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(c) Many significant research problems, however—dealing especially with the effectiveness of existing treatment methods, with genetic, family and community factors in the cause of mental disorder, and with methods of preventing it-can be pursued advantageously in many areas without large research centers.

(d) The most critical prerequisite to research is scientific personnel. State. training and research programs should emphasize the training of research personnel, making maximum use of the special talents and training of available academic and clinical personnel to every extent possible.

(€) Since successful research normally requires continuity of personnel, facilities, and financial support, the States should make every effort to assure sustained financial support, and thus avoid wasteful interruptions of the research program,

(f) Excellent opportunities for important research on mental disease exist in State hospitals, even where hospital personnel lack time or training to undertake it themselves. The States should encourage use of their hospital facilities by qualified scientists from other institutions. Such cooperative research arrangements may speed the discovery of more effective means of treatment, stimulate later research by members of the hospital staff, and improve community relations of the institution.

13. Although some mental hospitals, because of geographic isolation, overcrowding or inadequate staffing may not be suitable for major research projects, most of these can take advantage of potential opportunities for research effort more effectively than is now the case.

Research thrives on original thinking and the free exchange of technical information. Private and industrial research laboratories have demonstrated the value of providing leaves of absence with pay for professional staff who wish to acquire further research training or attend scientific meetings. It also has been fonnd benefiial to make maximum use of research consultants from other institutions.

At present, however, the daily care and treatment demands of most mental hospitals do not permit time for staff members to participate in any except the most casual research.

If headway is to be made against the rising number of admissions to mental hospitals, time and facilities for research should be made available to qualified research workers in them. Research activities in State mental hospitals should be coordinated under a research director. In small institutions, the research director may be the clinical director or superintendent; in other instances, the scope of the research program may require creation of a separate position. This may be particularly desirable if responsibility for the hospital's training pro. gram also can be placed under it.

14. Discovery of better ways to treat and prevent mental disorder is contingent on more fundamental studies in physiology, biochemistry, neurology, psychology, sociology and related fields.

Research laboratories in State institutions should be encouraged to undertake fundamental research in the biological and social sciences as well as to seek practical solutions to immediate problems.

15. Research scientists working on problems of mental health and disease need to be in close touch with the latest findings of the scientists engaged in mar studies. There is need for communication among hospitals, universities, and other research centers throughout the country on research in progress or being planned. Such communication can take advantage of new findings quickly and avoid unnecessary duplication of research effort. A scientific clearinghouse now exists, the Bio-Sciences Information Exchange of the National Research Council, from which individual scientists may obtain brief reports on research projects related to their own which are currently in progress.

It is suggested that all States arrange for the use of scientific exchange services hy members of their hospital staffs to increase the economy and effectiveness with which research is conducted. Staff members also should be encouraged to publish completed research findings in scientific journals and personally to present papers at professional meetings.

INTERSTATE COOPERATION

16. Where practical, it is desirable for States to provide adequate professional training in the graduate schools of their institutions of higher learning. Ilowever, many States which lack major teaching centers for the training of certain professions, are taking advantage of interstate compacts for this purpose. Physicians, dentists, veterinarians, social workers and public health officers are being

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trained, or plans are being made for their training, under interstate arrange ments of the Southern Regional Education Board and the Western Interstate Commission for Higher Education, both created by compact.

States already participating in interstate educational compacts may wish to consider extension of agreements under them to include specialized training in psychiatry, psychology, nursing, social work, and other specialized practices needed in hospitals and clinics.

Existing training and research centers in a number of States could be utilized as regional institutes for the training of therapeutic teams and for important research programs in the field of mental health. It usually is more desirable for a group of States to support one teaching or clinical training center which can achieve accreditation and prestige through the high quality of training it offers than to attempt to maintain a number of isolated, unaccredited centers able to offer only marginal training.

Where individual States find it impractical to provide adequate training for members of mental health professions in short supply, it is recommended that they enter into appropriate interstate arrangements for academic and clinical training.

17. No State lacks individual opportunity to contribute research toward pre vention and improved treatment of mental disorders; but most States, especially those that lack major research centers of their own, could strengthen their research efforts through cooperation with nearby States.

