higher states of development. Thus, European centers for leukocyte testing transplantation immuniology problems are presently most highly competent and able to develop the basis for future tissue and organ replacement techtiques Far Eastern institutions have high interest and talent in the study of berculosis and leprosy which are showing resurgence in the United States. Studies of the intricacies of biological and physio-chemical fundamentals Enderlying the complex field of biomedicine are primary fields of inquiry by which we have come to stand in the forefront of the practice of the science of medicine ang nations. But, it is only with the cooperation of talented scientists abroad in all fields of science that this status has been achieved in the past, and it follows that this situation can only be maintained by such cooperation now and in the future; for it is not given to persons of one nation alone to be endowed with all the necessary ingenuity, inventiveness, awareness, and insight that Est be applied to scientific endeavor.

In certain specific areas of research, of vital interest to NIH, some of the best work is being done abroad. By sending our own scientists on research training grants made in centers of excellence in these areas or on work assignRents or fellowships, we are extending our research potential for the present and the future. Thus, in the Institute of Cardiology in London, the Karolinska Institute in Stockholm, the Weizmann Institute in Rehovoth, the Hall Institute Melbourne, etc., training is provided for U.S. scientists in the newest skills in biomedicine.

Thus, a reasoned interaction among the talents of the world is the only means for the most rapid achievement of these fundamental objectives. Inasmuch as these achievements are universally beneficial we can expect, and have have experienced, wholehearted cooperation from scientists in most nations and an interested attitude of respect from even those with whom we may be at ideological odds. The maintenance of this position is at once our means for forging ahead to further objectives and for bringing about a more congenial attitude among Lations, in that it is also a means toward the establishment of a state of social and economic self-help which we have at great cost been forced to support through other drains on our economy.

While the research functions vested in the National Institutes of Health are basically oriented to new knowledge, NIH and the other bureaus of the Public Health Service are charged also with the application of such knowledge and with its incorporation into practice by the most suitable means and methodology. The development of these techniques in quantitative fashion, where statistical jigments on the trends and the exposure to corollary actions is most securely demonstrable can often only be carried out in nondomestic situations where environment. economy, and social tradition have conspired to involve large numhers of persons in contrast to a more fortunate situation in this country. The itimate gains are of course shared because of the universal applicability of truths once they are understood and interrelated.

The humanistic and philosophical background for otherwise strictly national gais in health and against disease have been recently emphasized by the President in his program for international health. It has been, in point of fact, the basis for our present very prestigious image in these fields abroad. It is also evident that the "American way" is a hallmark of good practice widely appreciated by our fellow scientists. Reciprocation between us in personal contact and teaching in the fields of science which augment American excellence is in large measure responsible for the widening opportunities to carry out research studies previously unapproachable. Support for publication and dissemination of knowledge in these fields satisfies not only personal and national needs but has the power of strengthening the resources abroad from which we must conLate to draw some of our facts and ideas in the future.

SCIENTIFIC ACCOMPLISHMENTS

The accomplishments achieved through support of foreign research by the National Institutes of Health and other bureaus of the Public Health Service are many and are on a continuing basis. Unlike other fields of science, in which achievements are measured in terms of the development of a piece of equipment or some other physical end product, progress in the health-related sciences is identified with the acquisition and collation of knowledge in a given program area. It is the view of the NIH that foreign scientists have contributed ap

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preciably in furthering its knowledge in those areas of interest. To illustr this progress, a number of examples have been cited below:

Dr. Anna Freud, Hampstead Child-Therapy Course and Clinic, London, Engla Project title: "Assessment of Pathology in Childhood”

One truly unusual foreign research project supported by the National Instit of Mental Health is being carried out in London by Dr. Anna Freud, daughter Sigmund Freud and founder of the world-famous Hampstead Child Thera Clinic. Although psychoanalytic theory has had a major impact on psychiat few clinicians have brought scientific methodology to bear upon psychoanaly treatment.

