In none of the bills does there appear to be sufficient emphasis on the support of basic and preclinical sciences such as physics, organic chemistry, biochemistry, physiology, anatomy, pathology, bacteriology. Fundamental progress in better understanding of physical and chemical changes in disease states of the heart will largely depend on advances in knowledge in these fields rather than from clinicians or cardiologists and it is strongly recommended that every effort be made to support financially departments and individuals specializing in the basic sciences.

In conclusion, I am strongly in favor of necessary legislation to afford governmental funds to support the study of heart disease and believe it proper and appropriate that this program be headed by the Surgeon General of the Public Health Service, but feel strongly that sufficient emphasis has not been placed on research now in progress at various universities nor on the outstanding contributions now being made by the National Research Council in approving or discouraging research projects after careful consideration of their merit.

If this, or a similar bill, becomes law it is apparent that its success or failure will depend upon the selection of outstanding scientists for membership of the National Heart Council and it is earnestly recommended that the selection be made from nominations proposed by leading scientific societies such as the National Research Council, the Association of American Physicians, the American Society for Clinical Investigation, the Central Society for Clinical Research, the American Heart Association, the American Surgical Association, the American Pediatric Society and comparable societies in the fields of basic sciences.

If such policies are adopted in my opinion great advances would be made toward attaining the objectives of reducing the mortality and morbidity from cardiovascular disease which now unquestionably represents the most important cause of death among all known diseases in the United States.

This statement prepared only 3 days ago was made before I had had an opportunity to read H. R. 6007 introduced by Mr. Wolverton. Since this bill answers all of the criticisms and objections voiced in my statement, I should like to state my enthusiastic approval of H. R. 6007, National Science Foundation Act of 1948.

That is all I have, Mr. Chairman.

Mr. HALE. Thank you very much, Dr. McGuire. Are there any questions of the doctor?

Mr. LEA. Mr. Chairman.

Mr. HALE. Mr. Lea.

Mr. LEA. I would like to know to whom you would furnish the grants-in-aid to carry out the purposes you have in mind; what class of students or research people?

Dr. MCGUIRE. I think primarily to fellows, residents and associate professors and actually to the heads of departments, the deans in the various medical schools, and similar institutions, or their associates and assistants, primarily. Research is carried out in medical schools, in certain medical schools, in one department and other medical schools in another medical department. To answer your question, the deans of the various medical schools would be in the best position to recommend the particular departments that are peculiarly qualified in various universities for such grants-in-aid.

Mr. LEA. Would you be in favor of grants-in-aid to under graduates? Dr. MCGUIRE. I would think that under very special circumstances, and certain universities, that occasionally a small grant-in-aid would be of value, but I should think that in a majority of cases the money would not be most wisely spent in that way.

Medical students have very little opportunity in general and in most medical schools, have very little additional time, other than their own work entails, for much research. I think that it is unlikely that many significant outstanding contributions would be made at the undergraduate level. Certainly there are notable exceptions to that statement. Dr. Kefer, as a medical student first discovered undulant fever in a human being and some of the early work in insulin was done by a medical student.

In general though I am sure that the funds would be most efficiently spent at the post graduate level.

Mr. LEA. If we embark on the plan of general aid for under graduates, that would likely lead to a general plan of subsidization of education generally, would it not?

Dr. MCGUIRE. Yes, I would think that might be the case.

Mr. LEA. And that might result in the danger of so scattering our attempts, that it would defeat the real purpose in mind.

Dr. MCGUIRE. I agree thoroughly, sir. The only possible such subsidy, would be if there are one or two small fellowships of three or four hundred dollars given to possibly two unusually deserving men in the class. That type of thing might be helpful. Other than that I would certainly not be in favor of such subsidy.

Mr. LEA. Well, in the allotment of funds, to universities, to medical schools, would you favor the allotment on the basis of the qualifications that that particular school had or student had, or indiscriminate distribution on a geographical basis?

Dr. MCGUIRE. I think, sir, it would be far better to have the application from each medical school or each department or section of that medical school carefully scrutinized by a board of experts who would pass on the merit or lack of merit of the proposed plan of investigation.

