Another outstanding development is the use of antibiotics in the prevention and treatment of subacute bacterial endocarditis, a form of heart disease which was once fatal in almost every case.

There have been many advances in the medical and surgical treatment of diseases affecting the blood vessels in the arms and legs.

These accomplishments, although important, are small in comparison with the job that remains to be done. The basic causes of the most common types of heart disease remain unknown. Their discovery, and the progress in prevention and therapy that will follow, still remain in the future.

Dr. WRIGHT. Now, there are other private agencies which make a real contribution to medical research.

It is impossible to list all of the foundations from which money is obtained for individual investigators. The life-insurance medicalresearch fund gives large grants during each year, amounting last year, I think, to about $800,000 or more.

I say that from various private sources money is beginning to come into the heart field, but when we are talking about a group of diseases that affect 10 million people, $2 million, or $5 million is 50 cents a head for the people that have the diseases, and that does not seem excessive. In fact, it seems almost miscroscopic.

In addition to these private groups, of course, is the great contribution made by the Public Health Service, and in this particular area of special interest is the National Heart Institute.

Now, I should like to ask Dr. Watt to speak regarding the National Heart Institute.

STATEMENT OF DR. JAMES WATT, DIRECTOR, NATIONAL HEART INSTITUTE, NATIONAL INSTITUTES OF HEALTH, PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, WASHINGTON, D. C.

Dr. WATT. Mr. Chairman, I am Dr. James Watt.

The CHAIRMAN. Will you give your name in full and position for the record?

Dr. WATT. I am Dr. James Watt, Director of the National Heart Institute. I am a regular corps officer of the United States Public Health Service, and have been for number of years.

The work of the National Heart Institute has been given to you in considerable detail in the general statement, titled "Heart Disease," which the chairman has indicated will be made a part of the record of this hearing.

We are a little apologetic about the length of this statement which we submitted, but the importance of this problem is such that we believe detail is desirable and should be considered.

Our own program, representing Federal portion in the partnership of resources against heart diseases parallels and complements in many areas that of the American Heart Association. Our activities are divided into two broad areas, first those in the grants field and second those in our own research operations within the Public Health Service. This comprises, as you are quite aware, the actual budget structure for appropriation purposes.

I have with me a brief budget history of the National Heart Institute, which I would like to submit for the record if you feel that this would be useful. It is a summary of the appropriations of the National Heart Institute since its inception, following its enabling act in 1948.

The CHAIRMAN. That will be accepted and made a part of the record.

(The matter referred to is as follows:)

National Heart Institute-Appropriations from inception of the program (excluding contract authority)

Dr. WATT. I would like to summarize rather briefly the division in our activities.

One major division is the research grants area.

Dr. Jones referred to it earlier and gave you a brief summary of how this research-grants mechanism operates. We believe that it truly keeps this research program in the hands of the men who are doing the research.

The scientists from the universities and the various other research organizations throughout the country come to our study-section meetings and pass, in an objective fashion, on these research grants.

They are submitted by the individual through the institution or organization in which he works and thence come to the study sections. The applications are reviewed by scientists on the basis of scientific merit.

The council, another group of individuals, another group of people, also meets and reviews these.

They do not spend time duplicating the work of the study sections, but rather their job is to look at these applications in relation to need, in relation to the development of a program, in relation to actually bringing to bear the full weight of our resources on the important phases of the program.

The two groups of organizations complement each other. Scientific judgment of the study section is essential, but also it is important. to have with it the judgment of both professional people and laymen looking at the overall picture of the problem and the available resources. Our councils do have, in addition to the professional mem

bers, leaders in community service throughout the country. The doctors in this help us develop the actual program itself.

Dr. Jones is a member of the Heart Council, and Dr. Andrus is soon to be one of our council members, and has also participated in the grant program in many ways. He is at present in a research laboratory made possible by Federal construction grant money.

We have with us today, if there are any detailed questions you would like to have answered, Dr. J. Franklin Yeager, who is in charge of the research-grant program as well as the teaching-grant program of the National Heart Institute.

The intramural research work done largely at Bethesda both in the Clinical Center and in the other research laboratory buildings is another important part of the Heart Institute program.

I shall speak chiefly of projects being carried on now.

Dr. Berliner who is chairman of our committee of laboratory chiefs is also here and he can give you some comments on the dif ferent types of scientific work that is going on.

We have a number of laboratories, some of whose names may not very directly relate to cardiovascular disease. For example, Dr. Berliner on my left is in charge of the laboratory 'of kidney and electrolyte metabolism.

Superficially, this might seem a little off from cardiovascular disease, but I am sure from the statement you heard earlier about the relationship of the kidney to hypertension you see that there is a direct relationship between studies involving the kidney and its functions and the study of cardiovascular disease. Some others are the laboratories of chemistry of natural products, cellular physiology, and chemical pharmacology.

This only gives a beginning idea of the many things that go on in the Heart Institute.

I could go on talking for a long time, but most of the information is in our prepared statement. I believe it would be much better to let you ask specific questions. If you wish to go into any of the details of the program any of the three of us who are here will be glad to take part in it.

Thank you.

The CHAIRMAN. Mr. Dolliver.

Mr. DOLLIVER. You have been the Director of the Heart Institute for several years; have you not?

Dr. WATT. Less than a year. Dr. Van Slyke, who is here, was the original Director of the Heart Institute and he is now Associate Director of the National Institutes of Health.

