invitation of the Surgeon General of the Army, visited U. S. Army Hospitals 
in Germany and Italy where Navy patients were hospitalized. 

Three Navy physicians specializing in submarine medicine — CAPT 
Gerald J. Duffner, LCDR John H. Ebersole, and LCDR Richard T. Arnest — 
accompanied ADM Hogan to the conference for the Navy presentation, ''Med- 
ical and Health Problems Associated with Nuclear Submarine Operations. " 
(TIO, B'Jvied) 

Command Changes at NNMC . In ceremonies at the National Naval Medical 
Center, Bethesda, Md. , 31 March I960, RADM Bruce E. Bradley MC USN 
relinquished command of the Center and terminated thirty-three and one- 
half years of active duty. ADM Bradley will become Medical Director of the 
Bankers Trust Company, New York City, and will reside in Tenafly, N.J. 
RADM Frank P. Kreuz Jr. MC USN, formerly Deputy Commanding Officer 
of the Center, and Commanding Officer of the Hospital at the Center, has 
assumed the vacated command. CAPT Robert B, Brown MC USN, Chief 
of Surgery at the Hospital since 1951, stepped up to become Commanding 
Officer of the Hospital. 

Project RAM Field Trip . On 23 March, a research team began a 22 -day 
field trip to visit eleven laboratories and contractor facilities for on-the- 
spot review of the uses to which Project RAM (Research Aviation Medicine) 
could be utilized in research on a cooperative basis. These included var- 
ious Naval laboratories and National Aeronautics and Space Administration 
facilities. Since its beginning in 1947, Project RAM, under the sponsorship 
of the Office of Naval Research and the Naval Medical Research Institute, 
has developed systems of medical instrumentation and air-to-ground tele- 
metering. With the development of the present astronautic and satellite 
research programs, the experience gained over the past 13 years is expect- 
ed to assist greatly in the instrumentation phases of research programs 
being planned or already under way. (TIO, BuMed) 

Blood Donations to Turkey . In conjunction with medical personnel of the 
Red Crescent — the Turkish Government directed agency which is the coun- 
terpart of the American Red Cross — the Medical Department of the USS 
FORRESTAL (CVA-59), under the direction of CDR R. E. Luehrs MC USN, 
recently organized and assisted in collecting 204 pints of blood from donors 



22 Medical News Letter Vol. 35, No. 8 



aboard the carrier as she lay at anchor in the Bosporus at Istanbul) Turkey. 
This contribution, bolstering the reserve of the one-year old Turkish Blood 
Bank, utilized only a fraction of the potential donors of the ship — 4200 officers 
and men, all catalogued as to standard and Rh factor type. 

Cold Weather Medicine and Injury . The Surgeon General of the Navy encour- 
ages submission to the Editor-in-Chief of ALASKA MEDICINE reports in the 
general field of cold weather medicine with special reference to research and 
clinical management of cold injury. This journal, published quarterly, is 
edited by William J. Mills Jr. , a Reserve Medical officer who is conducting 
clinical and laboratory studies on cold weather injury under an ONR contract. 
Studies on rapid rewarming with parallel studies on enzynne responses in 
relation to recovery are of special interest. Dr. Mills expects to devote one 
or more pages of each issue of the journal to Navy medicine. Manuscripts, 
addressed to 742 K Street, Anchorage, Alaska, should be typewritten, double- 
spaced — preferably in duplicate — with all tables and illustrations accompanied 
by brief legends. 

Berry Plan Surplus . For the first time since its inception about 5 years ago, 
the Berry program will produce a surplus of physicians for the Armed Forces 
this summer. Notices have been sent to 105 residents who expected to start 
active duty this year that billets are not available for them in their specialties 
and uniforms of choice. The number represents about 12% of the I960 "grad- 
uating" group. The Army and Navy are still short in some specialties while 
fully staffed in others. (Washington Report of the Medical Sciences, April 4, 
1960) 

Association of Military Surgeons . RADM Richard A. Kern MC USNR (Ret), 
President of the Association, announces the 67th annual convention at the 
Hotel Mayflower, Washington, D. C , 31 October to 2 November I960. 
The theme of the convention will be "The Military Role in Medical Progress. " 
RADM Curtiss W. Schantz DC USN, Assistant Chief of the Bureau of Med- 
icine and Surgery (Dentistry), has been apointed as General Chairman. 
CAPT Clifford P. Phoebus MC USN, Director, Astronautical Division of the 
Bureau, will be Chairman of the Scientific Program Committee. 

Psychologic Aspect of Thyrotoxicosis . Heretofore, the role of the personality 
in thyrotoxicosis has been stressed, and frustration of needs has been pro- 
posed as the predisposing factor in the onset of the disease. The authors con- 
clude that this factor has been overstressed, and that thyrotoxicosis is a 
metabolic disease nnanifested by impaired psychobiologic integration in- 
volving particularly the autonomic system. The adequately treated thyrotoxic 
patient closely resembles the normal person. (L. Robbins, D. Vinson, 
J. Clin. Endocrinol. , January I960) 



22 April I960 Medical News Letter 23 



New Dimensions of Submarine Medicine . This interesting report covers the 
significant environmental factors encountered in the first years of nuclear - 
submarine operation. The details of a 60 -day total submergence patrol are 
presented. (LCDR John H. Ebersole MC USN, New' England J. Med. , 
March 24, I960) 

Bacterial Endocarditis . In the January A. M. A. Arch. Int. Med., a sum- 
mary of experiences at the Johns Hopkins Hospital since 1945 in manage- 
ment of patients with bacterial endocarditis is presented by Philip A. Tumulty. 
A vigorous program of therapy is recommended — a program of management 
likely to cure the largest number of patients because "it may well be necessary 
to overtreat several in order to avoid undertreating a few. " 

" Second-Look" Surgery . This term has been used to designate operations 
which are performed upon asymptomatic individuals without clinical evidence 
of residual tumor 6 to 9 months after the primary resection of the lymph 
node-positive cancer. The authors present the case of adrenocortical car- 
cinoma which was negative at the time of the "second look. " However, approx- 
imately 2 years later the patient returned with an inoperable recurrence in the 
retroperitoneal tissue and liver. (LT Y. Jacobson MC USN, CAPT J. Richardson 
MC USN, Surgery, March I960) 

Lymphomas . The January Annals of Internal Medicine presents a combined 
clinic on lymphomas from the College of Physicians and Surgeons, Columbia 
University. Some phases of basic study which provide an understanding for 
methods of therapeutic approach are presented. 

