the high schools. There have to be demonstrations and films as to what this program is.

Most high-school girls and vocational counselors who do it as an avocation don't know too much about describing this program and what it means career-wise, and I think that is a part of the total educational program.

Then I think there has to be an expansion of facilities. The physical therapist schools are about at saturation, but I think with some financial help, and this is a rough estimate, they could be increased 50 percent without much building, or that sort of thing.

Senator PURTELL. You say the physical therapy schools are at a saturation point?

Dr. Rusk. They are about at saturation; but if they had some extra funds for teachers and for laboratory expansion, my understanding is they could take on 50 percent more.

Then, of course, I think we have to have new schools, but that again

takes time.

Senator PURTELL. I want to thank you, Senator Hill. I sort of intruded on your time.

Senator HILL. My dear sir, the chairman is the commanding chief. I am always glad to yield to him, particularly this particular chairinan we have here.

Senator PURTELL. You are being very nice. I thought we might explore that particular question.

You

Senator HILL. I am tremendously interested in what you say. see, I happen to be one of those who, for years around here, has been urging Federal aid for doctors, nurses, medical technicians, and people such as you have been talking about this morning.

You have certainly given us a picture here, I think, of a terrible shortage as far as personnel is concerned.

Dr. RUSK. There certainly is in our field, Senator Hill, right across

the board.

Senator HILL. There is a terrible shortage?

Dr. Rusk. Yes, sir.

Senator HILL. And to go out and provide the facilities for training this personnel and then bring this personnel in and train the personnel will take time, won't it?

Dr. RUSK. That is right.

Senator HILL. In a sense, sir-you are modest, I know-you are really pioneering now in this work, aren't you?

Dr. Rusk. That's right.

Senator HILL. You are pioneering, and it hasn't yet, so far as the country as a whole is concerned, caught fire, has it?

Dr. RUSK. Well, I am glad

Senator HILL. I don't know whether you want to say that exactly because, as I say, you are a very modest man, but you have certainly presented a very challenging picture here.

I don't know of anything that stirs one's emotions or affects one's heart more to see one of these unfortunate people like the paraplegic you have spoken of, and now you come here and tell us if we had the training and the personnel and the facilities so much could be done for those kinds of people; but it is going to take time to do that job, isn't it?

Dr. RUSK. Yes, sir; but every time we train a doctor to go out to a new center we have an entirely new concept.

The first doctor we trained went to Denver, where he has a magnificent program.

They are beginning to dot around, all over the country now.

We participated with the program in Connecticut. I was consultant to the chronic-disease group when the first program was started at Rockyhill.

Senator PURTELL. I remember that, Doctor.

Dr. RUSK. And where these young men go into the communities, then you have not only the nucleus, but a program that starts very rapidly.

So, I think with those coming off the line now and with the therapists that are available, we can still do a great deal more if we emphasize in our long-range program that we have to concentrate on the training, because that is the key.

Senator PURTELL. Have you any other questions, Senator Hill? Senator HILL. No.

I have been sorry to see budget cuts in some of our programs, particularly our rehabilitation programs. As far as the present program is concerned, there has been a very decisive cut in the funds for that program. Surely you feel that we ought to lean forward along the whole line?

Dr. RUSK. Absolutely.

Senator HILL. Absolutely.

Dr. RUSK. And I hope we can call it the rehabilitation program, not just the vocational rehabilitation program, because it starts with medical; it goes through educational, vocational rehabilitation and ends up in the job-and if it isn't total, it isn't totally effective. Senator HILL. That is all.

Senator PURTELL. Senator Cooper, have you some questions you would like to ask Dr. Rusk?

Senator COOPER. First, I would like to say I consider it a real privilege to hear the testimony of Dr. Rusk. I have been familiar, simply through reading, with the great work he has done in this field.

You have stated there are 2 million physically disabled persons in the United States who could benefit from rehabilitation services. Do you have any idea what the capacity of present facilities are to meet this need?

Dr. RUSK. No, sir; I couldn't answer it. I know there probably aren't 20 institutions in the United States which have the facilities for inpatients where they take the very seriously disabled person and set up a total program to meet all of their needs-physical, emotional, Vocational, social, and whatnot-which I think it has to be; and I can tell you in our own institute we have a waiting list all the time from 2 to 3 months, which is very bad.

Senator COOPER. You say there are only 20 institutions in the United States?

Dr. Rusk. Where they could take very seriously disabled inpatients. Senator COOPER, Yes.

Dr. RUSK. Now, there are many good workshops and ambulatory

centers.

We have done a lot in that regard for crippled children, for cerebral palsy, and now it is broadening into an adult program throughout

the country, but I feel the very severely disabled person deserves front rank in this whole program, and unless you have a place like a hospital-I say that our place is a beginning of a hospital, workshop, gymnasium, New England town hall, and a job-placement center all tied into one-but I would say there are not more than 20, and I think I am being generous when I say 20.

Senator COOPER. Could you state where the 20 facilities are located? You might not be able to state all of them, but, if not, to specify them

Dr. RUSK. Well, I can give you a number.

In New York there is our program and then a program in the city hospitals.

We have just opened a new program under the New York Medical College at the Bird S. Coler Memorial.

There is an institute for the crippled and disabled in New York which has done magnificent work for 25 years, but does not have any inpatients. That is tied in with Columbia University.

At White Plains there is a Burke Foundation which has just put in a dynamic program during the last 2 years and they are associated with Cornell.

One of my former students has an excellent program in the Rochester General Hospital in New York, and another at Buffalo, both associated with the medical school.

Senator HILL. The Buffalo Medical School?

Dr. RUSK. Yes, sir.

