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Growth Years 1953-1969

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Visiting Officials of the Clinical Center Image Removed
Oveta Culp Hobby, soon to be designated Secretary of Health, Education, and Welfare, visiting the Clinical Center building on April 6, 1953. With her are (l. to r.) CC Director John A. Trautman, Surgeon General Scheele, and NIH Director Sebrell.

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The very best definition I have ever found for a hospital is the old Quaker expression, “bettering house.” It is a simple, honest term, which sums up the whole reason for being of all our health professions as they work together on the hospital team.
Jack Masur, speech to Washington State Hospital Association, Spokane, October 19, 1955

As Dr. James Shannon remembered it, starting up the Clinical Center took “a very rough couple of years.”

Footnote
Shannon, Reminiscences, CUOHP, 32.

There was no established culture of medical practice supporting clinical research at Bethesda, no public funding commitment for basic science breakthroughs or for training the next generation of clinicians and scientists, and no clear paths to the next level of biomedical knowledge. The initial barriers were political. President Dwight D. Eisenhower took office in January 1953, determined to scale back federal health spending. His administration’s budget for the PHS fiscal year 1954 was $219 million, a reduction of $51 million from the previous administration’s projection.

Footnote
Rough notes on Scheele testimony, House Appropriations Subcommittee, March 3,1954, attached to minutes, April 1, 1954, Institute Directors Meeting, in Subject File, Office of the Director, NIH, box 3, RG 443.

The Clinical Center’s incomplete professional staff complement of 245 scientists and clinicians was frozen, and the April 1 opening was postponed for budgetary reasons.

Footnote
Topping, "The United States Public Health Service Clinical Center for Medical Research", pp. 544; NAHC minutes, February 20-21, 1953, Subject File, box 4, RG 443; memorandum, Sebrell to All NIH Employees, March 4, 1953, Historian’s File, HMD, NLM.

When Oveta Culp Hobby, the new Secretary of Health, Education, and Welfare, visited the building in April, she asked NIH Director William H. Sebrell whether the facility could be kept closed as an economy measure. Sebrell assured her that the political costs would be prohibitive, and the administration proceeded with plans to activate the first 150 beds on July 1.

Footnote
Sebrell, oral history, pp. 57, 160.

Dedication ceremonies marking the opening of the first 26-bed nursing unit were held the following day in sweltering, 100-degree heat. In her remarks, Secretary Hobby invoked the promise of “cures as yet unthought of” and praised Congress for its nonpartisan willingness to fund medical research. “Scientific truth knows no politics,” she averred, and dedicated the Clinical Center to “the open mind of research.”

Footnote
Hobby speech text, July 2, 1953, Office of the Director, NIH, in Historian’s Office File, HMD, NLM.

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Courtesy of Parklawn Library, Public Health Service.

First Patient of the Clinical Center Image Removed

In July 1953, Charles Meredith, a 67-year-old farmer, was admitted as the first patient. Under the care of Dr. Roy Hertz (rear), he underwent hormone therapy.

Getting Underway

Under the administration of the first operating director of the Clinical Center, Dr. John A. Trautman, patient admissions followed at a steady pace. By January 15, 1954, there were 115 occupied beds on seven nursing units.

Footnote
Minutes, Scientific Directors meeting, January 13, 1954, box 3, RG 443.

The original patient cohorts were largely ambulatory and not acutely sick, reflecting Sebrell’s desire that most “will leave the Clinical Center in better physical shape than when they entered.”

Footnote
Minutes, Scientific Directors meeting, April 2, 1952.

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Getting Underway

Under the administration of the first operating director of the Clinical Center, Dr. John A. Trautman, patient admissions followed at a steady pace. By January 15, 1954, there were 115 occupied beds on seven nursing units.

Footnote
Minutes, Scientific Directors meeting, January 13, 1954, box 3, RG 443.

The original patient cohorts were largely ambulatory and not acutely sick, reflecting Sebrell’s desire that most “will leave the Clinical Center in better physical shape than when they entered.”

Footnote
Minutes, Scientific Directors meeting, April 2, 1952.

Of 23 admissions to Patient Care Unit 12E in the first four weeks of activation, nine were cancer patients transferred from the endocrinology branch clinic at George Washington University Hospital, which NCI had set up under Dr. Roy Hertz in 1949. Six other admissions were involved in arthritis or diabetes studies conducted by the fledgling National Institute of Arthritis and Metabolic Disorders (NIAMD), and seven others, all ambulatory, were Heart Institute patients participating in arteriosclerosis investigations

...

.

Footnote
Washington Post, August 9, 1953, lB.

Of these, one case of thrombotic occlusion surgically removed was presented as a “complete cure” at the first Combined Clinical Staff Conference on January 20, 1954.

Footnote
Typescript, Proceedings of the Combined Clinical Staffs, NIH Clinical Center, January 20, 1954, presentation by Dr. James Wyngaarden, in box Miles, Institutes, folder Clinical Center, 1953, HMD, NLM.

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Visiting Officials of the Clinical Center Image Added
Oveta Culp Hobby, soon to be designated Secretary of Health, Education, and Welfare, visiting the Clinical Center building on April 6, 1953. With her are (l. to r.) CC Director John A. Trautman, Surgeon General Scheele, and NIH Director Sebrell.

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Courtesy of Parklawn Library, Public Health Service.

