One of the earlier and more specific statements expressing this problem was made by William Parr in 1873 in a letter to the Registrar General as quoted by Hirsch (2): "The infectious diseases replace each other and when one is rooted out it is apt to be replaced by others which ravage the human race indifferently whenever the conditions of health are wanting. They have this property in com-mon with weeds and other forms of life, as one species recedes another advances." Dr. Rene J. Dubois in his extremely thoughtful treatise, "Medical Utopias,' writes (3): "In the field of infectious disease, we need not go far for examples. because the future is already with us. While mortality from acute bacterial infections is at the all-time low, chronic disorders of complex and ill-defined microbial etiology loom larger and larger on the horizon."

Therefore, we may postulate that as the health profession solves one problem through research, this very advance may create new biological equations which require solutions. The genetic instability of infectious agents with reference to chemotherapy or to spontaneous mutations provides examples. Another variant is the changing pattern of reservoirs of infectious agents. As long as a potential agent of disease continues an uninterrupted natural cycle, it may remain nonpathogenic or only mildly invasive. However, the current mobility and numerical growth of our population, the substantial changes in domestic and wild animal life moities, the altered nature of land usage, and many other developments tend to disequilibrate these relationships. The result is a continuous "spinning off" of newly invasive agents which are disease producing to various degrees. This pattern of biological adjustment will probably go on indefinitely. Man's only safety from natural or overt biological warfare is the leadtime achieved by research. This lead is precarious. The recent emergence of staphylococcal strains, for example, marked by their communicability and virulence and by high resistance to antibiotics, is recognized in many hospitals as the most immediately urgent of all infectious disease problems (4). The resistance of the anopheline mosquito to insecticides is a major threat to success of worldwide malaria eradication programs (5).

In my opinion methods of control can be found for almost any pathological state, but we cannot be complacent. Disease agents will change through the adaptive reactions demanded by their environments. We must maintain a constant research effort to gain adequate knowledge about infectious agents and their ecology. We must be able to understand the manner in whch men respond to the infectious challenges which continue to arise from the environment.

ADVANCES IN MICROBIOLOGY

The National Institute of Allergy and Infectious Diseases has reported recent work that shows we are moving forward in our understanding of microbiology. The implications in terms of future public health programing can be envisioned. In collaboration with the Children's Hospital Research Foundation and the Washington, D.C., Welfare Department, Dr. Joseph A. Bell and his associates have demonstrated an epidemiological technique for intensive, detailed study of respiratory virus infections in a small population. They have traced a panorama of so-called undifferentiated respiratory illness, such as those caused by adenovirus, Coxsackie virus, and others. These studies in nursery and hospital groups have aided in the definition of the place of a new microbial group, the myxoviruses, in respiratory disease. These newly recognized agents were found to have caused more acute upper respiratory disease in the study group than Asian influenza during the pandemic year 1957 (6).

In collaboration with the animal research services of the U.S. Department of Agriculture, Dr. Robert J. Huebner and Dr. Francis R. Abinanti have demonstrated that parainfluenza virus occurs extensively in cattle. Preliminary studies (7) show a relationship of this virus to costly bovine respiratory diseases, particularly shipping fever. This may be a lead to recognition of a new animal reservoir of infectious agents which cause respiratory disease.

Dr. Sarah Steward, National Cancer Institute, Dr. Bernice Eddy, Division of Biologics Standards, and their coworkers revealed a filterable agent associated with tumor formation in mice (8), Huebner, Dr. Wallace Rowe, and associates (9-11) have applied precise virological methods to this mouse polyoma virus and have characterized it immunologically. They demonstrated its excretion in saliva, urine, and feces of infected mice, established its spread among mice by respiratory and intestinal routes, and showed it to occur as a contaminant of numerous transplantable tumors. The observations are pertinent to study of possible virus etiology in human cancer.

Dr. Carl L. Larson, Dr. Edgar Ribi, and coworkers of the Rocky Mountain Laboratory in Hamilton, Mont. (12), bave reported a method for harvesting cell walls free of contamination with cellular protoplasm. Fractionation of tubercle bacillus cell walls suggest a more effective, less toxic immunizing antigen can be obtained free of material which causes delayed hypersensitivity.

Perhaps these examples of research represent studies too intensive or specialized for the average health department to undertake, but, as I have suggested, there is a need and a role for the health department investigator in medical research.

APPLICATION FOR GRANTS

The application for a grant from the National Institutes of Health for research or training begins with the individual investigator. Thus, as a basic policy, the subjects of study are not prescribed, but instead follow the interest of the scientists themselves.

The application should be sponsored by the investigator's institution, since decisions must be made as to the adequacy of the research facilities available. When a grant application is received by the Institutes' Division of Research Grants, it is assigned to 1 of 33 study sections. These are composed mainly

of scientists from universities and medical schools. They assess the competence of the applicant and the merits of the proposed research.

