assigned to 28 American consulates abroad for the pre-departure examination of alien applicants.

EFFECT OF HOUSE REDUCTION

The House action reduced the request by $50,000. As a result of this reduction, planned increase in inspectional personnel and improvement in applying quarantine coverage on the Mexican border cannot be effected.

MEXICAN BORDER PROGRAM

Senator HILL. Did they hope that all the savings could be effected on the Mexican border? Was that the hope of the House in making that $50,000 reduction?

Dr. SPENCER. I am not certain. That would be in addition to the present operation which we had hoped to supplement. Apparently if left out, it would be recognized that this item would not be effective. Senator POTTER. You got $2,900,000 last year?

Dr. SPENCER. Yes.

Senator POTTER. You plan to put on additional inspectors on the Mexican border. That was the reason for your request for additional $100,000?

Dr. SPENCER. Yes, sir, that, and the effect of the fringe benefits that were added by legislation this last year to take up the remaining portion of the $100,000; yes, sir. Itemized, it is personnel $51,000, fringe benefits approximately $50,000.

New crossing points are being established (going back to the Mexican border) one presently operating is the Falcon Dam. Better access to presently operating crossing points as the result of road building and road improvement programs in Mexico is a stimulant to increased international road traffic in that area. There are approximately 25 border crossing points established and manned by Customs and Immigration border inspectors, and the Quarantine Division is presently covering 16 of the more important points. The Quarantine Service is unable, because of limited personnel, to provide service during all of the established open hours at these entry points.

UNDERSTAFFING AT BORDER POINTS

Senator HILL. You mean there are some hours when those points are open and you do not have the personnel to provide the protection, so to speak, that should be there?

Dr. SPENCER. That is right, sir. There are some points that are open 24 hours. I can give you a breakdown of that if you wish in tabular form, or I can discuss it here personally.

Senator HILL. Suppose you briefly summarize it for us here.
Dr. SPENCER. All right, sir.

Speaking to these 16 points that we are discussing here: Presently covered, open 24 hours there are 12; open 16 hours there are 3; open 12 hours there is 1. Those are covered during those hours by Customs and Immigration Services. The Public Health Service coverage in those places, going back to those open 24 hours, we are presently, staffing 24 hours at 3 of those places but that is because of air traffic coming into those points and not for coverage at border-crossing points.

We cover 17 hours at 2, 15 hours at 1, 8 hours at 2, and we are on call at 2.

Of those open 16 hours, 3 in number, we cover 8 hours at 2, and we are on call at 1. At the one open 12 hours, we are on call.

So we fall far behind in effective coverage to provide protection from the quarantine standpoint at those places.

Senator HILL. These additional funds make it possible for you to provide this protection, is that right?

Dr. SPENCER. Yes, sir. As we wish to say here, we would attempt to increase the coverage at the busier places to cover the full hours they are declared open by the other services. We would also provide coverage at Falcon Dam, which is not now presently covered.

ENTRY OF ALIENS WITHOUT PROPER INSPECTION

Senator POTTER. Those posts that are not manned on a 24-hour basis, can people come in without the proper inspection? Is there traffic in the hours you are not covering that post?

Dr. SPENCER. Yes, sir; that is a logical assumption because the Customs and Immigration Services do not have medical skills and they can pass through an alien temporary visitor, for instance, or a United States citizen, without knowing what disease he may have unless that disease is so apparent that any layman would recognize it. Aliens for permanent entry are required to return to Mexico and reenter during hours that medical examination is available.

SMALLPOX OUTBREAK IN NEW YORK

I might cite, also, the instance of some years ago in which a case came through a border point from Mexico. It is well known and has been publicized as one of the very severe scares which we had in this country. This occurred in 1947. An importer had been in Mexico City and on his return by bus came through Laredo. He continued on to New York and developed his illness there, and was hospitalized. As a result of this infection not being recognized immediately, a sharp outbreak, 12 cases and 2 deaths developed. During that period there was a mass vaccination program entered into in the city during which approximately 6 million persons were vaccinated. Of course, at terrific cost.

Senator THYE. The cost was not only to the city but to the individual family and the Government; all were involved.

Dr. SPENCER. Yes, all were involved. The estimate was in excess of $6 million if we assess one dollar per person for vaccination as an approximate figure.

HEALTH HAZARDS OF AIR TRANSPORTATION

Senator THYE. On airplanes when you move so rapidly from one country to another, the hazards are greater than if you come by steamship because often the disease could really incubate aboard a ship.

Dr. SPENCER. Yes. We have the time factor in the development of a disease during the incubation period on ship which we do not have by air. Of course, on the border, which we wish to supplement

presently, we are dealing with land traffic by auto, by bus, by train as well as plane. Because of the progression northward of yellow fever

Senator THYE. There is a reduction in the House appropriation in the Foreign Quarantine Service. The estimate was $3 million. The House allowed $2,950,000.

Dr. SPENCER. That is correct.

Senator THYE. You had $2,900,000 in 1954 and 1955?
Dr. SPENCER. Yes, sir.

