(Stroke. 1995;26:1490-1500.)
© 1995 American Heart Association, Inc.
Articles |
The Stroke Council of the American Heart Association
The Early Years
From the Department of Neurology, Mayo Clinic, Rochester, Minn.
Correspondence to Robert G. Siekert, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
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Abstract |
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 Top Abstract IntroductionBackgroundCoordinating Committee on...Council on Cerebrovascular...Appendix References |
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An account of the origin, within the American Heart Association, of a council devoted to vascular disease of the central nervous system, with particular attention to the context in which that occurred, is presented in this article. The forces of a service-charitable organization, political action, medical practice in general, and interested, strong-witted citizens provided the stimuli for the development of the Stroke Council.
Key Words: cerebrovascular disorders • history of medicine, modern • American Heart Association
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Introduction |
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The first meeting of the Executive Committee of the Council on Cerebrovascular Disease took place on Friday, January 27, 1967, at the Belmont Plaza Hotel, New York City.1
At its meeting on December 8 and 9, 1966, the Central Committee for Medical and Community Program of the American Heart Association (AHA) had endorsed the proposal from the Coordinating Committee that the Committee on Nationwide Stroke Program become the Council on Cerebrovascular Disease. The Board of Directors approved the formation of the council at its meeting on January 14, 1967. The rapidity of these final events in the story speaks to the administrative skills of many individuals from the private sector as well as the staff of the AHA.2
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Background |
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TopAbstractIntroductionBackgroundCoordinating Committee on...Council on Cerebrovascular...Appendix References |
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Interest in stroke had gradually increased during the 1940s and the 1950s when new diagnostic concepts and a more optimistic view of the therapy of stroke began to appear. A major stimulus to interest in cerebrovascular disease was the Princeton Conferences. Irving S. Wright, although a peripheral vascular specialist, had become interested in stroke in the 1930s. When he began to gather information with the view to initiate a program of clinical investigation of various therapeutic measures for patients with stroke, Wright realized the need for a conference.3 4 Wright discussed the matter with Mary Lasker, who supported the idea of a conference and promptly provided funds.5 The first Princeton Conference was held in Princeton, NJ, on January 24 through 26, 1954. It was sponsored by the AHA and supported by the Lasker and Kress Foundations and by the National Heart Institute of the US Public Health Service. The conferees, in their review of the current status of cerebrovascular disease, became aware of the problem of various ill-defined terms and recommended that a classification of cerebrovascular disease be composed.
The second Princeton Conference took place in January 1957 and was held under the auspices of the American Neurological Association (ANA) and the AHA; the funds were supplied by the National Heart Institute of the US Public Health Service. The transactions of the second conference contained the previously recommended classification and outline of cerebrovascular disease,6 prepared by a committee appointed by the Advisory Council from the National Institute of Neurological Disorders and Blindness (NINDB), also of the US Public Health Service. The Princeton conferences of 1961, 1964, and 1966 were also held under the auspices of the ANA and the AHA and were supported by grants from the NINDB. The National Heart Institute had withdrawn support because the meetings were closed.7
The importance of the early Princeton Conferences cannot be overemphasized. By 1950 or so, investigative work had begun on stroke-related topics such as atherosclerosis of the large extracranial arteries, related cardiac disorders, and increasing use of arteriography, but the medical profession in general remained aloof from the study of this subject. The first conference clearly indicated a desire to go forward. The second and third conferences brought forth previously unknown individuals, new insights in viewing stroke, and talk of therapy. By this time, neurologists showed interest in the field.
The Council on Cerebrovascular Disease had its beginnings in 1962 when the National Office Committee on Coordinated Stroke Program began to meet to address activities in the area of stroke.8 In the years before, volunteers had expressed concern that the AHA was not sufficiently active in community programs related to stroke. During 1961 through 1963, the committee prepared educational materials for physicians, nurses, and the public and provided suggestions for developing various programs to the community affiliates.
At its December 1962 meeting, the Board of Directors reviewed and approved, in principle, an outline prepared by the National Office for a Nationwide Coordinated Stroke Program. This program was intended to involve the talents of national, state, and local AHA affiliates in rehabilitation, community programs, professional education, and public education (radio, television, and film). At the board meeting of June 8, 1963, the president of the AHA was authorized to appoint a task force or coordinating committee of appropriate leaders from the AHA and other groups to formulate a definitive program and direct its implementation. Although it was noted that a number of affiliate and chapter heart associations already had stroke programs, the plan envisaged was to involve every one of them in the program on stroke.9
The AHA appointed the Ad Hoc Coordinating Committee on National Stroke Program in the fall of 1963, to be chaired by Wright. The committee members included Drs J. Gordon Barrow, David H. Brand, Michael E. DeBakey, David Frost, David Gelfand, Harold Griffeath, James Hammarsten, Albert Heyman, Frank H. Krusen, Clark H. Millikan, Nathan W. Shock, and James F. Toole, and representing the AHA, Chauncey Alexander of the Los Angeles County Heart Association and Arguyle Seikel of the Colorado Heart Association. The first meeting of the Ad Hoc Committee was held on November 15, 1963, and the following charge was adopted10 :
The Coordinating Committee on Nationwide Stroke Program is charged with the responsibility of initiating, developing and guiding the Stroke Program of the American Heart Association, Affiliates and Chapters. The scope of the program includes research, prevention, diagnosis, management and rehabilitation. As such, it is multidisciplinary and will require the coordination of all facets of American Heart Association talent, volunteer and staff, on National, Affiliate and Chapter levels. Further it will require cooperation and coordination with appropriate organizations outside the Association.
The program is to be implemented through appropriate research, undergraduate medical education, physician and allied profession education, public education and information, and community services at Affiliate and Chapter levels.
On the national scene, President Lyndon B. Johnson, in a special message to Congress in February 1964, informed the Congress that he was establishing a commission on heart disease, cancer, and stroke "to recommend steps to reduce the incidence of these diseases through new knowledge and more complete utilization of the medical knowledge we now have."11 12
At the first meeting of the President's Commission at the White House, 2 months later, President Johnson said, "Unless we do better, two-thirds of all Americans now living will suffer or die from cancer, heart disease or strokes. I expect you to do something about it."12
In 1965 the Congress passed the Heart Disease, Cancer, and Stroke Amendments of 1965,13 whose purposes were "through grants, to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training (including continuing education) and for related demonstrations of patient care in the fields of heart disease, cancer, stroke, and related diseases."13 Representatives from the AHA and several of its constituent groups, including the Coordinating Committee on Nationwide Stroke Program, provided testimony to the commission and its committees. John Stirling Meyer was the only neurologist on the national commission.
The creation of the President's Commission and the resultant passage of the enabling act and the publicity associated with them certainly enhanced the public's awareness of these disease conditions. Later, when funding was reduced and finally ceased, the Regional Medical Program gradually lost influence. This program, however, had long-term effects on methods of medical practice and types of medical training.
