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.

With an aging population and with the problem of chronic diseases as it is today, with diseases of the heart and of the arteries in the foreground, as was pointed out in the national health assembly last week that we have to orient our thinking to a dynamic problem to utilize these advices rather than simply a building of facilities.

It has been shown how such a program is advantageous, economically.

I think the experience of the Federal and State rehabilitation problems in their first year after the --LaFollette Act was passed is excellent evidence. The first year after this law was passed, 44,000 individuals had rehabilitation training under the law. Their average income before training was $148 per annum per person. The next year this same group received $1,768 per person per annum. Ninety percent had not been employed prior to their training. The average cost of their training was $300 per case. Their average relief payments prior to training was $500 per year.

There are now estimated, at most conservative estimates, to be 2,000,000 people in this country entitled to such care under the law, but who are not getting it because there are not the trained people nor facilities for much of the basic fundamental research that will establish the needs in the program.

I think, too, that industry and labor have a special interest in this heart program, and I should like to call your attention to the excellent results that have been attained in the garment workers industry in New York with a health-maintenance program providing facilities to treat the cardiacs on the job, special rest periods and so forth, enabling these individuals to go on and work with what they have left.

There are scores of men who under the ordinary rules would be relegated to their homes, who have worked on for many years and done an excellent job with this health maintenance service.

I make these points because this is an absolutely new field so far as investigation is concerned.

We need base lines. When the coronary gets out of bed at the end of 6 weeks, that is just the beginning of his problem. If he got his coronary because he was working 14 hours a day and needs to set his tempo of life at 4 hours a day, it is just not enough to say to that individual, "You can only work 4 hours," because if he works 4 and worries 10, you better let him work 14 because he will kill himself more quickly with the first regimen than with the second. That man has to be decompressed, just like a sand hog working under the river has to become decompressed when he comes up to sea level. There are techniques by which it can be done. Men who cannot go back into full work must have an avocational interest that they are trained for that will let them live for this sort of life. There is a phase of preservative medicine.

In Bellevue Hospital is the first program in any general hospital in this country. We have recommended to the national health assembly that this should be a part of the training in every general hospital. If it is to be so then we need a tremendous research program that will teach us the techniques and that will make these standards available to every doctor in the country so that it can be carried out simply as a part of total medical care.

It seems to me that such a bill as this and such a program as we are discussing this morning would give invaluable aid to the statement of not only this philosophy and concept but making it a reality. Mr. HALE. Thank you very much.

Mr. DOLLIVER. Mr. Chairman.

Mr. HALE. Mr. Dolliver.

Mr. DOLLIVER. I am very much interested in what you have had to say about the methods and means of making the information readily available, as to cardiac troubles. I quite agree with you that that is one of the very major problems of this whole thing. You are not testifying, however, that this bill covers that field, are you?

Dr. RUSK. Yes, sir; I think that that is a part of the research program that you are projecting because I think that the training of the cardiac, rehabilitation of the cardiac is a part of his treatment. I think it is covered under the bill.

Mr. DOLLIVER. Of course this is a research program rather than an informative program or public information program.

Dr. RUSK. That is exactly what I am speaking about. Maybe I did not make my point clear. But that is what the great need is for. Now we need research in the field of rehabilitation training, because we do not have the base line by which we can measure the amount of activity that a cardiac can do. Can he work 4 hours a day; can he work 6 hours a day; or can he do one of 10 jobs, or 1 of a thousand jobs. That requires patient, painful research in the hospitals, with the laboratory backing him up, working with patients until we get our base lines established. We do not have that.

Mr. DOLLIVER. That would be a clinical activity rather than pure research in a laboratory, would it not?

Dr. RUSK. Well, the clinical observation with laboratory tests to back up or refute your clinical observation, just like any phase of medical research. It is work with the patient and in the laboratory; a combination of the two. But, it is fundamental in the treatment.

Mr. DOLLIVER. I think that you would agree that a considerable amount of useful public information has been given by various insurance organizations.

Dr. RUSK. Absolutely.

Mr. DOLLIVER. The newspapers have given a fine service in that connection too?

Dr. RUSK. That is right.

Mr. DOLLIVER. Can you give us any idea of what your concept is of getting to the 4 or 5 million housewives that you talk about who are cardiac invalids; how can a program of this kind be brought to them? Do you envision that can be done under this bill?

Dr. RUSK. Yes, sir. I will speak to this one piece of research we are engaged in at the present time.

Mr. DOLLIVER. By "we," you mean the New York Times?

Dr. RUSK. No; New York University.

Mr. DOLLIVER. New York University?

Dr. RUSK. Yes, sir. We are at the present time engaged in a piece of research work for one of the large electrical companies. It is a hand-in-hand research project in which they have set up a model kitchen, even a laundry, designed so that a woman can operate it entirely while in a wheel chair. We have trained one of our para