they are urgently needed by the bureau. It has never been the policy of the bureau, nor of Congress, to confine hospitalization by State lines, or to consider that veterans from a given State were not properly provided for when they are in a bureau hospital, even though it might be outside of that State. It is probable that the provision of additional facilities which have been authorized for New York and New Jersey may relieve the immediate situation in Pennsylvania to some extent.

At the same time and following the establishment of a bureau hospital in a State, it would not be the policy of the bureau to provide additional facilities for patients from that State in some other State, unless the requirements of the service could better be met by such procedure. In the case of beneficiaries from Pennsylvania there would appear to be no question that they could be provided for to better advantage at Coatesville than at other bureau hospitals for neuropsychiatric cases.

You may be assured that the bureau will give full cognizance to the needs of Pennsylvania in connection with future construction programs, and that in connection with such studies the availability for enlargement of bureau hospitals in Pennsylvania will be duly considered. At the same time I believe that until the general policy of the Government regarding the hospitalization of nonservice-connected cases has been further defined the enlargement of facilities to the extent which has been suggested should be deferred.

Very truly yours,

FRANK T. HINES, Director.

Mrs. ROGERS. We will be very glad to hear you, Congressman Porter.

STATEMENT OF HON. STEPHEN G. PORTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA

Mr. PORTER. Madam Chairman and gentlemen, about five or six weeks ago the entire delegation from Pennsylvania, with all members present with the exception of two who were absent on account of illness, held a meeting, at which the officers of the American Legion from Pennsylvania were present. In effect we conducted a hearing, and, as Mr. Welsh has stated to you, it was the unanimous view of the entire delegation that we should support these highly meritorious

measures.

I agree with Mr. Welsh that it would not be quite fair for us to go into the details, in view of the fact that the facts have been assembled by the officers of the Legion, who will appear before you to-morrow. My only purpose in appearing is to assure you that the entire delegation is in support of these bills; and, incidentally, we represent one-seventh of the Republican membership of the House.

Mrs. ROGERS. Yes; I know. We are very glad to have your state

ment.

Mr. PORTER. I thank you.

Mr. WELSH. Madam Chairman, may I ask you to hear a few words from Mr. Wolfenden, who introduced H. R. 10527? Coatesville happens to be in his district.

STATEMENT OF HON. JAMES WOLFENDEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA

Mr. WOLFENDEN. I had the honor of presenting this bill, and it was based on figures that were furnished by the American Legion. I have those figures, but I do not feel that I should present them. I met with the Pennsylvania delegation, and all that I am able to do

at this time is to reiterate what Mr. Welsh, the chairman of the submittee of the delegation, and Mr. Porter, the dean of the delegation, have said. I am heartily in favor of this hospital legislation, and hope that the legionnaires will be given consideration to-morrow. Mrs. ROGERS. You are asking for 770 beds?

Mr. WOLFENDEN. Seven hundred and seventy beds, in addition to the present hospital.

Mrs. ROGERS. Making a total of

Mr. WOLFENDEN. One thousand two hundred and fifty.

Mrs. ROGERS. We are very glad to have your statement, and will be very glad to have you file any further evidence, if you wish to, after the legionnaires have appeared to-morrow.

Mr. WOLFENDEN. I will be glad to do so. I thank you.

Mr. WELSH. Mr. Swick has introduced H. R. 11584, and he would like to give you a little outline of the bill.

Mrs. ROGERS. Mr. Swick is a member of the Veterans' Committee. We shall be very glad to hear from him.

STATEMENT OF HON. J. HOWARD SWICK, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA

Mr. SwICK. Madam Chairman, I wish to speak for Pennsylvania, and particularly for Aspinwall in Pennsylvania. I want to speak just a word for all of the hospitals in Pennsylvania, but particularly the one at Aspinwall, the one in which I have been vitally interested ever since I came on the World War Veterans' Committee three years ago.

Soon after I came here I began trying to get some additional beds at Aspinwall. I went to the hospital and made a study of conditions there, and found that there were on the waiting list all the time from 50 to 75 men-nonservice-connected cases, however, but that many practically all the time. So I took up with the committee the question of having a 50-bed addition at Aspinwall.

Mrs. ROGERS. May I interrupt you for a moment? The Veterans' Bureau granted you a certain appropriation without coming to the committee?

