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Before we proceed there was a question which came to my mind in connection with what you were saying, Dr. Forster, and also in connection with what Dr. Traeger had said. How many hours of neurological training does a medical student get at a medical school in the course of the medical training?

Dr. FORSTER. That, of course, varies rather widely, Mr. Chairman; but I think that in those institutions which have a well set up neurology program we still use the didactic method of lectures as a sort of alphabet for their training, and they get 25 or 30 or 35 lectures, depending upon the school.

Where the main teaching is done at the bedside, the schools vary a little bit in the length of time.

We have 4 weeks of constant work with the students, 2 weeks in the junior year and 2 weeks in the senior year at the bedside, on grounds. in the clinics with the outpatients, doing nothing else but neurology: just living, eating, and sleeping with neurology residents and neurology teachers.

I think that we might say that sometimes in the neighborhood of about a total time effort of 5 or 6 weeks of clinical neurology out of the entire program is what it is.

In addition to that, there are courses in the anatomy of the brain and the function of the brain and the pathology of the brain that are usually handled on an interdepartmental basis.

Probably the total amount of time spent, which would be full time, if you sorted out all of these hours, would be somewhere in the neighborhood of about 4 months.

The CHAIRMAN. I have observed during these hearings that frequently it has seemed to me as a layman there has been a deficiency of time which is allotted to some of these diseases which have come to our attention.

Dr. TRAEGER. Mr. Chairman, may I interject two remarks at this point ?

In the first place, Dr. Forster is talking about Georgetown University, where he is the dean. They have a strong neurological department. At the university I went to we had a strong neurological department. I have had a lot of neurology as an undergraduate medical student.

But there are many medical schools in this country which have no neurology or very little neurology or neurology comes under "internal medicine-it is a footnote to medicine—and their training is nonexistent. You cannot compare the training in neurology of a place like Columbia, Harvard, or Georgetown with 20 medical schools Î can think of where neurology was the last man on the totem pole and just hardly even exists. It depends on the boy running the show.

There is another thing I would like to tell you about, and that is the question of the 250 qualified neurologists. Now, I do not want the members of this committee to get the idea that there are only 250 doctors in the United States who know anything about neurology. That is not true.

However, the medical profession has policed itself. It has developed a system of board certifications. Today a man cannot proclaim himself to be a specialist in neurology or a specialist in surgery or a specialist in obstetrics or in gynecology unless he has passed the examinations of a certifying board.

just chaos.

Now, there are boards covering all of the various categories, or many of them. The American Board of Neurology has qualified 250 neurologists. These men are certified.

There are other doctors who by their interest in the problem probably would be just as good, and we are glad that there are. We are glad that they do exist, because without them this problem would be

The CHAIRMAN. Your remarks, Doctor, with reference to the deficiency in some medical schools as to teaching neurology, are just one more count in the indictment that you have been drawing this morning which we have been taking note of.

Dr. TRAEGER. I thought I was going to be a sort of interlocutor but I turn out to be a district attorney. Maybe it is a better idea.

Mr. HESELTON. Mr. Chairman, may I ask a question?

Mr. HESELTON. What does it mean when a man is certified as a neurologist ? Does that mean that he can do certain very delicate practices other than those an ordinary practitioner can do?

Dr. TRAEGER. No, sir; that is purely an interfraternity police matter.

There are certain criteria established by the neurological board. He must graduate from a first-class medical school. He must have so many years of general internship and so many years in neurological internship and residency. He must have so many years in the practice of neurology, limited to neurology.

When the candidate meets all of those requirements, then he comes before the board for a written examination; and it is a honey. The mortality on those examinations is fantastic. It is better than 50 percent, I believe.

Dr. BAILEY. The average is about 50 percent.

Dr. TRAEGER. When they get through with the written examinations, they come before the board for an oral examination and a bedside examination. When they get through, it simply tells the world that this man has read the books and knows his job.

Mr. HESELTON. He is a specialist ?
Dr. TRAEGER. That is right.
Mr. HESELTON. To whom other doctors can turn?
Dr. TRAEGER. That is right.

