FUNCTIONS

SEC. 2. In carrying out the purposes of this Act, the Surgeon General of the Service (hereafter in this Act referred to as the "Surgeon General") is authorized to

(a) conduct, assist, and foster researches, investigations, experiments, and demonstrations relating to the cause, prevention, and methods of diagnosis and treatment of heart diseases;

(b) promote the coordination of research and control programs conducted by the Institute, and similar programs conducted by other agencies, organizations, and individuals;

(c) make available research facilities of the Service to appropriate public authorities, and to health officials and scientists engaged in special studies related to the purposes of this Act;

(d) make grants-in-aid to universities, hospitals, laboratories, and other public or private agencies and institutions, and to individuals for research, education, and control (service programs for prevention, diagnosis, and treatment utilizing current medical methods) projects and programs, including grants to such agencies and institutions for the construction, acquisition, leasing, and equipment of hospital, clinic, laboratory, and related facilities necessary for such research, education, and control;

(e) establish an information center on research, prevention, diagnosis, and treatment of heart diseases, and collect and make available, through publications and other appropriate means, information as to, and the practical application of, research and other activities carried on pursuant to this Act;

(f) secure from time to time, and for such periods as he deems advisable, the assistance and advice of persons from the United States or abroad who are experts in the field of heart diseases;

(g) (1) establish and maintain, from funds-appropriated or donated for the purpose, research fellowships in the Institute and elsewhere with such stipends and allowances (including travel and subsistence expenses) as he may deem necessary to train research workers and procure the assistance of the most brilliant and promising research fellows from the United States and abroad; and (2), in addition, provide such training and instruction, and demonstrations, through grants to public and other nonprofit institutions;

(h) (1) establish and maintain from funds appropriate or donated for the purpose of traineeships in the Institute and elsewhere in matters relating to the diagnosis, prevention, and treatment of heart diseases with such stipends and allowances (including travel and subsistence expenses) as he may deem necessary to train persons found by him to have proper qualifications; and (2), in addition, provide such training and instruction, and demonstrations, through grants to public and other nonprofit institutions; (i) for purposes of study, admit and treat at the Institute voluntary patients suffering from heart diseases, whether or not otherwise eligible for such treatment by the Service;

(j) adopt, upon recommendation of the National Heart Council (hereafter in this Act referred to as the "Council"), such additional means as he deems necessary or appropriate to carry out the purposes of this Act.

NATIONAL HEART COUNCIL

SEC. 3. (a) There is hereby created a National Heart Council, to consist of the Surgeon General or his representative, the chief medical officer of the Veterans' Administration or his representative, the Surgeon General of the Army or his representative, the Surgeon General of the Navy or his representative, and twelve members appointed without regard to the civil-service laws by the Surgeon General with the approval of the Federal Security Administrator (hereafter in this Act referred to as the "Administrator"). The twelve appointed members shall be leaders in the fields of fundamental sciences, medical sciences, education, or public affairs.

(b) Each appointed member of the Council shall hold office for a term of four years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term, and except that, of the members first appointed, three shall hold office for a term of three years, three shall hold office for a term of two years, and three shall hold office for a term of one year, as designated

by the Surgeon General. None of such twelve members shall be eligible for reappointment until a year has elapsed since the end of his preceding term, Every two years the Council shall elect one member to act as Chairman for the succeeding two-year period.

(c) The Surgeon General is authorized to utilize the services of any member or members of the Council in connection with matters related to the work of the Service for such periods, in addition to conference periods, as he may determine to be necessary.

(d) Each appointed member of the Council, while attending conferences or meetings of the Council or while otherwise serving at the request of the Surgeon General, shall be entitled to receive compensation at a rate to be fixed by the Administrator, but not exceeding $75 per day, and shall also be entitled to receive an allowance for actual and necessary traveling and subsistence expenses while so serving away from his place of residence.

(e) The Council will meet from time to time to (1) advise the Surgeon General on the conduct of the program of the National Heart Institute and (2) to review and make recommendations regarding requests for grants-in-aid for research, education, and control.

CONTROL GRANTS

SEC. 4. (a) The Surgeon General is authorized to make grants-in-aid, as provided in this section, to States, counties, health districts, and other political subdivisions of the States and to public and nonprofit institutions for the establishment and maintenance of programs of prevention, treatment, and control of heart diseases, including the provision of appropriate facilities for care and treatment and including the training of personnel.

(b) For each fiscal year, the Surgeon General, with the approval of the Administrator, shall determine the total sum from the appropriation under section 7 (a) which shall be available for allotment among the several States and other institutions under this section.

