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Senator YARBOROUGH. Understand, I am not asking you to endorse it, now. You have not had time to send it through the proper channels. But I wondered if you had any comments at this time on this linking up of remote hospitals with medical centers.

Dr. Wells. There is no question but what the state of the art has gotten to the point where we can now talk in terms of real linkage between hospitals and centers. This has been really rather minimal until quite recent times. Commercial equipment for closed-circuit television has only just now, almost in recent months, become good enough to talk in terms of distant linkage.

We have some 25 or 30 hospitals that have small within-hospital chains for educational use. We are now establishing outside of the hospital linkage, for instance, in New Orleans with the State univeristy, and with Tulane University and our hospital for teaching purposes.

A similar type of arrangment is being installed now at the new hospital in Atlanta in connection with Emory University, and we have many other places where experimentation is going on. Much of this is still in the pilot-project stage.

We have some rather interesting and quite effective radio intercommunication in the upstate New York hospitals. This has worked very well. There is really no reason why this could not be extended considerably in the peripheral hospitals. It is not an inexpensive venture, Senator, and this is one of the things that has restrained us.

Senator YARBOROUGH. Yes, I realize that this costs money, but we are talking about making good medical care available in remote

Unfortunately, there has been too much lag in America on the quality of medical care available out in remote areas which might encompass a number of States.

That brings up the expense of it, the questions that Senator Fannin previously asked. I believe, Dr. Engle, that you testified that the new VA budget was increased by $50-odd million-how much was that?

Dr. ENGLE. $59.1 million.

Senator YARBOROUGH. Was that for hospitals; $59 million more for staffing hospitals?

Dr. ENGLE. That is for medicine and surgery. It would provide over 3,000 additional staff.

Senator YARBOROUGH. Did the Bureau of the Budget give the VA all the money it asked for in that respect, or did the Bureau of the Budget cut back what the VA requested as needed for adequate care of the veterans?

Dr. ENGLE. I was not here at the time, Mr. Chairman. I do not know what the original request was. I can say this is the most significant increase for many years.

Senator YARBOROUGH. We have had problems with a number of departments coming up here with money wholly inadequate to render proper service. We have found that the Bureau of the Budget arbitrarily told them to cut it back.

But this, you say, is the most significant increase in a number of years?

Dr. ENGLE. Yes, sir.
Senator YARBORUGH. Are there any further questions?
Senator FANNIN. I have none.
Senator YARBOROUGH. Does the staff have any suggestions?

Thank you very much. We would like you to send us a communication if you have any further comments on H.R. 1163. I would like to have your comments, if any, on that.

Dr. ENGLE. Yes, Mr. Chairman.

Senator YARBOROUGH. Our next witness is Mr. Dixon Christian, colegislative director, Paralyzed Veterans of America.



Mr. CHRISTIAN. Thank you, Mr. Chairman.

Senator YARBOROUGH. Before you proceed, Mr. Christian, we have one other witness after you and I think-I understand that people out in the halls are interested in this question. As soon as we finish with the present witnesses, if some of you other witnesses wish to testify, we shall be glad to hear you. I have canceled my luncheon engagement and will stay here to hear all of these witnesses.

Also, if you other gentlemen wish to testify, I shall stay for that testimony.

Mr. CHRISTIAN. Mr. Chairman, I am here, really, as an assistant to Mr. Harry Schweikert, who is executive secretary of the Paralyzed Veterans of America. He asked me to come here and testify for him.

Mr. Chairman, members of the committee, the Paralyzed Veterans of America is composed of veterans afflicted with spinal cord injuries and diseases resulting in total paralysis from the point of injury down. It was created in 1946 for the specific purpose of improving liring conditions for its members and other persons afflicted with similar disabilities. Among our primary programs are (1) education of the public in the prevention of spinal cord injury; (2) improved methods of treatment; care and training, and (3) increased research in spinal cord regeneration. Because our immediate interest here is centered in the latter, I would like to speak first on the bill H.R. 203.

Through the years there have been many educated guesses at the number of persons in the United States afflicted with spinal cord injury. Until recently, however, no private agency or Federal department had substantiated these figures. Recently the National Paraplegia Foundation, supported by a grant from the Office of Vocational Administration and the PVA, concluded a three-State pilot program in this area.

