Senator PEPPER. By the way, can you tell us generally speaking the categories of ownership into which the existing hospitals of the country fall?

Dr. BRISTOL. Well, of course, they fall in general under those two headings, voluntary and governmental. By "voluntary" I mean institutions that are run by a church or a nonprofit association.

Senator PEPPER. Would you estimate the percentage of the total number of beds in each group?

Dr. BRISTOL. Well, I should roughly say, based on New York City, that perhaps two-thirds the number of beds are in the voluntary institutions, compared with one-third in the governmental hospitals. Is that a good guess?

Dr. ROREM. I think it is the other way. The governmental ones have 95 percent of the nervous and mental, and about 80 percent of the tuberculosis beds.

Dr. BRISTOL. I was speaking of the general.

Dr. ROREM. In that case it runs the other way, about two-thirds voluntary and one-third governmental.

Senator PEPPER. General hospitals are about two-thirds voluntary and one-third governmental.

Dr. BRISTOL. When it comes to special institutions for nervous and mental diseases and tuberculosis, there the statistics are reversed.

In the United States there is room for both governmental and voluntary institutions. In any program which may be developed for the medical and hospital care of returning war veterans, the services of private practitioners of medicine and voluntary hospitals should be included in the scheme of things.

Senator PEPPER. Dr. Bristol, you have certainly been helpful to us, and I appreciate your attitude of open-mindedness and helpfulness. That is the spirit in which we are trying to face this problem. Thank you very much.

Dr. E. I. Robinson, president of the National Medical Association. Doctor, please give us your representative capacity and your address, and a sketch of your background.

TESTIMONY OF E. I. ROBINSON, M. D., PRESIDENT, NATIONAL MEDICAL ASSOCIATION

Dr. ROBINSON. My address is 2510 South Central Avenue, Los Angeles, Calif. I am a graduate in the college department of Selden Institute. I am a graduate in medicine of Meharry Medical College in Nashville. I am an ex-professor of anatomy of Meharry Medical College. At the present time, I am examining physician for the Athletic Commission of the State of California, a member of the race relations committee of the Council of Social Agencies of Los Angeles, a member of the research committee of United Hospital Funds Association for the county of Los Angeles, and president of the National Medical Association.

I regard it a singular honor to appear before you in the interest of medical education and services for the people of this Nation. As far as I am authorized, I place at your service the National Medical Association and its facilities in order to afford the people of America the best possible medical education and care. In view of my absence from my office recently attending the National Association's meeting,

I have had but little time to assemble the material which you should have. I have thus selected some of the pertinent facts for your consideration.

There are five major items with respect to health problems and facilities in the United States, namely:

I. Significance of selective service and induction station examinations.

II. Health problems of Negroes in the United States.

III. Availability of good medical care to all the people in the United States.

IV. Assurance of a continuous supply of medical school graduates.. V. A hospital and medical center program.

It is shown by available figures that 50 percent of the persons examined for selective service have been rejected on account of some physical or mental defect. It is shown that, when these persons are divided in the two general categories of Negro and white, the major causes of rejection for Negroes are venereal diseases and illiteracy, and for whites defective eyes and teeth. A further break-down shows that 25 percent of the Negroes were rejected because of syphilis as against 2 percent of the whites for the same cause.

It appears evident that a broad program of rehabilitation and prevention is necessary to salvage rejectees and to protect all other persons in the United States, including the returning serviceman.

In addition to the above it should be noted that health problemsamong Negro people present a very serious picture. (In respect to statistics based on "race" as presented in my prepared statement it should be understood that these figures are presented as made available under customary bi-racial practices in the National and State communities. They obviously do not present racial characteristics or susceptibilities, but do indicate disparities in economic and cultural opportunities and reflect the discriminatory social pattern based on race in American life.)

(a) The mortality rate among Negroes in the United States is approximately 30 to 40 percent higher than among whites;

(b) The average expectancy of life among Negroes is about 10 to 12 years shorter than among whites;

(c) The tuberculosis mortality rate among Negroes in the United States is reported to be three times as high as for whites, and even higher in certain cities and certain age groups;

(d) Indications are that venereal disease is a more acute problem among Negroes than among whites;

(e) The maternal and infant mortality rates show a disproportion of about 2 to 1 for the Negro.

FACILITIES LACKING FOR NEGROES

However much I dislike raising this question of the Negro, I am so constrained on account of the lack of facilities for the proper care of this whole group, and because so often the Negro is not included in programs by which he can and must benefit. Medical care, and medical and health programs and services, should be made available to this group of American citizens on the basis of need rather than population considerations such as a 10 percent participation because he constitutes 10 percent of the national population.

It is now an accepted fact that Los Angeles lacks 4,000 hospital beds to serve its population. There is a ratio today in this city of 2.5 of 1 bed per 1,000 persons as compared to the accepted ratio of 5 beds per 1,000 persons. In Mississippi in 1940 there was a ratio of 0.5 of 1 bed per 1,000 Negroes as compared to the accepted ratio of 5 per 1,000 persons for adequate hospital care. Taken as a whole, these two illustrations can be considered typical of any American city. There is, therefore, a great need for increased hospital facilities and health centers. And when viewed with respect to the Negro the problem becomes more acute. In the Southern States, especially, there are not enough physicians, nurses, and social workers, medical and otherwise, to serve the Negro population. In Mississippi there is one Negro physician for every fifteen or twenty thousand Negro Americans.

SUPPLY OF MEDICAL SCHOOL GRADUATES

Any action to assure a continuous supply of medical school graduates should take into consideration the following:

That the facilities of Howard and Meharry Medical Schools should be used to capacity, and that these facilities should be increased as far as possible to meet present and future demands upon them. It is to be noted that the majority of the physicians returning after the war have indicated the desire to continue their training.

I might say, in mentioning Howard and Meharry, that 90 percent of Negro physicians are graduates of Howard or Meharry Medical College. At present, we have an enrollment of 500 students in the two schools, not nearly enough to meet the needs of the Negroes in America.

In view of the above, governmental subsidy should be made available for medical education, and such subsidy should be handled by the prospective students and by medical schools rather than by any supervision of the States.

It is also recommended that medical schools other than Howard and Meharry, 75 in number, admit qualified Negro students so that Negroes graduating in medicine from these schools each year will number three or more times the present 8 or 10.

With respect to a hospital and medical center program, the Surgeon General of the United States Public Health Service has suggested an excellent one to which the National Medical Association can readily subscribe. Dr. Thomas Parran's program consists of the following: (1) A broader preventive program; (2) a wider program and opportunity for medical research; (3) more accessible graduate courses and facilities for physicians; (4) development of hospital and health centers; (5) group medicine plan; (6) social insurance.

Dr. Parran points out that the country's need in this field could be met at the cost of $1,989,000,000. This sum would provide 166,000 general hospital beds, 191,000 mental hospital beds, 60,000 tuberculosis beds, 1,200 district health centers, and, 1,200 subhealth centers. Finally, the following considerations warrant attention: (1) It should be noted that the problems herein noted as affecting the practice of medicine also affect the fields of dentistry, nursing, and medical

social service; (2) that physicians, in good standing, with their medical societies and in active practice (provided such societies maintain the code of ethics laid down by the American Medical Association), such physician being not on the Federal pay roll, should be included in any program to assure better medical care on a pro rata basis.

Senator PEPPER. Doctor Robinson, thank you very much. That is a fine statement. I wish we had more time to go into details of it with you, but we are running a little late here, and I am afraid we haven't time. That is a very fine statement. Thank you for coming.

Dr. John P. Peters, secretary, Committee of Physicians for Improvement of Medical Care. Doctor, will you give us now, your address? Dr. PETERS. Yale University School of Medicine.

Senator PEPPER. Very well. We appreciate your being here. Could you give us just a word about your background? I know Yale University carries adequate connotation, but just give us a word of your own experience.

TESTIMONY OF JOHN P. PETERS, M. D., SECRETARY, COMMITTEE OF PHYSICIANS FOR IMPROVEMENT OF MEDICAL CARE

Dr. PETERS. I graduated from Yale in 1908, and from Columbia College of Physicians and Surgeons in 1913. Since then I have been in full-time medicine in various capacities, including two years abroad during the war, and I am professor of internal medicine at Yale, and also attending physician at the New Haven Hospital.

Senator PEPPER. Thank you, Doctor.

Dr. PETERS. The statement I want to make deals more, as it should, coming from members of the Committee of Physicians for Improvement of Medical Care, with some of the details required for any medical program than it does, perhaps, with the larger economic aspects of the situation. Especially I want to deal here with the situation raised by the emergency of the war.

ATTITUDE TOWARD MEDICAL CARE

When I entered upon my professional career along lines that were at that time considered decidedly unconventional, I was continually confronted by a reaction of the public and the medical profession that was somewhat disconcerting-the attitude that science and the scientist were all right in their place, but the bedside needed art and the proper manner. No one now has to defend the science of medicine, to justify the use of sulfonamide drugs, penicillin, insulin, and other modern diagnostic and therapeutic aids. The public does, to be sure still support certain cults that eschew the scientific method or accept it only with a religious doctrinal prefix. Both physicians and laymen still fail to accept the implications of science in medicine in two large respects that are, I think, at the roots of the problem your subcommittee is seeking to solve. The first of these is that those who apply these procedures must have sufficient scientific knowledge to understand what they are doing and assistance and facilities necessary for the conduct of the procedures. The second is, that the same ruthless logic must be applied to the development of machinery for the provision of care that has been so valuable in the development of diagnostic and therapeutic measures. A scientific pursuit can not be fitted into an utterly un

scientific frame. If any one objects that we must not sacrifice the bedside manner I can only answer that lack of the important ingredients of this attribute, humanity, sympathy and kindliness, is deplorable; their presence is something to be expected, not especially noteworthy or commendable. The addition of the blandishments of the salesman are no useful substitute for competence and knowledge.

The public regards medical care in terms of distribution of physicians, as if the mere exposure of a patient to a physician assured all the benefits of modern medicine. As a corollary it is assumed that physicians are more or less interchangeable units, This attitude led the military authorities to initiate an accelerated schedule of education in order to multiply medical units, without regard for quality; to assign these men to duties without due consideration of their special qualifications; to keep them for long periods without opportunity to practice their skill; and to use large numbers for purposes for which à medical education is unnecessary. All this was done, as far as can be ascertained, against the best advice of medical and educational experts. The program was so set up that parts of it would not bear fruit in medical officers until 1949. Under this schedule the first formal premedical class with a 2-year college course should enter medical school in the middle of 1945, complete its medical school course in 1948, and its curtailed internships in 1949. This means that the quality of young physicians has been compromised for more than 5 years unless some means can be found to permit these men to complete or supplement their education. Most of them will profit little from their military experience. The Army and Navy now find that they will not require as many physicians as this program will provide. Presumably, however, they believe that they will still require a large volume of undifferentiated youthful manpower. The easiest way to secure this appears to be the abrogation of their whole educational program, leaving available as medical students only discharged veterans, physically unfit persons and a large supposititious pool of women clamoring to become physicians. To make the picture complete it must be realized that throughout this period parts of our civilian population have had to cope with a serious scarcity of physicians without a concerted program, striving as best they could to utilize the services of what medical personnel the military forces allowed them to retain by an inherently inefficient system of individualized competitive practice that has broken down under the strain.

OBSTACLES TO ADEQUATE CARE

The criterion employed to estimate the adequacy of medical services in a community is the proportion of medical to lay hands in that community. The solution offered for the scarcity problem is to try to transfer a few medical hands from one community to another. Even the military mind has appreciated that those men who are to participate in medical activities must have more than their hands to work with. First of all they must have the physical facilities necessary for the proper practice of their profession, including access to a properly equipped hospital; second, they must be organized. No one man can pretend, in the old black-bag manner, to competence in all branches of medicine. He cannot afford to own all the facilities required and if he did, he would not have the time to use them, if he were superman