Mr. DOLLIVER. How long have you been in your present capacity? Dr. WATT. Since the 1st of December.

Mr. DOLLIVER. Since the 1st of December?

Dr. WATT. Yes, sir.

Mr. DOLLIVER. I am sure, as a matter of public interest that we would be glad to know the number of people that are engaged in this kind of work directly under you, Doctor.

Dr. WATT. At the present time?

Mr. DOLLIVER. I am talking about the grants to the different universities and the work at the Institute.

Dr. WATT. Would you like to have that by just the different types of scientists and different types of workers?

Mr. DOLLIVER. That would be all right.

Dr. WATT. Could we submit that for the record to go with this budget material, Mr. Dolliver?

Mr. DOLLIVER. That would be very good.

Dr. WATT. All right, sir.

(The matter referred to is as follows:)

National Heart Institute personnel

Research staff:

Professional (medical officers, chemists, physicists, etc.)

Technical assistants (biological, chemical, electronics, etc. aides) __

Total

Research-and-training-grants staff:

Professional (doctors of science) –

Other (clerical, typists, stenographers, etc.).

Total__

Administrative staff:

Professional (Director, executive officer).

Technical and clerical (fiscal analyst, secretaries, etc.) –

Total____

Mr. DOLLIVER. Now, there is a subject that maybe you do not wish to answer, and maybe you cannot answer, but I think it would be very excellent if it could be answered and come from this hearing. What do you consider the outstanding accomplishment or accomplishments in this field that have come about as the result of the activities of the Heart Institute?

I realize it has been in existence a relatively short time and maybe you cannot put your finger on any direct answer to that question. If you could I am sure it would be of great interest to me, and I believe others as well.

Dr. WATT. That is a tough one to answer, since so many of the developments that occur are really evaluated by hindsight rather than foresight. You look at a new fact today, and you hope it is going to be the key, a rather broad part of the picture. Ten years from now you look back and say, "How could I have been so foolish?" On the other hand maybe you have a key fact worked out. I would be very happy to mention a few of the items that appear to be of particular importance now.

Mr. DOLLIVER. Please do not mistake the purpose of my question. It is not to embarrass you in the slightest, Doctor.

Dr. WATT. Yes, I understand. I am perfectly happy to try to answer. As I say, we really do not think of findings in terms of what is the most and "bestest" of any given time, so it sort of takes you a little unaware when you are asked that question.

I would say this, that some of the studies being run now in the field of atherosclerosis, the field Dr. Andrus talked about, have some of the most exciting possibilities. I think that is probably the work referred to in the article quoted by Mr. Wolverton.

Mr. DOLLIVER. Would you care to be specific at that point?

Dr. WATT. It is a study of the factors which enter into the metabolism of the protein and fat molecules which are in the blood stream. The study actually is beginning to get at the mechanism by which the body takes a big fat molecule and breaks it down into a small harmless

molecule. This involves the study of enzymes, involves organic chemists, and involves a very complicated form of physical work. The ultra centrifuge is used at extremely high speeds for an opposite purpose for which the centrifuge is usually used. The centrifuge you think of as a device to throw heavy particles to the bottom of a tube you are spinning. Actually, Dr. Gofman who came up with this idea, reversed that process, and he used the centrifuge to float particles. This was made possible by adjusting the specific gravity of the fluid in which the blood serum was placed.

It is a technique of study which has let the scientists examine these molecules called lipoproteins, to see how frequently they occur and in what kind of individuals they occur. It has also let them use the enzymes to determine how to split them, how to improve the method of handling them.

Mr. DOLLIVER. Let me see if I can paraphrase your statement correctly. I have not the scientific language at my command that you have, but what you have said, in substance, is that your researchers have gone into the blood stream and you have tried to analyze the various ingredients there of the blood?

Dr. WATT. Right.

Mr. DOLLIVER. To determine how the blood converts certain elements that go into the body into useful or nonuseful deleterious substances that may result in arteriosclerosis or other diseases. Does that somewhere nearly paraphrase it?

Dr. WATT. That is awfully close to being exact. The only variation I would make is that at the moment we do not know which is the cause and which is the effect. We know these substances are present in atherosclerosis. Is there something which causes both of them, or is one the cause of the other?

Mr. DOLLIVER. In other words you do not know whether it is the cause or the effect?

Dr. WATT. We do not know whether it is a hen-and-egg relationship or something else, a third factor which causes both of them.

Mr. DOLLIVER. I take it, too, that in this research into this particular item you are using all of the facilities of chemistry, physics, electronics, radiology, and atom-smashing elements, all of those kinds of things that are available to the modern scientist?

Dr. WATT. Yes, sir, we are, and we are just beginning to use a facility which is just being completed, a clinical center which will let the Public Health Service for the first time actually have at the National Institutes of Health a clinical facility as well as laboratory facilities. This is the first time we have been able to do the total job in the one place, and it makes that unique situation there. We hope that it will be used not only by the Public Health Service, but by everybody.

Mr. DOLLIVER. By the way, have you any patients over there at the present time?

Dr. WATT. Yes, we have patients now. There is a schedule of buildup, which will carry us to somewhere between 200 and 250 patients in total by the end of this fiscal year. Heart is going to have on a scheduled basis approximately one-fifth of the total space, and, as the total increases, the heart patients will increase at about that ratio. Mr. DOLLIVER. Do you have any other example you would like to give us?