Acute Diabetic Episode with Remission . An unusixal case of a 39 -year old 
patient is reported with remission occurring following an acute episode of 
diabetic acidosis and coma. After several weeks of insulin therapy, the 
patient remains aglycosuric on diet regulation alone. A standard 5 -hour 
glucose tolerance test is normal; the test following cortisone reveals latent 
diabetes. (LT R. Barr MC USNR, J, Clin. Endocrinol. , March I960) 

Urinary Tract Infections . Based on observations of effects of treatment with 
sulfadlmethoxine of 65 patients with urinary tract infections, the authors con- 
clude that the drug constitutes a valuable and safe chemotherapeutic agent for 
treatment. All patients received 0. 5 gm. twice a day for 3 days followed 
by 1. gm. daily for 7 days for acute cases, and 1. gm. daily for 20 days 
in chronic infections. (J. Faulkner, A. Morrison, J. Urol. , February I960) 

Treatment of Angina Pectoris . A new sustained-action capsule form of penta- 
erythritol tetranitrate (Duotrate) enabled 76% of patients observed to reduce 
their intake of nitroglycerine by at least one -third, or to eliminate- it completely. 
Side reactions were few and negligible. (M. Plotz, Am. J. Med. Sci. , Feb. I960) 



24 Medical News Letter Vol. 35, No. 8 



Xanthines in Angina Pectoris . The author considers that recent observa- 
tions do not confirm that xanthines increase cardiac work proportionately 
more than coronary flow. A hydro -alcoholic solution of theophylline, ad- 
ministered orally, was shown to be effective in controlling symptoms and 
in modifying electrocardiographic response to standard exercise, because 
of rapid absorption. The author proposes that xanthine derivatives, both 
for IV and oral use, should be reinstated as valtiable agents in treatment of 
angina pectoris and other coronary disease states. (H. Russek, Am. J. 
Med. Sci. , February I960) 

Myocardial Revascxilarization . Searching for a substance to stimulate aug- 
nnented circulation to the myocardium from the pericardium, the authors 
employed thin sheets of Ivalon sponge. Fourteen patients have undergone 
surgery with implantation of the sponge and all have shown encouraging 
improvement. An incidental observation, when making preliminary studies 
with animals, showed the development of vascular spaces in the myocardium 
which connected with the coronary arteries on one side and the ventricular 
lumen on the other — arterio -luminal vessels. (A. Vineberg, et al. .Surgery, 
February I960) 

Smoking and Peripheral Circulation . As a result of studies at the Mayo 
Clinic and Foundation, it is indicated that in the normal person tolerance 
does not develop to tobacco so far as vascular effects are concerned; the 
blood pressure and pulse rate increase and the skin temperature of the 
extremities decreases on smoking tobacco; nicotine appears to the the most 
important factor, and alcohol does not nullify the effect. The authors con- 
sider that the evidence that smoking plays a role in progression of peri- 
pheral vascular disease is no longer controversial. (G. Roth, R. Shick, 
Dis. Chest, February I960) 

The Gastric Antrum . The Surgery section of the February American 
Journal of the Medical Sciences presents a comprehensive review of the 
gastric antrum and its physiology. The least understood area of the stonn- 
ach, the antrum is considered by some to hold the key to the surgical 
approach of ulcer in the future. 

Amphotericin in Histoplasmosis . Reporting use of Amphotericin in 30 
patients, the conclusion is that the drug is effective but is primarily sup- 
pressive. In view of the toxic effects, purification and isolation of the active 
principle is indicated. This indicates a need for further study and develop- 
ment of other antifungal agents which can be used in conjunction with Ampho- 
tericin, in addition to study of other methods of administration of the drug. 
(J. Yates, etal. ,Dis. Chest, February I960) 

# :4c 9): 4: 4= 3{i 



1 
I 



22 April I960 Medical News Letter 25 




RESERVE ^^^ SECTIOIM 



Screening for Officers Not Available 
for Mobilization 

Since 1955, approximately 35,000 Standby Reserve officers have been 
declared not available for mobilization by the Director of Selective Service. 
Under law, they cannot be involuntarily ordered to active duty in the event 
of mobilization. 

Therefore, to insure the availability of Reserve officers, it has become 
necessary to establish a policy for eliminating those officers who could not 
be ordered to active duty in time of war or national emergency. 

The first step in this process will take place in April I960. Standby 
Reserve officers who have been declared not available for active duty will be 
given an opportunity to make themselves available for mobilization. 

Each officer will receive a letter from the Chief of Naval Personnel 
containing a "declaration of availability. " If this declaration is completed 
and returned, the officer may remain in the Standby Reserve — Active, if 
otherwise eligible. The Director of Selective Service will accept this volui^- 
tary agreement. 

Officers who do not state their availability will be transferred to the 
Inactive Status List under the provisions of Article H-3032 l{5)(f), BuPers 
Manual. The transfer will be effective at 2400 on 30 June I960. 

However, an officer who wishes to remain in the Standby Reserve — 
Active, and who is prevented from declaring his availability by extenuating 
circumstances, may request retention by subinitting a letter to the Chief of 
Naval Personnel by 1 June I960. 

Officers who do not wish to declare their availability for mobilization 
may, of course, transfer to the Retired Reserve or resign — if they are 
eligible. 

