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do so.

families and to our whole economy, we must do so. If we can take measures to relieve more human suffering than at present, we must

Judging by the response with which the announcement of this inquiry has been received by the agencies, both private and public, most active in the heart field, I am encouraged to believe that much has been done and can be done toward these aims.

This is the purpose of our hearing, and an outstanding group of individuals active

in the heart field has come to assist in this inquiry. The committee has endeavored to provide a plan that will guide our discussion, which I will place in the record at this time for the benefit of those who read the testimony, together with a list of witnesses who are scheduled to appear.

(The matter referred to is as follows:)

HEART DISEASE

AGENDA

1. Purpose of the inquiry: Statement by committee chairman. 2. Where are we today with regard to heart disease compared to several years

ago?

The significance of heart disease.
Rheumatic heart disease: what is is, its importance, what we know

today in the way of prevention and treatment, where we stand in

research, where we stand in application of knowledge. High blood pressure and hypertensive heart disease: what it is, its

importance, what we know today in the way of prevention and treatment, where we stand in research, where we stand in application of knowledge. Hardening of the arteries and arteriosclerotic heart disease: what it

is, its importance, what we know today in the way of prevention and
treatment, where we stand in research, where we stand in application

knowledge.
Other types of heart disease.

By private or voluntary organizations on the community, State, and
funds are being employed in the attack on heart disease? What are the
cooperative relationships? How is coordination achieved ?
By private or voluntary organizations on the community, State, and

National levels.

By public agencies on the community, State, and National levels. 4. What are the goals, the weak spots, the obstacles to progress, the needs?

In research.

In the application of knowledge. 5. What are recommendations for strengthening the nationwide attack on

heart disease?

In research.
In research facilities.
In research training.
In medical education and teaching and training.
In community services.
In public education.

PARTICIPANTS

Dr. Irving S. Wright, past president, American Heart Association; professor

of clinical, medicine, Cornell University Medical School. Dr. T. Duckett Jones, medical director, Helen Hay Whitney Foundation, New

York City. Dr. Robert W. Wilkins, vice president, American Heart Association. Dr. E. Cowles Andrus, Johns Hopkins University, president-elect, American

Heart Association. Dr. Edward J. McCormick, Toledo, Ohio; president, American Medical Associa

tion.

Dr. James Watt, director, National Heart Institute.
Dr. Robert W. Berliner, chairman, committee of laboratory chiefs, National

Heart Institute.
R. O. Betts, executive director, American Heart Association.
Dr. Jean Jones Perdue, member, board of directors, Miami Heart Institute, and
practicing physician.

The CHAIRMAN. You gentlemen, and our distinguished lady, have already been supplied with a copy of this guide, so to speak, and we assume that your testimony will have regard to it.

The committee is honored to have with us this morning representatives of the American Heart Association, the National Heart Institute, the American Medical Association, and other outstanding authorities in heart diseases.

Dr. Irving Wright, of the Cornell Medical School, and former president of the American Heart Association, we are honored to have with us this morning. I understand that he and his associates in the American Heart Association and colleagues of the National Heart Institute are prepared to assist the committee in evaluating the problems this disease presents to the American people.

Doctor, I want you to proceed at this point, to take over as it were. In the past the usual procedure of this congressional committee has been for the chairman to call the different witnesses who are to appear. However, for the purpose of these hearings we have adopted a different course. Dr. Wright has been selected by those who are interested in this subject to act, so to speak, as the leader of the discussion. The discussion will, therefore, naturally, take on something of the appearance of a symposium.

We hope in this way to make it extremely informative and informal and to gain the greatest possible amount of information.

We want Dr. Wright to proceed just as he sees fit.

I would suggest that Dr. Wright introduce those who are present and who will testify in the hearing.

For the assistance of the reporter we have asked the different doctors to have their names prominently displayed upon their person so that the reporter may know who is speaking.

I have some doubt, however, as I look at your tagging, about whether it will be possible for him to read their names.

The reporter shakes his head in accordance with the statement I am making. Therefore, I would suggest, as an assistance to him, and in order that the record may be complete, that when a doctor speaks either in answer to a question by Dr. Wright or by anyone else or makes any statement that he preface it with giving his name, and in the first instance when you speak not only give his name, but give his identity with the heart activity and where he is located so that his testimony will take on added significance and importance because of the position that he occupies in this regard.