With the passage of the Regional Medical Program, the NINDB became the focus of stroke activities in the National Institutes of Health. In 1963, the Advisory Councils of the NINDB and the National Heart Institute had formed the Joint Council Subcommittee on Cerebrovascular Disease to enhance closer communication between these institutes.7 In 1968, one of the original purposes of the NINDB, research in blindness, was removed by the creation of a new National Eye Institute. Shortly thereafter, the word "stroke" was incorporated into the title to reflect the increased responsibility of the Neurological Institute in this area of research.14
Going on apace, apart from the administrative and political affairs of the AHA and the federal government, was the spread of surgical treatment of ischemic cerebrovascular disease after the early steps in the 1950s. By the mid-1960s, surgical correction of an occlusive lesion of the carotid artery was being established as an important prophylactic and therapeutic procedure.
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Coordinating Committee on Nationwide Stroke Program |
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At its first meeting in November 1963, the AHA's Coordinating Committee on Nationwide Stroke Program, while aware that the previous primary concern of the AHA in stroke matters was rehabilitation, decided to broaden the approach and to move into research, professional and medical student education, prevention, community programming, and public education and information. Rehabilitation, while remaining important, would no longer be the exclusive intent.10 At the meeting, George E. Wakerlin, MD, AHA staff, described the various materials for professional and public education that the staff had prepared. He listed pamphlets, films, slides, exhibits, and speeches. He reported on joint efforts with other agencies such as the American Medical Association, Vocational Rehabilitation Administration, and Heart Disease Control Program in cosponsoring a recent national conference on stroke and the upcoming congress on stroke planned for October 1964. The committee concluded that the AHA must assume the responsibility for a stroke program. The committee was of the further opinion that a substantial gap existed between the current level of knowledge and its application, that such knowledge should be made available to physicians and medical educators, and that the need existed for increased facilities and resources to provide appropriate medical care for patients with stroke. Finally, Wright appointed the following seven subcommittees to study specific topics10 : (1) Research (to study gaps in research): Drs Millikan, Heyman, and Shock; (2) Undergraduate and Graduate Medical School Education: Drs Hammarsten, DeBakey, and Krusen; (3) Scientific Program for Scientific Session, 1964 American Heart Association Annual Meeting: Drs Krusen and Gelfand; (4) Community Programs (including nursing home care): Drs Barrow, Brand, and Frost as well as A. Seikel and C. Alexander; (5) Public Education: Drs Griffeath and Barrow and A. Seikel; (6) Statement on Present Knowledge and Its Application: Drs Millikan, DeBakey, and Toole; and (7) Public Relations: F. Arkus and such members of the committee as he wished.
At the June 8, 1964, meeting of the Coordinating Committee on Nationwide Stroke Program, a number of suggestions were made.15 The committee noted the issuance of the revised pamphlet Stroke, A Guide for the Family and agreed to request funds from the NINDB for an educational conference and to request the opportunity to present educational programs at the Association of American Medical Colleges. The committee requested that the AHA fund two clinical fellowships in cerebrovascular disease.
Millikan presented the report of the research subcommittee, which requested that the AHA include a person versed in cerebrovascular disease on the editorial board of the journal Circulation, that papers on cerebrovascular disease be routinely included on the program of the annual sessions, that funds for research in cerebrovascular disease be increased, and that research to identify the "stroke-prone person" be undertaken. The report suggested for consideration that the next edition of the nomenclature book of the New York Heart Association include a section on cerebrovascular disease.
In presenting his report on the meeting of the subcommittee on research (which had met the previous day [June 7] and was attended by Heyman, Toole, and Wakerlin as well as himself), Millikan remarked "that the entry of the AHA into the field of stroke makes it [AHA] unique and central to the field. Not only will it play an extraordinarily large part in the problem of stroke but stroke will play a large part in the total program of the AHA"15 —a profound and prescient statement.
Millikan also made two rather bold comments: he suggested that the AHA might consider adding stroke to its official title to indicate its concern for and interest in the stroke problem and that, because of the national importance of the stroke problem and the complexity of cerebrovascular disease, the AHA should ultimately establish a council on cerebrovascular disease.15
The Board of Directors of the AHA in June 1964 directed that a stroke program become a major function of the AHA and its affiliates.
Wright appeared at the Central Committee for Medical and Community Program meeting in December 1964, basically to request clinical fellowships in stroke. After his introduction with general comments regarding the commonness and complexity of stroke, the need to train physicians, and the absence of any other voluntary health agency working in the field, a long discussion occurred as to whether the AHA would favor clinical fellowships.16 Later the discussion shifted to the administrative position in the AHA that stroke should occupy. David P. Earle stated that the leadership of the Council on Circulation would consider a section on cerebrovascular disease; members of the Central Committee indicated their assent to such a consideration!
Although AHA policy was clearly opposed to clinical fellowships, the Central Committee moved to establish the clinical fellowships. However, subsequently this program for clinical fellowships was not approved by the AHA board, a lack of funds being identified as the reason.17
Dr Wright mentioned at the December 7, 1964, meeting of the Coordinating Committee that an exploratory meeting of representatives of the American Academy of Neurology (AAN), the ANA, and the AHA had met at Mary Lasker's residence to discuss numerous areas of mutual interest and activity in the field of stroke. As a result, a planning meeting was scheduled and took place on January 7, 1965, with the following participants: Drs Carleton B. Chapman, Charles A. Kane (AAN), H. Houston Merritt, John Stirling Meyer, C.H. Millikan, J.J. Sampson, Peritz Scheinberg, Melvin D. Yahr (ANA), and Chairman I.S. Wright; the staff members were R.A. Betts, C.E. Wakerlin, MD, and John A. Hagan.18 Several individuals observed the need for a coordinated effort on stroke in general and more specifically for a response to the report of the President's Commission on Heart Disease, Cancer, and Stroke. Concern was expressed as to the specific place cerebrovascular disease was to have in the overall mission of the AHA. Wright, chairing the meeting, pointed out that the very reason for the present meeting was to overcome any weakness in the AHA program, and he asked Carleton B. Chapman, president of the AHA, to speak to this question. Chapman stated that the AHA "is tremendously involved in stroke" and planned to form a nonfederal group to serve the nation as a whole in the field of stroke. This group would be composed of experts who would determine what should be done and institute the proper steps to accomplish the task. The problem, he said, was to place the stroke group within the AHA in the proper spot and that it "not be submerged in an unimportant position."18 Within the structure of the organization of the AHA, there were three ways to put a stroke group: (1) as a standing committee of the central committee (the senior medical body); (2) as a committee within an already existing council; and (3) as a council.
The objections to the last two proposals were as follows. If placed within an already existing council, the activity of the stroke group might be dominated by a chairman uninterested in stroke. If set up as a separate council, it would compete with other councils for the same papers for programs (such as atherosclerosis). The meeting participants favored the stroke unit to be a standing committee of the Central Committee, option 1, a position that possessed the advantage of being associated with a key body directly responsible to the Board of Directors. The composition of such a committee with reference to disciplines was discussed, and it was decided that the ratio would be one third cardiologists, one third neurologists, and one third other disciplines. The committee would have one representative each on the Central Committee and Board of Directors and two on the Assembly.
