During World War II, the 15 million servicemen mobilized and deployed around the world produced an extraordinarily large and complex medical experience. The medical care provided by the armed forces was thorough and competent. A consultant system of leading medical scientists in all clinical disciplines was deployed and assigned to major commands in all zones of operation, both in the United States and overseas. Many distinguished medical teaching centers established affiliated general hospital units with research-minded faculty personnel, who were assigned to, and saw active service in, all overseas theaters of operation. Medical observations and data were recorded and centrally indexed. Medical problems in virtually all clinical disciplines, including trauma, surgery, infectious diseases, and psychiatry, often assumed urgent military importance and accordingly generated research and innovative therapeutic measures. Affiliated research activities of military import were also being provided by various committees of the National Research Council of the National Academy of Sciences.

Toward the end of the war, it became increasingly apparent that a vast amount of medical data and research observations on a wide array of medical problems had been accumulated, strongly suggesting the opportunity for follow-up studies. Accordingly, on March 5, 1946, I submitted a memorandum to Surgeon General Norman Kirk, pointing out that "an enormous amount of material of great clinical value" had accumulated in the medical records kept by the armed services, such that, in fact, "[i]t can fairly be said that no similar amount of material has ever been accumulated, and it is doubtful whether a similar amount will ever again be available." I then proposed to turn this material to a "practical use by the establishment of a clinical research program, including a follow-up

system to determine the natural and post-treatment history of such diseases and conditions as might be selected for the study." By this means, it would be possible to ascertain the long-term effects of various forms of treatment, as well as the natural history of certain pathologic processes. I further stated that "[t]hese and other data, departing from a given base line and followed-up over long periods of time dispassionately and in the absence of special pleading, have never been available."

I proposed that the project be a joint undertaking of the Army and the Veterans Administration, with the National Research Council assuming an important role in appointing a committee to initiate and implement the project and to "exercise a general supervisory function." I suggested that funding might be obtained through a direct federal subsidy or through a National Research Foundation, for which legislation was then pending and which later evolved into the National Science Foundation.

Fortunately, Surgeon General Kirk heartily accepted my memorandum and recommended its consideration to the National Academy of Sciences-National Research Council. The enthusiastic and expeditious response of the Academy and the committees it established to assess the proposal and "explore the most effective means by which a medical research program utilizing this material can be carried out" is reflected in the fact that by May 7, 1946, less than two months after I wrote my memorandum to Surgeon General Kirk, a Committee on Veteran Medical Problems was appointed under the chairmanship of Dr. Edward D. Churchill. The committee directed the staff, which was then composed of Dr. Gilbert W. Beebe and me (we were both still in the military and assigned by the surgeon general to the National Academy of Sciences-National Research Council on temporary duty to work on this project) "to prepare the groundwork for Committee action."

Dr. Beebe and I therefore prepared a "draft report of the character and scope of the follow-up proposal and the mission, structure, organization, and funding support." This report was discussed and generally approved by the committee at its final meeting on June 13, 1946. Within only about three months of my original proposal, on March 5, 1946, the program thus became operational under the aegis of the National Research Council, with the appointment of Dr. Beebe as its first full-time statistical analyst.

As the originator of this program, I am most gratified to observe the impressive medical scientific contributions emanating from its activities during its half century of existence, as well as the valuable tangential contributions made in setting the standards for the procedures and mechanisms of follow-up studies. These standards have greatly influenced subsequent studies, such as epidemiologic investigations, multicenter controlled clinical trials, and so-called outcomes research. In great measure this has been due to the capable leadership of Gilbert Beebe, followed by that of Seymour Jablon, and more recently, Richard N. Miller, along with the dedicated advisory support of a wide array of scientists.