both of preventing heart disease and also of finding and treating the disease in stages earlier than those in which we now find and treat it.

It is in the therapy of damage the treating of existing disease that the chief medical advances against high blood pressure and the consequences of hardening of the arteries have heretofore been made. Still more benefits for the already-damaged heart and blood vessels will undoubtedly be developed.

But it is from the seeking out of the underlying factors behind the rheumatic, the hypertensive, and the coronary diseases, which account for a vast majority of the deaths from heart ailments, that the greatest dividends will eventually come.

In writing of the fundamental importance of seeking understanding of the mechanisms of heart disease, Dr. Paul White says:

"It is in this direction that attention and support in research by both private and public enterprise should certainly have the utmost priority, since the sooner we understand the causes of diseases, the sooner we can control them and, by reduction of their prevalence, cut down the present heavy need for hospitali zation for elaborate study and often prolonged treatment.

66*** * it is evident that the sooner we discover and thereby learn to prevent the underlying causes of heart disease, the sooner we shall rescue our young people and middle-aged population from cardiac invalidism and death, and the less effort, time, and money we shall need to plan for and expend in their care. An increasing mortality from heart disease per se in the years to come need cause no alarm, in fact, such may be welcomed provided death comes quickly, comfortably, and quietly while at rest in bed or easy chair at an advanced age, say 90, after a long and happy and useful life."

Once any of the presently unknown causes underlying these three is discovered, a great deal will have been accomplished. Of course, progress in the control of heart disease in one or all of the three great brackets may be made through the extensive and intensive application of partial measures which have emerged or are emerging almost daily from the laboratory. But medicine's most complete conquests over disease are largely embodied in the history of the discovery of specific or contributory causes of diseases; the greater benefits almost always await such discovery. Here, then, is the hardest core of the problem.

Scientific research is the method to get at this core, and there is agreement among medical, scientific, and public health authorities that wide, intensive, prolonged, and collaborative investigation, by competent investigators who can devote adequate time and energies to the task, is the paramount factor in develop ing the nationwide heart program. This research, it is also felt, can best be done in an atmosphere of freedom without regimentation and with support from diversified sources rather than from a completely centralized resource.

Results of such research may arise from a modest laboratory where a single scientist makes a discovery for which hundreds of others in great laboratories have been seeking. Or results may come from a large group of workers of which each subgroup concentrates its efforts, in accord with its specialized interest and training, upon one or more aspects of a problem. Both kinds of endeavor, of the individual and of cooperating groups, must be supported and encouraged in any comprehensive and adequate research program. The fields of research from which discoveries of benefit for the heart may come are, moreover, not merely those in which lie the primarily cardiovascular investigations. They may arise from other areas of general medical or basic scientific research, and intelligent support does not circumscribe itself too narrowly. Furthermore, in the United States, with a population becoming increasingly aged, heart and circulatory disease must be considered to a very important degree in their gerontological aspects. Thus, research should seek for basic understanding not only of heart disease problems but also of appropriately related gerontological problems. The sum of the aging problem is not made up of cardiovascular disease problems, but there is a significant relationship, and this relationship is to be taken into account in the development of research programs.

Although the further knowledges that research much provide are highly important, there is much that can be done today in the way of establishing and improving the application of what is known already. This has been stated with wise caution by Dr. Paul White: "Some things we have learned which can be applied at once through community effort, but we must take care at the same

Heart Disease (fourth edition); the MacMillan Co., publishers.

White, Paul D.: Recent Advances in the Medical Treatment of Heart Diseases. Bulletin of the New York Academy of Medicine, August 1947, second series, vol. 23, No. 8, pp. 441-453.

time not to delude ourselves and others with false enthusiasm based on the frequency of heart diseases alone and on the idea that we can at once institute a campaign to control them all."

Fortunately, there is today large sympathy for and a growing understanding of the needs of disease-control activities as well as research and of other problems in the national heart program. Realization of the public-health importance of heart diseases has crystallized in the last few years among the public and physicians and scientists. Today there are active associations, both of medical and of public members, with years of solid groundwork upon which to base the programs which are needed.

