THE CENTRAL LABOR UNION AND THE METAL TRADES COUNCIL Hon. ALFRED L. BULWINKLE, Chairman, Subcommittee on Public Health Service, House of Representatives, Washington, D. Ỡ. DEAR MAJOR BULWINKLE: You recently received a letter from the Maritime Engineers Mutual Beneficial Association (Congress of Industrial Organizations) requesting that a change be made in H. R. 3379 to codify the laws relating to Public Health Service, and for other purposes. The change suggested is deleting from line 20, page 31, the following six words: "Other than those of the Panama (Canal." The representative of the M. E. D. A. for the Canal Zone attempted to obtain this result in H. R. 4251, section 5, a copy of which I enclose, marked as follows: "SEC. 5. The term 'seaman' whenever employed in legislation or regulations relating to the Public Health Service shall be held to include marine employees of the Panama Canal." Until a consultation was held on Tuesday with Dr. E. H. Carnes, senior surgeon, together with R. T. Hollinger and G. M. Harris, of the Public Health Service, it was not known that your committee was engaged in codifying the Public Health Service laws. These gentlemen suggested that the most effective way to accomplish the result desired would be to delete the words I suggest in the second paragraph. The organization I have the honor to represent is fully in accord with such a change and a resolution to that effect was approved at the last convention of the American Federation of Labor. Under the terms of Executive order dated February 20, 1914, Panama Canal and Panama Railroad employees are given free medical treatment and hospitalization (in ward) with a charge of $1 per day for subsistence. Surgical operations and dental work is charged for at rates prescribed by the Panama Canal. The change requested deleting the words "other than those of the Panama Canal" would place the marine employees of the Panama Canal on the same basis as those covered by paragraph 3, section 322, of H. R. 3379 and would entitle them to "medical, surgical and dental and hospitalization without charge," as covered by subparagraph A of section 322. Thanking you for your consideration in this matter, I am CHARLES F. WAHL, P. S.-The Governor's recommendation through the Secretary of War contained in hearings on H. R. 156 held on January 9, 1936, is as follows: "The Governor of the Panama Canal has recommended that bill S. 2625 "To extend the facilities of the Pubic Health Service to seamen on Government vessels not in the Military or Naval Establishments,' which was passed by the Senate on May 20, 1935, and referred to your committee on May 24, be amended so as to exclude from its provisions Panama Canal employees. "The Governor's reasons for this recommendation and the method suggested by him for accomplishing the results desired are set forth in his letter which is quoted below: "In its present form the above-titled bill is applicable to employees of the Panama Canal employed on vessels and other floating equipment used in the construction, operation, and maintenance of the Canal notwithstanding the fact that the medical care and hospitalization of such employees is specially provided. for in the Executive order of February 2, 1914, as amended. "Since there is no need for the inclusion of Canal employees in the said bill in order that they may be provided with free medical and hospital care, it is recommended that endeavor be made to secure the amendment of the bill by the insertion of the words "other than those of the Panama Canal," after the word "Government" in line 7.'" Hon. ALFRED L. BULWINKLE, M. C., HOUSE OF REPRESENTATIVES, Washington, D. C., March 21, 1944. House Office Building, Washington, D. C. DEAR MR. BULWINKLE: Following my telephone conversation with you this morning I am submitting a statement by J. W. Holloway, Jr., who is the director of the bureau of legal medicine and legislation of the American Medical Association. This statement to be inserted in the hearings on H. R. 3379, a bill to codify the laws of the United States Public Health Service. I appreciate the opportunity of having this statement made a part of the hearings. Very truly yours, A. L. MILLER, M. C., Fourth District, Nebraska. OSTEOPATHS AS MEDICAL OFFICERS OF THE UNITED STATES PUBLIC HEALTH SERVICE J. W. Holloway, Jr., Director Bureau of Legal Medicine and Legislation, American Medical Association Representatives of osteopathy appeared before a subcommittee of the House 'Committee on Interstate and Foreign Commerce, March 10, in connection with the hearing scheduled on H. R. 3379, a bill to codify the laws relating to the Public Health Service and for other purposes. They appeared in support of a provision contemplating the appointment of osteopaths as officers of the United States Public Health Service. The supporting evidence offered contained in-, ferences that the facts do not justify and the purpose of this statement is to present the facts. The chairman of the department of public relations of the American Osteopathic Association testified that in a number of States osteopathic applicants are re'quired to take the same examination as graduates of medical schools and are given identical or equivalent licenses to practice. As an example of how osteopathic candidates "measure up in these examinations" he referred to a report of the New Jersey State Board of Medical Examiners, published in the April 6, 1940, issue of the Journal of the American Medical Association, on page 1402. This report related to an examination held by the New Jersey board during the month of October 1939. At this examination, there was a total of 115 medical applicants for licensure. Forty-nine of these were graduates of accredited American medical schools