A Short History of NIH, 1887-1987

NIH traces its roots to 1887, when a one-room laboratory was created within the Marine Hospital Service (MHS), predecessor agency to the U.S. Public Health Service (PHS). The MHS had been established in 1798 to provide for the medical care of merchant seamen. One clerk in the Treasury Department collected twenty cents per month from the wages of each seaman to cover costs at a series of contract hospitals. In the 1880s, the MHS had been charged by Congress with examining passengers on arriving ships for clinical signs of infectious diseases, especially for the dreaded diseases cholera and yellow fever, in order to prevent epidemics. During the 1870s and 1880s, moreover, scientists in Europe presented compelling evidence that microscopic organisms were the causes of several infectious diseases. In 1884, for example, Robert Koch described a comma-shaped bacterium as the cause of cholera.

In 1891, the Hygienic Laboratory, as it came to be called, was moved to Washington, D.C., near the U.S. Capitol. For the next decade, Kinyoun remained the sole full-time staff member. He inaugurated a training program in bacteriology for MHS officers and conducted numerous tests of water purity and air pollution for the District of Columbia and the Congress. In 1901, the laboratory was belatedly recognized in law when Congress authorized $35,000 for construction of a new building in which the laboratory could investigate "infectious and contagious diseases and matters pertaining to the public health." Occupied in 1904, this building was located at 25th and E Streets, N. W., in Washington, D.C. The founding legislation for NIH, therefore, resides in a routine supplemental appropriations act. Many other scientific agencies of the federal government were also created via "money bills." Congress was not convinced that such bureaucracies would prove demonstratively useful, so it chose to preserve the option of divesting the government of them simply by not renewing their funding.

In 1912, another Service reorganization act shortened the name of the PH-MHS to the Public Health Service (PHS). This brief act also authorized the laboratory to conduct research into noncontagious diseases and into the pollution of streams and lakes in the United States. Under this law, PHS officer Joseph Goldberger in 1914 conducted an epidemiological study that identified the cause of the disease pellagra, a scourge of poor Southerners, as a dietary deficiency and brewers’ yeast as a cheap and widely available cure. Also, Earl B. Phelps, then director of the Division of Chemistry, described the behavior of oxygen in water that fostered better understanding of the effects of pollution in lakes and rivers.

In 1930, the Ransdell Act changed the name of the Hygienic Laboratory to the National Institute (singular) of Health (NIH) and authorized the establishment of fellowships for research into basic biological and medical problems. The roots of this act extended to 1918, when chemists who had worked with the Chemical Warfare Service in World War I sought to establish an institute in the private sector to apply fundamental knowledge in chemistry to problems of medicine. In 1926, after no philanthropic patron could be found to endow such an institute, the proponents joined with Louisiana Senator Joseph E. Ransdell to seek federal sponsorship. The truncated form in which the bill was finally enacted in 1930 reflected the harsh economic realities imposed by the Great Depression. Nonetheless, this legislation marked a change in the attitude of the U.S. scientific community toward public funding of medical research.

Vaccines and therapies to deal with tropical diseases were also critically important to the war effort. At NIH's Rocky Mountain Laboratory in Hamilton, Montana, yellow fever and typhus vaccines were prepared for military forces. In Bethesda as well as through grants to investigators at universities, a synthetic substitute for quinine was sought to treat malaria. The Division of Biologics investigated the fever-producing properties of bacteria which might appear as contaminants of plasma, serum albumin, or whole blood, and developed sampling techniques to avoid contamination. Research in the Division of Chemotherapy revealed that sodium deficiency was the critical element leading to death after burns or traumatic shock. This led to the widespread use of oral saline therapy as a first-aid measure on the battlefield. NIH and military physiologists collaborated on research into problems related to high altitude flying. They determined the altitude at which oxygen had to be administered to prevent pilots from blacking out and designed an apparatus to supply extra oxygen efficiently. They also studied the relation of pressure changes to bubble formation in liquids to address the problem of emboli forming in the blood of pilots. Other tests were made to evaluate the efficiency of flight clothing, especially electrically heated suits, and to determine the effect of altitude on visual acuity and the use of visual devices for improvement of night vision.

Accompanying growth in the grants program was the proliferation of new categorical institutes. Between 1946 and 1949, voluntary health organizations motivated Congress to create institutes for research on mental health, dental diseases, and heart disease. In 1948, language in the National Heart Act also made the name of the umbrella organization plural: National Institutes of Health. The original divisions of the old National Institute of Health were divided into two newly created institutes: the National Microbiological Institute (NMI) and the Experimental Biology and Medicine Institute (EMBI). The tradition of using such academic medical names, however, was being transformed by the conviction that institutes named after diseases stood a better chance for being funded by Congress. In 1950, EMBI was absorbed by the newly created National Institute of Arthritis and Metabolic Diseases. In 1955 NMI similarly became part of the National Institute of Allergy and Infectious Diseases. By 1960 there were ten components. This number increased by 1970 to 15, and by century’s end NIH had 27 institutes and centers.

Toward the end of the 1960s, the growth of NIH budgets slowed considerably, in part because of inflation in the U.S. economy and the advent of new programs such as Medicare and Medicaid that competed for congressional "health" funding. Tighter budgets also led to debate over the relative efficacy of unfettered basic research versus goal-directed applied research. In the early 1970s, Congress authorized major initiatives against two chronic killers, cancer and heart disease. The National Cancer Act of 1971 created fifteen new research, training, and demonstration cancer centers. The following year the National Heart, Blood Vessel, Lung, and Blood Act mandated an expanded program against all aspects of heart disease, including high blood pressure, elevated cholesterol levels, stroke, and particular blood diseases such as sickle-cell anemia. The AIDS crisis of the 1980s similarly provided at first an opportunity for goal-directed research quickly to uncover an effective therapy or vaccine. When no quick solution was forthcoming, leaders of the research effort against AIDS began to emphasize study of basic immunological processes as the most efficient strategy to find an effective therapy or preventative.

The close relationship between basic and clinical research at NIH reflects Louis Pasteur's observation that science is indivisible: "There is only science and the fruits of science." On the NIH campus, intramural clinical investigators interact with their basic science colleagues with the aim of developing improved intervention strategies for treating the knottiest disease problems. NIH also held Consensus Development Conferences of investigators and physicians from around the world, at which panels of experts appraise new modes of therapy or evaluate existing therapies about which questions have been raised. The first, held in 1977, recommended mammography as a routine diagnostic tool for breast cancer in women over fifty.