EDEMA-MEANING, CAUSES, ETC.

Mr. SHEPPARD. I do not know whether this question should be on or off the record.

I picked up an item the other day I was rather interested in, and perhaps misinterpreted it, and that is what motivates my question. What is the word "edema"?

I am not familiar with the medical terminology. It is a respiratory difficulty of some character, I understand.

General HEATON. An edema means an interference of a return circulation. It is a manifestation of return circulation.

An edema would be the swelling of the legs with a bad heart, or a pulmonary edema. It may mean water in the lungs. Mostly, you hear of an edema associated with a heart deficiency.

In other words, you cannot get enough air down and you have not enough to get it back to the heart to start it over again.

Mr. SHEPPARD. This particular item treated the lung aspect and not the circulatory aspect.

General HEATON. It is contributory.

Mr. SHEPPARD. In the last paragraph it did give an indication that it is related to the family of cancer. Is that true or not true, so far as you know, as far as research has indicated?

General HEATON. Of course, cancer can cause an edema by pressure. Cancer in the abdomen, by pressure upon what we call the inferior vena cava, the big vein returning the extremities, can cause an edema of the extremities. Of course, cancer up here in the throat, in the neck, can cause all sorts of blockage in the thoracic cavity. It can be a direct contributing cause, as it is a direct contributing cause to many other things.

Mr. SHEPPARD. It can become a related factor and it also can possibly be an exclusive disturbance within itself?

General HEATON. That is right.

Mr. SHEPPARD. And not a cancerous condition as such?

General HEATON. No, sir.

Mr. SHEPPARD. A patient suffering from an edema is not necessarily a cancer victim?

General HEATON. NO.

If you had an edema, you would not think of cancer right off like if you had a disturbance in a cough habit. That is the first sign of a cancer of the lung. A disturbance of the bowel is a very early sign of cancer of a bowel. You would associate that with cancer of those organs.

An edema would not strike you right away as being a primary

cause.

Mr. SHEPPARD. Do you find in your experience in your treatment of people that this particular pulmonary difficulty is in evidence any more than it has been normally?

Has it become an increasing problem in the last few years?

General HEATON. I do not think so; no, sir. Pulmonary edema has not shown any particular rise in incidence.

Mr. SHEPPARD. Is it an easy treatment situation, or a difficult one? General HEATON. It depends on what kind of heart you have back of that. You would treat the heart primarily. If it is not to become compromised

Mr. FLOOD. If you feel loss of any problems, or questions, here is the time to get in now. You have an expert here. It will not cost you a dime.

Mr. SHEPPARD. The item was in the Medical Journal. The way the subject matter was treated in the Journal excited my interest becase it left an inference there of a cancer situation, or potentiality. There is no question about it. The article clearly indicated that. That is what motivated my question.

I had not particularly heard of that in all the testimony that we have had from people of medical science and practice over the years that I have sat on the committee.

General HEATON. Pulmonary edema is very commonly, to all of us, associated, first, with a cardiovascular condition. When you have pulmonary edema with cancer, you are pretty well along toward the end.

Mr. SHEPPARD. Thank you.

PREVENTIVE MEDICINE

Mr. RILEY. General, is there a greater percentage of hospitalization among new recruits, or among those who have been in training for some time?

General HEATON. I am glad you asked that question, Mr. Riley. I think our preventive medicine people have done a magnificant job. I will tell you how they have worked.

At

At Fort Leonard Wood, recruits-I am speaking of now-as you know, recruits have shown a historical susceptibility to streptococcal disease, and to common respiratory infections and influenza. Fort Leonard Wood last year, the 1960 winter, between November and April 15, 1960, they gave every recruit bicillin. That is a penicillin, 1,200,000 units, one shot. In 1959 at Fort Leonard Wood they had 1,291 cases of severe streptococcal disease. Last year, when they instituted this, last year with the penicillin, they had only had 45 cases. Now mind you, the incidence of streptococcal disease is going up in this country from 108 per 100,000 to 322-the graph has gone up, but the incidence of rheumatic heart disease is going down in the Army. The incidence today as a result of our program directed against streptococcal disease is now about 12 per 100,000 troops.

