The support of these persons costs the taxpayers approximately $130,000,000 annually in relief allowances.

I ask you gentlemen to keep that figure in mind. I shall refer to it again.

Now I have already stated that 7,000,000 people are afflicted with rheumatic disease. Surely that is a sizable segment of our population. If all these people lived in one city, that city would have a population larger than Chicago, Detroit, and Los Angeles combined.

But I shall go further than that. The figure 7,000,000 represents the number of people who are afflicted now. That is about 5 percent of our population. But no fewer than 97 percent of our people, providing they live past middle age, will be afflicted with arthritis. That means that a large proportion of the persons in this room owe their impaired physical efficiency to the disease.

Yes, gentlemen, those minor aches and pains in our joints, the slowness of our gait, and many of the other infirmities which we may have philosophically accepted as signs of advancing years, are not necessarily inevitable. They may well be the results of rheumatic disease. You might say that, that were it not for arthritic changes taking place in the joints, the limbs of some United States Senators would be as supple as those of Mr. Clark Griffith's Senators.

The type of arthritis which comes with advancing age is known as osteoarthritis.

There is another rheumatic disease, much more serious, which attacks the youth of our Nation. It is rheumatic fever which is the chief cause of death among children of school age.

A third disease, rheumatoid arthritis, attacks principally persons between the ages of 20 and 50. This disease for some reason afflicts twice as many women as men.

On the other hand, gout, another form of arthritis, is particularly prevalent among men.

Thus we may see that all classes, conditions, and ages of our people are subject to rheumatic disease.

We may make one generalization about arthritis and rheumatism, however, which applies to all.

Rheumatism is a poor man's disease. It takes its greatest toll among our working people.

It is this fact which makes the prevalence of rheumatic disease decidedly the business of this committee and of our Government. Because of rheumatism, 320,000 persons, otherwise employable, are constantly out of work.

A rheumatism sufferer loses on an average 80 workdays per year, a higher figure than results from any other single cause.

Half of these lost workdays occur in families whose income is a thousand dollars or less per year.

That means that these people cannot take care of themselves. They must be cared for. They and their dependents must be fed, sheltered, and clothed. The medical care which they receive must be free.

I wish the members of this committee could visit a free arthritis clinic in one of our large cities-Bellevue Hospital in New York, for example. You should see for yourselves the unfortunate persons who are treated as out-patients despite their obvious need for hospitalization. There are not enough hospital beds to provide for them.

In

the entire country there are only 200 beds endowed for rheumatic disease patients.

Gentlemen, the social problems incident to rheumatism can be solved in only one way. Medical research must be stepped up in an effort to discover a cure or cures.

Without hesitation-and I'm sure that medical backing can be obtained for this statement-I say that progress in the treatment of rheumatism has lagged inexplicably far behind the progress made in other diseases. For some reason we have been content to accept as inevitable the fact that there is no cure for arthritis and rheumatism. Gentlemen, I say a cure can and must be found. The National Arthritis and Rheumatism Act, with its provisions for the support of research in the field of rheumatic disease, may well provide the cure which 7,000,000 Americans today need and demand.

Early in this testimony, I gave the figure of $130,000,000 as the amount of relief money which American taxpayers have handed out because of rheumatism. Gentlemen, that money is nothing more or less than tribute. And we have paid it year after year after year. Our slogan as regards rheumatic disease seems to be "One hundred and thirty millions for tribute, but not one cent for defense."

I ask you now to pass the National Arthritis and Rheumatism Act. And since about 5 percent of the American people suffer from these diseases, I suggest that about 5 percent of the sum which is paid out annually in tribute be appropriated for defense, in other words, to implement the bill. Seven million dollars-a dollar for each victimis what this amounts to. It may well prove the best investment this Nation has ever made.

Senator MURRAY. Thank you, Mr. Mandel. It is good to have a businessman, especially a man prominently identified in the business of the country, coming all the way to Washington to give us this splendid statement.

Mr. MANDEL. I am very happy to do it, I must say.

Senator MURRAY. I think you have demonstrated that the Govermment cannot afford to neglect providing a program of that kind because of the loss we suffer as a result of our failure to make an effort. Mr. MANDEL. Thank you.

