upper respiratory infections, and, as Dr. Glorig pointed out, that can be healed. We cannot reverse it, but if gotten early enough, it can be helped.

The other point is that, with generally wide health techniques of examining large numbers of children, there naturally comes into being problems in terms of administrative care at the level where children are insufficient to be able to respond to a good or designed test.

Mr. THORNBERRY. I understand that, but what worries me is that from what I understood you to say, even after you are able to examine children at that stage, it may be a little late.

Dr. HARDY. It certainly is too late to begin an operation or begin thinking about the problem of a certain child who has a serious impairment, because he has, before school age, already gone too far without attention. His developmental point for these aspects of language and speech and so forth are centered in the 4 years before school age.

Dr. GLORIG. I think the point here is not so much that we are able to reverse this process, but we are able to get the child in an educational setup whereby he will make the best of what he has if we get him early enough. However, we usually wait too late, and then it is a much more difficult problem.

Mr. THORNBERRY. Let me ask you this question. Is a large part of the loss of hearing hereditary?

Dr. GLORIG. A large part of it? You mean the whole problem? Mr. THORNBERRY. Yes. I mean the cause of it.

Dr. HARDY. Speaking in clinical terms, no, sir. A significant amount is, but I do not believe that there is any evidence that a large proportion of it is.

Mr. THORNBERRY. A significant amount is? Do you have any idea about how much that is?

Dr. HARDY. I can only deduct that from direct clinical experience, and our statistics are no good. We see children who are in trouble, and we have no way at all to relate that to an incidence. Of the last 850 cases of preschool children whose problems we studied carefully 17 were assignable clearly to a direct family strain.

Dr. GLORIG. Otosclerosis, which is hereditary, is of the entire deaf problem less than 5 percent.

Mr. THORNBERRY. Has there been any attempt to trace the family background as to whether or not some time ago they may have had it in the family?

Dr. ELSTAD. Our records would show that this 30 percent holds up pretty well, which we mentioned before. Of course, we have no way to check it.

Mr. THORNBERRY. That is what I understood awhile ago. So many say it is hereditary, but I am not so sure that is true.

Dr. HARDY. I think you are quite correct. The medical field is beginning to demonstrate beyond any doubt that, although these problems exist on a prenatal basis, it is not hereditary in a large proportion.

Mr. THORNBERRY. May I ask this question? It may sound ridiculous, but to the lay person it is not. Have you ever examined or found a person who was deaf, who, along with that, lost his speech? I know they do not talk, but so often they are referred to as deaf and

dumb people. They really do not speak, as I observe them, because they cannot hear. You have never run into anyone who was deaf and did not have speech organs?

Dr. GLORIG. No, sir. Well, you might have cases relating to a congenital condition, as it relates to a finger or thumb and so forth, but I have never seen one in my experience who did not have speech organs.

Mr. THORNBERRY. You often have people referred to who are deaf as being deaf and dumb, and they do not appreciate that very much when the term "dumb" is used.

Dr. HARDY. As a matter of fact, that is one of the reasons why this field has been so very slow in developing in terms of general education and in professional education. It has been assumed for years that this problem lay so far beyond comprehension and that nobody could do anything about it that they referred to them as "deaf and dumb" and felt that they belonged to some other level of society.

Mr. THORNBERRY. I think this is a field which has received less attention than any other one, and needs it very much.

Dr. Bailey, are any Federal funds set aside in the National Institute for this problem?

Dr. BAILEY. We have a responsibility for hearing losses in the National Institute of Neurological Diseases and Blindness, and we have an intramural program in which the amount set aside right now is very small. We are the youngest Institute of the National Institutes of Health, and we were born at a rather unpropitious time from the standpoint of economy. Although we have definite plans for research at the Clinical Center at Bethesda and we do have one or two people working on the physiological side of deafness and on the problem of hearing loss, it is very small. Besides this intramural program, we do have an extramural program which awards research grants to nonfederal institutions and universities for research in the problem of hearing loss as well as neurological diseases and blindness. I believe Dr. Stone has the latest figures on that.