Officers who are transferred to the Inactive Status List because they 
are not available for mobilization will no longer be able to earn retirement 
credit. Officers who have earned 50 retirement points in fiscal year I960 
will, of course, have that year credited as a year of satisfactory Federal 
service. After 1 July I960, however, officers who are declared not avail- 
able for mobilization will be afforded the opportunity as outlined above, and 
if they are unable to resolve their status shall be transferred to the ISL 
immediately. Thus, they will be unable to attain a year of satisfactory 
Federal service for the year in which they are transferred to the ISL. 



26 Medical News Letter Vol. 35, No. 8 



Officers on the Inactive Status List will be solicited before thay com- 
plete their third year on the ISL; at that time, they will be given an oppor- 
tunity to (1) return to an active status if otherwise eligible and available 
for mobilization; or (2) retire or resign if eligible; or (3) be referred to the 
Naval Reserve Officer Mobilization Disposition Board with the recommenda- 
tion that they be discharged. (The Naval Reservist, March I960) 

5!t jj; ^ ^ st; 3j: 

ANA Convention 

The Biennial Convention of the American Nurses Association will be 
held Z - 6 May I960, Miami Beach, Fla. A military program has been planned 
in conjunction with the professional meeting. Announcement of the time and 
location of the meeting will be made at the Reserve desk on the day of registra- 
tion. A social program for all Navy Nurse Corps officers — active, inactive, 
retired — and friends has been planned for Wednesday, 4 May I960, 5 - 7 p. m. , 
at the Algiers Hotel. 

One retirennent point may be credited to eligible Naval Reserve Nurse 
Corps officers on inactive duty for attendance at selected sessions of at least 
2 hours per day. A maximum of 4 retirement point credits are authorized 
per eligible officer for the period 2-5 May I960. 

****** 

American Board Certifications - 
Inactive Reserve Officers 

American Board of Dermatology 

LT Richard Mihan MC USNR 

Annerican Board of Obstetrics and Gynecology 
LT John N. McNair MC USNR 
CDR Robert L. Stone MC USNR 
LTJG Edgar B. Sylvester MC USNR 

American Board of Orthopedic Surgery 
LT Eugene E. Bleck MC USNR 
LTJG Thomas C, Leinbach MC USNR 
LCDR Ralph Lusskin MC USNR 

American Board of Pathology 

LT Jacob Malin MC USNR 

LT Rene A. Fontaine MC USNR 



22 April 1960 Medical News Letter 27 



American Board of Pediatrics 

LCDR Thomas E. Frothingham MC USNR 
LT Robert L. Nolan MC USNR 
LT Arnold B. Victor MC USNR 

American Board of Psychiatry and Neurology in Neurology 
LT John F. Kurtzke MC USNR 

American Board of Psychiatry and Neurology in Psychiatry 
CDR Joyce Perrin MCW USNR 

American Board of Radiology 

LT Curtis F. Ahrens MC USNR 
LT Walter J. Russell MC USNR 
LT OUie E. Southard MC USNR 

American Board of Surgery 

LT Charles H. Boggs, MC USNR 
CDR Martin Donelson Jr. , MC USNR 
LT Neal A. Goldsmith MC USNR 
LT Andrew L. Karavitis MC USNR 
LCDR Leo E. Robertson MC USNR 

American Board of Surgery and Board of Thoracic Surgery 
LT Thomas F. Boyd MC USNR 
LT Hobart M. Proctor MC USNR 
LT William H. Sewell Jr. , MC USNR 

American Board of Urology 

LCDR John M. Kennelly Jr. MC USNR 
LT Harold J. McLaren Jr. , MC USNR 
CDR Stanley J. Okulicz MC USNR 

sic 4: ^ ^ ^ :!c 



NOTE: In the Medical News Letter, Vol. 35, No. 3 (5 February I960) 
p. 21, the affiliation of CAPT Paul R. Leberman MC USNR with the 
Graduate School of Medicine, University of Pennsylvania, should have been 
identified as Assistant Professor of the Division of Urology. The Chief 
of Urology at the Graduate Hospital of the University of Pennsylvania is 
Dr. Harry M. Burros, 



28 Medical News Letter Vol. 35, No. 8 



AVIATION MEDICINE DIVISION 




High Altitude Balloon Research 
and Development Programs 

The STRATOLAB research and development program employing manned 
balloons was initiated by the Office of Naval Research to meet requirements 
of the U. S. Navy in the field of high altitude research. Carried out in col- 
laboration with the Bureau of Naval Weapons and the Bureau of Medicine and 
Surgery, it supplements the SKYHOOK project which uses unmanned balloon 
flights and provides an opportunity for the conduct of basic research not 
otherwise possible. 

The STRATOLAB program objective is "to provide a laboratory facility 
for observers in the stratosphere to conduct research that cannot be done by 
existing techniques. " The aim is to conduct unique experiments and make 
scientific measurenrtents never before possible at altitudes ranging to 100,000 
feet. The capabilities of human observers, various observational equipment, 
and the high altitude potentialities of the SKYHOOK type plastic balloons are 
combined to provide a stable stratospheric laboratory for studies in astronomy, 
aeronnedicine, aerology, cosmic rays, atmospheric physics, astrophysics, 
geophysics, and. military science. Valuable experience gained from numerous 
SKYHOOK flights contributed to the success of the STRATOLAB program. 

Present day high altitude research aircraft reach altitudes above 100,000 
feet. They remain above 80,000 feet for only brief periods of time, whereas 
the STRATOLAB balloon platform permits the collection of data over a period 
of nnanv hours. 

An official world altitude record for nianned balloon flight was set by 
CAPTs Orvil A. Anderson and Albert W. Stevens of the U.S. Army on 1 1 Nov- 
ember 1935 when Explorer II reached a height of 7Z, 395 feet. Jointly spon- 
sored by the U. S. Army and the National Geographic Society, Explorer II took 
off approximately 11 miles southwest of Rapid City, S, D. , landing approxi- 
mately 12 miles south of White Lake, S. D. 

The Explorer II gondola carried 4 tons of payload and weighed about 
three and one -fourth tons. The balloon had a volume of 3,700,000 cubic feet 
and weighed about 5,000 pounds. In contrast, the STRATOLAB balloon weighs 
less than one -half a ton, lifts a total take-off weight of about one ton and has 
a volume of 800,000 cubic feet. The magnesium gondola of Explorer II was 
9 feet in diameter compared with 7 feet 2 inches for the one -eighth inch thick 
aluminum gondola used in STRATOLAB. 