We have brought it down in 3 years from 58 to 12. In other words, that is only about 90 cases of rheumatic fever a year, and we figure that one case of rheumatic fever cost the Government at least $50,000 to treat, the hospitalization and the disability pay.

Now, on respiratory disease, which we have all experienced in two wars, there is a very phenomenal advance. We are giving recruits now what we call an adeno-virus vaccine. At Fort Leonard Wood again, before we gave this adeno-virus vaccine, in the 1959 winter, we had 6,900 cases admitted to the hospital at Fort Leonard Wood of upper respiratorial infection. Last year they had 3,600 cases, almost a 50-percent decrease, and we are doing that in every recruit center in the Army today, the streptococcal and the adeno-virus vaccine for the recruit.

For some reason or the other, the older individual who has been with us longer is not as susceptible to infection and has a much lower incidence to these diseases.

Mr. RILEY. Does the Army feel then you should have a first-class hospital and first-class medical staff at those stations where you train recruits?

General HEATON. Yes. We feel that such a facility is needed at each of the recruit training stations and, indeed, such a facility is believed to exist at each training station. While not all of the training stations have new permanent hospitals, all of the hospitals are competently staffed and each major basic training post has a fulltime preventive medicine officer.

COMMON COLD

Mr. ANDREWS. Mr. Flood, for 5 minutes.

Mr. FLOOD. That causes me to ask you about the common cold. Are you doing R. & D. on that?

General HEATON. Yes, sir.

Mr. FLOOD. Are you getting anyplace?

General HEATON. I don't know whether we are getting anyplace or not. I sincerely hope so. With the combination of this influenza vaccine and the adeno-virus vaccine I personally think we are, because, speaking for myself, the last 2 years I have had this and I have not had a common cold and I am very susceptible to it.

Mr. FLOOD. The last 2 years you have had what?
General HEATON. These vaccines.

Mr. FLOOD. You are in the area of R. & D. with the common cold? General HEATON. Yes, sir. It helps so far as I am concerned to guard against the common cold. That is like cancer. We have got to find the cause and a quick treatment of the common cold. Many man-hours are lost, as you know.

Mr. FLOOD. To the Army the man-hour loss is especially important. General HEATON. Yes, sir.

SUNBURN PREVENTION

Mr. FLOOD. What is the effect of the value of your R. & D.? Are you still doing it or have you solved these sunburn problems, another great problem with troops in the field? Where are you with sunburn pills or tablets?

General HEATON. The only sunburn protection that we have, and snowburn, as you know, is the local application. There are pills but we do not rely on pills like we do the local application and the helmets and the head protection.

Mr. FLOOD. A few years ago some of your people were telling me about a pill which has become very common, or was a few years ago, in civilian life. You could buy a certain pill which you would take every so often to protect you from sunburn.

Do you know about those pills?

General HEATON. I don't know the efficacy of those pills, no, sir. Mr. FLOOD. That is odd. I do not know whether it was an Army medical man, but some medical man here made quite a presentation to us 3 or 4 years ago on these sunburn pills and how the Army had developed them, or somebody had developed them for the Army. They were with the troops. They were very effective, et cetera. Then they were advertised in magazines and the public press for a period of time. I do not know whether it was a stunt or not, but

there was quite an advertising campaign in the press. You saw a great deal of this. I saw a number of my friends who were going to the South. They would show me a bottle of the pills they were going to take. They swore by them.

General HEATON. To protect them against sunburn and early tanning?

Mr. FLOOD. Maybe that is the phrase. Is that a different phrase, "early tanning?"

General HEATON. Yes, sir. In other words, it will give the skin a little tougher fiber and you won't get the original primary burning, I presume.

Mr. FLOOD. Do you give this to your troops to accelerate tanning as a form of protection from sunburn?

General HEATON. I don't think as a routine we give it to the troops. I am very familiar with the local protection, snow and sun.

Mr. FLOOD. Other than equipment, what local equipment do you give for protection to troops in the Tropics? What lotion or oil or cream do you use?

General HEATON. Just an ordinary ointment or lotion.

