of the offspring. Furthermore, these aspects have not been convincingly presented to the undergraduate medical student. As a consequence only small numbers of students with the talent for scientific investigation have turned to obstetrics as lifework.

Having already begun to recognize the need for research talent in obstetrics, we have hailed the concept of the new Institute as at least a partial answer to our problem. It seemed to promise support and direction for research workers and, more important, it appeared an essential step if this field of medical and human interest is to achieve concreteness and stature in the eyes of the public and the scientific community.

A single misgiving arises in the mind of the physician like myself, who, though interested in the whole field, is particularly concerned with the segment encompassed by obstetrics. This hesitancy is related to the precise name currently suggested for the proposed Institute. In its present form the name does not appear accurately to describe the area of intended endeavor and leaves out of consideration that most important area of antenatal influences. As obstetricians hoping that the new Institute would, by somewhat dramatizing the field, assist us in our newly adopted quest for scientific talent, it is disappointing.

From my concept of the program, the Institute would, more precisely as well as more comprehensively, be termed that of "Maternal Health and Human Development. If this phraseology seemed then to slight, by omission, another great branch of medicine, would not the title "Institute of Maternal and Child Health" be a more generally satisfying one than that presently proposed?

The CHAIRMAN. I would like one of your gentlemen to indicate which of you we might keep in touch with so that we will have a contact to refer these comments on the new proposals which you have indicated in your statement.

Would that be Dr. Eastman?

Dr. EASTMAN. I think it would probably be best if it were Dr. Hellman.

Dr. HELLMAN. Mr. Chairman, there are prepared statements for each of the six members here. I do not know whether you want us to read these statements. They are very short. Whether they will make any contribution more than has been said now, I think it is up to you.

The CHAIRMAN. Would you like to follow the same procedure Dr. Eastman and Dr. Taylor did, filing your statements and making your own comments? Would you like to do it that way?

Dr. HELLMAN. I think so; yes, sir.

I would like to have Dr. Davis talk.

STATEMENT OF M. EDWARD DAVIS, M.D., PROFESSOR AND CHAIRMAN OF THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, THE UNIVERSITY OF CHICAGO SCHOOL OF MEDICINE, AND CHIEF OF THE CHICAGO LYING-IN HOSPITAL

Dr. DAVIS. I am Dr. M. Edward Davis, Joseph Bolivar DeLee professor and chairman of the Department of Obstetrics and Gynecology, the University of Chicago School of Medicine, and chief of the Chicago Lying-In Hospital.

I gladly appear today representing the American Association of Maternal and Infant Health, an organization of men and women from such professions as medicine, nursing, social work, and other disciplines concerned with the medical care of mothers and babies, as well as nonprofessional members. Acquainting our young people and their mothers and fathers about the many facets of human reproduction is an important function of our society.

The American Association of Maternal and Infant Health endorses the objectives of bill H.R. 8398 to establish an Institute of Child Health and Human Development to promote the study of the causes, the prevention, and the cure of diseases and disabilities of childhood. However, we feel that the most important means of attaining this goal is missing from the bill's present draft. To prevent congenital defects in the newborn we must learn their causes; to understand developmental abnormalities we must acquire a great deal of new knowledge about the 267 days the baby spends in its mother's womb, to decrease the hazards of the birth process we must learn more about the mechanism of labor and its control.

The growth and development of a baby is dependent on the health and well-being of its mother prior to conception and during the 9 months of the pregnancy. The medical supervision of the mother during the crucial period that she carries her child is of the utmost importance for its normal growth and development. Her diet must contain the proper nutrients for these will supply the building blocks for her child. Pregnancy complications must be prevented, if possible. Even her emotional well-being during pregnancy, delivery, and the early days of the newborn's life may have a profound effect on her offspring.