Senator THYE. Your increased amount there would provide you with what in your Quarantine Service?

Dr. SPENCER. May I say the $2,900,000 represents a reduction from previous years, from $3,065,000 in the year 1953.

Senator THYE. You had that for 1953, $3,065,000 for 1953?

Dr. SPENCER. Exactly; and there has been a drop of personnel during that same period.

Senator THYE. That I recognize, but you have, however, in the 2 years gotten along with $2,900,000. What do you propose if this additional sum is granted? What would you do with that? Would you increase the personnel, or is it any other specific type of service that you are planning for?

Dr. SPENCER. We had specifically requested 15 positions which would take $47,000, plus some incidental items in the amount of $4,000; that is, travel and other contractual services and materials, and so forth. The remaining $50,000 requested would cover fringe benefits authorized.

Senator HILL. I might say, Senator, he gave us a breakdown as to where he needed these additional personnel.

Senator THYE. I am sorry. I was not here at the time the Doctor® proceeded with bis statement. I had committed myself to an appointment in my office at 3:30. Therefore, I had to go. I completed the appointment and came right back. that is the reason I was not here at the outset of your statement. Thank you for the information. Senator HILL. Are there any other questions? If not, Doctor, we are much obliged to you.

INDIAN HEALTH ACTIVITIES AND CONSTRUCTION OF INDIAN HEALTH FACILITIES

STATEMENTS OF DR JAMES R. SHAW, CHIEF, BRANCH OF HEALTH, BUREAU OF INDIAN AFFAIRS; DR. JOSEPH O. DEAN, BRANCH OF HEALTH, BUREAU OF INDIAN AFFAIRS; DR. JACK MASUR, CHIEF, BUREAU OF MEDICAL SERVICES; DR. W. PALMER DEARING, DEPUTY SURGEON GENERAL; AND JAMES F. KELLY, BUDGET OFFICER, HEALTH, EDCUATION AND WELFARE

APPROPRIATION ESTIMATE

Indian health activities: For expenses necessary to enable the Surgeon General to carry out the purposes of the Act of August 5, 1954 (Public Law 568), including services as authorized by section 15 of the Act of August 2, 1946 (5 U. S. C 55a) (including not to exceed $10,000 for such services at rates not to exceed $100 per diem for individuals, when authorized by the Surgeon General); hire of passenger motor vehicles and aircraft; purchase of reprints; payment for telephone service in private residences in the field, when authorized under regulations approved by the Secretary; and the pur

poses set forth in sections 321 and 509 of the Public Health Service Act; $33,590,000: Provided, That the Surgeon General is authorized to transfer from this appropriation to other appropriations of the Department of Health, Education, and Welfare such amounts as the Secretary may determine are required in such appropriations for Indian health activities.

PREPARED STATEMENT

Senator HILL. Doctor, your statement will go into the record. If you will, you may proceed in your own way, making any further statements or suggestions you may have.

GENERAL STATEMENT

Dr. SHAW. Thank you, sir.

This is our first appearance before this committee on the Indian health program. As you know, Senator Thye is very familiar with the fact that Public Law 568 transfers the responsibility for Indian health from the Department of Interior to the United States Public Health Service, effective July 1, 1955.

Currently there are about 450,000 Indians and Alaskan natives of whom approximately 350,000 live on reservations widely scattered over 24 States and the Territory of Alaska.

Today the state of health among Indians and Alaska natives still reflects the diseases introduced amongst them during early settlement of the lands they once occupied. Their conditions of health are similar in many respects to those of a half century ago in our States when limited knowledge of sanitation, hygiene, preventive and curative measures inevitably brought with them unusual morbidity and early loss of life.

The common infections and preventable diseases still make the Indian the victim of sickness, crippling conditions, and premature deaths to a degree which stands in sharp contrast to the health of other population segments of the Nation. Tuberculosis death rates are as much as 40 times the rate in the white population. Indian infant death rates have been 3 to 10 times as high as the rate found in the surrounding non-Indian population.

The average age at death for Indians is 36 years; whereas, it was 61 for the white population in 1950. Over half of the Indian population is under 20 years of age; whereas, among the non-Indian population of the United States over half are beyond 30 years of age.

The program we are proposing here reflects the immediate and specific steps that can be taken. In this program, the objectives are to bring the health status of the Indians and Alaska natives up to par with the surrounding non-Indian population in a way that encourages self-reliance and independence, strengthens their competency, and desire to manage their own affairs, and gives full recognition to their rights as citizens.

The budget provides for the care of more Indian patients in hospitals, clinics, health centers, and contract facilities; intensification of preventive and public health measures; and the training of Indians to render health and medical services to their own people. It provides for these services either directly or through contractual arrangements with State or local health agencies.

The program will be administered through the same organizational pattern as that of the Bureau of Indian Affairs. Through area offices we will direct the activities of the field preventive services, oversee the work of the 57 Indian hospitals and work out the necessary contractual arrangements with other hospitals, physicians, and health agencies.

For these purposes an appropriation of $33,590,000 is proposed.