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out objection, they will be made a part of the record of the hearings.

(The letters referred to, from Senator Ferguson, Baltimore City Hospital, and the Federal Security Agency, are as follows:)

UNITED STATES SENATE,

Washington, D. C., 28 December 1945. Hon. CLARENCE F. LEA,

Chairman, Committee on Interstate and Foreign Commerce. DEAR MR. CHAIRMAN: I am enclosing a statement which I have received from the board of commerce of Manistee, Mich., setting forth various facts regarding the hospital emergency in that area, and in view of the fact that your committee is at the present time giving consideration to S. 191—hospitals and public health centers—I would appreciate it if the facts set forth in the accompanying statement might be presented to the members of your committee. With best wishes for the New Year, I am Sincerely yours,

HOMER FERGUSON.

A FRANK STATEMENT ABOUT MANISTEE'S HOSPITAL EMERGENCY

Medical care for the Manistee area, as far as hospitalization is concerned, has been under the supervision of a charitable organization known as the Sisters of Mercy, for the past 57 years.

During all of that time the hospital authorities have asked for, and received, a minimum of financial aid from the community. The Sisters have given this area continuous hospital attention for so long a period of time that their seryice has come to be regarded as a matter of course, with little thought as to how it is financed or maintained. The result has been that the building has grown old and steadily deteriorated until the community now finds itself faced with the necessity of meeting a serious emergency if the medical needs of the people are to be housed and properly cared for.

The present building known as Mercy Hospital, after 57 years, is now outmoded, inefficient, unsafe, and costly to maintain. It is inadequate, ill-equipped, and of such ancient design that proper service, in keeping with present-day standards, is impossible. It lacks the compact unity of modern specifications, capable of rendering maximum care with the sensible economy of a minimum staff. The saving of steps and convenient arrangement, so essential for skilled medical attention and nursing care, cannot be provided.

The building absorbs a sprawling floor space, and its accommodations are unable to meet the demands of modern surgical and medical progress. With hardly a capacity for 35 beds, facilities are overtaxed and dangerously crowded, a condition that will definitely increase as hospitalization insurance becomes more prevalent in factory and home.

In order to fairly appraise the physical condition of the hospital building together with its facilities, and substantiate the pressing need for immediate action, the following summary of the property as it now exists is respectfully submitted.

Heating.–Since the building is old and worn through use and exposure during more than half a century, its walls are cracked and the bathhouse section is in a state of absolute decay. The windows and doors are out of adjustment, necessitating an exorbitant amount of fuel for heating. This probably exceeds twice the supply needed to heat a modern building of even larger proportions. Present boilers require frequent and costly repairs and might normally be condemned.

Radiation is antiquated, insufficient and improperly distributed. Safe and healthful room temperatures of an even character cannot be maintained. While the temperature in some parts of the building will rise to 85°, other sections will have a struggle to maintain 65°. The wind pours through cracks in the window casings and drafty air currents endanger the health of patients. Consistent ventilation is impossible.

Floors.-Warped and uneven, with frequent replacement needed due to rotting. Although covered by linoleum, wavy ridges soon appear, causing covering to crack and require repairs. As a result, the rolling of wheel chairs and operating tables over the floor becomes an unsatisfactory and painful procedure.

Door openings.The old-fashioned narrow doors opening into patients' rooms are a serious and dangerous handicap. The fire hazard attending this condition is a severe indictment. In case of fire the sick would be trapped in their rooms for not a single bed can be rolled through the narrow doorways. All inmates would have to be carried to fire escapes which are crude and awkward. The ancient high ceilings require excessive heating. The old plaster is loose and constantly falling, thus adding to the cost of opkeep as well as danger and annoyance.

Plumbing and sanitation.-Obviously the plumbing is old and inefficient. Pipes are rusty and leaky, and sanitation facilities are inconveniently distributed. If any institution has a right to demand new, modern, and up-to-date plumbing and sanitary equipment it certainly should be a hospital of the sick. A careful inspection reveals that the entire plumbing system of the present hospital must be replaced very shortly.

