pace, we will not be able to keep up with the rehabilitation needs of those entering the ranks of the disabled each year, let alone care for the enormous backlog of patients now awaiting help.

"It is curious how our attitude toward the disabled differs from our attitude toward victims of acute illness and injury. Somehow, we feel that their conditions persist so long it makes them more bearable. We forget that the longer they endure these conditions, the greater is their suffering.

"Imagine our feelings if these millions of Americans had by some tragic disaster become disabled in a single day. Such an occurrence would be greeted as a national calamity, sending a wave of shock and horror into every home in the country. And from every home, funds and assistance of every kind would pour out in a merciful flood to aid these victims.

"Essentially, there is no great difference between such a national disaster and the plight of our chronically ill and disabled. This is a national calamity. And I appeal to the American people to respond to it as such. Winston Churchill once said: 'You can measure the civilization of a people by the way they treat their older folks.' It may be said just as truly that you can measure the civilization of a people by the way they treat their chronically ill and disabled. Measured by this yardstick, we can be proud of the degree of civilization we have attained. We have made truly astounding progress in caring for and about our chronically ill and handicapped. But the help we provide is still pitifully inadequate to the need that exists.

"We must also remember that our responsibilities to the handicapped are not circumscribed by national boundaries. Our concern must be worldwide.

"Our efforts to help the handicapped both at home and abroad can have a farreaching influence on the attitudes of other nations toward the United States and our way of life. Rehabilitation is a triumphant affirmation of our belief in the intrinsic worth and dignity of the individual. According to this concept, eligibility for rehabilitation is not measured by an indvidual's potential usefulness to the state his ability to bear arms, produce his production quota, or qualify as a useful member of society according to utilitarian standards.

"Rehabilitation may mean that an individual will merely be able to raise a fork to his lips, hoist himself from a bed to a chair, or clutch a pencil in a clawlike device. It may mean that he will need an intricate arrangement of pulleys, weights, and springs to perform some of the simple actions of everyday life. But the mere fact that he is a human being is sufficient reason to exert all of our efforts to help him use his remaining abilities, no matter how slight they may be.

"Imagine the impact of this philosophy on people living under other political systems. We are currently engaged in a war of ideologies, one which holds that man exists for the state and our own which holds that the state exists for man. We have sought to establish the superiority of our way of life in various ways; by pointing to our high material standard of living, by vaunting our industrial might, by competing feverishly to assert our military supremacy.

"But the American qualities which have a greater appeal to the minds and hearts of our neighbors can be found in our simple human concern for a handicapped child or a disabled older person.

"On the one hand the world is faced with a system under which one of its leaders-Mao Tse-tung-is capable of saying that he would readily sacrifice 100 million of his countrymen's lives to gain his military ends. On the other hand, the world sees a system which mobilizes all of the agencies of science and society to aid an individual with a damaged body return to life.

"If we can summon the full support of this country's resources of generosity, and compassion, we can close the rehabilitation gap quickly and dramatically. We can respond to the needs of our handicapped here and abroad on a scale which can win us lasting respect and understanding. And in so doing we will proclaim more eloquently than any technological breakthrough, the true meaning of our way of life."

PROFESSIONAL COMPETENCE OF KENNY INSTITUTE

Dr. Frank Krusen, whose remarks I have just quoted, is head of the Kenny Rehabilitation Institute, Minneapolis, Minn. The institute has attracted worldwide attention for its outstanding success in restoring the chronically ill and handicapped to a maximum degree of physical, social, and vocational independ

ence.

The expansion of this institution's services to the point where it can realize its full potential would be an enormous step forward in the field of rehabilitation. The institute is a subsidiary of the Sister Elizabeth Kenny Foundation. Last September, the foundation underwent a complete reorganization following an investigation of fundraising irregularities conducted by the Minnesota State attorney general's office.

The Kenny Rehabilitation Institute was in no way implicated in this investigation.

The reorganization resulted in the removal of the officers charged with misuse of funds, and placed the foundation in the hands of a group of outstanding citizens, representing the clergy, the medical profession, banking, and industry. The integrity of the foundation is now beyond question. Remedial steps have been taken so as to assure the most unimpeachable procedures and personnel. The foundation will be a model for other voluntary groups.