Thus, it is apparent that the growth and development of a baby is inseparable from the health and well-being of its mother prior to conception and during the 9 months of the pregnancy. An inherited disease, a chronic illness, an acute infection, or a complication of pregnancy may result in the death of the baby prior to birth, gross abnormalities of its organs, or its premature delivery. The young mother who has diabetes must have strict and continuous medical supervision during pregnancy and delivery, for her own health and the health of the unborn baby may be seriously jeopardized. A mother may acquire German measles early in pregnancy during the formative stage of the fetal organs and the viral infection transmitted from mother to baby may cause serious malformations of the heart, the eyes, the ears, and other organs. Late in pregnancy a mother may develop a toxemia manifested by an increased blood pressure and kidney damage. Degenerative changes in the afterbirth may diminish the supply of the necessities for survival of her baby. The baby may die in the uterus or be born alive but resembling a little old man or woman.

The hazards of the birth process have been spectacularly reduced in recent years but it still remains the most crucial period in the life of the newborn. Proper preparation of the mother for this climactic event and the advances of the medical sciences have contributed much to safeguard her delivery. However, there is great need for more knowledge about the physiology of uterine action, the transport of lifesaving oxygen from mother to baby throughout pregnancy, and prompt establishment of breathing at birth. There is no greater disaster than the birth of a "damaged child" with cerebral palsy or mental retardation who will be unable to enjoy the unlimited rewards of its arrival on our planet.

We respectfully ask that the new Institute you are considering be designated as the "Institute of Maternal and Child Health and

Human Development." This will acknowledge the biologic fact that life begins at conception, that a baby is 9 months old at birth, and that the study of child health and human development must include the child's mother, for they are inseparable.

While I am particularly interested in the National Institute of Child Health and Human Development, I appreciate the fact that the breadth of concept of the proposed Institute of General Medical Sciences cannot help but further advances in the field of reproduction. The CHAIRMAN. Thank you, Dr. Davis.

I believe we have one more gentleman who has not spoken to this problem. Would you identify yourself for the record?

Dr. HELLMAN. I would like to have Dr. Reid talk next, and then there is Dr. Gordon Douglas and myself. There will be three more. STATEMENT OF DUNCAN E. REID, M.D., PROFESSOR OF OBSTETRICS, AND CHAIRMAN OF THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, HARVARD MEDICAL SCHOOL; CHIEF OF STAFF, BOSTON LYING-IN HOSPITAL; FELLOW OF THE AMERICAN GYNECOLOGICAL SOCIETY

Dr. REID. Mr. Chairman, I am Duncan E. Reid, professor of obstetrics, and chairman of the Department of Obstetrics and Gynecology at Harvard Medical School.

I can understand perhaps why my name might have been omitted. There is a rumor, in Boston at least, that there are too many people from Harvard down in Washington now.

The CHAIRMAN. The gentleman on my left will probably agree with you.

Mr. SCHENCK. That is right.

Dr. REID. Because I do not wish to be repetitious, I shall defer reading my prepared testimony in its entirety. I am submitting it for the record, however.

I come here representing the American Gynecological Society, whose membership is comprised mainly of the professors and chairmen of the departments of obstetrics and gynecology in medical schools of this country and most of the schools of Canada.

Certainly, I am here to support this bill, but, of course, I should also like to submit for your consideration that the changes which were suggested might be put into the final draft of the bill. It seems only reasonable that maternal and child health be considered together.

As I interpret this bill, its primary objective is to further and better coordinate the programs now in existence, thus assuring that whatever benefits which have already accrued in the field of maternal and child health will not only continue but also have a greater continuity and a unified purpose.

I think it is perhaps well to remind this committee that since the end of World War II there has been a great interest in this whole field, and I would also offer for their consideration that they be familiar with the progress which has already been made in the National Institutes of Health in support of maternal and child health.

I refer particularly to the fact, or the seeming fact at least, that some of the advances which have been made have been accomplished purely in the field of very basic research, and in this it has been possible to enlist the departments of the biologic sciences of our colleges and universities, as well as our medical schools.