Wiring.-Electric wiring with modern safeguards is an admitted necessity. Most of the electric wiring in the present hospital is very old. Much of it hidden in the ancient walls is dangerous and overloaded. Old-fashioned switches and base plates invite shorts and fire hazards. Many of them are inaccessible and old-fashioned light fixtures are poorly placed. Patients' call lights need replacement and many of the ward rooms have none at all.

Basement.The old basement is of a type that might be found in an ancient prison instead of a hospital. It is dark and damp, with much waste space, dismal walls and uneven floors. Ceilings are a network of exposed heating pipes, water and sewage pipes and electric wires, all too closely congested for safety. A modern hospital building would be able to use such a basement to distinct advantage.

Kitchen.This is one of the most important units for proper hospital attention for the sick and convalescent. The staff at the present hospital have done remarkably well with the facilities at hand, but a new kitchen arrangement with modern equipment is essential to prepare the special diets required for various types of ailments. The work of food preparation and the distribution of trays is multiplied many times on account of the existing set-up.

Passenger elevator.—Here is an antiquated bit of curiosity that should be in a museum. The elevator in use in this modern age in our present hospital is an old, creaking, water-operated antique that is as dangerous as it is inefficient. In its day it probably served quite well, but that was over 50 years ago. After one look at it, patients have expressed a desire to crawl upstairs rather than run the risk of riding in it.

Operating rooms.-In keeping with the rest of the building, the operating rooms are old and unmodern but make a valiant attempt to meet all emergencies. They are small, crowded and inconvenient. There are only two such rooms at present and often urgent cases must wait their turn. Additional operating rooms are a definite requirement.

Summary report.-A competent architect and construction engineer, experienced and expert in hospital designing, has carefully inspected the physical property of the present hospital and rendered an opinion that the cost of any attempt to remodel and modernize the building and equipment would not only be an unwise business venture but thoroughly prohibitive. It would mean throwing good money away, and the results would still prove inadequate.

What shall we do?—By all means build a new hospital. After an exhaustive study of the whole situation, this committee recommends that an entirely new and separate hospital building should be constructed just east of the present unit. The present grounds are satisfactory and represent a commanding site. The view from the proposed new building would overlook Manistee Lake, a beautiful and inspiring panorama, with good air, sunshine, and a healthful atmosphere.

Proposed new building. The proposed new building would be of three stories and full basement. It will be of brick and concrete construction and thoroughly fireproof. It will be entirely separate from the old building and connected with it by a wide, covered cori dor. The estimated size yould 40 feet wide by 150 feet long, and approximately 50 feet high. This would provide accommodations handily for 60 patients.

Basement.-It is proposed that the basement would contain a boiler room with stack, oil burners, and three boilers, two low pressure, and one high pressure. Also it would house a modern kitchen with special adjoining diet kitchen. Bathhouse and facilities for men and women, and bath patients' own dining room; also essential maintenance shops and customary workrooms.

First floor.Offices, waiting rooms, and private rooms for patients.

Second floor.—Private, semiprivate, and ward rooms for patients. Obstetrical beds, two delivery rooms, and nursery. No surgical cases on this floor.

The sep

aration of obstetrical patients from all others is now a standard rule in modern hospitals.

Third floor.-Two thoroughly equipped operating rooms, with X-ray rooms and associated laboratory. Pathological and biological laboratory. Cast and fracture room. Surgical cases and some beds for medical patients.

A quiet and modern electric elevator will operate from basement to roof, capable of taking beds and stretchers to any floor and also serving a glassenclosed solarium on the roof.

How much will it cost?-Consulting engineer on hospital construction estimates the minimum cost for new building as above outlined will be $250,000.

How shall we raise it?-By popular subscriptions. This is our community and our hospital. For the health and welfare of the community and for the safety of those we love, we need a modern hospital and we need it badly. There is only one way to get it, and that is to make a personal sacrifice and go after it.

What is the plan?—To organize a fund raising campaign enlisting the united and determined effort of all people in the city and county. Local industry is urged to take the lead and spark the campaign with substantial gifts. Inspired by strong intial subscriptions, all local civic groups and organizations will be asked to fall in line and share generously in the effort.

