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Mr. WILLIAMS. You mentioned among these neurological diseases migraine. Migraine is, as I understand it, pretty widespread among people and, yet, am I correct in assuming that no cure has ever been found for it?
Dr. TRAEGER. You are very correct. One of the worst cases of migraine that I ever came across was a person who was in a very gh place in the Federal Government-an extremely important personand when she had migraine her job stopped. That was the end of that story for a day, or 5 days, or a week; she was just as useless as though she never was in the job. That happened on many occasions. Migraine is one of the diseases which is intricately involved in the nervous system and circulatory system. There are many theoretical causes of migraine. Some drugs have been developed which help migraine in some people, but those same drugs do not do the job for everybody.
That is what I call a minor problem, but, as I said, it is not minor to the fellow who has it; it is a curse.
Mr. WILLIAMS. I know several Members of Congress who suffer from migraine headaches. It is really pitiful to see them on a day when they are really suffering. They are through as effective individuals for that day.
In regard to epilepsy, is not quackery rather widespread in the treatment of it? Also, medical racketeering! Are they not fair prey for racketeering?
Dr. FOSTER. Mr. Williams, that, fortunately has been decreased considerably, thanks to the action of Congress and the Food and Drug Administration. It is just because they find there are not enough men to handle the problem. There are not enough doctors trained in neurology to make service available to the 112 million epileptics, so that they fall prey occasionally to quackery. Fortunately, I think it is on the decrease because of the closing up of mail-order practices.
Mr. WILLIAMS. Is it not true that for a while that did present a problem to the medical profession?
Dr. FOSTER. It very definitely did.
I know that I have had young men get in touch with me in regard to claims they would have with the Veterans' Administration. Their cases would be diagnosed as either migraine or epilepsy or one of the nervous disorders. Those claims were usually denied by the Veterans' Administration on the ground that they could not be service-connected; that the condition of migraine was a condition rather than the effect of something that had occurred, or the result of something that had occurred, and that condition would have come about regardless of whether they had been in the service or not.
With regard to all these neurological diseases or ailments, can any definite cause be attributed to any of them?
Mr. BAILEY. In regard to your first question, I was at one time associated with the Veterans Administration in a medical capacity with neurological patients. In epilepsy that is thought not be service-connected; you frequently have a point of interpretation. The man, for example, was put under strain in combat and sustained an injury in combat. His resistance to epileptic seizures could be lowered to the extent that he would have certain seizures that he would not have had if he had not been subjected to strain or a head injury.
It does not mean, at the same time, that he would not have sustained head injury in civilian life or be put under strain. You have that interpretation, which is not a medical interpretation.
Mr. WILLIAMS. That would be a cause of aggravation?
Dr. Bailey. The disease actually was not present, but everybody has a certain tendency to epileptic seizures. Some people have a high resistance, some people a lower resistance. In one person, if he has a head injury, it lowers his resistance to the extent that he will develop seizures. Another person might have a similar head injury, but his resistance, or threshold, as they call it, will not be lowered sufficiently to produce epileptic seizures.
Mr. WILLIAMS. Doctor, you enumerated in the beginning quite a number of these neurological diseases.
Dr. TRAEGER. Yes.
Mr. WILLIAMS. You mentioned migraine, epilepsy, cerebral palsy, and many others. Can any of those be cured?
Dr. TRAEGER. No, sir.
Dr. TRAEGER. Not one. Not only are they not curable, many of them do not even have effective methods of control of the symptoms, and most of them we do not know what causes them to begin with.
Mr. WILLIAMS. It would appear to me, in view of that, our problem is in providing domiciliary care and making the patient as easy as possible; is that correct !
Dr. TRAEGER. That is part of the problem, his rehabilitation, the whole concept of rehabilitation. To my mind, the important thing is to find out what causes these diseases so we will not have to provide domiciliary care for them. That is the tail end of the wagon. That is the expense, the burden upon the taxpayer and on the family. Our job as doctors is to try to prevent those people from becoming custodial-care patients or, at least, to devise some method of control so they are adequate to carry on the business of daily living, cutting their food, brushing their teeth, telephoning, and that sort of thing.
