BUREAU OF STATE SERVICES

           DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

    WASHINGTON 25. D t.

April 30, 1957

Mrs. Albert D. Lasker
Chrys ier Building
New York 17, Mew York

Dear Mrs. Lasker:

1 appreciate the reprrnt iJliich you forwards.! tu me on  i;hs  ir~ter-

rclntionshir between cerebral and coronary athcroaclcrosis.

   Atherosclerosis presents a definite but net. inFossible problem
for the Heart Disease Control Program. While L cannot make specific
recommendations to prevent the development of thL disease, there are
things which may be done to prevent and minimize the secondary complica-
tions. We must extend and utilize the rehabilitattve and restorative
services beyond the larger hospitals to the snallcr comnunity hospitals
and to the home of the patient who may never be hospitalized. These
restorative services will enable the victim to be more independent and
thereby enable other members of the family to wark.

Hypertension presents anocher problem and T run confident that

before long the control program will be able to apply effectively the
measures which are being developed in the research laborataries.

Today, rheumatic fever offers the greatest chnllcn!:e. These

programs are acceptable by the community and by the clinical physicians
who must see that continuous prophylaxis is maintained for each patient.
Each year, I believe more children have rheumatic fever then have polio,
and if untreated the end results of rheumatic heart disease are more
disabling and terminate in much earlier death. with adequate prophylaxis
these cmplications can be prevented.

    You remember that the profassionol and technical assistance
program received a $100,000 increase last year.
support and place eleven medical officers in health departments to
initiate practical heart disease control programs.
are. rather dramatic and even spectacular.

I used these funds to

Sone of these results

In St. Louis, the rheumatic fever control progrcvn has been so

successful that two other cities in the State now want and are planning
to initiate a control program in cooperation with the State and the city
health departments, the county medical society, and the heart association.

-2-

Mrs. Albert D. Laskar---4/30/57

`in Chicago, a rheumatic fever registry was established. One

might think this would be designed to accumulate records, but actually
it is being used to enable the physician to follow-up each patient by
utilizing the community resources on the less cooperative parents. In
the first six months, approximately 1800 cases were added to the
register. In the previous year, only 200 were reported. I suspect
there is a lot more rheumatic fever than existing records indicate be-
cause so many cases are never reported. I feel it i.s our responAibility
to extend the best medical care and modern preventive medicine eo all
children who have had an attack of rheumatic fever.

    In North Dakota, the State health department worked with a six-
county medical society and the heart association to initiate a study of
coronary disease among farmers. The cooperation of over approximately
125 physicians in the study is marvelous. Dr. Paul Dudley White was
very helpful in initiating this program last fall..

    Middlesex County in Cbnnecticut planned and has started a similar
study of coronary disease in a high incidence area,  and in addition will
accumulate health information on a large population group which may be
used as a base line in later years after an atomic energy plant is in
operation for generating electrical energy.

I thought you might be interested in a few examples of what these

physicians have been able  to do.
that I now have 33 requests for assistance and T. expect to he able to
meet five of these in July. By strategically placing the preventive
medicine physician in a health department, it is possible to initiate
new programs and also meet a very definite personnel need of the area.

So successful have been their efforts

If you are interested in other activities of the control program,

I would be happy to describe them in greater detail.

With best personal regards.

Sincerely yours,

K. C. Arnald, Medical Director
Chief, Heart Disease Control Program
Division of Special Health Services

Enclosure