Senator MURRAY. Thank you very much.

The next witness is Dr. Russell Cecil.

STATEMENT OF DR. RUSSELL L. CECIL, PROFESSOR, CLINICAL MEDICINE, CORNELL UNIVERSITY

Senator MURRAY. You may state your name and residence and anything you wish to have in the record with reference to your position or standing in the profession or your interest in this problem.

Dr. CECIL. My name is Dr. Russell L. Cecil, and my address is New York City. I am professor of clinical medicine at Cornell University Medical College and visiting physician at New York Bellevue and Veterans Hospital in New York City. I am also past president of the American Rheumatism Association and New York Rheumatism Association.

Senator MURRAY. You specialize in this field of disease?
Dr. CECIL. Yes, sir.

Senator MURRAY. You may proceed with your statement, Doctor. Dr. CECIL. Senator, I have no particular statement to make, except that I am very enthusiastic over the idea of an appropriation for this good cause. Most of the notes that I made here have been already mentioned by the preceding gentlemen. That is, the prevalence of the disease; the great need for work in that field.

I might say that we have been preceded in this good work by Great Britain and Sweden and also the Dominion of Canada, where there are quite active drives on at the present time, not only in the way of providing funds for research, but also providing better facilities for the care of poor arthritics and more beds for them and better outdoor clinics. It is a disease that is prevalent in temperate and cold countries, and the Canadians, British, Scotch, and Irish have it; it is a scourge in these colder countries, and also the northern part or our country.

Senator MURRAY. The rapid change in climate has some bearing on it, does it not?

Dr. CECIL. Yes, it does, particularly where they occur quite suddenly. But it seems that moisture and cold, damp climate, where there is a great deal of water, for instance, like Great Britain, an island such as Great Britain, it is the ideal environment for producing rheumatic disease.

Strangely enough, some of the West Indies, those coral islands, where the soil is dry and they have trade winds blowing, they are quite ideal for the treatment of these conditions, even though they are surrounded by water; but the whole atmospheric condition is quite different from what it would be in England or Ireland.

We feel that strictly from the medical standpoint this subject needs attack in several different channels. It was 10 years ago that this American Rheumatism Organization was organized by a group of physicians who were interested in the problem. Since then the society has grown rapidly, and after many years of neglect, rheumatic disease has taken its place of importance, especially in medicine, alongside heart disease, cancer, and other such problems.

Two years ago the society felt the time was ripe for a fund-raising campaign, and that is the basis of the present Arthritis and Rheumatism Foundation, which is frankly created for obtaining funds and seeing that the cause is properly brought to the attention of the American public.

We feel that whatever funds we obtain, either from private sources or from the Government, should be put to three purposes: One, research work, because there is certainly great room for that; second, education of both doctors and the public as to the importance of the disease and its prevalence; and third, the proper care of indigent. arthritic patients, as one of my preceding colleagues stated, who are poor; arthritics are poor people. It seems to be a special kind of disease that hits people who are having a hard time in life.

If you get into the high blood pressure field, you get into the prosperous and well to do, but here is a chronic condition which attacks people who are having a tough time in life. So we would like to see them better cared for.

Senator MURRAY. At the present time, is there any research department set up in any of the large hospitals of the country devoted to the study of this disease?

Dr. CECIL. Yes; there are several very good funds. There is a fund at the University of Michigan, the interest on a million dollars, which goes entirely to the research on rheumatism and arthritis.

There is a fund at Presbyterian Hospital in New York, at the Columbia, of about the same amount. The proceeds go to the study of rheumatism.

Recently there has been a very excellent annual fund created by the Masonic Foundation. The Masons in New York State are raising quite a good-sized annual budget, which is distributed amongst the universities in New York State for research purposes, and for the care of arthritic patients as well.

Senator MURRAY. They are pursuing their studies and research, but none of these institutions has arrived at any conclusions with reference to the cause of the disease or its cure?

