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done while I was here and some things I have done that I should not have done.

The United States Conference of Mayors passed a resolution last December at its annual conference approving this type of legislation before any action was taken by the Senate committee. I would like to put that resolution in the record.

Mr. PRIEST. It may be included without objection. (The resolution referred to is as follows:)


Whereas there is great need for the expansion, construction and modernization of municipal health and hospital facilities, and

Whereas the Education and Labor Committee of the United States Senate has given approval to a program of Federal aid to municipalities for hospital construction, expansion and modernization: Now therefore be it

Resolved, That the United States Conference of Mayors in annual conference assembled urges the adoption of pending legislation as recommended by the Senate Education and Labor Committee.

Mr. CHANDLER. Then a number of the cities have written, expressing approval of the bill. And I believe, for the information of the committee, those letters could well go into the record, if agreeable.

The letters referred to were received from the following cities :
South Bend, Ind.
Fort Worth, Tex.

Covington, Ky.
Norfolk, Va.
Pittsburgh, Pa.

Rome, N. Y.
Birmingham, Ala.
Chicago, Ill.

Pontiac, Mich.
Jamestown, N. Y.

St. Petersburg, Fla. Wichita Falls, Tex.
Toledo, Ohio
Columbus, Ga.

Newport News, Va.
Bay City, Mich.
St. Paul, Minn.

Niagara Falls, N. Y.
Saginaw, Mich.

Atlanta, Ga. Winston-Salem, N. C. Kansas City, Mo.

Mr. PRIEST. Without objection, those letters will be filed with the committee.

Mr. CHANDLER. I think, in general, this is a very progressive piece of legislation. I do not believe that it is a party measure, but that it is an economic and a health measure.

It seems to me, obviously, that the most important thing in the world is human life, and the most important factor in human life is good health; and disease, strangely enough, is no respecter of State lines. That being true, it is the responsibility of Congress, it seems to me, to meet a growing problem which manifested itself very seriously in the examination of the young men who went into the military service in World War II.

For the State of Tennessee, I have these figures: 40 percent of the young men who were examined for induction were declared physically unfit. That is white. Among the Negroes, 57 percent in Tennessee were declared physically unfit.

Our State is not a particularly backward State in the matter of hospitalization, and as a matter of fact, the general average over the country was not much better than that.

Mr. Brown. You served in Congress too long. You suspected what we said to Mr. Priest.


Mr. CHANDLER. This bill recognizes one factor that impresses me, and that is the importance of health centers in the smaller areas. That strikes me as being the outpost, as we would call it in World War 1, on which the contacts come with the enemy which I could call germs in this case, and they work themselves up to the main line of defense, which would be the large centers where the hospitals are. And this program I could visualize as moving forward up to the main line of attack on what I regard as a very important thing in American life, the health program.

It seems to me that this bill is the first step in a great direction. It will cost money. I realize that. We all do. And yet in this country we have a lot of money. Our resources have hardly been tapped. This is not a bankrupt nation by any means.

Mr. Brown. Have you read the latest Treasury statement, Mr. Mayor?

Nr. CHANDLER. Yes; I have. And if Mr. Brown's party should come into power next year, you would still have a very rich country.

Another thing that is going to be noticed, the servicemen who are coming back from this war have had the benefit of the best hospital treatment and the best hospital service that could be given, and it has been good.

I believe Mr. Brown made the point the other day that it was overdone, that they had too many doctors in the service, but they had the best. They are not going to be satisfied with anything other than competent and efficient hospital service. They have learned about it. They have been cured by it and they have been benefited by it.

The health standards of this country are still low, as you will find in a study of the hearings before the Senate committee.

Mr. WINTER. They are the highest in the world.

Mr. CHANDLER. They are still the highest in the world, but still low for a country like ours.

Mr. WINTER. But the highest in the world.

Mr. CHANDLER. The survey that is going to be made, if this act passes, should develop not only the deficiencies in the present hospital system over the country, but it will result in a standardization, it seems to me, on a highly efficient plane, such as the United States Public Health Service can do and does in the other phases of your health program which have already been enacted into law.

