Throughout the bill, there are special provisions requiring the Surgeon General to consult with the National Advisory Council o particular matters. Thus, section 205 (c) requires that in determining what are specialist or consultant services-for the purpose of higher rates of remuneration to persons rendering such services-the Surgeon General must establish general standards only after consultation with the Advisory Council. Similarly, in connection with including any hospital on the list of participating hospitals, section 206 (b) requires that the Surgeon General makes his finding of factand decisions on the status of any hospital in accordance with genera standards established only after consultation with the Advisory Courcil. In placing any limitations on benefits under section 210 the Surgeon General must also first consult the Advisory Council.

These provisions assure that there will not be any dictatorship or regimentation under the bill as the National Physicians Committee falsely claims.

I do not wish to take up more of the committee's time enumerating the specific provisions of the bill which protect the doctor, the dentist. the nurse, the hospital, the individual patient and his family, and th Surgeon General. But if this committee can strengthen any of the provisions it will perform a great service. Passage of this bill wit be a great step forward in improving the health and adding to the happiness of the American people.

The CHAIRMAN. Thank you, Mr. Dingell.

Senator WAGNER. May I congratulate Congressman Dingell on his very persuasive statement. I wish the people would read it. They would be persuaded.

The CHAIRMAN. The Senator from Florida, Mr. Pepper, wishes to make a statement.

You may proceed.

STATEMENT OF HON. CLAUDE PEPPER, A UNITED STATES SENATOR FROM THE STATE OF FLORIDA

Senator PEPPER. Mr. Chairman, I deeply appreciate your invitation to present to the full Committee on Education and Labor the findings of the Health Subcommittee, of which I have the honor to b chairman. These hearings will, I am sure, be a high point along the road to better health for all, along which the American people have been struggling for many years. They are a tribute to your fir leadership, which has been discouraged by neither opposition nor delay. Year after year you have joined forces with that great veteran fighter, Senator Robert Wagner, on bis first national health bi Year after year you have carried to the people your message of bette health for all, and you have received sustenance from them. Yea after year you have given unsparingly of your time to present t the people the message that better health could be achieved through national health program. This work has made it possible for us t meet here today to begin hearings on one of the most important meas ures before the Congress, S. 1606, the Wagner-Murray-Dinge: national health bill.

I think we will all agree we are now at a critical point in this figh President Truman sent his health message requesting Federal legisla tion for a national health program to the Congress last November

The people want such a program, as I will show in some detail later in my statement. Farsighted medical and social security experts have shown us the means of achieving it. It is now up to the Congress to adopt it without delay. The situation is urgent and brooks no procrastination.

WORK OF SUBCOMMITTEE ON WARTIME HEALTH AND EDUCATION

In July 1943, the Senate took cognizance of the Nation's vast and urgent health needs by passing Senate Joint Resolution 74, which I had the honor to introduce, empowering the formation of a special health subcommittee of the Committee on Education and Labor. The distinguished Senator from Utah, Senator Elbert D. Thomas, then chairman of the committee, appointed me chairman of the subcommittee, which was composed of an able group of Senators, many of whom are present here today. For the last 22 years we, with the brilliant assistance of a devoted and able staff, have studied the state of the Nation's health. Hearings in the field and in Washington have been held, and reports which have won the attention of the Nation have been issued, on many facets of this great subject. Health conditions in the war industry and extracantonement areas, selective-service data on rejections for physical and mental disabilities, medical research needs, hospital and health center requirements, the health needs of veterans, dental and mental health care, and other subjects too numerous to mention, have been brought objectively to the attention of the Congress and of the people.

Finally, the subcommittee is about to issue a report entitled "Health Insurance," which represents some of our most important research. It summarizes the variety of voluntary health plans devised to meet the problems of medical care and the costs thereof to sections of the American people.

I wish to summarize this report as briefly as possible for the committee, since its contents are so central to the matter under discussion. It first reviews the major facts originally presented in our interim health report which I submit for the record of the hearings. Here I would like to offer the full exhibit, Mr. Chairman. The CHAIRMAN. It may be introduced. (Exhibit I referred to is as follows:)

EXHIBIT 1

WARTIME HEALTH AND EDUCATION

Interim report from the Subcommittee on Wartime Health and Education to the Committee on Education and Labor, United States Senate, pursuant to Senate Resolution 74, a resolution authorizing an investigation of the educational and physical fitness of the civilian population as related to national defense

(January 1945)

We have the honor to submit herewith the third interim report of the Subcommittee on Wartime Health and Education.

THE 42 MILLION IV-F'S

The Nation has been deeply impressed by the fact that approximately 4% million young men in the prime of life have been found unfit for military service because of physical and mental defects. In addition, more than a million men

have been discharged from service because of defects other than those sustained in battle. One and one-half million men now in uniform were rendered fit for service only through medical and dental care given after they were inducted.

