Dr. JONES. Well, only that the purposes are very mutually connected. The Whitney Foundation is presently directing its attention toward the support of research in rheumatic fever; and the secretary and treasurer of the Helen Hay Whitney Foundation, Mr. Frederick Trask, is, I believe, chairman of the finance committee of the American Heart Association.

And I am in the Heart Association and serve as a vice president. I think there has been a very close cooperation.

In fact, in the Whitney Foundation office for a period of some years now there has been a cooperative effort between the council on rheumatic fever of the Heart Association and the Whitney Foundation to get as accurate data as possible on all those services throughout the country which are being directed toward rheumatic fever individuals. That has been a very close tie.

Mr. HESELTON. You referred to the necessity of adequate contributions in order to maintain continuity of research. Would you care to speak more about that?

Dr. JONES. I think I could speak very briefly.

In 1947 there was approximately $300,000 for rheumatic-fever research from agencies outside of medical schools, and so forth. We never know exactly the total amount. There were about 25 individuals who had established themselves as being able investigators with an interest in this field. There were only 3 men out of the 25 who had any real position or stable job. All of the others were being supported by very short-term grants from agencies outside of the sponsoring institution.

In 1952 the volume of research support had a little more than quadrupled. It was $1.3 million, approximately. The number of able investigators had increased from 25 to somewhere between 50 and 60. You realize that these are evaluations of a scientist's ability, and that is a pretty personal evaluation.

The number of stable positions had increased from 3 to 7. Today we have, with 50 or 60 able research workers of various and very different ages, working mostly in our medical schools and research institutes, only 7 jobs which give them any sense of security or continuity. I think they are all very secure intellectual individuals, but whether they continue to do this work is dependent upon some group of individuals sitting far away from the place where the work is initiated and carried on. That is one of the serious difficulties today with relation to research support.

In addition to that, their running expenses are subject to shortterm decisions by individuals outside of their own institutions and their own group; and I would believe that rheumatic fever, like all other areas of research in the health field, very badly needs funds which can be designated for use in such ways as to give assurance of continuity, so long as work is of a very high level of contribution. In addition to that, a number of places are very badly handicapped through lack of facilities: Laboratories and equipment. That is a very difficult type of money to get. The private agencies can afford to do very little of it.

So far as I am aware in the heart field, the only construction funds of any magnitude or importance were in the 1949 or 1950 fiscal budget for the National Heart Institute, when I think about $6 million was

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given, and 22 or 23 institutions were aided to develop more laboratory research space. That has proved an absolute godsend to those institutions, but there are now many that need such facilities, and among them are some of the best rheumatic fever workers in the country.

Dr. WRIGHT. Are there any other questions before we proceed with the question of hypertension?

Mr. MOULDER. Mr. Chairman?

The CHAIRMAN. Mr. Moulder.

Mr. MOULDER. Dr. Wright, you made a statement awhile ago that one out of each two deaths resulted from heart disease. Do you mean all types of deaths?

Dr. WRIGHT. All deaths.

Mr. MOULDER. Not only heart disease, but all deaths?

Dr. WRIGHT. Yes, sir. For example, in New York State 52 percent of the people who died last year died of heart disease, using the definition which I originally gave, in a broad sense.

The CHAIRMAN. Any other questions, gentlemen?

I would like to ask you this, Dr. Jones: Have you any thought to express as to how rheumatic heart disease can be prevented?

Dr. JONES. I did not understand the first part of the question, sir. The CHAIRMAN. Have you any suggestion to make as to how rheumatic heart disease can be prevented or diminished?

Dr. JONES. I think at the present time the use of prevention methods-particularly the early treatment of streptococcal infections and controlling epidemics of streptococcal infections is probably the one and only immediate weapon of any importance that we have. I do not think it will be a final answer or a permanent one; but that is what we have now. I think the Heart Association and allied efforts to get that applied is perhaps the most important phase, from a practical point of view, at present, toward preventing or minimizing rheumatic heart disease.

