acceptance or rejection. The following data, however, indicate the order of magnitude of the problem.

Studies of IV-F's made by the Selective Service System and the Department of the Army indicate that a group which constitutes from 20 to 25 percent of their examinations fail to meet military medical standards. In the "Statement of Registered Manpower" as of April 30, 1961, 3,328,549 registrants are listed as having failed to meet the physical and mental standards established by the Armed Forces. Of these probably 35 to 40 percent would be on the basis of health standards. During the 1-year period ending June 1960, in 169,000 preinduction examinations 45,000 registrants were disqualified for medical and psychiatric reasons. This does not include the disqualifications that same year directly by local boards or through final induction examinations.

STERILITY

The fertility rate, as measured by the total number of live births per 1,000 women aged 15-44 years, was 120.2 in 1959, one of the highest in the postwar period. Since 1936, there has been a definite upward movement in the fertility rate, with some irregular fluctuations during World War II and the immediate postwar years. During the 1930's, the rate went as low as 75.8.44

Although the fertility rate is obviously affected by cultural, social, and economic conditions, there is at all times a substantial proportion of the population that is involuntarily sterile or cannot have as many children as they want or whose pregnancies end in abortions or fetal deaths instead of live-born infants. The 1960 White House Conference on Children and Youth recommended that the National Institutes of Health encourage and continue research on problems of sterility and infertility.45

A recent study, based on a sample selected to represent the approximately 17 million wives in our national population, indicated that about one-third of the couples were subfecund. Approximately one-tenth of all coup es were definitely sterile.45

These estimates were based on interviews with the wives, and not on medical examinations. However, the authors point out, "an accurate determination of the fecundity status of many of them would have been impossible in the current state of medical knowledge.

RESPONSIBILITIES AND FUNCTIONS OF THE TWO NEW INSTITUTES PROPOSED UNDER H.R. 8398

The proposed new Institute of General Medical Sciences will continue to carry out without any essential change the research and research training activities of the present Division of General Medical Sciences. It will support research and research training in those scientific areas which provide a common basis for understanding a wide range of disease and health problems. Specific areas of research will include:

1. The basic medical and biological and preclinical sciences, such as biochemistry, biophysics, molecular biology, cellular biology, enzymology, and pharmacology.

2. Certain clinical sciences, such as general surgery, orthopedic surgery, dermatology, pathology, and anesthesiology.

3. Public health, medical care, and nursing.

4. Methods and tools of science, such as bioengineering, bioinstrumentation, electron-microscopy, and biostatistics.

The National Institute of General Medical Sciences will support research training and research fellowships in the following specific disciplines: anatomical sciences, biochemistry, biometry and biomathematics, biophysical sciences, epidemiology, pathology, pharmacology, anesthesiology, and physiology.

Its relationship to the work of the proposed National Institute of Child Health and Human Development will be essentially similar to its relationships with the other seven existing categorical Institutes. In general, the National Institute of General Medical Sciences will be concerned with research and research training in the basic sciences as such; the several categorical Institutes will be particularly U.S. Dept. of

44 Vital Statistics of the United States, 1959, "Natality Statistics," sec. 3, pp. 3-4, 3-5. HEW, PHS, NOVS.

45 "Recommendations," 1960 White House Conference on Children and Youth, p. 47.

46 "Family Planning, Sterility, and Population Growth," by Ronald Freedman, Pascal K. Whelpton, and Arthur A. Campbell, 1959, pp. 10, 18.

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concerned with their categorical mission, and will support research and training in the fundamental sciences only in relationship to that mission.

Specifically, the program of the National Institute of Child Health and Human Development will encompass research and training in the following broad areas: 1. The biological and physiological aspects of the processes of human reproduction, growth, and development. Studies of genetics, comparative anatomy, physiology, and biochemistry will be supported only in relationship to the problems of child health and human development.

2. Studies in the prenatal and perinatal period in human development, from conception until shortly after birth.

3. Obstetrical and pediatric problems not directly related to the specific disease interests of the other Institutes.

4. Studies of the process of maturation, including physical, intellectual, and social development, with emphasis on the behavioral aspects and on normal development.

