What are the most pressing needs and the most promising means for securing this saving?

1. Research through grants-in-aid: The greatly improved outlook for epileptics now, as compared with only a dozen years ago, is the result, in large part, of a few hundred thousand dollars spent in research. The research money at present available annually, would not supply medicine for each epileptic for more than 5 days.

Epilepsy is different in this respect from other conditions. If a person has an impaired heart or kidneys, he is out and that is the end of it. If a person's brain goes haywire, he may cause immense destruction. Take for example our friend Mr. Hitler.

Anything we can learn about the fundamental workings of the human brain and what makes it behave wrongly is applicable not only to epilepsy but to the much greater problem of these millions. of mentally defective or abnormally behaving individuals who take up half the beds of our hospitals or, when in society, cause all sorts of damage, so I speak not just for this group of epileptics, but for persons with all sorts of nervous and mental diseases.

2. Clinics for the early diagnosis and treatment of patients, and for the training of doctors and social workers.

3. Schools (combining treatment and education) for children of adequate intelligence not able to attend public schools.

4. Agencies for the education of the public (this public to include doctors, employers, and possibly even some legislators) to the end that epileptics (and other handicapped persons) would be able to secure education and suitable jobs.

I speak then for burdened epileptics and their families and for burdened taxpayers in urging direct Federal aid, and undiluted by excessive administrative overhead, for persons subject to seizures. Senator MURRAY. Do you have any questions, Senator? Senator NEELY. Not at this time.

Senator MURRAY. Doctor, I certainly am in sympathy with the program that you are suggesting here, and I think that we ought to have some such program set up here in Washington to conduct research of that character.

We have also pending before us a bill, S. 1651, introduced by Senator Magnuson, and there is also a title in another bill which we have pending here, S. 1679, which also contains a program of research.

This bill 1659, and the one in 1759, provides for a program set up in the Health Department which would carry on research over a number of subjects in addition to this one about epilepsy.

We had before us yesterday Dr. Scheele of the Public Health Service who is advocating that we should not set up separate individual research bureaus, but should have them all in one department because the experts, the personnel that would be employed, could be used over various of these problems.

What do you think of that?

Dr. LENNOX. That is a logical idea. My only reservation is that epilepsy should not be squeezed out by being given a definite allotment. Of course, so much depends on public opinion and pressure.

Now it is all for polio, cancer, and heart disease, all of them important, but all of those things are obvious. Epilepsy is not obvious. It has been neglected. It needs a place in the sun.

Senator MURRAY. Well, I agree with you on that. I know of one or two cases of that kind that I have come across in my life, and I realize how important it is.

Referring to this program that I have just mentioned, of course it intends to regard epilepsy as one of the important diseases that should be given careful consideration. For instance, in the Magnuson bill, and also in the other bill, the omnibus S. 1679, it expressly names the different diseases that are to be given study under the research program. It mentions, for instance, rheumatism and arthritis, multiple sclerosis, cerebral palsy and epilepsy and other diseases, so that epilepsy would be recognized as one of the very important diseases that requires research of this kind.

Dr. LENNOX. The United States Public Health Service has, under the National Mental Health Act, I think some $700,000 set aside for research in mental disease. Epilepsy is about a tenth of the total burden of people in public institutions, and yet they have allotted only about $30,000 of that amount for research in epilepsy.

Now it may be our fault that we have not come down and hammered on somebody's table, but that is a great difficulty.

I wish there could be some provision in such an omnibus bill saying that there should be some proportion of the amount spent in proportion to the persons involved. That would make me a good deal happier.

Senator MURRAY. Well, I certainly am in sympathy with it. Is there any place at the present time in the country where research of this character is being carried on with reference to epilepsy?

Dr. LENNOX. Yes; there are a number of places. They are all supported by chance gifts. Our own efforts, for example, have had the support of the Rockefeller Foundation for the last 14 years. Otherwise we would have gotten nowhere at all, but now that grant is running out and other grants from other organizations usually are for only 1, 2, or at the most 3 years.

We need a long-term plan of research and funds that can be counted on and not have to go and hold out our hat and beg from some individual or some private endowment.

Senator MURRAY. I agree with you, Doctor, and am certainly glad to have had your testimony here.

