administering the scientific research bill would have to take into consideration that a certain effort had been made in this field, and perhaps in other fields the effort had not been made, and you would have to look at it that way.

Dr. RUTSTEIN. That is right.

Mr. HESELTON. I have one other question:

I do not know whether you would care to comment on the makeup of the commission?

Dr. RUTSTEIN. I was in favor of the makeup of the commission in terms of the Javits bill. Mr. Keefe said that he would accept that provision in place of his own.

Mr. PRIEST. That provides for the same number on the council, but six of them shall be particularly qualified as specialists in this field. Dr. RUTSTEIN. Then it corresponds to the cancer bill.

Mr. PRIEST. I think Mr. Keefe said this morning they had come to an agreement whereby sections four and five of the Javits bill would be substituted for similar sections in his own, and otherwise it would stand.

Mr. HESELTON. Perhaps you can answer this question: I understand what fundamental science is, and what medical science and education would be, and why they should be included but I want to know how far public affairs goes.

Mr. PRIEST. I did not get the question.

Mr. HESELTON. I said I understood why we should provide for medical science and so on, but what is meant by the leaders in public affairs?

Mr. PRIEST. You are referring now to the Science Foundation bill? Mr. HESELTON. I am referring to the Keefe bill, if they have changed that.

The CHAIRMAN. I would say Bernard Baruch might come within that classification, and there might be some Members of Congress that would.

Dr. RUTSTEIN. I think that there is no such provision in the Javits bill.

Mr. HESELTON. I think that there should be a heavy representation from the medical field, but that the bill should include a vigorous representation from the lay field.

Dr. RUTSTEIN. I think it should be half and half.

The CHAIRMAN. If there are no further questions, we thank you, Doctor, for your appearance here today. We feel that we have been highly privileged today in the witnesses that have already appeared, and those who are to appear before we finish the afternoon session.

We have been highly favored because of the background of experience each one has brought to us, and I can assure you it is appreciated by the committee, and it will prove very helpful to us.

STATEMENT OF DR. T. DUCKETT JONES, REPRESENTING THE AMERICAN HEART ASSOCIATION, HELEN HAY WHITNEY FOUNDATION, NEW YORK, N. Y.

Dr. T. DUCKETT JONES. I am the medical director of the Helen Hay Whitney Foundation. This foundation is interested in research in rheumatic fever and rheumatic heart disease, one of the major heartdisease problems. To occupy this position I am at present on leave

of absence as director of research in rheumatic fever and rheumatic heart disease at the House of the Good Samaritan, Boston, Mass., one of the few pioneer hospitals in this country devoted to the cure and study of rheumatic fever. I am also a member of the board of directors and the executive committee of the American Heart Association, chairman of the executive committee of the American Council on Rheumatic Fever of the American Heart Association, and a member of the National Heart Committee. I am a diplomate of the American Board of Internal Medicine, qualified in the subspecialty of cardiovascular diseases.

I should like to limit my remarks to the needs for funds for research in diseases of the heart and circulation. Pertinent data concerning the importance of this health problem has been presented. That which we do not know cannot be applied for the good of human beings. This indicates the need for new knowledge through research. Until such time as we no longer have heart deaths or heart crippling at an early age or in the productive period of life there will be a need for new knowledge. The immediacy for new knowledge is so frequently obvious to many citizens that it is difficult to understand why we have been so slow in making provisions for broadened investigations in this many faceted problem.

In strongly advocating the passage of this legislation, with changes suggested by Doctor Connor, we do not wish to imply any avoidance. of the research financing responsibility of the national voluntary agency-the American Heart Association. We feel strongly that both public and voluntary research funds are urgently needed, and could well augment and complement one another. There is abundant evidence that the public will increase its contributions for research to voluntary agencies. We urgently hope that as in the instance of cancer, the healthy situation will occur of a considerable and simultaneous increase in public and voluntary research funds.