In their research on the assessment of pathology in childhood, Dr. Freud a her coworkers are working systematically to refine and clarify theoretical a clinical concepts in psychoanalytic theory. A central aim in this project is construction and validation of a new tool for assessing the degree and nature pathology in childhood-the "developmental profile." Dr. Freud's approach based on her belief that because the child is a developing, incomplete being, usual guides to the assessment of mental illness or health used with adults unreliable in children. A more significant guide to a child's mental future the capacity to develop progressively, or damage to that capacity, which "developmental profile" can assess.

Dr. Freud's research to date on the developmental profile has already m significant contributions to our knowledge of diagnosis, prognosis, and tre ment of mental illness in children and is expected to make notable further pr ress in our understanding of mental illness in children. Dr. Freud's rec book on the early phases of this research project, "Normality and Pathology Childhood, Assessments of Development" (New York: International Universit Press, 1965), has already been hailed as a landmark in this field.

Dr. Jacques L. Monod, Institut Pasteur, Paris, France. Project title: "E chemical-Genetic Studies of Cellular Control Mechanisms"

The highly successful investigations on the biochemical-genetic control of enzyme synthesis and function pursued by Drs. Jacques Monod and Frand Jacob and their colleagues at Pasteur Institute on behalf of the National In tute of Allergy and Infectious Diseases attracted worldwide recognition 1 in advance of their being awarded the Nobel Prize in October 1965. The furt analysis and elucidation of basic cellular mechanisms by these workers a their disciples, many of them Americans, constitutes an entire new discipl rather than a limited research program. The laboratory is a site for the tra ing of scientists who are attracted to it from all over the world, and the w of the laboratory is carried out on a scale not matched by any other simi installation in the world.

In commenting on the Nobel award to these scientists and their colleag Dr. Andre Lwoff, a spokesman for the American Cancer Society stated: "Their work in interpreting the genetic code is an inestimable contribution our knowledge of life processes, a riddle of growth and heredity. Their stud of the cell and its genetic properties have been of great value in the developm of knowledge that is vital for the ultimate conquest of cancer."

Dr. George Klein, Royal Karolinska Institute, Stockholm, Sweden. Project tit "Viral Tumorigenesis and Cellular Phenotype"

A National Cancer Institute grant to the Karolinska Institute in Stockho Sweden, on behalf of George Klein, provides support for his highly original a productive work on tumor antigenecity. During the 5 years that this work 1 been supported in part by the National Cancer Institute, the studies have oper up the whole area of antigenecity of virus induced tumors. They have done mu to characterize this antigenecity having shown its specificity, its homotranspla like nature, and its stability. Dr. Klein is still the leading investigator in t area and although he has many followers, his work continues to be of such original nature that it is not duplicated elsewhere. The importance of th studies to the program of the National Cancer Institute is related to the devel ment of a new technique for testing human populations for evidence of vir caused human cancer. The finding of specific antigen also offers hope that ev tually it may be possible to prevent certain types of human cancer by immuni tion measures.

Dr. Elizabeth Goldschmidt, Hebrew University, Jerusalem, Israel.

Project title: "Children of Identical and Different Ethnic Groups" Most data relevant to human genetics is collected within stable populations Dear genetic equilibrium. What happens when two genetically diverse comEquities are in a transient phase of genetic and social integration?

The Jewish community of Israel provides a unique reservoir of several diverse mating systems, among which are several highly inbred oriental communities. The Kurdish Jews are particularly noteworthy in carrying a large genetic load of inheritable metabolic diseases. These communities are now beginning their genetic and social integration into the European components of the Israeli population. The socio-economic differences among these families are minimal and all enjoy adequate access to medical facilities. This type of study should thus furnish a more unbiased estimate of the biological effect of inbreeding and ontbreeding than has been obtained in similar studies elsewhere.