Dr. CECIL. There are a good many different kinds of arthritis and rheumatism. There is the type associated with venereal disease, which is pretty well understood and treated. But that is not a large problem as compared with the small groups. Rheumatic fever is supposed to be a streptococcus disease, but we are a long way from understanding the mechanism of how streptococcus causes these joint swellings.

Arthritis is just a completely blind book.

Senator MURRAY. You think there is a great need for setting up a research institute such as is proposed in this legislation?

Dr. CECIL. Very much so, and I feel that the fact that we have so much trouble getting the young doctors to become interested in the problem-all of our young men around the Presbyterian Hospital and Veterans Hospital in New York want to be heart specialists or they want to be psychiatrists. They want to be anything else but a specialist or student of rheumatism or arthritis. We want to get a change of attitude on that.

I think it can be done as soon as the young men realize it is interesting and has a future. The same thing existed a few years ago with respect to cancer. Cancer was kicked around as rheumatism is now. Then, all of a sudden people began to realize what a terrible problem cancer was; they began to give money to it, and now there are plenty of splendid young men going into the cancer field as their life work.

Senator MURRAY. And you think the same thing can be accomplished here?

Dr. CECIL. Yes; I think so.

Senator MURRAY. It is very important, but my understanding is that a person affected with rheumatism of any serious kind who would go to one of the large hospitals in the country would simply be told that there was no cure and that nothing could be done; is that right?

Dr. CECIL. He would be baked and rubbed and given a few conventional things.

Senator MURRAY. But nothing in the hospital they could do? Dr. CECIL. NO. Therefore, the hospital, which is always crowded for beds these days, will not keep them and pushes them right out. Senator MURRAY. I have heard of a number of cases where the patients went to the finest institutions in the country and were told there was no relief for them there; that they would have to go on home or

to go to some resort out in the dry countries and take life easy, maybe they would get over it.

and

Dr. CECIL. That is right. I often tell my patients in New York that they should go out to Arizona, and they simply laugh.

Senator MURRAY. Or Montana. They have a number of these hot springs around the country like Hot Springs, Ark., and the hot springs out in the Western States that give some relief.

Dr. CECIL. It is not exactly a cure.

Senator MURRAY. It is great relief and especially if it is in a country where the climatic conditions are good. I suppose a person would get along better there than in the part of the country where they have these extreme changes of climatic conditions and so much humidity.

Dr. CECIL. But, you see, the arthritic runs an up and down career. He goes out to dry country and feels better, and then comes back after a few months and then he goes back where he was before. They have a tough time. They take these cures at great expense often and then find themselves right where they were before they took the cure.

Our cure is mostly palliative: rest, aspirin, all these various things, mostly to try to make life more bearable for them, but we do not cure many of them. Nature cures a few.

Senator MURRAY. As to the statistics, you said you intended to cover some of them or that some of them had been covered by the previous witnesses.

Dr. CECIL. Yes.

Senator MURRAY. You are in accord with their views that this would be a splendid investment for our Government, because it will save money in the long run and would be a very desirable program for the Congress to adopt?

Dr. CECIL. I feel so, very strongly, Senator, I really do.

Senator MURRAY. Of course, we are met often with objections with regard to the cost of some of these programs, and they are fearful about balancing our budget.

From the statements made here this morning, we appear to be spending more money on animal and plant diseases than we are on human diseases. It seems to me the Congress would be saving money and making a wise investment of this money to set up an institution for research that could possibly find the cause and cure of this disease. Dr. CECIL. There is one very prevalent form that occurs in old people. All of us get a certain amount of stiffening and rheumatism pains as we get old, but there is reason to believe a lot could be done for old people who get rheumatism, you might say, naturally. A lot could be done if we have a better understanding of the mechanism of aging and rheumatism.

Senator PEPPER. Thank you very much for your statement here, Doctor. We appreciate your statement today.

Next is Dr. Paul Holbrook.

STATEMENT OF DR. W. PAUL HOLBROOK, TUCSON, ARIZ.

Senator MURRAY. Your may state your full name, Doctor.

Dr. HOLBROOK. My name is W. Paul Holbrook, and my address. is Tucson, Ariz. I am the president of the Arthritis and Rheumatism Foundation and chairman of the Research Committee of the American Rheumatism Association.