ton has their bowels upset, from the White House down and through Congress and every place else, and all the departments, over major cities. What about the "unmajor" cities which are your country? Dr. STEWART. Mr. Flood, it is true there are many what you call minor cities in the United States, but two-thirds of the people live in the major cities. ORIGINAL RURAL ORIENTATION OF HILL-BURTON PROGRAM Secondly, the Hill-Burton program has been, and was, conducted in such a way 10 years ago, when it started, to provide impetus for the rural areas and smaller communities. Some 75 percent of the projects have been in smaller communities, but in the meantime in the major cities the hospitals have not been able to bring themselves up to date. Any operating room that is more than 10 years old is out of date. In the distribution formula the Hill-Burton money was more likely to go to meet, at that time, what was the greater need for building hospitals in smaller communities. But now we estimate there is a $6-billion backlog in modernizing hospitals. Many of these are in smaller communities, but the bulk is in the larger communities. The population of the large urban centers is increasing, but the hospital construction of modernization has not been. Mr. FLOOD. The reason the population of the great metropolitan complexes in urban areas is increasing is because you are putting everything in there, and everybody is leaving the hinterland to go and get it. You go where the ducks are when you go hunting for ducks, and the ducks are in the big cities, not in the provinces. So everybody is leaving the provinces and going to the big cities, and the big cities are becoming bigger and bigger and bigger. The rich are getting richer and the poor are getting poorer. Happy new year. Dr. STEWART. I don't think they go there because that is where they want to go to a hospital. Mr. FLOOD. Yes, medical treatment, and the whole spectrum of social services, because they are apparently pet pigeons. I don't know if this is for good reason or for political reasons, or who is responsible for it, or what. But I know the Congress is falling over itself to be party to this, and I thought Congress historically was not so controlled, despite the Supreme Court decision of one-man, one-vote-I thought it was quite the contrary, historically, here. But here again in your report you have urban areas, seven of them. What do we do in the provinces-just keep breathing? Dr. STEWART. No, sir. As I pointed out, the Hill-Burton program was originally designed to help the smaller communities and the rural areas. Mr. FLOOD. It is. Dr. STEWART. And we have now met about 89 percent of the needs there, but in the meantime the larger city hospital systems have been deteriorating. Mr. FLOOD. All right. But you won't forget about us? Dr. STEWART. Not at all. RESULTS OF PROGRAMS UNDER EDUCATIONAL ASSISTANCE AND NURSES TRAINING ACTS Mr. FLOOD. On page 4, at the top, you speak about your Educational Assistance Act, and the Nurses Training Act, and all the things you have done. What are your results in numbers? In the Appropriations Committee, this is like the payoff window at Bowie, we are interested in figures. What is the payoff? What about the figures on nurses' training? If you don't have that available, can you prepare some sort of a statistical presentation as to just what the payoff is in numbers? Dr. STEWART. Certainly. Mr. FLOOD. How many nurses, how much assistance, where was it, what part of the country, how many men, women, technicians, nurses, the whole area of these laws. What did we buy? What did we get? Dr. STEWART. Certainly. (The information to be supplied follows:) Estimated number of trainees under the Health Professions Educational Assistance Act of 1963, Public Law 88-129, amended by Public Law 88-654, and the Nurses Training Act of 1964, Public Law 88-581 1. Student loans: Health professions. 2. Projects for improvement of nurse training: Estimated number of students who will benefit by awards in these programs... 3. Traineeships: Short-term traineeships: Estimated number of trainees. 1 Not available. Number of project grants.. Estimated number of students who will benefit by awards in these programs during the period funded. 1 District of Columbia and Puerto Rico. 2 Evanston Hospital Association, Illinois, submitted and was awarded 1 project grant in behalf of a council of 18 participating schools which will benefit from and participate in this i project. 3 Estimated. TABLE 2.-Payments to diploma schools Appropriation.... Total amount of grants awarded.. Number of States.. Number of programs eligible to apply.. Number of programs applying.... Number of programs receiving awards. Number of students enrolled in programs with payments to diploma schools. Total number of students on which awards are based.. Federally sponsored students.... TABLE 3.-Traineeships Fiscal year Number of sponsors of short-term training. Number of courses. Fiscal year 1966 (as of Feb. 15, 1966) It is estimated that 5,140 trainees will participate in short-term traineeships by the end of 1966. District of Columbia and Puerto Rico. Construction grants under the health professions educational assistance program (as of Jan. 18, 1966) MEDICAL LIBRARIES PROGRAM Mr. FLOOD. Now you say you are going to create a national system of medical libraries. I have a medical library in my county that has been running for years, and a very good one, under the auspices of my county medical association. What do you do-forget about me again and set up a lot of new ones? What about the existing medical libraries set up by medical societies all through the country? Dr. STEWART. At the present time, Mr. Flood, the medical libraries, some of which are at medical schools and most of which are not but are located with medical societies or large hospitals or academies of medicine, do have ties in with the National Library of Medicine. Any doctor who walks in your library and wants something and that library does not have it, they can get it from the national library right away. Mr. FLOOD. Do they know that? Dr. STEWART. Yes, they do. We are now beginning to develop regional libraries, which will tie in, and be able to get our medlars tape world literature closer to the man if he wishes. SCREENING TEST FOR MUSCULAR DISTROPHY Mr. FLOOD. I have one more question. On page 14 you refer to: A genetic screening test now permits physicians to identify 75 percent of women who, though showing no symptoms themselves, are carriers of progressive muscular distrophy and transmit this disease to half of all of their sons. Dr. STEWART. That is right. Mr. FLOOD. Say something about that. What is this carrier? Dr. STEWART. A recessive gene. And this is a genetic pattern that would occur, and what we have got now is a way of genotyping the person, screening the women, to find out if they are carrying this recessive gene. If they are, you can figure it transmits the disease to half of all of their sons. This is the standard genetic pattern. The new thing is they know how to do this genetic screening test. Mr. FLOOD. You have done it, and you now have identified a carrier. What do you do about it? Dr. STEWART. I can't go beyond what is said there. This was just developed with the last year or so. Mr. FLOOD. It sounds of great importance if you have the next step. Of course, even this step impresses me very much. Dr. STEWART. I am sure Dr. Masland can tell you more in detail. Mr. FLOOD. The nature of muscular dystrophy, being what it is, being identified is quite something. Dr. STEWART. Yes. Mr. FLOOD. What you do next is something else. COST SHARING BY RESEARCH GRANT RECIPIENTS Mr. FOGARTY. Before we adjourned at noontime I had one more question. What are your current regulations regarding cost sharing by research grant recipients? You can put the regulations in the record. |