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Dr. HUSSEY. No, sir.

Mr. WILLIAMS. Then, the position that you advocate here, of course, is that of the majority of the members of the house of delegates, consisting of some 200 doctors?

Dr. HUSSEY. Yes, sir.

Mr. WILLIAMS. And of necessity, it would be 100 plus.

Dr. HUSSEY. Yes, sir.

Mr. WILLIAMS. It is now 12:20. Obviously, we are going to have to adjourn.

Are there any further questions?

Would it be convenient for you gentlemen to come back this afternoon?

Dr. DARLEY. Dr. Sterling, you have to leave?

Dr. STERLING. I believe about 2: 30.

Dr. DARLEY. I would suggest that Dr. Sterling send a letter to you, Mr. Williams, as chairman, expressing the points he would have made in testimony, and that we continue the hearing in the morning.

Mr. WILLIAMS. If the members would like to stay, we could continue until we have a rollcall and hear Dr. Sterling.

(At this point the rollcall bell sounded.)

Mr. WILLIAMS. It is too late for that now.

I understand, Doctor, that you were planning for the panel to come back tomorrow.

Dr. DARLEY. Yes.

Mr. WILLIAMS. Let me ask you whether Dr. Rubin is here. (A gentleman in the audience rose.)

Mr. WILLIAMS. Julia Thompson?

(A lady in the audience rose.)

Mr. WILLIAMS. Dr. Armistead? Is he here? Or Dr. Kingman? Mr. J. A. McCALLAM (local representative, American Veterinary Medical Association). May I answer? They are scheduled tomorrow morning and will not arrive until this evening about 7: 30 or 8 o'clock. Mr. WILLIAMS. Who is that?

Mr. McCALLAM. Dr. Armistead and Dr. Kingman of the American Veterinary Medical Association.

Mr. WILLIAMS. Then this afternoon, I will ask Mr. Rubin, or Dr. Rubin, whichever it is, and Miss or Mrs. Thompson, as the case may be, if you could appear this afternoon, if it would be convenient for you to appear then.

Miss THOMPSON. Yes, sir. What time, Mr. Chairman?

Mr. WILLIAMS. I would think perhaps 2 o'clock.

Would you say so, Doctor?

Mr. NEAL. Yes.

Mr. WILLIAMS. About 2 o'clock.

Well, inasmuch as we would have only the two witnesses this afternoon, I think we could delay it until 2: 30, if that is satisfactory with the members of the committee.

Would that suit your convenience?

Then, when the committee adjourns, we will adjourn to meet again at 2: 30 this afternoon.

At this point, I think perhaps an apology is due Dr. Hussey for having to be the target of all the hot potatoes this morning. But I think the fact that you have announced yourself as spokesman on

this matter for the American Medical Association explains the situation.

Dr. HUSSEY. I understand.

Mr. WILLIAMS. I think you are the natural target, of course, as you probably expected to be.

I do hope that we have stayed within the bounds of propriety, though, in our interrogation of you, Doctor.

Dr. HUSSEY. Yes, indeed.

Mr. WILLIAMS. We will adjourn until 2: 30 this afternoon. (The following letter was later received for the record :)

Hon. JOHN BELL WILLIAMS,

HARVARD SCHOOL OF PUBLIC HEALTH,

Boston, Mass., May 13, 1958.

Chairman, Health and Science Subcommittee, Committee on Interstate and Foreign Commerce, House Office Building, Washington, D. C. DEAR CONGRESSMAN WILLIAMS: On behalf of the Association of Schools of Public Health, I submit for the hearing record the following information to supplement the testimony given by Dr. Ernest L. Stebbins at the subcommittee hearing on April 22, 1958, regarding the construction needs of the 11 accredited schools of public health.

School

Type of construction

Estimated cost

California.

Columbia.

[blocks in formation]

Additional facilities.

New building..

Harvard.

Johns Hopkins.
Michigan
Minnesota.
North Carolina.
Pittsburgh..

Puerto Rico.
Tulane...
Yale.

New biomedical library and new Laboratory of Physiological Hygiene..
New building.

New construction and expansion of existing facilities..

do.