Z2 April I960 Medical News Letter 29 



HISTORICAL BACKGROUND 

The first plans of the Office of Naval Research for a inanned. balloon 
flight into the upper atmosphere were made in 1946. At that time, it was 
realized that a stable platform from which scientific observations could be 
made was needed to gather information of value in connection with future 
high altitude flight. The basic problem was to find a vehicle capable of 
carrying a payload to sufficient altitude and remaining there long enough to 
make the desired observations. Inherent limitations of planes, rockets, 
and rubber balloons used in high altitude studies precluded their use in 
maintaining observers in the stratosphere for extended periods. 

The initial project, HELIOS, under contract with General Mills, Inc. , 
required the construction of plastic balloons that would make possible 
flight to the stratosphere with a manned gondola equipped with scientific 
instruments. It was anticipated that the balloon-borne gondola would re- 
main at a ceiling of 100,000 feet for about 10 hours and would collect data 
during the entire flight from launch to recovery. 

Among the principals working on the project were Doctor Jean Piccard 
who is now Professor Emeritus of Aeronautical Engineering, University of 
Minnesota; Mr. O. C. Winzen, President of Winzen Research, Inc. ; and 
CDR G. W. Hoover USN, then with the Naval Training Device Center. The 
concept of this system was the use of a thin plastic material which would 
permit a reduction in the weight of the balloon itself to only a fraction of 
the weight of rubberized balloons. It was planned to use a cluster of such 
plastic balloons in order to reach a very high altitude. 

Although the first manned plastic balloon flight operating under ONR 
contract occurred in 1949. plans for manned balloon flights were abandoned 
because the technology of plastic balloon manufacture was not sufficiently 
developed. The studies, however, definitely proved the feasibility of using 
plastic balloons to take scientific instruments to high altitudes and maintain 
them there for periods ranging from a few hours to a day or more. Such 
unmanned flights would provide some of the desired information, but were 
not acceptable as a substitute for manned flights. 

Accordingly, the Office of Naval Research initiated project SKYHOOK 
and the first flight of a SKYHOOK balloon developed by General Mills, Inc. , 
occurred on 25 September 1947. Launched at St. Cloud, Minn. , and carry- 
ing a payload of 63 pounds, it soared to an altitude of more than 100,000 feet 
before descending at Eau Claire, Wis. Since that time more than 1,000 such 
flights have been made from locations within the United States and Canada, 
and from naval vessels in the Atlantic, Pacific, Caribbean, and Northern 
waters. Winzen Research, Inc. began constructing plastic balloons under 
ONR contract for unmanned flights into the stratosphere. The G. T. Schjeldahl 
Company of Northfield, Minn, and Raven Industries of Sioux Falls, S. D. 
also construct plastic balloons for high altitude research. 



30 Medical News Letter Vol. 35, No. 8 



Once the feasibility of using plastic balloons for high altitude research 
was demonstrated, many and varied projects developed. Throughout the 
development of the art of plastic ballooning techniques. General Mills, 
Winzen Research, and the University of Minnesota, all under ONR contract, 
have held leadership in this field. 

Among the SKYHOOK flights and projects which have taken place, the 
following have particular significance: In 1948, the first successful three- 
balloon cluster was launched. In 1949, the first shipboard SKYHOOK launch 
took place from the USS NORTON SOUND. Nearly 300 shipboard launchings 
have occurred since that time. 

Project ROCKOON, which featured small Deacon rockets lifted to about 
70,000 feet and released fronm a SKYHOOK balloon, was held in Arctic waters 
during 1952. 

On 7 Septennber 1956, the University of Minnesota launched a giant 
Mylar plastic balloon developed by the G. T. Schjeldahl Company to set an 
unofficial balloon altitude record of 145,000 feet for unmanned balloons. 

On 18 May 1954, the largest plastic balloon ever built, the super 
SKYHOOK, was launched for the U.S. Navy by General Mills, Inc. , from the 
University of Minnesota airport. It soared to an altitude of 1 17,000 feet. The 
volume of the balloon was more than three million cubic feet and it lifted about 
400 pounds of scientific instruments useful in gathering information on cosmic 
rays. 

In 1957, the U. S. Navy began an operational serology system known as 
TRANSOSONDE (trans -ocean sounding) which consisted of almost daily balloon 
flights across the Pacific Ocean from Japan, On 25 September 1957, the tenth 
anniversary of the first SKYHOOK flight, project STRATOSCOPE used an un- 
manned SKYHOOK balloon to carry a special solar telescope aloft to 81,000 feet 
which obtained the sharpest photographs ever taken of the sun. Recent U. S. Air 
Force projects, such as MAN-HIGH and FARSIDE have also utilized the balloon 
techniques developed for SKYHOOK and other ONR balloon projects. 

The purpose of SKYHOOK flights has been to obtain cosmic ray, meteoro- 
logical, and other geophysical data. Although the Office of Naval Research 
originated Project SKYHOOK, in recent years the cosmic ray studies have been 
supported additionally by the Atomic Energy Commission. 

Project SKYHOOK contracts have stimulated research resulting in impor- 
tant innprovements in the relatively new field of plastic balloon technology and 
the connplex interrelations between the balloon vehicle and the atmosphere. 
Development of plastic balloons, ground-handling equipment and launching 
methods as developed by General Mills, Inc. , Winzen Research, Inc. , and the 
University of Minnesota has reached the stage where the technical capability 
to conduct manned plastic balloon flights into the stratosphere now exists. 

Both Aerojet-General and Douglas Aircraft under ONR contracts have 
analyzed problem^ and determined requirements for high speed, high altitude 
flight. In the aeromedical field, the Aerojet study showed that more informa- 
tion was needed on cosmic radiation, gravity free state, cabin environnient, 



22 April I960 Medical News Letter 31 



man-machine integration, the effects of high altitude on vision, acceleration 
and deceleration, and escape. Needed data on all except the gravity free 
state and acceleration problems may be obtained using the STRATOLAB 
platform. 