These recommendations were to be presented to the Central Committee February 25 to 27, 1965. Drs Kane and Yahr were asked to obtain approval of the representation and participation from their respective organizations.17 On March 19, 1965, the Executive Committee of the AHA approved the recommendation that the Coordinating Committee on Nationwide Stroke Program be made a standing committee of the Central Committee, with representation on that committee, the Board of Directors, and the Assembly. The members would be one third cardiologists and internists, one third neurologists, and one third specialists in other scientific areas; included was representation from the AAN and the ANA.19
At the July 15, 1965, meeting of the Coordinating Committee, Wright appointed a nominating committee composed of Millikan (chairman), Merritt, Griffeath, John W. Goldschmidt, and Wilson Fitch Smith. The recommendations were to be made to the Central Committee. Wright noted that this was his last meeting as chairman; the members "stood as a rising vote of thanks and of tribute to Dr. Wright for his splendid work" on the Coordinating Committee. Millikan became chairman. Great credit should go to Wright for bringing stroke into the activities of the AHA and opening the way for the establishment of the Stroke Council.
It was reported later that the AHA did not fund the clinical fellowships, and the Coordinating Committee on Nationwide Stroke Program then accepted an offer made by the Vocational Rehabilitation Administration to review the proposal with the possibility of providing funding.20
At the nominating committee meeting of July 30, 1965, the following members were nominated to begin the newly structured Coordinating Committee on Nationwide Stroke Program21 in October 1965. Included were neurologists Clark H. Millikan (chairman), Melvin D. Yahr, H. Houston Merritt, Charles A. Kane, Peritz Scheinberg, Albert Heyman, and John Stirling Meyer; cardiologists David Gelfand, Samuel M. Fox, Champ Lyons, Aaron Kellner, James F. Hammarsten, Ray W. Gifford, and William E. Connor; and specialists in other disciplines, John W. Goldschmidt (vice chairman), Francis J. Braceland, C. Robert Dean, Frank H. Krusen, Richard L. Masland, Arguyle Seikel, Earl Simmons, and Wilson Fitch Smith.
The nominating committee recommended that the duration of membership be 3 years. (The terms of the above nominees were staggered, and new members were to be added each year.) DeBakey, Griffeath, and Toole were thanked for their service; Wright remained as a consultant.
The Coordinating Committee on Stroke continued to meet regularly. The slate of members was approved at the November 22, 1965, meeting. At this meeting, the Scientific Session (at the annual AHA meeting) was reviewed and noted to have been very good.22
The committee accepted the invitation of the Council on Epidemiology to consider a joint session on the epidemiology of stroke. The committee discussed several types of programming arrangements at the fall meeting and asked the Central Committee to have a permanent member from the Coordinating Committee on the Program Committee for the annual Scientific Sessions of the AHA.22
The February 18, 1966, meeting23 consisted primarily of general information and reports of subcommittees. Particular note was made of the need for the Coordinating Committee on Stroke to take responsibility for providing information, teachers, and lecturers to the entire AHA and specifically to affiliates and all physicians. Films, slide sets, and pamphlets were available. A guide for affiliates on how to set up a stroke program was available. The committee took on itself the job of setting standards as well as criteria and guidelines for evaluation of stroke victims. The committee believed it should monitor legislative activity and advise where appropriate. With representation on the National Advisory Council by Millikan, the committee felt it would have a satisfactory voice. Letters were sent to the Regional Medical Program administration urging additional funds for facilities.
The Central Committee had approved the request for permanent representation on the Scientific Sessions Program Committee, and John Stirling Meyer was the individual designated. Richard Masland of the NINDB noted that funds were available for graduate training and that stroke was included.
The nominating subcommittee of the Coordinating Committee on Nationwide Stroke Program,24 consisting of Millikan (chairman), Goldschmidt, Smith, and Yahr, met on September 8, 1966, and made the following recommendations for members.
In neurology, they recommended Richard L. Masland, MD (1967); John Stirling Meyer, MD (1967); Clark Millikan, MD (1968); James O'Leary, MD (1968); Melvin D. Yahr, MD (1968); Albert Heyman, MD (1969); and Fletcher McDowell, MD (1969).
In medicine, Samuel M. Fox III, MD (1967); William E. Connor, MD (1968); Ray W. Gifford, MD (1968); Wilson Fitch Smith, MD (1968); George E. Wakerlin, MD, PhD (AHA staff; 1968); Alfred P. Fishman, MD (1969); and Robert E. Furman, MD (1969) were nominated.
Other nominees were Sterling B. Brinkley, MD (1967); Grace Lanning, RN (AHA staff; 1967); George Wheatley, MD (1967); John W. Goldschmidt, MD (1968); Mrs Edward McSweeney (1968); Warren Huber, MD (1969); Adrian M. Ostfeld (1969); Edwin Wylie, MD (1969); and Ernest Wood, MD (1969).
Recommendations for subcommittees were made as follows. Nominations for the Research Study Committee were Albert Heyman, MD (chairman, 1969); John Stirling Meyer, MD (1967); John W. Goldschmidt, MD (1968); Robert E. Furman, MD (1969); Fletcher McDowell, MD (1969); Ernest Wood, MD (1969); and AHA staff, John A. Hagan.
The Undergraduate and Graduate Medical School Education nominees were Melvin D. Yahr, MD (chairman, 1968); Richard L. Masland, MD (1967); William E. Connor, MD (1968); James O'Leary, MD (1968); Wilson Fitch Smith, MD (1968); Edwin Wylie, MD (1969); and AHA staff, Richard Hurley, MD.
The Scientific Program for Scientific Session 1967 Annual Meeting nominees included John Stirling Meyer, MD (chairman, 1967); Richard L. Masland, MD (1967); Ray W. Gifford, MD (1968); A.M. Ostfeld, MD (1968); Melvin D. Yahr, MD (1968); Warren Huber, MD (1969); Fletcher McDowell, MD (1969); and AHA staff, John A. Hagan.
Nominated for Community Program and Public Education were John W. Goldschmidt, MD (chairman, 1968); Sterling B. Brinkley, MD (1967); Samuel M. Fox III, MD (1967); Grace Lanning, RN (1967); George Wheatley, MD (1967); Mrs Edward McSweeney (1968); Wilson Fitch Smith, MD (1968); George E. Wakerlin, MD, PhD (1968); and AHA staff, Keith Thwaites.
Nominations for the Statement on Present Knowledge and Its Application subcommittee were withheld at this time because the committee had not yet been activated.
The Review Committee on Stroke and Coordinator Project nominees included John W. Goldschmidt, MD (chairman, 1968); Ray W. Gifford, MD (1968); Alfred P. Fishman, MD (1969); Clark Millikan, MD (ex officio); and AHA staff, John A. Hagan.