Another one of my young men, as I said, is in Denver, where he also is associated with the medical school.

We have another one with a health department at Pennsylvania; another who is establishing a program in Oklahoma, both with a State vocational program, and the medical school in Oklahoma.

Another one of my young men goes today to head the program at the Henry Ford in Detroit.

They have a small, but excellent program at the Mayo Clinic in Rochester.

Dr. Paul Magnuson has just opened a rehabilitation unit in conjunction with Northwestern University, with a capacity of some hundred beds, in Chicago.

Then there is the Fisherville program, which is primarily not a medical rehabilitation program, but an excellent vocational reliabilitation training program.

Those are a few.

There is one being established in Louisville, and my people are working very closely with them at the university at the present time. Senator COOPER. I thank you.

I notice from your statement of the 20 you have mentioned, perhaps 8 or 10 of them are in New York City or in New York State and 5 or 6 other States represented.

Dr. RUSK. I should have said there is an excellent brand-new program at the University Hospital in Philadelphia and a second backed up by another program at the Philadelphia General Hospital.

Senator COOPER. Does your figure of 2 million physically disabled persons include veterans?

Dr. Rusk. No, sir. The 2 million disabled are only those that I believe could benefit by such training under this act, that they could be made employable.

Senator COOPER. Yes.

Dr. RUSK. When you talk about numbers, it runs very much closer to 25 million in the country.

Senator COOPER. Doctor, does it take a long time to train a physician for the work?

Dr. RUSK. Yes, sir. It takes the same time as it does to train a man in internal medicine or surgery. They come to us after 1 year's internship and it takes 3 years of hospital and academic training and 2 years' supervised practice, or 5 years, unless they come to us with other specialized training.

The last group that came-five had their training in internal medicine. One is a professor of neuroanatomy at the University of Utah. Those we can train in 12 to 18 months, and that is the type we are getting now.

We are particularly interested in teaching teachers right now, because that is the seed."

Senator COOPER. How does this program that you are directing compare with any program that the Veterans' Administration is carrying out for similar purposes?

Dr. RUSK. It is the same concept. It started on the same ground rules. The man who established it under General Hawley, Dr. Donald Cobalt, who was my associate in the Air Force, and who was the first man who went in with General Hawley and established the program in the Veterans' Administration

Senator COOPER. Can you make any comments on the work of the Veterans' Administration in this field?

Dr. RUSK. In rehabilitation?

Senator COOPER. Yes.

Dr. RUSK. It is excellent, but they are short, too; especially phy

sicians.

Senator COOPER. Looking at the bills that are before us, do you think there is value in setting aside special funds or earmarking funds for the construction facilities as they provide?

Dr. RUSK. I do; yes.

Senator COOPER. Do you think it is better to earmark funds, or to carry out its purposes under the original act?

Dr. RUSK. Well, that I really am not qualified to speak to. All I can say, sir, is with funds we will get a lot more programs because they can take wings of general hospitals, or they can put additions on. Until we get some place to work, we are still stymied.

But I'm not qualified to say how it should be done legally. I know that we need facilities very badly, and I know we would have a lot more program if money were available to help hospitals to build facilities, but I think I would be presumptious to comment as to the best way, because I don't know.

Senator COOPER. I would assume any facility like this is more valuable when it is near, or used in connection with a general hospital facility. Is this true?

Dr. RUSK. I think that is fundamental, sir, in the program.

Senator COOPER. Yes, but are there any facilities which can be used in this field, even though they are not near or used in connection with general hospital facilities?

Dr. Rusk. I think there may be. There may be some-for example, Army facilities or Government hospitals.

I remember when we were surveying in Pittsburgh 2 or 3 years. ago there was a public health hospital that has been closed that was being discussed. Now, if you can get a facility of that type and tie it in with a staff, you are still all right. It isn't as good. If it isn't geographically too far away, it is all right if you have a staff who are willing to travel and give the time.

Senator COOPER. How would you envision the provision for training would be carried out under these rules?

Dr. RUSK. Well, I would like to see in the Department of Health, Education, and Welfare, in the Division of Vocational Rehabilitation, emphasis put on the training of technicians and the ancillary personnel and the physician training be continued in the Public Health Service, just as a part of their whole fellowship program.

I serve on one of their councils, the arthritis and rheumatism council. We are very deeply interested in this because 20 percent of all the persons who come to the rehabilitation center have arthritis.

The heart council is interested because of a large number of heart disease or strokes of apoplexy.

Neurology is interested because there is one of our largest feeders of patients.

I think every one is going to have to put something in the kitty to increase the number of trainees, because I believe we could double the number of trainees if the money were available for fellowships.

I am talking about medical now, but, as I would envision it, the ancillary personnel would be provided for by help through schools, fellowships, and what-not, for the therapists and what-not, in the Division of Vocational Rehabilitation, and the Public Health Service would handle the others. They have done it well the last year in my opinion.

Senator COOPER. I thank you.

Senator PURTELL. Senator Lehman, have you some questions? Senator LEHMAN. Yes; I would like to ask the doctor a few ques

tions.

I understand the work which you have so magnificently carried onI am not exaggerating when I describe it as magnificent work-has been done largely in the New York University Bellevue Medical Center.

Dr. RUSK. Yes, sir.

Senator LEHMAN. What extent have other city hospitals or private hospitals formerly engaged in this work of rehabilitation?

I am talking about general hospitals.

Dr. RUSK. In New York?

Senator LEHMAN. In New York, sir.

Dr. RUSK. It has come very fast in the last 4 or 5 years, Senator Lehman.

We have a program at Goldwater, and it is being put in every city hospital as quickly as we can get personnel.