The new foundation was extremely fortunate in securing the services of Dr. Krusen as president of the foundation and director of the Kenny Rehabilitation Institute.

Prior to accepting this appointment, Dr. Krusen was for 25 years associated with the section on physical medicine and rehabilitation at Mayo Clinic, Rochester, Minn., first as director of this department and later as senior consulant. He was granted an indefinite leave of absence from Mayo Clinic in order to accept this post.

Dr. Krusen is one of the world's foremost authorities in his field.

His pioneer work in the field of rehabilitating the handicapped has earned him the unofficial title of "Father of Physical Medicine."

Serving on the new Kenny Foundation board of directors is another outstanding leader in the field of rehabilitation, Dr. Frederic J. Kottke, director of the Department of Physical Medicine and Rehabilitation at the University of Minnesota.

Minnesota's leadership in the great humanitarian mission of helping the handicapped was evident last year when Dr. Krusen served as president of the International Congress of Physical Medicine held here in Washington, D.C., while Dr. Kottke served as president of the American Congress of Physical Medicine which sponsored this worldwide gathering.

The

Minnesota has made vast contributions to many areas of medical science through the University of Minnesota Medical School and Mayo Clinic. Kenny Institute and the rehabilitation center, with the University of Minnesota, offers the potential for making an equally great contribution in the field of physical medicine and rehabilitation. If it receives the support it deserves the Kenny Rehabilitation Institute can make an enormous contribution to closing the rehabilitation gap.

REHABILITATION CENTERS IN THE MAKING

I am hopeful of further great achievement along these lines.

Part of this hope rests on the splendid decision of the Senate and House Appropriations Committees to provide in H.R. 7035 for regional rehabilitation centers in the United States. These centers would really be national "showcases"-national models of the greatest deeds of phyiscal medicine and rehabilita

tion.

The case for these centers had been made in eloquent testimony before both committees by both Drs. Krusen and Kottke. The American people will always be indebted to these two great individuals for their personal presentations at the crucial time of the hearings. I am delighted to say that, in heartwarming response, both committees, in their official reports, cited the opportunity for each such center to be established at a leading medical school with the close cooperation of a voluntary health agency and of State and local governments.

I know of no circumstances in the 50 States where there is closer professional and lay cooperation than that which exists between the Kenny Institute, the University of Minnesota, and State and local authorities.

I am hopeful, therefore, that an application for a center which will be made by these experts will receive favorable action by the Office of Vocational Rehabilitation.

If it does, as I believe will be the case, then the need for citizen support will be heightened.

This, I repeat, is not a local or regional matter; it is a national need. A great pilot program will be launched. The eyes of the Nation will be upon it.

A magnificent chapter in physical medicine and rehabilitation will thereby be written. And countless disabled will benefit-directly and indirectly.

Thus, the voluntary health agency will require and I believe receive a new mandate from the American people.

It is their instrument-their servant. The Kenny Institute will, I believe. establish bold new precedents in competent and unimpeachable leadership. The next step is up to our citizens to give it the necessary support, as I believe they will.

EXHIBIT B.-NURSING HOMES AND HOMES FOR THE AGED

[Excerpt from Rehabilitation of the Aging by Frank H. Krusen, M.D., from the Southern Medical Journal of November 1960]

The American Medical Association has realized the need for rapid expansion of the number and quality of nursing homes in the United States. It is estimated that we have in this country about 25,000 nursing homes, containing 450,000 beds. One hundred eighty thousand of these beds are in what are called skilled nursing homes, and 80,000 in personal care homes that provide some skilled nursing care. The remainder of the beds are in personal care homes which do not have skilled nursing care.

The average age of persons in nursing homes is 80 years, and two-thirds of these are over 75 years of age. Only one-third are men. Less than half can walk with assistance, more than half have periods of disorientation. One-third are incontinent, and two-thirds have some type of circulatory disorder. In most instances the nursing home operators and nursing personnel require training for the provision of additional services to patients including rehabilitation services. There is need for rapid expansion of training in rehabilitation nursing in our nursing homes.