Dr. STONE. In the fiscal year 1953, we supported 5 projects in the total sum of $60,987-roughly $61,000; in fiscal year 1954 we are supporting now 8 projects in the amount of $72,573, and I would like to say at this point that we were forced to turn down, for lack of funds, approximately $50,000 in applications that we got in the hearing field that we could not support.

Mr. THORNBERRY. How much do you allow for blindness?

Dr. STONE. The amount for blindness in the last fiscal year, that is, the fiscal year 1954, is $392,000.

Mr. THORNBERRY. I believe those are all of the questions I have right now, Mr. Chairman.

Mr. HESELTON. Mr. Williams.

Mr. WILLIAMS. Quite a belief prevails among the lay public that the intermariage of relatives quite often causes deafness in offspring. Is there any evidence to support that?

Dr. HARDY. That statement, to my knowledge, sir, is a little bit too broad.

That there is some hereditary strain which is genetic, which involves the lack of development of the hearing mechanism, yes, there is a good deal of evidence that, but my goodness, I think we would be going pretty far to say that intermarriage is a cause for hearing dis

order, except that might involve general physical deterioration, and, therefore, be one of many possible results.

Two studies are being undertaken now in a community in which the family strains are particularly close, in which otologists have been interested in the past 7 years. In these particular families, both show the trend of strain. There are 360 in one group, and 158 in the other group, and they have two different types of impairment among those families.

I do not think of any sociological facts to support the other generalization clearly.

Mr. HESELTON. Excuse me, Mr. Williams. Do you wish to ask Dr. Glorig any questions? I ask that at this time because he wishes to get away.

Mr. WILLIAMS. I would like to ask him one question.

Doctor, you apparently are pretty familiar with the rating schedule of the Veterans' Administration in deaf cases.

In the case of men with amputations and men who have lost an eye, in addition to the percentage rating they are also granted a statutory award. It used to be $30, and I believe it is $47 now.

Does that apply also in the case of a man who has lost the faculty of hearing in one of his ears, or who becomes deaf?

Dr. GLORIG. Not that I know of; no, sir.

Mr. WILLIAMS. That is all.

Mr. HESELTON. Does anybody have any further questions of Dr. Glorig?

Doctor, we thank you very much for coming here this morning. Dr. GLORIG. Thank you very much, Mr. Chairman and gentlemen of the committee.

Dr. HARDY. You have touched in your questions on a couple of basic ideas about research. I have some personal opinions about this that may or may not be shared by other members of the panel group here.

I think, apparently from the facts that there are several lines of research, some of which are being followed, and all of which need to be further developed than they presently have been developed.

First there is a line that has to do specifically with prevention, and that is a specific medical inquiry at the level of both pure research, if you will, and applied clinical research, and the casual relationship between such things prenatally as damage in embryo and the effect of the RH factor, and damage in embryo or immediately after birth to the hearing mechanism, and more particularly the effects of withdrawal or the absence of a sufficient amount of oxygen in the blood as accompanying the phenomenon of birth.

Those are large questions that need a great deal of inquiry and attention focused on them generally and by people in obstetrical practice in various parts of the country.

It is one state of affairs in a large metropolitan center where there are large hospitals with big medical staffs, and it is quite a different thing out across the country where that kind of good medical attention is not available.

Then there is a range of research inquiry that has to do with the restoration of impaired hearing, so far as that can be done. Dr. Glorig commented on some of the problems centered around otosclerosis.

It is a familiar thing, which involves the growth of bone in the middle ear structure.

It usually has its onset toward the end of the second decade of life. As information is being gathered more extensively, it becomes clear that there are certain instances of it at birth or early in childhood.

Largely that problem is handled in these days by a procedure called fenestration, in which that part of the organism is bypassed and a new entrance is made into the inner ear structure.

Otherwise the problem is handled by rehabilitative methods.

The essential point is that a good deal more inquiry simply must go on about the effect of some of these basic pathologies beyond that presently known.

One inquiry we have been concerned with locally has to do with the maintenance of that part of the hearing mechanism leading to the middle ear in good mechanical function because we know, or feel we know, that many of the problems of conductive impairment in childhood center around organic malfunctioning, and everybody is searching for good, readily available, clinical tools that can be applied early in preventive treatments, to try to make sure that such chronic effects as we talk about do not occur.