The CHAIRMAN. I have noticed that at times part of the advertising conducted by life-insurance companies is such that they have given advice with respect to certain diseases, which they considered would be helpful to the general public in preventing the particular disease to which the advertisement was directed at the time. Is there anything that can be done to advise or inform the public as to the situations that can create or would be likely to create rheumatic heart disease; and which, by proper advice, could be prevented?

Dr. JONES. Well, I think that now the only preventive knowledge that we have is on these sulfa drugs or the antibiotics; that is, of any great importance.

The life insurance educational programs could certainly help in utilizing that. I think they are entertaining such a program.

Not only that, but I think that the continual attempts to bring these knowledges to the medical profession are important. Last year when the council of rheumatic fever of the Heart Association met, they issued a statement advocating a daily prophylaxis and early treatment of the streptococcal infections with penicillin. That statement appeared in about 12 or 15 of the officials' organs of the professional groups; a great many of them medical; one social service; a hospital association; and so forth.

-I think that the Heart Association has as one of its very important responsibilities this type of an educational program. It is mentioned, I believe, in nearly all the annual meetings, the open meetings of the Heart Association, in various parts of the country, which are held for not only physicians but also the lay boards and the general public. So it is beginning to get a very wide range of educational coverage. And I hope that this will help tremendously in an increasing way until our knowledge is better than it is now.

The CHAIRMAN. Frequently we get valuable information as to what has been done and what can be done with respect to certain diseases through the campaigns which are conducted by different organizations for subscriptions to support their work. Aside from that type of information which is given to the public, is there any way, in your opinion, which would suggest a general dissemination of information to the public? If so, whose duty would it be or who could best do that, in your opinion?

Dr. JONES. Well, I think that the American Heart Association, as the one voluntary national health agency interested in this field, has this as a primary obligation, and is trying to fulfill it to the very best of its advantage. One of the most important features of such a program is professional education, because there is no question but that to be effective this must come to the attention of every physician, and he must be urged to use it in his daily taking care of individuals. I do not know of any appreciable way in which this could be much more effective than it is at the present time, except that I think that it might be concentrated on in a somewhat wider way; particularly with regard to the professional aspects of it.

I think that practically every medical group in the country in the past several years has had it presented to them, and that this is very helpful.

Also, I would believe that the National Heart Institute is very desirous of playing a role in this and that it has been very helpful.

Then there is, for instance, the Heart Bulletin, a magazine which goes to a number of States and every physician in the States through sponsorship of health departments, medical societies, and heart associations. It has had a number of articles on this matter. And I think the constant channeling of information to media of communication such as radio, television, newspapers, and to professional groups, is presently going on at a fairly intensive level.

I think some of the officers of the Heart Association could speak to that. Mr. Betts, the executive director of the Heart Association, is here. He has that as one of his responsibilities. Perhaps he would like to speak to it.

The CHAIRMAN. We will undoubtedly hear later from Mr. Betts. Do you prefer that we have a reply at the present time, Dr. Wright, or when he is on the program subsequently to speak at some length? Dr. WRIGHT. Well, sir, the American Heart Association has had an active interest in education through leading publications, and in the last year more than 50 of the leading magazine publications of the country have caried extremely informative articles on the problems of heart disease. Many thousands of statements and educational programs have been conducted over radio and television. In order to encourage this the American Heart Association has set up what is

known as the Blakeslee Award for the outstanding accurate informative writing in newspapers, magazines, and so on or in a television or radio production in the media of communication, shall we say of each year, for the purpose of encouraging just exactly what I think you are asking about. We are doing everything we can in our power to see that this is encouraged.

Dr. ANDRUS. Dr. Wright, in anticipation of this question I had a conversation with Mr. Betts, who is beside me here. He tells me that in addition to the large sums which are spent by the State heart associations in public education, 10 cents out of every dollar which comes to the national organization is used to disseminate lay information with regard to heart disease and its control.

The CHAIRMAN. Well, my question originated with the thought as to how much information of a lay character is possible, and how much should be from the standpoint of the physician. I rather gathered from what was said by Dr. Jones that it was very largely a matter which had to be handled through the physician, rather than by public dissemination of information. Is that so; or is there a place in the picture for public dissemination of information?