Concern has been expressed by both legislators and physicians concerning the trend toward selecting specific health problems for legislation. Your commitee must be aware of the tremendous impetus and accomplishment already given specific health problems by the Congress, and to mention cancer and mental health is sufficient. Few additional specific health problems of great importance remain in addition to heart disease. One might just as well face squarely the facts by mentioning another health problem of magnitude warranting specific consideration-namely, arthritis. This covers a number of medical conditions loosely grouped in the lay mind as "rheumatism," and they are responsible for much suffering, disability, and economic loss. It seems likely that this will ultimately need avaluation. In my opinion, the magnitude and health importance of diseases of the heart justify the special attention which the Congress is now giving the problem. The purposes of this special attention can be accomplished through various means. Separate heart legislation would have many advantages, but inclusion as an integral part of a National Science Foundation or as part of Public Health Law 410 would accomplish the purpose, provided there is a separate administrative structure and a separate council, some of the members of which are well qualified as having special knowledge in the heart disease field.

There is urgency and immediacy in the need for special heart consideration. This urgency is dependent upon two needs: (1) The de

velopment of research careers for bright and able young scientists working on long-range projects with their primary responsibility that of adding new knowledge. Few such careers exist at present. Men must be carefully selected and trained. This takes time; (2) facilities are meager throughout the country at present, and construction is essential to provide space for research and the training of wellqualified men for research and specialist qualification in this field. Every year of delay hence slows the process of ultimate accomplish

ment.

At the recent Senate hearings on S. 2215-the National Heart Act of Senator Bridges, Senator Pepper, Senator Ives, and Senator Murray-the American Heart Association representatives were asked to submit to the Subcommittee on Health of the Committee on Labor and Public Welfare of the United States Senate, after consultation with the members of the United States Public Health Service, its recommendation as to the initial year appropriation required for a national heart program. A copy of the recommendation is introduced for your information. After hurried consideration a total of $4,427,769 was proposed for the fiscal year 1949.

Further discussions have been held with United States Public Health Service representatives, and it is obvious to both of us that this sum will be thoroughly inadequate to initiate a program which would be really effective. The main feature of this initial proposal was funds for actual research grants-in-aid for projects already approved or to be readily approved from the experience of the United States Public Health Service. However, this would give no appreciable stability to research, would allow for no improvement in teaching in medical schools, would give no long-range stability to research projects, no funds for the construction of facilities, no appreciable administrative organization, and no control grants to States, such as have been so effective under the National Cancer Institute.

We would hence like to submit a new appropriation recommendation, much larger than the initial recommendation but broken down so as to make it readily evident that a larger sum is needed in order to begin an effective national heart program of more than a single year's duration. The necessity for the inclusion of new items and the longrange expenditure of funds in implementing such a program must be evident to Members of the Congress. We hence would strongly urge your careful consideration of the various items which control the sum of $15,302,769. This represents an increase of $12.658,681 over the present 1949 House approved estimate allowed the United States Public Health Service for its program in cardiovascular disease. While this may seem large, it would be possible by some such sum to begin an effective program of which we could be proud, and the benefit of which would be far reaching to the people of this country. I should like to stress also that this is a small sum compared with the importance of the problem in the future health and happiness of our country.

I should urge also that in order to implement this program, funds be made available until expended, or at least, as is true of present cancer funds, be made available for 4 years unless expended. Such qualification of available funds is essential if an effective program is to be developed.

I hence join heartily with my colleagues in strongly advocating your favorable action on heart legislation now being considered.

(The information is as follows:)

Requirements for a National Heart Institute

Preparation and distribution of antistreptococcus typing serum
Epidemiological studies a

Demonstrations a

119, 110

Similar to grants under National Cancer Institute. 2200 traineeships at $5,000 per annum; or 100 research fellowships at $5,000 per annum for a minimum period of 2 years.

This sum to be kept available until spent.

$1,875,000 to cover needs for 1 year, but amount is doubled so as to provide for some stability for research grants.

Note that this is less than 2 percent of entire requested appropriation.

Present 1949 allowance in United States Public Health Service budget, or the amount needed for 1949.

Present allowance.

Where additional amounts are requested.

APRIL 8, 1948.