and only two failed to pass, a passing average of 95.9 percent. The remainder of the medical applicants was the product of foreign medical schools, 66 in number, and only 63.6 percent of these passed. Forty osteopaths took the examination and 85 percent passed. All of these osteopaths had previously been licensed to practice osteopathy in New Jersey under limited licenses, were examined only in the subjects of pharmacology, therapeutics and surgery and each had taken a special postgraduate course of 2 years to qualify them to take the examination for a license to practice medicine and surgery. To infer, therefore, that this particular examination reflected the general professional qualifications of osteopaths or offered an adequate comparison between the ability of osteopaths and doctors of medicine is to predicate a position on an unstable, misleading foundation. The chairman of the department of public relations of the American Osteopathic Association further stated, with respect to New Jersey, that the State makes its own examination of professional schools and has examined and approved osteopathic colleges as institutions possessing the training facilities and other requirements necessary to equip and qualify practitioners of the healing art in all its branches. He neglected to state that the State recognizes only two osteopathic institutions, the graduates of which may qualify for an examination to practice medicine and surgery in New Jersey, the Philadelphia College of Osteopathy, and the Los Angeles College of Osteopathy. Graduates from all other osteopathic institutions cannot qualify for such an examination, including the other four schools that are accredited by the American Osteopathic Association. The chairman of the department of public relations of the American Osteopathic Association referred in some detail to the healing arts practice act of the District of Columbia as imposing prastically the same requirements on osteopathic applicants as on medical applicants. He did not inform the subcommittee that since such requirements were imposed in 1929, only nine osteopaths have been able to obtain a license to practice osteopathy and surgery in the District, four after examination and five by reciprocity. If graduates of schools of osteopathy are equally as well qualified as graduates of accredited medical schools, why should there have been so few osteopaths able to obtain licensure in the District over a period of some 15 years? The chairman of the department of public relations of the American Osteopathic Association referred to Massachusetts as imposing equal requirements on osteopaths and doctors of medicine. In the February 24, 1944, issue of the New England Journal of Medicine, on page 242, will be found tabulated the results of the examination given by the board of registration in medicine in Massachusetts on November 19, 1943. Sixteen osteopaths took the examination; 1 passed. In 1943 amendatory legislation was enacted in Nebraska providing a means whereby osteopaths then practicing in the State under limited licenses could by taking the regular medical examination qualify for licenses to practice medicineand surgery. Since the enactment of this legislation, one regular medical examination has been held. Twenty-one osteopaths took the examination. Only 6 passed. So while it is true that in a limited number of States osteopaths have an opportunity to obtain unrestricted licenses by taking the same examination as do graduates of medical schools, the fact is that osteopaths meet with relatively little success in passing such examinations. To réfer, therefore, to the opportunity that osteopaths have been accorded in these few States without indicating the ability of such practitioners to accept that opportunity creates an erroneous impression. The difficuly that osteopaths have in qualifying for licensure when subjected to the same tests given graduates of medical schools in exemplified by a statement included in the annual report of the executive secretary of the American Osteopathic Association, covering the fiscal year 1940-41, and published in the September 1941 issue of the Journal of the American Osteopathic Association, on page 43. The statement follows: “The association of osteopathic examining boards, Dr. Lester R. Daniels, secretary, reports in addition to the above licensure statistics that 56 percent of examinations taken before composite boards were passed by osteopathic physicians, and 99.4 percent of examinations taken by osteopathic physicians before boards consisting of doctors of osteopathy were passed." This statement means that in the States in which osteopaths were required to take practically the same examination as doctors of medicine are required to take, then only 56 percent of the osteopathic applicants are successful. On the other hand, when osteopaths are examined by osteopaths and are subjected to examinations differing from those given to doctors of medicine, then only 0.6 percent fail. During 1940, of the 5,188 graduates of approved medical schools in the United States who were examined, only 5.1 percent failed. The year 1940 has been selected so as to contrast the percentage of failures of graduates of approved medical schools with the percentage of failures of graduates of osteopathic schools who were examined by medical boards or by composite boards. In a number of States basic science laws have been enacted which undertake to impose on all applicants for licenses to practice the healing art in any form a requirement that they be proficient in certain basic sciences, such as anatomy,. physiology, chemistry, bacteriology, and pathology. These examinations are conducted, in the main, by nonsectarian examining boards. From 1927 to 1940, inclusive, 