I think that that alone would justify the passage of the first phase of this bill.

You will find there is some overlapping in hospital services, in duplication of service. I think the surveys will eliminate those.

I think, also, that this bill is going to be highly important in the field of prevention. In that field, we are going to find that we will increase the productive capacity of the country. If you just think of the tremendous loss in man-hours during the war, you will realize that. You all know more about that than I do, because those facts have been presented to you time and time again.

Of course, the whole nation is affected to some degree by poor health conditions.

Another thing that I would like to bring out in my testimony is this: The relationship between disease and poverty,. The health centers were originated through the desire of the welfare agencies to take care of poor people who were sick, and sick people who were poor. And this program really began as a voluntary program and extended itself from year to year by reason of its increased usefulness.

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I want to make this point, too. I used to practice law. I have had some experience with bankruptcy law. I have made some studies of bankruptcy law and worked on bankruptcy acts while in Congress. Bankruptcy proceedings will show a tremendous amount of debt for sickness, hospitalization, nurses, doctors, and surgeon's bills. One serious spell of sickness will bankrupt the average workingman. And when you take that into consideration and realize the economic effect of improving the health of this country, aside from the actual usefulness of the citizen, why, you realize that if you can raise the standards of health of this country, you raise the workingman in many instances from a bankrupt to a solvent, responsible citizen.

That is a fact which I would like to impress on you because I know that that is true.

You look at the voluntary bankruptcy proceedings, Mr. Brown, in your county, and you will see how many of those bankruptcy proceedings have been brought on by serious illness in the family.

Take the question of people taking care of themselves: 21 percent of the families in this country receive less than $1,000 per annum, 21 percent; 29 percent receive between $1,000 and $2,000 per annum income; 20 percent between $2,000 and $3,000.

Mr. WINTER. Do you have those percentages divided into States and by size of community?

Mr. CHANDLER. No, sir; I have not.

Mr. WINTER. An income of $1,800 in a town the size I live in would be equal to $5,000 here in Washington.

Mr. CHANDLER. There is no doubt about that. Seventy percent of the country gets less than $3,000, and 20 percent receives from $3,000 to $5,000; 10 percent over $5,000 per annum. That is about the way the picture is.

So you have 70 percent of the people in this country who potentially are in need of assistance of this kind.

Mr. Brown. You are not suggesting, though, that Congress prepare to subsidize 70 percent of the people, are you?

Mr. CHANDLER. No, but I am trying to show the field over which this service can be beneficial.

No; I am not in favor of subsidizing any more people than you have to.

It is true, though, that the health clinics in the smaller communities and the hospitals, whenever they may be, will make it possible to reach the medically indigent, as they were called in hearings before the Senate committee, at the incipient stage, and will go a long way toward preventing not only the bankruptcy that I referred to, but the development of chronic diseases mentioned by the gentlemen who preceded me, and have the effect of obviating in many instances the unemployability of many people who are weighed down and overburdened and disabled by chronic diseases.

Insofar as this program is concerned, the greatest need of it is in the rural sections, in the smaller communities, where the absence of a hospital means the absence of a first-class, all-around modern doctor.

Mr. WINTER. What do you term a rural community?

Mr. CHANDLER. I would term a rural community a county with 3,500 population or counties with even larger population. I mean counties that do not have cities in them; that is, cities of 25 to 50 to 75 thousand.

Mr. WINTER. You are advocating one of these health centers based on counties up to 2,500 or less, with population figures of that kind?

Mr. CHANDLER. I do not know if you would have need for one of that size in those counties. It might be. The survey would show the need.

I am saying that where there is not a hospital the doctor is not going to stay, if he is a doctor with ambition and incentive. He is not going to stay there. The people will be left behind and will feel the absence of a good doctor.

Mr. WINTER. I think that is one of the mistakes that the doctors of the country are making.

Mr. CHANDLER. It is surprising, though. We have a University medical college, in Memphis. It is surprising, those doctors come from the country, and they come there and they will stay right there in the city, because they have hospitals, and the college, to keep on learning, and they have the teaching facilities.