(c) The Surgeon General shall from time to time certify to the Secretary of the Treasury the amounts to be paid to each State from the allotments to such State, reduced or increased, as the case may be, by the amount by which he finds that estimates of required expenditures with respect to any prior period were greater or less than the actual expenditures for such period. Upon receipt of such certification, the Secretary of the Treasury shall, prior to audit or settlement by the General Accounting Office, pay in accordance with such certification.

(d) The money so paid to any State shall be expended solely in carrying out the purposes for which the grant is made and in accordance with plans presented by the health authority of such State and approved by the Surgeon General.

(e) Requests for grants-in-aid for control, including education for projects and programs not in State health agencies, will be submitted, reviewed, and paid in manner similar to that established for research grants-in-aid.

GIFTS

SEC. 5. The Surgeon General shall recommend to the Administrator acceptance of conditional gifts, pursuant to section 501 of the Public Health Service Act, for study, investigation, or research into the cause, prevention, or methods of diagnosis or treatment of heart diseases, or for the acquisition of grounds or for the erection, equipment, or maintenance of premises, buildings, or equipment of the Institute. Donations of $50,000 or over for carrying out the purposes of this Act may be acknowledged by the establishment within the Institute of suitable memorials to the donors.

APPROPRIATIONS

SEC. 6. (a) There are hereby authorized to be appropriated for each fiscal year such sums as the Congress may determine to be necessary to carry out the provisions of this Act.

(b) Such appropriations as are hereafter made to carry out the purposes of this title may be expended in the District of Columbia for personal services, stenographic recording and translating service, by contract if deemed necessary, without regard to section 3709 of the Revised Statutes; traveling expenses (including the expenses of attendance at meetings when specifically authorized by

the Surgeon General); rental, supplies and equipment, purchase and exchange of medical books, books of reference, directories, periodicals, newspapers and press clippings; purchase, operation, and maintenance of motor-propelled passenger-carrying vehicles; printing and binding (in addition to that otherwise provided by law); and for all other necessary expenses in carrying out the provisions of this title.

GENERAL PROVISIONS

SEC. 7 (a) This Act shall not be construed as superseding or limiting (1) the functions, under any other Act, of the Surgeon General or the Service, or of any other officer or agency of the United States, relating to the study of the causes, prevention, or methods of diagnosis or treatment of heart diseases; or (2) the expenditure of money therefor.

(b) The Surgeon General shall perform his functions under this Act under the supervision and direction of the Administrator. The Surgeon General with the approval of the Administrator is authorized to make such rules and regulations as may be necessary to carry out the provisions of this Act.

(c) As used in this Act, the term "State" means a State or the District of Columbia, Hawaii, Alaska, Puerto Rico, or the Virgin Islands.

(d) The Surgeon General shall include in the report for submission to the Congress at the beginning of each regular session a full report of the administration of this Act, including a detailed statement of receipts and disbursements. (e) The name "National Institute of Health" shall be changed to "National Institutes of Health".

(f) The Administrator is authorized to fix the compensation for the services of specially qualified scientific and professional personnel concerned with research activities of the National Institutes of Health and the National Heart Institute provided that the rates of compensation for positions established pursuant to the provisions of this paragraph shall not be less than $10,000 per annum nor more than $15,000 per annum.

Senator SMITH. I may say that the Subcommittee on Health is very much concerned with the question of heart disease. The considerations before us are (1) the need for Federal aid and (2) choice of an operating agency. This bill proposes to meet those two questions.

We are privileged to have Senator Bridges with us, who is one of the sponsors of the bill, and I will ask him to proceed in his own. way and make his statement.

STATEMENT OF HON. STYLES BRIDGES, A UNITED STATES SENATOR FROM THE STATE OF NEW HAMPSHIRE

Senator BRIDGES. Mr. Chairman, first, I want to express my appreciation for this opportunity to appear before the Senate Committee on Labor and Public Welfare today to make a brief statement in support of S. 2215, a bill of bipartisan sponsorship designed to provide for research into and control of diseases of the heart and circulatory system. I feel strongly that this legislation is of considerable immediate importance to the public welfare of this country, and for this reason I am very glad that this committee has seen fit to hold hearings at this time.

It is a matter of common knowledge that in this country the greatest single killer of living Americans is diseases of the heart and circulation. In 1946 nearly 600,000 people died of these diseases. Fifty-eight million Americans now alive will die of heart disease before their time unless new treatments and cures are found. Today more than one out of every three deaths in this country per year are the victims of this killer.

Recent world developments give further evidence tending to emphasize the fact that the United States is obliged, in order to protect its

internal security, to undertake research programs in many fields. In times of vastly complex technical knowledge, research is essential to sound progress, and I can think of no more vital or fitting field, directly related to the national welfare, than research into the unknown in heart disease. During the period we were engaged in World War II, nearly 2,000,000 people in America died of heart and arterial illnesses. This is approximately seven times the number killed in action in our armed forces in this war.

