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tive fashion, we at Boston Lying-in have had representatives from Charity Hospital in New Orleans, the University of Minnesota, Brown University, and Providence Lying-in Hospital studying our methods of examining the mother and baby during and after delivery. Much more of this type of cooperation will be seen in the future for much of the work contemplated in this project is in an unchartered field. All of us who are cooperating in this national endeavor do so with the realization that only through widespread collaboration can the answer be found which will make it possible to prevent certain cases of cerebral palsy and mental retardation. We all realize that the incidence of these conditions in our own personal experience is so low that it would take a lifetime to accumulate sufficient material on which to make conclusions. Combining forces, therefore, is the only way this problem can be studied with some hope of success. Over a 5-year period of study, we believe that an absolute minimum of 40,000 infants should be studied. I should like to insert in the record at this point, Mr. Chairman, if I may, a breakdown for the approach to this goal. §§ FogARTY. Without objection, that will be done. (The above-mentioned document follows:)

Number of Total for Institutions cases per 5 years year

Boston Lying-in Hospital, Brookline, Mass---------------------------------- 1,000 5,000
Brown University, Providence, R. I.----------------------------------------- 500 2,500
Charity Hospital, New Orleans, La----------------------------------------- 500 2,500

Children’s Hospital of Philadelphia and Philadelphia Hospital, Phila-
delphia, Pa.--------------------------------------------------------------- 500 2,500
Children's Hospital, San Francisco, Calif.----------------------------------- 500 2,500
Columbia Presbyterian Medical Center, New York, N. Y------------------- 500 2,500
Johns Hopkins Hospital, Baltimore, Md------------------------------------ 500 2,500
Medical College of Virginia Hospital, Richmond, Va.------------------------ 500 2,500
New York Medical College, New York, N. Y------------------------------- 500 2,500
University of Minnesota, The Medical School, Minneapolis, Minn---------- 500 2,500
University of Oregon Medical School, Portland, Oreg. ----------------------- 500 2,500
Yale University School of Medicine, New Haven, Conn.--------------------- 300 1,500
Total------------------------------------------------------------------ 6,300 31, 500

Dr. CLIFFORD. At least three additional collaborating institutions should be added to this group to achieve our minimum goal of 40,000 infants. There is no question but that more than three are ready and anxious to join the project if funds can be provided.

At the present time, we have 12 collaborating institutions, and they are delivering around 32,500 babies at the present time. We need to come up to our full quota of 40,000 to do the job right. I would like to urge that this program be given full support and allowed to proceed for this period with a full complement of the babies upped to the number that we feel, and the statisticians feel, we need in order to answer a number of these important problems.

Mr. FogARTY. Thank you, Dr. Clifford.

Dr. Braley.

STATEMENT OF DR. ALSON. E. BRALEY

Dr. Boarx. Mr. Chairman and members of the committee, I am Alson E. Braley, professor and head of the department of ophthalmology at the State University of Iowa Medical School, located at Iowa City, Iowa. This is my third time coming back here, and I realize that you are sympathetic to our neurological and sensory diseases. Mr. FogARTY. I wish to say that at this point, too, when Mr. JenSen was on this committee, I remember him telling us of the high opinion he had of you and your work. Go right ahead. Dr. BRALEY. I wish to recommend the continued expansion of the research program of the National Institute of Neurological Diseases and Blindness. The Institute, under the direction of Dr. Pearce Bailey, has made outstanding progress this past year in its enlarged program in senSorv disease research. The number of persons affected by blinding diseases and hearing disorders, however, is so great and the cost to the Nation for their care and rehabilitation so high, I urge your careful consideration of an appropriation sufficient to move ahead research on sensory disorders with all possible speed. Let us consider the magnitude of the sensory-disease problem. It is estimated that approximately 40 percent of our population have eye defects and need glasses. There are about 334,000 legally blind persons in the United States today and almost 11% million who are blind in one eye. Of the estimated 27,000 persons who will go blind during the next 12 months, more than half will be blinded by disease. There are an estimated 15 million Americans with some kind of hearing defect. Of these, 41% million are seriously handicapped and approximately 760,000 are totally deaf. Fortunately, we have become more aware in recent years of the scope of the problem we face with sensory disorders. In the few short vears since the creation of the Institute of Neurological Diseases and Blindness significant progress has been made through research conducted both at the Institute and through grants to leading scientists and institutions. These findings not only have opened many doors to our understanding of the basic problems we face in the prevention, diagnosis, and treatment of sensory diseases, but have diminished greatly the frequency of some of these diseases. I have discussed with you before the success of the program on retrolental fibroplasia which was initiated in 1954. This disease, until recently, blinded thousands of premature babies every year. Within 2 years, the cause of the disease was positively associated with the duration of exposure of premature infants to oxygen and all pediatricians and hospitals in the United States were alerted as to the proper preventive measures. For all practical purposes, this disease has now been wiped out. An example of the urgent need for research with sensory disorders is the difficulty which has been encountered in detecting glaucoma in an early stage. so We know that glaucoma is one of the most deadly of the blinding diseases, and that it destroys the sight of thousands of Americans every year and severely impairs the vision of thousands of others.