Studies have indicated that future aircraft may not be able to operate 
in sustained level flight between the altitudes of 100,000 and 400,000 feet. 
Although the extreme boundary between our atmosphere and space occurs 
at about 600 miles, altitudes below 100,000 feet present many of the impor- 
tant operational and physiological space barriers. STRATOLAB provides 
a research platform through the zone to 100,000 feet which will continue to 
be useful altitudes for operational type military aircraft in the future. As a 
space laboratory it will provide continued opportunities for the study of 
various techniques and experimental equipment for manned flights into space . 

SKYHOOK 60 was conducted from the USS VALLEY FORGE (CVS-45) 
during the period 18-31 January I960 in Caribbean waters. Three balloons 
of 10,000,000 cubic feet each were launched from the carrier deck as well 
as several tracer balloons varying in size from 750,000 to 2,000,000 cubic 
feet. From this series of unmanned balloon launchings, the feasibility and 
desirability of the aircraft carrier as a launching platform for manned bal- 
loons was proved. 

Because of the complexity of the system, personnel from the Office 
of Naval Research, Winzen Research, Inc. , General Mills, Inc. , Office of 
the Chief of Naval Operations, Bureau of Naval Weapons, Bureau of Medicine 
and Surgery, Naval Air Crew Equipment Laboratory, Naval Research Lab- 
oratory, Naval Medical Research Institute, Army Signal and Transportation 
Corps, and the Corps of Engineers Research and Developnaent Laboratories 
may review certain requirements for STRATOLAB experiments. 

THE STRATOLAB PHASE 

The STRATOLAB program was initiated in 1954 when the gondola shell 
originally designed by Jean Pic card and built for Project HELIOS arrived 
at Minneapolis to be fitted out and tested. The first flights under Project 
STRATOLAB were conducted in 1955. These were low-level flights made to 
collect atmospheric data. The following year. Intermediate altitude flights 
were conducted as well as the first high STRATOLAB ascent. 

The STRATOLAB system consists of three categories — low, inter- 
mediate, and stratosphere flights. The open basket system is used for 
scientific observations in low and internnediate altitude flights. The basket 
is not pressurized and, therefore, the maximum altitude is limited to about 
42,000 feet. The gondola used for stratospheric flights is a true "space" 
cabin and is adequate for flights to any altitude. Originally designed for 
Project HELIOS, the gondola was completedandfittedout by Winzen Research, 
Inc. , and General Mills, Inc. It is designed to provide adequate climate. 



32 Medical News Letter Vol. 35, No. 8 



sensing, flight control, safety, and communication equipment. The octagon- 
al floor, 52 inches in diameter, has a total area of approximately 15 square 
feet. It is 9 inches above the floor of the shell. A shelf, 13 and 1/2 inches 
deep and 13 inches from the floor extends around the interior. 

An escape hatch above the center line, or equator, of the gondola pro- 
vides access to the top of the gondola. A second hatch, below the equator, 
provides for emergency escape. The hatches, 23 inches by 27 inches, are 
wide enough to permit exit by a man in a pressurized suit. 

Cabin altitude pressure equivalent to 21,000 feet is nnaintained in the 
gondola during flight. An autonnatic servo maintains the pressure at this 
level by controlling the flow of oxygen. The air conditioning equipment , 
similar to that used in Explorer II, uses liquid gas for the air supply as well 
as for pressure maintenance. For protection against the cold temperatures 
occurring at the tropopause and lower stratosphere balloonists wear Navy 
cold weather clothing developed for use in the Antarctic. Standard Navy 
gaseous and liquid oxygen systems are used. STRATOLAB HIGH #4 utilized 
a closed liquid oxygen system. 

The gondola is suspended from the balloon by a system of nylon v/eb- 
bings which are attached to the gondola. These webbings are also connected 
to an Air Force cargo type nylon parachute which can be used to lower the 
gondola in the event of an emergency. This parachute is attached to the main 
load line of the system. Above the parachute is a standard SKYHOOK termina- 
tion equipment which will permit severing- of the load from the balloon to in- 
itiate parachute descent of the gondola or to release the balloon at the moment 
of ground impact at landing tinne to prevent dragging. Imnnediately above the 
termination line is the SKYHOOK balloon. 

Balloon si«es can be varied according to the upper limit of the altitude 
desired, the nunnber of personnel to be accomnaodated, the weight of the 
scientific instruments, and the planned duration. The largest balloon used 
with this open basket system has measured about 80 feet in diameter. Since 
the vertical distance from the gondola to the top of the balloon is too great 
to use a simple "pull" valve, an electrically controlled valve is used. 

A STRATOLAB flight was made on 10 August 1956 to photograph vapor 
trails made by jet aircraft and to obtain aeromedical data. This was the 
first manned stratospheric balloon flight since Explorer II of 1935, and it was 
the first manned flight ever made into the stratosphere using the new type 
plastic balloon. Observations were made of cirrus cloud particles and aero- 
medical measurements were taken. 

During the sunamer of 1957, valuable observations in cloud physics were 
made in New Mexico during STRATOLAB open basket flights to altitudes of 
26,000 and 29,000 feet in the upper troposphere. Electrical field measure- 
ments were obtained and physiological data was collected. 

A STRATOLAB HIGH #1 flight, launched by General Mills, Inc. , on 
8 Novenaber 1956, reached an altitude of 76,000 feet. On this flight, the 



2Z Aptil I960 Medical News Letter 33 



21 -year old record of Explorer II was broken and an era of almost routine 
very high altitude manned plastic balloon flights became a reality. An ana- 
logy could well be made to the long standing barrier of the four-minute mile. 
In both cases, once the old barrier was shattered, new records have become 
commonplace. 

