The establishment of a joint committee was included in the following proposal: "That the plan for this year and its coordination shall be under a guiding committee composed of five members appointed by the American Medical Association, five members appointed from the National Council on Physical Fitness, under the chairmanship of Col. Leonard G. Rowntree. Therefore, it is recommended that the American Medical Association appoint a committee of five members with authority to act to join with a similar committee from the National Council on Physical Fitness, which joint committee shall be the joint committee of the American Medical Association and the National Council on Physical Fitness on Special Emphasis Year for Physical Fitness."

V. PRINCIPLES OF COOPERATION BETWEEN THE AMERICAN MEDICAL ASSOCIATION AND NATIONAL COUNCIL ON PHYSICAL FITNESS

1. Basis of cooperation.

Analysis of the leadership and tools made possible by this joint committee for the purpose of Nation-wide promotion of physical fitness indicates that with respect to physical fitness activities, the promotion of sports, conditioning exercise, and camping and outing activities is a common objective of both sections of the committee. The details as to what should be done and how are in the main the concern of the representatives of the National Council on Physical Fitness.

In like manner the need felt for competent medical care, the Nation-wide confidence in it and its early use, are common objectives of both partners. The details as to what should be done and how, are, in this case, the concern in the main of the American Medical Association.

To strengthen and streamline the cooperation for the common task, it is felt that

The American Medical Association should—

Convince the physicians and dentists of the country of the need for and the importance of physical fitness in the United States.

Endeavor to make the physicians and dentists enthusiastic for the spread of physical-fitness activities,

Encourage physicians and dentists to support actively all such endeavors in their community; and

Enter into active participation with other professions for physical fitness.
The Council on Physical Fitness should-

Strive for the fullest cooperation between medical groups and other professionals in physical fitness;

Attempt the fullest use of the expertness of medicine to secure early and continuous medical care as an effective means of prevention; and

Aid in developing an individual consciousness of the need for medical opinion on all cases who are outside of the safety zone for strenuous activity.

2. Objectives.

At their Chicago meeting June 11, 1944, the representatives of the American Medical Association and the National Council on Physical Fitness agreed that in the task of Nation-wide physical-fitness promotion, three common major objectives were: Development, restoration or rehabilitation, and prevention.

An outline of these objectives follows with suggested areas of service indicated for the joint committee.

(a) Development.-Development in the human being may be said to be the process and result of changing the potential possibilities of a person (set by hercedity) into realized powers and abilities.

This is a training or conditioning process.

This process may take place naturally and unconsciously through enforced activity along a certain line (shrewdness of the businessman, strength of the blacksmith), or it may be a conscious, persistent directed effort toward a desired goal (Helen Keller, Glen Cunningham).

There is universal testimony from high-ranking military officials as well as selective-service figures to prove that the Nation's manpower has been presented to the armed forces physically unfit for effective service.

Physically fit human power is essential to this Nation now and always will be for complete living during peace as well as the virile prosecution of war.

Much in our present civilization has prevented the natural automatic type of conditioning for the development of strength, endurance, and agility which was so much a part of the life of our rugged pioneer forefathers.

There is, therefore, an imperative need for the type of conditioning for physicalfitness development, which is eminently desired and strategically planned. Such conditioning results both in physiological development and psychological development. Both are imperative and the peculiar values of physical-fitness activities for this conditioning, must be continually realized.

Cooperative planning is essential in order to

(1) Develop an attitude on the part of all the people that will make a high degree of physical fitness an essential part of their personal daily living.

(2) Make available every means so that people can readily and with minimum inconvenience, participate in effective programs for physical fitness.

In planning and carrying out this conditioning for physical fitness development, professionals in this area have the advantage of an accumulation of experience stretching over the historic perspective of the world's use of sports and other physical fitness activities.

(b) Rehabilitation.-Rehabilitation involves those procedures which will help people to make adjustments to life as they find it, after circumstances (generally harsh) have destroyed or altered the former life pattern.

During and after the war, servicemen must be assured of adequate rehabilitation.

Furthermore, the stress and strain of war makes adequate civilian rehabilitation imperative.

Returning servicemen will be of two kinds:

(1) Those without physical impairment.

(2) Those who are wounded, ill, or have physical defects.