Recommendations for the Nominating Committee were Clark Millikan, MD (chairman, 1968); John W. Goldschmidt, MD (1968); Wilson Fitch Smith, MD (1968); George E. Wakerlin, MD, PhD (1968); Melvin D. Yahr, MD (1968); and AHA staff, John A. Hagan.
The meeting of the Coordinating Committee on September 9, 1966,25 proved to be its final one. The nominating subcommittee's recommendations were approved. John Hagan, AHA staff, reported on trips taken to affiliates to provide consultation on stroke programming and noted the distribution or sale of films, the supplement to Circulation (containing the articles from the session on stroke at the annual meeting), slide sets, and the sale of the book Diagnosis and Management of Stroke by J.F. Toole.
Through an oversight, proper representation on the Executive Committee of the Board of Directors had not been arranged when the present committee was authorized as a standing committee. Millikan brought this to the attention of the chairman of the board (Phillip Ardery) by letter. In return, the board indicated that the "Coordinating Committee will probably become a Council in January, with all proper representation. Hence no action is necessary at this time."25
Helen B. Taussig, president of the AHA, and Rome A. Betts, AHA staff, spoke on the meaning of Council status. They remarked that usually the founding members elect an executive committee of the Council; in the present situation, the Board of Directors authorized the founding members to become the Executive Committee.25
The committee moved to accept the authorization to become a council. The group, using a model set of rules and regulations for councils, discussed each item and constructed an appropriate set of rules that would be forwarded to the Central Committee for approval. (See "Appendix" for the first bylaws.)
Masland reported that 15 research centers were approved. Millikan reported that the National Advisory Committee had approved 15 applications related primarily to training. The attitude of the Stroke Council, he attested, was to assist in any way until every part of the nation was covered by regional medical complexes. He noted that the law (Regional Medical Program) was effective for 3 years and that by June 30, 1967, the Surgeon General was to submit a program report.
With this, the AHA's Coordinating Committee on Nationwide Stroke Program came to an end and was replaced by the Council on Cerebrovascular Disease. What a run—4 years and all the marbles!
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Council on Cerebrovascular Disease |
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One might ask how did the Stroke Council start? Who started it? These questions were implied when the matter of a Council history came up in February 1994. Truly, the Stroke Council started when the public and professionals interested in cerebrovascular disease deemed they were ready to have and to support such a group. The AHA staff's concern about stroke was an important stimulus to the Board of Directors to make stroke a priority (December 1962). At about this time, both Wright and Millikan were pushing for stroke to be a more up-front interest of the AHA, ie, something more tangible than the Board of Directors "making stroke a priority of its activities" (1962).26 When the Coordinating Committee on Nationwide Stroke Program was created in 1963 (with Wright as chairman), Wright and Millikan had a clear forum to advocate a stronger position for stroke. The AHA, they argued, was a logical place for stroke, a vascular disease, and to be effective in the AHA and to be accepted and effective in the medical community at large, stroke representation needed to be equal (in the AHA) with other vascular diseases, ie, a council.26
The first meeting of the Executive Committee of the Council on Cerebrovascular Disease proved to be seminal in many respects. Several items of significance were decided, and others were discussed in detail.
To the previously listed individuals on the Executive Committee were added William K. Hass, Lawrence C. McHenry, and Samuel M. Fox III.
The following members were present at the first meeting: Millikan (chairman), Goldschmidt (vice chairman), Brinkley, Connor, Fishman, Furman, Gifford, Hass, Huber, Lanning, McDowell, McHenry, Smith, and Yahr. Carroll Quinlan attended for Fox. Charles Kinnard attended by special invitation.
The following were absent from the first meeting: Heyman, Masland, McSweeney, Meyer, O'Leary, Ostfeld, Toole, Wakerlin, Wheatley, Wood, and Wylie.
Staff present were Rome A. Betts, Nathaniel H. Cooper, MD, John A. Hagan, Kenneth Lane, Campbell Moses Jr, MD, Ada Paul, Keith Thwaites, and Fanny L. Bluh (secretary).
One of the problems to be addressed was the election of an executive committee, as the number of committee members was larger than the bylaws permitted. A nominating committee was appointed to prepare lists of officers, delegates to the Assembly, and members of the Executive Committee. The members of the nominating committee were Goldschmidt, Smith, Wakerlin, Yahr, Furman, and Millikan (chairman).1
Another problem needing attention was the appropriate acknowledgment in the bylaws of the interrelationship of the AHA with the AAN and the ANA. The Executive Committee concluded that the nominating committee should select two representatives from the AAN and two from the ANA ("jointly nominated").1 The Executive Committee further agreed that the bylaws should also show how such representation was to be made.1
The criteria for membership in the Council were extensively discussed. Ultimately, Millikan appointed an ad hoc committee consisting of Goldschmidt (chairman), Fishman, Hass, Meyer, and Furman as members to formulate a plan.1
The editors of the supplement to the journal Circulation had turned down the proposed supplement on cerebrovascular disease that year because in their view the "quality of the papers, as a group, was irregular and not up to last year's standard."1 The committee discussed the idea of a professional journal on stroke. It was implied that a substantial amount of interest in a publication on cerebrovascular disease existed. The members of the committee believed that the AHA should seriously consider becoming involved in such a project. The group agreed to consider the idea further.1
The Scientific Sessions Program, the first under the aegis of this council, for the fall (1967) meeting of the AHA was noted. The title was "Therapeutic Trends in Stroke," chaired by John Stirling Meyer. There were five reports on collaborative studies: ruptured berry aneurysms (A.L. Sahs), surgical treatment of extracranial vascular occlusion (W.K. Hass), anticoagulant therapy in cerebrovascular accidents (C.H. Millikan), antihypertensive agents in the prevention of stroke (S.W. Hoobler), and the use of vasodilators and low-molecular-weight dextran in the treatment of stroke (J. Gilroy).
The staff was authorized to go ahead with the workshop on the Stroke Coordinator Project to determine what had been accomplished since the program was put into effect in 1965. A film on surgical management of cerebrovascular disease was to be developed, and $20 000 was to be requested to be included in the next year's budget. It was noted in passing that films and slide sets already developed had sold well in a comparatively short time.
John A. Hagan of the AHA staff reported that the New York State Heart Assembly had offered its publication Stroke: Current Concepts of Cerebrovascular Disease to the AHA so it could become a regular publication of the Association. Significant interest in this publication had been demonstrated, as 5000 copies were sold with minimal promotion. The Executive Committee of the Stroke Council believed this publication would be more appropriately placed under the aegis of the Council on Cerebrovascular Disease than elsewhere in the Association and so recommended it to the Publications Committee of the AHA.