The healthy development of the American Heart Association as a strong national voluntary health agency is a striking demonstration of the fact that the United States has embarked upon a comprehensive attack upon heart diseases. Once a small scientific organization, the American Heart Association reorganized and reoriented a few years ago and today includes a large and increasing number of lay people in its membership and on its governing bodies. With its growing number of local affiliates and the expanding programs of research, education, and community service which the national and local heart groups furnish, it forms a nationwide network of voluntary health structures. Integrated with official structures, in particular the public-health departments, and with the medical profession through its societies throughout the country, there is provided the partnership of interests indispensable to the success of a great undertaking against heart disease.

The observance of the collaborative principle on the part of the groups interested in the cardiovascular disease problem is significant. Coordination is being achieved by the various agencies through the interchange of information and by a truly cooperative spirit. The American Heart Association and its affiliates, other interested voluntary organizations, foundations, and privately financed groups, mutually share the responsibilities with public agencies. An exemplification of this is particularly evidenced in the close working relationships between the American Heart Association and the National Heart Institute. The collaboration is not passive, but active and positive.

The National Heart Institute's existence and place in this partnership is another manifestation of the crystallized recognition of the importance of heart diseases. The National Heart Institute and its program also mark acceptance by the Federal Government of its responsibility in this problem.

Thus has been supplied the structure and the authority for vitally needed Federal support added to the efforts of those who have long been working toward a great national endeavor against heart diseases. Such a combination of forces, voluntary and official agencies in teamwork, has been characterized by many leaders in the heart disease field as an ideal arrangement which provides the best way to achieving the conquest of heart disease. Thus the administrative machinery, both Federal and non-Federal, is well founded, organized, and functioning cooperatively.

Although research is necessarily stressed, the need for the application of knowledge must also be emphasized. Medical research supported by agencies such as the National Heart Institute and American Heart Association has its reason for being the finding out of facts which can be applied for the common good. That there be as short a lag as possible between valid new findings and their application-and that existing knowledges be widely and well appliedis a responsibility to which all those concerned in the nationwide heart program are giving most serious attention.

The eventual goal is, simply expressed, the prevention of heart diseases. Consequent upon this would be their reduction as the major cause of death before advanced old age, and the extension, as far as possible, of human life and health for both old and young through healthier hearts and circulatory systems. Toward this achievement is directed the attack upon the Nation's leading killer and great public-health problem.

RESEARCH STUDIES

At once the pace, the depth, and the range of the total heart research attack are keyed not only to personnel but also to available facilities and funds which stimulate research as well as provide the means with which to do research. In the past, heart research did not proceed as it profitably, from the standpoint of the increment of knowledge, might have done.

The mobilizing, strengthening, and expanding of America's resources in heart research which began only a few years ago has since that time resulted in perhaps the most promising advances seen in any of the major chronic illness fields. This has meant that the Nation was no longer postponing, but, in a very real sense, was providing itself with medical benefits to be realized in the foreseeable future. The Nation is making up for the lean years of insufficient interest and support.

Scientific publications ranging from clearly clinical reports of new or improved therapies to very fundamental reports in basic fields portray to the research and medical world the advancement of knowledge that has accrued through the programs of heart research support, public and private, although these programs have been in operation to a sizable degree hardly 5 years. A complete list of these accomplishments, represented in the published findings of the scientists, would show a tremendous range of basic and clinical progress along the whole frontier of heart disease and would require volumes merely to list.

Perhaps not a great deal of this progress reported in professional journals has apparent significance. The headlines and stories in the press, the encouraging articles in popular magazines, and the reports of television and radio hailing the achievements of heart research have, though perhaps overemphasizing advances in some instances, provided some public interpretation of this progress. A fundamental observation in the field of cellular physiology, which may well not today be related to a predictive test for premature hardening of the arteries has nevertheless a future potential. Research has been called guerrilla warfare against the unknown, and its forages and attacks are often remote and difficult to assess tactically. Particularly is this true of the more basic research.