Now, Dr. Wright, will you please proceed. Before you do so I will ask the members of the committee if they have any comments that they wish to make at this time or suggestions. If not, then, Dr. Wright, will you take over?

Dr. WRIGHT. Thank you, sir.

I wish, first of all, to express the grateful appreciation of the representatives of the American Heart Association, the National Heart Institute, and others who are here to contribute to this symposium testimony, for your generosity in inviting us and also for the very splendid manner in which you have proposed that we may proceed. I think and hope that we will be able to make a real contribution. I know that the members who are here assembled have come sometimes at some inconvenience because of the great importance of the problem as you have outlined it.

I am going to ask each of them—may they stand when they identify themselves so that everyone can see who they are?

The CHAIRMAN. I think that would be well, and before you proceed may I read a letter which has just come to my attention from Oveta Culp Hobby, who is Secretary of the Department of Health, Education and Welfare, dated September 30:

DEAR MR. WOLVERTON : Your September 18 letter, informing me of the committee hearings scheduled to begin October 1, and inviting me to send a special representative of my office to attend the hearings, is much appreciated.

The Assistant Secretary of the Department, Mr. Russell Larmon, responsible for legislation and congressional relations, is asking Mr. Donald Counihan, congressional liaison officer, to maintain continuing contact with the committee. In addition, Dr. Chester S. Keefer, Special Assistant to the Secretary for Health and Medical Affairs or his assistant, Mr. M. Allen Pond, plans to attend some of the committee hearings.

If through Mr. Counihan's services or in any other manner we can be helpful to you and the members of your committee and its staff, I hope you will let us know. Sincerely yours,

OVETA CULP HOBBY, Secretary. That leads me to inquire whether there are other representatives of the departments of government present today who would like to have their names made a part of the record.

I have the names presented to me of the following:

Dr. R. Keith Cannan, Division of Medical Sciences, National Research Council, Washington, D. C.; Dr. Stella L. Deignan, BioSciences Information Exchange, National Research Council, Washington, D. C.; Dr. Philip S. Owen, Division of Medical Sciences, National Research Council, Washington, D. C.; Dr. D. E. Price, Assistant Surgeon General, Public Health Service, Washington, D. C.; Dr. H. Burr Steinbach, Assistant Director for Biological and Medical Sciences, National Science Foundation, Washington, D. C., and Dr. C. J. Van Slyke, Associate Director, National Institutes of Health, Washington, D. C.

Now, if there are any others present than those whose names I have read I will be pleased to have you stand and identify yourself and give your name and position so that it may be made a part of the record.

Very well, Dr. Wright, you may now proceed in your own way.

Dr. WRIGHT. I am going to ask Dr. T. D. Jones to stand first and identify himself.

Dr. JONES. I am Dr. T. Duckett Jones, vice president and medical director of

the Helen Hay Whitney Foundation, vice president of the American Heart Association and a member of the advisory committee of the National Heart Institute called the National Advisory Heart Council.

Dr. WRIGHT. Dr. Perdue.

Dr. PERDUE. I am Dr. Jean Jones Perdue, of Miami Beach, Fla., a member of the board of directors of the Miami Heart Institute, a

member of the board of directors of the Miami Heart Association and a practicing physician in Miami Beach, Fla.

Dr. WRIGHT. Dr. Yeager.

Dr. YEAGER. Dr. J. F. Yeager, Chief of the Grants and Training Branch of the National Heart Institute located out at Bethesda, Md.

Dr. WRIGHT. Dr. Berliner.

Dr. BERLINER. Dr. Robert W. Berliner, chairman of the Committee of Laboratory Chiefs of the National Heart Institute.

Dr. WRIGHT. Dr. Robert Wilkins.

Dr. Wilkins. Dr. Robert W. Wilkins, associate professor of medicine, Boston University School of Medicine, director of the cardiovascular research laboratories at the Evans Memorial Hospital, Boston, and vice president of the American Heart Association.

Dr. WRIGHT. Dr. Andrus.