It is estimated that 1 million persons have glaucoma without knowing it, may lose their sight if untreated, and may suffer severe damage of their sight unless the disease is detected at an early stage. This past year at the Institute, under the immediate direction of the eminent Dr. Ludwig von Sallmann, one of the world’s leading ophthalmologists, a finding of considerable consequence in the diagnosis of glaucoma has been made. It has long been recognized that the main cause of blindness in glaucoma is the increase of intraocular pressure in the eye. It has now been found that the rigidity of the eye varies with the pressure on the eyeball rather than remaining static as previously believed. Inasmuch as the measurement of the pressure is the basis of glaucoma diagnosis by the widely used tonography method, any measurement which does not take rigidity changes into consideration might fail to make an accurate diagnosis. A corrective technique which compensates for the rigidity changes has now been worked out, and it is expected that it will be applicable to patients soon. Now as to other blinding diseases, in addition to research being conducted on glaucoma, the Institute is directing research on other blinding diseases for which the cause is unknown. Among these are uveitis, retinopathy, cataracts, and ocular tumors. Mr. FoGARTY. What is uveitis? Dr. BRALEY. Uveitis is an inflammation of the vascular lining inside the eye, of the iris, the curtain. Mr. FogARTY. Is is very prevalent? Dr. BRALEY. It is quite prevalent. I cannot give you the exact figures on the number of cases of uveitis, but there are many hundreds of thousands, I would say, in the United States. Mr. FogARTY. Proceed. Dr. BRALEY. Last year. I reported on both therapeutic and diagnostic developments at the Institute bearing on uveitis, a blinding disease brought on by tuberculosis, syphilis, and brucellosis. I am pleased to report that progress has continued during this past year. In addition, a specialized file system has been introduced which permits careful analysis of the clinical course of all uveitis g. with particular emphasis on any relapses which may occur. tudies are also underway to evaluate the relationship between uveitis and thyroid function. Among the most difficult blinding diseases to diagnose are the retinal disorders, particularly those of a progressive deterioration nature. Institute scientists have now developed electroretinography and allied techniques to an extent, that it is now possible to diagnose clinical disorders of the retina which were previously impossible or difficult to diagnose in the early stages. Now, Mr. Chairman, I should like to spend a few minutes discussing the number of persons handicapped by hearing defects—some 15 million, persons, with approximately one-third seriously handicapped. Because so many people have been involved, the major research efforts of the past have been directed toward the reduction of the hearing loss by hearing aids, an early diagnosis of the condition, and general rehabilitation. Rehabilitation techniques have made it possible to restore many persons with serious defects to productive lives. For this we are all grateful. However, the basic solution to the problem continues to lie in medical research dedicated to ascertaining the specific causes of the disorders and the development of effective preventive and therapeutic measures. Considering the scope of the problem, the Institute's research program in this field has not been large, but I am pleased to report that it has seen notable expansion this past year. In research, the scope of the program now ranges from basic studies of the sense organ of hearing and the physiology of transmission of nerve impulses to the clinical studies of specific disorders and effects of aging upon the auditory process. A solution to the problem of middle-ear deafness is being sought through investigations of the anatomy and function of the middle ear, both in the laboratory and in the clinic, in order to improve both the diagnosis and surgery for such disorders. Congenital disorders of hearing and nerve deafness are being approached through studies of the inner ear including the sense organ and the nerve tracts. These include electrophysiological studies of the translation of sound waves into nerves impulses, and thee onduction of the impulses, to the auditory cortex in the brain. The distribution of nerve impulses from the ear within the auditory cortex of the brain provides information on the so-called central hearing loss, which is often associated with congenital malformations, cerebral palsy, blood incompatibilities between mother and infant, and with diabetes. The discovery and tracing of the oliva-cochlear bundle, which I reported to you last year, has had a major impact on the direction of the Institute's hearing research during 1957. Using the basic data revealed by the finding, investigators invoked conditioned-reflex techniques employed by the psychologist to train animals to respond to various types of auditory stimuli. They then recorded the electrical changes in brain and ear which accompanied such responses. Specific changes in responses resulting from disease or injury were carefully observed and evaluated and are now being correlated with those made in the examination of patients whose brains have been harmed by injury, stroke, or tumor. The goal is to develop even more specific knowledge concerning the effect of injury and disease on the hearing system. As chairman of the Institute's Training Committee on Ophthalmology, I continue to have a very direct concern with the acute shortage of trained investigators and teachers in the ophthalmology field. As you are all well aware, the best laboratory facilities and the most advanced research techniques mean little if we lack the trained specialists required to man them. Although the program of training ophthalmologists for careers as teachers and investigators has developed slowly, considerable progress has been made in the past few years. At present, the Institute is supporting 34 graduate training grants totaling $822,481. Under these grants, 238 ophthalmologists are receiving training. In addition, the special traineeship program which was initiated in 1957 will provide postgraduate training for 16 ophthalmologists at a cost of $89,487.