Fraternities, societies, clubs, religious groups, merchants, professional men, and the rank and file of our citizenry will be expected to join wholeheartedly in support of the project, which will obviously be for the common good and benefit of all,

THE TIME TO START IS NOW

Pledges must be governed by a long look ahead, with payments spaced over a period of from 3 to 5 years. In studying our tax calculations for this year and into 1946, we should resolve to keep some of this tax money at home rather than pour it all into Federal coffers.

The first law of nature has always been the care and preservation of human life and the relief of human suffering. One of the keenest duties encumbent upon us is to surround our fellow men with every facility for this purpose. Manistee's greatest need at the moment is a new hospital, and we can have it if we have the will to work and sacrifice for it.

Other committees have pulled themselves up by their boot straps and met similar emergencies. So can Manistee. From weakness comes decay, but strength moves on to greater strength.

Manistee Board of Commerce Temporary Hospital Committee: GORDON JOHNSON, Chairman.

CHARLES O'DONNELL. OSCAR F. LUNDBOM.

CHESTER L. ADAMS. CHESTER C. WELLS.

WALTER HARDY, JR. E. C. HARDY.

WALTER HOLLINGSWORTH.

BALTIMORE CITY HOSPITALS,

P. J. McMILLIN, SUPERINTENDENT,

4940 Eastern Avenue, Baltimore 24, Md., March 11, 1946. Hon. CLARENCE F. LEA,

House of Representatives, Washington, D. C. DEAR REPRESENTATIVE LEA: Because no Representative from our home State is a member of the committee, I am addressing this same letter to each member of record of the Committee on Interstate and Foreign Commerce of the House of Representatives. This accounts for the fact that the letter is duplicated. I hope you will not object to this manner of saving time.

As past-president of the Maryland-District of Columbia Hospital Association, I am writing you regarding the socalled Hospital Survey and Construction Act which was guided through the Senate as bill S. 191, passed by that body under date of December 11, 1945, and now before your committee, or a subcommittee, for consideration. It is my understanding that hearings on this bill are being held, or about to be held, at the present time.

It would seem unnecessary to offer evidence of the need for additional hospital facilities in our land. Everyone who has given the subject any thought accepts this need as a fact. Further, everyone who has given the subject serious thought agrees the additional hospital facilities needed cannot be made available except as agencies at the local level get financial assistance. The only possibility of such assistance is through Federal aid. Hospital folks and governmental authorities alike have unanimously agreed on the above as facts. The only difference of opinion has been on the conditions under which the necessary Federal aid might be made available.

As hospital folks have studied this problem over recent years, certain pertinent points have come sharply into focus, for example, not only have they found a serious need for additional hospital facilities, but they have found that the distri. bution of these facilities is just as important as the need itself. They have also found that there must be more outside financial assistance in some States than in others. The answers to these, and other related questions are included in the Hospital Survey and Construction Act mentioned above.. This legislation was worked out in cooperation with representatives of the people in the Congress, and represents a meeting of minds on all debatable points. It is approved by those who know the hospital field, by community leaders everywhere, and by an adequate number of United States Senators to bring about passage in its present form.

As this act was guided through the Senate and just before the bill was passed, Senators Murray and Wagner 'made a strong appeal to weaken the authority of the Federal Hospital Council provided for in the act, and suggested other amendments which would have tended to concentrate power on the Federal level. However, these efforts to change the character of the bill by amendments were successfully resisted. The American Hospital Association, all the State hospital associations, and in fact, everyone interested in the health and welfare of all of our people, hope that you will find it possible in your wisdom to support this legislation and to resist any attempt to materially change it from its present form. Mr. James Russell Clark, Director of the Washington Bureau of the American Hospital Association, 1705 K Street NW., will be glad to furnish any factual material you feel you may need for proper consideration of this bill when it comes before you for your attention.

The writer, together with hospital folks and community leaders in our area, urge that you check this legislation completely, believing that having done this, there will be no doubt about your complete support. May we extend in advance our appreciation for your help. Yours truly,

P. J. McMILLIN, Superintendent.

FEDERAL SECURITY AGENCY,
OFFICE OF THE ADMINISTRATOR,

Washington 25, February 7, 1946. DEAR MR. LEA: There are pending before your committee two bills, S. 191 and H. R. 4730, in which this Agency is deeply interested. S. 191, as you know, is the proposed Hospital Survey and Construction Act passed by the Senate, and H. R. 4730 the proposed National Health Act.

