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Dr. ELSTAD. That is right. They can have an associated arts course. There would be 2 years of college, with terminal courses, so that they can leave at the end of 2 years and be given a credit for it.

Mr. ROBERTS. Of course, that would naturally call for additional appropriations from the Congress?

Dr. Elstad. That is right. We got no money for additional staff this year, but in the hope of getting the necessary instruction I hired 5 new instructors for $20,000. As a result of this work, we are getting it done.

Mr. ROBERTS. Off the record. (Discussion off the record.)

Mr. ROBERTS. We appreciate the fine work you are doing up at that college.

Mr. HESELTON. Doctor, you gave a figure earlier as to the economic loss by reason of deafness, did you not?

Dr. HARDY. 300 million man-hours is the best generalization that has been arrived at by a pretty responsible survey.

Mr. HESELTON. Nobody has translated that in terms of dollars ?

Dr. Hardy. No, sir; you would have to go through the wage scale. It amounts to quite a bit.

Mr. HESELTON. This committee in the last week or 10 days has had some very difficult if not unsolvable problems presented to it in terms of these various diseases which have been discussed. I would think that Dr. Elstad's presentation offered one of the most immediate means of helping to minimize that economic loss, as well as to make people who are unfortunately deaf have a much happier and fuller life.

Dr. HARDY. That figure, Mr. Chairman, does not relate to this group. That is exclusive of this group of deaf people. This relates to the status of hearing disorders in general in the population, exclusive of the deaf group. They were not included in it at all. This is man-hours lost of productive activity of folks who have been going along.

Mr. HESELTON. Yes. But in terms of young people who are handicapped and thereby not able to prepare themselves for a productive life this institution here will be a marvelous thing.

Dr. HARDY. That has never even been counted.
Mr. CROSSER. Mr. Chairman?
Mr. HESELTON. Mr. Crosser.

Mr. CROSSER. Referring briefly to your subject of heredity, suppose that

you had a father who was absolutely deaf and dumb, as we understand it today, and a mother who was likewise, except that she might be able to make out what a person might say. What would you say about the likelihood of the children, if they have any in such a case, being affected?

Dr. HARDY. As a scientist I would have to ask one more question, Congressman. What caused the impairment in either one or both of the people?

Mr. CROSSER. Well, of course, now, the father was a minister. He preached in a deaf-and-dumb church. The wife was a mother. They were both deaf and dumb.

Dr. HARDY. I cannot answer it intelligently because of that factor of causal determination which is critical to it. In the normal course of events it is quite natural to expect, and it does commonly happen, that two people who have similar kinds of handicaps and are thrown together in a social group somehow or other get around to being



married. That is a social event which is totally unrelated in medical terms as to why they are deaf.

Mr. CROSSER. What would you expect ?

Dr. HARDY. As a clinical scientist I naturally do not expect anything until we know more about the particular problem in all of its detail.

Mr. CROSSER. The father I am speaking about could not understand me and I could not understand him. The mother could.

Dr. HARDY. If there had been similar instances back down in their family background and a variety of people who had arrived at the same point

Mr. CROSSER. The wife in this case was deaf. If I would speak very slowly and carefully she could understand what I meant, although she could not hear it.

I happen to know that they have 2 children, both grown up, and if you ever saw 2 very loquacious individuals those were the 2 children.

Mr. THORNBERRY. Off the record.
(Discussion off the record.)
Mr. CrossER. This man was an Episcopalian minister.

Dr. Hardy. One of the things the field in general is trying hard to get at is to find these children early enough and get the facts on them and try to see to it that those who do not need to grow up as deaf people do not grow up as deaf people. There are many steps to be taken to redeem them, if you will, rehabilitationwise, for many children who otherwise are let go and have no attention paid to them and who naturally have only that as a future.

Mr. CROSSER. Until I heard what my colleague from Texas has said, I had heard of no other case but this one.

Dr. Hardy. We can give you ample assurance that happens very frequently.

