PAFERS ON MEDICINE AND PUBLIC HEALTH 413 



than that. This great number cannot properly be taken 

 care of without the aid of the public, and. under present 

 management, the number is increasing. This means not 

 only great and perhaps unnecessary Buffering to the in- 

 dividual but a great economic loss to the public. Dr. 

 Halsey has conservatively figured that each cardiac pa- 

 tient admitted to a hospital costs the community $200.00, 

 $100.00 for care and $100.00 from loss of work. In the 

 cardiac clinics in Xew York in 1922, there were 4,000 un- 

 der treatment, which would mean a loss of 8 million dol- 

 lars from this source alone. \Vhen you consider that a 

 large number of heart patients, if not properly managed 

 break down and have to enter a hospital repeatedly dur- 

 ing a year, you can see what an enormous loss to the 

 community this one disease is. From this one stand 

 point alone, heart disease is certainly a public health 

 problem. 



This is not. you can well imagine, the reason why the 

 doctors, nurses and social workers, who are constantly 

 dealing with those handicapped by heart disease, decided 

 that they needed help. Every one who is in any way 

 connected with public hospitals knows that the heart 

 cases fill the wards : not only because there are so many 

 but because the same patient returns time after time with 

 his heart broken down, until the final break-down comes. 

 It was this fact that induced Dr. Hubert V. Guile to start 

 a cardiac class at the Bellevue Hospital in 1911, to see 

 if he could not prevent some of these returns. His re- 

 sults were brilliant, and others rapidly followed his ex- 

 ample so that now there are 38 such classes in Xew York, 

 seven or more in Chicago and many in other cities. 



With the establishment of these classes or "cardiac 

 clinics" as they are called, it was soon found that, though 

 much could be done by the clinics, in order to get the 

 best results for the patient many other agencies were 

 needed. Some of these agencies perhaps existed, many 

 of them needed to be enlarged and many other social 

 organizations needed to be formed. It was thought that 

 the entire problem could be handled best by associating 

 all these organizations, and in 1915 the Association for 

 the Prevention and Relief of Heart Disease was formed 



