limbs happened, I feel certain we could have advanced this extremely important piece of work much, much faster.

Now let us look at the other extreme, those other parts of the world involving millions of people where no artificial limbs of any type are available. The need for research here, research which is tailored to the specific problems and needs of the individual country, is one of the great needs in world rehabilitation today. First we must bear in mind that, in many places in the world today, the highly developed artificial limbs which we use in the United States would be of little or no value. On a country-by-country basis, we need to study the question of what type of artificial limb is best suited, to the rice paddy of the Orient, the deserts and hills of the Middle East, and the extreme cold of nations in northern climates.

For example, it has been estimated that there are 5,000 amputees each year in Burma, many of them resulting from tropical or infectious diseases. Well planned and conducted studies need ot be made to determine on a practical basis the type of prostheses needed by amputees in Burma, where heat, humidity, and rural conditions combine to make many of our modern prostheses impractical for their local use.

I should mention that Burma has had one of the most heartening expansions of rehabilitation of any country in the Far East. A number of experts from this country and elsewhere have been invited to Burma to help them plan, staff and initially operate their new facilities and services. Mr. Kurt Jansson, Chief of the Rehabilitation Unit, United Nations; Mr. William Tosberg, Technical Director of the Prosthetics Service, Institute of Physical Medicine and Rehabilitation, New York University-Bellevue Medical Center; and other professional and technical experts have gone to Burma to help. Dr. Howard A. Rusk has visited Burma several times, the most recent visit being in November 1958.

As a result, Burma now has two excellent rehabilitation centers, the Thamaing Center and the Mingaladon Center. The facilities and services now are largely staffed by Burmese who have had excellent rehabilitation training in the United States, and the Office of Vocational Rehabilitation had the privilege of aiding in planning the programs for several of them.

Here is another illustration of a situation in which both the need and the opportunity for rehabilitation research and research training are present in full measure.

Blindness and other visual disabilities

Although blindness is one of the most prevalent of the severe disabilities of the world, no more than token efforts are being made at present to develop rehabilitation research in those countries most seriously affected. Here is a field in which all the armamentarium of present-day science-in prevention, in treatment, in rehabilitation, and in broad research-should be at work to control one of the oldest afflictions of mankind.

Although blindness is a disability common to all countries, certain nations in the Orient and Middle East have historically been the principal victims. The prevalence of trachoma, glaucoma, and other diseases of the eye still produce thousands of blind persons for countries such as India. In Ceylon, there are an estimated 6,000 blind persons in a population of less than 9 million.

Many effective procedures in the rehabilitation of blind persons have been developed in this country. Unfortunately, we do not know whether, or to what extent, these might be sucessfully applied in other countries, where differences in environment, employment, education, etc., raise important problems peculiar to the individual country.

Experiments should be conducted in establishing optical aids clinics, on the pattern now used in a number of communities in this country. Through the use of modern optical lenses, many persons with such extremely low vision that they are blind for all practical purposes now are able to read newspapers and perform other activities, including success in holding jobs. A sizable inroad on the problem of blindness in the world could be made if we were able to establish experimental pilot projects in adapting our optical aids clinics, along with related rehabilitation services, to the specific eye conditions and associated problems of those in other countries of the world.

Disability, employment, and social insurance systems

The progress made in the United States in bringing the handicapped into productive employment, much of it due to the fine work of the President's Committee on Employment of the Physically Handicapped, has been matched by

only a handful of other countries, notably in England, Canada, and the Scandinavian countries. Elsewhere, the handicapped are largel considered to be outside the labor force.

How much of American experience can be translated to other countries needs to be studied and tested. And, at the same time, we should be examining other countries for ideas which might be profitably adapted to our own hiring methods.

In many places, this situation is strongly affected by the social insurance systems in effect. An extremely valuable project, valuable to us as well as to the rest of the world, could and should be carried out to provide a comparative study of the statutory requirements on hiring handicapped workers in Great Britain, in contrast to the system in Italy.

INTERNATIONAL ORGANIZATIONS IN REHABILITATION

Substantial assistance in developing an active research program in rehabilitation already is available through a variety of international organizations. The United Nations itself, as well as its specialized agencies, already has shown its familiarity with rehabilitation needs and services and provides a basic framework from which our international research work can flow effectively. The World Health Organization, the Pan American Sanitary Bureau, the International Labor Organization, the United Nations International Children's Emergency Fund-all these represent experienced international organizations which, in their official capacity, already have given their attention to the problems of disability and rehabilitation in one way or another.

Excellent voluntary and professional organizations exist today which are primarily concerned with international rehabilitation activities. In August of 1960, the United States will be host to the Eighth World Congress of the International Society for the Welfare of Cripples, a well-established organization with affiliates in 36 countries, and with which the Office of Vocational Rehabilitation already is cooperating in a number of activities. The American Foundation for the Overseas Blind is one of the most respected and effective of our international organizations and has had wide influence in developing better programs for the blind throughout the world. The World Veterans Federation, incorporating the efforts of many nations on behalf of disabled veterans, has been and is an experienced and influential international agency with which we have cooperated for several years.

