of grade B medical schools receive instruction in the basic sciences and in the clinical subjects related to medicine, surgery, obstetrics, and pediatrics that is equivalent to that given graduates of approved schools of medicine.

The position of the Children's Bureau has been that it would gladly recognize graduates of schools of the healing arts that could show that the instruction with respect to the basic science and medical subjects given to students was the equivalent in kind and quality of the instruction given in approved medical schools.

In an effort to be as fair as possible to medical schools that are not graded as approved or other schools of the healing arts, and after prolonged discussions with representatives of the American Osteopathic Association, and on the understanding that the representatives of that association concurred in the plan, the Children's Bureau, in 1943, requested the National Research Council to undertake an impartial study of the schools of osteopathy and of an equal number of schools of medicine comparable in size and location to determine whether the instruction given was the equivalent in kind and quality of the instruction in approved medical schools.

The National Research Council agreed to undertake this and appointed a committee of experts in the basic sciences to undertake the study, men who were neither graduates of schools of medicine or osteopathy nor associated with such schools in their scientific work. An investigator who was not employed by a medical school was also chosen from the field of biological science.

The plan included the appointment of consultants, both to the committee and to the investigator, to be named by the American Osteopathic Association and the medical profession.

Though the National Research Council set up its committee and appointed its investigator, the American Osteopathic Association refused to appoint consultants or open the doors of its schools to the council representatives.

Therefore, the investigation could not proceed.

One school of osteopathy, however, requested through the commissioner of the health department of the State in which it is located that the council carry out its investigation of that school.

This was done, and it is my understanding that that school is now making every effort to raise its standards to meet those of the approved schools of medicine.

The Children's Bureau has informed the commissioner of health that a State plan for maternal and child health or crippled children will be acceptable in respect to this aspect of the program, if it provides for payment to physicians who have had their instruction in this school of osteopathy after it has reached the standards of instruction under which it can be approved.

Mr. GOURLEY. I ought to put in some comment on that.

The Children's Bureau follows the American Medical Association's say-so on all medical schools, but rejects American Osteopathic Association approval of osteopathic schools. Yet these two associations have equal standing before the licensure agencies of the respective States for purposes of accreditment of their respective schools. Graduates of so-called class A medical schools and graduates of the osteopathic schools successfully stand the same State examination in the

same subjects including surgery, obstetrics, and pediatrics before the same State boards and receive the same licenses to practice in a number of States, thus evidencing a comparable training in all branches of the healing art.

With regard to the projected "study" of osteopathic schools by the Children's Bureau, the House committee in the same report on the labor appropriation bill to which I have referred, had this to say:

The Children's Bureau has now arranged to have a study made to determine the relative merits of various types of schools giving instruction in healing arts. This is a matter which, in the judgment of the committee, lies entirely within the jurisdiction of the States.

The American Osteopathic Association adopted that view of the congressional committee.

Congress embodied the same views in the Labor Federal Security Appropriation Act for the fiscal year 1944, and subsequent years, in relation to the Children's Bureau Maternal and Child Health and Emergency Maternity and Infant Care programs, as follows:

Provided, That no part of any appropriation contained in this title shall be used to promulgate or carry out any instruction, order, or regulation relating to the care of obstetrical cases which discriminates between persons licensed under State law to practice obstetrics: Provided further, That the foregoing proviso shall not be so construed as to prevent any patient from having the services of any practitioner of her own choice, paid for out of this fund, so long as State laws are complied with.

Senator PEPPER. Thank you very much.

This will conclude the hearings on this bill.

(Thereupon, at 4:45 p. m., Saturday, June 22, 1946, the committee recessed.)

DEAR SENATOR PEPPER: I regret very much that the engagements I have in St. Louis prevent my appearing before your committee. Enclosed is the statement covering my testimony. I hope it can be put to some use at the meeting. You can use the copies in any manner which you feel may be advantageous.

Sincerely,

ALLAN M. BUTLER, M. D.

STATEMENT OF ALLAN M. BUTLER, M. D., ASSOCIATE PROFESSOR OF PEDIATRICS, HARVARD MEDICAL SCHOOL, CHIEF OF THE CHILDREN'S MEDICAL SERVICE, MASSACHUSETTS GENERAL HOSPITAL, MEMBER OF THE AMERICAN PEDIATRIC SOCIETY, AMERICAN ACADEMY OF PEDIATRICS AND AMERICAN MEDICAL ASSOCIATION

I appreciate the invitation to come before this committee to add my testimony to your hearings on the Maternal and Child Welfare Act of 1945, S. 1318. As stated before this committee in my testimony favoring S. 1606, legislation pertaining to establishment of a national health program is not the product of New Deal politics or sentimental reform. It is reflection of the impact of science upon medicine. To avoid repetition may I refer you to that statement 'as to why I believe we must evolve some method of adequately financing medical care in an orderly and predictable manner, why a legislative medical-care program is a sounder way of meeting this need than reliance upon voluntary plans, and why your task requires imagination and boldness in creating a comprehensive program but conservatism in putting that program into operation. In that statement the reasons why you, in doing the required job, would encounter the opposition of so-called organized medicine were stated. Well, you have encountered that opposition. I trust you appreciate that it reflects the inevitable reactionary attitude of such organized groups and as such must not stop constructive conservative action.