Mr. WINTER. From a financial standpoint, I could tell a lot of them they are making a lot of mistakes.

Mr. CHANDLER. We are trying in Tennessee to get them to go back to the communities where they came from.

Mr. BROWN. That trend has started, has it not?

Mr. CHANDLER. I think it has, Mr. Brown. Those in the armed services that have been practicing in these fine hospitals, are going to feel the need of them and going to recognize the absence of any hospital, and that is going to be a deterrent to their going there.

Mr. WINTER. The doctors in my community that were in the service, and some of them are good, every one of them have all come back to their practice, every one of them.

Mr. CHANDLER. That is good. They probably had established practices before they left.

Mr. WINTER. They did.

Mr. CHANDLER. The same thing applies to a human being, regardless of whether he is a doctor or a lawyer, or whatever he is. He will leave the rural sections where he cannot get modern conveniences, and electric lights, and sanitary facilities. He will go to the cities.

It is going to be hard to get him back on the farm. And the same thing is true of all.

Mr. WINTER. It would not be very hard if this thing keeps on going. They will have to get out and raise something to eat.

Mr. CHANDLER. We can use a great many on the farms in the South now.

Mr. Brown. I am afraid that you just have not been out in the country lately.

Most farm homes, in our section of the country at least, have electricity and bathrooms and all of these facilities you talk about.

I do not know many farmers who live under other conditions.
Mr. CHANDLER. You live in a highly developed State.
Mr. BROWN. I have been down through Tennessee.
Mr. CHANDLER. Tennessee has TVA.

Mr. Brown. That is one thing that you have to give Ohio credit for, because we have certainly paid for it.

Mr. CHANDLER. You surely helped. You helped and we bought many a rubber tire from Ohio for the automobiles, too.

It is a reciprocal thing.

But, so far as Memphis is concerned, let me say this to you, an illustration of a rule that prevails over the country. People will bring their sick to the city. They will come with the sick. They will stay there, as near as they can get to them. It costs money. But cost means very little when a person is in pain and suffering.

And the result of it is that Memphis has very fine hospitals because people in those rural sections of Mississippi and Arkansas and southeastern Missouri and Tennessee will come there with the sick folks, but it is, as I say, very costly. They have got to stay away from home. It is a very expensive thing.

If the hospital services could be moved closer to the homes of the people, it would be a much more useful service.

Of course, one State cannot legislate for another State, but Congress can legislate for the whole country and establish the standards which, I believe, in the discretion of these boards, these agencies, and councils, will be pretty safe standards.

Finally, insofar as the cities are concerned, we in Memphis have a fine college.

This program will fit well into a city with what you call the larger health center, where the doctors, the young doctors, can be taught, where the teaching hospitals surround the health center. They ought to be close together. And as that is done, the benefits will extend themselves to the rural areas.

The benefits that modern medicine offers to the city will filter through in time, if there is a place for them to go, in the smaller areas:

Take, for instance, Memphis, State lines mean very little to us. We are getting ready to build a Negro hospital in Memphis.

Mr. Brown. We have them up in Ohio.

Mr. CHANDLER. Our municipal hospital is 75 percent occupied by Negroes. That is our city hospital. We have spent a million dollars a year maintaining our general hospital there.

We are going to build a separate Negro hospital, not to take them out of the general hospital, but to provide a place where Negro doctors, Negro nurses, interns, can come and treat their own patients, and they, in turn, learn something about their profession, and then can go to the rural sections and treat their people, so that they will not have to come to our hospitals some day.

The dirth of Negro physicians and nurses and attendants and interns is appalling in the South. It is one of the difficulties that we face.

We are trying to solve that great problem.

The State of Tennessee, of which the chairman of the subcommittee is a very worthy representative, has 53 counties which have no general hospital facilities at all. We need about 6,770 beds to make up our quota of 13,050 beds based on that desirable basis set forth in the Senate hearings. Because this question would

naturally concern the Health Commissioners of the various States, I asked our own Health Commissioner, Dr. Hutcheson, to write a letter, which I will ask be put in the record. I think it will shed some light. He is the head of our State program.

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