I am sure that many of us here feel that this is a highly important and significant approach in terms, not only of new knowledge, but also of creating interest within these institutions for attracting men into medicine. I know that this committee is quite familiar with this particular problem. At any rate, we have received support from private foundations and the U.S. Public Health Service, especially through the Human Embryology and Development Study Section, which was established in 1955, and on which original committee Dr. Hellman and I both had the privilege of serving. From this, I think, it has come to be appreciated that the process of human reproduction presents basic biological problems which ramify into all fields of medicine, and also that this phenomenon, whose physiologic controls are little understood, contains social and economic considerations upon which the very survival of democratic government may well depend. Actually, the horizons of all of the biological sciences will remain restricted until the intrauterine phase of human existence is better delineated. From the overall advances of our time, there has emerged emerged sufficient evidence to permit the belief that birth trauma, cerebral palsy, mental retardation, and congenital malformations can be eliminated. It would be paradoxical, indeed, for our society to spend much of its substance caring for individuals who are victims of nature's developmental mistakes without directing a major portion of their energies to understanding the biological processes that account for these anomalies.

Factors which cause alterations in intrauterine existence, which in turn may influence the incidence of malformation, cerebral palsy, and other congenital disturbances, have been enumerated by my colleagues. It is evident as a conclusion, I believe, that, even though not curable, these conditions may well be preventable. Thus, because the ultimate aim of medical science is to prevent disease, a major step in achieving this objective must, therefore, be related to life in its beginning.

As a Nation, as we define and expand what we regard to be the rights of man, I would submit and suggest that the initial right of man is to be born without handicap. It is upon these precepts that I would support this bill.

I would like also to say in conclusion that we are, as a groupcertainly I am personally-interested in this bill as it supports the general medical sciences and, hence, the broad field of obstetrics and gynecology. I would also submit for your consideration that I see no conflict of interests or duplication between the general medical sciences and this proposed new Child Health Institute.

Thank you.

The CHAIRMAN. Thank you very much, Dr. Reid.

Dr. HELLMAN. The next speaker will be Dr. Gordon Douglas.

STATEMENT OF R. GORDON DOUGLAS, M.D., PROFESSOR OF OBSTETRICS AND GYNECOLOGY, CORNELL UNIVERSITY MEDICAL COLLEGE; OBSTETRICIAN AND GYNECOLOGIST IN CHIEF TO THE NEW YORK HOSPITAL, NEW YORK; AND PRESIDENT OF THE AMERICAN ASSOCIATION OF OBSTETRICIANS & GYNECOLOGISTS

Dr. DOUGLAS. Mr. Chairman and members of the committee, I am Dr. R. Gordon Douglas, professor of obstetrics and gynecology to Cornell University Medical School, and I am here representing the American Association of Obstetricians & Gynecologists, of which I am president at this time.

The membership of this organization comprises some 130 active fellows who have been elected to fellowship because of their outstanding achievements in this discipline, and it comprises most of the professors of obstetrics and gynecology in this country.

I will be just as brief as I can.

I would like to endorse what Dr. Reid said concerning the establishment of the Institute of General Medical Sciences, which our organization would like to support.

We do object to certain features in the bill in its present form; namely, in the name of the proposed Institute of Child Health and Human Development and the phraseology that has already been referred to.

I should like to make some very brief comments concerning what I consider the most critical phase of human development, which occurs during the first 20 weeks of pregnancy, and the greatest loss of human life occurs during this period of time. According to a recent study from the University of California concerning the experience in Kauai, 7 percent of all pregnant women abort during the critical period between the 8th and the 11th week of gestation. Another 7 percent abort prior to this time, and another 7 percent between the 11th and the 20th week.

Unfortunately, in these days and times, there are no precise figures indicating the total magnitude of this problem in this country. In fact, in some areas of our country very incomplete information is available.

In the 10-year period 1952-61, there were 48,675 pregnancies cared for in the New York Hospital, and approximately 10 percent of these terminated in abortion-"abortion" being synonymous with "miscarriage." This figure includes only those patients, of course, who were admitted to the hospital, and does not reflect entirely the magnitude of the total problem in our community.

In New York City, where excellent records are available, every termination of pregnancy is reportable, including those terminating in the earliest weeks of gestation. Mr. Carl L. Erhardt, director of the Bureau of Records and Statistics in the Department of Health of New York City, has done a great deal to accumulate information in this area, and reports some 23,000 fetal deaths reported each year in this city alone. Seventy-five percent of these, approximately, terminate as abortion. This indicates somewhat over 16,000 documented abortions annually.