Mr. SWICK. Yes. We have that promise of those 50 beds, and we expect to have them by late this fall. But there are so many peculiar needs surrounding Aspinwall that it seemed to me, with that great center there, so near to Pittsburgh, that the most economical way to conduct a hospital is to have about 450 to 500 beds. Aspinwall now has but 180 beds, and will only have 230 with this additional 50. So I have introduced this bill, H. R. 11584, calling for 200 additional beds at Aspinwall. I have asked the manager there to give me some special reasons why they should have these beds at Aspinwall, and I am going to read part of this report [reading]:

The hospital should be increased by at least 200 beds to take care of the veterans now hospitalized in other hospitals in the vicinity of Pittsburgh and to increase the facilities of this hospital for the care of general medical and surgical cases.

It was

Mrs. ROGERS. You have tuberculous cases, have you? Mr. SwICK. Yes. It is a T. B. hospital, understand. opened October 10, 1925, as a T. B. hospital exclusively, but the T. B. cases are now on the wane and the general medical and surgical cases

are on the rise. And so to-day we feel that it should be made not only a T. B. hospital but that it should also have beds for general medical and surgical cases. [Continuing:]

Second. That there are a number of cases hospitalized in contract hospitals other than Government hospitals which would be taken care of by making such an addition to this plant as recommended by you.

That it would cost infinitely less, as explained to you upon your visit to this hospital, to increase this plant, as we have provided at this time facilities for heat, sewerage, water, recreation, kitchen and mess hall, as well as acreage which would take care of more than twice the present bed capacity.

We have now five 100-horsepower boilers there, and there are only two of them being used. Those boilers have been in existence there for the last six years, and they are rusting and wearing out faster in nonuse than they would in use.

So I say that if we want these hospital beds at the least cost to the Government, we can get them at Aspinwall cheaper or as cheap as we can get them at any other spot in the United States. That is a great military center there, too. In an area of 50 miles from Pittsburgh, or from Aspinwall, there are more than 3,000,000 people. So with a trip of less than 50 miles these ex-service men can be brought to Aspinwall, whereas now they have to travel all the way to Walter Reed or to Philadelphia or to Perry Point. [Continuing:]

With the 200 additional beds all types of cases could be cared for-tubercular, general medical and surgical, and mild forms of neuropsychiatry-thereby eliminating the necessity of transferring the latter two types of cases to either a general medical and surgical hospital or an N. P. hospital, saving large transportation costs.

This station, as it now stands, cares for tubercular cases only. Necessarily our present staff are highly specialized in tuberculosis. With an addition of 200 beds, and changing of the hospital to a general medical and surgical hospital, caring for all types of cases, our staff would be more versatile, enabling them to fully diagnose every case and prescribe treatment which would then be given at this institution.

Right here I would like to say a word about diagnostic centers. I heartily agree with our chairman, Mr. Welsh, that we should have a diagnostic center in Philadelphia. The time will come, however, when there will be a small diagnostic center at each one of these great medical centers, and Pittsburgh is a great medical center to-day. We have our university there, and we have some of the most outstanding specialists in the country right in the city of Pittsburgh. Philadelphia is another great outstanding center. And this is what the bureau is doing to-day: They are training men; they are putting on a postgraduate course at Mount Alto, here in Washington, and if the plan is carried out as they have outlined it they will send to these various diagnostic centers all over the country these highly trained men, who will be able to diagnose; and it has been my contention since I have been in Congress that the first thing to do is to find out the condition of the man and what treatment he needs. For the first 10 years since the war they have, in a way, failed in that. It has been nobody's fault. It is simply because it has not grown up, we might say. They have not injected into it the diagnostic center until just recently, and it seems to me it is one of the most essential things that we have in the treatment of these cases. So I hope we can get a diagnostic center at Philadelphia, and then from that we can have some of those highly trained specialists sent out to Aspinwall. That is what the ex-service man needs. I think

that is the thing that he needs to-day above all others; that is, to find out the real cause of his trouble and then it can be treated in almost any hospital.

This would give a chance for these men to be hospitalized near their homes. Within a 50-mile radius there are, as I said before, 3,000,000 people, and these men could travel, and their friends could travel to see them, in an hour and a half or two hours. And if the question of State lines-which up to the last year we had tried to forget-is to be a paramount question, and if every State is insisting on having hospitals, then, in all fairness, Pennsylvania deserves just what we are asking here to-day-a diagnostic center at Philadelphia, with the additional beds there; a hospital in the northwestern part of the State to take care of tuberculosis alone, and these additional 200 beds at Aspinwall.

Mrs. ROGERS. It really does not make much difference how many we build and how much we spend, so long as we take care of the men and women veterans, but we must try to work intelligently.