742 osteopaths undertook to pass basic science examinations, and only 59 percent were successful. During the same period 11,814 students or graduates of medical schools attempted to pass such examinations, and 88 percent succeeded. If osteopaths were as equally schooled in the sciences that are basic to every form. of healing, as are doctors of medicine, then it seems obvious that the former should have no more difficulty in passing the basic science examinations than the latter. The Surgeon General of the Navy, Vice Admiral McIntire, recently testified before the House Committee on Appropriations in the hearing conducted on the Navy Department appropriation bill for 1944 that osteopaths do not at the present time "meet the requirements of medical officers in time of war." After calling attention in a prepared statement to the fact that most osteopaths are authorized to practice a limited form of healing without the use of drugs generally and without the right to practice major surgery, he stated: "To attempt to treat pneumonia, diphtheria, syphilis, or other contagious diseases, acute appendicitis, ruptured ulcer, renal colic, compound fractures, and many other pathological conditions which are not uncommon among men of the Navy, by osteopathic methods, could but lead to disastrous results" (House hearings, Navy Department appropriation bill for 1944, p. 253). The prepared statement concludes in the following language: "It is not considered to be to the best interests of the naval service to commission in the Medical Corps of the Navy physicians who are not fully trained and qualified to serve on independent duty. It is of paramount importance that the Medical Corps of the Navy be composed of medical officers who have received the. best available medical training and who are qualified to render the highest accepted standards of treatment to naval and Marine Corps personnel" (House hearings, Navy Department appropriation bill for 1944, p. 253). On another occasion, before the same committee, the Surgeon General of the Navy said: "One of the schools [osteopathic] is really quite good. They lack in two regards, and in that we are telling them where their graduates will have to bring themselves up to a certain point. I have made some very definite suggestions to them as to how they can do these things, and they have turned me down on my proposition. I asked them to let us have some of their graduates to bring in so that we could try them out in internships to see what they can do. We have gotten nowhere. Where they fall down is in preventive medicine. That applies to the sending of doctors out into the field, into the Solomons, for instance. I always say a good doctor has a small sick list. No commanding officer wants many sick men on board. No man who is operating in the field wants a lot of sick men who are going to immobilize him. What I am trying to show these people is the fact that they must approach the whole plan from the preventive side, not wait until a man gets sick and then cure him. Now, that is the trouble with osteopaths, as I find them. We are putting our cards right on the table, because I realize they have spent a lot of time in their schools, and they are American citizens, and they have a right to consideration, but we are fighting a war, and we have got to have medical officers in the naval service, and, I think, the Army as well. When I send a man out on independent duty I have got to know that man can discharge all of his duties. I am not going to let anybody go out if I know that he lacks something professionally. He may not stick, and he may not do what I want done, but it will not be because he did not have the ground work in the beginning" (House hearings, supplemental Navy Department appropriation bill for 1943, p. 444). Osteopaths are not now accepted as medical officers in the Navy. Officers in the United States Public Health Service, in time of war, are called on to function in association with the armed forces and certainly it is desirable that the quality of officers in the service should not be lower than the quality of officers with whom they have to collaborate in the war effort. The chairman of the department of public relations of the American Osteopathic Association testified, in answer to a question, that he thought osteopaths are licensed to practice major surgery in about 40 States. He promised to submit for the record authentic information about the matter. Accompanying this statement is a memorandum summarizing the laws of the several States relating to osteopathy insofar as they indicate the scope within which osteopaths may practice. These laws present a confused picture, almost defying generalization. They do not, however, support an unqualified claim that all osteopaths in 40 States may practice major surgery. The situation with respect to the practice of surgery by osteopaths seems to be as follows: In four States-Alabama, Minnesota, North Dakota, and South Dakota-osteopaths are by statute denied the right to practice major surgery, and no provisions obtain whereby that right may be secured. In three other States, Louisiana, Maryland, and New York, osteopaths are generally denied the right to utilize any operative surgery. In New York, however, they may by complying with certain requirements obtain the right to use surgical instruments for minor surgical procedures. In five States, California, Connecticut, Illinois, New Jersey, and Virginia, osteopaths are generally denied the right to use any surgery, but specific statutory provisions obtain whereby the right to utilize surgery may be secured. Possibly Michigan should be in this classification. In seven States, Arizona, Arkansas, Montana, Nebraska, Ohio, Pennsylvania, and Rhode