This flight demonstrated the feasibility of the system and important 
information was obtained. This was the first time that the sky overhead was 
seen as black. Cirrus cloud observations were made, photographs were 
taken of the sky horizon above the troposphere, the full panorama of the 
color variation from horizon to zenith was observed and reported, and the 
fliers were subjects for experiments in aviation medicine which gave val- 
uable results. Numerous scientific experiments were conducted on a suc- 
ceeding flight, STRATOLAB HIGH #2, which went to nearly 86,000 feet. 

The primary purpose of a later flight on 29 July 1958 was to test and 
evaluate the sealed cabin system and serve as an operational and logistic 
rehearsal for a subsequent flight, STRATOLAB HIGH #3, on which it was 
planned to lift a relatively large, externally mounted telescope for use in 
observing the atmosphere of Mars. On this flight, the balloon stayed up 
for 34 hours, a new endurance record for manned balloon flights. 

STRATOLAB HIGH #3 was terminated when the 2,000,000 cubic foot 
plastic balloon failed on the ground prior to take-off. 

STRATOLAB HIGH #4 was launched from Rapid City, S. D. , on 
28 November 1959 and terminated at Manhattan, Kansas. The purpose of 
the flight was to study the planet Venus and take photographs through the 
use of a specially designed 16-inch telescope. 

Chief pilot on the above flights was CDR Malcolm D. Ross USNR, of 
the Office of Naval Research. Copilot for the first three flights was the 
late LCDR M. Lee Lewis USN (Ret), head of the balloon flight operations 
for Winzen Research, Inc. , developer of the gondola and plastic SKYHOOK 
balloon carrying the men aloft. The scientific observer for the STRATOLAB 
HIGH #4 was Charles B. Moore Jr., staff of Arthur D. Little, Inc., 
Cambridge, Mass. 

DESCRIPTION OF SYSTEM 

The polyethylene film for the balloons was first produced in thin gauge 
in 1947. Today polyethylene film and bags have become a household item, 
and a tremendous packaging industry has arisen as one of the results of this 
government sponsored research. 

The rolls of plastic are dispensed onto a balloon table. One edge of 
the table is contoured so that when all segments of the plastic are cut to this 
contour and sealed together the desired balloon shape is developed. Each 
segment is sheared roughly to shape and then cut to final shape, heat sealed, 
and each seam tempered by a specially designed balloon manufacturing machine. 



34 Medical News Letter Vol. 35, No. 8 



The balloon is encased in a plastic tube, and then carefully folded 
accordion fashion into a large box. This method of packaging provides 
protection for the balloon during shipment and storage and facilitates layout 
at launching tinne. 

Lifting gas is introduced into t^ie upper portion of the balloon by means 
of a separate plastic inflation tube or tubes. Other accessories serve safety, 
control, and launching purposes. A valve at the top is used for vertical con- 
trol in flight. 

The balloons constructed by General Mills, Inc. , were tested in a 
hangar at South Weymouth, Mass. Tests were made of the structural proper- 
ties of the balloon, strength of the end assemblies, and the general shape and 
appearance under full volume conditions corresponding to actual flight. One 
balloon was inflated with a properly carbureted mixture of air and helium 
while in the hangar to simulate the actual balloon flight. It was then inflated 
with pure heliuna until it failed, thereby determining the safety factor and 
weakest component. General Mills, Inc. conducted five flights using the 
128 TT balloon in order to evaluate its performance and to determine the 
characteristics of the valve and ballast. During the test program, larger 
balloons of 2,000,000 cubic foot capacity developed by Winzen Research, Inc. , 
were also used. Winzen Research, Inc. conducted three flights with the 
smaller balloon and five flights with the larger balloon. 

MEDICAL MONITORING 

The instrumented aeromedical monitoring equipment used on the 
STRATOLAB flights consists of telemetering equipment developed at the 
Naval Medical Research Institute, Bethesda, Md. Monitoring of the bal- 
loonist's heart and respiratory rates are begun several hours prior to the 
flight. Records of the balloonist 's physiological reactions, including a 
continuous record of heart reactions and respiratory conditions, are trans- 
mitted to medical observers on the ground and in an accompanying aircraft. 

Flat electrode pick-up discs slightly larger than a shirt button are 
held in place on the balloonists by black plastic electric insulating tape. 
Small amplifiers which are about the size of a cigarette box are used. 
A thernnistor connected to a respiratory voltage measuring device is fas- 
tened to each microphone. The electrocardiograph amplifiers and respira- 
tory voltage devices are fed into an FM subcarrier oscillator and to an FM 
transmitter. A transmitter with a range of about 100 miles is used. Without 
batteries, the telemetering system in the gondola weighs approximately 
5 pounds. 

Monitoring equipment is carried in a specially configured R5D type 
aircraft, an ambulance, and a carry-all. These vehicles also track and 
follow the course of the balloon. The equipment in the aircraft includes a 
Clark receiver, AN/UKR-2 telemetry set, and Brush recorder. The 



22 April 1960 Medical News Letter 35 



composite signals are recorded on magnetic tape for future study. The 
signals are fed in parallel to the Brush recorder for instantaneous observa- 
tion during the flight. Constant voice communication is maintained between 
the balloonists and the medical observers. Communications are recorded 
for correlative post flight study. 

Continuous monitoring of the physiological condition of the balloonists 
permits monitors to provide early warning of possible impending danger to 
the safety of the flight and permits termination of the flight if necessary. 

The indoctrination and training in aviation physiology of the balloonist 
and the accompanying scientific investigator are routinely accomplished. 
This includes fitting and indoctrination in the use of the pressure suit and 
other protective personal equipment. This equipment is checked out and 
oxygen indoctrination given in a refrigerated low pressure chamber. Since 
there is no heat in the gondola, indoctrination in the use of cold weather 
equipment is particularly important. 

In addition, research studies on the effects of flights into the strato- 
sphere upon man's physiological system are conducted. Direct assess- 
ments of adrenal cortical activity have been obtained as well as indirect 
measurements through studies of protein metabolism, electrolyte meta- 
bolism, and white blood counts. Restdts of these studies are published 
from the Naval Medical Research Institute. 