First Patient of the Clinical Center Image Added

In July 1953, Charles Meredith, a 67-year-old farmer, was admitted as the first patient. Under the care of Dr. Roy Hertz (rear), he underwent hormone therapy

Footnote
Washington Post, August 9, 1953, lB.

Of these, one case of thrombotic occlusion surgically removed was presented as a “complete cure” at the first Combined Clinical Staff Conference on January 20, 1954.

Footnote

Typescript, Proceedings of the Combined Clinical Staffs, NIH Clinical Center, January 20, 1954, presentation by Dr. James Wyngaarden, in box Miles, Institutes, folder Clinical Center, 1953, HMD, NLM

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Medical policies in the fledgling hospital were set by the Medical Board, composed of institute clinical directors and chairs of the operating medical departments, who met to advise the Clinical Center director. Projecting the Clinical Center as “the ‘ideal hospital’ of the future,” the Board established broad responsibility for patient welfare. Study patients were to be considered members of the research team, entitled to “full understanding of the investigation contemplated” and to free care for the duration of the research. Investigators were enjoined from imposing citizenship or residence requirements. The Board also disallowed “any restriction based on race, creed, or color.”

...

Footnote
Sebrell, oral history, pp. 96-97.

retired in August 1955. NIH leadership passed to Dr. Shannon, who vigorously exploited opportunities for expanded research, administration, and funding.

Footnote
Minutes, NAHC meeting, 10/27-28/55, Supp. II,2,4, in box 3, Subject File, RG 443.

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Responding to Changing Times

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In the years after 1965, expansion leveled off for NIH as a whole. A mature institution emerged, with a fresh overlay of training and education responsibilities added by the administration of Lyndon B. Johnson.

Footnote
NIH Study Committee, Biomedical Science and Its Administration: A Study of the National Institutes of Health, Washington, DC: GPO, 1965, pp. 8-9; James A. Shannon, “The Advancement of Medical Research: A Twenty-year View of the National Institutes of Health,” Journal of Medical Education, 42: 102-108 (February, 1967).

For the Clinical Center this meant growing interaction with regional clinical research centers, partially funded by the NIH Division of Research Resources, as sources for patient referrals and opportunities for clinical trials. Johnson reorganized the PHS to put NIH directly under White House control, and he also recruited Masur as a Great Society spokesman to promote the acceptance of Medicare and to push for a greater distribution of the fruits of medical research.

Footnote
Congress and the Nation, vol. II, 667-72, 680-90; Masur speech to New England Hospital Assembly, March 28, 1966, excerpts in Providence Journal, March 29, 1966; New York Times, May 30, 1966.

Visiting the Clinical Center on August 9, 1965, Johnson publicly signed the Health Research Facilities Amendments Act, which allocated $230 million for research contracts and construction grants to regional medical centers.

Footnote
NIH Record, August 24, 1965.

Subtly, the Clinical Center adopted the administrative requirements involved in servicing the expanded health system. The 1967 mission statement promised “opportunities for young physicians and other professionals to prepare for careers in medical or related research.”

Footnote
Annual Report of Program Activities, Clinical Center, 1966-67, OD-1.

The hospital continued to grow, as 24 beds were added for the new National Institute of Child Health and Human Development between 1966 and 1968. But some NCI patients were now housed in local motels, family-style meals were being replaced by tray service on the wards, and nurses noted “a great many more sick patients in the house.”

Footnote
Annual Report of Program Activities, Clinical Center, 1965-66, OD-5, Nr 3; minutes, Medical Board Meeting, June 18, 1965; minutes, Clinical Directors meeting, September 16, 1967, box 3, RG443.

Slowly the hospital was becoming more of a service center and less of a self-contained chronic care community.

The critical point in this transformation came in 1968, as the Vietnam War reached its crisis and President Johnson announced his intention to leave office. The administration could not fund its Great Society programs for fiscal 1969. In July the budget was reduced from $30 billion to $24 billion, and a 10 percent surtax was imposed to keep the government solvent. Masur’s staff recognized that federal services would be reduced, that personnel vacancies at the hospital would go unfilled, and that a period of “lean years” lay ahead.

Footnote
Minutes, Clinical Center staff meeting, July 2, 1968, box 3, RG 443; Joseph Califano, Jr., The Triumph and Tragedy of Lyndon Johnson: The White House Years, New York: Simon and Schuster, 1991, pp. 253-73.

With the retirements of Dr. Shannon as NIH director in September and Senator Hill as chief sponsor of medical research in November, the federal science enterprise was for the moment a political orphan.

Footnote
Hamilton, Lister Hill; Statesman from the South, pp. 275-81.

Dr. Masur’s sudden death from acute myocardial infarction on March 8, 1969, was a tragic loss, which closed two decades of political good fortune, scientific brilliance, and clinical elan. No other director would style himself “superintendent of the hospital,”

Footnote
Masur, Reminiscences, NLM OHP, pp. 27-28.

and no other hand would influence as critically the institution’s development and daily life. In a time of great turmoil in American society at large, his passing left the Clinical Center a future replete with both promise and uncertainty.

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Director Trautman and the Red Cross Volunteers
Director Trautman and the Red Cross volunteers, valued for bringing a personal touch to patient service.

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Courtesy of Parklawn Library, Public Health Service.

Nurse attending a patient in Life Island
Nurse attending a patient in Life Island, a bacteriologically controlled environment. October 1964

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Beacon of Hope | 1953–1993

The Clinical Center Through Forty Years of Growth and Change in Biomedicine

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