Studies of incidence, causative factors, characteristics, and methods of treatment of specific complications of pregnancy, such as toxemia, infectious conditions, or fetal loss.

Long-term studies of girls, from the beginning of adolescence, to identify factors in adolescence that are correlated with maternal diseases and perinatal casualty.

Then there is a need for basic studies in all of the countries in diseases and other handicapping conditions of children.

For example, I have seen malnutrition in children from other countries due to intestinal parasites and other causes-children so undernourished and anemic that they are too listless to enjoy living and learning children whose very growth processes are being inhibited. Research is needed on the drug treatment of these parasites, as well as on the prevention of this infestation in so many children in so many countries. We need answers to such questions as: How fre quently is it necessary and safe to treat children to eliminate intestinal parasites? What drugs will prevent the intestinal population from draining the nutrition from these children?

Many other studies are need, such as:

Studies or major childhood diseases in various countries in order to develop methods for their prevention, treatment, and control as related to the culture of the country and the existing or needed health services-e.g., tetanus of newborn, diarrheal diseases, childhood anemias.

In the whole area of crippled children, as we studied crippled children prior to the 1935 act, it became apparent it was not easy to count the numbers by those that came to the hospitals. Teams were needed to find out how many there were, what kinds of handicaps they presented, and how we could manage to provide for these handicaps.

Other countries in various stages of development will need to make such a study of existing problems; and, as Miss Switzer has said, studies of children's prosthetics, such as medical and engineering studies for developing new types of braces and artificial limbs; and studies of how children learn to use prostheses, the age at which they can most profitably be fitted with them, and the cultural and family attitudes toward mutilation and toward acceptance of substitutes for the absent limb. All are important studies. We need to collaborate with other countries in making the most effective use of the gains that have been made in this country.

Studies pertaining to mentally retarded children; for example, studies of diagnostic techniques that are independent of cultural factors; studies of the frequency of various classes of retardation as related to factors associated with specific countries, such as the level of service to maternity patients, diet, climate, nature of the society. Epidemiological studies of congenital malformations, to determine distribution as related to such factors as geography, altitude, race, inbreeding, nutrition, epidemics of infectious diseases, background radiation and radiation exposure.

These illustrations merely serve to highlight a few of the aspirations for advancing the health of mothers and children in every corner of the earth which would be made possible under Senate Joint Resolution 41.

In conclusion, I want to join the Secretary and others in stressing that I think this bill presents one of the most effective means of pursuing our objective of intensified effort in international cooperation in the health field, though none of us would exclude other means, emphasizing as it does research and research training. This is especially true with respect to mothers and children. They make up more than 50 percent of the world's population. They are the groups most vulnerable to the cripplers and killers of mankind. They stand to receive the most benefit from worldwide health and medical research undertakings which would be made possible under the provisions of Senate Joint Resolution 41.

The CHAIRMAN. We certainly thank you, Mrs. Oettinger, for your

statement.

Senator Javits.

Senator JAVITS. First, Mr. Secretary, this is not an anti-Communist bill?

Secretary FLEMMING. I do not regard it as such.

Senator JAVITS. It is a bill for humanitarian activities and international cooperation?

Secretary FLEMMING. It is a bill to help other peoples to realize their highest potential.

Senator JAVITS. I emphasized that because I think there is so much thinking in the international field about the fact that everything has to be directed to the cold war struggle, and I myself think this is one of the most effective things we could do. I think the record should be clear that this is a humanitarian effort.

Secretary FLEMMING. That was the purpose, Senator, of the concluding part of my opening statement, to try to stress the very thing you are stressing now.

Senator JAVITS. I might say that I am inclined to agree with you as to the desirability of putting this in the hands of the President, but I will say that Senators Hill and Humphrey have taken such an outstanding lead in this particular field that I think all of us would want to see how they feel about that particular, before we jump. Finally, I will ask this question:

I noticed an explosive report on our population growth showing 90 million people added to the world's population in 2 years, and a forecast of astronomical increases in the human race.