New construction and expansion of existing facilities..
Expansion of school, and purchase and rehabilitation of research unit.
New wing and rehabilitation of existing facilities.

[blocks in formation]

Total.

20, 950,000

Without matching funds in some form of Federal aid, none of the schools is able to finance this necessary construction which would enable them to improve and expand their programs of teaching and research and to increase student enrollment.

With best wishes.

Sincerely,

HUGH R. LEAVELL, M. D., Dr. P. H., Professor of Public Health Practice and Assistant Dean.

(Whereupon, at 12:25 p. m., the hearing adjourned for lunch, to reconvene at 2:30 p.m.)

AFTERNOON SESSION

Mr. WILLIAMS. Is Dr. Rubin here?

Will you come up to the witness table, please?

I believe you have a prepared statement which has been passed around to the members?

Mr. RUBIN. Yes, Mr. Chairman.

Mr. WILLIAMS. You may proceed, Doctor.

STATEMENT OF DR. ABE RUBIN, SECRETARY AND EDITOR, AMERICAN PODIATRY ASSOCIATION

Mr. RUBIN. Honorable chairman and members of the Subcommittee on Health and Science of the House Committee on Interstate and Foreign Commerce, I, Dr. Abe Rubin, secretary and editor of the American Podiatry Association-known from 1912 to 1958 as the National Association of Chiropodists-speak as the executive officer of our professional association. I believe I also can speak with some knowledge of our schools and colleges, having come to my present position less than 3 years ago from a position of administrator and educator in one of our colleges, on whose staff I served between the years 1937 to 1955, less war service.

Almost 20 years ago, a published medical opinion, Report of the Judicial Council, Journal of the American Medical Association, April 8, 1939, page 1384, was that our profession fairly well satisfies a gap in medical care that the profession has failed to fill.

The opinion also implied that too often the doctor of medicine neglected the field of foot care. In 1956, a published paper, Interesting Facts About Feet, D. M. MacBane, Journal of the American Geriatrics Society, 4: 1121-1125, 1956, called to the attention of our Nation's doctors of medicine interested in geriatrics that the Cope ReportGreat Britain-agreed with representatives of the British Orthopedic Association that members of our profession should be available in both inpatient and outpatient departments in every general hospital, and especially in departments treating diabetic, orthopedic, dermatologic, and rheumatic patients.

The paper went on to state that there would be an increasing demand for podiatry-chiropody services as geriatric work continued to develop.

The two citations have been made to indicate the professional reinforcement of the public's recognition of the ever-increasing need for members of our profession.

None of our institutions are supported, even in part, by any public funds although one school, Temple University School of Chiropody, 1810 Spring Garden Street, Philadelphia, Pa., has available State senatorial scholarships. The schools have been able to come as far as they have because of the sacrificing efforts of their staffs, almost all of whom devote long hours to their institution with little or no salary. The rank and file practitioner has been called upon to support our institutions financially.

At this point I would like to interject that in preparing this statement I omitted of course the numerous philanthropies that are helping to support the schools.

Mr. WILLIAMS. Doctor, you are free to add anything you would like to the statement.

Mr. RUBIN. I just happened to notice I omitted that.

In common with all academic institutions, we are reaching the financial breaking point. Funds that had been set aside to provide for expansion, development, and modernization of physical plants have had to be tapped in order to simply maintain standards. In one instance, during the few years it took to complete a building fund cam

paign, the cost of the construction had doubled so that the proposed building is still in the blueprint stage.

The present total enrollment of our schools is at a low point. By 1961 our schools' capacities will have reached the straining point.

Our profession has been remarkably independent and is very proud of its growth and development. However, because of the present increasing demands and needs for competent professional foot care, and because we recognize that we perform a scioeconomic and medically significant health service, we must now seek public funds for our schools. Our 6 schools provide all the practitioners for the 48 States, the District of Columbia, and the Territories of Hawaii, Alaska, and Puerto Rico. Therefore, we appeal for the same consideration projected for other schools of medical sciences accredited by an agency recognized by the Office of Education of the Department of Health, Education, and Welfare.