In all, it is estimated that at least 40 percent of the 22 million men of military age between 8 and 9 million men-are unfit for military duty. This is more than twice the number of men we now have overseas engaged in the great offensives that will bring total victory.

The 4 million men in class IV-F are those who remained unfit for military service after all doubtful cases have been reexamined in terms of the latest revision of Army and Navy physical and mental standards, after induction of those acceptable for rehabilitation in the Army and Navy, and after reclassif cation of all who by self-rehabilitation or other circumstances had become eligible for military duty. It should be emphasized that these 4%1⁄2 million men are all rejectable under the lowest possible physical and mental standards, as defined by a special commission of physicians appointed by the President.

Interpretation of the selective service rejection data as an index of national health was challenged at the subcommittee's hearings by representatives of the American Medical Association. They pointed out that the standards of physica fitness demanded for military service are considerably higher than those required for normal civilian activity.

While it is true that many people are afflicted with defects that do not prevent participation in ordinary activities, such defects often reduce initiative and working capacity, and, if neglected, may eventually result in serious illness or disability. Certain minor defects of this kind may not appreciab'y affect mor tality and morbidity rates, or life expectancy tables, and they may offer little of interest to physicians engrossed with more spectacular ills. But the patient with a toothache, or with impaired hearing, is well aware of the distress and limitations imposed upon him by his infirmity. In the aggregate, minor defects constitute a serious drain on our manpower.

Regardless of how the selective service data are interpreted, the widespread existence of illness and defects among our population has been demonstrated by numerous extensive surveys conducted under both governmental and private auspices. The findings of some of these surveys, which also have shown that many of these diseases and defects are preventable or remediable with proper medical care, will be cited later in this report.

MEANING OF THE FIGURES

It would be wrong to conclude from the selective service rejection figures that we are a nation of weaklings. Our enemies labored under that delusion, and they are learning their error the hard way. On the other hand, it is evident that we have no reason to be smug or complacent about the state of our people's health. We must ask, "What do these figures mean?" and then, "What must we do about it?"

It is clear that the figures do not reflect discredit on the men themselves. The great majority of them are the victims, not the villains, of the situation. Nor do the figures mean that the rejectees are unfit for participation in the war effort; in most cases they are serving honorably in war production or in some other necessary civilian activity.

The large number of rejections does mean that the manpower problems of the Army and Navy have been much more serious than they would have been had the Nation's health been better. The unavailability of the rejected men means that it was necessary to call into military service hundreds of thousands of other men better fitted for essential civilian tasks and more deeply committed to responsibilities in the society we fight to preserve-men with families, trained mechanics, skilled technicians, and teachers in scientific and technical schools. If this situation was preventable and we are profoundly convinced that it was-this Nation has an immediate duty to seek an immediate remedy.

REHABILITATION OF REJECTEES

According to officials of the Selective Service System, at least one-sixth of the defects for which men were rejected could be remedied with relative ease, as far as medical science is concerned, to fit them for general military service.

Early in the war, test rehabilitation programs were undertaken by the Selective

Service System, but they yielded meager results and were abandoned. In sharp contrast to the results of the Selective Service efforts are those of the Army rehabilitation program. Here remarkable success has been achieved. Approximately 1 million men with major defects have been inducted and rendered fit for duty, including 1,000,000 men with major dental defects, more than 250,000 with impaired vision, 100,000 with syphilis, and more than 7,000 with hernia. The success of this program demonstrates what can be done by vigorous and coordinated effort.

1

The magnitude of the Army's total dental program is apparent from the following figures: During 1942 and 1943, more than 142 million cases were treated, 31,000,000 fillings were provided, 6,000,000 teeth were replaced, and nearly 12 million bridges and dentures were supplied. This work required 53,000,000 sittings by patients, and the production of three and one-half times the normal quantity of dental supplies and equipment produced in the United States in any one year. We are told that registrants will continue to be called into service even after VE-day. Since the only physically fit men available will be the newly registered 18-year-olds, men with dependents, and those in essential occupations, wisdom and fairness demand that as many as possible of the registrants now in the IV-F classification be made fit for service. The subcommittee therefore recommends that the Army continue and, if feasible, expand its rehabilitation program. Another opportunity for better rehabilitation service is presented by the Barden-La Follette Act (Public Law 113, 78th Cong.). This act recently made Federal funds available to State rehabilitation agencies for medical correction of defects hindering employment. Some IV-F's have already been referred by selective-service boards to State vocational rehabiliation agencies and have had their defects corrected. The immediate possibilities of this mechanism are somewhat limited because initiative is in the hands of the individual States, many of which have not yet developed the medical phase of their rehabilitation programs. Nevertheless, if the opportunities offered by the Barden-La Follette Act program were more widely known and utilized, more substantial progress could be made in the rehabilitation of rejected men.