The rehabilitation of healthy veterans is a task for physical fitness. The purpose to help

To carry the homecoming soldier over the difficult time of transition and adjustment;

To build him up for his civilian future, physically, and psychologically; To enable him to "take" primary failures and disappointments with optimism and equanimity;

To create in him the physical strength and psychological drive to build up a new life.

The rehabilitation of wounded and sick veterans is at first a concern of medicine; later a concern of medicine and physical fitness with medicine taking the lead; still later, a concern mainly of physical fitness with medicine still in control; and finally, a concern of physical fitness alone (for psychological reasons) with only occasionally medical check-ups.

The rehabilitation of sick or physically defective civilians follows the same pattern as for wounded or sick veterans whereas, the rehabilitation of physically healthy civilians to post-war conditions is likewise a concern of physical fitness. (c) Prevention.-Prevention of disease is an important objective of public health and medicine. Physical fitness, while not claiming the prevention of specific diseases is the word's technical meaning, shares the task of prevention in two respects:

1. Prevention of neuroses: Physical education and sports have a definite effect upon the psychological balance of the individual. They contain an education for energy and self-control, a deliberate conditioning against self pity and neurosis. 2. Prevention through health instruction: Health instruction which results in intelligent understanding and motivation is a powerful force for prevention.

IV. NEED FOR SPECIAL EMPHASIS YEAR

The urgent need for the increased physical fitness of the Nation's man power has been continually indicated by National Selective Service surveys and the attestations of high ranking military and civilian officials. A statement of the needs for physical fitness among the civilians of the Nation is being prepared by Selective Service National Headquarters.

STATEMENT OF RESPONSIBILITY FOR THE SPECIAL EMPHASIS YEAR

The joint committee.-The joint committee shall be made up of five members appointed by the American Medical Association-Dr. Roscoe L. Sensenich, Dr. Morris Fishbein, Maj. Gen. George F. Lull, Dr. William Stroud, and Dr. L. A. Buie; five members appointed by the chairman of the National Council on

Physical Fitness-Dr. Hiram A. Jones, Dr. William P. Jacobs, Dr. John W. Studebaker, Mr. Arch Ward, and Mr. A. H. Pritzlaff; Capt. C. Raymond Wells, president of the American Dental Association; Mr. Watson B. Miller, Assistant Administrator, Federal Security Agency, who shall serve particularly to advise on governmental relationships; the president of the American Medical Association and the chairman of the committee on physical fitness shall be ex officio members; Col. Leonard G. Rowntree, chairman; Frank S. Lloyd, secretary; Dr. Franz Schuck, assistant to the chairman; and Loretta Flannery, recording secretary. The joint committee is responsible for the policy, plan, supervision, and evaluation of the special emphasis year. The committee shall meet at the call of the chair and the expenses of the first meeting shall be carried by the committee on physical fitness.

Advisory committee of Surgeons General.-The Surgeons General of the Army, Navy, and the United States Public Health Service will serve in an advisory capacity to the joint committee. They shall be kept continuously informed and provide advice from their own initiative or in the light of the requests from the joint committee.

Advisory committee on Government liaison.-Shall be made up of representatives of the various Government agencies which are particularly concerned with this special emphasis year. It shall include Maj. Gen. Lewis B. Hershey of Selective Service; Gov. Paul V. McNutt, Federal Security Administrator; Dr. Warren F. Draper, United States Public Health Service; Mr. Donald M. Nelson of War Production Board; Mr. Elmer Davis of the Office of War Information; Gen. Frank T. Hines of the Veterans' Bureau; and others as necessity may demand. Coordinators.-The chairman of the joint committee on special emphasis year for physical fitness, hereafter referred to as the chairman of the joint committee, shall appoint individuals to serve as aids to the joint committee in areas where coordination is necessary. These shall include finance, program, manuals, inventory, public relations, and evaluation. It shall be the responsibility of these coordinators to inform the joint committee concerning the effectiveness of the programming in their particular area, paying particular attention to unnecessary overlap and gaps in the general strategy of approach. These individuals shall be continuously informed of the planned and completed programs. It shall be their further responsibility to carry out special tasks assigned to them by the joint committee of their particular area of interest. These coordinators have no administrative authority or responsibility in the actual program areas.

Program council.-The program council shall consist of the chairmen of the various programming sections to be described below and other persons to be appointed by the chairman from time to time as it is deemed necessary for effective programming. This program council shall elect a chairman, and the secretary of the joint committee shall appoint members of his staff to aid the council as it is deemed necessary.

