Our general death rate-that is, the rate for all ages and from all causes of death-was higher than that of eight other countries. In tuberculosis deaths we ranked fifth among the nations; in diphtheria deaths, seventh.

Before the war, from 7 to 11 countries had lower death rates among adolescents than did the United States-the number depending upon the age group chosen. With regard to deaths of persons aged 35 to 64, at least 20 countries had better records than ours.

Not only are death rates higher in the United States than in many other lands, but we are not showing as rapid a rate of improvement as some other countries. During the period 1920–36, at least 33 other nations registered greater reductions in the general death rate than did the United States. At least 10 other countries brought their infant mortality down more rapidly than we did. And five countries outstripped us in lowering the death rate from tuberculosis.

TABLE 1.-General tuberculosis, and diphtheria death rates

1 Exclusive of aboriginal population.

2 1935 (last year available).

3 1934 (last year available).

Excluded are some countries which reported lower rates than the United States, but which are known to have incomplete or unreliable reporting.

Also excluded is the Union of South Africa, with a reported general death rate of only 9.5 and a tuberculosis death rate of about 41. These rates, however, do not include deaths among the large native population.

Sources: All causes-Department of Commerce, Bureau of the Census, Tables: Crude Death Rates Recorded in 55 Countries, 1930-44 (November 29, 1945).

Tuberculosis and diphtheria-Department of Commerce, Bureau of the Census, Vital Statistics-Special Reports, vol. 9, No. 36 (International Vital Statistics; Summary).

Source: Department of Commerce, Bureau of the Census, Vital Statistics-Special Reports, vol. 9, No. 36 (International Vital Statistics; Summary).

People who want to explain away America's not-too-good health record sometimes say that if it were not for our Negro population our death and disease rates would be much lower.

True, some diseases take a heavier toll among Negroes than among whites. But it is difficult to understand why this should make anyone feel complacent. When a Negro dies he is just as dead as a dead white man. His survivors feel just as grief-stricken as the white man's. And the disease that kills him is a menace to the whole community-not merely to any one part of it.

But suppose, for the sake of argument, we left the Negro population out of our calculations altogether. The figures would still show that the rest of our citizens do not enjoy the same degree of health security as the people of many other nations. The prewar statistics reveal that: For white boys in the United States, life expectancy at birth is less than in four other countries. For white men at age 20, it is less than in eight other countries. For white men at age forty, it is less than in 11 other countries. And for white men at age 60, it is less than in 12 other countries.

The next time someone tells you that Americans are the healthiest people in the world, ask him where he got his information. Chances are he won't be able to tell you. He will probably look at you patronizingly and say, "Why, I thought everyone knew that!" Then tell him that he should not be so guillible," that he ought to go and look up the facts.

Senator DONNELL. Senator Pepper, what is the profession of Mr. Malmberg, if you know?

Senator PEPPER. Senator, Mr. Malmberg, at one time, I believe worked for the United States Health Service in the Federal Security Agency. I know for a considerable time he was attached to the staff of the Committee on Wartime Health and Education, of which I was chairman.

Senator DONNELL. Was he secretary of the Democratic National Committee at any time, if you know, or employed by that committee? Senator PEPPER. Senator, after he left the committee, he, I think for a time was employed by the Democratic National Committee in a research capacity. I do not believe he is connected with them at the present time. This book, of which he is the author, came out in the last few months.

Senator DONNELL. Thank you, sir.

Senator PEPPER. Mr. Chairman, for the record, I want to apologize to Mr. Goldblatt for missing his testimony this afternoon.

Senator SMITH. We gave him the memorandum. He made a very interesting and eloquent statement.

Senator PEPPER. We are very glad to have him here.

Senator SMITH. For the record, I would like to state that Senator Murray of Montana expresses his regret that he could not be here today as he has to be in Montana on a necessary trip. So we will have the record show that Senator Murray expresses his regrets as a member of the subcommittee that he was not here.

Dr. CONNOR. We have been advised, Mr. Chairman, that the report you asked about yesterday will be here before the day is over. Senator SMITH. Senator Pepper just raised that point.

Dr. CONNOR. It is being typed now.

Senator SMITH. I will see that it is incorporated in the record. (The report referred to appears on p. 96.)

Senator PEPPER. I talked with Mrs. Lasker last night over the longdistance telephone. She asked me if the list of membership of the National Heart Committee would be included in the record. Has that been put in?

Senator SMITH. That was introduced in the hearing this morning. Senator PEPPER. I wanted to be sure about it.

Senator DONNELL. Is that the American Heart Association or the National Heart Committee?

Dr. CONNOR. The National Heart Committee.

Senator PEPPER. That is the one.

Senator DONNELL. The National Heart Committee membership list was introduced this morning. General Donovan was kind enough to give it to us.