The World Rehabilitation Fund, under the guidance of Dr. Howard A. Rusk and his associates in many places, has become, in a relatively short period of time, an extremely active and helpful organization in pushing forward with rehabilitation projects and plans for other countries.

The International Congress of Physical Medicine which will hold its third congress here in Washington in August 1960, the World Federation of Occupational Therapy which met in Copenhagen last August, the World Confederation for Physical Therapy which will convene in Paris in September 1959-these and other organizations which already cooperate actively with this Office in international activities are thoroughly prepared to give outstanding aid in the conduct of this proposed new research program in rehabilitation.

TRAINING AND EXCHANGE OF RESEARCH PERSONNEL IN REHABILITATION

This legislation would encourage and support the training of personnel for rehabilitation research and would provide for the interchange of scientists, research workers, research fellows, technicians, experts, and teachers in rehabilitation and research specialists. This provision of the bill deals with one of the fundamental needs in rehabilitation research, for it is only through the exchange of professional and technical people, and the exchange of professional data, that we may insure that the results of the collaborative work of nations in restoring the handicapped will be fully capitalized upon. I would hope that the bill would permit a "triangular" exchange of researchers-with American personnel going to foreign countries, with scientists from other countries coming to our research institutions, and with provisions for foreign scientists for one nation to study and lecture in the research facilities of other foreign nations. The relatively small exchange of such personnel so far has only served to emphasize how important it is to expand this kind of activity, if we are to fully capitalize upon the research talent of all rehabilitation personnel in nations here and abroad. For example, our work during the last 2 years to help bring

to full development the so-called Heidelberg arm has encountered many complications because of the lack of free consultation back and forth between prosthetics researchers in this country and the engineers, physicians, and others who were at work on this device in Germany.

Along the same line, we were concerned a year or so ago with the cooperative effort of a small group of scientists in Canada, England, Holland, and the United States in trying to advance investigations into communication systems for the deaf-blind certainly one of the most difficult and challenging fields which is presented to us in rehabilitation today. To move into this problem with vigor and determination, we should be in a position to have ready exchange of plans, programs, and results between the countries involved, and to bring into this common effort scientists from other countries who have contributed so much. This interchange of research personnel often is the really decisive factor in determining whether we make a breakthrough in a difficult research problem, or whether we wait for years to achieve results.

OTHER PROPOSED ACTIVITIES

Certainly the proposal to establish an international clearinghouse on research would be of inestimable value in rehabilitation. Factors like the great geographical spread of the participating countries, the differences in languages, the variety of rehabilitation activities and the different governmental systems involved all these make establishment of such an international clearinghouse essential to the full success of an international research program.

We welcome the related provisions for disseminating the results of research activities and for reporting on new knowledge and techniques developed. It is extremely important to have adequate provisions for necessary translations, publication, and distribution of findings of projects and for the development of other informational, technical, educational, and training materials to fully exploit the work done through this proposed new international program.

The Office of Vocational Rehabilitation has recognized this necessity as it pertains to the medical phases of rehabilitation. About a year and a half ago, we entered into negotiations with the international professional journal Excerpta Medica which provides digests or excerpts of principal medical papers in a variety of specialties. As a result, Excerpta Medica now publishes a special issue devoted to the medical aspects of rehabilitation, bringing to medical practitioners in most parts of the world the essence of recent medical publications on the rehabilitation of the disabled.

I should mention to the committee that the International Society for the Welfare of Cripples already has done a pioneering job in translation, even though its work so far necessarily has been on a very small scale because of the limited funds which they have had available. Rehabilitation workers in many countries already have expressed their deep appreciation for this work by the international society. I am convinced that the provisions of the resolution now before this committee, if enacted, would make it possible to build upon this small but important pioneering effort by the international society, so that rehabilitation literature coming out of this international research program could be freed of language barriers and be made widely and promptly available to rehabilitation workers everywhere.

THE OFFICE OF VOCATIONAL REHABILITATION

Bearing in mind the considerable responsibilities which would be involved for the Office of Vocational Rehabilitation under Senate Joint Resolution 41, I feel an obligation to describe rather briefly the international activities now being conducted by this Office and the background against which such an international research effort in rehabilitation would be undertaken.

Since 1947, the international program of this Office has cooperated with agencies administering U.S. programs of economic and technical assistance to foreign countries. Our activities have included the introduction and demonstration of rehabilitation methods and techniques for foreign countries; assistance in recruiting qualified experts for projects and for consultation; carrying forward the exchange-of-persons training programs; help in developing U.S. policy position in fields related to this Office; providing specialists to survey national rehabilitation needs and plan programs and services in vari

ous countries, through cooperation with the State Department and the United Nations and its specialized agencies.