To assay the new information added in the past few years as a result of the expanded nationwide research attack and with certainty to announce or predict its ultimate significance is not possible. Retrospect provides the truest evaluation; today, for example, it is possible to trace back to years ago the developments in related fields, such as physiology, which helped make possible current striking achievements in heart surgery. A seemingly small discovery of today or last year may provide a clue or become a turning point which leads to the development of preventative measures for atherosclerosis, the form of hardening of the arteries which eventuates in many coronary heart attacks.

It can be said, despite the unpredicability of the pieces of information which science must slowly but surely fit into patterns, that the programs of support for heart research in the past 5 years have resulted in stepping up its pace, in widening and deepening it, and in bringing ever nearer the day when untimely death and long-term suffering from heart disease will be drastically reduced.

RESEARCH TRAINING

When the Nation's resources against heart disease began to be strongly mobilized a few years ago, it was said that the first and greatest need was for additional trained and capable men and women, particularly in scientific fields because research offered the paramount hope for the conquest of heart disease. This need, like others, has had concerted and cooperative effort directed toward it since that time, by such organizations as the American Heart Association and its affiliates, foundations, and other private organizations, and the National Heart Institute.

It is however, a continuing need. Efficient, trained researchers are too few in number not only in the special field of heart disease but also in basic disciplines like physics, chemistry, biology, physiology, and so on, from which come scientific knowledge of fundamental importance.

The progress to date in research training is encouraging. Though perhaps not large in terms of numbers, a new and more highly trained group of younger scientists is being added to the Nation's research potential at a time when there is critical need and demand for such personnel on almost all scientific fronts. The programs for research training throughout the country are increasing the caliber of research workers in medical and allied fields. Not only is this true because of direct support given to men and women, as research fellows, to permit and stimulate them to enter into and remain in research work. It has also been helped, indirectly, by the programs of support, like the National Heart Institute research-projects grants, for research studies. For the assistants and technicians who work with and help the scientists directing an investigation also, by learning while doing, receive a not inconsiderable research training.

It is, further, worth noting that the programs for research fellowships and research training are resulting in definite research advances, additions to our knowledge of heart disease, emanating from work done as a part of the research training itself. Examples of this appear frequently in medical and scientific journals in reports of studies authored by heart-research fellows either alone or in collaboration with others.

Because of the many promising avenues of investigation that have been opened in heart disease in recent years, this field and the basic related sciences cannot, however, afford smaller numbers-and can well use greater numbers of highly trained workers who are at a stage in their development where they can establish and carry on important research studies.

MEDICAL TEACHING

That heart teaching in the medical schools could be improved and expanded has been recognized and the schools have done much toward this end. The need, however, is a continuing one, that grows as it continues. The rapid and marked advances of heart research have brought this about, having, in a sense, a disconcerning impact upon medical education.

Not only is the subject matter of medical-school courses influenced as new knowledge is obtained, but, because of advances in clinical methodology and instrumentation, the mechanical and physical means of medical instruction are also affected. To maintain up-to-date instruction on heart disease it has become increasingly necessary that the schools put extra time, money, and effort into a constant improvement of their heart-teaching program.

The schools have manifested not only interest and willingness but also have taken positive action, to the extent that available funds and support and the particular condition within each school permit, to strengthen and improve heart teaching. The direction that this effort must take varies from school to school and can only be determined by the school itself in the best American tradition of academic freedom. In some places the major needs are for differently trained personnel, in some for additional personnel, in others for improved teaching equipment, and in still others for an expanded curriculum or greater coordination. The investment which the medical schools and their supporters, both public and private, are making in this field is an investment in better heart care for the people of the United States. The medical students of today are the doctors of tomorrow. Already the percentage of heart-disease cases in the average medical practice is high; the number of persons who will go to their physicians because of heart disease will increase still more in the coming years. It is therefore, especially important that students now and in the future be given strong courses of instruction in heart disease, thoroughly covering the latest advances.