Senator PEPPER. I think since we have mentioned the names of Mr. and Mrs. Albert D. Lasker, if it has not already been introduced, Mr. Chairman, I would like to offer for the record a copy of an award of citizen fellowship to Albert Davis Lasker by the Institute of Medicine, in the name of the president, Mr. R. T. Woodgett, and George S. Coleman, secretary, dated December 3, 1941, presented by Joseph A. Capps. This is a testimonial to the outstanding work in the medical field of Mr. and Mrs. Lasker.

Senator SMITH. I think this statement was introduced in other hearings, but it may be incorporated in the record of this hearing. (The award referred to is as follows:)

INSTITUTE OF MEDICINE

AWARD OF CITIZEN FELLOWSHIP TO ALBERT DAVID LASKER

A man of distinguished ability in the business world, a man of imagination and vision, with keen interest in his fellow men and an urge to improve their lot. In the field of education he has been an outstanding benefactor, in recognition of which he was elected a trustee of the University of Chicago. During a long career he had been generous in support of hospitals and charitable institutions. For many years he has been impressed with the importance of research in advancing the understanding of the processes of disease, and in furthering the progress of medicine in its treatment. Twenty years ago he gave liberally to cancer research. Subsequently, with Mrs. Lasker, he established at the University of Chicago the Lasker Foundation for the Investigation of Degenerative Disease. In recognition of the rare qualities of head and heart that have inspired him to become so valued an ally of the medical profession in advancing its scientific ideals, the Institute of Medicine of Chicago has chosen him for citizen fellowship and is honored by his acceptance.

R. T. WOODGETT, President.
GEORGE S. COLEMAN, Secretary.

Presented by Joseph A. Capps, December 3, 1941.

Senator DONNELL. I hand the reporter for incorporation in the record the document which Mr. Foote has furnished the committee, which was handed to him by Mrs. Lasker.

(The document referred to is as follows:)

BRIEF OF TESTIMONY TO BE GIVEN BY EMERSON FOOTE BEFORE LABOR AND PUBLIC WELFARE COMMITTEE HEART HEARINGS

Americans have always made the proud boast that they are "the healthiest people on earth." It's time that statement was challenged.

Last year, out of approximately 1,400,000 deaths from all causes, fewer than 28,000 persons died of just plain old age. But out of the remaining deaths more than 588,000 Americans were lost-killed, would even be a better term-by diseases of the heart and circulation.

It seems to me that much of our failure to sit up and take active notice of this threat to our society, much of our failure to "do something" about this scourge, stems from the fact that we've begun to really believe the truth of the shibboleth that we are "the healthiest people on earth." We are nothing of the kind. No people, no nation, could lay claim to that distinction which permits one out of every three of its citizens to die from heart and arterial diseases.

And no nation has the right to lay such claims, which, despite this mounting threat to its well-being, sees fit to only allocate little more than $2,000,000 annually for research into the causes and possible cures and treatments for

such diseases. For, in 1946, that was the sum total of moneys expended for such research from all sources-out of which the Government contributed slightly more than $900,000 and the balance was made up by life-insurance companies, and other private sources. What a commentary for a people that could spend $40,000,000 for admissions to college football games alone during the same year. It would be equally pertinent at this point to take note that in 1947 Congress spent almost $30,000,000 for the control of plant and animal diseases, while, at the same time, it failed to provide any specific amount to learn more about the Nation's No. 1 killer-diseases of the heart and arteries.

The American Medical Association has pointed out that, out of an active force of more than 137,000 physicians in the country, only 638 specialize in the practice of heart. With proper Government aid, proper teaching and student interest could be advanced to a point commensurate with the needs of our people and the extent of the disease. In 1945, the AMA census of hospitals listed some 7,000 institutions in the United States. Nevertheless, there are only 1,109 beds in the Nation's hospitals specially set aside for cardiac patients-1 bed in every 7 hospitals. It is incongruous that more than 9,000,000 Americans presently suffering from diseases of the heart and circulation must depend upon such pitiful facilities.

These diseases are far from being due only to old age. Thirty percent of the deaths occurring in the age group from 20 to 59 are cardiovascular; more children die each year of heart diseases than the total of all ages of death from infantile paralysis.

These are days of momentous decision for Congress on the international scene. I submit, gentlemen, that these are equally momentous times for Congress where the health of its citizenry is concerned. We cannot permit this challenge to our people's well-being to go unanswered. We dare not permit the rising tide of heart and circulatory deaths to continue. We must not idly sit by without giving our doctors and scientists an honest chance to pool their abilities in an all-out fight to defeat this national menace.

The time is propitious for Congress to enact the legislation presently being considered by this committee. By enacting S. 2215, otherwise known as the National Heart Act, Congress will make it possible for a National Heart Institute to come into being. That Heart Institute, in turn, will give our Nation, its doctors and scientists, the first real impetus in the fight against heart and allied diseases. In other words, passage of the proposed legislation will be the first step forward to saving thousands of the more than half million lives annually lost to those diseases.