Mr. HESELTON. That does not mean, I take it, that the ordinary practitioner cannot prescribe, for instance, for migrane or even for epilepsy.

Dr. TRAEGER. Precisely. The ordinary practitioner can do that, and that is the great problem that faces us. I do not expect the ordinary practitioner, bless his soul, to be an expert. But this information is available to the ordinary practitioner. He can treat diabetes. He can treat heart disease. He can treat arthritis. He can treat tuberculosis. He can treat neurological diseases. It is all in the book. The information is available for him. If he does not know where to find it, he can call up.

Goodness knows, we get 400 calls a week dealing with multiple sclerosis. The information is available. They can do it. There is no secret to this thing. It is just interest. Are they interested?

The average person who comes into the general practitioner with epilepsy or with arthritis causes him to say:

“Oh, gee whiz. I do not know what to do about this. I do not know. I cannot cure it. I have arthritis myself. I wish I could do anything about it, for I would cure myself. My son has epilepsy. I wish I could cure it for him.” That is why we are worried about it.

Mr. HESELTON. I wanted to ask Dr. Forster one other question. Is diet a factor in epilepsy?

Dr. FORSTER. During the period of time when we had relatively few medicines that were really worthwhile diet was employed rather extensively. It is not as successful as a medical treatment as the use of drugs in the treatment of epilepsy. It works best in children. Of course, the youngsters are the hardest of all to keep on a diet. They will slip off and get an ice cream cone or something like that.

It can be used, but it is not a very effective way of treating them. Mr. HESELTON. That is all.

The CHAIRMAN. I think what Dr. Traeger has said is highly important. This special study as to this certification as to ability is important because, as I observe, we are getting more and more, all the time, into a field of specialized practice, especially in our cities. The general practitioner seems to me to be disappearing. Everyone is becoming an expert in some particular line.

When you go to your physician he says, “I would like to have Dr. So-and-so's opinion on that.” Then maybe it will be Dr. Somebody Else's opinion, or something else, and so forth and so on. So it has been observable to me that practically all physicians are becoming specialists. I can see the importance of the certification to which you have referred.

Are there any further questions?
Mr. HELLER. Mr. Chairman?
The CHAIRMAN. Mr. Heller.

Mr. HELLER. Doctor, can the American Medical Association furnish us with the number of men qualified in the major divisions of medicine, such as the diseases we are studying?

Dr. BAILEY. I do not think they could furnish you with a list of the number of men qualified. They could furnish you with a list of the number of men certified in various specialties.

Mr. HELLER. Certified ?
Dr. BAILEY. Yes.

Mr. HELLER. May we have that list for the record, to be inserted at this point?

Dr. BAILEY. Yes, sir.
Mr. HESELTON. Would the gentleman yield?
Mr. HELLER. Yes.

Mr. HESELTON. It would be good to have the addresses, so that we could determine where these specialists are concentrated.

Mr. HELLER. Can the addresses be furnished ?

Dr. FORSTER. There is a published book on that, the Directory of American Medical Specialists, which lists the men by specialty and geographically, also." It is a whole volume.

Dr. BAILEY. It gives the addresses.
Dr. FORSTER. It gives the whole business.
Mr. HELLER. Is that issued by the American Medical Association?
Dr. FORSTER. No. It is published by the board.

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Dr. BAILEY. We could send it.
Mr. HELLER. It is accepted by the profession?
Dr. BAILEY. Yes.
Dr. FORSTER. Oh, yes.

Mr. HELLER. Suppose we get that list and put it in the record at this point.

The CHAIRMAN. I do not know whether it would be too large to put in the record or not.

Dr. TRAEGER. It is a big volume.
Dr. BAILEY. About 1,500 pages.

The CHAIRMAN. It could be an exhibit, probably, that we could have available to us.

Mr. HELLER. I will withdraw that request.

(The list of practicing certified neurologists was submitted to the committee and this list was not incorporated in the record but is available in the committee files.)