EXHIBIT C.-DISABILITY DETECTION

[The following address by Frank H. Krusen, M.D., president of the Sister Elizabeth Kenny Foundation and director of Kenny Rehabilitation Institute, Minneapolis Minn., was presented on Monday, October 30, 1961, at a meeting held at Kenny Rehabilitation Institute, before a group which included representatives of the following organizations: Minnesota State Medical Association; Hennepin County Medical Association; Minnesota Division of the Academy of General Practice; the Minnesota State Division of Vocational Rehabilitation; the Minnesota Rehabilitation Association; the Minnesota Department of Health; the Minnesota Easter Seal Association; the Minnesota Tuberculosis Association; the Minnesota Heart Association; Minnesota State Services for the Blind; the Minneapolis Vocational Rehabilitation Center.]

A UNIFIED APPROACH TO EDUCATION AND INFORMATION IN THE REHABILITATION FIELD

I feel sure that all of us here today are proud of Minnesota's leadership in the field of rehabilitation. This area is endowed with rehabilitation personnel, facilities, and services of an exceptionally high order.

I am not referring solely to leadership in the purely medical aspects of rehabilitation, but to the total complex of services represented in this room-the health professions, the public health, social and welfare agencies, our educational institutions, and the voluntary health agencies.

Today, I would like to discuss with you a way in which Minnesota can once more assert its leadership in this field, and by so doing bring lasting rewards to the chronically ill and handicapped.

It concerns what I have frequently referred to in the recent months as the rehabilitation gap. All of you know the meaning of this phrase. It means that there is a wide gap between what we can do for the disabled and what is actually being done. It means that our scientific, technical, vocational, and social technics are years ahead of the service our handicapped actually receive. It means that the vast improvements in the science and technology of rehabilitation have not produced a corresponding improvement in the overall condition of our disabled population.

It means, too, that rehabilitation facilities and services in this area and elsewhere are not being utilized to the fullest by the maximal number of persons who could benefit by them.

The people of this area are offered every opportunity to obtain the finest rehabilitation services available. Yet, a large number remain locked in the grip of handicaps they could overcome. This is a tragic paradox.

I do not intend to minimize the great work which we have accomplished. To a greater degree than most States we have fulfilled the needs of our disabled population.

But we must do immeasurably more.

The State division of vocational rehabilitation estimates that there are 323,000 persons in Minnesota who need rehabilitation. If you include the disabled populations of North and South Dakota, Iowa and Wisconsin, the figure exceeds 1 million. In Minnesota, some 1,000 handicapped persons are returned to work each year through our vocational rehabilitation program; in the five-State area, about 3,000.

Nationally, the number of handicapped persons exceeds 20 million. These are persons who have difficulty in moving or cannot move about without help. Between 2 and 3 million physically handicapped adults are in need of rehabilitation to return to remunerative employment. An additional 250,000 persons become disabled each year. But less than 100,000 are returned to work annually through the State and Federal programs of the Office of Vocational Rehabilitation.

In other words, we are rehabilitating less than one-fourth of the annual increment of cases, while doing nothing about the enormous backlog.

Many of you are familiar with these figures. I repeat them only to emphasize the point that I am trying to make; namely, that our rehabilitation services reach only a fraction of those who urgently need them.

I think everyone will agree that the demand upon our rehabilitation services is by no means commensurate with these figures.

While not concerned primarily with rehabilitation, the study of Minnesota's aging population conducted by Bernard Nash, special consultant to the Governor's Conference on Aging, provides an interesting parallel. I believe the findings of this extensive and carefully documented study show that a large percentage of those 65 and over are not utilizing the health services available to them. If this is true of health services in general, I daresay it is even more true of rehabilitation facilities which represent a newer and hence less well-known complex of services.

Many of us know from personal experience that this rehabilitation gap exists. I remember the case described by Dr. Howard Rusk concerning a girl of 17 paralyzed in an auto accident. After lying in bed for more than 19 years she finally learned of the existence of a modern rehabilitation center. Five months after admission, walking on crutches she went out and found a job and, at the age of 36, began a new life. Had she learned about rehabilitation earlier, the waste of 19 precious years might have been prevented. But despite these wasted years, this young woman was one of the lucky ones. How many others have wasted all the years following the onset of disability?

I think also of the case of Della Derein, who was discharged from Kenny Institute just a few weeks ago. Della was struck by spinal meningitis in April of 1955, shortly after graduating from high school. Her condition developed into encephalitis, resulting in total deafness, aphasia, and spastic paraplegia. She was told that nothing could be done for her. And for 5 long years nothing was done. Then, through a friend, she learned of Kenny Institute.