Our colleges have estimated that $470,000 in matching funds will be required just to bring our present physical plants up to date, and an additional $1,520,000 to expand the institutions to the capacity which we feel capable of filling and serving competently.

It is our belief that the above statement justifies our petitioning you to modify the bills you are considering, H. R. 6874, H. R. 6875, and H. R. 7841, to provide funds for podiatry-chiropody institutions in the best interests of our Nation's foot health and its impact on the general health and economy of our country. It would please me to be of service to you by attempting to answer any question you might raise. If I cannot answer your questions, I will make a note of them and endeavor to provide a satisfactory reply by letter to your committee.

Before I close, however, I would like to suggest a totally different reason for your inclusion of funds for our institutions in the bills under consideration. The following thoughts may be premature by a decade or two in the view of the many, but some are beginning to face up to the problem.

Medical arts and sciences are becoming increasingly complex. This complexity will increase the amount of knowledge required by physicians. This problem cannot be met by simply adding a few more years of instruction in general medicine and in the specialities as this will continue to compound the presently justifiable mounting costs of medical care, as well as remove numbers of qualified individuals from the opportunity to proceed with medical training.

Medicine is facing this problem in that a few of its schools are instituting programs of training requiring fewer years. Dentistry and the podiatry-chiropody profession have shown that in a specific field a specialized profession can flourish, develop, and provide a needed special service to the satisfaction of everyone.

Perhaps medicine can adapt its philosophy and curriculums along these lines.

The basic medical sciences taught in medical, dental, and podiatrychiropody schools resemble each other remarkably. It would seem to the speaker that with relatively small outside financial support and with some leadership, guidance, and assistance from medicine-of which we presently avail ourselves-our institutions in the next 10

years might provide experience for expansion of this concept-with appropriate modifications to other areas of medical practices.

I thank you for your kind consideration.

Mr. WILLIAMS. Thank you very much, Dr. Rubin.

Are there any questions?

(No response.)

Mr. WILLIAMS. Dr. Rubin, as I indicated this morning, I am extremely doubtful of the wisdom of providing for Federal aid to any field of education. However, I personally think-and this is my own opinion—that if this legislation should be reported, that you have made an excellent case for your profession.

Mr. RUBIN. Thank you, sir. (Discussion off the record.)

Mr. WILLIAMS. Back on the record.

Generally, what are the educational requirements for entry into a school of podiatry?

Mr. RUBIN. Two years of prechiropody, very similar to premedical training, and then 4 years in the professional school itself.

Mr. WILLIAMS. It is a 4-year course?

Mr. RUBIN. After the 2 years of "pre" from the arts and sciences. Mr. WILLIAMS. So, starting out from the high school, it requires 6 years to become a qualified podiatrist.

Mr. RUBIN. That is right. In some areas it will require an extra year of internship also.

Mr. WILLIAMS. Do you have associations in all of the 48 States? Mr. RUBIN. Yes, sir; we do.

Mr. WILLIAMS. In the same manner that the American Medical Association has?

Mr. RUBIN. That is correct. We have 48 States, the District of Columbia, the Territories of Hawaii and Puerto Rico. We have affiliated State societies.

Mr. WILLIAMS. And your association, I presume, sets the standards for admission or licensing in each of the States?

Mr. RUBIN. We have-no. We have a council of education which accredits the schools. Each of the States and the Territories has its own board of examination for licensing. In many cases this is also a part of the medical licensing board.

Mr. WILLIAMS. If there are no other questions, we thank you very much.

Mr. NEAL. I wonder if the board wouldn't explain why it is that today, with all the scientific shoe fitting and better protection of the feet, why is it that we require so many more men of your profession as compared to the old days of stone bruises and bunions?

Mr. RUBIN. Well, I taught for a number of years, and I would like to, if this is pertinent, explain what I believe is the reason for this. Our foot fundamentally was evolved in an environment with a rough underground surface, not necessarily hard or soft, but uneven. In that way, the stress was dispersed over all parts of the foot.

In our highly cultivated civilization today, we have flat surfaces, all of them being flat. And in this way the stresses tend to become concentrated in the individual foot.

The shoe then becomes a protection for that, but it can not do all of the work that is necessary to redistribute the stresses, since the

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