There is another major category that has much to offer in terms of fundamental research in physiology and partly in pathology and in the entire field of geriatics.

Whether you realize it or not, the reduction of infant mortality and the extension of the life span at the other end cause literally untold, uncounted kinds of problems medically and in rehabilitation. We do not yet know about the results in physiological terms in some of these aging processes to be able to think clearly about them.

We do not know the time and the nature and the extent, for instance, relative to Dr. Glorig's remarks, of the effect on the hearing mechanism of the aging process through the decades 60 to 70, 70 to 80, and from 80 on. Now, that information must be obtained. Mr. HESELTON. Doctor, may I ask you a question which may sound absurd, but what does a hearing aid do?

Dr. HARDY. A hearing aid, sir, makes sound louder.

Mr. HESELTON. Is that confined to one where there is a conductive defect?

Dr. HARDY. No, indeed. We are beginning to have the courage of our convictions and with all of the professional power we can exert in terms of professional advisers and consultants, when we know the facts and the diagnostic picture is clear in these cases and everything has been done that can be done medically and there is enough residual hearing to act as a foundation for amplification through hearing aids, we use them. We start infants wearing hearing aids these days as soon as they are able to walk. The youngest aid user was 9 months old.

That was a slightly different problem. That child was born with a condition called bilateral atresia in which the external and parts of the middle ear failed to develop. Later when he is perhaps 5 or 6 years old surgical steps will be taken to correct that, but it cannot be done now. In the meantime he has to live for the next 6 years. The nerve structure is perfectly normal and at the age of 21 months that child has a vocabulary of about 50 words, and I am sure that

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within another year he is going to get useful communicative develop

ment.

There are a lot of misconcepts of what a hearing aid can do. It does not have any brains and all it can do is amplify sounds coming in if there is enough residuum in the hearing mechanism in an adult, for instance, or a younger person.

Dr. ELSTAD. Is there not such a thing as having sound perception but no sound interpretation? I have a young man in my office and if he closes his eyes and I speak in a loud voice, he cannot get a thing, but if I speak to him when he has his eyes open, he can understand. He has sound perception.

Dr. HARDY. It is a correlative thing.

Dr. ELSTAD. Yes; they work together.

Dr. HARDY. Yes. Do you care to make a statement at this time, Dr. Elstad?

STATEMENT OF DR. LEONARD M. ELSTAD, PRESIDENT, GALLAUDET COLLEGE, WASHINGTON, D. C.

Dr. ELSTAD. Mr. Chairman and gentlemen of the committee, I am not an M. D. and I am not a Ph. D. I am an honorary LL. D. I have spent 31 years in working for the deaf. My part here is to show what is being done for deaf children.

We have 21,000 children in various schools for the deaf today in residential State schools, deaf schools, and special day schools for the deaf; 14,000 of those are in State residential schools for the deaf.

There are State residential schools for the deaf in all the States except Delaware, Nevada, Wyoming, and New Hampshire.

These children go up to approximately the 10th grade in high school. They are about 18 or 19 when they finish that course and they go out into industry at that time.

Those children who go to day schools go to approximately the eighth grade and in many cases get their education along with hearing children. Unfortunately, many of them, because of the communication handicap, are not successful in high school and drop out of school at an early age.

Then, in higher education, there is only one college for the deaf and that is the one of which I am president, Gallaudet College. It is a private corporation subsidized by Congress and, being so, we have three Congressmen on our board, one of whom is Mr. Thornberry here, who is a very good member.

Gallaudet College is a liberal arts college for the deaf. That does not mean that it is not possible for a deaf high-school graduate to go to an ordinary hearing college, but it is easier for them to get a full college education in a college such as ours where it is geared to the handicap under which they labor.

There is no excuse today for any deaf child not getting an education in any State of the United States.

Mr. HESELTON. Would you give us an idea of how many students you have and from where they come?

Dr. ELSTAD. You are speaking of the college now?

Mr. HESELTON. Yes.

Dr. ELSTAD. We have at the present time 262 students enrolled this fall. They are from 40 States, 4 from Canada, 1 from England, 1