Dr. ANDRUS. I think there is a very large place for dissemination of well-founded information to the public. As you are aware, sir, physicians have difficulty in expressing themselves in lay terms. With the assistance of good lay writers I think that difficulty is being

overcome.

To say the least, the Heart Association and those in the field are awakening to the importance of disseminating information to the public; accurate information and information which will allay fear and provide accurate hope in the future.

The CHAIRMAN. What I had in mind was whether the situation is such that the dissemination of information to the public would materially reduce the number of those suffering with rheumatic heart conditions, or whether it is entirely a matter of treatment after they have it. Is there anything that can be done from a public standpoint in bringing home to them what, if anything, has a tendency to lead to rheumatic conditions, and, therefore, should be avoided? That is a layman's question.

Dr. WRIGHT. Will you answer that, Doctor?

Dr. ANDRUS. I think, as Dr. Jones has pointed out, that insofar as rheumatic fever is a consequence of an infection, the advice to the public to consult their physicians when they have sore throats is a sound means of prevention. I think that the insidious nature of the onset of rheumatic fever in so large a proportion of the incidence, as Dr. Jones has emphasized, would make it difficult for the layman to recognize the need.

Does that answer your question?

Dr. JONES. May I say, sir, in addition, that in some areas of the country-and we hope this will increase more and more—there are movements to develop programs which will help protect the identified rheumatic fever individual. And, in addition to that, efforts on a communitywide basis would help control streptococcal epidemics. For instance, in Youngstown, Ohio, there is a study in which all children with respiratory infections in the schools of Youngstown are seen by a physician and nurse, and cultures are taken to see if they have the streptococcus in their throat. They are promptly treated if

this turns out to be true. This is a very complicated and difficult problem, but cooperation between schools and varied agencies in the community, and private physicians and so forth, unquestionably is probably more important than the individual parent or family, in view of the fact that so much of the streptococcal infection is quiet and does not cause symptoms.

In Newton, Mass., in a demonstration program of the Public Health Service, there was a very beautiful communitywide program conducted with the cooperation of the physicians of that community to see that every known rheumatic got prophylaxis daily, and that streptococcal disease, wherever it appeared in the community, was promptly treated.

I am sure that that will increase, and it is one of the very important efforts which I think will result in a diminution of this health problem. The CHAIRMAN. What I am interested in, of course, is our particular opportunity for service in the Congress. Is there any definite opinion with respect to what Congress could or should do through public agencies by giving authority to them that they do not have at the present time, or to better utilize what authority they do have? Or, is it, instead of a Federal proposition, a State proposition, or a local proposition? In other words, in what way, if any, by legislation would it be possible for Congress, a State legislature, or a local governing body to be helpful in this particular matter?

Dr. JONES. Well, as the present research pattern in health is organized I think it unequivocally is true that the funds for research which are presently going to the Heart Institute and other institutes of health are very important. I would like to say that in approaching any one of these health problems if you support basic work you may surprisingly find that your research is helpful to a number of disease entities and not necessarily the one you are particularly interested in. That is a very important feature of research support, and it is vitally essential that funds for research not specified to rheumatic fever particularly but to the Heart Institute, and generalgrants program of the Public Health Service, be provided. That is one of the most important features in the advance of health knowledge throughout the country.

I would hope, also, that the Heart Association as a voluntary agency would continue to exert its efforts to raise funds for research, because this is of extreme importance to the health of the American people in other areas of heart as well as in rheumatic fever.

I would hope that through both agencies that there could be means. ultimately developed whereby we could give greater stability and continuity of assurance of support to outstanding workers.

I think the Public Health Service, National Institutes of Health, has given every evidence that it is interested in that and is accepting its responsibility.

I am not at all certain that there is any legislative need for changing the law to make that possible, but I do think that the level of funds is one way in which it could be helped.

So far as the motion with regard to applied knowledge is concerned, I would say that the local heart associations throughout the country, under the guidance of the national organization, have this as one of their major problems, and that they are doing as much as