At the clinic, every patient has a chart. The chart includes all the crucial information--when the surgery or other procedure was performed, exactly what was done, what follow-up medical procedures should now be carried out, what exercise routine is appropriate, and what foods the patient should eat and avoid. Some charts include electrocardiogram printouts, which, for some strange historical reason, are called EKGs. Most have records of the patient's blood chemistry and cell counts. All include a billing record. Many charts say "house with a companion."

House with a companion?

These are the charts of Dr. Victoria Hampshire's patients -- sheep, goats, dogs, cats, rabbits, pigs, mice, rats, and ground squirrels. In Hampshire's animal facility at the NIH, the routine is for most animals to live with a buddy or in a larger group. Hampshire finds that the animals are happier that way. And, in times of special stress, such as when a dog is recovering from surgery, Hampshire finds that another animal, specifically a cat companion, is often the best medicine.

Hampshire is a veterinarian at the NIH. She works mostly with large animals. Her charges range from animals who are normal blood donors to those participating in high-risk studies.

First thing each morning, technicians at the clinic and another veterinarian visit all the animals who have had surgery and assess the status of each. They make decisions about which animals need medical attention and which ones need it fastest. This process is called "triage," the French word for "sorting," a word that came from the battlefield where doctors would evaluate soldiers to figure out which ones had the most severe wounds and needed care most urgently.

When the line-up is set, Hampshire goes on rounds, examining the animals. On any one day, there will be some who are really sick, others who are recovering from consequences of the experiment that they are participating in, and some who have incidental illnesses or injuries. Hampshire may have to operate on a few, repair surgical stitches on some that were operated on the previous day, and start intravenous fluids for those that have become dehydrated. If animals have been fighting, she will sew up the bite wounds.

By midmorning on most days, all the emergency and basic health needs of the animals are taken care of, and the research activities can begin. In Hampshire's clinic, the protocols are wide-ranging, from brain scans on cats to artificial heart valve research in sheep to day-long medicinal drug tests in several species.

"Pigs are," says Hampshire, "next to humans, the best animals for physiological studies. They can be 'chronically instrumented' with a tube, called an indwelling catheter, that is connected to a blood vessel. Like patients who are receiving chemotherapy, their blood can be sampled and they can receive medicines through the catheter." A valve that works like a two-way spigot on a sink is attached to the catheter, so that repeated injections and measurements can be made without causing discomfort to the animal. The animals wear spandex sweaters that hold the tubing in place. "Pigs are not stupid," says Hampshire, "they are just tolerant of the instruments."

"The pigs are happy when their comfort needs are met," she says, "and their progress is tremendous when they trust the people working with them." They enjoy food, attention, and toys and like to pile up next to each other in the pen. Most days, staff members play with them, and the pigs pick treats from the treat cart. Hampshire says that the pigs like the company of humans better than they like being with other animals. As we talked, a pig passed by the office on a stroll with a technician.

All animals at NIH are bred on the site or are purchased from "class A vendors," which breed and sell animals for research. The smallest pigs in Hampshire's facility are Minnie, Moe and Max, three black, hairy siblings who were born in December. These "mini-pigs" are hybrids of a Vietnamese Potbelly pig and a Yucatan pig. Hampshire has spent the past two years trying to develop "transgenic" offspring in this breed. If the experiment works, the transgenic pigs will carry the human globin gene and produce its protein product, globin.

Interest in putting new genes -- transgenes -- into animals is high right now, and scientists are taking many different approaches. Another, besides breeding, is to put genes into skin cells and graft the cells onto the animal's back. Pigs, especially the pink ones, are good for these studies, because their skin is very similar to human skin, and skin grafts can be seen easily and watched closely.

Some of the dogs in Hampshire's clinic are participants in studies of drugs that make blood vessels grow. The issue here is whether the drugs can force new vessels to form at specific locations. If this works in the dogs, it may be a reasonable option for people who need heart bypass surgery but are too sick to survive such an operation.

Other dogs, those in a septic shock study, are considered at "high risk." They need added attention, because the experiments that they are part of can be fatal. Septic shock is a condition that often develops in hospitalized patients as a complication of cancer, diabetes, and a number of other diseases. It kills some 200,000 people in the United States each year and, therefore, is a major problem.

At the opposite end of the risk spectrum is Buster, a dog who came to Hampshire's clinic four years ago to participate in a heart study. During the pre-experiment physical, the doctors found that Buster had a heart murmur that disqualified him from the experiment. He has been a normal blood donor ever since and is comfortable hanging around the clinic offices.

In all experiments that may cause pain to an animal, Hampshire looks for the best approach for lessening or eliminating the pain. She says she is guided by the principle that "if it is painful to a human, it is probably painful to an animal. If we waited for animals to cry before giving them pain relievers," says Hampshire, "we would be underdosing them." When animals cry, their heart rate and blood pressure go up, and they bleed more than usual. These problems can be avoided by early treatment with pain killers. Hampshire has found that marcaine and related pain killers (whose names all end in "caine") are effective drugs in many experiments. She typically starts the drugs well ahead of time, so that the animals will not have to experience unnecessary pain.