HEALTH OF THE REST OF THE POPULATION

According to the National Health Survey, conducted by the United States Public Health Service in 1935, more than 23,000,000 people in the country had a chronic disease or a physical impairment. In the working-age group (15-64), more than 3,000,000 people had impairments such as deafness, blindness, or orthopedic handicaps, and more than a million were estimated to have hernia.

A Farm Security Administration study of 11,495 individuals in 2,480 farm families residing in 21 typical rural counties in 17 States in 1940 showed that 96 percent of those examined had significant physical defects. The average number of defects per person was 32. Only 1 person out of each 100 examined was found to be "in prime physical condition."

Among nearly 150,000 young people examined by physicians for the National Youth Administration in 1941, 85 percent needed dental care, 20 percent needed eye refractions, 19 percent needed tonsillectomies, and 12 percent needed special diets. Approximately 1 youth in every 7 was in urgent need of some kind of medical or dental treatment. About one-third of the young people had health defects which limited their employability. Only 10 out of each 100 examined had no defects for which the examiner made a recommendation.

High defect rates are not limited to low-income groups such as those studied by the Farm Security Administration and the National Youth Administration. The Life Extension Institute, in examinations of 300,000 insurance policyholders selected indiscriminately with regard to sex, age, and occupation, found that 59 percent were so physically impaired as to need the services of a physician at the time of examination.

Industrial casualties take a heavy toll. From Pearl Harbor to January 1, 1944, 37,600 American workers were killed on the job-7,500 more than the military dead for the same period. More than 200,000 workers were permanently disabled and 42 million were temporarily disabled,

1The word "cases" as used here does not refer to individuals; an individual may have been recorded more than once as a "case" for separate treatments at the same or different Army posts.

85907-46-pt. 1-7

EFFECT OF ILLNESS ON WAR PRODUCTION

The profound influence of illness and disability on war production is illustrated by figures on work absences due to sickness and accidents. In 1943, the average male industrial worker lost 11.4 days and the average female industrial work 13.3 days of work due to sickness and injury. By far the greater proportion this loss-80 percent in the case of men and 90 percent in the case of womenwas believed to be due to common ailments. Application of these figures to the number of employed male and female workers in the United States tod.” indicates a loss of more than 600,000,000 man-days annually. This is abo 47 times the amount of time lost through strikes and lock-outs of all kind) during 1943.

Intensive investigation and the testimony of many expert witnesses has cer vinced the subcommittee that a great deal of illness and disability could t avoided if the benefits of modern medical and public health science were mad readily available in all sections of the country and to all persons regardles of economic status. In recent years, and especially since the outbreak of wa there has been a great awakening of public interest in all matters pertaining to health. More than 10,000,000 men and women in the armed forces are now receiving the benefits of complete medical and hospital care. The advantage of such care will not be forgotten after the war. Considerable increase in the d mand for medical care may therefore be expected in the postwar period, and we should plan immediately to meet this increased demand.

On the basis of the information it has gathered to date, the subcommittee : not prepared to formulate a complete national health program or to makdetailed recommendations concerning all the health problems that remain u solved. In this interim report, however, we shall make preliminary observation regarding certain basic subjects which require further study; we shall also mak specific recommendations regarding provision of facilities and services whic we believe to be prerequisites to better national health and physical fitness.

NEED FOR IMPROVED PREVENTIVE SERVICES AND FACILITIES

During the period 1900-1940, the death rate in the United States fell from 17.2 per 1,000 population to 10.8 per 1,000, a reduction of nearly 60 percent. I provement has been most notable with respect to diseases which respond fave ably to better sanitation and immunization procedures. The death rate fro typhoid and paratyphoid fevers, for example, was reduced by 97 percent, from diarrhea and enteritis by 92 percent, and from diphtheria by 97 percent.

A major share of the credit for this remarkable progress belongs to the pub" health agencies of Federal, State, and local governments. The development ( the preventive services furnished by these agencies, however, has been ver uneven in different sections of the country. As recently as 1935, only 6* of the 3,070 counties in the United States had full-time local public-heal agencies. By 1942, under the stimulus of Federal grants made available by th Social Security Act, the number of counties served by such agencies had appro mately tripled. Today, however, about 40 percent of the counties of the Unite States still lack full-time local public-health service. Many of the existirhealth departments are inadequately financed and staffed. Minimum preventiv services under the administration of full-time local public health departmentstaffed with qualified personnel should be provided in every community. To : complish this, additional Federal financial aid would probably be necessary. new and consolidated areas of local health administration were established, h › ever, as suggested by the American Public Health Association, the total fur needed probably would not exceed greatly the present total of health departm expenditures.

Complete geographic coverage by full-time local health departments would : be sufficient in itself, however, to enable us to take full advantage of the poss bilities for further advances in the control of venereal infections, tuberculos malaria, and other preventable diseases. Funds are needed for expansion health-department activities in these fields and many others, such as food a milk sanitation, industrial hygiene, maternal and child health, and he... education.