Mr. HESELTON. That is what I had hoped you would suggest. It seems to me we are beginning to get the emphasis. You believe that the research to find out the cause of the disease is of utmost importance, more important, perhaps, than the care of those afflicted; but in order to do that you have to have trained personnel ?
Dr. TRAEGER. Precisely.
Mr. HESELTON. If you had $100 million today, the question is, Could you use it effectively? That is my point. Where do we put the emphasis?
Dr. TRAEGER. At the risk of incurring the extreme disfavor of all my colleagues, I would say, I would not know how to use $100 million today.
Mr. HESELTON. That is it exactly.
Dr. TRAEGER. I would not know how to use it intelligently, but I would, with a fifth of that sum, perhaps, develop an intelligent program so that within a foreseeable time we would have personnel and places and the toys and instruments and the security of these researchers so that we could come up with the answer.
Mr. HESELTON. I agree completely with what my chairman said. I want these hearings to be a source of hope and confidence for the American people and you people, you who are interested in trying to bring up the proper results, but, as I see it, trying to appraise the situation which confronts us and the American people, this is not an analogy to the success we had with nuclear research. Because of the war it was possible to pick that out and do it no matter how many billions we were going to spend. We cannot do that in this field because there are so many other things that call for our sympathy and our efforts. That is my reason for trying to get you to give us the key to the program of what the chairman wants to come up with.
The CHAIRMAN. Are there any further questions, gentlemen ?
Dr. TRAEGER. I think that it would be of some importance to the committee to hear something about some of these various diseases, what they are, how many people are affected, what they cost the
ion, and things that have to be done about them, and so forth. Now I am going to call on the various doctors representing the agencies, and they may do one of two things: they may make a summary statement of their problem as they see it, or the committee might ask questions to be answered. I leave that to the choice of the individual. I now introduce Dr. F. M. Forster.
STATEMENT OF DR. F. M. FORSTER, PROFESSOR OF NEUROLOGY
AND DEAN OF GEORGETOWN UNIVERSITY MEDICAL SCHOOL
Dr. FORSTER. I think that after listening to you gentlemen on this committee you are very well informed, and I think you have a very good idea of what epilepsy is. I might just briefly, though, say a few words more about it.
We all understand by epilepsy those generalized convulsions, the great seizures that people have, but we sometimes overlook the fact that there are other kinds of attack which are quite disturbing also.
There is sometimes a youngster who may have a very sharp blacking out, and he may have a whole series of them. That of itself does not seem very important, but a kid sitting in school may miss a good part of what is being taught to him. He may appear quite dumb and stupid because he does happen to black out and miss that which was being told him.
There is another kind of seizure, a peculiar one, in which a patient does not fall down. He may walk around and talk and say something relevant and have no recollection of it. I can bring that home to you by telling you of a school teacher that I took care of in Philadelphia. During the last war they were having a general assembly of the school faculty and the students in the amphitheater. The school band struck up our national anthem, and at that point he had one of these seizures and remained sitting in his chair and cursing audibly. When he came to the anthem was over and he did not know what had happened, but he knew it was bad.
Now, fortunately, we were able to save his job with the school board because rationally it was not possible for him to be a Nazi. His whole future hung on that fine margin.
These are the kinds of seizures that people have. How many of them? The figures of the draft board are 1 out of 200, which would
give us about 800,000 in the country. There is a fallacy in that figure. We all know that that is a selected age group, and these youngsters who have seizures in school enough to disturb their learning process, they are given the nickname of "Fitsy” in school and other derogatory terms, and they may, by medicine, get rid of these seizures, so they do not appear in those draft figures.
Likewise we have the veterans that Mr. Williams had in mind a few moments ago, whose seizures develop after the draft age, who would not appear in those figures. That is the reason why we think that the proper figure probably is somewhat closer to 11/2 million people across the country.
That, I think, sets the total picture of what the patient has with seizures, and the total incidence is at about 142 million in the country.
So far as the cost of this to the patient and so on is concerned, we are not primarily concerned here with service, and yet I think we should know it probably costs them, as a very minimum, about $100 a year for treatment. That is a small thing, really, proportionately.