Hon. H. ALEXANDER SMITH,

Chairman, Subcommittee on Labor and Public Welfare,
United States Senate, Washington 25, D. C.

DEAR SENATOR SMITH: At today's hearings on the proposed legislation to create a National Heart Institute, your subcommittee requested the American Heart Association to submit its recommendation as to the initial-year appropriation required for a national heart program.

The undersigned representatives of the American Heart Association propose an appropriation of $4,427,769 for the fiscal year 1949. As shown below, the 1949 House-approved estimate allows the Public Health Service $2,644,088 for its program in cardiovascular diseases. This is less than the $2,900,000 which the American Heart Association urged be appropriated a year ago. This plan, which on July 19, 1947, was justified in detail at the Senate Appropriations Subcommittee hearings on H. R. 4269 (pp. 101-107), covered a minimal need at that time. The current requirements include these needs, plus increases for fellowships and a start on construction grants to provide additional facilities for heart research.

In our judgment, a really effective heart program for the fiscal year 1949 requires an appropriation increase of $1,783,681 over the present allowance to the Public Health Service. This involves appropriating the full $550,000 recommended for intramural research under the National Heart Institute. With sufficient funds, the Public Health Service at its Bethesda laboratories will be able to staff and equip a diversified program of basic research in cardiovascular disease; in addition, it can establish a few small groups or "colonies" of its staff engaged in clinical studies in cooperation with several of the leading hospitals and medical schools in the country.

Many more research personnel must be trained if there is to be an adequate attack on heart disease. Since 1946, the Public Health Service has had a modest fellowship program for providing training in medical and physical services. Since last July, when the first estimate of $150,000 was made for heart fellowships, the rate of applications received for fellowships has increased fivefold. At least 10 percent of the total applicants express a special interest in cardiovascular fields. With the stimulus provided by passage of a comprehensive National Heart Act, increasing numbers of promising students in medicine and science will be attracted to the field of heart disease, if funds can be made available for their receiving specialized training. For these reasons we now recommend $500,000 should be provided to finance fellows and trainees in this field.

The original item of $125,000 for surveying research and clinical facilities is essential in planning the future development of heart research in this country. We know that adequate studies cannot be accommodated in existing facilities, but the location and extent of necessary expansion can only be determined after a thorough survey has revealed the areas of greatest need. The proposed erection of a 500-bed clinical center at the National Institute of Health will partially meet the need when it is ready in 1951 with 150 research beds and associated laboratories for heart research. The funds for this project are in a separate appropriation bill now before the Senate.

A national heart program should include construction grants by the Federal Government to assist public and nonprofit research institutions in financing erection of additional laboratory and clinical facilities. The survey would provide the basis for selecting the most essential projects throughout the country. The appropriation should include at least $1,000,000 to establish firmly the interest of the Federal Government in the expansion of heart-research facilities. In the event planning or construction delays should delay some of the first projects so that the entire million dollars need not be expended in 1949, the association suggests that the Congress make such funds available for construction until expanded

The above program, calling for an initial appropriation of $4,427,769 would provide a sound basis for starting an all-out attack on the problems of heart disease. The amount of funds required is, in our judgment, a minimum estimate, but any funds which could not be wisely and economically expended in the first year could be used to underwrite grants for essential research projects requiring prior assurance of financial support over more than a 1-year period. The amount of future appropriations for heart disease should depend upon the national growth of interest in the problem and the demonstrated capacity of the Public Health Service to use its funds effectively.

ARLIE R. BARNES, M. D.

CHARLES A. R. CONNOR, M. D.,
DAVID D. RUTSTEIN, M. D.,

T. DUCKETT JONES, M. D.,

Representing the American Heart Association.

Dr. JONES. I might say that one reason I was selected for my position with the Helen Hay Whitney Foundation is I worked on the problem for many years, and I was made available to them from the House of the Good Samaritan of Boston, which is one of the few pioneer hospitals devoted to this problem.

I would like to stress that I have been mostly interested in research. I am sure that the committee is well aware of the fact that there is great need for knowledge in this entire field of heart disease, because