Based on the results of this study, projected figures indicated that about 5 our of every 10,000 adults in the United States suffer from paraplegia or quadriplegia. Using current population figures, this puts their number at approximately 63,000. Estimates of the number of children suffering from spinal cord injuries are even more difficult. The study's findings suggest that the total number of children (18 years and younger) affected amounts to two-thirds of the adult paraplegic population, or 52,210. Allowing for a 20-percent margin of error would place the total range of all persons affected between $4,000 and 126,000.

The incidence of such catastrophic injuries as paraplegia and quadriplegia will, logically, increase greatly in the immediate future because of increased armed conflict, worsening automobile traffic, everpresent industrial accidents, and a new, totally mobile society resulting from increased earnings and more leisure time. Due to quicker and better medical care and the miracle of antibiotics, life expectancy for these severely injured has risen steadily (now almost normal), so that the cumulative paraplegic population, is expanding more rapidly than the rate of incidence.

Few persons afflicted with spinal cord or cervical injury are able to underwrite the costs of their own medical care and rehabilitation. Average hospital costs run $60 per day, or almost $22,000 per year. And these costs are rising. One American insurance company anticipates the loss of $400,000 on a single quadriplegic who remains hospitalized. The loss to the Nation's economy is proportionately prodigious. Because of the lack of accurate statistics, costs are hard to estimate, but if we assume that half of the total number of present adult paraplegics is employed (a generous assumption) and averaging $100 per week, the economic loss in earning power to the Nation as a result of the remainder being unemployed, exceeds one-half billion dollars per year.

These are statistical and economic facts. There are human factors also. An injury to the spinal cord does more than deprive one of motor control; it causes internal paralysis from the point of injury down, affecting the physiological functions of bowel, bladder, and reproduction; it slows blood circulation, causing injuries to be slow healing and more susceptible to infection; it keeps the victim always in the shadow of the hospital, severely limiting his mobility, committing him to the use of a wheelchair for the rest of his life. It also exposes him to the ignorance and prejudice of his fellow man, who cannot grasp the fact that his mental ability and efficiency have not been impaired. It inhibits family relationships and development. It adds greatly to the cost of living because of the special care, special equipment, and special or private transportation required.

There is a legend that, by mere concentration of its energies, inventiveness and wealth, America can solve any problem, cure any ill, reach any goal. In the field of medicine this has been well proven. There is little to fear from plague or epidemic; tuberculosis and polio have been virtually wiped out; heart disease, cancer, and strokes will certainly be next. In our search for health through support of research on the great killers and cripplers of mankind, we have, however, overlooked one long-suffering segment of our disabled population, and one field of promising research has been relatively ignored. That segment is paraplegia; the field is that of spinal cord regeneration.

There has always been some interest in disorders of the spinal cord. Plutarch noted the symptoms and gave paraplegia its name. The earliest reference to regeneration, at least in peripheral nerves, occurred in 1893. There were periodical reports in 1896, 1901, and 1902. Interest was rejuvenated during the First World War, and many textbooks describing the paraplegic man still quote Head and Riddock, who attempted to do something about spinal cord injuries in 1918. The earliest successful animal experiments seem to have been those done by Hooker and Nicholas in 1930 on rat embryos.

In the aftermath of World War 2, with increased experience in the handling of spinal cord cases, and with progressive discoveries in the field of wonder drugs, many more names cropped up, each with a little to offer. And still there was no continuous program of research, no massive endeavor by science, society, or the Government. ever to obtain any progress in the development of our knowledge on spinal cord regeneration, it can only be done through the interest and investment of the Federal Government. No smaller organization can support the research which is necessary, and, in the final analysis, the Federal Government, after the individual, has the most to gain. No matter how great the cost of a cure, it surely will be less in the long run than that of care.

Mr. Chairman, the members of the Paralyzed Veterans of America would be among those benefiting from such research. But they have not sat idly by waiting for such a miracle. In 1948 they created the National Paraplegia Foundation as an independent agency to foster and promote programs of research in spinal cord regeneration. PVA has given freely of its talent and strength to support this organization, contributing approximately half a million dollars to promote its programs. In the last 3 years alone its monetary contributions to research have amounted to more than $50,000, to say nothing of the time and effort which has gone into the pursuit of increased research in this field by the officers and members of the PVA and NPF. But this does not even nibble at the edges of what is needed.