Mr. CROSSER. It was amazing.

Dr. HARDY. That was what I meant, sir, in the comment a while ago. Until better means of apprehending these various problems have been developed, there will be difficulties in solving them. A child may lose a great deal of his hearing at the age of 2. In prior years they just automatically put them in the category of deafness. In the view of many people he might as well have been born deaf because he never learned to talk. But actually what caused the impairment had nothing to do with prenatal experience.

Mr. CROSSER. These people were all educated people, although it was hard for them. They educated the children, and they were all well educated.

I suppose you are quite familiar with this new treatment by surgery operated by this man in New York. I cannot think of his name. Dr. Hardy. You mean fenestration surgery? Mr. CROSSER. They go into a very delicate operation.

Dr. HARDY. That is Dr. Lempert you are referring to. That eurgery is a specific for only 1 kind of hearing impairment from 1 source. It is not generally applicable. For instance, it has no use at all for a nerve-type impairment.

Mr. CROSSER. Well, one of the doctors out at the Naval Hospital, I know, does a lot of successful operating with that. Dr. HARDY. Yes.

I wonder, Mr. Chairman, if we should take a few minutes to get back to the general question of research in the field.


Dr. Hardy. And some of the needs. Dr. Bailey, will you address yourself to that?

Mr. HESELTON. Before you proceed may I ask one question of Dr. Elstad.

Does the Department of Health, Education, and Welfare have any specific office whose duty it is to follow this education problem and rehabilitation problem?

Dr. ELSTAD. So far, up until this year, it was just on budgetary matters, but now there is a liaison man appointed, Mr. Baxter, who have five institutions. Ours is one. He has Howard, Columbia, St. Elizabeths, Freedman's and one other. We are getting excellent service from him.

Mr. HESELTON. Proceed.



Dr. BAILEY. First of all, Mr. Chairman, allow me to excuse myself for appearing before this committee twice.

Mr. HESELTON. You are very welcome.

Dr. BAILEY. I assure you I am not trying to afflict myself on the committee, but the spectrum of diseases covered by our research institute is so large it cannot be covered in 1 day.

I would sort of like to make a few remarks on how we tie this up from a research program standpoint. As you heard in the testimony previously, our research responsibilities cover neurological and sensory disorders.

As you know, neurological disorders are diseases of the nervous system, and sensory disorders are diseases of the important end organs of the brain, particularly the eye and the ear.

Now, in medical practice there is a tendency to separate these disciplines. Thus we have the specialty of neurology, the specialty of ophthalmology for blindness, and the specialty of otolaryngology for deafness.

Now, in research we do not need these artificial lines of demarcation. They are all part of the same system. That is, the eye transmits light to the brain, and it is the responsibility of the brain for perception and interpretation of visual images. In the same way the ear conducts sound to the brain which is recorded, received, and interpreted by the brain.

Therefore, blindness can result from disorders of the nervous system or the eye, and in the same way deafness can result from disorders of the ear or the brain or both.

To show you the rather across-the-board nature of it, if you will remember last Wednesday we spoke of some work we were contemplating on regeneration of nervous tissue. Well, if such experiments prove practical the results would be beneficial to injuries of the nervous system and also to the visual system and to the hearing system. That is, you have the optic nerve and the brain in the visual system and the auditory nerve and the brain in the hearing system.

I would just like to mention one aspect which may not come out, which is related to the problem anatomically, at least, of hearing. That is that from the nervous standpoint, the standpoint of nervous tissue, there are two nerves connected with the inner ear; the cochlear nerve for hearing and the vestibular nerve for special orientation and equilibrium. These nerves naturally lead to different parts of the brain; rather adjacent parts of the brain.

There are diseases which involve this vestibular apparatus as well as the hearing apparatus. Perhaps the most common is motion sickness, which includes seasickness, car sickness, and air sickness, which, though a rather temporary disability, is of major importance particularly from the military standpoint. As you can realize, with landing operations and things of that sort, the question of motion sickness is of critical importance.