This type of view is now being carried out by the National Research Council and I think it is a very effective method of separating the chaff from the wheat.

Mr. LEA. Well, does not an ordinary medical school devote itself to instruction of all of the known abilities of the medical profession rather than the discovery of new methods of treatment?

Dr. MCGUIRE. No, sir. Nearly all medical schools have departments and the majority of their departments are actively investigating new horizons.

In general a department that is not doing research is not well regarded by other departments or other medical schools.

Mr. LEA. Who does that research in an ordinary medical school? Dr. MCGUIRE. The research generally is directed by the professor of the department concerned and often carried out by his associates, assistant professors and fellows, sometimes by his resident physicians. Mr. LEA. Well, is the research actually done by the ordinary student or by a member of the faculty?

Dr. MCGUIRE. The vast majority of the research is done by members of the faculty. Very often by relatively young members of the

faculty. In the ordinary department of medicine we would have a professor of medicine, several associate professors of medicine, each of whom head up a special department, such as the department of gastrointestinal diseases or the department of heart diseases; department of metabolism. Each of these associate professors or assistant professors have grouped about them additional young men and many of the medical schools and consequently the research is done, by the professor of medicine who heads the department and is carried on at a lower echelon, with his advice and help.

Mr. LEA. So far as discovery of new things in and basic problems done, we necessarily have to depend on men of broad experience and training?

Dr. MCGUIRE. Yes, sir; I think that is true.

Mr. LEA. That is all.

Mr. HALE. Dr. McGuire, have you any peculiarity or procedures in research peculiar to Cincinnati?

Dr. MCGUIRE. We have established a cardiac laboratory devoted to research at the University of Cincinnati which is housed in the Cincinnati General Hospital. We have a staff of approximately 14 individuals in this organization. There are nine physicians and laboratory technicians and secretaries.

The funds for the operation of this laboratory are completely derived by the members of the laboratory from private individuals. We receive no support whatsoever except for the space in the hospital, for financing this laboratory. Obviously this presents a very important problem and many of the investigations which we would like very much to carry out we cannot do because we have not got enough money to buy the necessary apparatus; to get some of the qualified individuals that we would like to have to carry out these investigations.

I do not know whether that precisely answers your question or not. Mr. HALE. There was some discussion here yesterday about the work I think Dr. Kempner, of Duke University, did on rice diet for high blood pressure.

Now, was that kind of work carried on by men giving their whole attention to a particular piece of research or was that arrived at more or less accidently by doctors actually in practice?

Dr. MCGUIRE. I think no one can give an absolute yes or no answer to that question. In various medical schools there are two types of professors: Full time and part time; and in a research of that character, there is usually the participation of both a full-time man and a part-time man.

In the first 2 years of medical school in practically all medical schools, all of the professors are full time. For instance in physiology, biochemistry, pathology. Those physicians are occupied 100 percent of their time in teaching and in research.

In the last 2 years of teaching in the medical school and in the so-called clinical fields in certain universities the heads of the department are full time-100 percent of their time is spent in the university. That is usually common. That situation is true at Johns Hopkins University, for example, at the present time, and a relatively few other medical schools. In other medical schools the professor of medicine does not practice in the sense that a general practitioner practices.

He does not have an office, for instance, but is given the privilege of seeing patients in consultation with other physicians. Consequently, his research activities and teaching activities probably constitute 85 or 90 percent of his time; but he is not occupied in research 100 percent of his time.

Mr. HALE. Doctor, did Dr. Kempner give his whole time to research or was he actually engaged in practice when he worked out this rice. diet?

Dr. MCGUIRE. I do not know if Dr. Kempner has any private practice. I think he is full time. I am not absolutely sure of that. I believe that Duke University-and I have not been there recently and am not completely sure of that statement-has full-time professors. Mr. HALE. When members of the medical-school faculty are giving their full time to teaching, I suppose they still see people in hospitals? Dr. MCGUIRE. They are seeing very large numbers of so-called charity cases on their service in the hospitals, but not seeing private patients in other hospitals except under circumstances, such as I have discussed before, in consultation, for example. They are not divorced from seeing sick patients, if that is your question.