A draft of the history of the Cerebrovascular Council, which was to be included in the AHA pamphlet on Scientific Councils of the American Heart Association, was noted and approved. The final text became part of a booklet by Alfred M. Bennett, published by the AHA in 1967.8
The second meeting of the Executive Committee of the Council on Cerebrovascular Disease took place on April 3, 1967. The bylaws were amended and approved.10 The bylaws established the manner of nomination of the members of the Executive Committee and further designated that the distribution of the Executive Committee members—on the basis of their professional interest—would approximate the ratio of one-third cardiovascular, one-third neurological, and one-third other disciplines. Two members of the Executive Committee would represent the AAN and two members the ANA. Millikan acknowledged in particular the interrelationship of the AAN and the ANA with the AHA.19 At the April meeting, the committee also established and defined the categories of council membership: member, fellow, and scientist in training. A credentials committee was put forward to implement these decisions.
Further discussion took place concerning the need for a separate publication dealing with cerebrovascular disease, and a subcommittee to study the matter was appointed. This publications subcommittee of the Council consisted of Wright (chairman), Fishman, Goldsmith, Meyer, O'Leary, and Millikan (ex officio).
The third and final 1967 meeting of the Executive Committee of the Council on Cerebrovascular Disease met on September 25, when it was reported that the Central Committee had approved on May 5, 1967, the amendment to the bylaws that established the Executive Committee at 22 members of 3-year terms, with a ratio of one-third cardiovascular, one-third neurological, and one-third areas of other interest; two members each from the AAN and ANA would be included.19
At this meeting, Wright reviewed the deliberations of the Council's publications subcommittee and its conclusion that a journal on cerebrovascular disease was needed; he proposed the establishment of Stroke, A Journal of Cerebrovascular Disease. Wright further reviewed his presentation in support of the establishment of such a journal at the AHA Publications Committee (September 22, 1967). The Publications Committee decided to meet again in February 1968 with representatives from the Cardiovascular Council to consider the matter further; Wright, Meyer, Goldschmidt, and Millikan were selected.19 Campbell Moses, AHA staff, noted that the matter would be on the agenda of the Board of Directors meeting in June 1968 and that Hurley, also of the AHA staff, would supervise the collection of data relative to papers on stroke in the medical literature.
Goldschmidt, chairman of the Council's Stroke Coordinator Project, reported on the Stroke Workshop, May 1967. Although the committee members were intrigued by the variety of activities of the stroke coordinators, it was apparent that not all the coordinators were functioning effectively. The committee concluded that there was a need to stimulate this effort and to establish a prototype of stroke activity for the Regional Medical Program. John Hagan, in reviewing the history of the project, noted that often the desired results proved to be more idealistic than attainable and that the major difficulty for the coordinators was an inability to organize community resources and involve the professional community in the project.19
Fletcher McDowell reported that 30 abstracts had been received for the Scientific Sessions program at the AHA meeting and that 17 were selected for presentation. Millikan mentioned the need for the AHA to be involved with the Regional Medical Program, particularly since it was concerned with two of the three major diseases included in the program. Goldschmidt observed that it might be worthwhile to have a symposium of 3 days on stroke, using the 3 days of cardiology as a guide.19
Thus, by the end of 1967, the first year of existence of the Council on Cerebrovascular Disease, the following fundamental actions had taken place: (1) revision of the bylaws, (2) establishment of the structure of the Executive Committee and how the members were to be appointed, (3) creation of the mechanism of appointment of members to the Council and its categories, and (4) recommendation for the establishment of a separate publication on stroke. These were outstanding accomplishments, and much credit should go to the Council's chairman, Millikan.
The Central Committee at its meeting on February 23, 1968, discussed the representation of the Council on Cerebrovascular Disease on the Research Committee.27 Stuart Bondurant stated that when the Council on Cerebrovascular Disease was formed in 1967, it "was agreed"27 that during its formative period it [Stroke Council] would be represented on the Research Committee by the member representing the Council Coordinating Committee for Community Program and the Council on Epidemiology. Although the Research Committee had always believed that it could do its assigned task much more effectively by keeping its current size with an option for retaining a few members-at-large, at the same time the committee recognized that the growing research-oriented activities of recently formed councils deserved direct representation on the Research Committee. A current member of the Research Committee (Toole) was thus designated as a representative of the Council on Cerebrovascular Disease.27 When the Council's rules and regulations were approved at the annual meeting of the Council on Cerebrovascular Disease (November 24, 1968), it was stated that the Council chairman and chairman of the Research Committee would nominate a person and the Central Committee would affirm that nominee as the representative of the Council on Cerebrovascular Disease.28
During 1968, the Regional Medical Program was accepting proposals from groups or organizations for guidelines on management of heart disease and cancer. The AHA decided to produce such guidelines for heart disease and later for stroke.29 However, the Council on Cerebrovascular Disease reported that it was already writing guidelines on the treatment of stroke23 and that the guidelines would be the product of authorities in the field, and not only by individuals associated with the AHA.29 Similarly but along the specific lines of education, the Council of Cerebrovascular Disease was developing methods for stroke education in hospitals and medical schools and was planning to put a program in place to prepare a statement about risk factors in cerebrovascular disease with documentation from evidence available at that time.29
The Publications Committee on September 27, 1968, approved the publication of a new journal titled Stroke, A Journal of Cerebral Circulation, to begin January 1970 with six issues per year; Millikan was named as editor. The committee also approved Toole as editor of Current Concepts of Cerebrovascular Disease/Stroke.
John Stirling Meyer was elected chairman of the Executive Committee of the Council on Cerebrovascular Disease at its meeting in November 1968. The February 14, 1969, meeting of the Executive Committee was opened by Chairman Meyer with Ray W. Gifford as vice chairman.30
Members present included Edward Cooper, Robert Furman, Murray Goldstein (new member), Arnold Greenhouse (new member), William Hass, Warren Huber, Phillip Klieger, Willard Krehl, Grace Lanning, Fletcher McDowell, Laurence McHenry, Mrs Edward McSweeney, Clark H. Millikan, Carroll Quinlan, Robert G. Siekert (new member), and Melvin Yahr.
Members absent were Sterling Brinkley, Alfred Fishman, Samuel Fox, John Goldschmidt, Edward Gordon, Jerome Green, Albert Heyman, Adrian Ostfeld, Wilson Fitch Smith, James Toole, Ernest Wood, Irving Wright, and Edwin Wylie. Staff present were John Hagan, Kenneth Lane, Campbell Moses, Hubert Wouters, and Tomasina Zaino (secretary).
Meyer reported that the Scientific Session at the November meeting was the best to date regarding attendance and number and quality of the papers. In response to the interest generated, 22 applications for membership were received; council membership was now close to 300.
Because one of the main topics at the upcoming 9th International Congress of Neurology (September 1969) was stroke, the committee recommended that the AHA cosponsor the Congress and as a "tangible expression of sponsorship" contribute $1000 to the Congress and an additional $500 to develop a scientific exhibit to be shown at the Congress. This was later carried out.
A discussion ensued on a stroke workshop and its relationship to AHA affiliates and chapters. Sufficient progress had not been made, and it was recommended that the affiliates and chapters secure a person who would devote sufficient time to the project.