Basic biological experiments preliminary to manned space flight are 
conducted. Fruit flies, house flies and fleas have remained at altitudes of 
from 78,000 to 82,000 feet for 16 hours in balloon gondolas, exposed to 
cosmic ray attack 60 times more intense than at sea level. These exper- 
iments have been performed in cooperation with the U. S. Department of 
Agriculture whose scientists examine the genetic makeup of the insects 
and their progeny to determine the chromosome damage resulting from 
cosmic ray bombardment. 

sic * * sj: * sj: 

Policy 



The U. S. Navy Medical News Letter is basically an official Medical 
Department publication inviting the attention of officers of the Medical 
Department of the Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to medicine, dentistry, 
and allied sciences. The amount of information used is only that necessary 
to inform adeqtiately officers of the Medical Department of the existence 
and source of such information. The items used are neither intended to be, 
nor are they, susceptible to use by any officer as a substitute for any item 
or article in its original form. All readers of the News Letter are urged 
to obtain the original of those items of particular interest to the individual. 



36 Medical News Letter Vol. 35, No. 8 




DENTAL tef^m^l SECTIOIM 



Extension Course in Oral Surgery - 
Continuing Education Program 

An extension (correspondence) course. Oral Surgery, NavPers 10729, 
is now available to officers of the Dental Corps of the U. S, Navy and the 
Naval Reserve. 

Developed by the staff of the U. S. Naval Dental School, National 
Naval Medical Center, Bethe^da, Md. , with the assistance of professional 
test writers of the home study department of the University of Chicago, the 
course is comprised of ten assignments covering exodontia; special problems 
in oral surgery; oral, face, and neck infections; cysts of the oral cavity and 
their surgical treatment; salivary gland problenns; surgical treatment of non- 
malignant tumors; complications associated with oral surgery; oral malig- 
nancies and congenital clefts; reduction of mandibular prognathism; fractures 
of the mandible, maxilla, and facial bones; radiographs; pain; oral surgery in 
the hospital; legal aspects of oral surgery; and suggested treatment procedures. 
Included in the course material is a recent edition of a widely accepted text- 
book on oral surgery. The textbook and course outline provide a framework 
of information in oral surgery which the enrollee is encouraged to supplement 
with study of the basic sciences and other topics pertinent to oral surgery. 

This is the fourth in a series of postgraduate extension courses offered 
by the U. S. Naval Dental School to augment the continuing education program 
of the Navy Dental Corps. The courses previously prepared are Prosthodontics, 
Part II, NavPers 10764, (partial denture); Endodontics, NavPers 10407; and 
Oral Diagnosis, NavPers 10739- 

These courses presented by the Department of the Navy are intended to 
provide Navy Dental officers with a balanced educational progrann. They are 
not intended to replace existing postgraduate or graduate courses, residency 
training, or the many other excellent educational experiences now enjoyed by 
officers of the Dental Corps. Rather, they are designed to assist Dental 
officers — especially those at sea and at remote or isolated stations — in pro- 
viding Navy and Marine Corps personnel with the highest possible type of 
dental service. 

Reserve Dental officers may receive promotion and retirement points 
which are credited upon successful completion of course units. 

Units one and two of the Oral Surgery course are comprised of assign- 
ments 1 through 4, and 5 through 8, respectively, and are each evaluated at 



22 April I960 Medical News Letter 37 



twelve points; unit three consists of assignments 9 and 10 and is evaluated 
at six points. 

Applications for enrollment should be submitted on NavPers 992, 
Application for Enrollment in Officer Correspondence Course, via official 
channels to the Commanding Officer (Code 5), U.S. Naval Dental School, 
National Naval Medical Center, Bethesda, Md. 

^ sj; ^ ^ :ic ^ 

Resuscitator 3 in Dental Clinics 

Resuscitators for use in dental clinics have been the subject of con- 
siderable discussion and correspondence in the Defense Department as well 
as outside. After deliberating with specialists in anesthesiology, and con- 
sidering the views of representatives from civilian and military dental 
professional groups, the National Research Council, National Academy of 
Sciences, made the following recommendations on 4 Novennber 1959; 

"1. Dentists in the service clinics should receive periodic refresher 
training in resuscitative measures, 

2. Dental clinics should have a prearranged plan for managing res- 
piratory emergencies. 

3. The use of a mechanical positive pressure or positive-negative 
pressure cycling device in the naanagement of dental respiratory emergencies 
is definitely not recommended. 

4. The simplest pressures, such as bag, mask, and oxygen supply 
should be available. " 

These conclusions represent the opinions of a representative group of 
knowledgeable people and provide appropriate advice and guidance as deemed 
applicable. 

* * * 5}: 3^ J; 

Dental Treatment Prior to Transfer Overseas 

A serious problem develops when personnel in need of dental treatment 
are transferred to remote areas overseas where the services of a dentist are 
not availalbe. As quoted in part from the Manual of the Medical Department, 
Chapter 6-92: "Whenever practicable, personnel who are being transferred 
to stations where the services of a Navy Dental officer are not available 
should receive treatment prior to transfer. " 

■il sfe iSfi ^ ^ S^ 



38 Medical News Letter Vol. 35, No. 8 



Course in Complete Dentures 

A Short Postgraduate Course in Complete Dentures, part of the Navy- 
Dental Corps Continuous Training Program, will be presented at the U. S. 
Naval Dental School, NNMC, Bethesda, Md. , 16-20 May I960. CAPT 
R. B. Lytle DC USN, Diplomate, American Board of Prosthodontics, will 
be the instructor. 

This course will consist of demonstrations and lectures in each phase 
of complete denture construction. Making accurate impressions, recording 
maxillomandibular relationships, occlusal corrections, and characterization 
of denture bases will be emphasized. The physiology of soft tissues will re- 
ceive special attention. 

Quotas have been assigned to the 1st, 3rd, 5th, 6th, and 9th Naval 
Districts, the Potomac River and Severn River Commands, and the Naval 
Air Reserve Training Command. 