It shall be the responsibility of this council to share the plans and experiences of the various sections; to view the program in its entirety; to recommend these programs to the joint committee; to carry out the instructions of the joint committee for more effective planning.

This council shall meet from time to tome as it is deemed necessary by the chairman of the program council and the chairman of the joint committee. Programing sections.-There shall be appointed eight programing sections: Institutional planning, management, labor, promotion, associated industry, schools and colleges, State and local organization, and medical affiliates. Others may be added at the discretion of the joint committee. These sections shall be cochaired by a representative of the national council and a representative of the American Medical Association, these persons to be recommended to the chairman for appointment. The members of these sections shall be drawn from representatives of the various agencies concerned with a specific section, e. g., labor. These sections shall be completely responsible for the program in their respective areas, reporting through the program council to the joint committee on proposed plans and progress of their particular program. The joint committee shall have the authority to approve such programs for action, of bringing to the attention of the chairmen of these sections suggestions concerning the program, and of requesting from time to time reporting which will insure both adequate record and proper evaluation of their efforts in the special emphasis year.

Realizing that the programs of action will be carried out by the various agencies concerned and further that these agencies are represented in the various programming sections, it is the firm conviction that these sections should have freedom

in planning and must carry the responsibility for effecting programs. Duplication and total coverage will be discernible in the program council. Further, it is the peculiar responsibility of the coordinators.

The success of this special emphasis year can only be achieved as there is deputization of responsibility and where the responsibility is placed in the hands of individuals or agencies which can effect such programs. Therefore, the joint committee sees itself as an initiator and responsible for the outline of the plan in and through which various agencies and organizations can work. The success of the year will be read in the degree to which individuals, agencies, and organizations feel a particular obligation for carrying out their responsibilities for the stimulation of physical fitness during the special emphasis year.

OUTLINE STATEMENT SUBMITTED BY T. R. PONTON, M. D., EDITOR OF HOSPITAL MANAGEMENT

1. The approved hospitals of the United States have sufficient bed capacity to meet all needs in 35 of the 49 States, including the District of Columbia.

2. In five States the approved hospitals cannot adequately care for the more complex cases that may be referred.

3. In 33 States some of the nonapproved hospitals are necessary. Improvement to meet recognized standards is strongly indicated in 12 of these.

4. Ambulance service would be an advantage in 20 States.

5. Indications for new construction:

(a) In four States increase of capacity of some of the approved hospitals is desirable.

(b) There is no indication for new construction in any of the areas served by nonapproved hospitals. There is, however, every indication for the increased financial support which will enable these hospitals to improve their standards. (c) In areas beyond service distance of any hospital, small hospitals are indicated in 11 States and first-aid stations in 13.

6. In every State in which there is an appreciable Negro population there is great need for increasing the facilities for their care. There appears to be two means by which this can be accomplished, both involving a great deal of new construction. These are:

(a) Where color discrimination can be ignored, a great many Negroes can be admitted to existing hospitals. A large number could be cared for in bedɛ now unoccupied, but for adequate care new construction would be necessary. (b) Where color discrimination prevents admission to existing hospitals, new construction is necessary.

STATE OF NEW JERSEY,

Subject: Chronic illness..

Hon. CLAUDE PEPPER,

DEPARTMENT OF INSTITUTIONS AND AGENCIES,
Trenton, N. J., July 13, 1944.

Chairman, Subcommittee on Wartime Health and Education,

Washington, D. C.

DEAR SENATOR PEPPER: It is a great satisfaction to learn of the interest of your subcommittee in the problems of chronic illness with especial reference to the Nation's wartime health program. I am glad to send you a statement for the record of your hearings together with certain opinions and conclusions reached by the joint committee of the American Hospital Association and the American Public Welfare Association, as well as certain personal observations in regard to the subject.

The joint committee has been in existence for more than 6 years. It has sought a solution of the problems of the public welfare and hospital administrators who are called upon to provide medical care for an ever-increasing load of indigent persons, acutely or chronically ill, in a manner fair to the hospitalɛ, to the taxpayer, and the philanthropic public.

Lack of facilities for care of chronic ill.

We have found ourselves caught in a rapidly swelling tide demanding care for the chronically ill aged with which we cannot keep pace. Hospital beds are filled by the acutely ill; the availability of auxiliary services such as private licensed commercial nursing homes, visiting nurse service, and philanthropic homes for