Dr. ANDRUS. Dr. E. Cowles Andrus. I am president-elect of the American Heart Association, associate professor of medicine, Johns Hopkins University, and physician in charge of the adult cardiac clinic at Johns Hopkins Hospital.

Dr. WRIGHT. Dr. Watt.

Dr. WATT. Dr. James Watt, director of the National Heart Institute, Bethesda.

Dr. WRIGHT. These individuals will speak on matters of policy in reference to the organizations which they represent and on matters concerned with research or medical opinions. They will be asked to speak as private individuals.

The CHAIRMAN. I would like to also make mention of the fact that the following members of the committee staff are present:

Dr. Stevenson, Dr. Stockburger, Dr. Borchardt, and our special counsel, Mr. John B. Teeter, executive director of the Damon Runyon Cancer Fund, who has assisted us in bringing together this symposium.

Dr. Wright. Before I proceed I should like to ask whether there are individuals who have been asked to testify who have not identified themselves thus far?

STATEMENT OF DR. IRVING S. WRIGHT, PAST PRESIDENT OF THE

AMERICAN HEART ASSOCIATION AND PROFESSOR OF CLINICAL MEDICINE AT THE CORNELL UNIVERSITY MEDICAL SCHOOL

I should first like to make a statement regarding the significance of heart disease as it affects the American people. Perhaps we should preface this by pointing out that heart disease is not a single disease, but it is a term which is commonly used to include many diseases, some of which I will mention.

Of these the three outstanding causes of death and prolonged illness are arteriosclerotic heart disease, hypertensive heart disease, and rheumatic heart disease.

Id addition, howover, there is a long list of other diseases which are capable of affecting the heart and the blood vessels in the body, and we include in this problem all of the blood vessels from the head to the toe, so to speak. These other diseases include problems of congenital defects either of the heart or of the blood vessels, syphilis, diphtheria, viruses, pulmonary diseases which secondarily put strain on the heart and affect the heart, tuberculosis, diabetes, excessive activ

ity of the thyroid gland, and various types of anemias or tumors which sometimes involve the heart and the blood vessels, various types of endocrine disturbances which secondarily involve the heart and many other diseases, almost too numerous to mention.

We will speak of them in our discussion throughout the day using the term "heart disease” as inclusive.

Now, here are some of the facts which are staggering to the imagination, but nevertheless represent the picture as heart disease affects our country.

In the first place, heart disease is the leading cause of death in the United States. It causes the death of or kills more than 1 out of every 2 persons that die each year in our country.

It is anticipated that in the current year about 785,000 people will die of heart disease.

It is less understood that heart disease is the leading cause of death among children.

It is generally thought of as being a disease which primarily affects the aged and maybe perhaps in some persons' minds is considered inevitable. This is a misconception, although it does affect a very large number of people as they grow older.

It causes about one-sixth of all the deaths in the military ages, that is between 20 and 39.

It causes one-third of all the deaths in the productive years, shall we say, the most productive years between 35 and 54.

It causes half of all the deaths in the ages between 55 and 74, and it causes far more than half of all the deaths after the age of 74.

Now, in terms of manpower about 31/2 percent of all the World War II selective-service registrants examined were rejected because of heart disease. That represents figures somewhat as follows:

Three hundred and seventeen thousand five hundred men were rejected as of August 1, 1945, because of heart disease.

About 80,000 men were given disability discharges from military service or died in service because of heart disease in the war years between 1942 and 1945.

It is readily understood that this involved younger men in the socalled prime of their physical life.

Rheumatic fever alone immobilized more than 40,000 men in the Armed Forces during World War II.

Rejections from military service for heart disease were high during the Korean conflict also.

In 1 area in 1 State it was found that 1 out of every 8 men rejected, all under 26 years of age, were turned away because of organic heart disease.

In the Navy alone, in World War II, 4 million man-days were lost because of rheumatic fever and rheumatic heart disease.

The actual or potential manpower contribution—to defense or the Nation's general productiveness of 1 person out of 15 or 16 is limited to some degree because he or she has heart disease.

Approximately 176 million workdays are lost yearly because of heart disease.

At least 653,000 man-years are lost each year in industry alone because of heart-disease disabilities.

It is estimated that in 1951 about $2,124 million was the cost of heart disease in loss of productivity.

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