Mr. FLOOD. No different from the commercial product?
General HEATON. No, sir.

Mr. FLOOD. Do you labor under the illusion that these things work?
General HEATON. I think they do, sir.

Mr. FLOOD. Is it psychological or do they work?

General HEATON. I think you can do a great protection in the Tropics or hot sun with local applications and head protection, yes, sir.

QUALITY OF MEDICAL FACILITIES AND PERSONNEL

Mr. FLOOD. Tell us about your hardware in your hospitals, generally speaking. What does the civilian profession think about you fellows? Do they think you are good? Do they think you are as good as they are? What is the reputation in the trade, as to hospitals, quality of surgeons, performance of your doctors and dentists? What about your whole setup? Are you as good as you think you are? What do they think about you people?

General HEATON. I think we are as good as we think we are. I am proud of them, Mr. Flood, and I think we are accepted in all the high circles of surgery and medicine. I think the proof of the pudding of that is the acceptance of some of us in the most exclusive societies of this country and the recognition of all of our hospitals in this country-every 51 of them are recognized by the Association of Medical Colleges and the American College of Surgeons for teaching purposes.

Mr. FLOOD. You are respected in the professions?

General HEATON. If I may be modest and humble, I would like to say so, yes, sir.

Mr. ANDREWS. The time of the gentleman has expired. Mr. Mahon, you have 5 minutes.

BLOOD CHOLESTEROL

Mr. MAHON. General, would you take a few minutes to talk about the latest determinations of the Army, and maybe your own views,

with respect to this very controversial question of cholesterol in the blood and would you also give us a little idea about the most striking, spectacular development that has taken place in Army medicine in the last year or so?

General HEATON. This cholesterol is quite a controversial question, as you know, but I think it is a very good question, and it is very good that all of us, except these young men sitting here, should be aware of it. As you know, the cholesterol is elaborated in the liver as an end product, and in its chemical structure is a high alcohol. It is waxy. We don't mind cholesterol in younger people who are metabolizing or burning their food properly and getting, more important, plenty of exercise. It is the middle age and older group that we are concerned with, because on our backs, militarily speaking, you are riding a lot of money for training.

We are very concerned about cholesterol and cholesterol metabolism, because it has more or less been proven that it is a great cause, a very important cause of coronary artery disease and generalized arterial disease over the body.

We know that by diet-and I have been intimately acquainted with a very distinguished patient on this-when you get out of bounds, your blood cholesterol will go way up. You can control your blood cholesterol by proper dieting. I refer to particularly the fat content of your diet. There are three fats. There are the saturated fats which are the animal fats, milk, cream, and butter and eggs. There is the monounsaturated fat, and there is the polyunsaturated fat. The monounsaturated fat will keep your cholesterol reading about even, reading between 180 to 250 milligram percent. The polyunsaturated fat, which is corn oil and soya will lower the cholesterol. We know that in Italy, where they use the olive oil, which is a monounsaturated fat, as a primary cooking medium, coronary artery disease is very, very low. We know that in Norway during the German occupation, 1940 to 1945, Norwegians could not obtain any milk products from Denmark, and the coronary artery disease was very low.

Among rice-eating people, coronary artery disease is very low. The main thing in this basic consideration of cholesterol, which is coronary artery disease, is diet, proper diet, have no animal fat. If you are going to drink milk, say skim milk, lean meat, no bacon, margarine and such things as that-corn oil, peanut oil for cooking, but regular exercise. That is why we have people dying shoveling snow. They are not used to regular exercise. It is not necessarily what their cholesterol is, but the regular exercise. It is a very complex problem. We in the Army are very aware of it. We have our physical examinations once a year and an individual who comes in a little bit on the up with his weight and blood pressure which is creeping up from last year, we do blood cholesterols and we go into his diet thoroughly and his program of exercise.

In the old days in the Army, and it is too bad we haven't got it today, Wednesday afternoon and Saturday afternoon were available for exercise and at the end of each month we signed a certificate on our honor, as to what kind of exercise did you take on Wednesday afternoon, what kind of exercise did you take on Saturday afternoon, clear on up until you were retired.

Mr. LAIRD. Will the gentleman yield?