I have said before that we have a program on hearing impairment, to get to the bottom of it both from the standpoint of medical and clinical research, at the new Clinical Center. We have not as yet received sufficient funds to implement this program.

We have a program and extramural projects through non-Federal institutions, of which Dr. Stone gave you the amount. If you care to, Dr. Stone could say a few words on what type of project these are and what areas they cover in the hearing field.

Thank you very much.



Dr. STONE. In fiscal year 1953, it was really the first year in which our extramural research grants got under way. Actually, in that year cf time we had two grants that extended for any reasonable period. They were largely of a clinical nature.

But in the last half of that fiscal year and the present fiscal year of 1954 we have, as I told you before, supported a greater number of grants. The trend of these grants is to maintain the clinical level that was then apparent. But additional work which is fundamental to the hearing process is also being supported. I mean it is fundamental in the sense of physiology of the hearing process and the biochemistry existing within the hearing end organs.

This, I think my colleagues will agree, is a very healthy situation, researchwise, in the sense that fundamental findings are being made available for clinical application. All of these research grants I have mentioned but one, as a matter of fact, are taking place in a hospital environment or a medical school environment, where the basic findings can have immediate clinical application.

Dr. Hardy and I were discussing the situation just before the hearing started. It actually is a twofold problem we have. It is a problem of finding the money to support the individual projects, but it is also an equal problem, and perhaps greater, to find the money to support the training of scientists, both clinical and basic, so-called, for further experiments in this field. It is actually a twofold problem relative to needs.


I remember that on Wednesday when I was here I believe you addressed yourselves to the question of what were the needs. In one sense it is actually a twofold need. There is a need for research moneys to support projects. There is also an equal and perhaps a greater need for moneys to support younger researchers in their training toward a research career.

We have several extramural activities by which we do this. Actually we have two types of programs. One is a grant type of program where a large sum of money is given to an institution in the name of the man in the department. And we have another type of program where we give individual stipends to high caliber younger people for their individual support during a year of training.

I will not proceed further with these details unless the committee wishes.

Mr. HESELTON. Are there any questions? Possibly you will not care to answer this, Doctor, but one member of the panel will. What about the medical personnel who are available to treat these diseases? Is it adequate, in your opinion?

Dr. HARDY. The availability of clinical personnel for treatment is perhaps the only part of the question that is reasonably adequately met. That there are enough well-trained men available where they are needed is another question which is perennial with all sorts of professional training. I think the big dearth centers in young people, well-trained basically in the various disciplines, who apply, who go on with the training to become sophisticated and knowledgeable about some of these very fast-moving modern trends. I think that is one thing that Dr. Stone meant implicitly. You cannot carry out any concerted program of research without a strong support from various

a sources to provide funds for equipment and the expenditure of specialists' time and the like of that.

But, so help us, you cannot even begin that job unless you have adequate people far enough along in the field so that they can project imaginatively and ask the right questions to be answered later on in a laboratory.

Mr. HESELTON. What about the availability of instruction in medical schools? Is that pretty well set up so that people can receive that sort of instruction?

Dr. Hardy. It is spotty, Mr. Chairman, but I think certainly there is plenty of evidence that it is present in enough places scattered across the country, enough key positions, key medical institutions, which usually involves teaching hospitals which have a source of supply of problems to study and therefore a means to fill in the curriculum. Yes. I do not believe there is a great dearth of teaching institutions available.

Mr. HESELTON. You stressed the importance of the early discovery of treatment of hearing difficulties.

Dr. HARDY. Yes, sir.

Mr. HESELTON. Is the situation satisfactory so far as attending physicians are concerned? Do they understand the necessity of that and do they, generally speaking, see that that sort of specialized attention is given to the infant ?

Dr. Hardy. It is just beginning.
Mr. HESELTON. Just beginning!

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