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spinal cord the patient remains a hopeless cripple because of one very obvious defect. The spinal cord, and for that matter, the brain also, does not show any evidence of regeneration or of healing. If one fractures a leg, the bone of the leg heals and he eventually is restored to quite normal functioning. If one wounds the skin, the skin heals. If one wounds the spinal cord, however, the spinal cord does not heal in the sense that it can regenerate and restore its functions. It heals with a dense scar which prevents the growth of the nerve fibers which transmit the nerve impulses, and that has been classical pathology and classical clinical understanding of the nature of spinal injury.
Interestingly enough, about 5 years ago, Dr. Windle, who incidentally is coming to Bethesda as Chief of our Laboratory of Neuroanatomical
Sciences, who was then professor of anatomy at the University of Pennsylvania, and Dr. Chambers, were working on a field which was not remotely connected with this problem of regeneration. They were studying the effects of a peculiar substance produced by bacteria which causes fever in animals and in man, and they were trying to localize the site of this fever production—where does it occur and how does this material act. In order to do that they did as many scientists do, they performed a series of experiments in which they cut the spinal cord of cats under anesthesia. They cut the spinal cord in various places in an attempt to see if there was one place which if cut would prevent the rise in fever.
Well, their experiments on the site of localization of fever were not terribly important, and I do not recall whether they got anywhere with the experiments, but they made a very interesting incidental observation: That these cats who had their spinal cords cut, cats who should have remained completely paralyzed from then on, these cats who got this particular substance showed some regeneration of the spinal cord, and when they examined these cut spinal cords under the microscope they found, to their astonishment, that nerve fibers were growing across the cut. This was really an epoch-making discovery.
Incidentally, it comforts me because it was a discovery made in the line of basic research. These people were not looking for a cure for paraplegia; they were looking for something different. Incidentally, because they are trained observers and because they also had an element of good fortune, they found this very interesting phenomenon that regeneration was occurring in the spinal cords of these cats, a phenomenon which no one had ever observed before in any significant quantity.
They went on with this and implanted a nerve into the brain, and they gave their animals this particular substance and found that the nerve grew right in the brain in a most amazing manner, and their slides which I have seen and which were reported at one of the physiological society meetings, show these nerve fibers growing beautifully into the brain,
That, as I said, is an epoch-making discovery. It does not mean that we can go out right now and treat patients and they will immediately get well. There is a great deal more that has to be learned. It is not enough to have the nerve fibers grow across the spinal cord; we have to know where they go to. Their growth has to be controlled. It has to be possible to stop the growth after it has achieved an optimum distance and the fibers have grown to the regions where they are destined to activate. But the important thing here is a major step which had been held to be impossible before, and Dr. Windle, who intends actively to pursue this problem, has the greatest confidence that within the next decade he will have a very important answer to the question of regeneration in the central nervous system and a great deal of hope for the future victims of spinal cord injury, and who knows, even for the present victims.
Mr. DOLLIVER. When was it that this rather epoch-making discovery was made?
Dr. KETY. It was made about 1948 or 1949.
Dr. TRAEGER. When you are through questioning Dr. Kety about this particular problem I would respectfully ask you to refer to Dr. Bailey to tell you something about the economic problems posed by paraplegics, which is very germane to the problem Dr. Kety is discussing.
Mr. DOLLIVER. I would just like to make another comment about that. That appears to me to be another example of the importance of basic research. Here research is going on in a field entirely different or dissociated from this problem of nerve reconstitution. Because, as you said, the observers were trained in basic research, they immediately saw the significance of what happened.
The CHAIRMAN. Are there any other questions!
Mr. PRIEST. Dr. Traeger, I understood you to say that the Federal appropriations for all victims of neurological diseases amounts to about 3 cents per victim. That includes all the victims of what we call the neurological diseases?
Dr. TRAEGER. Neurological and sensory.
Mr. PRIEST. I want to express my deep appreciation of your very logical and persuasive presentation of the overall subject this morning. I thought that you did a very magnificent job. This committee, of course, has been interested in these matters for a number of years. I do not take any personal credit because all of the committee have worked on it, but it just happens that of the bills which bear my name and which have become public laws, I am perhaps more proud of the mental health bill and the bill authorizing neurological and blindness institutes than any others that bear my name. I think that they are in the fields which have been most neglected in the past and have greater opportunities for some real progress.