It is recommended that States participate jointly in mental health research suitable for such cooperation and that they investigate practical means to cooperate in supporting and enlarging the research activities of institutions in their regions, under arrangements by which the personnel and cost of facilities and equipment may be shared equitably.

Interstate cooperation for research could be facilitated markedly through leaves of absence for hospital and university personnel in States lacking major research centers to spend periods of time at research institutions in other States.

18. Interstate mental health conferences may be devoted profitably to problems of research, training facilities and standards, treatment methods, hospital administration, forensic psychiatry and hospital-community relations.

All States should cooperate in periodic regional mental health conferences. 19. It is difficult at present to obtain comprehensive data on many aspects of the mental health programs of the 48 States, particularly with regard to current training and research activities. State legislators, State officials, and others concerned with mental health repeatedly seek information on the experiences of other States, to learn what their institutions and agencies are doing to reduce the prevalence and severity of mental illness.

It is suggested that the States establish an interstate clearinghouse, the functions of which may include the following:

(a) To maintain up-to-date information on the mental health programs of all States, especially with reference to the scope, nature, and results of training and research activities, and to make the experiences of each State available to all.

(0) To cooperate with Federal, local, and private agencies in making maximum use of existing resources in the promotion of mental health.

(c) To aid in initiating arrangements, where requested, for interstate cooperation in academic and field training and in use of existing research institutions.

(d) To provide expert field consultation for States wishing more detailed assistance in establishing effective mental health programs.

The CHAIRMAX. I would like to say that if you have any additional comments or statements that you would like to have made a part of the record, bring them to the attention of the clerk of our committee, so that we can comply with your request.

(Thereupon, the committee adjourned.)

HEALTH INQUIRY
(Hearing Defects)

FRIDAY, OCTOBER 9, 1953

HOUSE OF REPRESENTATIVES,
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The committee met, pursuant to adjournment, at 11 a. m. in the committee room of the House Committee on Interstate and Foreign Commerce, Hon. John W. Heselton (acting chairman) presiding.

Mr. HESELTON. The meeting will please come to order.

I would like to explain that the chairman was unexpectedly called back to New Jersey and will not be here during the day. He regrets it very much, because he did want to be here for this hearing. Also, several of our members have been called back to their districts, but I am sure we will have a very satisfactory hearing. The previous hearings have been most interesting and most helpful. For the benefit of those who have just come in today for this particular subject, may I explain these hearings will be printed and will be available to every member of the committee, so that they will be familiar with all the testimony presented to us.

We are to hear testimony this morning relating to deafness and the various hearing defects. The committee is eager to hear what the witnesses have to say on this subject, particularly in the areas of what deafness costs the American people, what is being done and can be done to diminish the problem, and what unmet needs exist insofar as facilities, research, and trained specialists are concerned.

These inquiries this morning are part of a broad series of hearings seeking to lay before the American people facts they should know about health and disease.

It is the chairman's impression that far too little attention, medical and otherwise, is paid to deafness and related disorders. He hopes that you gentlemen will do everything in your power to make the current situation clear to us.

The procedure that has evolved during the health hearings is one in which a discussion leader chosen by the witnesses conducts what is in

а effect an informal symposium based on a prepared agenda. I understand that such an agenda is at hand and that Dr. William G. Hardy has agreed to serve as discussion leader. The members of the committee will want to ask questions rather freely, Dr. Hardy, and we hope the witnesses will ask questions of each other, also. Our purpose is to make this hearing as informational as possible.

To make the record complete, to assist the recorder in indentifying you, and in order that you may be known individually to the members

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of the committee, it would be appreciated if each member of the panel will stand in turn and give a bit of his background and his present position. I notice that several of the witnesses are familiar to the committee, having testified earlier in connection with other disease entities. We welcome them back.

At this point, I would like the prepared agenda and the list of witnesses to be made a part of the official record of this hearing.

(The matter referred to is as follows:)

HEARING DEFECTS-AGENDA POR DISCUSSION, OCTOBER 9, 1953 I. Opening remarks, chairman, discussion leader. II. What is the importance of deafness and other hearing disorders as health

problems in America today? III. What are the various kinds of hearing defects? How are they charac

terized medically? IV. What is the current status of knowledge relating to these disorders

V. What are the major private and public efforts in the deafness field? VI. What are the promising lines of research? VII. What are the medical-care problems in the treatment of deafness? VIII. What can be done to prevent deafness? IX. What is the relation to deafness of such disorders as otosclerosis?