The situation in the hearing field, insofar as trained investigators and teachers are concerned, is very acute. Recognizing this need, the Institute's training program has expanded steadily since fiscal year 1957, when 3 grants totaling $57,000 were awarded at the postgraduate level in the clinical field of otolaryngology. In fiscal year 1958, 12 training grants will be supported at a total cost of $204,750. Only four special traineeship awards were made by the Institute in fiscal 1957; approximately 12 will be made this fiscal year. o trainees not receiving direct awards, but supported by ograms under the training program grants, totaled 44 in fiscal 1957 and will be approximately 115 this year. Expansion of this training program will be slow because of the acute shortage of qualified teaching personnel. Our hope for coping effectively with the many and varied blinding diseases and hearing disorders is tied, to a very large extent, to a successful training program which will meet the existing dearth of teachers and investigators in the shortest possible time. I, therefore, urge you to continue supporting the research and training facilities in the blinding diseases and in the hearing disorders, because this is an area that is extremely short at the present time. Mr. FoGARTY. Thank you, Doctor.

BUDGET RECOMMENDATIONS

Dr. Merritt, do you want to speak about the budget?

Dr. MERRITT. Yes, Mr. Fogarty, if I may. Our committee proposes a budget of $29,750,000; and I would like to put that breakdown in the record.

Mr. FoGARTY. Without objection, it will be placed in the record at this point.

(The above-mentioned document follows:)

NATIONAL COMMITTEE's BUDGET PROPOSALS, FISCAL YEAR 1959

Every year since 1953, the National Committee for Research in Neurological Disorders has proposed a citizens’ budget for the National Institute of Neurological Diseases and Blindness. These budget proposals of the national committee are presented only after careful studies and surveys have been made of the Institute’s actual needs. A review of the committee's annual proposals since 1953, demonstrates that they closely paralleled the Institute's capacity for productive growth.

PROPOSED. 1959 BUDGET, $29,750,000

The total Institute budget proposed by the committee for the fiscal year 1959 is $29,750,000, an increase over the Institute's fiscal year 1958 budget of $8,363,000. A breakdown of the committee's 1959 proposals as compared to the Institute’s current budget is contained in appendix I.

I. Research, $17,000,000 1. Research projects, $12 million.—The committee proposes an allocation of $12 million or an increase of $4,250,000 over the current figure for research projects.1 This increase is based on the committee's estimates of : (1) Anticipated backlog of over $2 million in unpaid but approved grants; (2) the rising cost of research ; and (3) providing for normal growth in productivity, which will require additional financing for new research projects.

* This increase is predicated on the current rate of 15 percent for indirect costs (oyeread ). -

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