This 3 cents per victim appropriation, in my opinion, is very, very much too low, and I hope when budgets come before the Appropriations Committees for the next year it can be greatly improved.
There are several other questions that I think may be covered by other witnesses and I will not take further time now, Mr. Chairman.
Dr. TRAEGER. Thank you, Mr. Priest.
I would like to have Ďr. Bailey tell the committee something about the economic importance of paraplegics, people who are paralyzed in their limbs, which has a direct bearing on the work that is being described.
The CHAIRMAN. Would there be any objection to withholding that until the members have questioned ?
Dr. TRAEGER. Not at all.
Mr. HESELTON. I am every glad that our colleague, Mr. Priest, has made the statement he has because I think that represents the general
opinion of the committee. However, I want to bring up another phase of it, not necessarily to you, but to the entire panel, for two reasons.
It happens that yesterday my attention was called to an article with reference to the tragic lack of care in one of our States of mental patients. I dare say that if anyone saw fit to go into the other States they would find relatively the same conditions, but it was almost unbelievable in terms of the inadequate food. I think that something like 58 cents a day was being allowed for food for the patients. There were completely inadequate attendants to see that they got outdoors They were sleeping in corridors and so on.
I cannot believe that the State legislatures are made fully aware of the conditions. I think it is not only the responsibility of the Congress, but there is a definite responsibility on the States themselves.
Certainly, while I share Mr. Priest's desire that Congress find the means somehow to improve conditions so far as these particular diseases are concerned, the longer these hearings proceed, the more convinced I am that a task is being laid before this committee and the Congress that is almost beyond its power to deal with financially,
I am not criticizing any of you experts, but we have heard some people in connection with heart disease and in connection with cancer and arthritis and rheumatism, and every one has a good case.
But with the financial situation of this Government such as it is, it is utterly impossible to do all the things that you ask us to do next year, or in a number of years. Having that in mind, I would hope that there would be a realistic attitude on the part of those appearing before us. You should know where the emphasis should lie, whether it is in the care of people suffering now; whether it is in research; whether it is in the training of additional personnel or in some other field. I think that it would
be very helpful to us if we could get from some of you people the priorities. For instance, what is the No. 1 thing that should be placed before anything else in the field, as you see it? I know that is a difficult thing to ask anyone. We asked someone yesterday. He frankly admitted that he felt his own field was the most important. I think that anyone sincere and interested would say that.
We have the very difficult job of making a decision and picking out those things which are most immediate and can be done most effectively, even though we reluctantly have to say, "We are sorry, but the taxpayers cannot bear the full burden you are asking us to impose upon them.” That is just more or less an observation. I hope from these hearings that we will have something concrete.
The CHAIRMAN. I think it is an observation well taken in view of what has been presented in these hearings as far as we have gone. On the other hand, while there is apparently much to discourage, yet I do not want this committee to become discouraged in its endeavor to meet this problem. I realize the difficulties that we face, but at the same time there has been much of optimism that has been presented by the several witnesses who have appeared here, and I am hopeful that the inspiration that comes with the knowledge there is so much being accomplished will encourage this committee to attack this problem, which we recognize to be a very great one, in a way that will ultimately lead to some solution. In that aim we are seeking the help of individuals who appear before us, and asking them what they think should be done. We are all aware of the fact this problem is a great one, that it is not only a Federal problem but a State and local problem, and is also a problem for the professions involved.
I did not hear all of Dr. Traeger's statement today, but I heard enough to indicate to me that he was laying a pretty severe indictment against somebody. I do not know who John Doe is in this case, whether it is the medical profession that these studies are not carried on more fully in our universities, or whether it is someone else. That is helpful to us in the way of criticism.
That is the thing that we want to know-where the deficiency exists, and then we would like to turn to the other side what can be done about it.
This committee is engaged in seeking the cause of these conditions; seeking whether they can be controlled. In other words, we are looking to you people, who are so intimately connected with these diseases, for some program that we, as representatives of all the people, can help make effective for the common good.
Dr. TRAEGER. I am grateful to you for your remarks because they point up precisely our job—your job and our job.