Senator NEELY. Doctor, is there any publicly supported institution in the country that specializes exclusively in these diseases of which you have been speaking?

Dr. LENNOX. No, there is not, sir. There are State hospitals, State epileptic colonies, and they are very useful for catching the driftwood, people that cannot be maintained in the community, but that is all they are at present.

There is no place such as they have in Europe where you can take a person who is mentally normal and just starting to have seizures, say, where he can go for complete check-up and stay for treatment if necessary, where they have education of children, training of young people for some job which is commensurate with their illness and their abilities.

I did not say anything about how such money might be spent if available. I think that is appropriate. I would think if there were $3,000,000 annually available, I would say $500,000 for research; I would say $1,000,000 for the establishment of pilot clinics around the

country, perhaps 50 to 100; those clinics to be well manned and used as diagnostic centers where people could send patients in for diagnosis and advice about treatment, and where workers could come for training doctors, electroencephalographers, school teachers, and what not. Those would not fill the total bill, but they would act as pilot plants, and State authorities or others could establish treatment clinics which would take care of the ordinary case and not attempt to do research and so on.

Then there should be another $1,000,000 which would be used for a few, perhaps only 10 or 12 throughout the country, combination schools and sanitarium or hospital, where these young people who are just starting to get this condition-and this is predominantly a disease of young people-could go for several months and get adequate training and at the same time education and so on. There is no such

place in the country.

Senator NEELY. Doctor, is there any treatment of epilepsy, which is generally approved by the medical profession, that is applicable to the average case, or does the treatment have to be designed for each particular person in accordance with the peculiarities of his affliction?

Dr. LENNOX. Each one is different. That is why it takes men who are skilled, who have had experience to sort out the causes in each case, to remedy them if possible. If not, then to pick the most appropriate medicine for that type of case, that type of seizure.

Now as a result of experiment in the last dozen years, we have five or six drugs that are quite effective so that we believe that at least three-fourths of the patients can be relieved of at least threefourths of their seizures.

Senator NEELY. Does the present treatment consist principally of the administration of drugs, medicines, or of strict diet or physical exercise, education, or what? What is the principal feature of your present treatment?

Dr. LENNOX. As far as the medical condition is concern ed, for perhaps 90 percent of the patients it is medical, proper medicine. For a small proportion, less than 10 percent, surgery may be involved. For example, these men who had gunshot wounds in the head in the war may have to have a part of the brain excised. Determining just what is the cause in each individual case requires a pretty careful study of the individual, but after you establish that they can be given medicine and can carry on for years and years under moderate medical supervision.

Senator NEELY. In the cases which originate in the brain, is it confined to some particular portion of the brain as a rule, or may the seizure originate in any part of the brain?

Dr. LENNOX. It may originate in any part. It depends on the type of seizure that you have.

They all originate in the brain. They are all due to disburbance in the electrical activity in the brain, and one of these charts shows the type of brain-wave rhythm you encounter.

That is the advantage of this modern treatment. With this brain wave machine we can tell a great deal about the patient, what kind of attacks he is having, how serious the outlook is and whether there is a localized condition that might mean surgery or might mean that he had some damage which perhaps could not be treated by surgery but would have to be treated by medicine.

I have emphasized throughout this the social treatment too, because even though you get a person free of attacks and he goes to enlist in the Army, supposing he had an attack 5 or 10 years ago, he is not taken, or if he goes to an employer and says ""I had an attack 2 or 3 years ago, but I am O. K. now," they say "We cannot use you. You may have a fit and then we would be liable for increased compensation."

Senator NEELY. Does electricity or X-ray have any therapeutic value?

but

Dr. LENNOX. No; not therapeutic, just diagnostic. Senator MURRAY. How is the problem handled in Europe? Dr. LENNOX. We are far ahead of them in regard to research, as for the care of patients, they are ahead of us because they do have these school hospital combinations for taking care of moderately affected people whom you expect to be able to salvage.

In our country that is the ideal of our epileptic State colonies, but it never is reached because there is such a clamor for beds for patients who are just hopeless patients whom you cannot expect to do anything for. The average turn-over in such institutions is 10 years.