Millikan reported that he would begin to solicit papers for Stroke with a target date of January 1970 for start of publication. When Meyer reported to the Central Committee on February 21, 1969, that efforts had begun to solicit papers for the new journal Stroke, the problem of charges and allocation of costs came under considerable discussion. The position of the Publications Committee was that if the journal was to break even, the subscription charge would need to be $38 per year, based on an estimated circulation of 2000. Although support for that concept was expressed, some believed the charge should be less, since this was a new journal and was to be published only six times per year. Finally, the fee of $30 was decided on. The Central Committee reviewing all these elements finally set the cost at $25 per year. Any shortage in the budget was to be made up from the general funds from the AHA and not from the support for existing programs, such as those for the journals Circulation and Circulation Research.31
At the October 10, 1969, meeting, McDowell reported, in his capacity as head of a group to produce a statement on risk factors, that the Council would join with the Council of Epidemiology in cosponsoring a meeting on the epidemiology of stroke, scheduled for March 1970.32
Siekert, chairman of the Credentials Committee of the Council, noted that the criteria for fellowship would be broader and that the word "meritorious" would be replaced in the bylaws by the phrase "professionally concerned." The application form was designed to imitate that of the Council on Cardiology. A discussion arose on developing a larger membership. Members of the Executive Committee were asked to investigate their own organizations and institutions for possible candidates. Fellowship cost was $30, $25 for the journal Stroke, and $5 for the membership.32
The meeting of January 30, 1970, with Meyer as chairman and Gifford as vice chairman, comprised the following members.33
Members present were William Blaisdell (new member), Robert Furman, Murray Goldstein, Jerome Green, Arnold Greenhouse, Lawrence McHenry, William Hass, Warren Huber, William Kannel (new member), Fletcher McDowell, Mrs Edward McSweeney, Clark Millikan, Mannie Schechter (new member), Raymond Seltser (new member), Wilson Fitch Smith, Carroll Quinlan, and Irving Wright.
Members absent included Sterling Brinkley, Edward Cooper, Alfred Fishman, Samuel Fox III, John Goldschmidt, Edward Gordon, Phillip Klieger, Willard Krehl, Grace Lanning, Robert Siekert, James F. Toole, and Melvin Yahr. Staff present were John Hagan, Ezra Lamdin, Kenneth Lane, Robert Okin, and Lucille Anderson (recording secretary).
The Council agreed that it must interest young investigators in the field of stroke and approved two prizes for the best papers, one in clinical research and one in basic research, with a prize of $750 for each. Wright had proposed the idea and personally supplied the funds.
Because the cost to produce Stroke was greater than monies received, the Executive Committee requested that the AHA review its policy and consider reducing the price to attract more readers.33
In January 1970, noting that although "hundreds of professional journals crowd the shelves of medical libraries," Millikan, as editor, asserted that the new publication "Stroke, a Journal of Cerebral Circulation, is to fill a gap and meet a responsibility."34 He listed some 48 types of specialists who could be involved in the care of a stroke victim, of whom "any of 20 [individuals] may be directly responsible for decisions about diagnosis and treatment." He concluded, "The lack of a journal to place under one cover manuscripts dealing with all of the facets [of stroke] is the gap to be filled."33 Associate editors were A.B. Baker and Fletcher McDowell. The editorial board consisted of William Findel, Anthony P. Fletcher, Robert Furman, James Galbraith, Ray W. Gifford, Albert Heyman, W.F. Hoyt, John Moossy, Erland Nelson, Adrian M. Ostfeld, James C. Quinn III, Richard Remington, Charles Rob, Mannie M. Schechter, Peritz Scheinberg, William Spencer, Arthur Waltz, and Edwin J. Wylie.
The journal began with six issues per year and went to 12 per year beginning with the January 1988 issue (19th volume). Fletcher McDowell became editor in 1976. The journal Stroke was well under way from its beginning and required little input from the Executive Committee. The interest then of the Executive Committee continued in educational activities (with publications) and the affiliates, their programs of hands-on education and patient service, research awards, and the annual programs at the AHA meeting.
Thus, by 1970, all the elements desired by the originators of the Council were in place.
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This brief account of the early history of the Stroke Council results from a request to me by the Executive Committee of the Council (February 1994) to gather information in one place. James F. Toole, I believe, brought forward the idea during the 19th International Joint Conference on Stroke and Cerebral Circulation at that time—slightly over a quarter of a century after the founding of the Council.
For its full support of this project, I thank the staff of the AHA; Brenda Gardner, Project Coordinator, Office of Science and Councils, for her diligence, enthusiasm, and skills in getting this project accomplished; and Susan Lucius, Records Management Specialist, for finding all the material hidden everywhere. Those individuals outside of the AHA who responded to my request for information, I thank for their efforts.
The majority of the people mentioned in this report are physicians or scientists not directly connected to the AHA. Over the years hundreds of individuals, AHA staff and volunteers, remain—unfortunately—anonymous and unknown. To them all must extend deep appreciation for their being an important part of the stroke effort. A few who were particularly involved are identified.
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Council on Cerebrovascular Disease of the American Heart Association
Rules and Regulations35
Article I NAME
The name of the Council shall be the "Council on Cerebrovascular Disease of the American Heart Association" (hereinafter called the Council).
Article II PURPOSE
The purpose of the Council is to achieve the objectives of the Association in respect to prevention, identification, management and rehabilitation in patients with cerebrovascular disease, particularly those manifested as stroke. These objectives will be achieved through research, undergraduate and graduate medical education, allied professional education, public education and information and community services implemented at the National, Affiliate and local Heart Association levels.
Article III MEMBERSHIP
1. Members of the American Heart Association may become members of this Council according to criteria established by the Executive Committee of the Council.
2. These criteria will be consistent with membership policies of the American Heart Association.
Article IV MEETINGS
1. There shall be a business meeting of the Council at least every two years, preferably concurrently with the Annual Meeting of the Association, for the purpose of receiving the Chairman's report on the activities of the Council and its committees and making recommendations regarding them, and for transcribing such business as should come before the Council.
2. Special meetings of the Council shall be called by its Chairman on request of three-fourths of the Executive Committee or at the request of its ex-officio members from the Association. Such meetings shall be held within 30 days unless otherwise stated in the request. Notice of all Council meetings shall be mailed to each member at least 14 days before the date of the meeting and shall specify the time, place, and the purpose.
3. Twenty members of the Council present at any duly authorized meeting of the Council shall constitute a quorum. The act of a majority of the members present at any meeting and constituting a quorum, shall be the act of the Council.
4. Minutes and records of meetings and proceedings of the Council and its committees shall be maintained and shall become a part of the minutes and records of the American Heart Association. They shall be open to the inspection of any Council member and to officers of the Association and members of its Board.
Article V OFFICERS
1. The officers of the Council shall be a Chairman and Vice-Chairman. Each officer shall serve for a term of two years and until the election and qualification of his successor. The Chairman and Vice-Chairman shall be eligible for re-election for one additional term.