Currently before your subcommittee is H.R. 203, which would direct that the Veterans' Administration set aside $100,000 per year for research into spinal cord injuries and diseases. An objection to the bill has been registered by the Veterans' Administration on the basis that it would "fragmentize” research. The VA has, of its own accord, already fragmentized their research program by classifying it under headings such as “tuberculosis," "cancer," "arteriosclerosis," "multiple sclerosis” and so forth. Why not "spinal cord injury'?

The Veterans' Administration is, in fact, investing much more than that each year in research on disorders caused by spinal cord injury or disease, but not on the source of the disorders, not on the spinal cord itself. Mr. Chairman, the original purpose of this bill was to assure that a program of research in spinal cord regeneration would be constantly maintained and $100,000 per year is a relatively small monetary investment for the Veterans' Administration, but it is a huge investment in hope for the 10,000 or more veterans afflicted with spinal cord injury and disease and for the additional 100,000 civilian children and adults who suffer the same catastrophic disability. It will help us, through example, to focus the attentions of medical researchers and the world on the serious needs of our particular group. We earnestly hope that your committee will favorably consider the passage of H.R. 203 in the context we have outlined.

Senator YARBOROUGH. This is a very, very interesting statement. There was a great amount of information in this.

Of course, you have heard the Veterans' Administration contentions in the past. They say that they are devoting much more money to research and spinal cord injury than is requested here. They also say that fragmentation of this research retards their overall efforts.

Mr. CHRISTIAN. Yes, sir, Mr. Chairman. In that, I think one point would be that we are interested in having research done on the basic problem of nervous regeneration. This has been neglected. I think the problems created by paraplegia are so great that they have captured a great amount of the interest of the medical profession in this area. They have problems in urology and that sort of thing, the complications that grow out of being a paraplegic or a quadriplegic. As I said in this statement, our life expectancy has been greatly increased by the research done in these areas. But we feel that, sooner or later, there will have to be a point where we do research on spinal cord injury, research on the basic problem. There has been work done in this area, but this is where we feel in the future the major emphasis has to be if we are to eliminate the problem other than just deal with the symptoms of it.

Senator YARBOROUGH. Is any research being done in this field to any appreciable extent outside of the Veterans' Administration now, through any foundations or medical schools or research institutes carrying on research?

Mr. SCHWEIKERT. There is very little, Senator. We did have a continuing program under the University of Indiana, which was conducting programs. But their research-I think their grants from the Harvard fund have been discontinued this year,

But in the United States, there has been very little done on spinal cord regeneration. I think our country has been surpassed by research in Canada and other countries such as Japan.

Senator YARBOROUGH. Where were the grants to Indiana University from, the National Institutes of Health?

Mr. ScHWEIKERT. No, it was from a source called the Harvard fund.

Senator YARBOROUGH. A private fund?
Mr. SCHWEIKERT. Yes, sir.
Senator YARBOROUGH. Are there any questions?

Mr. CHRISTIAN. I might say further that we recognize that the VA, of course, as we say in the statement, had spent money in this area. But we feel that it would be a great help to us in focusing attention on the problem to have it set aside as a specific area of research in the VA program, I think that your first witness said that if this were the intent of the program, then perhaps it would have merit in that area.

Senator YARBOROUGH. What comment do you gentlemen have on the VA's testimony as given here by Dr. Engle, when he estimated that approximately $200,000 will be expended in fiscal year 1965 for research directly related to spinal cord injury and disease?

Their contention is that they are already spending more than this bill would require. What comments do you have?

Mr. SCHWEIKERT. Senator, the moneys--we admit in our statement that there is a great amount of money being expended by the Veterans' Administration on some of the disorders of spinal cord injury. But these disorders are not directly the cause of spinal cord injury. There is quite a sum, I think, being spent on research in urological disorders, which not only stem from spinal cord injury and disease, but from other reasons and sources as well. This is one of the areas in which a lot of money is being spent, in the urological area. This is, of course, our greatest illness. Our greatest illness and mortality is from the urological area. This is just one example.

Senator YARBOROUGH. From cumulative problems.

Mr. CHRISTIAN. Kidney disease and stones and other things. These have been the great killers in the past. As I have said, the research that has been done in the past and advances that have been made in medicine that has developed have assisted in this. This is one of the areas and there are other areas VA is doing research in.

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