Ménière's disease? Motion sickness? X. What are some of the needs in the field? Is there anything not being

dove that should be done in order to facilitate progress against these diseases?

PARTICIPANTS

Dr. William Hardy, director of the Johns Hopkins Hospital Hearing and Speech

Center, Baltimore, Md. Dr. Aram Glorig, Heid, Audiology and Speech Correction Center, Walter Reed

Army Hospital, Washington, D. C. Dr. Leonard u. Elstad, president, Gallaudet College. Dr. Pearce Bailey, Dr. Seymour Kety, Dr. Fred Stone, National Institute of

Neurological Diseases and Blindness, Public Health Service.

Mr. HESELTox. Will you please proceed, Dr. Hardy. Then after the introductions, you may go right ahead with the discussion in any way that you see fit.

STATEMENT OF DR. WILLIAM HARDY, DIRECTOR OF THE JOHNS

HOPKINS HOSPITAL HEARING AND SPEECH CENTER, BALTI. MORE, MD

Dr. HIRDY. Thank you, Mr. Chairman. My name is William Hardy. I am director of the Johns Hopkins Hospital Hearing and Speech Center, and am on the faculty of the School of Medicine and Hygiene. During the war I had the honor to serve in a capacity with the Navy directly related to these problems, as have some other members of the panel.

I will ask the other members of the panel to identify themselves in order down the line.

Dr. Bailey. My name is Pearce Bailey, a physician, presently Director of the National Institute of Neurological Diseases and Blindness; a professor of clinical neurology at Georgetown University; and past president of the American Academy of Neurology.

Dr. STONE. My name is F. L. Stone. I am chief, extramural programs, National Institute of Neurological Diseases and Blindness, National Institutes of Health.

Dr. Elstad. I am Leonard M. Elstad, president of Gallaudet College, Washington, D. C., and executive officer of the Institute for the Deaf. I have been working with deaf children for 30 years.

Dr. GLORIG. My name is Aram Glorig. At present I am chief of the Army Audiology and Speech Correction Center at Walter Reed Army Hospital, which takes care of all hearing problems of the Army and Air Force. I am a member of several societies which have to do with hearing and its ramifications.

Dr. HARDY. I would like to make a short statement first and then call on Dr. Glorig to summarize his ideas. It will be necessary, perhaps, for him to leave early.

The approach to the general problem of hearing disorders spreads to a set of definitions and a review of facts as they exist in general.

The term “deafness” has been known and used in our language for many years in a fashion that is too hard to define in medical terms in case finding, diagnosis, therapy, into the problems of rehabilitation, and education.

Dr. Elstad is most experienced in the training of deaf persons. A deaf person, by definition, is one whose hearing is so nonfunctional that he has had to develop language and communication by nonverbal or nonoral means. The hearing mechanism serves as the base for our intake from our environment for the development of speech in a child.

The other level is the group known as the hard of hearing, where there is a hearing disorder but not so extensive that it interferes completely with symbols in ordinary conversation. The differentiation between those two groups is difficult to make clear.

The general problem of hearing defects and hearing disorders continues to be widely misunderstood and misapprehended, perhaps largely because a hearing disorder does not show as a human disability; it does not have a mortality rate; the fear of continued welfare does not show. What shows is the effect of noncommunication or interference with communication in terms of some of the psychological aspects of being able to converse freely, and that results in a real disability.

There are about 200,000 to 250,000 persons who can be called deaf in the sense I have just defined. They have been treated as deaf people, pretty largely employing nonoral or nonverbal communicative means.

There are probably somewhere between 15 and 20 million persons in this country with some aspect or other of hearing disorder as a general broad category, sometimes involving one ear and sometimes both ears.

There are probably somewhere around 11, million persons who are disabled to the extent of interference with their daily occupations or potential occupations and normal social existence to the extent of needing to use a hearing aid as a means of helping them to communicate.

As we look at the general problem, first from a medical and later from a rehabilitative point of view, there are a good many ways of approaching an analysis. I can speak better, perhaps, as a person who sees the problem at a clinical level. There are four categories:

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