Mr. SwICK. I want to take care of the men. That is the primary question in my mind, and it is just a question of how we can work

it out.

I have in my mind another very important thing, and I think, if I may, I shall have it placed in the hearings.

The recent survey made by the American Medical Association reveals a startling fact, and that is that in the past year only 65.5 per cent of the beds in all of the civilian hospitals in the United States have been occupied. In other words, 3412 beds out of every 100 have been vacant every day in the past year-the lowest rate that has ever been known in the United States. Now, I am going to introduce in the House to-day or to-morrow a bill calling for a survey of all hospitals in the United States, with this idea in mind: If the Veterans' Bureau is going to continue to build hospitals and hospitalize, and put out of business civilian hospitals, then it looks reasonable to me, as a matter of economy and common sense, that we should take over one-third of all the civilian hospitals in the United States and make them veterans' hospitals; because more than one-third of the beds in civilian hospitals are vacant to-day, and have been every day in the past year, and I think that one of the most vital questions that we are confronted with in this country to-day is the hospital stuation.

Mrs. ROGERS. Will the medical profession fight our providing more hospitals, do you think?

Mr. SwICK. You mean more veteran hospitals?

Mrs. ROGERS. Yes.

Mr. SwICK. I think they will be heartily in accord with it.

Mrs. ROGERS. And they will join the veterans' medical service? Mr. SwICK. I should think they would. I do not think there will be any fight on their part.

Mrs. ROGERS. I understood that it was coming. That is why I asked the question.

Mr. SwICK. In my own county we have three hospitals. They are hospitals of about 80 or 90 bed capacity each. Now, I find that those three hospitals have been struggling along, all with a deficit, all in the red, because they have only 651/2 of those beds out of 100 full all the time. It costs $3 a day to keep an empty bed, and it costs

$3.80 or $3.85 to keep a bed occupied. So you can see that it is an absolute injustice on the people of the United States, because the hospitals are supported in three ways-by State aid, by the patient himself, and by charity, through community chests, the Red Cross, and so forth-and the taxpayer pays the bill. If a hospital has more than 15 per cent of its beds vacant, it can not prevent operating at a loss.

So I am insisting that we think these problems through, with an idea of saving to our Government millions of money in the next few years. I am heartily in accord with this hospital program, but I think there should be a survey made in order to find out just how many hospitals are being used and how many beds are vacant to-day. Mr. FENN. Doctor Swick, I notice in your bill that you mention no figure of cost. Have you made any estimate in regard to that? Mr. SwICK. No; there was no estimate made.

Mr. FENN. You simply say, " Such sum as is necessary."

Mr. SwICK. It costs about $2,500 a bed; so for 200 beds it would be $500,000-although this will be much less than that. They have the ground and they have the other facilities.

Mr. FENN. I think the committee would like to have the figures as to the cost.

Mr. MADIGAN. The cost runs from $2,000 to $2,500 a bed for additions to existing hospitals.

Mr. FENN. Doctor, you say you do not think that State lines should prevail in this hospitalization?

Mr. SwICK. I was taught that when I first came to this Congress.. That was the idea, and with that idea I grew up.

Mr. FENN. Let me ask you another question. There is to be a new hospital-I think it is under construction, although I am not informed as to that-a 400-bed hospital in western New York, and I understand it is to be near the northern line of Pennsylvania. Now, how far is Aspinwall from the New York State line?

Mr. SwICK. Aspinwall would be about 125 miles, I should say, from the New York State line.

Mr. FENN. This is a 400-bed hospital to be erected in western New York for general hospitalization. Your bill, as I read it, provides for general hospitalization in Aspinwall.

Mr. SWICK. In Aspinwall; yes.

Mr. FENN. I was wondering if they would not overlap each other if we regarded State lines.

Mr. SWICK, Well, even at the shortest distance, they would still have to travel some 65 miles.

Mr. FENN. What would that be-by auto or by rail?

Mr. SWICK. Either way.

Mr. FENN. About 65 miles to the New York State line?

Mr. SwICK. It would be more than that. It is 125 miles. It would be probably 200 miles from Aspinwall. Yes; it would still be a matter of 85 to 100 miles to travel to get to the New York State line; I mean from the mid-point. That is what I am talking about. Mr. FENN. How far will it be from Aspinwall?

Mr. SwICK. It would be probably 150 miles from Aspinwall. But the great mass of the population is right at Aspinwall. There in the city of Pittsburgh, and with its surroundings there are 3,000,000 people within a radius of 50 miles.