Patient 00-00-01

"To obtain the best results from laboratory research," said the U.S. Public Health Service, "there should be available a hospital to which patients suffering from a particular disease . . . could be admitted." That was in 1911, and it took a generation for PHS to get its plans to the blueprint stage. Last week in Bethesda, Md., the blueprint at length became reality; the spang-new Clinical Center of the National Institutes of Health opened its door to patients.

First to arrive was a tall, aging Maryland farmer who got out of a car, clumped across the terrazzo-floored lobby, and was checked in as "Patient 00-00-01." On the twelfth floor, the farmer found himself in an air-conditioned, semiprivate room (as are all the center's 250 rooms), done in robin's-egg blue, with figured draperies and blond modern furniture. His room had its own bath, outlets for radio and TV sets, and an intercom for talking to the nurses at their stations.

Hollywood Beds. Patient 00-00-01 was made comfortable in a hospital bed, and there he had a good lunch. If he had not needed bed rest for observation, he would have had a room with a Hollywood bed and a desk, and would have taken his meals in a dining room with settings for 26. By week's end the Clinical Center had admitted 22 patients, aged 14 to 71; six for cancer studies, eight with heart and artery diseases, two diabetics, four with arthritis and two for studies of blood distribution.

In the four decades in which the PHS has been planning its Clinical Center, the emphasis in medical research has switched from infectious diseases to the chronic, disabling illnesses which are estimated to afflict 25 million in the U.S. The subdivisions of the National Institutes of Health reflect the change: one each for cancer, heart disease, mental health, arthritis and metabolic diseases, neurological diseases and blindness. The only major infectious disease remaining high on the N.I.H. list is rheumatic fever, which can permanently damage the heart.

Life Comes First. N.I.H. Director William H. Sebrell summed up the center's purposes: "You don't get into this hospital just because you're sick. Medical care is incident to study here. We're not interested in rare, exotic diseases, but in those that damage and kill the most Americans." However, the patient's welfare comes first. If any of the center's 90 physicians has to choose between going on with research and immediate measures to save a patient's life or well being, he will ditch the research. And though each patient agrees, before admission, to submit to testing and research, he may quit and go home when he likes.

The doctors hope that patients will come back regularly for rechecks. For this reason, though there is no charge for care that may cost thousands, Director John A. Trautman would choose a well-heeled patient over a charity case with identical symptoms; the well-to-do are easier to keep track of for checkups. Admissions are arranged only by doctors and other hospitals; individual patients who apply are wasting their time.

To qualify as one of what Dr. Sebrell calls "the best-studied patients in the world," a victim of prostate cancer may have to agree to a routine in which his body wastes are collected for as long as three weeks, the enzyme content of his blood is checked each day, his blood pressure taken as often as every half-hour, and he may be dunked into a pool now and then to gauge the water content of his body. Some arthritis patients with a stubborn type of anemia will give blood which will be made radioactive before it is put back into their systems; thus the researchers can test a theory that the red blood cells are dying off faster than normal.

Dr. Trautman expects to take a year filling the $64 million center to half its capacity and another year to fill it entirely. Eventually, for care of its patients and to man its 1,100 laboratory spaces, it will have 100 or more physicians and hundreds of other scientists in a total staff of 3,000. He expects no quick miracles. Against the common chronic diseases, unlimited research time at the patient's bedside is needed.

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