As I indicated here, the turn-over is becoming less and less because these poor hopeless babies that come in are given all these prophylactic injections so they cannot get any illness that would carry them off and make way for someone else.

Senator NEELY. What European country has most advanced methods?

Dr. LENNOX. Scandinavia, a place called Philadelphia being an excellent place.

Senator MURRAY. They have no elaborate research centers?

Dr. LENNOX. No; we are far ahead of them in any research work. Senator NEELY. Dr. Lennox, could you state for the record whether you know of any confirmed epileptics who have had their disease sufficiently treated to enable them to work in factories or hold places in any sort of industrial organization successfully?

Dr. LENNOX. Yes, Senator. The problem in placement is that of job placement.

Obviously an epileptic, even though he has been free of seizures for perhaps some years, should not pilot an airplane, should not run machinery where the machinery, himself, or others might be injured.

However, those categories of employment are a relatively small proportion of the total categories, so that the great majority of epileptics can be properly placed and employed in industry, although not perhaps with moving machinery but in some other place.

Now to answer specifically your question, as I said previously we expect at least three-fourths of our patients to be rid of at least threefourths of their seizures. A large proportion of those are entirely free, and in my own practice, which covers perhaps 6,000 or 8,000 patients, I have had literally hundreds who are now actively engaged in renumerative employment, not necessarily in the lower brackets, because we have college professors and lawyers and teachers.

I even know of several Members of Congress, State legislators who have had seizures, but are sufficiently controlled so that they can go about and do their best and are self-supporting and assets to society. Senator NEELY. In the matter of healing and rehabilitating epileptics, does outdoor work have any advantage over indoor work?

Dr. LENNOX. Not for the average patient. We have great trouble with Civil Service, for example. In some of our veterans' hospitals epileptic patients who want employment in the hospital where they would be under proper medical supervision where they could be doing work which would not endanger them or anybody else, are still screened out by the Civil Service Commission.

Senator MURRAY. Is it not true, Doctor, that epileptics have an advance feeling that they are going to have a seizure so that they would be able to protect themselves?

Dr. LENNOX. Yes; there are many conditions which modify any complete prohibition against employment. One is the warning that about half the patients have of a coming seizure. Another is that most seizures occur in bed and when the person is asleep so that the person constantly having seizures of that sort can keep it quiet and nobody will ever know it.

I gave a lecture the other day at the University of Vermont. They brought in a patient as an illustration. This woman had had seizures for 17 years, but had them always at nighttime in bed, so there was no trouble about her employment, but she could not get a room because when she had these seizures at night it would disturb the household where she was, so that was her difficulty.

Also the type of seizure makes a difference. Many patients have merely transitory black-outs, lasting 5 or 10 seconds without any convulsive movement, and this is especially true in children. They may have dozens a day, hundreds a day, and still be able to carry on.

I had one secretary who has had at least 150,000 of these mild seizures. Yet she was the best secretary I ever had. She had an intelligence quotient of 139, which I am sure is far above my own. Senator MURRAY. Well, thank you very much for your testimony, Doctor.

Paul A. Strachan, president of the American Federation of the Physically Handicapped.

STATEMENT OF PAUL A. STRACHAN, PRESIDENT, AMERICAN FEDERATION OF THE PHYSICALLY HANDICAPPED, ACCOMPANIED BY HARRY S. WENDER, GENERAL COUNSEL, AMERICAN FEDERATION OF THE PHYSICALLY HANDICAPPED, AND MILDRED SCOTT

Mr. STRACHAN. Mr. Chairman, among other disabilities, I am totally deaf. I ask permission of the committee to submit a brief statement and to speak orally for a moment on economic aspects, and if the committee wishes to direct cross-examination, our general counsel, Mr. Harry Wender, will reply.

May we do that?

Senator MURRAY. Very well.

Mr. STRACHAN. I am very anxious to raise a question as to certain. economic aspects. I believe it can be truthfully said that the organization that I represent has made a greater effort to determine facts about the handicapped than any other group in the country within the past 10 years. We have striven first to find out how many handicapped there are, and in what classifications, and what has been done. For example, I may say that I was responsible for establishment of the Kelly Committee, but unfortunately the Congress at the time did