Now, this presents us with many challenging problems. Since scientists today are more than just scientists, they are also politicians and to some extent diplomats, and everything else, I will ask you, Mr. Secretary, do you feel that a measure of this character will help us with our population growth, bearing in mind that it may contribute to the population growth, because the analysis is that because we have found how to extend life and reduce death rates, we have had this explosive population growth, through all of these medical activities throughout the world.

Now, can you tell us whether you feel-and I will say that I dothat it will help us to deal with the population growth far more effectively in terms of proportion than it will encourage the growth of population?

Secretary FLEMMING. I agree with you 100 percent, because I feel that the only way to approach that problem is in a positive way, and

37629-59-13

I think, it seems to me that everything that we do to put each individual in a position where he can realize his highest potential represents a positive approach. He, in turn, will be able to make a positive contribution to the kind of opportunities that confront us, so I am in complete agreement with your point of view.

Senator JAVITS. Can we say, therefore, Mr. Secretary, that the emphasis of this kind of program will be on creating productive people, and if we have productive people, we can take almost any population growth which is forecast?

Secretary FLEMMING. I agree.

Senator JAVITS. Thank you.

The CHAIRMAN. Senator Yarborough.

Senator YARBOROUGH. I noticed in your letter, Mr. Secretary, to the chairman of the committee, of March 9, in the numbered paragraph 4 (see p. 6), you strongly urge deletion of the specific statutory authorization of an appropriation of $50 million annually, in section 14 of the bill, and, in your statement this morning, you say that you are delighted to discover that in fiscal year 1959 our Nation will spend approximately $80 million in the international health field.

Taking those two statements together, I gather you are saying we are already spending more in this bill than we are appropriating, and that you recommend that that $50 million should not be appropriated. Taking the two together I think it is a recommendation really against implementing the bill.

Secretary FLEMMING. Senator Yarborough, it is certainly not the latter. In the first place, my comments in my statement dealt with our expenditures in the total field of international health. This bill deals with the field of international medical research and, as I tried to indicate in my opening statement, I feel that when you look at the total field of international health you consider first of all our activities dealing with the control of communicable diseases.

You consider, in the second place, the contributions that we make to the development of strong and sound health services throughout the world, and then in the third place you deal with the field of medical research.

Now, as I indicated in my opening statement, we of course are already, as a nation, making an investment in the field of international medical research which I feel is all to the good.

In our Institutes of Health this year we estimate we will invest aproximately $4 million in that area. We estimate that in 1960 it may go to $5 million. As I have indicated, the mutual security bill calls for a contribution of $1 million for international medical research to the World Health Organization. There is not any doubt in my mind but that if this bill should pass and we should get the kind of coordination and concentration in the field of international medical research that is called for by this bill, that there would be expenditures over and above what is contemplated for 1960 for the total field of international health, which will run about $100 million.

Now, how much it will be over that in the first year, the second and third years, is very difficult to estimate.

As you appreciate, it takes a little while for a program of this kind to get underway.

When we deal with our activities in the Institutes of Health we are in a position where we can identify the number of approvable applications and then we can proceed from there to determine what is going to be involved, as far as expenditures are concerned. We do not have many applications in this area up to the present time. No one knows how fast they will come in. No one knows what the quality of those applications may be, but there is no doubt in my mind but that if this bill shall pass there would be an increase in 1960 of our total expenditures in the field of international health. However, I frankly cannot predict at this time, at this particular time, because I do not have the evidence on which I will have to base such a prediction.

Senator YARBOROUGH. As you recommended, there would be no appropriation under this resolution if it passed?

Secretary FLEMMING. Senator Yarborough, we do not recommend the deletion of language authorizing the appropriation. Senator YARBOROUGH. Paragraph 4 reads:

We strongly urge deletion of the specific statutory authorization of an appropriation of $50 million annually in section 14 of the bill.

Secretary FLEMMING. Senator Yarborough, if you turn to page 2 of my letter, paragraph 2, we recommend that

the bill authorize appropriations to carry out the provisions of this joint resolution, be made to the President, as a part of the appropriations structure of the special assistance program.