Dr. Goldschmidt and her group are presently evaluating children of the various types of marriages. A variety of methods is used, including IQ tests, biochemical techniques, and anthropometric measurements.

The results will not only be of practical significance to genetic counseling, but will also have important theoretical implications.

Dr. John F. Brock, University of Cape Town, South Africa.
Project title: "Human Protein Malnutrition"

This is a grant supported by the National Heart Institute and made to the Tniversity of Cape Town, South Africa. Dr. Brock's studies and experimental designs provided the basic information on the importance of dietary fats and cholesterol in the development of atherosclerosis. His studies were one of those which were primarily responsible for the recent intent interest in the possibility of preventing atherosclerosis by dietary means. Although similar projects were Sorted in this country, it was primarily the excellence of the experimental design and the results of Dr. Brock's research that brought about this interest. Dr. F. M. Burnet, Royal Melbourne Hospital, Australia.

Project title: "Selected Aspects of Cellular Immunology"

Sir Frank Macfarland Burnet has an outstanding record of research which has been recognized by the Lasker Award in 1952, the von Behring Prize in 1952, the Copley Medal of Royal Society in 1959, and by the Nobel Prize for Medicine in 1907). In addition, he has been knighted for his work.

His outstanding competence is currently being brought to bear on two problems of major academic and clinical importance; the achievement of homotransplantation and the understanding of autoimmune disease.

His present contributions may be measured in terms of his own excellent research as well as the training he is presently extending to U.S. Public Health Service Post-doctoral Fellows.

Dr. Yash Pal Kapur, Christian Medical College, Vellore, India.

Project title: "Effect on Hearing of Infectious Tropical and Nutritional Diseases"

The injurious effect of the childhood diseases on hearing, and the widespread incidence of hearing loss due to such diseases, is becoming more clearly evident. Attention focused on this problem will yield to improved prophylaxis and, we hope, treatment.

A pool of 986 normal hearing schoolchildren has been developed in Vellore. The pool is being used to study the effect of the common infectious tropical and rutritional diseases on the hearing of this population for the National Institute of Neurological Diseases and Blindness.

At the Infectious Diseases Hospital in Madras, all cases admitted with smallpx. chicken pox, cholera, mumps, measles, and malnutrition states are studied Specifically for the effect on hearing of these diseases.

Temporal bones and brains are removed from cases going to autopsy for correlation of the hearing studies and the histopathological changes in the ears and brains.

Dr. J. C. Beck, McGill University, Montreal, Canada.

Project title: "Metabolic Effects of Growth Hormone in Man"

Dr. Beck and his colleagues are engaged in an attempt to find a hormone that would be an alternate to the human growth hormone (HGH) in that it would mimic the latter's physiological action in the promotion of growth. Hormone interactions, in addition to other factors, for example, genetics and nutrition,

influence the extent to which a human will grow. Their recent work compare the physiological effects on humans of treatment with HGH and a highly pur fied ovine prolactin, a hormone derived from sheep and more readily availabl The preliminary studies suggest that the physiological effect of ovine prolacti is similar to that of HGH. In vitro studies indicate that there are comparabl physiologic actions on the utilization of glucose by adipose tissue and on amir acid transport and/or incorporation into muscle with the administration ( these two hormones.

Dr. Carl A. Gemzell, University of Uppsala, Sweden.

Project title: "Human Pituitary FSH and LH Purification and Ovaria
Steroid Action"

In 1964, Dr. Carl A. Gemzell, a grantee of the National Institute of Arthriti and Metabolic Diseases at the University of Uppsala, Sweden, reported that h had induced ovulation followed by pregnancy in previously sterile women b treating them with a preparation of human gonadotropic hormones. Multipl births (twins or quadruplets) were not uncommon in those previously barre women who subsequently conceived and delivered. This work is considered b many gynecologists as perhaps the first major medical breakthrough in fertilit research in the past 30 years.