The real problem is that many of these people are incapacitated and cannot work, so that there is a loss to the country in manpower productivity.
I have yet to see a patient with seizures who is working and carrying on his job at the level of his own capabilities.
Now, I want to preface this by saying that in my own practice I have taken care of physicians and clergymen and lawyers and engineers and people in all walks of life. Every one of those men, while still gainfully employed, certainly would have been doing a better job and would have been working at a higher level were it not for bis seizures.
Even though an epileptic can be employed—and it is difficult if he is an epileptic,he is still not doing as much for the community as should be done.
Mr. DOLLIVER. Mr. Chairman, may I ask a question?
Mr. DOLLIVER. The disease that we call epilepsy has been known for many, many centuries, has it not?
Dr. FORSTER. Yes, sir; it is the most ancient of all. It is probably the most ancient of all diseases.
The CHAIRMAN. You will have to go back pretty far, because we had some testimony here the other day that rheumatism was observable in the mummies.
Mr. DOLLIVER. Is that a matter of historical record, or do you, like the osteoarthritis people, see the evidences in the mummies ?
Dr. FORSTER. No, sir; it is historical. Actually, we cannot tell from the brain of an epileptic whether or not he ever had seizures. This is based on the descriptions of Hipprocrates and even prior to Hipprocrates in the oldest recordable medical literature. I think much of our problem in epilepsy, too, is that in those days it was considered a visitation of spirits, so that it is referred to in the Bible--I believe in St. Luke, but I am not certain. Because of that reason it was called morbus insputatus, or spitting sickness.
It was considered in biblical times that when a man fell in the street with a seizure the passers-by went over to spit on him, so that the demon could not get out of him and go to the passers-by.
The Romans, on the other hand, thought it was a good spirit, and when a seizure occurred in the senate, the senate adjourned sine die, as a sign of the gods that no more business was to be transacted that day.
I think the evidence that ours is an old disease is there, sir, without the mummy.
Mr. DOLLIVER. Is it definitely determined that it is a brain lesion which causes epilepsy?
Dr. FORSTER. Yes, sir. I think it was about in the 1600's when a British physician, Sir Thomas Willis, first concluded that the seizures arise from the brain.
It was about 1870 when Sir Hughlings Jackson, another British physician, pointed up the fact that it came from the outermost portion of the brain, the cortex, where the cells are.
In 1945 two American neurologists, Dr. Lennox and Dr. Gibbs, of Boston, proved it was an electrical discharge from the gray matter of the brain. Now the work going on is to find out what sets off this gray
matter both electrically and biochemically. These are the fields in which the future lies.
Mr. DOLLIVER. Are there any specific medical remedies that relieve the fits?
Dr. FORSTER. Yes, sir. During this era of mysticism and spirits, when epilepsy was known as ambulanta incantatus, it was then when neurology began to come forward that was the beginning of real treatment. This was almost that kind of fortuitous thing that Dr. Kety described for Dr. Windle's work.
Sir Stephen Hauptman in 1857 was presiding at a medical meeting, and learned that someone prescribed bromides as a means of decreasing sexual desires, and he was concerned with that, and he gave his patients bromides and found that the seizures disappeared. That was the beginning of the treatment.
In 1912, when phenobarbital was introduced as a sedative, the QED kind of mathematical interpretation was made that, if bromides are sedatives and if phenobarbital is a sedative and if bromides are good for seizures, then phenobarbital should be good for seizures.
Phenobarbital was tried and happened to be a success. Thank heaven that of all the barbiturate derivatives phenobarbital was the first one that was found, because it has turned out to be the best.
The next great stride was by the Boston group, Dr. Merritt and Dr. Putnam, who were concerned, because in order to keep some of their patients from having seizures they had to carry the anticonvulsant drugs to the point where they were drowsy, where the kiddies fell asleep in school and began to flunk. They felt that perhaps it was not necessary for a drug to be both a sedative and an anticonvulsant, that perhaps they were separate. They went to the drug houses and got from them the drugs that the chemists had designed for sedatives but which had failed to be sedatives. They tried these on cats, whom they gave electrical shock to cause seizures. Out of those drugs they chose the three which did the best job in stopping the induced seizures and