Here, in a period of 18 months, she progressed from a state requiring custodial bed care, and complicated by severe decubital ulcers, to complete independence in a wheelchair and gained some ability to walk with crutches. Through lipreading and speech therapy she regained the power to communicate with the world. Back home in Sheboygan, Wis., Della expects to work in a craft shop and is looking forward to going to art school.

Sitting down the table from me, I see my good friend and former patient, Judd Jacobson. Years ago, a spinal cord injury suffered in a diving accident left Judd a quadriplegic. Judd has built a fine career as a radio newscaster and leads a full and independent life. But while he is an example of highly successful rehabilitation, his case also illustrates the lack of contact between society and our rehabilitation resources. In the early days of his disability Judd received little encouragement in his attempts to make a comeback. But he kept trying and through his own courageous efforts finally received the help he needed to help himself.

What are the causes of the tragic situation we see illustrated in these cases? It stems partly from certain deep-seated human and social attitudes. The handicapped individual and those around him often view disability as an immutable condition ordained by fate or providence and accept it with stoic resignation or despair.

Disability does not kill in the same sense as, say, heart disease or cancer. Nor does it imperil others in the same way as communicable diseases. Nor is disability amenable to the dramatic cures available through surgery and chemotherapy. Hence, it does not arouse the same urgent appeal for immediate attention.

Moreover, we cannot offer an ultimate weapon for the conquest of disability. We cannot promise a vaccine to eradicate it, nor an antibiotic to control it. The very weapons which save lives mean that more patients survive to become handicapped.

But perhaps the greatest single cause of the rehabilitation gap is lack of information and education. This is where the vital connection between rehabilitation and society breaks down. Our disabled people and the society in which they live are generally unaware of the advanced state of the art and science of rehabilitation. They simply do not know how dramatically rehabilitation has changed the outlook of the handicapped person.

In the world outside rehabilitation, the prevailing attitude toward disability is still expressed in the chilling term, "hopeless invalid," while for us it is personified in the inspiring lives of severely handicapped persons who are living full, productive lives.

My good friend and colleague, Dr. William Spencer, of Houston, Tex., Rehabilitation Center, has said that the first step in rehabilitating the bedridden patient is to "change his horizon from the ceiling to the world."

But society continues to feel that the outlook for the handicapped patient is the ceiling or the four walls at which he stares from his bed or wheelchair. It is up to us to widen this horizon to take in the new world of rehabilitation. The handicapped patient, his family and friends, and sometimes his physician are not aware of where and how these services can be obtained. There is a breakdown in the simple process of getting the patient into touch with our rehabilitation services.

Most of us here in this room share the conviction that the needs of the physically handicapped represent one of our Nation's most serious health problems. In fact, many of us could make a good case for the assertion that is now or soon will be our greatest health problem. But we must concede that we are a long way from convincing the general public and our legislative bodies of this fact. Compare the funds contributed and appropriated for research in the categorical diseases with those for rehabilitation. This is one indication that this field is not being supported on a scale corresponding with the need that exists.

Why is this true?

Primarily because chronic disability has not established the same clear claim to our society's compassion and concern as the specific conditions. And this is largely owing to the fact that the magnitude of this problem has not been brought home to the public in terms sufficiently dramatic and persuasive. We cannot expect the public and our legislative bodies to fully recognize the needs of the handicapped when the majority of the handicapped themselves do not seek rehabilitation.

I am convinced that we must shock our society into a new awareness of these needs. We must bring about a demand for rehabilitation which is truly commensurate with the amount of disability that exists. The purpose of this meeting today is to present the preliminary proposal for accomplishing this goal.

First and foremost, it is intended to bring the chronically ill and handicapped into touch with the services which exist to help them toward the end of restoring as many as possible to maximal function. At the same time, it would have the purpose of presenting to the public the living, indisputable evidence that disability is among the Nation's most pressing and serious health problems. This is perhaps the most effective way we can win the understanding and support necessary to meet the needs of the disabled now and in the future.

Secondly, it is hoped that each group will serve the active function of encouraging, each in its appropriate way, the demand for rehabilitation services by the handicapped.

This in broad outline is the program we propose.