Island, osteopaths are denied generally the right to practice major or operative surgery, but there are provisions under which that right may be obtained if osteopaths meet certain additional requirements. In four States, Iowa, Oklahoma, Utah, and Washington, two types of licenses are issued: (1) To practice osteopathy; and (2) to practice osteopathy and surgery. Osteopaths holding licenses to practice osteopathy may not practice major surgery in Iowa and Oklahoma, operative surgery in Utah, or any type of surgery in Washington. In 16 States, Colorado, District of Columbia, Florida, Indiana, Kentucky, Massachusetts, Maine, Nevada, New Hampshire, Oregon, South Carolina (minor surgery), Tennessee, Texas, West Virginia, Wisconsin, and Wyoming, all osteopaths who receive their licenses at the present time are apparently authorized by statute to practice surgery. In Maine, however, the right to practice major surgery is subject to the qualifications specifically noted in the Maine act. In four States, Delaware, Idaho, Mississippi, and Vermont, osteopathic applicants are merely licensed to practice osteopathy, without any definition of that term. Wherever the courts have been called on to define the term "osteopathy," they have held it to mean a method of practice without the use of drugs or operative surgery. In the remaining States, Georgia, Kansas, Missouri, New Mexico, and North Carolina, osteopaths are licensed to practice in accordance with the type of practice taught in recognized colleges of osteopathy. In two more or less recent court decisions, State ex rel. Beck, Attorney General, v. Gleason (Kans.), 79 P. (2d) 911, and State v .Wagner (Nebr.), 297 N. W. 906, it was held that when a statute authorizes an osteopath to practice as taught and practiced in recognized schools of osteopathy no right was conferred on the licentiate to practice operative surgery. The foregoing summary, it is believed, is factually correct. It illustrates the rashness of general statements such as made by the chairman of the department of public relations of the American Osteopathic Association. The fact that osteopaths may obtain the right to do surgery carries with it no implication that osteopaths in a particular State have actually acquired that right. The distinction between an opportunity afforded and a right acquired is a basic one that must be kept constantly in mind when construing osteopathic licensure laws. Another witness before the subcommittee, a professor of pathology of the Philadelphia College of Osteopathy, presented testimony concerning the type of instruction offered in the college he represented. He offered for the record certain tables showing the relative curricula of all osteopathic schools, of the Harvard Medical School, of the University of Kansas, and of Stanford University. The apparent objective in submitting these data for the record was to support a contention that the quality of instruction offered in osteopathic schools is on a par with the quality of instruction given in medical schools and that therefore the graduates therefrom should be given equal recognition by the United States Public Health Service. Assuming that the same subjects may be taught in osteopathie schools as are taught in medical schools, that the same textbooks were used, and that the same number of class hours are devoted to each subject, such facts do not support a claim of equality of quality of instruction. There appeared in the Journal of the American Osteopathic Association for October 1942, a discussion under the heading "Standardization of the osteopathic curriculum," by J. M. Peach, D. O., dean of the Kansas City College of Osteopathy and Surgery. Dean Peach was at one time president of the Associated Colleges of Osteopathy. As a part of his article, Dean Peach included a table showing the relative number of hours of instruction given in osteopathic schools and the Harvard Medical School, the University of Kansas Medical School, and the Stanford University School of Medicine, a table similar to the one introduced in the record in connection with the hearing on H. R. 3379. There is reproduced below the concluding paragraph of Dean Peach's discussion: "It will be noted that the curricular content of the various approved colleges of osteopathy conform quite closely to the recommended standard. There is no greater variation between the content of our colleges than exists between the curricular content of the approved medical colleges that were studied. * * *. It appears to the writer that the true test of the curriculum of an institution is not to be found in a consideration of the 'hours' devoted, within reasonable limits, but to the effectiveness of the educational program, the competency of the faculty and the capability and enthusiasm of the students." Even assuming that the six osteopathic schools that are now accredited by the American Osteopathic Association have adopted a standard curriculum practically identical with the standard curriculum adopted by accredited medical schools, it cannot be concluded that the quality of instruction given in the two types of schools is on a par. The experience of osteopaths before State basic science boards and before State examining boards composed of doctors of medicine and doctors of osteopathy, as previously indicated, presents evidence leading to a contrary conclusion. The National Research Council of the National Academy of Sciences has agreed to make an impartial comparative study of the quality of instruction offered in the accredited medical and osteopathic schools. This study has been delayed, it is understood, because of a disinclination on the part of the osteopaths to collaborate in the project. The purpose of the study was to develop current |