Mr. HALE. Well, yes. Leaving apart the question of seeing patients for hire and making money and that sort of thing, which might easily be detrimental to the work of the school, I should think that a professor in a medical school would need to come actively in contact with hospitals and with diseases of some kind.

Dr. MCGUIRE. That, sir, is universal of the case. They are all actively in contact with very large numbers of desperately ill patients. These professors nearly always have their offices in hospitals with wards crowded with very ill patients.

Mr. PRIEST. Will the gentleman yield for one question?

Mr. HALE. Yes.

Mr. PRIEST. That is particularly true, that is, the question of seeing large numbers of patients is particularly true in connection with Veterans' Administration hospitals, is it not, that are situated close to a medical college?

Mr. MCGUIRE. I think the situation in the Veterans' Administration hospitals, or the ones which I have visited, and I visit them once a week as a consultant, that the veterans' hospitals are essentially identical with that of a big city hospital. I would not think that there is any difference at all. The type of calls are the same and the activities of the heads of the service are essentially the same.

Mr. HALE. Any other questions of Dr. McGuire? Thank you very much, Dr. McGuire. The committee is indebted to you.

STATEMENT OF DR. HOWARD A. RUSK, ASSISTANT EDITOR, NEW YORK TIMES, NEW YORK, N. Y.

Mr. HALE. The next witness will be Dr. Howard A. Rusk, assistant editor, New York Times, New York, N. Y.

Dr. RUSK. Mr. Chairman and gentlemen, I regret that I have not a prepared statement and will have to speak extemporaneously.

I am particularly interested in one part of this problem, that is, the rehabilitation of the cardiac patients.

As a qualification statement for the record, I am professor and chairman of the department of rehabilitation and physical medicine,

New York University, college of medicine; head of the department of Bellevue Hospital; director of the Institute of Rehabilitation of New York University; consultant in rehabilitation to the Air Forces, Veterans' Administration, and the United Nations.

The particular facet of this problem that I should like to speak about today is the rehabilitation or reclamation of the 8,000,000 individuals suffering from heart disease today as to training and plans in productive occupation.

From techniques that were developed during the war and since, we know that a large number of disabled people can, with proper training and treatment, be taught to do gainful work.

Of the 8,000,000 cardiacs that we have, I think that it can be assumed that at least 2,000,000 have severe cardiac damage.

Rehabilitation is a third phase of medical care. That is the training necessary between acute illness and the individual's ability to do gainful work.

At Bellevue Hospital for the last year we have had, for the first time in the hundred years' history of this hospital, 80 beds for the training of disabled people, among whom have been a considerable number of cardiacs, and 100 individuals who have had strokes of apoplexy. There are estimated to be more than a million of these individuals in the country, and in the past they have been considered more or less hopeless cases.

Our year's experience with this hundred patients has shown us that they are not hopeless. In our hundred cases, 90 we have been able to teach to walk and complete self-care, and 40 have been trained to the point that they could get back to work.

We are particularly interested right now in the problem of the disabled housewife. That is the largest occupational disability group in America. There are 5,000,000 of them with orthopedic handicaps. We estimate to be 4,000,000 cardiac housewives, a million of whom have severe cardiac damage.

We know that in industry during the war that with research and proper promotional studies we could go into a war plant and reduce the energy requirements on a job from 10 to 75 percent. Such research has never been done for the housewife. She cannot even qualify for disability insurance because she is not a wage earner.

We know from our preliminary experiments that if we could do a real research project in this field that it could be organized on a national scale through home-economics departments, through farm bureaus, through women's organizations, so that a service could be set up for the cardiac-disabled housewife, so that an expert could go into her home, just like we went into the factories and industries and work out on a scientific basis a rearrangement of her housework, her schedules, and reduce her energy requirements by expert service.

The reduction of energy is the keystone of the management of the severe cardiac.

In many cases it would be a difference between a life of usefulness and chronic invalidism and inability to function as head of a family. I do not think that you could measure such a program in dollars and cents, but you have to think in terms of social relations or marital relations and also in juvenile delinquency. That is simply one facet. This concept of medical rehabilitation is really dynamic therapeutics in chronic diseases.