Today I want to support S. 1318 amended as recommended by Senator Pepper and Dr. Martha Eliot as a logical way to take the first step in such a program, if you should feel that the program of S. 1606 is too broad and introduces too much too rapidly. S. 1318 is a logical first step because it provides a method of introducing a health program for maternal, infant, and child care gradually under controlled conditions. The need of improving such medical care is so generally recognized that there is no argument about it. These needs as recognized by the American Pediatric Society and American Academy of Pediatrics were presented in my testimony on this act before the Subcommittee on Aid to the Physically Handicapped of the House Committee on Labor June 7. That testimony also presents specific criticisms of the bill as written. It is, therefore, pertinent to submit it as part of my testimony this morning.

"I come before this committee under instructions of the president of the American Pediatric Society to act as a representative of that society. I am a practicing pediatrician and a teacher of pediatrics in Boston, Mass.; associate professor of pediatrics at Harvard University; and chief of the children's medical service, Massachusetts General Hospital. I am also a member of the American Academy of Pediatrics and the American Medical Association.

"The American Pediatric Society's interest is primarily in teaching, research, and standards pertaining to medical care of infants and children. I would like to submit as part of the record a report of a joint committee composed of representatives of the American Pediatric Society, the American Academy of Pedi

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atrics, and the Medical Advisory Board of the Children's Bureau. is stated as being

The objective ""To make available to all mothers and children in the United States of America all essential preventive, diagnostic, and curative medical services of high quality, which, used in cooperation with the other services for children, will make this country an ideal place for children to grow into responsible citizens.' This is also the objective of this bill (H. R. 3922).

"The reasons why large numbers of children do not receive preventive and curative care compatible with present-day standards are listed in this report in considerable detail. Included as reasons are:

1. Lack of and poor distribution of properly trained physicians.

2. Lack of facilities for training.

3. Lack of dentists.

4. Lack of nurses.

5. Lack of health officers.

6. Lack of hospital facilities.

7. Lack of health centers.

8. Lack of proper districting of health departments.

9. Need of more adequate support of research.

10. Need of adequate remuneration of persons providing professional care, "The report then recommends a survey whose purpose will be to see what total facilities and professional personnel actually are available in each State and local community in the country, so that there may be accurate data for indicating how and where improvement may be accomplished.

"As this report is the statement of needs and recommendations of physicians, it deserves particular consideration. I therefore submit it to you. [Report handed in.]

"If you have not had Dr. John Hubbard, who is conducting the survey recommended in the report, appear before this committee, I suggest that you do in order to learn exactly what information he might provide which would be pertinent to the work of this committee.

"I would now like to make a few general comments concerning such legislation as you are considering and then a few specific criticisms of the bill as now written.

"1. The major danger of tax-supported medicine is its threat to medical education. If all the persons now being cared for by our teaching services throughout the country should, under a tax-supported plan, decide to obtain medical care from an individual physician, the teaching of medicine by specially qualified groups, such as teach today, might be seriously affected. That does not mean that we should perpetuate indigency, but it does mean that steps should be taken to protect teaching services as indigency is lessened. Good teaching determines the quality of our medical care to a very great extent. Therefore, a specific modification must be made in the bill under discussion to assure that an individual can seek medical care from a group of physicians or institution as well as from an individual. And groups of physicians or institutions must be permitted, under the bill, to compete for the provision of such care. Appropriate amendments to cover this could be readily made. Interestingly enough, no voluntary scheme operating on a State-wide basis has made any provision for protecting teaching services. The two chief aims of a national health program should be to improve, first, the quality and then the availability of medical care. Voluntary plans do not consider the former and make but a minor contribution to the latter. Moreover, voluntary schemes cannot coordinate medical with other health services required by children.

"2. This bill provides the funds necessary for its purposes from general tax funds. The question as to whether this is correct or whether individual prepayments for medical care should be made by those who can afford it, as provided under title II of the Wagner-Murray-Dingell bill, deserves very careful consideration. Administratively, it is simpler to draw from general tax funds because the care of the so-called medically indigent will have to be financed in this manner, anyway. So why not cover the costs of all people this way? On the other hand, it is psychologically and perhaps economically sound to insist upon individual contribution for health services wherever possible. The WagnerMurray-Dingell bill resorts to this in spite of the administrative difficulties.

"3. One of the dangers of a Government program for medical care such as this is that it is 'big' and may be put into effect more rapidly than is consistent with available administrative and professional personnel and facilities. On the other hand, a Government program provides a better opportunity than does a volun