State is unable to provide for such an institution. I think that is now being done under the Lanham Act in connection with war industries. Senator PEPPER. Suppose the Federal Government followed a course somewhat analagous to the one it follows now in the Social Security System, that is, suppose it required the States to submit approved plans, and then with its greater capacity to see the over-all picture, develop a plan as to how the country might be served by hospital and medical facilities, and then by grants through the public health agencies of the several States stimulate the building up of such a system. FEDERAL AND LOCAL COOPERATION I can well understand that the State public health agency, in a State like Florida, for example, might take certain municipal hospitals, or certain private hospitals even, and say, "How would you like to expand this hospital into the concept of the base hospital that Dr. Parran outlined here? Now, we will be glad to give you some funds in aid of such a project. We will be glad to provide some of your personnel, and this will be what we will call the base hospital in a complete hospital scheme, and hospitals all over this State may send in patients and laboratory specialists, and laboratory work may be done here." I can understand how a local public health authority might work out such a plan. It might have its base hospital by working out such a plan. It might not have to build another, a new one. Then, in places where there were not adequate district hospitals, they, with the aid of Federal funds, could build such hospitals, if they didn't exist, or they could convert a local hospital into that kind of a hospital, and then these remote health centers could be built. Maybe they could get the county to contribute a certain amount; the State health agency would have certain Federal funds with which it might match its own expenditures, and so the State public health department could formulate a system of medical centers around the State, and nurses, at least, would be on duty in those places. The citizens could come in and get advice concerning the prevention of communicable disease, and certain laboratory services. I think it may also be essential that the public to a considerable extent, provide clinical facilities and equipment and personnel that would permit a physical check-up-examinations for the citizenry-because otherwise people aren't going to get examined. Therefore, I was wondering if the system could be made flexible so that the Federal Government would not go into the details of either construction or operation, but would always strive to assist in such a way that there would be complete and adequate service. For instance, we have had enough experience in building hospitals so that the Federal Government, the Public Health Service, should be able to tell any community, "Here are various plans you might use in building a hospital of a certain size. This is about what the cost is. This is about the kind of hospital you should have for your kind of community. The Federal Government could certainly aid in doing that. Then, by counsel with the State agency and by making funds available, we could gradually evolve, no doubt, an adequate hospital system for the country. The Federal Government and the State government might begin by providing the basic facilities and services and certain laboratory equipment, and then gradually working out this more complicated and difficult problem of how these medical services of a more complex character are to be paid for by the citizen, which is a field about which at the present time there is not great agreement, I dare say. CORRELATION OF FACILITIES Dr. JOHNSON. Well, I think the whole problem requires close collaboration between local and Federal authorities. I would hate to see any rigid system, and I would agree with you that a high degree of flexibility is required to meet the greatly varied needs in the various States. We have heard mention, today, of the State of Iowa, which has its State hospital at Iowa City and has a very excellent system of transportation-busses owned by the State which go to all parts of the State and pick up patients and take them to this central hospital. Well, now, that works very well in a relatively flat State with excellent roads. It might be entirely inadequate in some other State, and Iowa, if it were advised to change its system, might dislike very much to do so. It might say, "This is working out well." It might extend its present plan at certain points, but it might not wish to conform to any over-all plan. Senator PEPPER. Do you agree with Dr. Parran's thesis that a hospital system, to be adequate, needs to be integrated in some way? Dr. JOHNSON. That is right; yes. Senator PEPPER. So that there will have to be some sort of general correlation of hospital facilities in a given area? Dr. JOHNSON. That is right. Senator PEPPER. Some relationship. I don't know anything about the skills, but I imagine that there are a lot of techniques which not many men are able to do, certain operations that not many men are able to do or to do well, so that you can't expect every little town that has a hospital to have a staff that is as good as Mayo's, or Johns Hopkins, or some other large institution. Dr. JOHNSON. There is a system in operation in Massachusetts now which is centered about the Tufts Medical School Hospital, I believe it is; cooperating with that central hospital are several hospitals throughout the State. The idea is that these smaller hospitals can take care of the usual cases. The medical center is for the treatment of the more difficult cases, and, on the other hand, the central hospital considers itself responsible educationally for these smaller institutions and sends teams for graduate work and draws in men from these smaller hospitals for intensive work of several weeks, perhaps, so that they can keep up with modern developments. Senator PEPPER. Do you know of any agencies so well qualified to bring about the integration which should exist among hospitals, in order to have a complete system, as the public-health departments in the several States? Dr. JOHNSON. I think that they should certainly figure in a very important way in such an integration. Senator PEPPER. Doctor Johnson, we thank you very much. You have heard me say that we are going to ask the American Medical Association to suggest to us certain other representatives of the association who might come and discuss various phases of this subject. We want to welcome everything that your