I take the liberty of suggesting that your committee give consideration to S. 191 in advance of your consideration of H. R. 4730. S. 191 falls in a relatively narrow compass as compared with H. R. 4730. It was passed by the Senate with the support of both parties, and at least in its main features I think can fairly be described as noncontroversial. The planning and construction of hospitals will be necessarily be a time-consuming undertaking. Yet the provision of these facilities is basic in our progress toward improving the national health. Therefore I earnestly hope that S. 191 may be passed and the program got under way within the next few months.

We shall probably wish to suggest some minor revisions of S. 191 at the appropriate time. Sincerely yours,

MAURICE COLLINS,

Acting Administrator. Hon. CLARENCE F. LEA,

Chairman, Committee on Interstate
and Foreign Commerce,
House of Representatives,

Washington 25, D, C.

INDEPENDENT CITIZENS' COMMITTEE OF THE
ARTS, SCIENCES, AND PROFESSIONS, INC., .

New York 19, N. Y., March 8, 1946. The Honorable J. PERCY PRIEST,

House Office Building, Washington, D. C. DEAR CONGRESSMAN PRIEST: Attached please find statement of the medical advisory board of the Independent Citizens' Committee of the Arts, Sciences, and Professions on the hospital-construction bill now being considered in the House Committee on Interstate and Foreign Commerce. Sincerely yours,

JOHN P. PETERS, Chairman Medical Advisory Council.

The Medical Advisory Council of the I. C. C. A. S. P. heartily approves the purposes of the Hospital Construction Act, S. 191 and the corresponding House bills, H. R. 2498 and 2755, introduced by Congressmen Nealy and Patrick, respectively. The construction of adequate hospitals is an essential step toward the pr vision of medical care to the people. If these facilities are to be adequate they should be planned in advance to meet the needs of the areas in which they are to be constructed. Both planning and construction should be on a national basis because health needs are not limited by State boundaries and because without Federal aid some States would probably be unable to assume the burden of planning and construction.

There are, however, certain serious defects in the bills as they now stand which may jeopardize the programs which these legislative proposals are intended to promote. These defects were ably exposed by Senator Murray in his minority statement to the Senate Subcommittee on Education and Labor. Despite the efforts of Senators Murray and Wagner to correct these errors, S. 191 was passed by the Senate without amendment. The Independent Citizens' Committee strongly urges that your committee take steps to correct these errors.

1. The Independent Citizens' Committee views with sympathy the effort to grant States and communities autonomy in the conduct of their programs. The Federal Government must, however, be invested with sufficient regulatory powers to insure the proper use of the public funds granted to the States. In the present bills the Federal Government is empowered to prescribe standards and regulations for the nature, distribution, financing, and construction of the hospitals and health centers. Standards for the maintenance and operation of these facilities, on the other hand, are delegated entirely to the States. At least minimum standards should be established by the Federal Government to prevent misuse of Federal funds by any individual State. This will leave the States ample room for desirable local variation and experimentation above the level of minimum standards.

2. Provisions should be added to assure the general use of these facilities by physicians as well as patients. Such provisions should be so drawn that they will not prevent the proper organization of a hospital staff with respect to the competence of its members and the most effective utilization of the hospital facilities; but so that they will prevent the exploitation of these facilities by certain individuals to the exclusion of others for reasons not related to the public interest.

3. The administrative provisions are highly objectionable. Essential administrative functions and veto power over the responsible administrator are vested in a Federal council. This dissipates responsibility. The Independent Citizens' Committee strongly endorses Senator Murray's recommendations on this subject. Authority should be vested as it was in the previous bill, in the Surgeon General, who may be held directly responsible for the conduct of the program. The Federal Hospital Council should have only advisory powers. In order that it may not be neglected it should be made mandatory upon the Surgeon General (1) to consult the hospital council on all matters of policy, and (2) to publish a report of consultations with the hospital councils and the recommendations and decisions of this body.

4. Without additional legislation it may be impossible to operate or even construct these hospitals in some of the poorest communities that need them most. There is before Congress legislation directed toward the institution of a national health program which would solve the problem of paying for the costs of medical care and hospitalization. Whatever may be the immediate fate of

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