PROPOSED FUTURE SUPPORT OF RESEARCH IN OTHER COUNTRIES

In order to carry out its responsibilities to improve the health of the America people, it is considered essential for the National Institutes of Health to b able to take advantage of any unusual research opportunities which may becom apparent in other countries and which are likely to advance our scientifi knowledge in a given field. The National Institutes of Health expects to cor tinue its review of the various mechanisms designed to support research an research training activities abroad in order to maintain sound managemen practices in the expenditure of funds overseas. During the continuing inter national balance of payments deficit, NIH will continue to exercise specia surveillance to assure that expenditures abroad are essential to the program. The NIH anticipates the continuing need for funds for overseas research a a level consistent with the present "ceiling" established by the Executive Offic of the President, that is, $9.5 million for fiscal years 1966 and 1967. At the en of that period, it is anticipated that the needs of the National Institutes o Health, and the Public Health Service as a whole, may increase due to the activa tion of new program areas in this country. This total amount will necessaril represent "gold flow" and will not include payments in U.S.-owned local cur rencies or funds expended for the purchase of U.S. manufactured equipment NIH expects to play a more active role in seeking out new research oppor tunities which are most likely to provide information to those scientific program of such a priority nature. It is also expected that NIH will continue to see closer cooperation with agencies of other governments responsible for the con duct of biomedical research in order to exchange information on the plannin level. It is hoped that this in turn will lead to a more judicial use of scientifi manpower on an international basis and improve the opportunity to find solution to our most pressing health problems.

BIOMEDICAL ENGINEERING

There is a great deal of activity in the relatively new field of bio medical engineering. Grantees of the Heart Institute have invented two new pacemakers which are more efficient, more reliable, and mor convenient than the earlier battery-powered models. I have on my desk in Bethesda a prototype component of an implantable artificia heart developed, with NIH support, by a collaborative project a Baylor and Rice Universities. Six new contracts have recently beer

awarded for research on artificial heart mechanisms. The National Institute of General Medical Sciences is supporting 67 biomedical engineering projects which include such new approaches as the use of ultrasonic techniques for medical diagnosis, the development of a combination television-camera and computer which can make and record Laboratory observations, and the ingenious application of mathematical processes used by utility companies for the study of power transmission lines to the study of certain aspects of the human nervous system.

VACCINE DEVELOPMENT

There have been a number of important advances in vaccine development. A live oral vaccine against adenovirus type 4, which has caused severe epidemics of respiratory disease in military training camps, has now been successfully tested in field trials. There is also a very promising new experimental vaccine against Mycoplasma pneumoniae, a primitive organism which is a major cause of a form of pneumonia among college students and military trainees. Good progress is being made in the development of an improved immunizing agent against tuberculosis.

VACCINE AGAINST GERMAN MEASLES

Work on a vaccine against German measles has been stimulated by the funds which the Congress made available for this purpose in the 1966 appropriations. An intensive collaborative program has been launched in an effort to develop such a vaccine.

I suggest that when Dr. Murray testifies you might ask him about some of the work he is doing in the Division of Biological Standards. He has some strikingly new observations.

Additional evidence of the viciousness and insidiousness of this disease which most people regard as a relatively mild and routine childhood infection-has turned up during the past year.

A study of some of the 20,000 to 30,000 infants with birth defects resulting from the 1964 and 1965 rubella epidemics shows that German measles contracted by the mother during pregnancy can cause a number of birth defects that had not previously been associated with this disease these are serious defects such as bone marrow lesions, anemia, hepatitis, and a severe hemorrhagic disease. It has also been found that an apparently normal infant who was exposed to maternal German measles early in pregnancy can shed the virus for as much as 18 months after birth, thus spreading the infection to other pregnant women. A valuable tool in the battle against German measles is a much more rapid test for identifying those who have been exposed to German measles. It used to take 2 weeks to make this determination; the new technique, which was developed at NIH with the cooperation of several outside scientists, does the job in 24 hours.