Next, the application is considered in the light of the total research program of the institutes. The matter is then brought before one of the nine National Advisory Councils, composed of non-Federal leaders in science and public affairs. The councils have two functions: they review the actions of the study sections and make final recommendations to the Surgeon General of the Public Health Service, and they advise on general program policy questions.

Following council recommendations, the Surgeon General approves or disapproves the grants. If the decision is favorable, the Division of Research Grants handles the mechanics of payment.

So far as I have been able to determine, more professional and scientific people have participated in this program through membership on advisory councils and study sections than in any other medical research program in history. This broad participation by the scientific community is, we think, one of the great strengths of the extramural grants program.

In summary, it has been my purpose to describe the research grants program of the National Institutes of Health, to point out the health department's unique opportunity for productive research in the natural history of disease, and to explore the concept that infectious disease research today is prologue to the control measures of tomorrow. I am sure that great new challenges and opportunities for service lie ahead for the public health departments.

REFERENCES

(1) Meyer, K. F.: "The Natural History of Plague and Psittacosis." Public Health Report 72, pp. 705–718, August 1957.

(2) Hirsch, A.: "Handbook of Geographical and Historical Pathology." London, The New Sydenham Society, 1885-86.

(3) Dubos, R. J.: "Medical Utopias." Daedalus, summer 1959, pp. 410-424. (4) U.S. Public Health Service: "Proceedings of the National Conference on Hospital-Acquired Staphylcoccal Disease." Atlanta (Ga.) Communicable Disease Center, 1958.

(5) Simmons, S. W.: "Current Status of Insecticide Resistance in Industry and Tropical Health." In proceedings of the third conference, Industrial Council for Tropical Health. Harvard School of Public Health, Boston, 1957.

(6) Chanock, R. M., Parrott, R. H., Cook, K., Andrews, B. E., Bell, J. A., Mastrota, F. M. and Huebner, R. J.: "Newly Recognized Myxoviruses from Children With Respiratory Disease." New England Journal of Medicine, vol. 258: pp. 207-213, January 30, 1958.

(7) Abinanti, F. R., and Huebner, R. J.: "The Serological Relationships of the Strains of Parainfluenza 3 Virus Islolated From Humans and Cattle With Respiratory Disease." Virology 8, pp. 391-394, July 1959.

(8) Stewart, S. E., Eddy, B. E., Gochenaur, A. M., Borgese, N.G., and Grubbs, G. E.: "The Induction of Neoplasms With a Substance Released From Mouse Tumors in Tissue Culture." Virology 3, pp. 380-400 (1957).

(9) Rowe, W. P., Hartley, J. W., Estes, J. D., and Huebner, R. J.: "Studies of Mouse Polyoma Virus Infection. I. Procedures for Quantitation and Detection

of Virus." Journal of Experimental Medicine, vol. 109, pp. 379–391, April 1959.

(10) Brodsky, I., Rowe, W. P., Hartley, J. W., and Lane, W. T.: "Studies of Mouse Polyoma Virus Infection. II. Virus Stability." Journal of Experimental Medicine, vol. 109, pp. 439-447, May 1959.

(11) Rowe, W. P., Hartley, J. W., Law, L. W., and Heubner, R. J.: "Studies of Mouse Polyoma Virus Infection. III. Distribution of Antibodies in Laboratory Mouse Colonies." Journal of Experimental Medicine, vol. 109, pp. 449– 462, May 1959.

(12) Ribi, E., Larson, C. L., List, R., and Wicht, W.: "Immunologic Significance of the Cell Wall of Mycobacteria." Proceedings of the Society of Experimental Biology and Medicine, vol. 98, pp. 263-265, June 1958.

Dr. MERRILL. In that regard, our association has for a number of years been interested in this broad general field. There have been a number of resolutions by its governing council over the years and on page 2 of the written statement, that is presented as the most recent resolution which, in essence, it seems to me covers the broad areas that are being considered by these four bills here before the committee.

I will not take the time to read the resolution but in essence it does indicate an interest on the part of the association in these measures and an interest in having Federal action for the implementation of the ideas contained in the four bills.

There are still, as Dr. Stebinns indicated this morning, some urgent needs in the field of public health schools which are of particular concern to those of us who are in the administrative phases of public health. Yet, as the resolution itself indicates, we have a profound concern also about the training of physicians, of dentists, of the auxiliary personnel because it is the total public health team that has the impact on the health of our people and we realize that we, as a small portion of that total group in official public health activities go only as fast as the entire team moves forward in protecting the health of the people.

With reference to the first measure, H.R. 6906, I think it can be summarized by the one or two sentences on the bottom of page 2 of our

statement:

The association expresses the gratitude of the Nation's public health workers for the support that they have received in their schools from both government agencies and private groups. We come seeking more help, however, and give our support to the principles of H.R. 6906, the passage of which, we believe, is vitally necessary to the promotion and protection of the Nation's health.

Going directly to the other two measures, H.R. 10255 and H.R. 11651, medical and dental scholarships, I think I can summarize that, Mr. Chairman and members of the subcommittee, by indicating that we do feel that there is need for making provision so that we can make available to the cream of the crop of our high school graduates the opportunities for entering into medical and dental professional training, and I think with that statement I can just let the written statement itself carry an indication of the interest of our association in measures of this type, provision of scholarships of this type or encouraging the brilliant young men and women of our country to enter the health professions.