MEDICAL TRAINING

The programs of training for already practicing physicians in the clinical aspects of heart disease conducted throughout the country through the auspices of medical societies and cooperating groups, such as heart associations, health departments, hospitals, and medical schools, have strengthened in recent years and represent a healthy and encouraging facet of the nationwide endeavor against heart disease. Reflecting work toward meeting an increasing need, these programs range from single lectures through short courses, symposia, clinics, longer-term courses, and so on to sustained, intensified training for a year or

more.

If these programs were not in existence, or if they were not to continue and grow, a serious gap would be left in the national attack on heart disease. For through them physicians-and allied workers because there are also courses for professional personnel such as nurses-are better fitting themselves for clinical and other phases of activity in the heart field, both in practice and academic medicine.

There is a new philosophy toward heart disease, once considered inevitable and unconquerable. The attitude of unreasoning fear and spirit of fatalism used to pervade both the public and the professions. Physicians and researchers today have a positive approach and philosophy. But heart disease still meansto too many of the general public-a short life and a death sentence. The fact that this attitude is changing is itself encouraging. But it is changing slowly. Not all know, as they should, these basic facts:

Heart disease is not one but many diseases blood vessels *** with many causes.

* of the heart and the

Some types of heart disease can be prevented *** and some types can be cured.

It has been proved that, either without therapy or by medical and surgical treatment, every kind of heart disease formerly considered incurable and rapidly fatal, can be reversible.

Most patients with heart disease can be materially improved * * * not only saving lives but bringing useful, happy years * * * by proper treatment and management.

All types of heart disease can be handled best if diagnosed early and treated properly.

Heart disease does not necessarily prevent one from living comfortably and earning a living, providing the type of work is selected according to the limitations of the individual.

Symptoms and signs suggesting heart disease do not necessarily mean a diseased heart.

On the part of many medical authorities and scientists there is today confidence that within the next quarter of a century the Nation can master much, if not all, of the untimely death and disability caused by the major types of heart disease.

FELLOWSHIP AND RESEARCH GRANT AWARDS, 1952-53

AMERICAN HEART ASSOCIATION, INC., NEW YORK, N. Y.

The American Heart Association has established fellowships to develop a continuing program of productive research and to develop future leaders in the broad field of cardiovascular function and disease. Two classes of fellowships are awarded annually as follows:

1. Fellowships for established investigators, open to individuals of proven superiority and originality with a doctorate or equivalent degree, who are interested in a career in research.

2. Research fellowships, open to graduates of approved medical or graduate schools who are interested in research and intend to follow an academic career. Career investigatorships are available to a few outstanding persons of unusual ability and originality.

The American Heart Association also will support grants-in-aid for research in cardiovascular function or disease, or related fundamenal problems for periods of from 1 to 5 years, subject to annual review.

Applications for research fellowships, for established investigatorships and for grants-in-aid are considered once a year by the research committee. Nominations for career investigatorships are considered at appropriate intervals as funds permit. Application blanks and information bulletins concerning each of the various categories may be obtained from the medical director of the American Heart Association.

The awards listed in the announcement were made by the board of directors of the American Heart Association on recommendation initiated by the research committee and approved by the executive committee of the scientific council.

During the past year, applications for approximately 55 fellowships and 108 applications for grants-in-aid were received by the research committee. The limitation of funds available for research precluded the support of many worthwhile fellows and requests for research grants-in-aid.

FELLOWSHIP AWARDS

CAREER INVESTIGATOR

LORBER, VICTOR, Minneapolis, Minn., 40; University of Illinois School of Medicine, 1937; Ph. D., University of Minnesota, 1943; the study of myocardial metabolism, especially fatty acid and ketone body metabolism; the study of trace constituents of the myocardium; University of Minnesota Medical School. Original award July 1, 1951.

CONTINUED ESTABLISHED INVESTIGATORS

BLOCH, EDWARD H., Cleveland, Ohio, 37; University of Tennessee College of Medicine, 1945; Ph. D., University of Chicago, 1949; a study of the living microscopic blood, blood flow, and vessel walls in patients and experimental animals with