association will present to us. As I say, we have no preconceived plan. If we were called upon today to make a recommendation, we wouldn't know what to recommend. We are just trying to find the right way to provide better health. This concludes this particular 3-day series of hearings. We feel that we have at least opened up the subject by what the doctors might call an exploratory operation. We hope that the patient will live long enough for the operation to be a success. Our next hearing will be announced later. (Whereupon, at 1:15 p. m., the committee adjourned subject to the call of the chairman.) APPENDIX The following statements, correspondence, and exhibits are included in the record in accordance with instructions from the chairman: COMPARISON OF REJECTION RATES WORLD WAR I AND WORLD WAR II1 A logical comparison of rejection rates for the First World War and the present one is practically impossible because of the differences in standards, methods of examination, and policies used in the two periods. There can be no doubt of the value of such a comparison but the figures indicated in this statement must be used very cautionsly. In the First World War a total of 3,208,446 registrants were examined. Of this number 29.6 percent were disqualified for service. However, the rejection rate, eliminating limited-service registrants, would be 26.8 per 100 men examined. The rejection rate for World War II was at its highest in the early part of selective service prior to the actual declaration of war when 52.8 percent of all registrants examined were rejected. The lowest rejection rate experienced was in January 1943 when it reached 31.4 percent of all registrants examined. In December 1943 the highest rate during actual wartime was experienced when 46.9 percent of all registrants examined failed to qualify for military service. Table 1 attempts insofar as possible to compare the broad causes of rejection in World War I with those of World War II. Since the groupings are not identical it has been necessary to combine certain causes in the case of the figures for World War II. It is felt that the figures are now fairly comparable on the basis of the groupings listed. TABLE 1.-Comparison of rejection rates, World War I and World War II Based upon estimated number of registrants in class IV-F by cause of rejection as of May 1, 1944. Includes manifestly disqualifying defects, musculoskeletal defects, and feet defects. Includes eyes, ears, and nose. Includes cardiovascular, varicose veins, and blood and blood-forming defects. Includes tuberculosis, syphilis, and gonorrhea. Includes underweight and overweight, and endocrine. Includes skin, teeth and mouth and gums. 1 Submitted by Maj. Gen. Lewis B. Hershey, Director, Selective Service System. The Honorable CLAUDE Pepper, United States Senate. SELECTIVE SERVICE SYSTEM, Washington, D. C., August 12, 1944. DEAR SENATOR PEPPER: In further reply to your letter of July 22, 1944, the following information has been obtained as to the number of fathers drafted by local board No. 1, Washington County, which has jurisdiction over the city of Hagerstown, Md. The total living registrants aged 18 through 37 years in the local board number 6,159. Of these, 1,996 are classified as pre-Pearl Harbor fathers and 4,163 as nonfathers. As of July 1, 1944, 320 of these fathers were in the armed forces, either by induction or enlistment, and 222 were in class IV-F as disqualified for military service. Among the nonfathers, 2,437 were in the armed forces and 1,025 were in the disqualified category. The remaining registrants were unclassified because they had just registered as 18-year-olds, or were deferred in industry, agriculture, for hardship, or by law. It is logical to assume, as you suggested in your letter, that if more of the nonfathers had been physically fit fewer of the pre-Pearl Harbor fathers might have been drafted. The study, Child Health and the Selective Service Physical Standards, which was published in Public Health Reports, volume 56, No. 50, December 12, 1941, presents a comparison, for each disqualifying cause, of the childhood status of 411 Hagerstown registrants included in the Hagerstown morbidity studies. These observations indicate that a relatively large number of the registrants who were rejected because of defective teeth or defective vision gave evidence of the same defects 15 years earlier when they were in elementary school. They also indicate, though not conclusively, that most of the other causes for rejection were apparent as childhood defects. I trust that this information will serve the purpose of your request for the Subcommittee on Wartime Health and Education. Sincerely yours, LEWIS B. HERSHEY, Director. STATEMENT OF COMMITTEE ON PHYSICAL FITNESS, FEDERAL SECURITY AGENCY, OFFICE OF THE ADMINISTRATOR 1. FUNCTIONS OF THE COMMITTEE The Committee on Physical Fitness was established by Administrative Order No. 42, April 29, 1943. Its functions are to: 1. Define and study problems relating to the promotion of physical fitness, in cooperation with national agencies and organizations, and encourage the development of cooperative programs for their solution. 2. Serve as a center for the stimulation of State, district, and local programs for the promotion of physical fitness. 3. Make available to States, localities, and organizations and agencies, upon request, the services of specialists in physical fitness. 4. Prepare materials and serve as a clearinghouse on informational matters pertaining to the development of a national program of physical fitness. The Committee on Physical Fitness at its first meeting, June 16, 1943, defined physical fitness as follows: 1. A fitness that will result in a minimum of disability due to sickness of any type. 2. A fitness that will result in the ability to recover rapidly from fatigue and exhaustion. 3. A fitness that will insure the ability to perform our tasks (whether military or civilian), efficiently and well within the limitation of the human body. 4. A fitness based on an ideal which will demand a continuous effort on the part of individuals for an appearance, representative of a high degree of health and vigor, as well as a pride in rugged endurance. 5. A fitness based on sound home, school, and community training which produces well-disciplined individuals who reject soft living and take pride in physical vigor. 6. A fitness resulting from self-direction and inner propulsion rather than compulsion. 1 Submitted by Col. Leonard G. Rowntree, Vice Chairman, Committee on Physical Fitness. |