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Personnel and Professional Notes 

LT Flrtell Commended . LT David N. Firtell DC USNR was recently com- 
nnended by the Commander, Amphibious Forces, U. S. Pacific Fleet, for 
his outstanding perfornnance of duty while assigned as Dental Officer on 
board the USS GEORGE CLYMER. The commendation read in part: 
"Your interest in the dental health of all personnel of Amphibious Squadron 
Three has been exceptional. You have consistently accomplished a highly 
commendable amount of dental treatnnent of excellent professional standard. 
The initiative you have displayed in coordinating and assisting with the dental 
treatment requirements of personnel of Amphibious Squadron Three has been 
outstanding. " 

New Naval Reserve Dental Company . On I April I960, Naval Reserve Company 
12-9 was activated at the University of California, Third and Parnassus, San 
Francisco, withLCDR Jannes C. Wasley DC USNR as Commanding Officer. 
Membership is composed entirely of Ensigns 1925 attending the College of 
Physicians and Surgeons, University of California. 

FDI Gavel. The gavel to be used by the speaker of the Federation Dentaire 
Internationale in Dublin, Ireland, in June I960, contains sixty separate sec- 
tions of wood representing the various organizations in the Federation. Fifty- 
four of them represent constituent societies of the American Dental Associa- 
tion, five represent the dental departnnents in government services, including 
the U.S. Navy Dental Corps, and one is from the central office of the American 
Dental Association. 



22 April I960 Medical News Letter 39 



Anesthesia Conference at NDS . Problems in administration of general and 
local anesthetics were discussed recently by a panel of dentists and phys- 
icians at a special conference at the U. S. Naval Dental School, NNMC, 
Bethesda, Md. Attended by staff, resident, and postgraduate Dental officers, 
as well as civilian guests, the conference consisted of a formal presentation 
by each panelist with members of the audience joining in a question and 
answer period. CAPT Ingram W. Ogden DC USN of the Oral Surgery Division 
of the Dental School moderated the panel composed of Dr, Daniel F. Lynch, 
Oral Surgeon, and Dr. Frank J. Grabill, Anesthesiologist, both of Washington, 
D. C. ; and CAPT James G. Kurfees MC USN, Chief of the Anesthesiology 
Service, U. S. Naval Hospital, Bethesda, Md. 

CAPT Wunderlich Visits Fourth Naval District . CAPT Harry J. Wunderlich 
DC USNR, Head, Reserve Branch, Dental Division, Bureau of Medicine and 
Surgery, recently visited the Fourth Naval District. While on this trip, he 
met with several Naval Reserve Dental Companies — 4-2 Pittsburgh, Pa. ; 
4-3 Columbus, Ohio; 4-6 Cleveland, Ohio; and 4-1 Philadelphia, Pa. — and 
with Ensigns 1925 at Ohio State University, University of Pittsburgh, Temple 
University, and the University of Pennsylvania. The Ensign 1925 Indoctrina- 
tion Course to be held at the U.S. Naval Schools Connmand, Naval Station, 
Newport, R. I. , was the main topic of discussion. The new Navy filnn. The 
Navy Dental Corps , was shown to all groups. 

New London County Dental Society . Dental officers from the New London 
Submarine Base Dental Department and the Naval Medical Research Labora- 
tory were hosts at the annual dinner meeting of the New London County Dental 
Society. The dinner, attended by 50 Navy and civilian dentists, was held in 
the Submarine Base Officers Club. CAPT George W, Lautrup Jr. USN, 
Submarine Base Comnaanding Officer, welcomed the group. Among those 
present were Dr. John Wakim, President of the New London County Dental 
Society; CAPT Francis Waters, U. S. Public Health Service, Senior Dental 
Officer at the U.S. Coast G\iard Academy; and CAPT Harry B. Mclnnis 
DC USN, Submarine Base Senior Dental Officer. Following the dinner, 
Dr. Wakim introduced the guest speaker, LT Max J. Perlitsch DC USN who 
spoke on dentistry in Antarctica. LT Perlitsch, attached to the Medical 
Research Laboratory, was stationed in Antarctica for 13 months during 
Operation Deepfreeze IIL 

Dental Health Week at Camp Lejeune . Brigadier General S. S. WadeU. S. M.C. 
Commanding General, Marine Corps Base, Camp Lejeune, N. C. , recently 
proclaimed "I960 Childrens' Dental Health Week" at the Base. The Base 
Dental Officer, CAPT C. T. Pridgeon DC USN assisted by personnel of the 
base dental department, carried on a week-long program to focus attention 
on the importance of dental health. Utilizing a wide assortment of educational 



40 



Medical News Letter 



Vol. 35, No. 8 



material procured from the American Dental Association, the program was 
chiefly concerned with dental health education. A visit was made to each 
Camp School and to one county school to present demonstrations in dental 
health practices. In addition, the students were given an opportunity to re- 
ceive a dental examination. CAPT Pridgeon stated that approximately 3,000 
pupils received instruction during Dental Health Week at Cainp Lejeune. 

Recent Guest Lecturers at NDS . Dr. Leonard M. Monheim, Professor and 
Head of the Department of Anesthesiology of the School of Dentistry, and 
Assistant Professor, Department of Surgery (Anesthesia), of the School of 
Medicine, University of Pittsburgh, presented a lecture entitled "Newer 
Concepts of Local Anesthesia in Dental Practice. " Dr. Monhein stressed 
that the dentist is treating patients, not merely taking care of teeth; he also 
showed the need for the dentist to have a thorough understanding of pharma- 
cology, physiology, and other related sciences in order to accept this newer 
concept. 

Dr. Irving Glickman, Professor of Oral Pathology and Periodontology 
and Director of Graduate and Postgraduate Studies, Tufts University School 
of Dental Medicine, Boston, presented a lecture, "A Master Plan for the 
Treatment of Periodontal Disease. " In the presentation on effective perio- 
dontal treatment techniques. Dr. Glickman discussed a "master plan" which is 
the basis for clinical management of periodontal disease, and explained how 
it can be applied as part of the daily chairside practice of general dentistry. 

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