We recognize there must be language in here authorizing the appropriation. Our only suggestion is that you simply open-end the figure, that you do not put in a specific amount.

I have given one reason why we think it would be wise not to put in a specific amount, because we feel that other nations might interpret that as a commitment on our part to start right after the bill was passed to spend money at that rate. I do not think there is anyone who is interested in the bill who alleges you could start right out spending at that particular rate.

This is really a matter of not holding out some hope that will not materialize in the first, at least in the first few years, but we agree that there must be language in here authorizing the appropriation, but we suggest that no figure be used there.

Senator YARBOROUGH. This $5 million which you will spend in 1960 might increase for research to $6 million in 1961, and then increase at the rate of $1 million a year?

Secretary FLEMMING. No; I will not use the figure of $1 million a year by any means. My feeling is that if this bill should pass, that we would be in a position to recommend expenditures of several million dollars additional in 1961 over and above the $5 million to which I have called your attention. In other words, even if this bill does not pass, we will spend at least $5 million through the National Institutes of Health, and we will spend another $1 million, that is, if the Congress concurs, in making a contribution to the World Health Organization, to carry on that work in the field of international medical research, and then I would anticipate, if this bill passed, on top of that $6 million we would add several million dollars additional. Senator YARBOROUGH. Mr. Secretary, if this resolution passes, are you in favor of it being used as a research measure, or as a spiritual value measure?

Secretary FLEMMING. I think it is pretty difficult to respond directly to that type of question. Let me approach it in this way:

I agree with Senator Javits that all of us should keep uppermost in our minds the fact that our major objective is to help the peoples of other nations, as well as our own, because, as Senator Hill has very appropriately pointed out, the type of research that is carried on will be beneficial to our people as well as to other peoples, but it seems to me that we should keep constantly in mind the fact that our basic objective is to help other peoples to realize their highest potential.

Now, I am one who believes that if you keep that objective in mind, and work toward that kind of an objective, that of course there will be political, using that word in its broadest sense, benefits that will flow from it, but the most important benefit that I think will flow from it is that we will be demonstrating to other people that we believe in spiritual values to such an extent that we are willing to apply them for the opportunities that confront us today.

When they discover we are willing to do it, not for political or military advantages, but to help them, they may be attracted to that spiritual value. It may embrace them, and together we may be able to get a spiritual breakthrough that will lead to peace.

Senator YARBOROUGH. That is just the point I want to make. If your recommendations are followed and this is put under other administrative agencies, do you not think the great purpose of this resolution is apt to be lost in lumping it in with other so-called aid programs which sometimes have political considerations tied to them, or such conditions tied to them that the people to whom they go lose faith in their spirit and purpose?

Secretary FLEMMING. First of all, let me say this: I believe there are aspects of our total mutual security program that fit the kind of a statement that I have just made. That is one of the reasons why I am a great believer in the mutual security program and one of the reasons why I feel that as a nation we should be willing to travel a second mile in order to help other peoples in the economic realm, the technical realm, and so on.

I think there is a great deal going on under the mutual security program today that does help to demonstrate to other peoples that we believe in spiritual values to such an extent we are willing to apply them to the opportunities that confront us. Now, as I indicated in my response to questions addressed to me by Senator Hill, and as my letter indicates, I fully expect that certainly the major responsibility for the carrying out of the objectives of this bill would be placed with the Department of Health, Education, and Welfare.

The only thing that we are suggesting is that this after all does become a part of our total activities in the international field, whether you are thinking of relations of people to people or whether you are thinking of relations of one government to another. We think that it is wise under those circumstances, to give the President of the United States the opportunity to make assignments in the light of the total operations in the foreign policy field, and also to take a look at this in the light of our total expenditures in the foreign policy field.

I would agree with you. I think that if this type of activity can be carried on by agencies such as the Public Health Service, the Office of Vocational Rehabilitation, and the Children's Bureau, that it will help