Every experiment that involves animals is classified for its pain category, and these range from "column C" experiments to experiments in "column E." The animals in column C experiments are expected to experience no pain or minimal pain. Those in column D experiments may experience pain but can be given standard pain relievers, called analgesics. In column E experiments, pain and suffering may be severe, but the animals cannot be given analgesics, because the drugs would mask the purposes of the experiments. Hampshire says that sometimes, through the use of local "blocks," she can "take an animal out of a category," moving it backward up the scale to a category that allows for less pain. She says that acupuncture is another option that she has been considering, because acupuncture is a proven pain reliever for show horses who suffer from back and leg pains. In addition to assessing subjective indicators of discomfort and pain, she measures various serum compounds -- cortisol, prostaglandins, and cytokines -- that are released during pain reactions. These objective measures are adding to her understanding of the animals' pain responses and what can be done to alleviate their suffering.

Hampshire spends most afternoons reviewing proposals by researchers for upcoming experiments. A nine-member committee including veterinarians, scientists, people from the community, safety officers (if radiation is involved), and others evaluates all experiments with animals. With each proposal Hampshire considers whether she "can support it, if it's humane. If not, I indicate what changes need to be made." She helps researchers rethink the designs of their experiments and write appropriate protocols.

Hampshire is constantly "challenging the status quo," looking for ways to enrich the lives of the animals under her care. Years ago, research animals lived in pristine, even sterile, environments, but now "we rely on really good animal husbandry (careful and caring management)" instead. Says Hampshire: "We don't sterilize the hay, but we do look for and remove moldy hay. We stuff the animals' cages full of straw, and, when we began doing this, we stopped seeing animals with sore feet and breeding problems."

"Rabbits in experiments will sometimes go off their feed," says Hampshire. So she began giving the rabbits fresh kale and parsley and dried oatmeal instead of rabbit pellets. By enriching the rabbits' diets in these ways, she says, "we have seen tremendous improvement in stress-related problems."

Hampshire is concerned about the medical and the emotional well-being of the animals under her care and also about the emotional needs of her staff. She says it is a "research risk" when people are upset at work and that it is not easy for people to work with animals that are sick or in pain. All staff members have opportunities to make suggestions for improving conditions for the well-being of the animals. Recently, for example, technicians were disturbed because mice were receiving injections of antibiotics in a rather large volume of fluid. One suggested that, if the antibiotic were injected in half the volume, the mice would experience less stress. The change was made.

Hampshire's daily routine is actually far from "routine," and it got even less so in February and March, 1997, when she packed up 3000 rabies vaccines and traveled for three weeks on a public health mission in Alaska. The team included one other veterinarian and pediatricians, dentists, obstetricians, and other physicians. The plan was to fly in and out of ten remote villages in the Yukon delta; the military transport plane spent nights in an air force hangar and so did the team members, often sleeping on the hangar floor.

Hampshire and the other veterinarian immunized 250 domestic dogs and cats against rabies. Rabies is brought to the villages by Arctic foxes that come searching for food; they fight with and bite the local animals and, through their bites, spread the disease. Hampshire did a radio show and also gave talks in classrooms about rabies prevention and the importance of reporting dog bites.

The trip did not go entirely as planned, in part because snow kept them in some villages longer than they expected and out of others. But the longer stays, says Hampshire, gave the doctors time to "learn of some significant public health problems that might have gone unnoticed."

With no running water and outside temperatures of minus 40, malnutrition and sickness were everywhere in the Yukon villages. Some villagers had giardiasis, a disease caused by the parasite giardia, which enters streams and rivers in the feces of beavers. The villagers get their water from these sources and then develop diarrhea, cramps, nausea and other symptoms of the disease.

Brucellosis, a bacterial disease that causes high fevers, aches, sweats and depression, also comes from contact with animals and is another problem in the villages. Caribou carry the bacteria, and the villagers get the disease either directly, when they slaughter caribou, or indirectly from dogs and wolves that feed on the caribou and then pass the bacteria along.

Another infectious disease that they found is leptospirosis, which is caused by spiral bacteria that normally live in rodents. The Eskimos have an old custom of harvesting and eating mouse food -- seeds and nuts mounded together with mouse saliva and urine. The symptoms of leptospirosis resemble those of alcoholism; because alcoholism is a problem among the Eskimos, the bacterial infection might sometimes be overlooked and thus go untreated.

Hampshire said that they saw dog feces in school yards and everywhere else in the villages. Few dogs passed the physical that was a prerequisite to other procedures -- like spaying and neutering -- that she had hoped to carry out in an effort to control the animal population and improve health conditions for the animals. The village children run around barefoot in the summertime and pick up infections from the feces; in the wintertime, "they simply get feces on their hands." The feces contain hookworms; the children develop larva migrans or "creeping eruption," an itchy skin rash and blisters that mark where the larvae have been moving through human skin.

These and other infections can often be treated, but they have to be recognized first. The team members will be developing a 5-year plan directed toward improving conditions in the villages for both the animals and their owners.

An animal clinic, whether a field station in Alaska or a clinic at the NIH, "is not the typical government workplace nor does it run on a typical government schedule, which is not always compatible with the care of animals," says Hampshire. "We sometimes need someone to stay with an animal all night. So we juggle schedules, and people make accommodations."

Staying with a sick animal all night is nothing new for Hampshire. She grew up on a farm, had her own horse, and, early on, learned to diagnose her horse's health problems. Lots of dogs were also on the scene, because her mother bred basset hounds. Now, when Hampshire goes home at night, it's the proverbial busman's holiday: in addition to her children and husband, she shares her home with two cats and two yellow Labradors.