The research in nuclear fission has been going on for 20 years all over the world. Research in nuclear fission was taking place in Italy, Germany, and in the Scandinavian countries, America and England, but it was pedestrian; it was slow. It would still be pedestrian, it would still have leaden feet, if we had not gotten into World War II and somebody in our hierarchy said, “Here is $2 billion, get the best brains in the country and get the answer.” We had the answer in 1 year. That is the problem presented by these diseases, these mysterious diseases. We do not even know what causes them. We autopsy these people and cannot tell why they die, and they are dying. They represent a tremendous financial loss to the country in manpower. We have gone all through that. If we could get, not 3 cents per patient, but $2 a patient, I think that we could do a job that the Atomic Energy Commission did, or what preceded the Atomic Energy Commission did, in nuclear fission, and in about the same time.
Mr. HESELTON. How many patients are there?
Dr. TRAEGER. Yes; and it is not easy. That, to my mind, Mr. Heselton, is not an unrealistic budget. I hope to be able to convince you people.
The CHAIRMAN. I think aside from government itself there is a responsibility that falls not only on the organizations of a medical character, but on the people generally. Last night I addressed an organization known as the Tall Cedars of Lebanon, a Masonic order. I learned that that organization had taken upon itself a responsibility with reference to providing funds for research into muscular distrophy in connection with the work being conducted at the New York Hospital. That opened my eyes to possibilities, when an organization such as that, not an exceedingly large organization, takes up its responsibility and endeavors to raise funds to carry on research. It is an indication of what can be done if the public generally is made to realize what the conditions are and what its responsibilities are. I think that we are moving along in that respect.
I think that all of these organizations-heart, cancer, and those represented here today—and all the various organizations that are out making their drives for funds from the public are necessarily showing the public that the need exists and what can be accomplished if the funds are provided. So I am hopeful as a result of these hearings there will be an awakening of the public conscience; of its responsibilities and the part it should take in the carrying on of this work that will mean so much to the future happiness of our people.
Mr. HELLER. Dr. Kety, I have always accepted it as classic that cells once destroyed never regenerate; is that correct?
Dr. KETY. Yes. If the cell is destroyed, it does not regenerate.
Mr. HELLER. You talked of an experiment whereby the nerve fiber in the spinal cord and the brain was cut and there was complete regeneration is that correct?
Dr. Kety. Yes; there was certainly partial regeneration.
Mr. HELLER. Is not the question of regeneration the real nub of the neurological problem?
Dr. KETY. Certainly, if one could get all diseased nerve cells to regenerate, one would be able to accomplish a great deal.
Mr. HELLER. How does this regeneration come about?
Dr. KETY. I do not believe that Dr. Windle understands the mechanism of the regeneration yet, although he knows it has occurred.
I think that it should be pointed out this was not a dead cell which came back to life, which was regenerated, because the fibers in the spinal cord which were cut were the long fibers coming from the cells. The cells themselves may be up in the brain or lower down in the spinal cord. That is the part of the cell that was regenerated.
I think that it would be a much larger problem and a less hopeful one to look for regeneration of a dead cell. This was merely a part of the long nerve cell which was capable of regeneration.
Mr. HELLER. Is there any method used today on man which can bring about regeneration of destroyed cells—let us say in the brain?
Dr. KETY. Physicians were quick to try the material that Dr. Windle had elaborated on. The results, however, were not entirely encouraging because it is one thing to get the first stages of regeneration and another thing to get complete restoration of functions. A great deal more research lies between this great surge forward and a practical application to the patient's disease. Factors are responsible for the control of this regeneration, for the direction of the way in which the nerve fibers grow which are completely unknown and upon which more work has to be done. If one were permitted to speculate without limit, one could postulate with the newer work being done on the culture of nerve cells outside the body, plus the ability to cause these cells to grow within the brain and spinal cord. Perhaps 50 or 100 years from now it may be possible to put a culture of nerve cells into a destroyed area of the brain and by guidance, which we do not understand yet, have these new cells grow into the places where they are destined to have their function. I think such speculation, however, is unwarranted at the present time.
Mr. HELLER. When was this electroencephalograph brought out? I get the impression from Dr. Traeger's testimony that cells can now be grown and be reproduced.
Dr. KETY. Yes.