And I might say, leaving for a moment my prepared testimony, that yesterday I was very much impressed with the group who came before the Appropriations Committee asking for us to go ahead with a new building for the library of the Surgeon General of the Army of the United States, which at the moment has the largest accumulation of medical information and data in the world, and the best.

That is made more important at this time, because all over the world great libraries and great centers of accumulation of that type of data, that kind of material, have been destroyed as the result of World War II, and we are the only country left in the world that has intact. this accumulation of medical and scientific data, and we have it revolving around the Surgeon General's department.

Congress some years ago authorized the purchase of land near the Congressional Library for this purpose, and now the question is whether they have money to go ahead and are able to index and catalog the tons and tons of material, many times only single copies, the only copies available in the world, which we have stored in various places in our Nation. I think this is one more instance where a great burden falls upon America to do definite research and take definite head the medical profession in our country, but also because of the destruction in the rest of the world and of the fact that we are in a position to do so, not only because of our assets, our wealth as a Nation, and the intelligence and superiority of many of the men who head the medical profession in our country but also because of the utter destruction of physical data in other lands, and further because, as a result of a totalitarian regime in many of those countries, it is impossible for capable men in those countries to go forward with research on their own initiative, as they have done in past decades. Senator SMITH. Senator Bridges, did you say that the first request for appropriation came from the Surgeon General of the Army? Senator BRIDGES. Yes, Senator.

Senator SMITH. Not from the Public Health Service?

Senator BRIDGES. No, it is built around the Surgeon General of the Army.

Senator SMITH. One of our problems before this committee has been to coordinate the various health activities engaged in by different agencies, the Medical Corps of the Army; the Public Health Service, Federal Security Agency. That is one of the problems we are studying. I just wanted to get it clear whether this was a special Army request or an over-all request.

Senator BRIDGES. It is very interesting, in answer to your question, Senator, to say that there were no Army people present. They were all doctors from various institutions, Johns Hopkins and other places, our own Dr. Calver here at the Capitol, and others who have been interested in this problem. The Army people themselves were not pres

ent in person, but it was the advisory group of people from the public who were interested in seeing this developed.

I think, as you do, Mr. Chairman, that one of the problems that we must face is not to spread out and build up a great bureaucracy in this country that is going to make itself felt everywhere, but in some way to allow our country to sponsor leadership in these things without dominating the activities and without stifling but instead encouraging such activities in the States, cities and towns of our country.

Of course, one of our problems here is that, from the point of view of efficiency and economy, you cannot have too many people doing the job.

Senator SMITH. That is one of the problems before the committee

now.

Senator BRIDGES. Under the provisions of S. 2215, a Nation-wide program of research into heart diseases, its causes and control, would be centered in a National Heart Institute to be a part of the United States Public Health Service in the Federal Security Agency. Under the immediate direction of the Surgeon General of the Public Health Service, a coordinated program of research, training and control of heart disease would be undertaken on a national level.

The program called for is a broad one. It includes grants-in-aid. to appropriate universities, hospitals, public and private agencies, and institutions for such research, education and control. There would be established a national information center on research, prevention, diagnosis, and treatment of heart diseases over the world. This information would be reflected in the publications to be distributed to Americans throughout the country from this information center to help them avoid and prevent the scourge of this terrible disease.

More important from a long-range viewpoint is the provision of S. 2215 which establishes research fellowships, both in the institute itself and at appropriate institutions, to train research workers and to procure the assistance of the most brilliant and promising research fellows from the United States and abroad. In this way, a practical program of training and instruction will provide a constant source of technically equipped and trained presonnel whose cumulative efforts will protect Americans everywhere from the hundreds of thousands of fatalities each year which have come from ignorance in this field.

It is hard to understand why such a step as this has not been taken before. A great majority of people in this country have indicated in various ways their wish that Congress provide for research in this field. In 1947, 83 percent of the people polled by Research Capital Associates in a pilot poll said "Yes" in response to a question whether Congress should put aside a substantial sum of money to be used in research on the diseases of tuberculosis and of the heart and arteries. When we consider the known facts that 1 person of every 16 in this country suffers from diseases of the heart and circulation and that nearly 1 out of every 2 deaths after the age of 45 is caused by heart disease, it is apparent that it is time the Federal Government took sound steps to meet this challenge to the national health.

In the United States Department of Agriculture, nearly $30,000,000 was appropriated during the last fiscal year for research and control of plant and animal diseases. This is almost 10 times more than the amount spent from all sources on diseases of the human heart and