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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.
Mr. HESELTON. Thank you, Doctor. Dr. Stone?

STATEMENT OF DR. F. L. STONE, CHIEF, EXTRAMURAL PROGRAMS,

NATIONAL INSTITUTE OF NEUROLOGICAL DISEASES AND BLINDNESS, NATIONAL INSTITUTES OF HEALTH

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?
Fossibly 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 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?

Dr. HARDY. Just beginning. This treatment, as we presently know it now in clinical terms, with the tools that are available and what information is coming through from basic and clinical research jobs, is not as old as the last year of World War II. It is moving very freshly, very fast.

Mr. HESELTON. Proceed, Doctor.

Dr. Hardy. Does anybody else in the group wish to add to this general question of research?

I think we may summarize at this point, Mr. Chairman, unless there are other questions from the committee.

Mr. HESELTON. Are there any further questions?
Mr. THORNBERRY. Off the record.
(Discussion off the record.)

Dr. HARDY. I believe the picture can be summarized fairly directly. I think we tried to cover at least the high spots of the general field.

There is an ongoing, slowly developing program designed to find cases at least of certain ranges of children's problems, now centered under the public health or school health auspices in most States. That program has not gone very far.

As Dr. Glorig suggested, in his opinion perhaps 1 out of 5 children who have these problems are known by case-finding techniques and actually are being followed through. The necessary indicated steps in diagnosis and therapy are shown. A good deal more needs to be done.

That is one need in the field for professional personnel trained in modern terms to move into those programs and organize them better from the community level on up. That probably will not happen until and unless there is much further development in public education in these specific terms and needs.

I think it is worth while restressing over and over that the preventive aspects of this question of hearing disorders are by all means the most important. When one deals in the field of prevention, he is dealing not with the 100,000 or 200,000, but with potential millions, and the figure gets there very rapidly, across the period of one decade. It stands to reason, I think, from any approach, that prevention of disease and of the effects of disease must be No. 1 on anybody's roster or agenda of things to be done. The next step is in the field of restoration of impairment.

A good deal of work is going on, but the surface is barely being scratched largely because of some implications of what Dr. Bailey and Dr. Stone have been discussing. There is a great dearth of knowledge and information of basic physiology, basic function and disfunction. That kind of research must center in adequately equipped institutions.

There there is a third aspect of the field, which includes the broad range of rehabilitation in the widest sense. As I would define that now, I should assume that that also includes all known and knowable steps of education or special training. At the level that Dr. Elstad addressed himself to for the deaf people, but also at the level which is being addressed by every State organization of vocational rehabilitation that is necessary, to find the best aptitudes and see to it that the individual is helped by whatever means society can provide, to achieve accomplishment in those aptitudes.

You have three aspects : Prevention, restoration, and education and rehabilitation. They all need a vast amount more help, understanding, and information at every level.

Personally I believe that the No. 1 requirement is people trained and interested and willing to go on to work, and then funding for the particular jobs of inquiry that those people are able to address themselves to.

Mr. HESELTON. That completes your testimony?
Mr. Hardy. Unless the panel has something more to say.

Mr. HESELTON. I cannot resist repeating that in the course of this hearing it seems to me that there are at least two points as to which something can be done and rather quickly. One is that I hope the Appropriations Committee is going to know a good deal more about the work you are doing, Doctor. Certainly that is a very practical and very profitable way of attacking a certain part of this problem, it seems to me.

Next is in connection with the fact that I suppose almost all births today are attended by physicians. It seems to me it ought to be possible to see to it that in the general medical schools the problem which you have outlined to us is made very clear to all practicing physicians today and to obtain their cooperation. It would seem to me that would be an invaluable asset to the work you would like to do with the young children.

In any event, I am sure this hearing has brought to this committee a great deal of very valuable information, and I dare say that many of my colleagues, like myself, have learned it for the first time, rather well along in life. I can assure you that the committee does appreciate the care with which all of this has been prepared. We realize you have had to come here at some inconvenience, but we feel confident that each of you may look forward to something this committee may be able to do in this field which will reward you for coming here this morning

The committee will stand adjourned until Monday at 10 o'clock.

(Thereupon, at 1:08 p. m., Friday, October 9, 1953, an adjournment was taken.)

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THE CAUSES, CONTROL, AND REMEDIES OF THE

PRINCIPAL DISEASES OF MANKIND

PART 5

OCTOBER 13 AND 14, 1953

4. S. Congress. House

Printed for the use of the Committee on Interstate and Foreign Commerce

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