2. The Chairman shall preside at meetings of the Council and of the Executive Committee and shall have such duties and powers as may be assigned to or vested in such office by the Council or its Executive Committee.
3. The Vice-Chairman shall perform the duties of the Chairman in his absence and shall assist the Chairman whenever called upon. The Vice-Chairman shall have such further duties and powers as may be assigned to or vested in such office by the Council.
4. Election of the officers shall take place at the business meeting of the Council or at any special meeting at which an election is to be held. Nominations may be made from the floor. Election shall be by a majority vote of the members present.
5. In the case of a vacancy in any office, the Executive Committee may appoint a member of the Council to fill such vacancy until the next business meeting or any special meeting at which an election is to be held.
Article VI EXECUTIVE COMMITTEE
1. The Executive Committee shall consist of the officers and the two most recent past-Chairmen of the Council; the Chairmen of the Research Study Committee, Program Committee and Nominating Committee. The Council Chairman shall be Chairman of the Executive Committee. The President, President-Elect and the Chairman of the Central Committee shall be ex-officio members. Additional members not to exceed fifteen may be authorized by the Council in its Rules of Procedure. Total membership is not to exceed twenty-two.
2. The Executive Committee shall conduct the affairs of the Council in the intervals between regular meetings of the Council and shall carry out the objectives of the Council within the policies of the American Heart Association.
3. Any vacancy in the membership of the Council's Executive Committee may be filled by its Chairman.
4. The Executive Committee shall meet at least once a year and on the call of the Chairman or upon the written request of any three members of the Executive Committee. The time and place of such meetings shall be fixed by the Chairman, or in his absence or disability, by the Vice-Chairman, and shall be within 30 days of an authorized request.
At least 10 days' notice of each meeting of the Executive Committee shall be given.
5. The number constituting a quorum shall be one half.
6. The Executive Committee may act without a meeting, provided that a majority of the members of the Executive Committee shall have concurred in such action.
Article VII COMMITTEES
A. Standing Committees
1. Nominating Committee. A Nominating Committee of at least three and no more than five members shall be appointed by the Chairman, within 90 days of his taking office. This Committee shall prepare and present at the next business meeting, or at special meetings at which elections are to be held, nominations for:
a. Officers
b. Five delegates to the Assembly of the American Heart Association.
c. Two representatives to the Board of Directors of the American Heart Association
d. Program Committee
e. Research Study Committee
f. Other Council Committees.
The slate proposed by the Nominating Committee shall be submitted to the Executive Committee for approval prior to its presentation at the next business meeting, or at a special meeting at which elections are to be held.
2. Research Study Committee. The Executive Committee of the Council shall elect a Research Study Committee of the Council, composed of at least three and no more than six members.
a. One member of the Research Study Committee shall represent the Council and its Research Study Committee on the Research Committee of the Association for a term of five years. This representative shall be proposed by the Chairman of the Council following consultation with the Chairman of the Research Committee and elected by the Central Committee.
b. The other members of the Committee shall serve for terms of three years, and these terms shall be staggered to assure continuity of experience.
c. The duties of the Committee shall include evaluation of research applications referred to it by the Research Committee as well as the formulation of recommendations regarding research policies and needs in the area of the Council's interest.
d. No more than one member from the same institutional department shall serve on the Committee at a given time.
3. Program Committee. The Executive Committee shall elect a Program Committee and a Chairman, who shall serve as a member of the Committee on Scientific Sessions Program for three years. The Program Committee shall review all abstracts in the Council's special field submitted to the Committee on Scientific Sessions Program. The terms of Committee members shall be staggered to insure continuity. The Program Committee shall arrange also for Scientific Programs at the Annual Meeting and at special meetings as may be requested by the Executive Committee. B. Other Committees
The Executive Committee of the Council shall elect such other Committees as it deems advisable. C. Action in Absence of Meeting
All committees provided for in this Article may act without a meeting, providing a majority of members shall have concurred in such action.
Article VIII RELATIONSHIP TO AMERICAN HEART ASSOCIATION
Recognizing the special interest of the American Heart Association in the field of cerebrovascular disease in its broadest aspect, the relationship between this Council and the American Heart Association shall be governed by the following provisions:
1. The Council shall operate under the Certificate of Incorporation, By-Laws, and Policies of the American Heart Association.
2. The Council shall elect annually five delegates to the Assembly of the American Heart Association. The Council shall elect annually two representatives to serve on the Board of Directors of the American Heart Association, either of whom shall be designated by the Council as a member of the Executive Committee of the American Heart Association.
In case a delegate cannot attend a meeting of the Assembly, the Chairman is authorized to appoint an alternate.
3. The Council shall be responsible, through the Central Committee for guidance and development of programs of the American Heart Association relating to cerebrovascular disease. Disbursement of funds which may be made available through any source to the Council shall be made subject to approval of the Board of Directors of the American Heart Association upon proper recommendation from the Council, through the Central Committee.
4. Appropriate staff will be assigned by the Medical Director to expedite the work of the Council, its officers and committees. To assure coordination of Council activities, all actions of the Council, its officers and committees shall be reported to the staff member or members assigned to serve the Council.
Article IX RULES OF PROCEDURE
1. The Council may establish Rules of Procedure consistent with these Rules and Regulations to facilitate the work of the Council in accordance with its specific function.
2. These Rules of Procedure may be amended or revised by a two-thirds vote of the membership of the Executive Committee. This vote may be taken at any regular meeting of the committee or at a special meeting of the committee called for that purpose, provided that written notice of the proposed amendment(s) or revision(s) be mailed to members not less than 30 days prior to such meetings. All amendments and revisions, while operative immediately on passage as provided for above, are subject to ratification by the Council at its next meeting.
Article X AMENDMENTS
Recommendations for amendments or revisions of the Rules and Regulations may be made at any regular business meeting of the Council, or at a special meeting of the Council called for that purpose, at which a quorum is present, by two-thirds vote of the members present, provided that written notice of the proposed amendment(s) or revision(s) be mailed to the members not less than 30 days prior to such meetings. All recommendations relating to amendments and revisions are subject to the approval of the Central Committee and the subsequent approval of the Board of Directors of the American Heart Association. Approved by A.H.A. Board of Directors, Jan. 14, 1967
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References |
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1. Minutes of the Executive Committee, Council on Cerebrovascular Disease. Dallas, Tex: American Heart Association Archives; Jan 27, 1967.
2. Many individuals were involved in the creation of the Council on Cerebrovascular Disease (later, Stroke Council). A number of them are listed herein, but I judge it is not possible to be certain that all are identified or linked to specific events or acts. Nonetheless, I believe it is clear that Irving S. Wright, MD, and Clark H. Millikan, MD, separately and jointly, were the forces that caused the Council to be established. (See also note 27.)