Recruitment

For the past several years this Office has been the focal point for recruitment of specialists and various experts in rehabilitation for assignment to the governments of other nations to direct new projects or to serve as expert consultants in planning governmental programs in rehabilitation. These specialists have come from a wide range of American governmental, private, and voluntary sources; it is especially interesting that we have recruited a number of State vocational rehabilitation agency officials to serve in these international commitments. In 1948 we recruited the State director of the vocational rehabilitation program in West Virginia for an extended tour with the Government of Brazil, to study their needs in detail and to advise on a sound approach to developing a more effective and adequate program of rehabilitation services. Other countries for which we have recruited experts in rehabilitation have included Mexico, El Salvador, Peru, Brazil, and the Dominician Republic. This phase of our activities, along with the training programs for other nationals (mentioned below) and certain related activities, are carried out through arrangements with the International Cooperation Administration. Training of other nationals

Perhaps the most colorful of the various phases of our international rehabilitation work has concerned the training of other nationals. During the last 10 years, we have arranged training for more than 800 people from more than 60 countries. They have come to us from practically every portion of the globefrom numerous countries behind the Iron Curtain such as Russia, Poland, and others; from Burma, Thailand, and elsewhere in southeast Asia; from a great majority of the Latin American countries; and from practically every country in free Europe.

Training plans developed during the first half of fiscal year 1959 included long-term training and observation in vocational rehabilitation for 28 persons from 9 countries, plus short-term observation experience for 40 persons from 19 countries.

Other international activities

In 1950, an international program for rehabilitation was prepared and subsequently adopted at the seventh session of the Social Commission of the United Nations. This international program provided a blueprint for use by any nation interested in developing, expanding, or improving its rehabilitation services. Later there was prepared by this office (former Assistant Director Dabelstein) a policy statement for use by the rehabilitation member of the United States delegation to the International Labor Conference in 1954-55. Report IV (2), page 66, contains the "proposed recommendation concerning vocational rehabilitation of the disabled," developed and later adopted by the International Labor Conference, 38th session, 1955. Adoption of this recommendation reflected the mounting interest among the member nations in resolving some of their conceptional differences on how rehabilitation programs should be constituted to serve disabled working men, and was an important step forward in securing a more universal view of rehabilitation as a dynamic and comprehensive program of services to deal with disabling conditions.

A United Nations working paper dated May 2, 1958, lists current rehabilitation projects in 23 countries, with projects anticipated in 17 others.

The substantial number of projects under United Nations sponsorship has been a direct result of the work of this office with the United Nations and with the International Society for the Welfare of Cripples, through which the number of rehabilitation projects has expanded.

We have had a special interest in a project in Mexico because it is the only project sponsored so far by ICA (except for consultation in rehabilitation to El Salvador and Peru) and also because we recruited the Director of Vocational Rehabilitation in the District of Columbia to head this project. The results achieved in the project in Mexico are both stimulating and revealing, for they provide an excellent idea of how much can be accomplished with projects which are properly conceived, adequately staffed and followed through.

STATEMENT OF MRS. KATHERINE B. OETTINGER, CHIEF OF THE CHILDREN'S BUREAU, SOCIAL SECURITY ADMINISTRATION, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

The CHAIRMAN. Mrs. Oettinger, we will be glad to hear from you at this point.

Mrs. OETTINGER. Thank you, Senator Hill and members of the committee.

I am happy to have the privilege of appearing before you today to help present the department's views on Senate Joint Resolution 41, a bill designed to establish the machinery for maximum mobilization of the health research resources of the United States, and for cooperation in a program of international health research.

The Children's Bureau on the basis of its 47 years of serving mothers and children in this country and of participating in our Government's international activities in behalf of children firmly believes that a worldwide international health research program would indeed prove to be an avenue to future peace in the world.

I will confine my remarks to some of the potentialities this bill promises for better health for mothers and children. People everywhere are united by their concern for the needs of mothers and children.

Under the basic act creating it in 1912, the Children's Bureau is charged with investigating and reporting on all matters pertaining to children and childlife, including specifically such health matters as infant mortality and accidents and diseases of children.

Since the enactment of the Social Security Act in 1935, the Bureau has also been responsible for the administration of two related grantin-aid programs in the health field.

Under part 1 of title V of this act, the Bureau administers grants to States for maternal and child health services for promoting the health of mothers and children.

Under part 2 of title V, the Bureau administers grants for crippled children's services. These are services for locating crippled children, for providing medical, surgical, corrective, and other services and care, for facilities for diagnosis, hospitalization, and aftercare, for children who are crippled or suffering from conditions which lead to crippling. For the past 12 years, the Chiefs of the Children's Bureau have benefited from the close association with the activities of UNICEF through serving as the U.S. representative on its executive board.

Another important part of the Bureau's international activities lies in planning the professional training in this country for persons from all parts of the world. This includes training in the various specialties involved in the broad field of maternal and child health, such as pediatrics, obstetrics, orthopedics, nutrition, medical social work, and nursing.

Trainees come primarily from ICA, but some are also sent to the Bureau by the World Health Organization, and a few come from other sources, including private organizations. During the past 6 years, the Bureau has planned long-term training for some 300 persons about two-thirds of whom were physicians.

Because of these various activities, the Children's Bureau is keenly aware not only of the many unsolved health problems affecting mothers