We-Congress, as well as the entire American people are at the crossroads of decision in this fight to preserve our Nation. There is a crying need for the bill now being considered by this committee. Upon your decision rests the future of millions of American lives. There can be but one proper determination by this honorable body: S. 2215 must become law; Congress must declare war on diseases of the heart and circulation.

Mr. FOOTE. I want to make one correction, if I may. I just heard the Senator from Missouri say this statement was furnished by Mrs. Lasker. I said it came from her office. I do not know whether she herself or her assistants prepared it.

Senator DONNELL. I did not mean to make any misrepresentation. Senator SMITH. We are glad to have the correction.

Mr. FOOTE. Maybe she did. I do not know.

Senator SMITH. I have a statement submitted by Dr. Chester D. Swope, American Osteopathic Association, which may be inserted in the record at this point.

(The statement of Dr. Swope is as follows:)

STATEMENT BY DR. CHESTER D. SWOPE, WASHINGTON, D. C., CHAIRMAN, DEPARTMENT OF PUBLIC RELATIONS, AMERICAN OSTEOPATHIC ASSOCIATION, HEARINGS ON S. 2215, SUBCOMMITTEE ON HEALTH, SENATE COMMITTEE ON LABOR AND PUBLIC WELFARE, APRIL 9, 1948

Mr. Chairman and members of the subcommittee, I appreciate the privilege of submitting for your consideration this statement in relation to the program contemplated by S. 2215, the National Heart Act. Heart disease is the leading

cause of death in the United States. It has become progressively so, and as life expectancy generally is increasing, its importance as the leading public health hazard must obtain the emphasis which the provisions of this bill are calculated to subserve.

The bill provides Federal grants-in-aid to the States, to public and private institutions, to individuals by way of fellowships and traineeships, and provides for the establishment of media for the correlation and dissemination of research findings and information relating to the cause, prevention, and methods of diagnosis and treatment,of the heart and circulation.

The bill also provides aid for refresher courses for physicians. This is a most important provision. Physicians of all schools of medicine should be given the opportunity of keeping abreast of, and having access to, the latest methods for diagnostic and preventive measures and facilities.

Writing in the Journal of the American Osteopathic Association in June 1944 on the subject of examination of the heart, Lester R. Daniels, D. O., stressed the importance of keeping in mind the following general facts, which I believe will be of interest to the members of this subcommittee:

1. Certain types of heart disease occur more frequently in certain age groups. In infancy, congenital heart disease is the only type found. During childhood and up to the age of 40, rheumatic heart disease dominates the picture. Between 40 and 60, the chief causes of heart disease are hypertensive, and coronary arteriosclerotic and hypertensive conditions prevail.

2. Sex plays a part in the causation. Coronary and syphilitic types are more frequent in males. Rheumatic heart lesions appear with about equal frequency in men and women. Thyrotoxic heart disease is more prevalent in women.

3. Certain features of the medical history are important. Rheumatic fever, scarlet fever, diphtheria, tonsillitis, chorea, suggest the possibility of resultant heart damage. Questions concerning the history of syphilis should never be asked in a tone which invites denial.

All osteopathic colleges carry on some clinical and laboratory research in heart diseases. Independent osteopathic investigators have also been at work on these problems. It has been found that certain persistent vertebral strain produces fibrous areas in the heart which is conducive to high blood pressure which in turn is an important factor in the causation of diseases of the heart and blood vessels. This is a field of research suggesting a new approach to the study of arterial sclerosis.1 Limited research has indicated that vertebral joints lesions have a definite place in the causation of cardiac disorders in patients suffering from pyogenic (pus producing) infections."

There is a great need for trained investigators and funds to support research projects.

It has been well said that the hope of humanity lies in the prevention of degenerative diseases, not in the mere care of their symptoms. Federal Security Administrator Oscar R. Ewing has told you that among children of school age, heart diseases (chiefly rheumatic fever) rank second only to accidents as a cause of death. There should certainly be an expansion of present-day physical examinations of school children and follow-up treatments to check trends toward degenerative diseases, rather than wait for such examinations and treatment until an individual has reached middle life and has already developed definite patterns of organic disease. Programs, supplementing present schoolchild health examinations, should be expanded to provide for periodic radiographic postural studies and evaluation of thyroid functions. Structural analysis of the growing child's bony architecture is not a thing apart from health examinations; it should be an important element of the total diagnostic procedure applied to each child. Hence, postural X-ray studies should be made of each child on his admission to school and at periodic intervals during his school years. Postural studies should include analysis of body-part mechanics, with special consideration to strains and interference with autonomic functions which may favor degenerative diseases.

Further references to osteopathic research reports on cardiovascular diseases published in the Journal of the American Osteopathic Association during recent years include:

1 Early Pathogenesis Following Vertebral Strain, Louisa Burns, D. O., Journal of the American Osteopathic Association, October 1944.

2 Certain Cardiac Complications and Vertebral Lesions, Louisa Burns, D. O., Journal of the American Osteopathic Association, December 1947.