3. Wright IS. Telephone conversations, March 30, 1994, and December 27, 1994. Wright recalled that physicians, neurologists in particular, had shown little interest in patients who had suffered a stroke. Wright remarked that in the 1930s stroke patients were admitted to the medical services at Bellevue Hospital and not to the neurological services. He was primarily concerned with peripheral vascular disease. Since some of the disorders he saw were the result of clots, he began studies with anticoagulant therapy (and was perhaps the first to do so). He commented that later anticoagulant therapy was used in some cardiac disorders and that it was not far to move to get to cerebrovascular disease. Wright observed that the AHA began as a group of cardiologists, but over time the association enlarged its interest to all types of vascular disease. He had discussed stroke in the AHA. He had frequently talked of these ideas also with his friends Irvine H. Page and Edgar V. Allen. (All three were presidents of the AHA: Wright in 1952 through 1953, Page in 1955 through 1956, and Allen in 1956 through 1957.) When the Princeton Conference came up, the AHA provided funds. They were helpful and attended the first Princeton Conference. Wright noted that Allen had suggested that Clark H. Millikan, a colleague at the Mayo Clinic, attend the first conference, as Millikan had displayed some interest in cerebrovascular disease. (At about this time, Millikan mentioned to me that Allen had been helpful to him.) It is likely that Millikan attended a luncheon put on by Mary Lasker (see Reference 6). Wright recalled the difficulty in identifying potential attendees at the first conference. "We even had to get a neuroanatomist," he remarked.
4. Luckey EH. Cerebrovascular Diseases, Transactions of a Conference, Princeton, NJ, January 24-26, 1954. New York, NY: Grune & Stratton; 1955.
5. Wright IS. Telephone conversations, March 30, 1994, and December 27, 1994. Wright had begun to discuss strokes with Mrs Lasker in the early 1950s. (William Hass, in a personal conversation in December 1994, stated that Howard Rusk, physiatrist, likely was involved in the matter of raising Mrs Lasker's interest in stroke and rehabilitation.) Mrs Lasker, perhaps at Wright's request, had a luncheon to get some feeling about the matter and to interest neurologists in the cause. Wright stated that H. Houston Merritt (Professor of Neurology at Columbia) showed little interest in stroke. Later to Wright, Mrs Lasker remarked that "stroke was not a good title for such a conference; rather vascular disease of the brain would be a good title and this would get the interest of the neurologists, and they would then become involved."
6. Originally published in Neurology. 1958;8:395-434.
7. Goldstein, Murray. Letter to R.G. Siekert, Aug 1, 1994.
8. Bennett, Alfred M. A History of the Scientific Councils of the American Heart Association. Dallas, Tex: American Heart Association; 1967:46. Summary Notes, Staff Meeting on Coordinated Stroke Program, Nov 26, 1962.
9. Minutes of the Board of Directors. Dallas, Tex: American Heart Association Archives; June 8, 1963.
10. Minutes of the Executive Committee of the Council on Cerebrovascular Disease. Dallas, Tex: American Heart Association Archives; April 3, 1967.
11. DeBakey ME. Letter to R.G. Siekert, Aug 30, 1994. Dr DeBakey noted, "This idea [President's Commission on Heart Disease, Cancer and Stroke] originated with Mary Lasker, Dr Sidney Farber, and me following a Lasker Jury meeting. At that time the concept was proposed to President John F. Kennedy, and indeed a meeting was held under his sponsorship, but unfortunately, he was assassinated and the commission did nothing. The proposal was then made to President Johnson, by Mary Lasker, who approved the concept. He appointed the commission."
12. Report from the President's Commission on Heart Disease, Cancer, and Stroke, provided by M. Goldstein.
13. Pub L No. 89-239, 79 Stat 926. This law was an amendment added to the US Public Health Service Act (42 U.S.C. Ch 6A) as Title IX.
14. The NIH Record, October 14, 1970.
15. Minutes of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; June 8, 1964.
16. Minutes of the Central Committee for Medical and Community Program. Dallas, Tex: American Heart Association Archives; Dec 4, 1964.
17. Minutes of the Central Committee. Dallas, Tex: American Heart Association Archives; May 6, 1965.
18. Minutes of the Planning Meeting of Representatives of the AAA, ANA, and AHA. Dallas, Tex: American Heart Association Archives; Jan 7, 1965. This was a key meeting whose significance cannot be overemphasized. Presumably, it came about from a discussion involving at least Wright, Millikan, and Chapman. The presence of senior members of three influential societies and their decision on how to structure one of them are noteworthy. On several occasions at this time Millikan told me of his belief in the importance of codifying the relationship of the neurological community and the stroke effort of the AHA. In a letter to me dated Dec 22, 1994, Melvin D. Yahr, MD, stated, "At that time [planning meeting] there was no overwhelming interest among neurologists about stroke in general and even less about joining the A.H.A. In fact, I served on the Council of the A.H.A. by default since I could not interest anyone else in going to their meetings. It was always of some interest to me that people at the Heart Association were very interested in attracting neurologists to work along with them and, indeed, to join their stroke effort."
19. Minutes of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; Mar 15, 1965.
20. Minutes of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; July 15, 1965.
21. Minutes of the nominating subcommittee of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; July 30, 1965.
22. Minutes of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; Nov 22, 1965.
23. Minutes of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; Feb 18, 1966.
24. Minutes of the nominating subcommittee of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; Sept 8, 1966.
25. Minutes of the Coordinating Committee on Nationwide Stroke Program. Dallas, Tex: American Heart Association Archives; Sept 9, 1966.
26. Hurley R. Telephone interview, Jan 9, 1995. Dr Hurley made no distinction as to who of Wright and Millikan was the earlier or more vocal in these matters.
27. Minutes of the Central Committee for Medical and Community Program. Dallas, Tex: American Heart Association Archives; Feb 23, 1968.
28. Minutes of the Central Committee for Medical and Community Program. Dallas, Tex: American Heart Association Archives; Dec 13, 1968.
29. Minutes of the Central Committee for Medical and Community Program. Dallas, Tex: American Heart Association Archives; May 3, 1968. The tenor of the phrasing provides clear indication that the Council will have activities independent of the central administration, ie, the Council will "do its own thing."
30. Minutes of the Executive Committee, Council on Cerebrovascular Disease. Dallas, Tex: American Heart Association Archives; Feb 14, 1969.
31. Minutes of the Central Committee for Medical and Community Program. Dallas, Tex: American Heart Association Archives; Feb 21, 1969.
32. Minutes of the Executive Committee, Council on Cerebrovascular Disease. Dallas, Tex: American Heart Association Archives; Oct 10, 1969.
33. Minutes of the Executive Committee, Council on Cerebrovascular Disease. Dallas, Tex: American Heart Association Archives; Jan 30, 1970.
34.
Millikan CH. A new journal.
Stroke. 1970;1:1. Editorial.
35. Bennett AM. A History of the Scientific Councils of the American Heart Association. Dallas, Tex: American Heart Association; 1967:121-123.
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