possible. Only the cold injury study was added to the clinical follow-up program during fiscal year 1951, and the agency sacrificed the expansion of ''record follow-up studies" (those that did not involve clinical observations) in order to complete the clinical studies. The military emergency in Korea also made it more difficult for the agency to obtain the equipment necessary for its work, such as the IBM machines "best suited to the kind of work performed."45

During this period, Gilbert Beebe began giving speeches in which he described the Follow-up Agency's mission to military and medical audiences. In these talks, he put forth questions that the agency sought to answer, such as: Do men with severe frostbite and trench foot recover completely? or What is the chance of survival for men with Hodgkin's disease? He emphasized the value of military records for scientific investigation. "If you want a thousand cases of schistosomiasis, there is a specific place to go and you can physically put your hands on a thousand punchcards which represent a thousand admissions for this disease," he said. He claimed that "everyone has felt much better ... knowing that a single group has been entrusted with the responsibility of organizing access to this material and of evaluating the specific research proposals made in connection with it." As for the investigators who worked with this material, Beebe cited a group of committed doctors who had become interested in a particular problem during the war and who were willing "to put up with a considerable amount of necessary administrative and organizational work" in order to use the records. However, even the most committed clinical investigators required the help of agency staff in acquiring rosters, locating individuals, and examining sample records, and even then, considerable problems remained in getting people to report for examinations. Still, concluded Beebe, the rewards of such an enterprise were immense.46

Despite Beebe's optimism, the future of the follow-up program was far from ensured. Between 1952 and 1955, the agency faced a painful transition from total dependence on the Veterans Administration to more diverse sources of financial support. This period coincided with expansion of the VA's own intramural activities, which decreased its reliance on external contracts, and with the arrival of the first Republican administration in Washington since 1932.

In a statement prepared in April 1952, Gilbert Beebe wrote that until final reports were prepared for some of the larger and more expensive studies, it would be difficult to "know whether the program should be brought to an end as a postwar episode of temporary interest and value." At the end of fiscal year 1952, total costs for the effort were expected to reach $2.2 million, with about 38 percent going to the Follow-up Agency itself. The most expensive of the 25 projects cost $600,000. Beebe admitted that the conduct of cooperative, multicenter projects had proved to be a challenge. Even within single centers, the staff noted that well-qualified examiners differed greatly in their reports "as to specific signs, symptoms, and laboratory values." These diagnostic differences, coupled with the agency's inability to compel individuals to submit to examination, revealed ten-



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement