Federation of Labor, and we are very happy of their interest and the support people give.

I am also interested because I am the orthopedic consultant for United States Public Health in this area, and we get many patients who are compensation cases, and they in many instances require rehabilitation.

I am particularly interested because we are doing a pilot plan study for the Bureau of Employees' Compensation, which deals with civilservice employees. That is being done at this present time.

We are learning a great deal from this pilot plan study.

We felt that a pilot plan study in a demonstration area was necessary in order for us to come to some real conclusions concerning the value of rehabilitation.

I wish to state that rehabilitation in our experience in this pilot plan study is proving of real value.

We feel that money should be expended for rehabilitation.

We can see some faults in it, but the advantages of it are very great. There is no question about the economic advantages.

I want to pose some problems that come up to us, and I am sure will come to the legislators, concerning these bills.

When I speak of the orthopedic disabilities, which are tremendous in number, I am not even taking into consideration many other disabilities. For instance, the cardiacs make up a large number of patients. The arthritics are probably twice as many as the cardiacs, and I would say they go into many thousands, probably millions.

If you want to put your psychosomatic cases in that group, you are going to have many, many more.

So, if you see you are going to do rehabilitation completely, you have something which is very expensive, and it is unlimited. It will require constant expansion in the future, so that it means you must use good judgment in any appropriations that are made.

I feel there must be an increase in appropriations, however. Now, when we attacked this problem over at the Anderson Orthopedic Hospital or the Anderson Orthopedic Rehabilitation Center. we felt we should draw up some plans for the future as to what would constitute the best type of rehabilitation program, and I made these

notes:

That a rehabilitation center should be nonprofit.

It should be a chartered and incorporated institution in the State or the District of Columbia.

It should be a combination of outpatient hospital, domiciliary, and vocational or trade-school components.

By outpatient, I mean patients who are coming in that can be rehabilitated. They naturally won't cost as much as the patients who have to be hospitalized.

Hospitalization is very expensive. You can't rehabilitate many patients who have to be hospitalized. Only those who are most seriously involved should be hospitalized.

Therefore, I recommend a domiciliary type of care and there is no reason in the world why many of these patients can't receive domiciliary care, which is much cheaper. That can be done on a cooperative basis. Many of those patients can help themselves. Many of them could go to the cafeteria. Many of them can help the patients who are receiving hospitalization.

I also included in here the vocational section or trade school. In our plan at the Anderson Rehabilitation Center one wing of that Y will be used as a trade school. Now, you probably wonder why you should have a trade school linked with a hospital in doing rehabilitation. Well, it is from the standpoint of economy. In the trade school you ought to have normal individuals-in fact, the preponderance of normal individuals-so that your handicapped patient can get the benefit of it. If you don't do it that way, the cost of taking care of those handicapped patients is going to be tremendous, because you will need a large number of instructors; you will need a large amount of equipment.

I would say that to run the program properly you would probably need 200 to 300 outpatients; you would need about a hundred inpatients requiring domiciliary care or hospitalization, and you ought to have a trade school in which you have 300 or 400 people.

This trade-school idea arose at the Woodrow Wilson Hospital in Staunton, Va. I think it is a good one. We feel it would be better placed in a metropolitan area because many of the patients don't care to travel 160 miles away. I don't mean to criticize Woodrow Wilson Rehabilitation Center because I think it is an excellent center of its particular type, but I believe a rehabilitation center is better located in a metropolitan area because that is where you can have a trade school. You have ease with which your outpatients can get to it. You get the satisfaction of the families of the individuals. It is hard to get people to go 150 to 200 miles away from their home. So, I feel that combination of outpatient hospital, domiciliary care, and trade school is essential for doing it at a reasonable rate. I feel that volunteeer functions are important.

Now, in what we have over there at the Anderson Orthopedic Rehabilitation Center we have the entire community interested. I am sure you can appreciate that because we would have never had the hospital built with free labor and materials unless we had the wholehearted cooperation of the community. They provide transportation. They help in the rehabilitation center. In fact, our women's auxiliary, the Gray Ladies, the Red Cross, and others offer help in rehabilitation which cuts the cost down tremendously.

I feel that the hospital should be approved by a board of accreditation.

Now, our hospital is approved by such a board. It isn't wise to try to run any rehabilitation project unless you have accreditation by accepted groups, such as the American Medical Association and

others.

I feel the rehabilitation center should be designed to rehabilitate all types of patients.

At the present time we are rehabilitating orthopedic patients. I feel that is very uneconomical. For that reason, we are going to take all types of patients into our center.

Now, I frequently mention our own center. From what I have described, it probably would appear to you that we are very well satisfied the way things have been going. We are satisfied, except for this problem: There are many patients who require rehabilitation, for which there is no money for their room and board.

Now, we are willing to do free work for patients who can't afford it. We feel, however, that the doctors who do that type of work can't do all free work and there must be some agencies that should pay the doctor for work which is not given to indigent patients.

Specifically, we need some money to be able to pay the room and board of patients who come in. We would like to be able to do more than we are doing right now.

For the Bureau of Employees' Compensation we are taking in 4 patients at the present time. The Bureau of Employees' Compensation couldn't afford to send in more patients.

There has to be an appropriation somewhere to do this job right. I would like to request that the committee give some consideration to using the Anderson Orthopedic Center as a pilot-plan study. I think we are deserving of it because we have not asked the Government for any money in the past. We have proved we can do the job in an economical manner.

We feel you need a pilot-plan study so you can proceed with some of the needs in rehabilitation in the future. There is a great deal to be learned from a pilot-plan study.

Senator PURTELL. May I interrupt a moment, Doctor?

Unfortunately, official business requires my presence elsewhere, so I must leave; but I assure you all the testimony will be very carefully read and digested by all members of the committee. Others members of the committee are at other meetings, I am sure, this morning. So I am going to turn the meeting over to my colleague, Senator Goldwater, from Arizona.

Senator Goldwater.

Dr. ENGH. I would like to suggest the use of the Anderson Rehabilitation Center as a demonstration center or pilot-plan center for other reasons. In this area we have the Federal Office of Vocational Rehabilitation. They can keep their eye on what is being done. They can advise us.

In this area we have the Federal offices of the American Federation of Labor and, as I said before, the American Federation of Labor is intensely interested in what is being done. They can also help us and advise us in our problem.

In this area also we have United States Public Health and I feel that United States Public Health has an interest in what is being done.

The fact that we are located only 15 minutes away from the Capitol will make it possible for all these agencies to give reasonable consideration to the value of a pilot-plan study.

Now, as I have said before, this may appear selfish on my part in asking it, but I feel I am justified that by virtue of what we have done in the past and anything that we do over there is essentially for the purpose of making rehabilitation work better.

I thank you.

Senator GOLDWATER (presiding). Do you have any questions, Senator Lehman?

Senator LEHMAN. May I express my regret that I have to leave to attend another meeting. I would like to hear the other witnesses, but I simply have to get to this meeting.

I assure you I will read your testimony with a great deal of interest.

Mr. MASON. Thank you, Senator.

Senator GOLDWATER. You may proceed, Mr. Mason.

Mr. MASON. Mr. Chairman, this session of Congress will consider nothing more important to the well-being of America than a program to restore to its physically handicapped the dignity of fully productive and self-reliant life. In no other field are the opportunities greater for constructive action to increase America's productive resources and to improve the welfare of its citizens.

America's handicapped citizens have been the subject of many past congressional hearings. Yet, the action that has followed from these hearings has been inadequate and far too meager. We hope that this time it will be different.

It is our hope that this session of Congress will enact comprehensive, constructive legislation to truly help restore to active productive community life the millions of handicapped persons needing assistance today.

Over many years Congress has given much attention to the problems of conservation. This proper concern of the Nation's legislative body with conservation and proper development of our country's natural resources has covered a wide range of problems and has resulted in a variety of programs, but it is fair to say that more action has been taken by our Government in the past to assure conservation of wildlife alone than to help conserve our most precious possessionAmerica's industrial manpower.

The few existing programs scattered and uncoordinated among the several agencies of our Government provide only a limited and superficial degree of recognition to a problem which looms large in the modern industrial life of our country, the problem of physically handicapped workers and of bridging the gap which separates them from self-reliant, productive, useful employment.

Current studies indicate that our economy sustains a loss of over 250,000 workers annually through disablement because of disease or injury.

These homefront casualties are staggering. A very high proportion of them are a permanent loss to the economy, because the rate of rehabilitation is extremely low.

Much of this loss is unnecessary. The vast majority of workers now deprived of means to overcome their disability or to secure employment opportunities can be readily brought back within the ranks of productive wage earners.

In 1952, according to the Department of Labor figures, 2,031,000 workers were injured in occupational accidents in industry.

The immediate loss of productive time directly resulting from industrial injury is estimated to have totaled 41 million man-days in 1952. However, in 15,000 cases, the injury was fatal and in 84,000 additional instances injury resulted in some permanent disability.

Considering their total effect, these 1953 industrial injuries will cause a total production loss of approximately 206 million man-days, or more than 8 times the economic loss caused by all 1953 work stoppages.

These figures establish the tremendous size of the problem of conservation of industrial manpower arising solely from employmentconnected injuries in industry and trade.

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Apart from the loss to industrial production, we also have to consider the loss of income to the wage earners resulting from occupational injuries. Last year the wage loss due directly to accidental injuries sustained while at work amounted to $1 billion.

This represents the cost to the wage earners of the wage loss alone and does not include the heavy additional cost of medical expense and other outlays necessitated by disability.

But the problem with which we are concerned is even greater. Disability and physical handicaps result also from injuries sustained in the accidents occurring on the highways, in the homes, and from other occupational causes.

When we consider that the total annual accident toll in the United States exceed 9.5 million people with over 350,000 persons suffering permanent impairments as the result of accidents, we begin to realize the enormous scope of the nationwide problem which we must endeavor to resolve.

We are confronted today with a situation that can only be described in terms of a crisis. A few more statistics make this quite clear. The estimated number of handicapped individuals in the United States ranges as high as 28 to 30 million. Of this total, about 7 million are severely disabled, being from 60 to 100 percent handicapped.

While these figures are only estimates, there is little doubt that fully 2 million of this total are individuals who are today unable to work fully as a result of a disability and who, at the same time, could be fully employed if they received proper vocational rehabilitation services.

This is the situation confronting the country at the present time.

However, each year this problem intensifies. During 1953, for example, there were 2 million disabling work injuries; there were 1,350,000 injuries as a result of motor vehicle accidents; there were 2,150,000 injuries as the result of nonmotor vehicle accidents; and there were 4,200,000 disabling injuries in the home.

Of course, not all of these injuries were serious or caused serious disabilities. The most accurate estimate is that 250,000 individuals each year suffer disabilities sufficiently serious to put them in need of vocational rehabilitation services. Yet, as President Eisenhower pointed out in his special message of January 18, only 60,000 of those disabled are returned each year to lead a normal life. Moreover, the disabled have to wait many years before they can be given proper attention by the Nation's program for vocational rehabilitation.

It is easy to see that our budget for the handicapped is desperately out of balance.

This is a shockingly low mark of progress in the Nation's effort to conserve and develop human skills and to enable willing and eager persons to become productive and self-supporting members of the community.

Our first and foremost need is to greatly strengthen the machinery established by States under workmen's compensation laws and to integrate the necessary medical care with vocational training, education, and other means for the industrial rehabilitation of the handicapped. Let me point up the urgency of this need by citing from a recent article by Dr. Alexander Aitken, published in a medical journal in September 1952, entitled "The Need for Adequate After-Care in Complete Rehabilitation of the Disabled":