5. Studies in special problem areas such as mental retardation.

6. Studies in the biological, medical, and behavioral aspects of aging.

In summary, the Institute of General Medical Sciences will support research of, and provide training for, those disciplines representing basic medical sciences and other sciences which provide the foundation for the study of health and disease. The Institute of Child Health and Human Development will be concerned with the study of the normal and abnormal development of the human being, supporting research, and providing training as indicated for the effective investigation of these areas of concern.

(Whereupon, at 12:15 p.m., the hearing was adjourned, to reconvene at 2 p.m. the same day.)

AFTERNOON SESSION

The CHAIRMAN. The subcommittee will please be in order.

Our next witness is Dr. Robert E. Cooke, professor of pediatrics, the Johns Hopkins Hospital, Baltimore, Md.

STATEMENT OF ROBERT E. COOKE, M.D., PROFESSOR OF PEDIATRICS, THE JOHNS HOPKINS HOSPITAL, BALTIMORE, MD.

Dr. COOKE. Mr. Chairman, it is a great pleasure to be permitted to testify in behalf of H.R. 8398.

I am Dr. Robert E. Cooke, professor of pediatrics, the Johns Hopkins University School of Medicine, and pediatrician-in-chief of the Johns Hopkins Hospital.

I am appearing in support of H.R. 8398, as chairman of the joint committee on pediatric research, education, and practice, whose constituents are the American Academy of Pediatrics, the American Pediatric Society, the Society for Pediatric Research, and the American Board of Pediatrics, and the Pediatrics Section of the American Medical Association.

I had the privilege of serving on President Kennedy's Task Force on Health and Welfare, and am a member of the President's Panel on Mental Retardation, as well as a member of various NIH special committees and study sections.

I have a personal interest in this legislation as a father of five children, two of whom are severely retarded. I appreciate that the committee has a large number of witnesses to be heard, and, therefore, I should like to introduce the subject briefly, rather than elaborating extensively, and I should like permission to submit a more detailed statement for the record.

The CHAIRMAN. You may proceed.

Dr. COOKE. The child population in the United States is now larger than at any time in our national history.

In 1960, children under 21 years of age in the 50 States and the District of Columbia are expected to number some 73.3 million as compared with 54.5 million in 1950. Two out of five persons in the total population of 1960 will be under 21 years of age, according to

these estimates.

If fertility levels of the recent past, 1955 to 1957, continue, children will number 91.3 million in 1970, and comprise 42.3 percent of the total population.

I should like to illustrate this with these graphs which I would hope might be entered into the record.

(The graphs referred to appear on pages 62-63.)

Dr. COOKE. As a physician, educator, and research worker in the field of child health and disease for the past 17 years, I have become increasingly impressed with the importance of research into the causation of abnormalities and the prevention of disease for it is only through an understanding of their origins that diseases may be prevented.

Through the advances in vaccine and antibiotic therapy acute, infectious diseases-formerly the great cripplers and killers of infants, children, and adults have given way to the chronic, disabling, irreversible conditions often originating before birth, such as mental retardation, congenital anomalies, disorders of speech, hearing, vision, and the degenerative disorders of the heart, limbs, brain, and so forth. Although not lethal at the time, the burden of such problems in terms of suffering to patients and family, and in terms of cost to private and public services is enormous.

The treatment of the limb paralyzed by poliomyelitis, for example, requires many thousands of dollars in medical care to permit even limited, halting ambulation.

Prevention by vaccines developed through research can eliminate this entire tragic loss to the Nation's health and economy.

Obviously, the key to prevention is the understanding of the causation of disease, which requires fundamental knowledge gained through research in the basic medical sciences of chemistry, anatomy, biology, physiology, microbiology, and the like, as well as the intensive investigation of normal developmental processes of human beings.

The wisdom of H.R. 8398 is in its provision for the strengthening of the basic sciences through the elevation of the division of general medical sciences to an institute, as well as the creation of a National Institute of Child Health and Human Development, to complement through the existing body system and disease-oriented institutes endeavors which will span the development of the individual from preconception onward.

Since my major area of professional proficiency is in child health, I shall confine my subsequent remarks to that area. However, as a former full-time member of a basic science department and as an associate professor of physiology at the Yale University School of Medicine, I also recognize and suggest the great importance of the second half of this bill.