I think the data that have been given already by several of the other speakers, to some of which we refer in our statement, need no further application.

With reference to H.R. 10341, the institutional grants, again our association favors the concept presented in this measure. Yet there is

one item here that we would like to call specifically to the attention of the subcommittee.

Our association supports the general intent of this bill but would give its specific support to its principal idea in the event that the words "health departments" were inserted in the proper place, suggested line 8, page 1, between the word "laboratories" and the phrase other institutions." We understand that this would be possible under the present measure that the administrative intent is to concentrate in other areas and we feel that it is imperative that encouragement be given to public health research, as such, and that the institutional grant should be available to public health departments as it is to other types of institutions.

Mr. Chairman and members of the committee, there are a number of reasons why we think this is the case and again we have delineated those in our report and I would like just to indicate one or two ideas with reference to this.

We, in the application end of the health services in Public Health, feel that too frequently there is too long a lag existing between the acquiring of the scientific knowledge and our ability to actually put it into practice and I need mention as one example, for example, the Salk vaccine for polio where we have had it now for several years, it is highly effective, and yet 40 percent of our people at risk have not availed themselves of the utilization of this lifesaving prophylactic and our feeling is that we need to do research on why this is the case and it is the official operating Public Health departments that work with the community that are in the position to carry on this type of research.

I could enumerate a number of instances if time permitted in a number of other areas where this type of practical applied research is necessary in order to bring these scientific advances really into action and in form so that they will protect the public health.

So, as far as this measure for institutional grants is concerned, as I indicated, our association favors this legislation. We would hope, however, that health departments would be specifically indicated in the measure itself to assure that we can compete in a sense with the other agencies on an equal basis forgetting the base support that is necessary in order for health departments to carry on this type of activity.

I think unless there are questions, Mr. Chairman, I will not take further time of the committee. I think these are the general ideas that we wanted to present to you.

Mr. ROBERTS. I know, Dr. Merrill, that you would have to be quite interested in your position in California in this whole problem of air pollution. What is your opinion about whether or not we have enough people adequately trained in the public health field to handle that particular problem?

Dr. MERRILL. I would think, Mr. Roberts, that there is a real shortage of people who are adequately trained to move into this area.

As I am sure you are aware, we have just recently made the first steps in California in establishing the standards of community air quality. We had to limit ourselves to a very limited number of agents simply because there was not enough information available concerning many of the other materials that appear in the atmosphere on which we felt we could definitively set standards.

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A tremendous amount of research work is going to be needed in order to refine those standards and to be able to substantiate them because when we get into a field like this, where the costs are so very tremendous, to make the corrections we just must be right. We must have the real facts on which to base our actions as official operating agencies.

Mr. ROBERTS. It has been a very expensive operation as far as the State of California is concerned; has it not?

Dr. MERRILL. That is correct. There have been many, many millions of dollars expended by industry and by Government in our State in an attempt to solve this problem, and these expenditures are perhaps not great in terms of what is before us before the problem is actually solved, particularly as we move into the field of control of the individual automobiles that function in our State.

Mr. ROBERTS. I know your legislature recently passed a law requiring the new type of smog device or eliminator of unburned hydrocarbons on all new vehicles sold in that State, I believe, beginning

in 1961.

Dr. MERRILL. Well, it begins 2 years after the new board authorized under the law certifies two or more devices that are approved. Mr. ROBERTS. Of course, you are also left with the problem of vehicles coming in from other States because I know your State has a large number of tourists at all times.

Dr. MERRILL. Surprisingly enough, though, in terms of the total percentage, it is the local automobiles that really present the problem. Even in Los Angeles, it is estimated that upward of 95 percent of the automotive miles are by residents of the county.

Mr. ROBERTS. That is interesting.

Thank you very much, Doctor.

Are there any questions, gentlemen?
Thank you.

Dr. MERRILL. Thank you very much.

Mr. ROBERTS. Our next witness is Dr. C. V. Rault, Georgetown School of Dentistry, representing the American Association of Dental Schools.

Dr. Rault.

STATEMENT OF DR. C. V. RAULT, DEAN OF THE SCHOOL OF

DENTISTRY, GEORGETOWN UNIVERSITY

Dr. RAULT. I am Dr. C. V. Rault, dean of the School of Dentistry, Georgetown University, and a member of the Committee on Legislation of the American Association of Dental Schools.

It was my privilege to appear before this committee in 1958 and I am pleased to be here again to review with you the needs which the dental schools of the country have for legislation such as proposed in H.R. 6906, H.R. 10255, and H.R. 11651.

With me is Mr. Reginald Sullens, secretary of the association, who will assist me in answering any questions which the committee may have.

The fact that the committee has called this hearing illustrates its awareness of the critical health care problems which face the Nation unless steps are taken promptly to assist the schools of dentistry, medi