The CHAIRMAN. I might say that I think the doctors, scientists, and laymen who have appeared as witnesses in these hearings would constitute as fine a set of specialists as I know of. I have been greatly impressed. I know that all the members of the committee have been impressed with those who have appeared before this committee.

You may proceed, Doctor.

Dr. TRAEGER. Mrs. Tankersley, do you have anything to add to the problem of epilepsy, as you see it?



Mrs. TANKERSLEY. I would like to make 1 or 2 sort of disconnected remarks just as an augmentation to the things that have been said about epilepsy:

First, I would like to underline, from my point of view as president of the National Epilepsy League, the tremendous need for more qualified doctors, more men trained. Every year my agency gets about 25,000 to 50,000 letters from epileptics who are receiving totally inadequate medical care, asking us where to send them. We have nothing whatever to say to them. There is not any place we can send them. There are not competent doctors and big enough clinics and enough clinics for us to send these people to. It is the most terribly disheartening feeling to run an agency and to have these people coming to you for help and having practically no place to send them, and their family doctor, who cannot keep up with everything, is not up on the medicines that will control epilepsy.

So that our biggest problem in epilepsy is that we can control 80 percent of these people if we can only get them a doctor and get them good medical care.

Another remark I would like to make about that is that of all the neurological disorders epilepsy is probably the most hopeful, because we can control 80 percent of it. We are not controlling it, however. What that means in terms of the economy of this country, I think, is tremendous. One out of every 200 persons is an epileptic. If we could put 80 percent of those people into the taxpaying, self-supporting, able-to-fight, able-to-work rolls of this country, it would mean a tremendous amount of production and manpower.

During the war the epileptics were not allowed in the service. Some of them were well enough controlled so that they flew planes in the carrier service over to England. They were able to do remarkable work if we got medication for them. But there was so much prejudice against them because of most of them not being controlled that we lost a lot of manpower.

I know about this very personally, because my husband was an epileptic. During the war even the railroads would not give him a job, when they were so desperate for help. They would not give him a job because even a railroad company was afraid to take a chance on an epileptic; and he only had, oh, 2 or 3 seizures a year.

Another point I would like to make is that I have never had it explained to me, but somehow the expenditure of public funds in research and in training is always followed by a greater response from the public itself. This year we were awfully pleased to get some increase in the budget of the National Institute of Neurological Diseases and Blindness, and we hope that when we testify later this year for an increase again in that budget that we will be able to show that that is true; that we will be able to already see private funds coming in. I can see it in my own agency already, because I have got at least something to say to these epileptics who write to me, the ones who are having difficulty being controlled. I can say, at least: “There is a central place where research is going to be conducted. There are going to be more men trained. There is hope for you. There is hope for your little girl that in the next few years we may be able to find something to control her."

That is going to encourage the parent of the epileptic child to support my agency, so that I can do the social job for that child; I can get that child accepted in the schools; and when it grows up I can get it a job.

I think that there is a threefold reason for public funds in epilepsy. First, that we must have public funds for research. We have been over that thoroughly, I think, this morning.

Secondly, that public funds in research and training will promote private funds and will double the value of the Government dollar.

And there is one more thing I wanted to mention, which is to congratulate this committee. I have been before several committees and have heard several committees over the last 10 years, and this is the first committee that I have been before which I think realizes the importance of the overall neurology picture. My agency and the doctors in epilepsy feel very strongly that all of our work in Government and in private life must go along with the other neurological disorders.

Mr. DOLLIVER. Mr. Chairman?
The CHAIRMAN. Mr. Dolliver.

Mr. DOLLIVER. I do not know who this question can be answered by. I have observed this large new Institutes of Public Health building going up out here at Bethesda. It is a large hospital. I wonder how many beds there are going to be devoted to these neurological diseases ?

Dr. TRAEGER. Dr. Bailey.

Dr. BAILEY. The number of beds allocated for neurological diseases at the present time is 52 out of 500.

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